R.B. Bracken

Arterial occlusion of pelvic bone tumors

Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, I aneurysmal bone cyst, I recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and I metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.

TRANSCATHETER EMBOLIZATION OF RENAL CELL CARCINOMA

Experiences with transcatheter embolic occlusion of 12 hypernephromas are presented.Tumor occlusions were performed preoperatively in 6 of the patients to aid surgical management. In the 6 inoperable cases, embolizations were performed for palliation of specific symptoms and to reduce tumor size, usually in conjunction with chemotherapy.Results of the preoperative embolizations are encouraging as surgical resections have been facilitated with decrease in operative times and blood loss. Follow-up data are presently accumulating in the inoperable cases.Pertinent technical considerations of tumor infarction and side effects of the procedure are discussed.

Radiologic features of adrenal metastases

The incidence of adrenal metastasis is surprisingly high with certain types of malignant neoplasms such as carcinoma of the breast and lung, and melanoma. Since adrenal metastases are usually clinically silent, radiologic findings assume greater importance. The radiologic features found in 21 patients with proved adrenal metastases are presented.

Prognosis for Pathologic Stage I Non-Seminomatous Germ Cell Tumors of the Testis Managed by Retroperitoneal Lymphadenectomy

The over-all 3,5 and 10-year survival rate for 87 patients with non-seminomatous germ cell tumors of the testis undergoing retroperitoneal lymphadenectomy was 90.5 per cent. Of the 72 patients receiving no form of therapy other than retroperitoneal lymphadenectomy after operative removal of the testicular tumor the 5-year survival rate was 90.8 per cent. The 5-year survival rates for these 72 patients, calculated according to the histologic characteristics of the primary tumor, were 74.4 per cent for 18 patients with embryonal carcinoma, 93.0 per cent for 36 patients with teratocarcinoma and 100 per cent for 18 patients with teratoma. Although no advantage could be demonstrated for bilateral lymphadenectomy as opposed to unilateral dissection, it is concluded that a modified bilateral dissection should be reserved only for tumors on the left side.

Percutaneous transfemoral renal artery occlusion in patients with renal carcinoma preliminary report

Twenty-four patients have undergone percutaneous transfemoral selective renal artery occlusion as part of their management for renal carcinoma. Preoperative infarction was performed in 7 cases. This facilitated surgery by eliminating the major blood supply to the tumor and resulted in collapse of the large collateral veins and created edema within the perirenal tissue. In 17 patients with visceral metastases, tumor infarction was performed in lieu of nephrectomy for control of the primary lesion and in hopes of stimulating an autoimmune response. The current status of this procedure s discussed in light of its indications, complications, and preliminary results.

Sexual function and fecundity after treatment for testicular tumors

Questionnaires were mailed to patients who had undergone either radiotherapy, lymphadenectomy, or a combination of both as treatment for malignant disease of the testis in an attempt to define the effects of their therapy on sexual function, ejaculation, and fecundity. The forms returned by 29 patients with seminoma treated with irradiation alone indicated that little change had occurred in their sexual performance or sex drive. Diminished semen volume was reported by 10 patients but was severe in only 1. Two of 3 patients who desired children after therapy were successful. In patients with nonseminomatous testis tumor treated surgically, 42 of 50 reported a significant decrease in semen volume, but 7 of 12 who desired children following therapy were successful. The physiology of ejaculation is reviewed, and comments are offered on the means by which retroperitoneal lymphadenectomy may disrupt normal ejaculation.

Computed tomography in the evaluation of post-nephrectomy patients.

Twenty-one CT examinations were performed in 19 patients who had undergone previous nephrectomy for renal carcinoma or retroperitoneal malignancy. Nine patients were free of disease and 10 had recurrence. Findings of recurrent disease included masses in the vacant renal fossa, inability to visualize the inferior vena cava or aorta, and ipsilateral psoas muscle thickening. Possible pitfalls in diagnosis are discussed.

Treatment of multiple superficial tumors of bladder with intravesical bleomycin

Twenty-six patients with superficial Stage O or A transitional cell carcinoma of the urinary bladder, whose lesions were not amenable to transurethral resection, received bleomycin sulfate intravesically at weekly intervals for eight treatments. Five different drug regimens were tried, and the optimal concentration appeared to be 60 units dissolved in 30 cc. of sterile water. Serum determinations failed to reveal any significant absorption. There was a 27% complete response rate in patients with small tumor burdens. An additional 9% had partial responses which allowed the tumors to be readily managed transurethrally. However, no patients with extensive superficial tumor showed complete response to therapy. Although belomycin used intravesically is active against transitional cell carcinoma, the current cost of the drug precludes its routine use and restricts it to situations in which other agents are contraindicated.

Retroperitoneal lymphadenectomy as adjunctive therapy in selected cases of advanced testicular carcinoma

The findings in 10 patients with advanced non-seminomatous testicular malignant disease in whom either complete remission or reduction in clinical stage was achieved with chemotherapy and later retroperitoneal lymphadenectomy are presented. The procedure in these selected instances allowed for a more accurate assessment of the disease status. The operative findings served as an accurate guide to determine the need for further drug therapy.

Renal cell carcinoma metastatic to penis

Abstract Metastasis from renal cell carcinoma to the penis is rare. We report on 2 patients: in one, priapism developed and in the other, diffuse penile enlargement secondary to metastatic disease.