The role of the radioimmunoassay of serum alpha-fetoprotein and human chorionic gonadotropin in the intensive chemotherapy and surgery of metastatic testicular tumors

Quantitative measurement of serum alpha-fetoprotein and human chorionic gonadotropin by double antibody radioimmunoassays reflects the efficacy of surgical, radiation and/or chemotherapeutic regimens in patients with bulky disseminated testicular tumors. When these therapies are effective they produce an immediate decrease in serum levels of these markers that reflects the decrease in tumor size and could be as rapid as the catabolic decay rate for alpha-fetoprotein or human chorionic gonadotropin. The alpha subunit of human chorionic gonadotropin has a short half-life (20 minutes) and has been used for the first time to localize a recurrent metastatic testicular tumor. Cellular localization of these markers by immunochemical techniques has helped us to understand the natural history of this cancer and the cell types responsible for production of the markers.

Cellular localization of alpha-fetoprotein and human chorionic gonadotropin in germ cell tumors of the testis using and indirect immunoperoxidase technique

An immunohistologic study of 21 patients with germ cell tumors of the testis with measured serum levels of chorionic gonadotropin (HCG) and alpha-feto protein (AFP) was undertaken to correlate the various types of neoplasms with the presence of these tumor markers in the tissue and serum. AFP was demonstrated in mononuclear embryonal cells within embryonal carcinoma and endodermal sinus tumor. HCG was identified within syncytiotrophoblastic giant cells, frequently in association with embryonal carcinoma, and rarely with endodermal sinus tumor and seminoma, as well as in the syncytiotropho-blastic component of choriocarcinoma. Eighteen of the 21 patients (86%) had elevated tumor markers in their serum; serum HCG alone was elevated in five (24%), AFP alone in five (24%) and both were elevated in eight (38%). There was tissue localization of HCG in 12 of the 13 patients (92%) with elevated serum HCG while AFP was identified in the tumor in eight of the 13 patients (53%) with elevated serum AFP levels. Based on these findings, a tentative immunohistologic classification of germ cell tumors utilizing AFP and HCG is proposed. Thus, embryonal carcinoma, adult type, is frequently associated with both AFP and HCG, endodermal sinus tumor with AFP and choriocarcinoma with HCG, whereas pure seminoma and teratoma are unlikely to be associated with either marker.

Computed tomography and transabdominal ultrasound in the evaluation of the prostate

The prostates of eight patients scheduled to undergo prostatectomies were studied prospectively by transabdominal gray scale ultrasound and computed tomography. Computed tomography gave excellent visualization of prostate morphology and pelvic anatomic relationships. Ultrasound provided more histopathologic information in the cases of carcinoma and prostatitis. Additionally, its capacity to distinguish surgical capsule from adenoma, in benign prostatic hypertrophy, made it more useful for volume determinations.

Ureterosigmoidostomy

Some historical aspects of ureterosigmoidostomy are described, and various techniques are discussed and illustrated. Our own satisfaction with the results when the procedure is done through the open sigmoid colon is expressed. Ureterosigmoidostomy, which has in some surgeons' hands fallen into disuse, will continue to be used and probably should be used more than it is at present. When ureterosigmoidostomy is done meticulous care is important in producing a long submucosal tunnel with direct anastomosis of the ureter to the bowel. Preoperative bowel preparation is mandatory. Patients who have undergone ureterosigmoidostomy should remain on a low chloride diet indefinitely with an adequate supplement of sodium potassium citrate to diminish the dangers of electrolyte imbalance and hyperchloremic acidosis. Careful postoperative management and followup care are vital to success.

Carcinoma arising in a branchial cleft cyst

A patient is presented who was found to have invasive squamous cell carcinoma arising in the epithelial lining of a lateral cervical cyst which had been present for more than 40 years. Radical neck dissection was performed, and metastases were found in a single cervical lymph node. A critical review of cases of branchiogenic carcinoma reported over the past quarter-century yielded no more than three others which meet the criteria for diagnosis of this entity established by Martin, Morfit, and Ehrlich in 1950.

Segmental renal vein renin assay and segmental nephrectomy for correction of renal hypertension

Selective segmental renal vein catheterization was used to obtain venous blood samples for renin assay. With this technique a localized source of hypersecretion of renin was identified in 2 patients. Using samples from the main renal veins we found no significant difference in renin activity and, therefore, the etiology of the hypertension in these 2 patients would have been missed. Segmental nephrectomy resulted in a cure of the hypertension in both patients who were followed for a minimum of 14 months.

Sigmoid conduit urinary diversion

The courses of 11 patients with sigmoid conduit urinary diversion following total pelvic exenteration were reviewed in detail and the results presented. The sigmoid conduit appears to be a safe alternative to the ileal conduit for urinary diversion, and offers in addition the possible advantage of an effective antirefluxing ureterocolic anastomosis.