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OBJECTIVES: To evaluate the justification of routine removal of ipsilateral adrenal gland as part of radical nephrectomy for renal cell carcinoma (RCC). METHODS: The medical records, pathologic specimens, and computed tomographic (CT) scans of 77 patients who underwent radical nephrectomy and ipsilateral adrenalectomy for RCC were reviewed. Comparison was made between radiologic analysis and pathologic findings regarding involvement of the adrenal gland. RESULTS: The size of the renal tumor varied between 3.5 and 19 cm (mean 8.5). The upper pole was involved in 45%, the lower pole in 28%, and the midpole in 18% of the patients, and in 9% the whole kidney was involved by the tumor. Histologic findings showed that 72 (94%) of the 77 adrenal glands were normal and 70 of these were normal on CT as well. Two adrenal glands involved by metastases showed heterogeneous contrast entrancement on CT. The benign lesions of three adrenal glands were also picked up as abnormal on CT. In 2 patients adrenal glands could not be visualized on CT because of a paucity of retroperitoneal fat. CONCLUSIONS: Adrenalectomy with nephrectomy may not be performed in patients with RCC in whom CT demonstrates normal adrenal glands. In patients with adrenal abnormality on CT, magnetic resonance imaging can separate metastases from incidental benign adrenal adenoma, further reducing the number of patients requiring removal of the adrenal gland.

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A case of superficial gangrene of penis after insertion of a malleable penile prosthesis is presented. In all 4 cases previously reported in the literature, the penile prosthesis had to be removed. We managed this patient conservatively without removing the prosthesis. We suggest that in cases of superficial gangrene of penis without infection the prosthesis may not have to be removed.

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Rectal administration of 100 mg indomethacin in solution had as good, and almost as rapid, an effect on renal colic as 50 mg given intravenously. Side effects were significantly fewer with the rectal than with the intravenous route.

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To obtain more information about the natural history of compensatory renal hypertrophy beginning in childhood we traced those who were nephrectomized in childhood for Wilm's tumor (W) and hydronephrosis (Hn) between 1950 and 1978 at one department of surgery in Stockholm. All W patients had received treatment that suppresses cellular division. None of the patients were in renal failure or treated with antihypertensive drugs. All the patients in the follow-up study (22 W, 15 Hn) had a normal contralateral kidney at nephrectomy. Five healthy adults served as controls. The kidney was enlarged in both Hn (142%) and W (125%), but significantly larger in Hn than in W. Renal compensatory growth in W was retarded during the first two years after nephrectomy. The glomerular filtration rate (GFR) was 92% of control in Hn and 82% of control in W. The GFR did not seem to decline with a longer follow-up time in any of the groups. PAH clearance was the same in Hn and W. Albumin excretion was significantly higher in Hn than in W, but not significantly higher in W than in controls. The highest albumin excretion rates were found among the Hn patients with long follow-up time. The results suggest that the large increases in size and function that follow childhood nephrectomy can be blunted by antimitotic agents.

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A partial ureteral obstruction (PUO) was created in 5-day-old rats by implanting the left ureter in the psoas muscle. The surgical technique was modified to produce mild or severe hydronephrosis [Hn (m) and Hn (s)]. The rats were studied at ages between 45 and 65 days with regard to kidney weight, number of functioning glomeruli, mean arterial blood pressure (MAP), total glomerular filtration rate (GFR), nephron filtration rate (SNGFR), tubular free-flow pressure (PT, and stop-flow pressure (SFP). Total GFR was determined after the release of obstruction. The other studies were performed in the obstructed state. Reference values were obtained from sham-operated and untouched control rats. The number of functioning nephrons was depressed 38% in Hn (m) and 73% in Hn (s). Total GFR was preserved in Hn (m) and depressed 54% in Hn (s). SNGFR in the remaining nephrons was significantly elevated in Hn (m) and normal in Hn (s). SFP was significantly elevated in Hn (s). The Hn (s) rats were hypertensive. The glomerular density was lower in the hydronephrotic than in the contralateral kidneys. This suggests a compensatory growth of the remaining nephrons in the Hn kidneys. We conclude that PUO present since infancy will either destroy the nephrons or elicit an adaptive response that will tend to preserve GFR.

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A retrospective analysis of the natural history of 63 consecutive patients with gallbladder cancer during 30 years at a county hospital in Sweden is presented. Dominating symptoms were pain, jaundice, weight loss, and a palpable mass. Fifty patients were subjected to surgery. Forty-one patients had an extensive tumor spread in the abdominal cavity. Twenty-six patients were cholecystectomized and in 24 patients biopsy from the tumor was the only measure taken. The gallbladder cancer was occult in four patients. The median survival time was 1 month in patients who underwent autopsy, 2 months in patients who were biopsied and 4 months in patients who were cholecystectomized. The overall 6-month and 1-year crude survival rates were 16% and 8%, respectively. Comparison with previous reports regardless of treatment reveals that the prognosis of gallbladder cancer is still dismal and unchanged.

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