Review of experimental work indicates that renal papillary necrosis (RPN) is more readily induced by mixtures of analgesics which include phenacetin or paracetamol, than by either of the latter drugs alone. In an experiment in which moderate doses of analgesics were given to rats over a long period, it was shown that aspirin had a greater nephrotoxic effect than either phenacetin or paracetamol although less than in combination with either. In a study of the evolution of aspirin-induced damage, the earliest changes were shown to occur in the interstitial cells. There was also loss of medullary mucopolysaccharides. Occlusive lesions were demonstrated in the vasa recta. Using partial papillectomy, it was shown that the development of analgesic-induced cortical lesions did not depend on the presence of papillary necrosis. It was suggested that the early papillary changes might be due to ischemia, medullary blood flow being reduced as a result of aspirin's action as an inhibitor of prostagladin synthesis. The lesions in the vasa recta might cause ischemia at a late stage, leading to total RPN.
3 additional cases of "nephrogenic adenoma" of the bladder are added to the 20 previously reported cases. Light and electron microscopic studies of the first 2 cases support the hypothesis of urothelial metaplasia. The name "adenomatous metaplasia" should replace "nephrogenic adenoma". Malignant change occurred in the third case, suggesting that this ought to be regarded as a potentially dangerous from of metaplasia. In the absence of malignant change, ileocaecocystoplasty with subtotal cystectomy afforded symptomatic cure in 2 cases: radical cystectomy was performed in the third because of malignant adenocarcinoma.
The light- and electron-microscopic appearances of a liver biopsy from a case of erythrohepatic protoporphyria are compared with the appearances of the liver in griseofulvin-induced porphyria in mice. Crystals are present in hepatocytes and in the bile secretory pathways in each case. The nature and significance of these is discussed.
Sixty-five cases referred to one hospital between 1964 and 1977 were studied. Forty-one presented in Stages 1 or 2 and when treated by the Iridium mould technique gave a 12/13 (92.3%) crude 5-year survival rate, an improvement over the results of previous methods of treatment, including partial amputation. In Stage 3 radical amputation gave an 89% 5-year survival rate. Node dissection was reserved for inguinal nodes in Stages 1, 2 and 3 which failed to resolve after treating the primary tumour. Undifferentiated tumours and those with the microscopic "cord" pattern of growth did badly.
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