Biomedical subjects
Publications and source records attributed to K R Herwig.
Computed tomography (CT) was used to distinguish between pelvic lipomatosis and idiopathic inferior vena caval thrombosis as a cause of a pear-shaped bladder seen on intravenous urography. The findings on CT were explicit in explaining the patient's clinical problem.
Adrenal scintiscanning and venography with sampling of adrenal venous blood are valuable methods to localize adrenal cortical lesions of Cushing's syndrome and primary aldosteronism. Adrenal scintiscanning with dexamethasone suppression is most useful in differentiating adenoma from hyperplasia of primary aldosteronism.
Thirty-eight hypertensive, hypokalemic patients underwent adrenalectomy for primary aldosteronism. Thirty-one patients were found to have an adenoma and seven patients "idiopathic" hyperplasia. The diagnosis was made by finding low plasma renin activity, which could not be stimulated, and unsuppressable elevated plasma or urine aldosterone. The distinction between adenoma and hyperplasia and the localization of an adenoma were accomplished by adrenal venography, adrenal vein blood analysis, and iodocholesterol scanning. Venography was accurate in 87%; adrenal vein blood analysis in 91%; and iodocholesterol scanning in 72%. Dexamethazone suppressed scanning heightened discrimination to 91%. The adenomas were equally distributed between the right and left adrenal gland, with one patient having bilateral adenomas. All but two patients underwent adrenalectomy from a posterior lumbar incision. Postoperative recovery was uncomplicated. Eighteen months after operation 77% of patients with an adenoma were normotensive.
Organ explants from the canine prostate with and without methylprednisolone pretreatment were cultivated for ten days in Trowell's T-8 medium or medium supplemented with testosterone and/or vitamin A. Upon termination of the experiments, explants were fixed and examined histologically. All glands from the most central section of each explant were graded according to epithelial type, and from these grades the proportion of acini with maintained columnar cells was calculated for each explant. Stromal cellular maintenance was also estimated. While a small proportion of explants from the vitamin-treated and methylprednisolone-pretreated groups showed epithelial maintenance, a combination of these treatments significantly increased such maintenance. Stromal maintenance was enhanced with methylprednisolone pretreatment but not by vitamin A. These results are in accord with the hypothesis that methylprednisolone acts to stabilize the lysosomal membrane, thus protecting tissue against the effects of ischemic shock. In protected explants vitamin A is able to maintain a columnar glandular epithelium. In a subsequent experiment a series of linoleic acid dosages was tested in the presence or absence of vitamin A. In neither case was this fatty acid of value in improving epithelial or stromal maintenance.
Interstitial cell tumor of the testis in an adult male can present with feminization and psychologic changes. The feminization and psychologic changes most likely reflect production of estrogen by the interstitial cell tumor. Removal of the tumor causes rapid return of the pituitary-testicular axis to normal, loss of feminization, and development of male psychosocial characteristics.
A renal myoepithelial hamartoma presented as a lucent filling defect with gross hematuria in an adult female. Preoperative studies caused conflicting impressions. The predominance of smooth muscle and incorporated tubuloepithelial elements characterize the tumor as a hamartoma of myoepithelial type. Pertinent review of the literature confirms the rarity of this lesion in adults.
The simple life support system of organ culture contrasts sharply with the life support system in vivo. Organ culture, a technique for characterizing the effect of various substances on an organ, has potential clinical usefulness in many areas. In the present case explants of canine prostate are minimally maintained when cultivated in a medium enriched with testosterone and insulin. Pretreatment of the dog with methylprednisolone or the addition of vitamin A markedly improves the maintenance of normal structure. Methylprednisolone pretreatment and the addition of vitamin A had a significant synergistic effect. The clinical significance and implications of the findings are presented. We believe these preliminary experiments with organ culture can serve as a basis for deciphering some of the complex functions or an organ.
