Computed tomographic imaging of microscopic dystrophic calcification in urachal adenocarcinoma.

Supravesical calcification noted on conventional radiography when associated with a bladder lesion has been considered nearly pathognomonic of the uncommon lesion, urachal adenocarcinoma. As the case reported here demonstrates, stippled microscopic calcification undetected by conventional means can be demonstrated uniquely by computed tomography with great sensitivity. Because urachal adenocarcinoma may be managed in a distinctly different manner if adequate preoperative preparation is made, it is suggested that in cases of anterior bladder lesions, computed tomographic imaging can detect this typical characteristic of urachal adenocarcinoma and may thereby provide further comfirmatory diagnostic evidence helpful in surgical planning.

Effect of long-acting LHRH analog (Zoladex) on prostate cancer: evaluated by transrectal ultrasonography.

Transrectal ultrasonography has proved valuable in assessing the effect of primary treatment modalities for prostate carcinoma. This study shows patients who had a significant reduction in primary tumor volume had a significantly better prognosis and had less local symptoms than did the group of patients that did not have a significant reduction (less than 50%) in primary volume secondary to therapy. Patients were treated with either castration or Zoladex and all had Stage D2 cancer of the prostate.

Transrectal ultrasonography. Early experience with use as prostate cancer detection tool.

Two hundred forty asymptomatic males, aged fifty-five to seventy years, underwent transrectal ultrasound of the prostate as part of a screening examination in conjunction with The National Prostate Cancer Detection Project (NPCDP). Nineteen prostate adenocarcinomas were detected, eight of which were nonpalpable. Fifteen of these patients had pathologic Stage B, 2 had microscopic Stage C (seminal vesicle involvement), and 2 had Stage D2 (bone) disease. While the activity and treatment of the eight nonpalpable lesions remain in question, the diagnosis certainly was made only with this type of examination. The use of transrectal ultrasound as a screening tool must continue to be prospectively evaluated in a multicenter trial.

Radical prostatectomy 1972-1987 single institutional experience: comparison of standard radical prostatectomy and nerve-sparing technique.

During the period of time from 1972 to 1987 a total of 104 radical prostatectomies were performed at the Ohio State University. From 1972 to 1985, standard radical retropubic prostatectomy was done in 60 patients and from 1986 to June 30, 1987, radical retropubic nerve-sparing prostatectomy was carried out in 44 patients. Transrectal ultrasound evaluation was available only for three quarters of the patients in the latter group. In the early part of the series, standard prostatectomy revealed 51 percent of the patients to have organ-confined disease and in the latter series 75 percent had organ-confined disease. In the earlier study only a retrospective analysis of the pathology reports was available, and in the latter study prospective evaluation was available with regard to pre- and postoperative staging, erectile function, blood loss and replacement, PSA data, and clinical and pathologic staging. It appears the radical nerve-sparing prostatectomy has several advantages including decreased blood loss, increased reservation of erectile function in 70 percent of the patients who were potent preoperatively, and a more accurate assessment of clinical stage prior to surgery through the use of transrectal ultrasonography.

Localized staging of prostate carcinoma: comparison of transrectal ultrasound and magnetic resonance imaging.

To evaluate the usefulness of two new imaging modalities in the clinical staging of prostate cancer the following study was done. Twelve patients with biopsy-proved carcinoma of the prostate were evaluated preoperatively with magnetic resonance imaging (MRI) of the pelvis and transrectal ultrasound of the prostate. The main parameters evaluated were the ability of these two modalities to accurately predict capsular penetration and seminal vesicle involvement in these 12 patients: 10 went on to pelvic lymph node dissections, and 8 had radical retropubic prostatectomies. Thus the preoperative studies could be compared to the pathologic results. Based on our results we believe transrectal ultrasonography is more accurate in the assessment of seminal vesicle involvement and comparable to MRI in determining capsular penetration. Because of the lower cost of ultrasound we believe it to be both an economical and accurate way to preoperatively stage prostate carcinoma.

Relative value of prostate-specific antigen and prostatic acid phosphatase in diagnosis and management of adenocarcinoma of prostate. Ohio State University experience.

Serum concentrations of prostate-specific antigen (PSA), prostate-specific acid phosphatase (PAP), and transrectal prostatic ultrasound were utilized in the evaluation of 193 men with various urologic disorders. Of the 193 patients, 48 had prostate cancer, and the other 145 included 5 with genitourinary neoplasms, 69 with benign prostatic hypertrophy, and 71 with other non-neoplastic genitourinary disease. PSA levels were elevated in 35 patients with prostate cancer and in 25 of the 145 without prostate cancer. PAP levels were elevated in 15 with prostate cancer and in 2 of the 145 without prostate cancer. The data indicate that PSA is a more sensitive but less specific tumor marker than PAP in the detection of prostate cancer. PSA appears to be more sensitive than PAP in monitoring the response to treatment. The use of PSA and PAP jointly to detect and to monitor prostate cancer did not appear to enhance the clinical utility over that of PSA alone.

Radical prostatectomy: OSU and affiliated hospitals' experience 1985-1989.

A total of 528 patients have been treated with radical prostatectomy and node dissection during the last five years. Correlation of clinical and pathologic staging will be presented. Over 85 percent of these patients had Gleason scores of 6 or less. Patients who had nerve-sparing surgery had a potency rate of over 60 percent post surgery.

ESWL treatment of urinary calculi.

A total of 711 patients with symptomatic upper and lower urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at the Ohio Kidney Stone Center during the first six months. At follow-up 84 percent of the first 180 patients are stone-free. Retreatment was required for 2.8 percent of the patients with residual stone material. Thirty-seven percent of the treatments required cystoscopy with ureteral stent placement for manipulation of stones or delineation of distal ureteral anatomy to facilitate ESWL. Complications were minimal at less than 3 percent.

