Impact of pathologic extraprostatic disease on local and systemic progression following radical prostatectomy.

Fifty patients underwent radical prostatectomy for localized prostate cancer (Stages A2, B) between 1977 and 1982. Surgical specimens were examined for tumor grade and extraprostatic extension of the disease. Forty-one of the 50 patients had capsular involvement (82%), 26 (52%) positive margins and 14 (28%) seminal vesicular involvement. Six patients progressed locally, six systematically and three both. Eight patients progressed at five years and an additional seven at ten years. In all 15 progressors tumor involved the capsule yet four patients with capsular involvement alone progressed. Eleven of the 26 patients (42%) with positive margins progressed. Five of the 14 patients (37%) with seminal vesicle involvement progressed, all five had positive margins as well. None of the patients with disease confined within the capsule progressed. Gleason score for non-progressors ranged between three and nine with a median of six while for progressors it ranged between five and nine with a median of seven. Long rank test and Cox Proportional Hazard Model statistical analysis were employed among all the factors: capsular involvement, positive margins, positive seminal vesicles and grade of tumor. Positive margins was the only statistically significant factor affecting local progression of the disease in both univariate and multivariate analysis at a 95% confidence (p=0.04). All factors were statistically insignificant in affecting systemic progression (p>0.5).

The "cricket bat" flap: a one-stage free forearm flap phalloplasty.

Total and subtotal penile reconstruction represents a major surgical challenge. We present a new method and two illustrative cases using a modified design of the radial forearm free-tissue transfer: the "cricket bat" flap.

Intracorporal injection of papaverine and phentolamine in the management of impotence.

Intracorporal injection of 0.5 ml papaverine (30 mg/ml) and phentolamine (2.5 mg/ml) was given to 144 patients presenting with various types of impotence. The high response rate (97%) precluded the use of this test to differentiate between types of impotence but provided patients with the choice of embarking on a self-injection programme. Of the 101 patients entering the programme 78 are continuing self-injection therapy with a mean follow-up of 6.5 months. The incidence of complications is low and patients are generally very satisfied with the treatment.

Congenital arteriovenous malformation of kidney in pregnancy.

Two cases of rupture of an arteriovenous malformation (AVM) of the kidney during pregnancy are reported. The surgical options are presented, and a new classification of arteriovenous malformation is proposed.

Procoagulant activity in renal transplant recipients.

Procoagulant activity (PCA) of leukocytes of renal transplant recipients was studied. This material, which activates coagulation, has previously been shown to be released from macrophages after they interact with mitogen-stimulated or antigen-stimulated T lymphocytes. Under endotoxin-free conditions, PCA of peripheral blood leukocytes, incubated for 90 min in tissue culture, was elevated in postoperative transplant recipients and in many transplant patients tested around the time of a rejection episode. The response to lipopolysaccharide added during culture was also increased in these populations. The PCA response was factor-VII-dependent when tested with washed peripheral blood mononuclear cells (PBMC), but was factor-VII-independent when tested with unwashed PBMC in their original culture medium. The results indicate a possible link between immunologic events and coagulation in transplant recipients.

Donor-specific antibodies in renal allograft recipients. A reevaluation of the 51Cr-release assays comparing fibroblast and lymphoid target cells.

Donor-specific alloantibody was monitored in recipients of 81 renal allografts by 51Cr release assays. Complement-dependent cytotoxicity and antibody-dependent cell-mediated cytotoxicity were both followed. In addition to the conventional lymphoid target cells nonlymphoid target cells, namely fibroblasts from the donor, were used. Although antibody against donor lymphoid cells was found more frequently, associations with graft loss and with rejection were greater with antibody against fibroblasts. The superior association of antibody against fibroblasts with clinical events suggests that wider use of nonlymphoid target cells would be of value in studies of alloantibody responses in renal transplant recipients.

Microsurgical replantation of a completely amputated penis.

Replantation of a penis with microsurgical repair of vessels and nerves can restore normal genitourinary function. A case is presented of an amputated penis that was ischemic for sixteen hours before being microsurgically revascularized. The patient has at all times appreciated having an intact penis despite the fact that the injury was self-inflicted. Self-mutilation is not considered to be an absolute contraindication to replantation.

Renal artery aneurysm rupture in pregnancy.

Acute rupture of a renal artery aneurysm is more likely to occur during pregnancy and when it does there is an associated high mortality for the mother and child. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. When a renal artery aneurysm is discovered in a woman of childbearing age surgical treatment, preferably primary repair, is indicated to prevent subsequent rupture during pregnancy. We report on a mother and child who survived acute rupture of a renal artery aneurysm following treatment by primary repair.