Cavitron ultrasonic surgical aspirator. Applications in urologic surgery.

The Cavitron Ultrasonic Surgical Aspirator is a unique modality for precise tissue removal which results in increased visibility, reduced bleeding, and shorter operating time when dealing with vascular lesions or organs. Herein, we present our experience in a dog laboratory as well as in a clinical setting with this new instrument. The mechanism of action, proper surgical technique required, and further application in urologic surgery are discussed.

Use of ultrasonic surgical aspirator in renal surgery.

The Cavitron ultrasonic surgical aspirator (CUSA) was used to fragment and aspirate normal and pathologic renal tissue. The operative blood loss utilizing the CUSA was markedly reduced compared to electrocautery or the cold scalpel. This is due to the ability of the instrument selectively to fragment and aspirate tissue with high-water content, such as renal parenchyma, while sparing tissue with higher elastin and collagen content, such as collecting system or blood vessel. The surgeon can therefore skeletonize and secure the blood vessels before they are divided.

Circadian variation in plasma prolactin, gonadotropins, and testosterone in diabetic male patients with and without impotence.

The circadian variation in plasma levels of prolactin, gonadotropins, testosterone, and glucose were studied in 10 young diabetic male patients. Four patients were asymptomatic without sexual dysfunction and six patients had organic impotence. The results of this study indicate that diurnal levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone are similar in diabetic patients with and without impotence. During the nocturnal period, a sleep-related increase in plasma prolactin levels was noted in diabetic patients without impotence. In diabetic patients with impotence, plasma prolactin levels were similar during the diurnal and nocturnal periods. These results further support previous findings that diabetic patients with organic impotence do not have abnormal gonadotropin and testosterone levels.

Technetium-99m glucoheptonate renal scan in diagnosis of acute renal injury.

Twenty-four patients with suspected renal injury were evaluated using high-dose intravenous pyelography, technetium-99m glucoheptonate radionuclide studies (RNS), and selective renal arteriography. Critical examination of these three diagnostic modalities reveal that RNS are extremely accurate in renal trauma evaluation and are more sensitive than intravenous pyelography. When RNS are used in conjunction with high-dose intravenous pyelography in the third workup for renal trauma, 60 to 65 per cent of diagnostic angiograms may be avoided.

Preoperative renal embolization as adjunct to radical nephrectomy.

Radical nephrectomy preceded by preoperative renal artery embolization using Gianturco-Anderson-Wallace steel coils has objective value as determined by comparing records of 15 patients who had adjunctive embolization with 15 patients who did not. Embolization of the major renal artery facilitated surgery allowing initial renal vein ligation resulting in reduction of blood loss and operative time. The described experience and current literature review support adjunctive embolization and document minimal risk to the patient.

Sexual function and hormonal abnormalities in uremic men on chronic dialysis and after renal transplantation.

Twenty-one adult uremic males on chronic hemodialysis were studied to determine the circulating levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and prolactin and their relationship to sexual function. Ten of the twenty-one patients were on exogenous testosterone, and its effects were measured. Twelve adult males with successful renal transplants were likewise examined. Testosterone concentrations were low in dialysis patients not on androgens (429 ng/dl +/- 85 SE), but FSH and LH levels were elevated (8.0 mIU/ml +/- 1.4 SE and 31 mIU/ml +/- 5.4 SE, respectively. Testosterone returned to normal after transplantation, but FSH and LH levels remained elevated. Prolactin levels were significantly increased in dialysis patients (25.5 ng/ml +/- 5.6 SE) and remained so despite androgen therapy, but returned to normal after transplantation. There was no correlation in any group between laboratory data and potency before androgen therapy. However, excessive testosterone replacement was shown to have an adverse effect on potentia.

Steroid hormone receptor characterization of several histologic variants of a rat prostatic adenocarcinoma.

Several histologic variants of the transplantable R-3327 prostatic adenocarcinoma carried in male Copenhagen rats have been characterized and the histologic types have been correlated with steroid hormone receptor content. One type is clearly an adenocarcinoma; this tumor is hormonally responsive and contains substantial amounts of both androgen and estrogen receptors. In contrast, another histologic type, a fibrosarcoma, is hormonally nonresponsive and does not contain either receptor. A third histologic variant is classified as a carcinosarcoma and contains histological elements of both adenocarcinoma and fibrosarcoma and is also hormonally responsive. This tumor contains lower receptor levels than the adenocarcinomas but more than the fibrosarcomas. The androgen receptor appears to be identical in the different histologic forms of the tumor: the sedimentation coefficient is 7.8S and the dissociatiln constant for methyltrienolone is 4 x 10(-9) M. Similarly, the estrogen receptor from the different histologic forms of the tumor has a sedimentation coefficient of 8.3S and the dissociation constant for estradiol is 7 x 10(-10) M. These findings clearly distinguish the cytosol binding macromolecules from plasma binding proteins, and classify them as steroid hormone receptors. Further, rat serum was devoid of androgen and estrogen binding in the 8S region. Normal prostate tissue from Copenhagen rats contained low levels of an androgen receptor, but no estrogen receptor. It is possible that during growth and/or passage of the R-3327 tumor, the hormonally responsive adenocarcinoma cells do not survive and there is a gradual emergence of the nonresponsive fibrosarcoma. If, as we suspect, the receptors are found in the epithelial cells and not the stromal cells, there clearly should be considerable variation of receptor content in the different intermediary histologic forms of the tumor.