Background: The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.

The metastatic behaviour of renal cell carcinoma has been studied in a series of 687 necropsies. The observations were consistent with the concept of "metastatic inefficiency", in that in 295 cases, including 25 with renal vein invasion, there were no detectable metastases. In the present series, renal vein involvement was not an important prognostic factor in stage 1 or 2 disease. In 73% of cases without lung metastases there were none in other sites, and in 84% of those with lung metastases there were others elsewhere, consistent with a metastatic "cascade" in which metastases first developed in the lungs and were later detected in other organs. However, the observations did not permit discrimination between anatomic cascades, in which other organs were seeded from metastasizing pulmonary metastases, and temporal cascades, in which the other were seeded at the same time as the lungs, but with fewer cancer cells. The patterns of arterial metastasis were consistent with the "seed-and-soil" hypothesis, and a novel index was developed to quantify differential organ "soils". The contralateral kidney was not the best soil for metastases from renal carcinoma. Given the presence of lymph node metastasis, the probability of heamatogenous metastasis is 90%. However, in the absence of nodal metastasis, approximately half the cases had haematogenous metastasis.

Hypercholesterolemia and other vascular risk factors for atherosclerosis are commonly associated with impotence. To characterize cavernosal smooth muscle reactivity in hypercholesterolemia, we performed isometric tension studies (with norepinephrine, acetylcholine, papaverine and electrical field stimulation) on isolated strips of corpus cavernosum from rabbits fed a 1% cholesterol diet. To assess the impact of cholesterol reduction, a group of rabbits was fed a cholesterol diet for 4 weeks and was then returned to a normal diet for 4 weeks before testing. Potential structure-function relationships were delineated by ultrastructural evaluation with transmission electron microscopy (TEM). All forms of cavernosal relaxation, including papaverine relaxation, were impaired with hypercholesterolemia, and norepinephrine contraction was augmented. In addition, ultrastructural evidence of an early atherosclerotic process in the cavernosal sinusoids was detected. Importantly, reduction of elevated serum cholesterol normalized cavernosal relaxation, including that of papaverine, and decreased the sensitivity to norepinephrine, thereby suggesting that cavernosal smooth muscle dysfunction in hypercholesterolemia is reversible.