Herbert Brendler

Adrenalectomy and hypophysectomy for prostatic cancer

Abstract Hypophysectomy thus appears to be slightly more effective than adrenalectomy in advanced cancer of the prostate, especially in terms of short-term objective response. Like adrenalectomy, it has proved much more beneficial in breast cancer. Neither adrenalectomy nor hypophysectomy are currently advocated as primary procedures in previously untreated prostatic cancer patients but reserved rather for selected patients who have relapsed after or proved refratory to conventional endocrine therapy, and in whom the disease is actively progressing.

Ureteral injuries during vascular surgery.

The rapid increase in the number of vascular surgical procedures done has led to a new class of iatrogenic ureteral injuries. Vena caval ligation, bilateral lumbar sympathectomy, bypass procedures and abdominal aortic aneurysmectomy produce the majority of these injuries. Established principles useful in the repair of iatrogenic injuries following a gynecologic or colonic operation often are inapplicable.

Retroperitoneal fibrosis secondary to metastatic neoplasm.

Retroperitoneal fibrosis may occur secondary to metastatic neoplasm and may simulate the features of the idiopathic variety. A case of retroperitoneal fibrosis due to gastric carcinoma is presented and the historical, physical, cystoscopic, urographic, operative, and pathologic similarities to the idiopathic form discussed. Generous biopsy of retroperitoneal plaques and careful pathologic examination are stressed to avoid missing malignant disease.

Carcinoma in Situ of the Ectopic Testis

A young man with a palpable ectopic testis underwent right testis biopsy and orchiopexy. Since histological findings of the biopsy specimen revealed an unsuspected intratubular carcinoma in situ and evidence of diminished spermatogenic potential, an inguinal orchiectomy was done. This appears to be the first reported case of a tumor of this type developing in an undescended testis.

Preoperative Diagnosis of Renal Angiomyolipoma

Six cases of renal angiomyolipoma are reviewed. In 5 of these 6 cases a characteristics radiolucent fat sign was present overlying the renal mass. In 10 cases of hypernephroma selected only on the basis of a tissue diagnosis and the availability of a pre-injection scout film this sign was not present. The recent literature is reviewed on the radiographic diagnosis of angiomyolipoma. We conclude that angiography is not reliable in the differentiation of angiomyolipoma from hypernephroma. However, demonstration of a radiolucency on the pre-injection scout film is virtually pathognomonic of angiomyolipoma. Tomographic cuts without contrast injection may increase diagnostic accuracy.

Lymphography and percutaneous lymph node biopsy in clinically localized carcinoma of the prostate.

Accurate staging of prostatic carcinoma requires determination of the status of the regional draining lymph nodes. Pelvic lymphadenectomy is the definitive examination but has certain morbidity and even mortality. Lymphography is safe but may not be sufficiently accurate. A total of 41 patients with clinically localized disease and abnormal or suspicious lymphograms underwent percutaneous lymph node biopsy. Ten of 11 patients (91 per cent) with abnormal lymphograms and 14 of 30 (47 per cent) with suspicious lymphograms had positive cytology studies. Of the suspicious defects an unopacified void in a nodal chain most frequently was positive. Of 22 potentially curable patients with stages A and B1 disease 12 had metastatic disease.

Early days of urology at Mount Sinai

The Jews Hospital (Fig . 1), later Mount Sinai, The two attending surgeons were Israel Moses was chartered and founded in 1852 . Three years (Fig. 2), an Army surgeon who aided in establishlater, the hospital opened on West 28th Street ing the hospital; Alexander B . Mott (1826-1889) ; with 45 beds. There was no separation of medical (Fig. 3), son of one of New Yorks most influential and surgical services at that time . physicians, Valentine Mott (1785-1865), who was, a consultant to the hospital (Fig . 4) .