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Re: Reduction of Infection Stones in Rats by Combined Antibiotic and Phosphocitrate Therapy, by J. D. Sallis, R. Thomson, B. Rees and R. Shankar, J. Urol., 140: 1063–1066, 1988
0022-534 7/90/1431-0::.35$02.00/0 THE JOURI,TAL OF UROLOGY Copyright© 1990 by AMERlCAN UROLOGICAL
AssoCIP.TION,
'/oL 143 JaLuary Printed in U.S.A. 1
INC.
Letters to the Editor RE: ADRENAL AUTOTRANSPLANTATION WITH ATTACHED BLOOD VESSELS FOR TREATMENT OF CUSHING'S DISEASE
Y.-M. Xu, Y. Qiao, P. Wu, Z.-D. Chen and N. T. Jin
J. Urol., 141: 6-8, 1989 To the Editor. I am disturbed by this article on adrenal autotransplantation. First, adrenal transplantation has been done for a long time. Brooks accomplished this procedure with a Millipore* filter and Hardy accomplished an almost identical procedure 25 years ago! The authors state that the procedure was successful and I would have some questions about this. In fact, they performed pituitary irradiation, which probably would have cured the patient of Cushing's disease irrespective of the adrenal operation. Also, they state that they simply transplanted too much of the adrenal. In fact, the patient still had the basic disease. Finally, and most importantly, in the current era of adequate replacement therapy there probably is no good rationale for this type of gymnastic procedure. Respectfully, James F. Glenn Department of Surgery (Urology) University of Kentucky Medical Center Lexington, Kentucky 40536 1. Hardy, J. D.: Autotransplantation of adrenal remnant to thigh in Cushing's disease. Preserving residual cortical activity while avoiding laparotomy. J.A.M.A., 185: 134, 1963. * Millipore Corp., Bedford, Massachusetts.
Reply by Authors. We reviewed the related literature and found that 25 years ago Hardy reported the treatment of Cushing's disease by bilateral total adrenalectomy. The left adrenal gland was transplanted to the right thigh with the central vein anastomosed to the distal end of the divided saphenous vein. Vascular anastomosis in his procedure was performed in a vein-to-vein manner. Therefore, the chance of thrombosis in the graft was greatly increased and the clinical result was not as satisfactory. However, in our procedure the anastomosis was made between the adrenal central vein and inferior epigastric artery, saphenous vein and adrenal middle artery, so that the graft not only increased the supply of arterial blood but it also facilitated venous drainage. Thus, the graft was more likely to survive and steroid replacement was not necessary. In this aspect our procedure was more or less different from that of Hardy. Since the result of pituitary irradiation was considered to be poor in the treatment of adult Cushing's disease, we treated our patient with a course of 5,000 rad pituitary irradiation after excision of part of the graft as a supplementary measure, which seemed to be reasonable. On April 28, 1988 we treated another case of Cushing's disease with the same procedure except that only a quarter of the adrenal tissue was transplanted. The patient did not receive pituitary irradiation postoperatively but she had no symptoms or sign of Cushing's disease, and levels of plasma cortisol, 24-hour urinary 17-hydroxycorticosteroids and 17-ketosteroids were within the normal range. Whether adequate replacement therapy could displace the role of this type of gymnastic adrenal operation in the treatment of Cushing's disease is a matter of further investigation. To our limited knowledge replacement therapy is not without shortcomings.
prised when they showed the weight of recovered bladder stones in figure 1 and the number of bladder stones recovered in figure 2, and then in the discussion stated that "PC is not an antibacterial agent but by discouraging daughter stone formation, it has the capacity to minimize any inherent potential for perpetuating recurrent infection through the entrapment of bacteria within crystalline structures.", when nowhere else is the term daughter stone stated. In the article by Vermeulen and associates figure 4 shows the explanation of daughter stones. 1 One wonders where the authors of the current article obtained the term. In addition, Vermeulen and Goetz showed the effect of infection,2 and Miller and associates showed the effect of antibiotics' on such foreign body stone growth, infected as opposed to noninfected, which the authors suggest is a new finding. It appears that nothing new is reported but one always hopes that there would be at least a passing mention of the previous research upon which modern research is based.
