No abstract

SummaryBetween January and July 1995, 227 patients at the Bronx-Lebanon Hospital Center had positive fungal cultures. Candida spp were the most common fungi isolated. Forty-three patients with invasive disease, as indicated by fungus-positive blood cultures, became the focus of our study. C albicans caused fungaemia in 21 patients (49%). Twenty-eight patients (65%) were less than 50 years of age; three were neonates. The most common presenting symptoms were fever, chills, and weakness (20 patients, 47%). Thirty patients died, giving a mortality rate of 70%. The patients who died stayed in the hospital an average of 49 days.The highest mortality occurred among patients who became bacteraemic before or at the same time they became candidaemic (24 of 26 patients) or who were receiving broad-spectrum antibiotics (20 of 26 patients). We also found high mortality rates from invasive fungal infection among patients with HIV infection, a central venous catheter, and liver, renal, or respiratory failure. We did not find any increase in the incidence of invasive fungal infection or mortality among leukopenic or diabetic patients.

Fig. 1. A, Diagnostic MRI and, B, 1 year after treatment shows almost complete involution of an orbital metastasis of a prostatic adenocarcinoma. Case reports Cases 1 and 2A 76-year-old man (patient A) and an 83-year-old man (patient B) were examined in 1993 by the ophthalmologist because of diplopia due to progressive unilateral exophthalmus. CT and MRI in both instances showed locally destructive tumours in the right (patient A) and left (patient B) orbital bony and soft tissues. Biopsies revealed adenocarcinomas, which were positive for PSA and PAP on immunohistochemistry. Both patients had high levels of PSA in the serum, 211 ng/mL in patient A and 131.6 ng/mL in patient B. The serum alkaline phosphatase values were normal, although bone scintigraphy showed multiple 'hot spots'. In both cases, a DRE indicated grossly extra-prostatic disease of TNM-stage T4; moreover, TRUS showed multiple hypoechoic lesions, extracapsular disease and seminal vesicle invasion. The TRUS-guided prostate needle biopsies in both patients revealed poorly differentiated adenocarcinomas. Patient A was treated with bilateral subcapsular orchidectomy. One month later the orbital tumour was clearly regressing and the serum PSA level had decreased to 15.4 ng/mL, with a testosterone level of 0.8 nmol/L. A follow-up MRI scan at one year showed almost complete involution of the orbital metastatic process (Fig. 1) and all the visual variables improved to near normality. However, follow-up bone scintigraphy revealed new 'hot spots' in the lumbar vertebral region, while the patient remained in good condition with no pain and an active daily life. The serum PSA level stabilized, with a final value of 14.0 ng/mL. The total follow-up after diagnosis has been 25 months.Patient B was treated with local radiation of the orbital metastasis and chemical castration using the LHRHanalogue goserelin (Zoladex) in 3.6 mg monthly subcutaneous depots after initial pretreatment with cyproterone acetate (Androcur) 100 mg three times daily for 4 weeks. Several weeks after initiation, the serum PSA level was 62.7 ng/mL and the serum testosterone was 0.6 nmol/L. The impaired visual variables showed no improvement.© 1997 British Journal of Urology 288

No abstract