Urethral carcinosarcoma following total cystectomy for bladder carcinoma.

A patient with carcinosarcoma of the urethra occurring 15 years after a radical cystoprostatectomy for transitional cell carcinoma is presented. The tumor arose from the penile urethra and invaded the glans penis and penile corpus cavernosum. The tumor was composed of mixed carcinoma (squamous cell carcinoma, adenocarcinoma and transitional cell carcinoma) and rhabdomyosarcoma. Biopsy of the right inguinal lymph node showed simultaneous metastasis of sarcomatous and transitional cell carcinoma elements.

The value of adrenal autotransplantation with attached blood vessels for the treatment of Cushing's disease: a preliminary report.

We treated 5 patients with Cushing's disease by total adrenalectomy and left adrenal autotransplantation with attached blood vessels. An end-to-end vascular anastomosis was made between the adrenal central vein and the inferior epigastric artery, and the saphenous vein and adrenal middle artery were anastomosed by intussuscepting the artery into the vein in 4 patients. Steroid replacement was withdrawn 7 to 90 days after bilateral total adrenalectomy. The patients were followed for 1 to 4 years. Repeated measurement of plasma cortisol, 24-hour urinary 17-hydroxycorticosteroid and 17-ketosteroid levels in all cases was normal. As soon as the adrenal central vein and inferior epigastric artery were anastomosed part of the adrenal gland was then excised. Oozing of blood from the cut surface was retained and the adrenal gland was then embedded into the inguinal muscle in 1 patient. Small doses of steroid replacement (12.5 mg. cortisone per day) were still necessary 1 year postoperatively. The result thus indicates that this procedure is feasible and valuable for the treatment of patients with Cushing's disease and no evidence of pituitary adenoma on magnetic resonance imaging or computerized tomography.

Microsurgical treatment of chyluria: a preliminary report.

We treated 80 patients with recurrent chyluria (68 men and 12 women) by a microsurgical technique since 1978. Transinguinal spermatic lymphangiovenous anastomosis was performed in 64 patients and inguinal lymph node-saphenous vein anastomosis was performed in 16. Followup was 6 months to 11 years in 50 of the former and 12 of the latter patients. Chyluria disappeared completely in 30 (60%) and 8 (66.7%) patients, respectively. In 6 of the former patients (12%) chyluria had disappeared immediately after the operation but it recurred within 1.5 to 3 years. The procedure has the advantage of a superficial operative field, and is simple and less traumatic.

Adrenal autotransplantation with attached blood vessels for treatment of Cushing's disease.

A case of Cushing's disease was treated successfully by staged total adrenalectomy, left adrenal autotransplantation with the attached blood vessels and pituitary irradiation. In the first stage the left adrenal gland was removed with its attached blood vessels intact, and adrenal autotransplantation then was performed. An end-to-end anastomosis was made between the adrenal central vein and the right inferior epigastric artery. The anastomosis between the right saphenous vein and the adrenal middle artery was accomplished by intussuscepting the artery into the vein followed by suturing. The second stage operation was total right adrenalectomy. Steroid replacement therapy was stopped 7 days postoperatively and all laboratory studies were normal. Two months after total right adrenalectomy the patient had a sensation of facial fullness. Plasma cortisol and 24-hour urinary 17-hydroxycorticosteroid levels were elevated. Part of the graft was excised with the patient under local anesthesia. The symptoms disappeared and the laboratory studies returned to normal. Pituitary irradiation was administered as supplementary treatment of Cushing's disease. This method for the treatment of Cushing's disease has proved feasible. The inguinal region is the optimal site for adrenal autotransplantation.