Value of computerized tomography and ultrasonography in the preoperative diagnosis of renal cell carcinoma extending into the inferior vena cava

During a 15-year period, 34 patients with renal cell carcinoma extending into the inferior vena cava were submitted to radical ablative surgery at our institution. 8 patients had caval tumor thrombus (TT) extension at the level of the renal veins, 17 had infrahepatic, 8 retrohepatic and 1 atrial TT extension. Cavography, computerized tomography (CT) and ultrasonography (US) were performed preoperatively on 34, 24 and 16 of these 34 patients, respectively. The sensitivity of the techniques used in diagnosing caval involvement was 100, 97 and 87.5% for US, cavography and CT, respectively. The upper limits of TT were clearly detected by US, CT and cavography in 100, 95 and 76% of diagnosed cases, respectively. From this study it appears that US and CT have a sensitivity comparable to cavography in the detection of caval TT. However, US and CT allow a more precise delineation of the upper limits of TT if compared to cavography. This implies that the role of cavography in diagnosing caval TT and its upper limits must be reappraised in light of the progress of noninvasive outpatient procedures.

Successful extraction of renal cell carcinoma thrombus extending into the right atrium using extracorporeal circulation, profound hypothermia and cardiac arrest

The authors report a case of successful extraction of renal cell carcinoma thrombus extending into the inferior vena cava and right atrium in a 36-year-old female patient using extracorporeal circulation, profound hypothermia and cardiac arrest.

Hydroxylation of dibutylnitrosamine in the human liver and intestinal microsomal fractions

The metabolism of the bladder carcinogen N-nitroso-di-n-butylamine (NDBA) was studied in microsomal preparations of tissues of patients of both sexes, aged 59-69 years undergoing abdominal surgery. Samples of liver, ileum, and colon were of normal histological appearance. For comparison, samples of rat liver and small intestinal mucosa microsomes were included in the study. Using 1-14C-labeled NDBA, the biotransformation to hydroxylation products retaining the nitroso group, NDBA-2-OH, NDBA-3-OH, and NDBA-4-OH, respectively, was investigated by reversed phase HPLC. In order to separate these metabolites, pooled samples were analysed by normal phase HPLC. The rate of hydroxylation of NDBA was found to be 5.5 times higher in rat liver microsomes compared to those from human liver (2.86 +/- 0.29 vs 0.52 +/- 0.03 nM X min-1 X mg-1). NDBA-3-OH proved to be the major metabolite formed (greater than 80% of total metabolites). The metabolism of NDBA was low but detectable in seven out of nine specimens of human gut, 0.1-0.5 nM X mg-1 in 1 h of incubation, and of the same order of magnitude in rat intestinal tissue (0.4-0.6 nM X mg-1).

Surgical management of renal cell carcinoma with vena cava tumor thrombus

The results of the surgical management of 28 patients with renal cell carcinoma extending into the inferior vena cava have been analyzed. 8 patients had caval tumor thrombus extension at the level of the renal veins, 14 had infrahepatic, 5 retrohepatic and 1 atrial tumor thrombus extension. The caval wall was infiltrated by tumor in 7 cases. 9 patients had metastases. Lymph node involvement was seen in 9 patients. Life-table analysis of all 28 patients revealed on overall probability of survival of 32 and 9% at 2 and 5 years, respectively. The patients with caval involvement alone (N0M0) had a 2-year survival rate of 69%. Those with distant metastases or caval infiltration had a 2-year survival of 27 and 0% (p = NS). The level of caval tumor thrombus extension had a statistically insignificant influence on the survival of patients. In fact the 2-year survival rates of patients with caval thrombus at the level of the renal veins, below the large hepatic veins and above the large hepatic veins were 30, 36 and 32%, respectively. Our statistical data demonstrate that caval involvement has a very negative impact on the prognosis of patients with renal cancer.

Glucuronidation of 1-naphthol in nuclear and microsomal fractions of the human intestine

The glucuronyl transferase activity was measured with 1-naphthol as a substrate in nuclear and microsomal fractions of the human intestinal mucosa. The mucosa was obtained from different parts of the intestine. The rate of 1-naphthol glucuronidation ranged between 0.70 and 1.26 nmol/mg/min (nuclear fraction) and 0.21 and 0.54 nmol/mg/min (microsomal fraction). The average (+/- SEM) of the nuclear/microsomal ratios of the glucuronyl transferase was 2.48 +/- 0.19. The epoxide hydrolase activity towards styrene oxide was measured in the same subcellular fractions; it was undetectable in the nuclear fraction, whereas it was 0.46 +/- 0.04 nmol/mg/min (mean +/- SEM) in the microsomal fraction. The glucuronyl transferase activity was also measured in nuclear and microsomal fractions of the human liver. The activity (mean +/- SEM) was 1.14 +/- 0.21 nmol/mg/min (nuclei) and 5.00 +/- 0.80 (microsomes). The average of the nuclear to microsomal ratios (mean +/- SEM) was 0.32 +/- 0.03.