Testicular torsion and its effects on contralateral testicle.

Twenty-six male adult Noble (Nb) rats underwent unilateral left testicular torsion of 720 degrees. The testicles of the 6 control animals were immediately detorsed. The experimental animals were divided into 4 groups according to the surgical approach (abdominal vs. scrotal) and location where the torsed testicle was placed (abdomen vs. scrotum). After six hours all torsed testicles in the experimental groups were detorsed. One month later all animals were sacrificed, and the contralateral testicles were examined for spermatogenesis and mean seminiferous tubular diameter. All groups displayed decreased spermatogenesis with smaller mean seminiferous tubular diameter as compared with the control group.

Histopathological changes following removal of the perineurium.

Using microsurgical techniques, the perineurial sheath was stripped off the sciatic nerves of rats over a 0.5 cm length at a point where the nerve consists of a single fascicle. The nerves were excised 0 to 84 days after the injury, and were examined in semi-thin transverse section. A new sheath, closely resembling normal perineurium, became organized during the first 10 days; it appeared uniformly over the length of the injured segment. The new perineurial sheath was probably formed by endoneurial fibroblasts migrating from within the fascicle. In undamaged specimens, the asons immediately beneath the excised perineurium underwent no degenerative changes.

The Nb rat transitional cell bladder carcinoma model: dose response to methotrexate and adriamycin.

The Nb rat transitional cell bladder carcinoma has a stable doubling time of approximately 4 days, with an incidence of metastasis of 30 percent. Those responses were evaluated with treatment of these tumors with 3 doses of Adriamycin and 2 doses of Methotrexate. Adriamycin treatment resulted in decreased tumor volume, and there were no animals with metastasis in the high dose group. Methotrexate also decreased metastasis and tumor volume. No animal treated with either agents in this protocol had the tumor undergo complete regression.

Chemotherapy and vitamin E in treatment of Nb rat prostate tumors.

Combination of Vitamin E in a single megadose of 20 units per 200 gram rat and chemotherapy was performed. The results revealed that Vitamin E treatment does indeed reduce Adriamycin toxicity and adds to tumor reduction and decrease metastasis. Vitamin E also enhances the efficacy of Cyclophosphamide, Adriamycin and Methotrexate.

Ectopia of the vas deferens.

Ectopic location of the vas deferens is a rare congenital abnormality that has a spectrum of presentations. Such cases have been associated with anorectal anomalies. Knowledge of distal Wolffian duct embryology may help to explain the developmental steps involved in these anomalies, as well as provide theories for the variations that may be encountered. Vas deferens development is reviewed, and two cases of vas ectopia are presented to illustrate and lend support to current theories of normal and abnormal vasal embryology.

Extracorporeal shock wave lithotripsy (ESWL).

There hundred sixteen patients with symptomatic upper and lower urinary tract calculi underwent extracorporeal shock wave lithotripsy (ESWL) at the Ohio Kidney Stone Center during the first three months. Ninety-seven percent of the stones were treated with one ESWL session. Twenty-four percent of the treatments required cystoscopy with ureteral stent placement for manipulation of stones to facilitate ESWL. Complications were minimal, less than three percent.

NB rat bladder cancer model: evaluation of the subrenal capsular assay system.

Since 1978 this laboratory unit has evaluated the Nb rat prostate adenocarcinoma model. More recently, over a 15-month period we have studied the Nb rat number one bladder tumor, a spontaneously appearing tumor in an aged female noble rat. Initial chemotherapeutic experiments have been carried out, revealing activity of this tumor to cyclophosphamide. Herein we report the feasibility of utilizing the subrenal capsular assay in the model. The advantage of this system is that one is able to determine the effect of chemotherapy in a very short time, i.e., 7 days. This method may save considerable expense and may serve as a useful projector for potential future chemotherapeutic trials of bladder cancer. In this assay system, cyclophosphamide, adriamycin, and cis-platinum and methotrexate did result in a significant decrease in tumor volume change. This change paralleled the results that we had seen in the past from the use of chemotherapy with cyclophosphamide alone in treatment of subcutaneous tumor nodules of bladder carcinoma. Further exploration of this method is warranted from a time efficiency as well as from a cost standpoint.

Adult Reye's syndrome.

A 40-year-old woman with a history of alcohol abuse, drug-related suicide attempts, and depression presented with a flu-like illness, vomiting, and changes in mentation. On admission, therapeutic blood levels of salicylates, trazadone, and acetaminophen were found. A tentative diagnosis of a psychotic crisis with possible superimposed drug overdose was made. The etiology of the patient's acute encephalopathy remained unclear until a plasma ammonia and liver biopsy established the diagnosis of Reye's syndrome. The patient was given supportive therapy and recovered completely.

Peritoneal extravasation during percutaneous lithotripsy.

Extravasation of irrigation fluid during percutaneous nephrostolithotomy is a major complication and can result in severe morbidity. We report 3 cases of peritoneal extravasation of irrigation fluid. Ventilatory difficulty and narrowed pulse pressure suggest intraperitoneal extravasation of irrigation fluid, which should be treated by rapid drainage of extravasated fluid and careful monitoring of electrolyte concentrations.

Renal angiomyolipomas.

Renal angiomyolipomas are generally benign tumors which are composed of smooth muscle, fat, and blood vessels. Classically these have been diagnosed with the use of arteriograms; however, since ultrasound and CAT scans have come into use these now are the common modalities for diagnosis. All angiomyolipomas generally can be followed conservatively, whereas larger ones have a tendency to bleed and require intervention. This paper reviews the diagnosis, treatment, and prognosis of patients with angiomyolipomas.