Location and Setting of the Mars InSight Lander, Instruments, and Landing Site.

Knowing precisely where a spacecraft lands on Mars is important for understanding the regional and local context, setting, and the offset between the inertial and cartographic frames. For the InSight spacecraft, the payload of geophysical and environmental sensors also particularly benefits from knowing exactly where the instruments are located. A ~30 cm/pixel image acquired from orbit after landing clearly resolves the lander and the large circular solar panels. This image was carefully georeferenced to a hierarchically generated and coregistered set of decreasing resolution orthoimages and digital elevation models to the established positive east, planetocentric coordinate system. The lander is located at 4.502384°N, 135.623447°E at an elevation of -2,613.426 m with respect to the geoid in Elysium Planitia. Instrument locations (and the magnetometer orientation) are derived by transforming from Instrument Deployment Arm, spacecraft mechanical, and site frames into the cartographic frame. A viewshed created from 1.5 m above the lander and the high-resolution orbital digital elevation model shows the lander is on a shallow regional slope down to the east that reveals crater rims on the east horizon ~400 m and 2.4 km away. A slope up to the north limits the horizon to about 50 m away where three rocks and an eolian bedform are visible on the rim of a degraded crater rim. Azimuths to rocks and craters identified in both surface panoramas and high-resolution orbital images reveal that north in the site frame and the cartographic frame are the same (within 1°).

Prostate cancer screening before and after abdominoperineal resection: recommendations, biopsy, and therapeutic techniques.

BACKGROUND: The purpose of this study was to determine the incidence and mortality rate of prostate cancer in men without a rectum at a single institution. The usefulness of serum prostate specific antigen (PSA) to screen for prostate cancer in men without a rectum was defined. Improved biopsy techniques and therapeutic options were developed in those with elevated levels. METHODS: We undertook a retrospective review of 65 men who underwent an abdominoperineal resection. Twenty-five of these men underwent serum PSA determinations (mean age, 68 years). RESULTS: Four (16%) of 25 patients had elevated PSA levels. Three of these four men and two additional patients (one before the availability of PSA and one with normal serum PSA level) were found to have biopsy-proven prostate cancer. Two men (3% of the 65 patient population) died of metastatic prostate cancer. CONCLUSIONS: We believe that men about to undergo an abdominoperineal resection should have a preoperative serum PSA measurement. Moreover, we recommend that men older than 49 years of age (older than 39 years for those with positive family histories) without a rectum should have annual serum PSA determinations as if recommended for the general male population at large. If an elevated serum PSA level is discovered, the transperineal ultrasonogram-guided biopsy technique offers an effective method to detect peripheral zone prostate cancers.

Gallbladder and gastrointestinal motility after hemorrhagic shock.

The alterations in fasting gallbladder and gastrointestinal motility during hemorrhagic shock were investigated. Eight opossums implanted with a gallbladder cannula, gastrointestinal bipolar electrodes, and a carotid catheter were subjected to hemorrhagic shock of 30 mm Hg for 60 minutes by the removal of arterial blood. Shed blood was reinfused after the shock period. Fasting gallbladder volume and gastrointestinal electrical activity were studied before, immediately after, and 24 hours after hemorrhagic shock. Control measurements demonstrated a slow-wave frequency maximal in the duodenum (18.1 +/- 1.1 waves/min), with a plateau in the proximal third of the small bowel, decreasing thereafter. The migrating motor complex (MMC) had a duration of 118 +/- 28 minutes. The average volume of the gallbladder before shock was 5.4 +/- 1.5 ml. Gallbladder volume fluctuated with the MMC, being maximal during phase I and minimal in phase III. The volume of blood removed to reduce mean arterial pressure to 30 mm Hg was 45 +/- 5 ml/kg. Immediately after the shock and blood reinfusion, slow-wave frequency decreased by 40% in the antrum and 25% in the small bowel. The MMC was of shorter duration (91 +/- 22 minutes; p less than 0.05), and gallbladder volume increased to 7.0 +/- 1.7 ml (p less than 0.05). Fluctuations in gallbladder volume during the MMC were absent. Twenty-four hours after shock, slow-wave frequency, MMC, and gallbladder volume had returned to normal and were not different from control measurements. Ischemic damage to the gastrointestinal tract is postulated as the cause of gallbladder dysfunction and altered intestinal motility after hemorrhagic shock.

