We present a patient in whom unresectable lymph node metastases developed within 6 months of negative bilateral sentinel lymph node biopsies. The management of regional lymph nodes of patients with carcinoma of the penis is discussed.

To evaluate the effect of mini-dose heparin therapy on lymphocele formation after extraperitoneal pelvic lymphadenectomy we reviewed the records of 38 patients undergoing this procedure for prostatic cancer during a 24-month period. All patients had a minimum of 6 months of followup. Lymphoceles occurred in 3 of 8 patients (38 per cent) receiving mini-dose heparin and prolonged lymph drainage occurred in 1 other patient (12 per cent). In contrast, only 1 of 30 patients (3 per cent) not receiving mini-dose heparin had a lymphocele and 1 (3 per cent) had prolonged lymph drainage. The results suggest that mini-dose heparin may delay clotting of lymph and, thus, may be associated with an increased incidence of lymphocele formation after extraperitoneal lymphadenectomy.

Followup of 5 cases presented in 1971 and report of 8 additional cases confirm the initial conclusions that pelvic lipomatosis is a benign but potentially progressive process leading to ureteral obstruction. Young black subjects are affected most commonly. More than 40 per cent of the patients have required permanent urinary diversion.

There is little rationale to support the currently accepted 10 to 14-day treatment period for urinary tract infection. To assess the cure rate in patients given 3 days compared to the standard 10-day period of antimicrobial therapy a prospective trial was designed to test the over-all effectiveness of each treatment. Sixty patients were randomized to either penicillin-G or trimethoprim-sulfameth-oxazole for either 3 or 10 days. Urine and external vaginal cultures were done before therapy was instituted, at day 3 while on therapy and 7 days after the completion of treatment. The over-all cure rate in the short-term treatment group was 86 per cent and in the long-term treatment group it was 88 per cent. Patients receiving trimethoprim-sulfamethoxazole had a much better response to clearance of the pathogenic bacteria from the external vagina but this did not correlate with clearance of the bladder bacteriuria. Bacterial sensitivities on the external vaginal cultures suggest that in some patients 10 days of therapy actually may aid in the development of bacterial resistance noted in subsequent bladder infections. Finally, a cost-benefit analysis revealed that the use of a 3-day regimen as standard treatment for urinary tract infections would result in a savings to our patients conservatively estimated at $62,000,000 yearly.