0022-534 7/84/1315-1020$02.00/0 Vol. 131, May Printed in U.S. A.
THE JOURNAL OF UROLOGY
Copyright © 1984 by The Williams & Wilkins Co.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Disseminated Candida Glabrata and Report of a Uniquely Severe Infection and a Literature Review F. HICKEY, L. H. SOMMERVILLE AND F. J. SCHOEN, Departments of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Amer. J. Clin. Path., 80: 724-727 (Nov.) 1983 A 45-year-old diabetic woman suffered immune complex glomerulonephritis and diabetic nephrosclerosis, terminating ultimately in renal failure, for which she underwent renal transplantation. She subsequently required aortoiliac bypass and later a cholecystectomy, which was complicated by small bowel obstruction associated with necrotic bowel. Sepsis resulted secondary to a variety of organisms and the patient was treated with several wide spectrum antibiotics. Blood cultures 46 days postoperatively yielded Candida glabrata but she died 9 days later despite treatment. Autopsy revealed disseminated yeast involvement of the lung, abdomen, kidneys, brain and heart, where microabscesses were demonstrated. Candida glabrata is a monobudding yeast that normally is saprophytic and not pathogenic, except in patients whose resistance is lowered by therapy or indwelling catheters. This patient had all of these risk factors except malignancy and died despite treatment with amphotericin B. T. D. A. 2 figures, 1 table, 24 references
Disseminated Infection by Aspergillus Terreus S. L. TRACY, M. R. McGINNIS, J. E. PEACOCK, JR., M. S. COHEN AND D. H. WALKER, Departments of Pathology, Mi-
crobiology and Immunobiology, and Medicine, University of North Carolina, School of Medicine1 Chapel Hill, North . Carolina Amer. J. Clin. Path., 80: 728-733 (Nov.) 1983 Aspergillus terreus is a ubiquitous saprophytic fungus that rarely is invasive as a human pathogm. The portal of entry usually is the lungs, where it is taken in by inhalation. A 23year-old man was undergoing treatment for leukemia when he suffered fever unresponsive to wide-sJectrum antibiotics. Aspiration of an enlarged lymph node revealed Candida and the patient was treated with amphotericin B but suffered pulmonary nodular infiltrates. Biopsy ultim1tely revealed Aspergillus terreus. 5-Fluorocytosine was added ;o the treatment protocol but the patient suffered central ner,ous system signs, which progressed. Decerebrate and decort:cate, the patient died 81 days after hospitalization. Autopsy s'lowed widespread involvement with the fungus, especially in the lungs and central nervous system. T. D. A. 8 figures, 1 table, 40 references
Mycobacterium Fortuitum Infection of a Hickman Catheter Site J. R. SVIRBELY, W. J. BUESCHING, L. W. AYERS, P. B. BAKER AND A. J. BRITTON, Departmint of Pathology, Ohio State
University, Columbus, Ohio
J. Clin. Path., 80: 733-735 (Nov) 1983
A patient with histiocytic lymphoma who suffered Mycobacterium fortuitum infection of a Hickman catheter exit site is described. Because of the risk of dissemination in immunosuppressed patients and the resistance to antibiotic therapy, rapidgrowing mycobacteria should be considered when gram-positive bacilli are associated with infections in patients with these catheters. Authors' abstract 1 figure, 13 references
ONCOLOGY AND CHEMOTHERAPY Clinical Aspects of the Rhabdoid Tumor of the Kidney: A Report of the National Wilms' Tumor Study Group F. PALMER AND W. SuTOW, Department of Pathology, Columbus Children's Hospital, Columbus, Ohio and Department of Pediatrics, M. D. Anderson Hospital, Houston, Texas
Med. Ped. Oncol., 11: 242-245, 1983 Rhabdoid tumor of the kidney was described originally as a monophasic sarcomatous variant of Wilms tumor and presently is considered a highly malignant, non Wilms tumor, possibly of neuroectodermal origin. Between 1969 and 1978, 21 patients with this tumor were included in the National Wilms Tumor Study. Mean patient age was 18 months, with 16 being <2 years old at diagnosis. Two patients had stage I, 10 stage II, 5 stage III and 4 stage IV disease. Only 1 patient is continuously free of disease and 1 is surviving free of disease after excision of bilateral pulmonary metastases, while 1 died of sepsis early during therapy. Therefore, 18 of 19 patients with relapse died (15 in ~1 year after diagnosis) and all had progressive tumor. The rapid appearance of metastases (mean 4 months), often to multiple sites, and short subsequent survival indicate a malignant tumor resistant to current treatment stratagems. G. P. M. 1 figure, 1 table, 12 references
Prognostic Significance of Biopsy Results of NormalLooking Mucosa in Cases of Superficial Bladder Cancer G.SMITH,R.A.ELTON,L.L.BEYNON,J.E.NEWSAM,G.D. CHISHOLM AND T. B. HARGREAVE, University Department
of Surgery/Urology, Western General Hospital, Edinburgh, and Medical Computing and Statistics Unit, University of Edinburgh Brit. J. Urol., 55: 665-669 (Dec.) 1983 Transitional cell carcinoma of the urinary tract is the fifth most common human tumor in the United Kingdom. Approximately 50 per cent of the cases have superficial lesions at presentation but up to 70 per cent have recurrence despite apparently adequate endoscopic treatment and, in some, the recurrence is invasive or metastatic, leading to death. The current method of assessing these tumors in the United Kingdom is clinical staging using the tumor, nodes and metastases categorization, and histological grading of the tumor biopsy from GO to G3. Patients with stage Tl and grade G3 tumors have a poorer prognosis than those with stage Ta and grade G 1