James A. Roberts Department of Urology Delta Regional Primate Research Center Three Rivers Road Covington, Louisiana 70433 1. Vermeulen, C. W., Grove, W. J., Goetz, R., Ragins, H. D. and Correll, N. 0.: Experimental urolithiasis. I. Development of calculi upon foreign bodies surgically introduced into bladders of rats. J. Urol., 64: 541, 1950. 2. Vermeulen, C. W. and Goetz, R.: Experimental urolithiasis IX: influence of infection on stone growth in rats. J. Urol., 72: 761, 1954. 3. Miller, G. H., Chapman, W. H., Seibutis, L. and Vermeulen, C. W.: Furadantin treatment of experimental urinary tract infection and its influence on stone growth. Experimental urolithiasis. XI. J. Urol., 76: 42, 1956.
RE: PRIMARY SIGNET RING CELL ADENOCARCINOMA OF THE BLADDER
M. L. Blute, D. E. Engen, W. D. Travis and L. K. Kvols J. Urol., 141: 17-21, 1989
To the Editor. I read this article on a patient with primary signet ring adenocarcinoma of the bladder with interest. This, indeed, is a rare lesion and I agree with the over-all discussion and review of the literature, and the generally poor prognosis that the authors cited. I write simply to correct a minor error. The authors stated the longest reported survival to be 45 months. In 1980 we reported on a patient with metastatic primary signet ring cell adenocarcinoma of the bladder who survived for 16 years. 1 The patient ultimately died of the metastatic disease when he presented 16 years postoperatively with bowel and urinary obstruction due to carcinomatosis from the original lesion. Respectfully, Arthur I. Sagalowsky Department of Urology University of Texas Southwestern Medical Center at Dallas 5323 Harry Hines Boulevard Dallas, Texas 75235-9031 1. Sagalowsky, A. and Donohue, J. P.: Sixteen-year survival with
RE: REDUCTION OF INFECTION STONES IN RATS BY COMBINED ANTIBIOTIC AND PHOSPHOCITRATE THERAPY
metastatic signet ring cell bladder carcinoma. Urology, 15: 501 1980. '
J. D. Sallis, R. Thomson, B. Rees and R. Shankar Reply by Authors. We regret not having detected the case report on signet ring cell adenocarcinoma of the bladder by Sagalowsky and Donohue during our literature review. The case is fascinating and well documented, and it is appropriate to draw one's attention to it.
J. Urol., 140: 1063-1066, 1988 To the Editor. To my surprise, the authors of this article did not cite the original developers of this technique. 1 I was particularly sur135
AssoCIP.TION,
'/oL 143 JaLuary Printed in U.S.A. 1
INC.
Letters to the Editor RE: ADRENAL AUTOTRANSPLANTATION WITH ATTACHED BLOOD VESSELS FOR TREATMENT OF CUSHING'S DISEASE
Y.-M. Xu, Y. Qiao, P. Wu, Z.-D. Chen and N. T. Jin
J. Urol., 141: 6-8, 1989 To the Editor. I am disturbed by this article on adrenal autotransplantation. First, adrenal transplantation has been done for a long time. Brooks accomplished this procedure with a Millipore* filter and Hardy accomplished an almost identical procedure 25 years ago! The authors state that the procedure was successful and I would have some questions about this. In fact, they performed pituitary irradiation, which probably would have cured the patient of Cushing's disease irrespective of the adrenal operation. Also, they state that they simply transplanted too much of the adrenal. In fact, the patient still had the basic disease. Finally, and most importantly, in the current era of adequate replacement therapy there probably is no good rationale for this type of gymnastic procedure. Respectfully, James F. Glenn Department of Surgery (Urology) University of Kentucky Medical Center Lexington, Kentucky 40536 1. Hardy, J. D.: Autotransplantation of adrenal remnant to thigh in Cushing's disease. Preserving residual cortical activity while avoiding laparotomy. J.A.M.A., 185: 134, 1963. * Millipore Corp., Bedford, Massachusetts.
