Robert K. Rhamy

Pheochromocytoma: present diagnosis and management.

In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.

Surgical experience with Cushing's disease.

During the period 1952 to 1976 at Vanderbilt University Hospital 119 patients with pituitary-dependent hypercortisolism or Cushings disease were studied. The less severe cases, which constitute a majority, were treated by pituitary irradiation with endocrinologic cure or improvement in two-thirds of the treated patients. Bilateral total adrenalectomy was reserved for the most severe cases and for failures of pituitary irradiation. In 29 patients with total bilateral adrenalectomy there was one postoperative death. Two of 28 survivors had incomplete relief of hypercortisolism and required additional therapy for its control. One patient with recent operation is improved and another with early improvement died suddenly at home three months after operation. The 24 other adrenalectomized patients, followed 6 months to 20 years, were considered endocrinologic cures of Cushings disease. One patient in the group who had not received pituitary irradiation developed signs of expanding pituitary tumor after adrenalectomy (Nelsons syndrome) with satisfactory response to radiation therapy.

Anaerobic Infection as a Consequence of Transrectal Prostatic Biopsy

Reports on large series of prostatic needle biopsies have revealed many and varied complications but none has described anaerobic bacteremia as a complication. Herein are reported 2 such cases, with a discussion of the etiology various altered host factors and therapeutic modalities important to anaerobic infections. The consideration of anaerobic infection in the febrile patient after transrectal prostatic biopsy is emphasized.

Extended biopsy followup after full course radiation for resectable prostatic carcinoma.

Extended biopsy followup of 17 relatively young men with resectable prostatic cancer treated by external supervoltage radiotherapy is presented. Although 6 of the 8 surviving patients now have negative biopsies, the over-all survival rate and the over-all incidence of negative biopsies are not so encouraging, with only 35 per cent rendered free of tumor. Thus, the role of radiotherapy in resectable prostatic carcinoma should be critically scrutinized. More accurate staging is needed. Hopefully, more sophisticated studies of diagnostic and prognostic value will be available in the near future.

Toxicity of Intra-Arterial Barbiturates and Tranquilizing Drugs

Radiologists frequently utilize intravascular sedative and tranquilizing drugs during or prior to the performance of certain radiologic procedures. Since in many cases a needle or catheter may be within the arterial system, this site of injection may be chosen. The purpose of this paper is to emphasize the intra-arterial toxicity of some of these drugs. Interest in this subject was stimulated by the fact that several patients have been seen in this community following the accidental intra-arterial injection of barbiturates or hydroxyzine hydrochloride (Vistaril). In some of these patients, injection was into an artery of the upper extremity with resultant complete or partial loss of limb (Fig. 1). In one case, the injection was into the superficial temporal artery with subsequent necrosis of the scalp and face (Fig. 2). It was found possible to produce similar lesions in rabbits by the intra-arterial injection of 60 mg of pentobarbital sodium into the brachial artery in a 10- to 15-second period. Promazin...

Renal Carcinoma Discovered Incidentally by Arteriography During Evaluation for Hypertension

Since June 1, 1971 patients undergoing evaluation for hypertension have been evaluated with rapid sequence excretary urography, abdominal aortography and selective renal arteriography. Renal venous assays have been done in selected patients. Through July 31, 1974, 812 arteriographic studies in new hypertensive patients have been done. In 6 of these patients renal tumors were discovered by arteriography only and were not suggested by symptoms, urinalysis nor diagnosed on hypertensive excretory urography. This high incidence surprised us and we hope others will review their arteriographic series of hypertensive patients.

Radioisotopic determination of glomerular filtration rate.

AbstractOur experience with radioisotopic determination of glomerular filtration rate in 263 patients is presented. The isotope that we think is now most workable is 99mtechnetium diethylenetriaminepentaacetic acid. The technique meets all the criteria for glomerular filtration rate and the radiation dose is low. Likewise, it has proved to be an accurate and simple procedure to perform

Renovascular hypertension secondary to atherosclerosis

Abstract Atherosclerosis is a common cause of renovascular hypertension. However, the association of hypertension and renal artery stenosis does not establish a causal relationship. At present the best methods of determining the significance of a given renal artery stenosis are split renal function studies and differential renal venous renin assays. When these tests indicate a stenosis to be functionally significant our experience suggests that a good result can be expected from surgical treatment in over 90 per cent of the cases. When the tests showed no differences between the two kidneys, surgical treatment has been a failure in every instance.

Diagnostic Criteria of Bilateral Renovascular Hypertension

Thirteen patients with renovascular hypertension and severe bilateral renal artery stenosis were cured or significantly improved at least one year after bilateral revascularization. Preoperative screening tests (excretory urography, split renal function studies, and renal vein renin assays) were positive in most patients. These results were not significantly different from those noted in a group of patients with unilateral renovascular hypertension.

Anaphylaxis manifested by hypotension alone.

Three instances of life-threating adverse reations to intravenous contrast media and penicillin have been presented. Hypotension was the major presenting sign, and was prolonged and relieved only by copious dluid therapy. In 1 case the onset of hypotension was delayed for an hour. Urologists should be aware of the variety and proper treatment of drug reactions.