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Current status of prostatic echography
ABSTRACTS FROM C U R R E N T L I T E R A T U R E
SURGERY, GYNECOLOGY, AND OBSTETRICS b y T. B. Rangjitkar, M.D.
Radioeholesterol Adrenal Images for the Localization of Pheochromocytoma, M. F. Sturman, D. C. Moses, W. H. Beierwaltes, T, S. Harrison, R. D, Ice, and R. P. Dorr (138: 177, 1974)-Pheochromocytoma is a tumor of the adrenal medulla and is a surgically correctable cause of hypertension. Once the clinical diagnosis has been confirmed by hormonal tests, a knowledge of the location of the tumor may simplify the surgical procedure. The 13~I-1-19-iodocholesterol adrenal scan has permitted a noninvasive, nontraumatic method of imaging the adrenal cortex, and the authors report success in lateralizing the side of a pheochromocytoma preoperatively in 6 patients. The lzli_i_19_iodocholesterol is not concentrated in the adrenal medulla but shows the distortion or destruction of the adrenal cortex by the pheochromocytoma. Unfortunately, it cannot detect the pheochromocytoma unless there is distortion of the adrenal cortex. In all 6 patients the image of one adrertal gland was abnormally decreased in size or intensity by the associated pheochromocytoma. The localization of the • unilateral tumor, but not the size, was accurately predicted by adrenal imaging as confirmed by surgical exploration. At the present time the most commonly used methods for such localization are adrenovenography and arteriography, which are not without morbid and fatal outcomes. The authors suggest that radiocholesterol adrenal scan is a valuable adjunct to the localization of adrenomedullary tumors and is particularly useful in patients who are unable to tolerate venography or angiography.
JOURNAL OF THE AMERICAN MEDICAL A S S O C I A T I O N b y Alan Sperber, M.D.
Current Status of Prostatic Eehography, W. King, R. M. Wilkiemeyer, W. Boyee, and W. McKinney (226: 444, 1973)-Sixty-six patients with various prostatic diseases underwent prostatic echography through the use of a transrectal probe with an oscillating disk which emits and receives an ultrasonic beam,
UROLOGY / JUNE 1974 / VOLUMEIII,NUMBER6
with a cathode ray tube displaying the echogram. Transverse sonotomograms were obtained by inserting the probe 8 to 9 cm. into the rectum with the patient in the lithotomy position, starting at the level of the bladder and seminal vesicles and progressing distally at 1-cm. intervals throngh the region of the prostate. In 10 patients, measurement of maximal transverse and sagittal diameters closely correlated with prostatic size found at surgical procedure. In cases of prostatic carcinoma, increased acoustical output power and higher receiver gains were often necessary to delineate the prostatic outline at the interface of normal and carcinomatous prostatic tissue; in addition, large irregular echo patterns were frequently seen at the interface. In 10 of 13 patients with exta-aprostatic carcinoma, the diagnosis could be made on echogram in this manner. However, only five of ten echograms showed positive findings in patients with carcinoma confined to the gland. Prostatic calculi tended to be indistinguishable from carcinoma in the absence of capsular deformity. Inflammatory nodules of the prostate were accurately predicted in 2 cases where the entire prostate was displaced anteriorly by a sonolucent process. Examination was performed in thirty minutes with no complications, although eight examinations were technically unsuccessful. The authors felt that despite the current imprecise nature of this technique, refinements in instrumentation, modifications in technique, and extensive clinical evaluation were justified.
Mapping Cancerous and Precancerous Bladder Changes, L. G. Koss, E. M. Tiamson, and M. A. Robbins (227: 281, 1 9 7 4 ) - T h e total epithelium of the bladders of 10 patients who underwent cystectomy for multiple widespread neoplastic lesions of the bladd e r - p a p i l l a r y carcinoma, either invasive or noninvasive, and nonpapillary carcinoma in s i t u - w e r e studied in an effort to map the entire bladder, including areas not clinically suspicious for tumor, to determine the extent of urothelial involvement, Eighty to 120 blocks measuring 2.5 by 0.5 by 0.5 cm. were made per specimen. Although 2 bladders showed no gross evidence of neoplasia, and 3 bladders had tiny and "inconspicuous" bladder tumors, all patients histologically demonstrated carcinoma in situ, and 9 of 10 patients had either infiltrating or noninfiltrating papillary carcinoma, or nonpapillary infiltrating carcinoma. Ureters showed positive evidence of carcinoma in situ in 6 cases, and in situ or papillary carcinoma of the urethra were found in 4 of 10 cases.