Reply by Authors. We reviewed the related literature and found that 25 years ago Hardy reported the treatment of Cushing's disease by bilateral total adrenalectomy. The left adrenal gland was transplanted to the right thigh with the central vein anastomosed to the distal end of the divided saphenous vein. Vascular anastomosis in his procedure was performed in a vein-to-vein manner. Therefore, the chance of thrombosis in the graft was greatly increased and the clinical result was not as satisfactory. However, in our procedure the anastomosis was made between the adrenal central vein and inferior epigastric artery, saphenous vein and adrenal middle artery, so that the graft not only increased the supply of arterial blood but it also facilitated venous drainage. Thus, the graft was more likely to survive and steroid replacement was not necessary. In this aspect our procedure was more or less different from that of Hardy. Since the result of pituitary irradiation was considered to be poor in the treatment of adult Cushing's disease, we treated our patient with a course of 5,000 rad pituitary irradiation after excision of part of the graft as a supplementary measure, which seemed to be reasonable. On April 28, 1988 we treated another case of Cushing's disease with the same procedure except that only a quarter of the adrenal tissue was transplanted. The patient did not receive pituitary irradiation postoperatively but she had no symptoms or sign of Cushing's disease, and levels of plasma cortisol, 24-hour urinary 17-hydroxycorticosteroids and 17-ketosteroids were within the normal range. Whether adequate replacement therapy could displace the role of this type of gymnastic adrenal operation in the treatment of Cushing's disease is a matter of further investigation. To our limited knowledge replacement therapy is not without shortcomings.
prised when they showed the weight of recovered bladder stones in figure 1 and the number of bladder stones recovered in figure 2, and then in the discussion stated that "PC is not an antibacterial agent but by discouraging daughter stone formation, it has the capacity to minimize any inherent potential for perpetuating recurrent infection through the entrapment of bacteria within crystalline structures.", when nowhere else is the term daughter stone stated. In the article by Vermeulen and associates figure 4 shows the explanation of daughter stones. 1 One wonders where the authors of the current article obtained the term. In addition, Vermeulen and Goetz showed the effect of infection,2 and Miller and associates showed the effect of antibiotics' on such foreign body stone growth, infected as opposed to noninfected, which the authors suggest is a new finding. It appears that nothing new is reported but one always hopes that there would be at least a passing mention of the previous research upon which modern research is based.
James A. Roberts Department of Urology Delta Regional Primate Research Center Three Rivers Road Covington, Louisiana 70433 1. Vermeulen, C. W., Grove, W. J., Goetz, R., Ragins, H. D. and Correll, N. 0.: Experimental urolithiasis. I. Development of calculi upon foreign bodies surgically introduced into bladders of rats. J. Urol., 64: 541, 1950. 2. Vermeulen, C. W. and Goetz, R.: Experimental urolithiasis IX: influence of infection on stone growth in rats. J. Urol., 72: 761, 1954. 3. Miller, G. H., Chapman, W. H., Seibutis, L. and Vermeulen, C. W.: Furadantin treatment of experimental urinary tract infection and its influence on stone growth. Experimental urolithiasis. XI. J. Urol., 76: 42, 1956.
RE: PRIMARY SIGNET RING CELL ADENOCARCINOMA OF THE BLADDER
M. L. Blute, D. E. Engen, W. D. Travis and L. K. Kvols J. Urol., 141: 17-21, 1989
To the Editor. I read this article on a patient with primary signet ring adenocarcinoma of the bladder with interest. This, indeed, is a rare lesion and I agree with the over-all discussion and review of the literature, and the generally poor prognosis that the authors cited. I write simply to correct a minor error. The authors stated the longest reported survival to be 45 months. In 1980 we reported on a patient with metastatic primary signet ring cell adenocarcinoma of the bladder who survived for 16 years. 1 The patient ultimately died of the metastatic disease when he presented 16 years postoperatively with bowel and urinary obstruction due to carcinomatosis from the original lesion. Respectfully, Arthur I. Sagalowsky Department of Urology University of Texas Southwestern Medical Center at Dallas 5323 Harry Hines Boulevard Dallas, Texas 75235-9031 1. Sagalowsky, A. and Donohue, J. P.: Sixteen-year survival with
RE: REDUCTION OF INFECTION STONES IN RATS BY COMBINED ANTIBIOTIC AND PHOSPHOCITRATE THERAPY
metastatic signet ring cell bladder carcinoma. Urology, 15: 501 1980. '
J. D. Sallis, R. Thomson, B. Rees and R. Shankar Reply by Authors. We regret not having detected the case report on signet ring cell adenocarcinoma of the bladder by Sagalowsky and Donohue during our literature review. The case is fascinating and well documented, and it is appropriate to draw one's attention to it.
J. Urol., 140: 1063-1066, 1988 To the Editor. To my surprise, the authors of this article did not cite the original developers of this technique. 1 I was particularly sur135