D. Borrelli

Adrenal masses in neoplastic patients: The role of laparoscopic procedure

BackgroundThe incidence of complications resulting from fine-needle biopsy of adrenal masses in patients already treated by radical procedures for primitive neoplasms of the lungs and kidneys substantiates our opinion concerning laparoscopy as both a diagnostic and therapeutic procedure.MethodsWe performed 70 laparoscopic adrenalectomies from April 1995 to December 1999. In five patients, the adrenal mass appeared at follow-up evaluation in patients submitted to surgery for a spinocellular lung cancer. One patient underwent surgery for renal adenocarcinoma. In two patients, the adrenal mass was present already at the time primitive lung tumor was diagnosed, so adrenalectomy was performed at the first lung surgery in one patients were placed in a lateral position for a transperitoneal approach. Right adrenal masses were present in seven patients, whereas one patient had an adrenal mass in a left location.ResultsNo laparotomy was required. The average surgical time was 160 min. (range, 115–120 min). No morbility or mortality occurred, and the average hospital stay was 4 days (range, 3–11 days). All the patients had a complete removal of their masses, which averaged 4.5 cm (range, 2.5–6 cm) in size. Histology confirmed the metastatic origin of the mass in five of seven patients with primary lung cancer, and in one patient with previous kidney cancer. At this writing, three patients were disease free and still alive respectively at 3, 5, and 18 months. Three patients died of brain metastases respectively at 16, 36, and 36 months. An adenoma was proved in the other two cases.ConclusionsLaparoscopic adrenalectomy allows us to propose a much more aggressive approach to adrenal masses demonstrated at follow-up evaluation or in patients with primary lung or kidney cancer and no masses at other locations. Nevertheless a much larger study is required for definitive conclusions on a survival rate. We believe that a mini-invasive procedure such as laparoscopy may allow us to replace a rational surgical approach with a more certain pathologic diagnosis.

Age-related secretion of androstenedione, testosterone and dihydrotestosterone by the human testis

To study the production of testosterone, dihydrotestosterone (DHT), and androstenedione by the human testis during advancing age, these substances were measured in the spermatic venous blood plasma of 38 17-80 year old men. Samples of blood from the spermatic veins were collected during the operative repair of inguinal hernias. Plasma concentrations were determined by radioimmunoassay after paper chromatography. Control experiments were done with added known amounts of these substances to steroid free plasma. It was found that in old age the testicular production of DHT decreases significantly as well as its concentration in peripheral venous plasma. Spermatic androstenedione is unchanged while testosterone is decreased in senesence. This finding suggests that the decreased Leydig cell function in old age may be partly due to an enzymatic defect in the testicular steroidogenesis pathway because androstenedione is a direct precursor of testosterone.

Portal thrombosis. A rare complication of laparoscopic splenectomy.

Abstract. Portal thrombosis is a rare complication of splenectomy. We performed 12 laparoscopic splenectomies and observed this complication only in one patient with idiopathic thrombocytopenia (ITP). The right branch of the portal vein presented a partial thrombosis, while the left branch was completely obstructed by thrombi. Abdominal ultrasonography and an ultrasound doppler exam allowed us to diagnose this event and a retrograde angiography performed afterward confirmed our diagnosis. A 48-h intravenous heparin treatment was promptly begun, followed by anticoagulant drugs (dicumarol). The patient was dismissed 5 days afterward, presenting a steady-state ultrasound doppler pattern and a complete normalization of liver parameters. An ultrasound doppler exam performed 1 month after anticoagulant therapy showed a complete resolution of portal thrombosis. We believe that early diagnosis of this rare complication, prompt beginning of anticoagulant therapy, and care in surgical procedures may reduce patient life-threatening risks and assure complete remission.

Simultaneous determination of androstenedione testosterone and 5α-dihydrotestosterone in human spermatic and peripheral venous plasma

Androstenedione (Δ), Testosterone (T) and 5α-Dihydrotestosterone (DHT) concentrations in spermatic and peripheral venous blood obtained from twenty four men have been measured by radioimmunoassay. The concentrations (mean ± S.D.) of 5α-dihydrotestosterone in the spermatic vein (0.42 ± 0–33 μg/100ml) were higher than those found in the cubital vein (0.030 ± 0.012 μg/100ml). The blood plasma levels of 5α-dihydrotestosterone correlated significantly with testosterone levels in spermatic (P < 0.05) as well as in peripheral venous blood plasma (P < 0.01); on the other hand, 5α-dihydrotestosterone did not correlate with androstenedione. The results confirm the production of 5α-dihydrotestosterone by the human testis. Since there is a significant correlation between testosterone and 5α-dihydrotestosterone both in peripheral and in spermatic venous blood and an insignificant correlation between 5α-dihydrotestosterone and androstenedione, testosterone has been confirmed to be the most important precursor of 5α-dihydrotestosterone in the testis as well as in the other androgen target tissues.

Human testicular secretion with increasing age.

Δ4 and Δ5 androgens were measured in spermatic venous blood of 25 subjects (age range 20–70) during surgical intervention for hernia repair. All androgens measured decreased significantly with age. However the androstenedione to testosterone ratio in spermatic venous blood of men aged between 60–70 was higher than that of subjects aged between 20–40. 17β-Oestradiol levels were unchanged in spermatic venous blood of the same subjects. These results seem to demonstrate that there is a general decrease with age of androgen secretion by the human testis and the increase of oestradiol in systemic blood in senescence is due to an increase in peripheral conversion of aromatizable androgens.