Lymphography and percutaneous lymph node biopsy in clinically localized carcinoma of the prostate.

Accurate staging of prostatic carcinoma requires determination of the status of the regional draining lymph nodes. Pelvic lymphadenectomy is the definitive examination but has certain morbidity and even mortality. Lymphography is safe but may not be sufficiently accurate. A total of 41 patients with clinically localized disease and abnormal or suspicious lymphograms underwent percutaneous lymph node biopsy. Ten of 11 patients (91 per cent) with abnormal lymphograms and 14 of 30 (47 per cent) with suspicious lymphograms had positive cytology studies. Of the suspicious defects an unopacified void in a nodal chain most frequently was positive. Of 22 potentially curable patients with stages A and B1 disease 12 had metastatic disease.

Extended pyelolithotomy: the use of renal artery clamping and regional hypothermia.

Extended pyelolithotomy is a technique applicable for removal of most staghorn, and large pelvic and caliceal calculi. Nephrotomy incisions can be avoided in many cases. The efficiency of extended pyelolithotomy in difficult cases can be improved by renal artery occlusion combined with regional renal hypothermia. Devascularization of the kidney produces softening of the renal substance, which facilitates stone removal. The operative method is described and 5 cases are presented.

Ureteral injuries during vascular surgery.

The rapid increase in the number of vascular surgical procedures done has led to a new class of iatrogenic ureteral injuries. Vena caval ligation, bilateral lumbar sympathectomy, bypass procedures and abdominal aortic aneurysmectomy produce the majority of these injuries. Established principles useful in the repair of iatrogenic injuries following a gynecologic or colonic operation often are inapplicable.