Treatment of prostatic cancer with a depot form of a luteinizing hormone-releasing hormone analogue

Chronic administration of a depot form of D-Trp6 luteinizing hormone-releasing hormone (LH-RH), an LH-RH analogue (3 mg i.m. every 28 days for a mean period of 9.1 months), to 14 patients with locally extended or metastatic cancer of the prostate provided a good degree of disease control. After a slight and transient increase in gonadotropin secretion, the peptide induced a sharp and long-lasting inhibition of both gonadotropin and testosterone secretion, contemporaneously with clinical improvement and without any important side effects. These results are comparable to those recorded by others after daily administration of LH-RH analogues.

Bethanechol versus antiacids in the treatment of gastroesophageal reflux

To compare the efficacy of bethanechol in the treatment of gastroesophageal reflux with that of antiacids, a prospective, cross-over study was undertaken, in which 20 affected infants and children were randomized into two groups on 6-week alternate bethanechol and antiacids oral medication. Patients were evaluated clinically and by esophageal pH-metry before and after each treatment. Clinical score amelioration was achieved earlier than reflux number reduction and with similar incidence in both groups of patients, irrespectively to the initial medication; moreover, the differences in the degree of improvement between the two groups after either treatment were not found to be significant. These results fail to show that bethanechol is more effective than antiacids in controlling gastroesophageal reflux; moreover, bethanechol is more difficult to administer and offers a higher rate of undesired side effects.

Results of radical cystectomy for primary bladder cancer. Retrospective study of more than 200 cases

During a seven-year period 202 patients with primary bladder cancer had radical cystectomy with bilateral pelvic lymphadenectomy and urinary diversion. Lymph node metastases were found in 28.7 per cent. No significant differences in overall survival owing to age were apparent. Only extension and grade of histopathologic differentiation of the tumor proved to be an important prognostic factor. The five-year survival rates for pT1, pT2, pT3, and pT4 tumors were 76, 56, 19, and 0 per cent, respectively. In patients with deep invasive (T3 and T4) tumors no significant differences of survival rate depending on N and M categories were found. Nevertheless in pT3 tumors the probability of remaining alive was significantly decreased in those patients with histologic grade 3 compared with grade 2 tumors (P less than 0.01). The prognosis for patients submitted to radical cystectomy for bladder cancer has been classified as good: tumors confined to superficial muscle (pT1 and pT2); intermediate: tumors mildly differentiated infiltrating the deep muscle (pT3/G2); fairly poor: tumors undifferentiated infiltrating deep muscle (pT3/G3); and poor: adjacent invasive bladder tumors (pT4).

Angiographic treatment of high-flow priapism

Priapism can be successfully treated by unilateral or bilateral percutaneous transcatheter occlusion of the internal pudendal arteries. Occlusion should be reversible in order to avoid impotence. Embolization with an autologous clot satisfies this requirement because of clot lysis and consequent vessel recanalization. This treatment is the most specific therapy in 'high-flow' priapism. The authors describe extensively 5 cases which demonstrate the feasibility of the method by which sexual potency is preserved.

Immediate and long-term results of parathyroid autotransplantation in primary hyperparathyroidism

The authors review the experience of total parathyroidectomy with microsurgical autotransplantation with reference to the long-term results. This method--after further control investigations--may be envisaged for making a definitive evaluation of the results.

Percutaneous temporary embolization of the internal pudendal arteries in idiopathic priapism: 2 additional cases

We report 2 cases of successful treatment of priapism by transcatheter embolization of the internal pudendal arteries. Recovery of penile blood flow was confirmed by Doppler flowmetry and potency was preserved. Embolization with autologous clot is at least partially reversible and interventional angiography warrants consideration in the treatment of priapism.

Nuclear epoxide hydrolase in the human fetal and adult liver

The epoxide hydrolase activity with styrene oxide as substrate was investigated in the nuclear fraction of human fetal and adult liver specimens. All investigated liver fractions catalyzed the hydration of styrene oxide and the average epoxide hydrolase activities were 0.37 and 1.90 nmol/min/mg protein in fetal and adult specimens, respectively. The enzyme followed Michaelis-Menten kinetics in fetal nuclear fraction and biphasic kinetics in adult livers. The nuclear/microsomal enzyme activity ratios of epoxide hydrolase were 0.09 and 0.11 for fetal and adult livers, respectively.

The role of venography and sclerotherapy in the management of varicocele

Venography has recently been introduced in routine diagnostic evaluation of varicocele, and a pathogenetic classification based on venographic findings has been proposed. Transcatheter sclerotization of the internal spermatic vein completes the angiographic management of varicocele. After venographic classification of 56 cases, the patients with type-1 varicocele (reno-spermatic reflux) were treated by transcatheter sclerotization (group A, 25 patients) or high inguinal surgical ligation (group B, 15 patients). The results were quite similar, whereas the cost/benefit ratio was favorable to sclerotherapy.