Biomedical subjects
Publications and source records attributed to D L McCullough.
Ileum was used as a ureteral replacement in 12 patients, 7 of whom had solitary kidneys. The conditions that necessitated an operation included renal pelvic and ureteral complications of calculi, a variety of traumatic ureteral injuries, retroperitoneal fibrosis and ureteral neoplasms. Renal function has been well preserved and electrolyte imbalance has been minimal.
Radical retroperitoneal pelvic lymphadenectomy is associated with rather minimal morbidity but, when combined with radical prostatectomy, the morbidity is increased. The only complication that seemed to be solely owing to the lymphadenectomy was lymphocele formation, which occurred in 10 per cent of the patients. This rate is below that reported in the gynecologic-oncology literature.
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.
A safe and effective method for long-term relief of renal obstruction is presented. This method has been successful in buying time for patients in stiuations in which other approaches are hazardous or more complex. Its use can be modified for short-term therapeutic drainage of the upper urinary tract.
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.
A 76-year-old woman with virilization had menopausal levels of circulating LH and FSH, and a markedly elevated concentration of plasma testosterone (9130 pg/ml) into the range for adult men. Plasma cortisol and androstenedione levels andurinary 17-ketosteroid secretion were normal. Ethinyl estradiol suppressed plasma testosterone, LH, and FSH levels into the normal range for premenopausal women, but the testosterone concentration was unaffected by the administration of dexamethasone or ACTH. Retrograde venous sampling and angiography localized a right adrenal adenoma preoperatively. Following adrenalectomy, there was a prompt fall in testosterone, but there was no change in the LH concentration. Thus, this patient had an adrenal adenoma which secreted only testosterone and appeared to be gonadotropin-responsive. Testosterone levels in the adult male range failed to suppress gonadotropins. The significance of these findings is discussed.
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Eleven patients with urologic cancer had an abnormal 99mTc (technetium-99m) bone scan as the sole evidence of metastatic disease. Potentially curative therapy should not be withheld on the basis of a "positive" bone scan if such an area is accessible to selected bone biopsy and proves to be negative for tumor histologically.
External counterpressure with a gravity suit was used to control intractable postoperative bleeding in 4 urologic patients. Two patients had coagulation defects, and 2 had been unsuccessfully reexplored prior to application of the G-suit. The bleeding was controlled with preservation and restoration of vital signs in each case. In 3 cases external counterpressure may have been lifesaving.
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.
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.
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Direct injection of a new hyperemulsified radiopaque medium into the parenchyma of the testes produced rapid and excellent visualization of testicular lymphatic vessels and nodes. The technique is much simpler than previous methods. No ill effects on reproduction were demonstrated. Prostatic injections demonstrated the parenchyma well but no nodes or vessels were demonstrated.
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Explore the source record for details and available documents.