Edward M. Mahoney

Malignant pheochromocytoma: clinical course and treatment.

We describe 7 patients with 16 malignant pheochromocytomas, with followup for 7 to 21 years. Five patients are free of disease at a mean of 13.5 years and 2 patients died of malignancy at 10 and 13 years. The 3 criteria believed important for a maximum tumor-free interval are: 1) adjunctive lymphadenectomy at the initial operation when 1 or more lymph nodes contain tumor, 2) close followup of all patients with pheochromocytoma by diagnostic biochemical assay for 15 years and 3) an aggressive excision of all single or multiple recurrent pheochromocytomas as soon as a biochemical diagnosis is established.

Tumors of the adrenal cortex

Extensive advances in surgery of the adrenal cortex have occurred in the last 23 years. The significant historical events are outlined herein. The demonstration 22 years ago that man can survive after bilateral total adrenalectomy, with adequate substitution therapy, has given a great impetus to surgery of tumors of the adrenal. The pathology, the pathologic physiology, and important steps in preoperative evaluation and diagnosis are given in detail. The intraoperative and postoperative management are described, including the details of effective chemotherapy. Emphasis is appropriately placed on the importance of the team approach to the problem of neoplasm of the adrenal cortex, for nowhere is there a greater necessity for the combined efforts of internists, radiologists, chemotherapists, and surgeons.

Hypertension due to primary renal ischemia: a correlation of juxtaglomerular cell counts with clinicopathological findings in twenty-five cases.

THE literature now contains incontrovertible evidence that some forms of severe hypertension in man can be cured by revascularization or by nephrectomy.1 , 4 The prime example is hypertension associated with relative renal ischemia, the most clearcut mechanism being partial obstruction to renal-artery flow, similar in many respects to the Goldblatt kidney in dog,.5 , 6 From time to time, interest has centered on the juxtaglomerular apparatus in these kidneys. The juxtaglomerular apparatus consists of the macula densa and the juxtaglomerular body. The latter is made up of epithelioid cells grouped about the afferent arteriole. Goormaghtigh7 first postulated an endocrine function for the juxtaglomerular .xa0.xa0.

Functioning and nonfunctioning cysts of the adrenal cortex and medulla.

Adrenal cysts are rare clinical and pathologic entities. The vast majority are minute in size, unilateral, and found in females at autopsy. They come to the physicians attention when they produce symptoms or are identified on x-ray studies. When symptomatic, they generally produce lumbar discomfort and gastrointestinal symptoms, and occasionally are palpable by abdominal examination. There is no significant agreement as to cause and pathogenesis of the disease. The most common histologic types are lymphangiomatous endothelial cysts, secondary to lymphangiectasis, and the fibrous wall or hemorrhagic pseudocysts. In many patients preoperative diagnosis is now possible with high quality nephrotomography, ultrasonography, and adrenal arteriography. The presence of a suprarenal mass with peripheral or laminar calcification strongly suggests the presence of an adrenal pseudocyst. Selective biochemical studies are mandatory to rule out the presence of an occult cystic pheochromocytoma, and adrenal cortical tumor. Adrenal cysts must be differentiated from all space-occupying lesions of the upper abdomen. Surgical exploration is recommended in almost all patients for accurate diagnosis and to rule out malignant disease or occult pheochromocytoma. The choice of the surgical approach should be planned to provide for safe and adequate exposure, depending on the size and location of the lesion. Careful dissection with preservation of the adjacent kidney, liver, and pancreas should be performed.

Post-Diversion Pre-Cystectomy Irradiation for Carcinoma of the Bladder

In 47 patients treated sequentially with urinary diversion and laparotomy staging, irradiation therapy and total cystectomy for invasive carcinoma of the bladder, the mortality rate was 2 per cent and the complication rate was 20 per cent. The survival rate was most favorable in patients in whom the pathologic specimen revealed no tumor after irradiation. The lower mortality and morbidity rates are attributed to staging of surgical procedures and the challenge remains to increase the number of patients in whom carcinoma of the bladder is converted by irradiation therapy to a lower stage or no tumor.

Venacavography, corticosteroids and surgery in the management of idiopathic retroperitoneal fibrosis.

Four patients with idiopathic retroperitoneal fibrosis were found to have characteristic obstruction and anterior displacement of the lumbar vena cava. Varying degrees of venous collateral circulation were present, depending on the degree of vena caval compression. All 4 patients underwent ureterolysis to relieve the hydronephrosis and to confirm diagnosis by biopsy. Two patients were treated with corticosteroids postoperatively. Followup venacavography demonstrated improved filling and decrease in the collateral circulation in these 2 patients. Of the remaining 2 untreated patients 1 was lost to followup and the other revealed no change. Diagnosis of idiopathic retroperitoneal fibrosis can be made if characteristic changes are present on inferior venacavography and may provide an objective measure for following the basic disease process during medical treatment.

Orchitis due to Coxsackie virus group B, type 5. Report of a case with isolation of virus from the testis.

ORCHITIS is an uncommon but recognized complication of Bornholm disease.1 2 3 4 5 6 7 The role of Coxsackie Group B viruses in the etiology of Bornholm disease is well established.8 9 10 This commu...

Useful technique for long-term urinary drainage by inlying ureteral stent six-year experience☆

Endoscopically placed inlying ureteral stents have proved useful in the conservative management of patients with ureteral obstruction, urinary fistula, and malignancy and have obviated the need for operative intervention. In high-risk symptomatic patients with widespread malignancy, internal urinary diversion offers the opportunity for an improved quality of life without the surgical risk or potential morbidity of supravesical diversion. Potential candidates for this simple, safe, and effective technique include: those with postsurgical obstruction and/or fistula, retroperitoneal fibrosis, metastatic carcinoma, congenital ureteropelvic junction obstruction, as well as those with reversible obstruction from lymphoma and carcinoma of the prostate who are undergoing radiotherapy and/or chemotherapy. The focus of this report is on the technique we have found successful in providing us with stents that fit our individual patients. Readily available fabricated graduated ureteral catheter can be cut and shaped to particular measurements unlike prefabricated catheters. Minimal preparation time is demanded, and there is no need for extensive stocking of various catheter sizes.

An Improved Non-Intubated Cutaneous Ureterostomy Technique for the Normal and Dilated Ureter

Cutaneous ureterostomy is a simple procedure to perform but is attended by high morbidity owing to recurring abscesses, strictures and stenosis of the stoma. An improved technique applied to the diversion of 4 normal renal units and 3 dilated ureters is described. We have not experienced the complications mentioned in previous studies and none of the patients has required ureteral intubation in this small series with a 3-year followup.

Ambenonium in the Treatment of Urinary Retention and Constipation

TRINARY and fecal retention, either alone or ^- together, poses a serious problem in the management of the patient. Unfortunately, these complications are appearing much more often than they were a few years ago. This is, for the most part, a result of the introduction and use of numerous highly potent drugs for the treatment of a variety of conditions from hypertension to Parkinsons disease. The ganglionic-blocking drugs widely used in the treatment of hypertension are frequent offenders, and all of them have a depressant action on the bowel and bladder that, in some patients, leads to serious loss of .xa0.xa0.