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Adrenergic Blockade in Pheochromocytoma
1250
CALCULUS
pheochromocytomas examined were located by scintigraphy. Confidence in the ability of newer techniques allows the use of a flank incision in most cases, thus, reducing the operative morbidity. W. W. K. 5 figures, 2 tables, 14 references
Adrenergic Blockade in Pheochromocytoma R. S. MODLINGER, N. H. ERTEL AND J. B. HAUPTMAN, Veterans Administration Medical Center, East Orange, New Jersey
Arch. Intern. Med., 143: 2245-2321 (Dec.) 1983 The authors review the use of phentolamine mesylate, phenoxybenzamine hydrochloride, prazosin and metyrosine for adrenergic blockade in patients with pheochromocytoma. Much debate surrounds the medical treatment and preoperative management of epinephrine-secreting pheochromocytomas, especially in patients who require treatment for severe epinephrineinduced symptoms but in whom concomitant secretion of norepinephrine is not determined. {3-Blockers are the primary agents. Major concern stems from the possible development of unopposed a effect, whereby blockade of {3 dilating vessels leads to increased a-sensitivity and severe hypertension. Conversely, profound hypotension and arrhythmias have developed in such patients given a-blockade alone, even when epinephrine and norepinephrine secretion is demonstrated. The authors advise the initial use of small doses of propranolol hydrochloride only in patients with no clues suggesting coexistent norepinephrine secretion, under careful observation in the intensive care unit. They state that the major use of metyrosine may be in patients with pheochromocytoma unable to tolerate or resistant to ablockers, and patients with inoperable or metastatic tumor. E. D. W. 17 references
Epididymal Metastasis From Prostatic Cancer D. P. SARMA, M. WEINER AND T. G. WEILBAECHER, Department of Pathology, Louisiana State University Medical School and Veterans Administration Medical Center, New Orleans, and Department of Urology, Tulane University Medical School, New Orleans, Louisiana
J. Surg. Oncol., 24: 322-324 (Dec.) 1983 The authors present a 59-year-old black man with prostatic adenocarcinoma diagnosed at transurethral resection. Bilateral orchiectomy was done and both testicles were normal, although the tail of the epididymis on the right side was involved with metastatic prostatic adenocarcinoma. The authors have reviewed 9 single cases of adenocarcinoma metastatic to the epididymis. It is of interest that their patient survived for 18 months, while in the literature 1 patient has survived ~2 years after diagnosis. P. R. R. 1 figure, 1 table, 9 references
Comparison of Formalin- and Acetone-Fixation for Immunohistochemical Detection of Carcinoembryonic Antigen (CEA) and Keratin
T.
KAKU, J. K. EKEM, C. LINDAYEN, D. J. BAILEY, A. w. P. VAN NOSTRAND AND E. FARBER, Department of Pathology, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
Amer. J. Clin. Path., 80: 806-815 (Dec.) 1983
The authors compare the effects of cold acetone and formalin fixation for the detection of carcinoembryonic antigen and keratin in sections from a variety of normal and malignant human tissues. Sections from the formalin-fixed tissues were examined with and without pronase treatment. The peroxidaseantiperoxidase procedure was used to localize antigens in tissue sections. Based on their results the authors believe that acetone-fixation combined with embedding a low melting point paraffin should be considered as an alternative to formalin fixation in prospective immunohistochemical studies. This approach readily permits localization of antigens that do not survive the rigors of routine fixation and embedding. It also is compatible with the histochemical analysis of several enzyme activities, including acid and alkaline phosphatase, nonspecific esterase, cholinesterase, ,y-glutamyl transferase and aminopeptidase. The authors recommend acetone fixation combined with embedding a low melting point paraffin for the optimum retention of antigenic activity in permanently embedded tissues. P. R.R. 3 figures, 2 tables, 27 references
The Influence of Intravenous Hyperalimentation (IVH) on Wound Healing in Tumor-Bearing Rats P. W. DE GRAAF AND A. ZWAVELING, Laboratory of Experimental Surgery, State University, Leyden, The Netherlands
J. Surg. Oncol., 24: 332-337 (Dec.) 1983 An experiment was designed to evaluate the effect of a nonmetastasizing subcutaneously transplanted malignant tumor on the metabolic state of the rat as expressed by wound healing qualities, and to assess the effects of preoperative intravenous hyperalimentation in the same experimental situation. Bursting pressure of a colon anastomosis and tensile strength of an abdominal skin closure were compared to results in controls and groups that had received intravenous hyperalimentation for 2 weeks preoperatively during early and later stages of tumor growth. Both stages of tumor growth lowered normal healing qualities significantly but hyperalimentation in tumor-bearing rats restored wound healing qualities to normal during both stages. Tumor transplantation did not lead to anorexia or weight loss in this rat tumor model during the study interval. It appears that tumor growth leads to a poorly defined disturbance of metabolic equilibrium, perhaps caused by a deficit in 1 or 2 proteins or amino acids that are replenished by the amino acid content of intravenous hyperalimentation. M. G.F. 2 figures, 8 tables, 20 references
CALCULUS Laser Fragmentation of Renal Calculi
s.