Hematogenous metastasis of nonseminomatous germ cell testicular cancer.

A case is reported of a twenty-five-year-old man in whom paraplegia developed due to spinal metastasis from a nonseminomatous germ cell tumor immediately after retroperitoneal node dissection in which all nodes were found to be negative. This case emphasizes deficiencies in knowledge concerning the routes of metastasis of testicular tumor and points out that retroperitoneal lymphadenectomy is not an infallible staging procedure in patients with this disease.

Sertoli cell tumor of testis.

A case is reported of a patient with Sertoli cell tumor of the testis, the second known to have had a lymphangiogram and the third with histopathologic examination of retroperitoneal lymph nodes. Lymphangiography was performed because of extension of the tumor through the tunica albuginea into the adjacent adherent scrotum at the site of previous testicular biopsy. The lymphangiogram proved to be falsely positive following retroperitoneal lymph node dissection. The patient has remained clinically free of tumor for eight years.

Ambulatory extracorporeal shockwave lithotripsy.

The Kidney Stone Center in Fort Lauderdale, Florida, is an ambulatory ESWL facility where 226 patients have been treated since July, 1985. A total of 258 kidneys were treated over a period of five months with a success rate of 99 per cent. The post-treatment admission rate, both immediate and delayed, was 14.2 per cent. Outpatient ESWL treatment of both renal and ureteral calculi is feasible, medically safe, and cost-effective.

Intravesical CDDP therapy compared with combined CDDP and external radiation in noninvasive bladder cancer. Monitored with quantitative fluorescence cytology.

Results of intravesical CDDP or CDDP combined with external beam radiation are compared in a group of 13 patients with low-stage bladder cancer. Six patients with low-stage bladder cancer received 4 or 12 treatments of CDDP intravesically with an initial complete response in 3 patients. Within six months, recurrent disease developed in 2 of 3 patients. Seven patients received the combination therapy of 400 rad (weekly for six weeks) followed two hours later with 50 mg of intravesical CDDP. A positive response was observed initially in all 7 patients as determined by pathology, PAP cytology, fluorescence cytology, and quantitative nuclear fluorescence determinations. Therapy was discontinued in 1 patient in each group because of irritative symptoms. The results indicate combination therapy is of tolerable toxicity, and quantitative fluorescence cytology is a useful adjuvant for guiding future treatments in patients with low- and high-grade bladder tumors.

Ileo-cecal junction: a valve or a sphincter? An experimental study in the opossum.

The characteristics of the ileo-junction (UIC) were examined in seven opossums in vivo, and the effect of the UIC on colo-ileal reflux in eight opossums in vitro. Electromyography and intraluminal manometry were studied during intestinal distensions, and administration of phenylephrine, isoproterenol and carbachol. In vitro studies used preparations of ileum, UIC, and colon, attached to a propulsion evaluation system. Fluid flow across the UIC was studied basally and after phenylephrine, isoproterenol and carbachol. A high pressure zone in the UIC was not observed in vivo. Colonic distension increased the pressure and electrical spike bursts in the ileum and UIC, while ileal distension had the opposite effect. Myoelectric and contractile activities were inhibited by adrenergic agonists and stimulated by carbachol. In vitro studies demonstrated aborally migrating ileal contractions initiated by fluid injections into the ileum, and cecal contractions elicited by fluid injections into the colon. The UIC only prevented colo-ileal reflux when it was undergoing contraction as part of ileal or colonic activity. These findings suggest that the opossum UIC does not have valvular properties and ileal fluid propulsion is the main factor in the prevention of colo-ileal reflux.

Transcervical resection of submucous uterine fibroids: an alternative approach to management.

Transcervical resection of submucous uterine fibroids can be an effective alternative to laparotomy and transuterine myomectomy in selected women. To date the authors have performed this procedure in three patients in an ambulatory environment. In two patients, transcervical resection was performed for giant intrauterine myomas which caused pathologic uterine bleeding and infertility. In a third patient the procedure was performed to resect multiple small submucous myomas causing infertility.