807
SURGERY, GYNECOLOGY, AND OBSTETRICS b y T. B. Rangjitkar, M.D.
Radioeholesterol Adrenal Images for the Localization of Pheochromocytoma, M. F. Sturman, D. C. Moses, W. H. Beierwaltes, T, S. Harrison, R. D, Ice, and R. P. Dorr (138: 177, 1974)-Pheochromocytoma is a tumor of the adrenal medulla and is a surgically correctable cause of hypertension. Once the clinical diagnosis has been confirmed by hormonal tests, a knowledge of the location of the tumor may simplify the surgical procedure. The 13~I-1-19-iodocholesterol adrenal scan has permitted a noninvasive, nontraumatic method of imaging the adrenal cortex, and the authors report success in lateralizing the side of a pheochromocytoma preoperatively in 6 patients. The lzli_i_19_iodocholesterol is not concentrated in the adrenal medulla but shows the distortion or destruction of the adrenal cortex by the pheochromocytoma. Unfortunately, it cannot detect the pheochromocytoma unless there is distortion of the adrenal cortex. In all 6 patients the image of one adrertal gland was abnormally decreased in size or intensity by the associated pheochromocytoma. The localization of the • unilateral tumor, but not the size, was accurately predicted by adrenal imaging as confirmed by surgical exploration. At the present time the most commonly used methods for such localization are adrenovenography and arteriography, which are not without morbid and fatal outcomes. The authors suggest that radiocholesterol adrenal scan is a valuable adjunct to the localization of adrenomedullary tumors and is particularly useful in patients who are unable to tolerate venography or angiography.
JOURNAL OF THE AMERICAN MEDICAL A S S O C I A T I O N b y Alan Sperber, M.D.
Current Status of Prostatic Eehography, W. King, R. M. Wilkiemeyer, W. Boyee, and W. McKinney (226: 444, 1973)-Sixty-six patients with various prostatic diseases underwent prostatic echography through the use of a transrectal probe with an oscillating disk which emits and receives an ultrasonic beam,
UROLOGY / JUNE 1974 / VOLUMEIII,NUMBER6
with a cathode ray tube displaying the echogram. Transverse sonotomograms were obtained by inserting the probe 8 to 9 cm. into the rectum with the patient in the lithotomy position, starting at the level of the bladder and seminal vesicles and progressing distally at 1-cm. intervals throngh the region of the prostate. In 10 patients, measurement of maximal transverse and sagittal diameters closely correlated with prostatic size found at surgical procedure. In cases of prostatic carcinoma, increased acoustical output power and higher receiver gains were often necessary to delineate the prostatic outline at the interface of normal and carcinomatous prostatic tissue; in addition, large irregular echo patterns were frequently seen at the interface. In 10 of 13 patients with exta-aprostatic carcinoma, the diagnosis could be made on echogram in this manner. However, only five of ten echograms showed positive findings in patients with carcinoma confined to the gland. Prostatic calculi tended to be indistinguishable from carcinoma in the absence of capsular deformity. Inflammatory nodules of the prostate were accurately predicted in 2 cases where the entire prostate was displaced anteriorly by a sonolucent process. Examination was performed in thirty minutes with no complications, although eight examinations were technically unsuccessful. The authors felt that despite the current imprecise nature of this technique, refinements in instrumentation, modifications in technique, and extensive clinical evaluation were justified.
Mapping Cancerous and Precancerous Bladder Changes, L. G. Koss, E. M. Tiamson, and M. A. Robbins (227: 281, 1 9 7 4 ) - T h e total epithelium of the bladders of 10 patients who underwent cystectomy for multiple widespread neoplastic lesions of the bladd e r - p a p i l l a r y carcinoma, either invasive or noninvasive, and nonpapillary carcinoma in s i t u - w e r e studied in an effort to map the entire bladder, including areas not clinically suspicious for tumor, to determine the extent of urothelial involvement, Eighty to 120 blocks measuring 2.5 by 0.5 by 0.5 cm. were made per specimen. Although 2 bladders showed no gross evidence of neoplasia, and 3 bladders had tiny and "inconspicuous" bladder tumors, all patients histologically demonstrated carcinoma in situ, and 9 of 10 patients had either infiltrating or noninfiltrating papillary carcinoma, or nonpapillary infiltrating carcinoma. Ureters showed positive evidence of carcinoma in situ in 6 cases, and in situ or papillary carcinoma of the urethra were found in 4 of 10 cases.
807