G. M. WATSON, J.E. A. WICKHAM, T. N. MILLS, G. BOWN, P. SWAIN AND P. R. SALMON, Institute of Urology
and Department of Lasers, University College Hospital, London, England Brit. J. Urol., 55: 613-616 (Dec.) 1983 An ideal method for endoscopic stone fragmentation would have the characteristics of 1) rapid fragmentation of all types
CALCULUS
pheochromocytomas examined were located by scintigraphy. Confidence in the ability of newer techniques allows the use of a flank incision in most cases, thus, reducing the operative morbidity. W. W. K. 5 figures, 2 tables, 14 references
Adrenergic Blockade in Pheochromocytoma R. S. MODLINGER, N. H. ERTEL AND J. B. HAUPTMAN, Veterans Administration Medical Center, East Orange, New Jersey
Arch. Intern. Med., 143: 2245-2321 (Dec.) 1983 The authors review the use of phentolamine mesylate, phenoxybenzamine hydrochloride, prazosin and metyrosine for adrenergic blockade in patients with pheochromocytoma. Much debate surrounds the medical treatment and preoperative management of epinephrine-secreting pheochromocytomas, especially in patients who require treatment for severe epinephrineinduced symptoms but in whom concomitant secretion of norepinephrine is not determined. {3-Blockers are the primary agents. Major concern stems from the possible development of unopposed a effect, whereby blockade of {3 dilating vessels leads to increased a-sensitivity and severe hypertension. Conversely, profound hypotension and arrhythmias have developed in such patients given a-blockade alone, even when epinephrine and norepinephrine secretion is demonstrated. The authors advise the initial use of small doses of propranolol hydrochloride only in patients with no clues suggesting coexistent norepinephrine secretion, under careful observation in the intensive care unit. They state that the major use of metyrosine may be in patients with pheochromocytoma unable to tolerate or resistant to ablockers, and patients with inoperable or metastatic tumor. E. D. W. 17 references
Epididymal Metastasis From Prostatic Cancer D. P. SARMA, M. WEINER AND T. G. WEILBAECHER, Department of Pathology, Louisiana State University Medical School and Veterans Administration Medical Center, New Orleans, and Department of Urology, Tulane University Medical School, New Orleans, Louisiana
J. Surg. Oncol., 24: 322-324 (Dec.) 1983 The authors present a 59-year-old black man with prostatic adenocarcinoma diagnosed at transurethral resection. Bilateral orchiectomy was done and both testicles were normal, although the tail of the epididymis on the right side was involved with metastatic prostatic adenocarcinoma. The authors have reviewed 9 single cases of adenocarcinoma metastatic to the epididymis. It is of interest that their patient survived for 18 months, while in the literature 1 patient has survived ~2 years after diagnosis. P. R. R. 1 figure, 1 table, 9 references
Comparison of Formalin- and Acetone-Fixation for Immunohistochemical Detection of Carcinoembryonic Antigen (CEA) and Keratin
T.
KAKU, J. K. EKEM, C. LINDAYEN, D. J. BAILEY, A. w. P. VAN NOSTRAND AND E. FARBER, Department of Pathology, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
Amer. J. Clin. Path., 80: 806-815 (Dec.) 1983
The authors compare the effects of cold acetone and formalin fixation for the detection of carcinoembryonic antigen and keratin in sections from a variety of normal and malignant human tissues. Sections from the formalin-fixed tissues were examined with and without pronase treatment. The peroxidaseantiperoxidase procedure was used to localize antigens in tissue sections. Based on their results the authors believe that acetone-fixation combined with embedding a low melting point paraffin should be considered as an alternative to formalin fixation in prospective immunohistochemical studies. This approach readily permits localization of antigens that do not survive the rigors of routine fixation and embedding. It also is compatible with the histochemical analysis of several enzyme activities, including acid and alkaline phosphatase, nonspecific esterase, cholinesterase, ,y-glutamyl transferase and aminopeptidase. The authors recommend acetone fixation combined with embedding a low melting point paraffin for the optimum retention of antigenic activity in permanently embedded tissues. P. R.R. 3 figures, 2 tables, 27 references
The Influence of Intravenous Hyperalimentation (IVH) on Wound Healing in Tumor-Bearing Rats P. W. DE GRAAF AND A. ZWAVELING, Laboratory of Experimental Surgery, State University, Leyden, The Netherlands
J. Surg. Oncol., 24: 332-337 (Dec.) 1983 An experiment was designed to evaluate the effect of a nonmetastasizing subcutaneously transplanted malignant tumor on the metabolic state of the rat as expressed by wound healing qualities, and to assess the effects of preoperative intravenous hyperalimentation in the same experimental situation. Bursting pressure of a colon anastomosis and tensile strength of an abdominal skin closure were compared to results in controls and groups that had received intravenous hyperalimentation for 2 weeks preoperatively during early and later stages of tumor growth. Both stages of tumor growth lowered normal healing qualities significantly but hyperalimentation in tumor-bearing rats restored wound healing qualities to normal during both stages. Tumor transplantation did not lead to anorexia or weight loss in this rat tumor model during the study interval. It appears that tumor growth leads to a poorly defined disturbance of metabolic equilibrium, perhaps caused by a deficit in 1 or 2 proteins or amino acids that are replenished by the amino acid content of intravenous hyperalimentation. M. G.F. 2 figures, 8 tables, 20 references
CALCULUS Laser Fragmentation of Renal Calculi
s.
G. M. WATSON, J.E. A. WICKHAM, T. N. MILLS, G. BOWN, P. SWAIN AND P. R. SALMON, Institute of Urology
and Department of Lasers, University College Hospital, London, England Brit. J. Urol., 55: 613-616 (Dec.) 1983 An ideal method for endoscopic stone fragmentation would have the characteristics of 1) rapid fragmentation of all types