The purpose of this study was to determine the efficacy and safety of long-term treatment of nocturnal enuresis with desmopressin intranasal spray. Sixty-five children with primary nocturnal enuresis with a mean age of 11.3 years (range 7-17) underwent a 2-week observation period followed by dose titration period of 1 week. Those children completely dry with desmopressin entered a randomized, placebo-controlled, double-blind phase lasting 2 weeks, followed by a 6-month open treatment. The enuretic status of the children was documented for 2 weeks after the treatment was stopped. Eleven children had no change from baseline wetting with desmopressin. Thirty-two children receiving 20 mg and 9 children with 40 mg desmopressin were completely dry. Thirteen children were wet 1-2 nights per week, which was better than in the pretreatment period. During the 6-month open-treatment period, the effect of desmopressin was found to be stable. No side effects or adverse reactions were encountered. Two weeks after the treatment was stopped, 25 children were still completely dry (38% of the initial study population, 50% of the responders). The cure rate appeared to continue beyond 18 months after discontinuation of the treatment.

A rare case of primary renal carcinoid tumour is presented. The diagnosis was based on immunohistochemically diffuse cytoplasmic positivity for chromogranin A and neuron-specific enolase, in addition to histologic findings. Only 14 previous cases of this tumour have been documented in the literature.

Although nocturnal enuresis was first described centuries ago, there is still a lot unknown about its pathophysiology. The functional bladder capacities, diurnal vasopressin levels, urine osmolalities and urine output of enuretic and normal children were compared. We have concluded that enuretics have normal bladder capacities insufficient for increased nocturnal urine volumes because of loss of diurnal variation in serum vasopressin levels and related decrease in urinary osmolalities.

During an 18-year period, 17 patients with renal pelvic and 8 with ureteral carcinoma were seen in our clinic. The lesion was transitional cell carcinoma in 23 patients, and epidermoid and anaplastic carcinoma, respectively, in 2 others. Because of frequent tumour recurrence in the lower tract, we recommend total nephroureterectomy including a cuff of the bladder as the treatment of choice for renal pelvic neoplasms. For ureteral tumours, less aggressive and conservative procedures can be considered.

Bilateral interstitial cell tumours of the testes are very rare. The first case was reported in 1907 by Kaufman (Davis, 1972). Herein we report an adult case. Case ReportA 24-year-old man was admitted to the Mevki Army Hospital with a 10-year history of pain in both testes. He had also noticed a definite decrease in the size of each testis. His growth and development were normal until the age of 6, at which time his family noticed pubic hair and at the age of 10 he became bearded and his voice changed. At the age of 16 he stopped growing; he also lost his desire for sexual activity and his potency. Physical examination revealed an adolescent male of normal stature. The chest, abdomen and back were grossly hirsute. Both testicles measured 5 x 5 cm, were quite firm and contained nodules. There was no gynaecomastia. His urinary 17-ketosteroids were 52 mg/24 h. He had azoospermia. Other routine tests were normal. Bilateral inguinal orchiectomy was carried out.Histological examination of both testes showed medium-sized polygonal cells with thick chromatin networks, oval or round nuclei, eosinophilic cytoplasm and indefinite cell boundaries in cords or islet form ( Fig.). All types of staining failed to show the Reinke crystal. In the testicular tissue, which was compressed by the tumour, the seminiferous tubules were hyalinised and thickened in the lumen. CommentInterstitial tumours comprise only 1.2% of all testicular neoplasms and 9% are bilateral (Mostofi and Price, 1973). In a more recent report, 170 cases of interstitial cell tumours were reviewed, of which 40 occurred prior to puberty. Dalgaard and Hesselberg (1957) collected 94 cases. Of these, 23 occurred in boys under the age of 15 and all showed virilisation. Histologically the lesion may be mis-diagnosed as hyperplasia of interstitial cells of testes, in which spermatogenesis is decreased, but histopathological studies show an increase in interstitial cells between the tubules without destruction or displacement of the tubules. An interstitial cell tumour, however, should be encapsulated or at least demonstrably separable from the surrounding normal tissue, with displacement of the testicular tissue and absence of semini ferous tubules. Fig. Photomicrograph of the tumour which shows cells with eosinophilic cytoplasm. and round nuclei (H and E x 400).