D.L. McCullough

Prostatic Carcinoma: Incidence and Location of Unsuspected Lymphatic Metastases

Prospective pathologic staging by pelvic lymphadenectomy in 60 patients with clinically localized carcinoma of the prostate disclosed a high incidence (35 per cent) of clinically silent and unsuspected lymph node metastases. When present, metastatic disease was frequently bilateral (57 per cent) and most commonly involved the obturator-hypogastric lymph nodes (87 per cent). Micrometastases alone were found in 5 patients and the potential significance of this finding on survival is discussed. Although the presence or absence of metastases could not be accurately predicted by histologic analysis of biopsy or prostatectomy specimens, the finding of undifferentiated tumor, marked anaplasia and penetration through the capsule correlated positively with nodal metastases. Pelvic lymphadenectomy is a safe and important diagnostic tool in the accurate staging of these patients. Its widespread use is advocated in patients with clinical stage B1, B2 and C tumors prior to definitive therapy. Based on the prospective data generated in this study lymphatic metastasis appears to be an early event in the spread of prostatic cancer.

Familial Transitional Cell Carcinoma of the Bladder

AbstractTransitional cell carcinoma of the bladder was found in 6 family members from 2 generations. The possibility that the tumors in this family were mediated by an autosomal dominant gene is raised. No common carcinogenic exposure was present and studies of tryptophan metabolism and immunologic competence were negative.

Bench Surgery for Tumor in a Solitary Kidney

Bench surgery which included ex vivo partial nephrectomy with subsequent autotransplantation was successfully performed on a solitary kidney containing renal cell carcinoma. Helpful adjuncts included perfusion with a hyperosmolar intracellular-like solution, perfusion with a preservation machine and upside-down ipsilateral transplantation.

Ligation of the Renal Vein in the Solitary Kidney: Effects on Renal Function

Three patients with right renal tumors extending into the inferior vena cava underwent ligation of the left renal vein coincident with right nephrectomy and en bloc resection of the vena cava. Two patients exhibited no postoperative renal dysfunction while the third demonstrated renal dysfunction which cleared by 9 days postoperatively. Features of the temporary renal dysfunction included proteinuria, elevated serum creatinine levels, oliguria, hypertension, elevated peripheral venous renin level, as well as radiographic evidence of swelling the kidney. The collateral venous drainage of the left kidney makes it possible to ligate the main vein of a solitary kidney with survival of the patient. However, postoperative temporary renal dysfunction may occur and a plan to deal with this problem should be fromulated.

Renal hamartoma Current concepts of diagnosis and surgical management

Abstract Five new cases of renal hamartomas are presented. Diagnostic methods, including ultrasound, and a plan of management are discussed. An unusual documentation of growth of a solitary hamartoma over a five-year period is presented.

Diagnosis of Retroperitoneal Fluid Collections by Ultrasonography: A Series of Surgically Proved Cases

Herein are presented 18 patients with a variety of retroperitoneal fluid collections. Etiologic factors and culture results are discussed. Ultrasound was the single most valuable diagnostic study. Because of its accuracy and non-invasiveness it should be used early in the diagnostic study of a patient with a suspected retroperitoneal fluid collection.

Successful renal transplantation after forty-five hours of extracorporeal perfusion

Abstract Successful renal transplantation was performed using a human cadaveric allograft which had been maintained on extracorporeal perfusion for forty-five hours. Various techniques of renal preservation and the benefits provided by prolonged preservation are discussed.