Although radioiodinated cholesterols furnished the first noninvasive imaging of the adrenal glands, it would be desirable to decrease the time for imaging and decrease the radiation dose. The relative tissue distributions of two radiolabeled enzyme inhibitors [3H] metyrapol and I-125-SKF-12185 were studied in dogs and man. Their percentage uptakes and target-to-nontarget ratios were similar. The adrenals of three dogs were imaged sharply at 2 hr after injection with 4--6 mCi of I-131-SKF-12185, confirmed by subsequent imaging with 1 mCi of I-131-6-beta-19-nor cholesterol at 5 days after injection. The use of 1 mCi of I-123-SKF will permit imaging of the adrenals in 1--2 hr and will decrease the radiation dose in the human to 0.76 rads to the adrenal, 0.18 rads to the ovaries and 1.7 rads to the liver.
Patients with recurrent Cushing's syndrome after bilateral adrenalectomy should have an adrenal scan prior to any attempt at repeat laparotomy. In those patients with a localized remnant on the adrenal scan and no evidence of a tumor of the pituitary gland, unilateral exploratory laparotomy should be considered for removal of the remnant. In our series of five patients fulfilling the aforementioned criteria, we have been successful in terminating the recurrence of Cushing's syndrome in these patients.
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Organ cultures of rodent and human prostate glands have shown marked differences in their morphological response to testosterone. In this study, explants from 19 canine prostate glands were cultivated for a minimum of 9 days in Trowell's T-8 medium. Groups of explants were exposed to media containing from 0.05 to 100 mum testosterone. While the higher testosterone levels (50 and 100 mum) markedly decreased explant viability, explants cultivated at lower levels (0.05 to 5 mum) appeared similar to control explants in testosterone-free Trowell's T-8 medium. Atmospheric mixtures containing either 95% or 50% oxygen were equally effective. Shortly after the cultures were initiated, large amounts of secretory product were liberated into the lumen. After 9 or more days in vitro, glandular epithelium appeared cuboidal and never revealed the acid phosphatase-rich secretory granules seen in the preculture control. However, the epithelium exhibited an increase in alkaline phosphatase and lipid content following cultivation.
During the last 2 years 7 patients with intestinal urinary conduits, exhibiting symptoms of gross hematuria and ureteral stricture or other difficulty with the conduit, were examined with flexible fiberoptic endoscopes. The entire lumen of the intestinal conduit, all urinary-intestinal anastomoses and the bladder of 1 patient were visualized successfully. Retrograde pyelography was performed on 2 patients. In 4 of 7 patients we were able to demonstrate abnormalities that were not demonstrable by any other method.
The dexamethasone-modified adrenal scintiscan, a noninvasive procedure, is described for the preoperative distinction between primary aldosteronism (aldosterone-producing ademona) and idiopathic aldosteronism (bilateral hyperplasia) and for the preoperative localization of aldostersone-producing adenomas. This procedure has been carried out on 17 subsequently proved cases of primary aldosteronism and nine cases (four unexplored) of idiopathic aldosteronism. In the tumor cases, it indicated correctly the side of the tumor in 88 per cent. It was correct in predicting the existence of bilateral hyperplasia in all of the five cases explored. It produced the same response in four more cases believed to have bilateral hyperplasia, in which surgical exploration has not been carried out. Many of the same patients had, in addition, standard adrenal scintiscans (SS), adrenal venography, and determinations of aldosterone in adrenal venous blood. These results are compared with those of the dexamethasone scintiscan (DS). In tumor localization, the 88 per cent figure for the DS was only moderately better than that of the other three (71 per cent, SS; 80 per cent, venography; 80 per cent, adrenal venous aldosterone levels). However, in predicting bilateral hyperplasia, the DS was 100 per cent correct, as were the levels of aldosterone in adrenal venous blood. The SS and adrenal venography failed in bilateral hyperplasia and gave many false-positive results indicating tumor. The DS, a relatively simple outpatient procedure, appears to be at least as effective, both in lateralizing tumors and distinguishing between tumor and bilateral hyperplasia, as the more difficult, expensive, and sometimes hazardous invasive procedure of bilateral adrenal vein catheterization.
Urinary tract reconstitution was done in 170 consecutive renal transplant patients, using an extravesical ureteronecystostomy. The urologic complication rate was 8.5 per cent but complications associated directly with the anastomosis occurred in only 5 per cent of the cases. There have been no anastomotic complications in the last 104 transplants. Vesicoureteral reflux occurred in 20 per cent of 50 patients surveyed. Death in 2 cases and loss of the kidney in 1 were associated with urologic complications.
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