Long term follow-up after surgical removal of pheochromocytoma--observations in 61 patients.

89 patients were operated on for pheochromocytoma. 61 patients (37 women and 24 men) were available for extended follow-up. The final survey, performed 79.1 +/- 66.9 months postoperatively, provided data on survival, blood pressure tumor recurrence, malignant metastatic lesions, cardiovascular complications and coexisting diseases. There were 4 deaths during the follow-up period, including 2 instances of malignant pheochromocytoma. Permanent normalization of blood pressure was achieved in 38 patients (62.3%). This hypotensive effect was noted in 79.2% of patients with preoperative paroxysmal hypertension and in 40.8% of those with sustained hypertension. Permanent or re-developing postoperative hypertension was noted in 23 (37.7%) patients. This includes 4 cases of malignant pheochromocytoma, 4 cases of recurrent benign pheochromocytoma and 15 cases of essential hypertension. Cardiovascular complications during follow-up were rare and concerned the patients with essential hypertension diagnosed postoperatively.

On the flow characteristics of the renal artery transplants--model studies.

It is shown analytically and experimentally that, within the scope of a surgery, the effects of variations in the position of the transplant-aorta contact point (relative to the renal artery natural location), in the transplant departure angle (relative to the aorta), in the transplant length and in the transplant curvature are relatively insignificant regarding mean flow resistance. Hence, it is concluded that, from this point of view, it is not important how the transplant will be situated and that the space convenience should be the surgical determining factor. Nevertheless, it is also shown that the rate of blood flow to the kidney may be significantly curtailed if the selected transplant diameter is too small. However, it is indicated that the above may not constitute the only criterion. Since there exists a theory that the atherosclerotic formations begin and develop within the separation regions, additional research is suggested correlating separation regions with the variables indicated above.

Calicopyelocystostomy in auto- and allotransplanted kidneys. Report of 2 cases.

A case of calicopyelocystostomy and one of pyelocystostomy are reported. In the first case, the operation was performed on an autotransplanted kidney. The operation was done in a patient with sponge kidney to facilitate spontaneous excretion of calculi. In the second case, the operation was performed in a patient with long-lasting urinary fistula which developed in a cadaver kidney transplant. Although the authors present only 2 cases, calicopyelocystostomy and pyelocystostomy can be recommended as a valuable method in complicated cases of recurrent nephrolithiasis and in patients with nonhealing long-lasting urinary fistulas which developed in transplanted kidneys.

Nelson's syndrome: incidence and prognosis.

Fifty patients bilaterally adrenalectomized for Cushing's disease were followed for 1 to 22 (mean, 12) years. In 14 of them (28%) Nelson's syndrome appeared within 1.5 to 12 (mean, 4.8) years after adrenalectomy. All the patients were deeply pigmented, 12 had a radiologically demonstrable tumour and six had visual defects. Plasma ACTH levels ranged from 450 to 8000 ng/l. However in every case at least one estimation during circadian studies equalled 2000 ng/l. One patient with an anaplastic pituitary tumour died 3 years after the discovery of the tumour. Anaplasia was also diagnosed in another patient with recurrence of pituitary tumour after a transsphenoidal operation. Symptoms of tumour infarction occurred in two patients, followed by clinical remission of Nelson's syndrome. In the majority of cases the course was benign. We conclude that all cases, however, should be followed indefinitely because Nelson's tumours are not infrequently aggressive.

Successful pregnancy following surgery for a masculinizing adrenocortical carcinoma.

A 16-year-old girl with a masculinizing adrenal carcinoma treated surgically is presented. Following surgery a full clinical and steroid remission has been achieved, without any adjuvant chemotherapy. In the 7th year after the surgical treatment the patient became pregnant. Pregnancy and labour were uncomplicated. The patient continues in complete remission, and her son has been noted to have normal development at 21 mth of age.