Retroperitoneal Metastatic Disease Research Articles

Duodenal Duplication Cyst Masquerading as Metastatic Nonseminomatous Germ Cell Tumor

Testicular cancer can result in retroperitoneal metastatic disease, requiring further intervention with chemotherapy and/or surgical resection. We present the case of a large retroperitoneal mass concerning for metastasis resulting in the identification of a duodenal duplication cyst rather than metastatic disease.

EUS-guided choledochoduodenostomy using a lumen-apposing metal stent in a patient with preexisting duodenal stent and ascites.

Video 1EUS-guided choledochoduodenostomy using a lumen-apposing metal stent in a patient with preexisting duodenal stent and ascites.

Role of primary retroperitoneal lymph node dissection in stage I and low-volume metastatic germ cell tumors.

Early-stage testicular cancers are highly curable. Following orchidectomy, management options for stage I disease include active surveillance, nerve-sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy as recommended by the current guidelines. Primary RPLND has for decades played an integral part of treatment in patients with early-stage testicular germ cell tumors (TGCT), particularly in nonseminomatous germ cell tumors (NSGCT) with focus on reducing the long-term morbidity. We review the role of RPLND in stage I NSCGT as well as stage II A/B NSGCT and as seminoma. Radiation therapy and systemic chemotherapy are established treatments for seminoma; however, long-term data has demonstrated the association of such therapies with late toxicity including secondary malignancies, hearing loss, cardiovascular disease as well as metabolic syndromes. Given the well established role of RPLND in NSGCTs, clinicians have developed an interest in utilization of surgery for low-volume retroperitoneal metastatic disease. Two prospective clinical trials (SEMS and PRIMETEST) are underway to determine the role of RPLND alone in low volume metastatic seminoma. RPLND is a highly effective treatment for early-stage germ cell tumors but represents overtreatment in low-volume stage I disease where active surveillance is recommended. RPLND has shown a promising role in low-volume stage II seminomas. Two phase II clinical trials are underway to further determine the curative potential of this approach.

A Case of Adrenal Metastasis in Seminoma

We report an uncommon case of testicular cancer with adrenal metastasis without retroperitoneal or distant metastatic disease. This situation is highly unusual. In fact, no similar case was reported in the literature. Our case is the first adrenalectomy that has been performed for secondary localization of testicular cancer. After eighteen-month followup, the patient was doing well, with no evidence of disease.

Predictors of Positive Retroperitoneal Lymph Nodes in Patients With High Risk Testicular Cancer

Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease. Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30% embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained. Of 353 patients 90 (25%) had greater than 30% embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50%) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46%) and 15 (60%) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95% CI 1.00-1.04) and lymphovascular invasion (OR 3.52, 95% CI 1.43-8.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100% embryonal carcinoma was 65.5%, although the negative predictive value for 30% embryonal carcinoma was 85.7%. Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options.

Gestational trophoblastic neoplasia with retroperitoneal metastases: A fatal complication

BackgroundGestational Trophoblastic Neoplasia (GTN) is a pathologic entity that can affect any pregnancy and develop long after the termination of the pregnancy. Its course can be complicated by metastases to distant sites such as the lung, brain, liver, kidney and vagina. The therapeutic approach of this condition includes both surgical intervention and chemotherapy. The prognosis depends on many prognostic factors that determine the stage of the disease.Case ReportWe present a woman with GTN and retroperitoneal metastatic disease who came to our department and was diagnosed as having high risk metastatic GTN. Accordingly she received chemotherapy as primary treatment but unfortunately developed massive bleeding after the first course of chemotherapy, was operated in an attempt to control bleeding but finally succumbed.ConclusionThis case demonstrates that GTN, while usually curable, can be a deadly disease requiring improved diagnostic, treatment modalities and chemotherapeutic agents. The gynaecologist should be aware of all possible metastatic sites of GTN and the patient immediately referred to a specialist center for further assessment and treatment.

Imaging-Guided Percutaneous Radiofrequency Ablation of Retroperitoneal Metastatic Disease in Patients With Gynecologic Malignancies: Clinical Experience With Eight Patients

The purpose of this study was to evaluate the efficacy of imaging-guided percutaneous radiofrequency ablation to treat metastatic retroperitoneal disease in patients with gynecologic malignancies. Patients with retroperitoneal metastatic disease due to gynecologic malignancies were evaluated for imaging-guided percutaneous radiofrequency ablation in this study. Efficacy of treatment was assessed by post-radiofrequency ablation activity on PET/CT scans. Eight patients were considered for imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease. Radiofrequency ablation was successfully completed in five patients with six metastatic tumors. All procedures were performed with the use of hydrodissection as an adjunct maneuver to displace adjacent structures. All patients showed absence of FDG activity on post-radiofrequency ablation PET/CT scans. Three (60%) of the five patients showed absence of FDG activity of the treated disease at 23.5 months after radiofrequency ablation. Imaging-guided percutaneous radiofrequency ablation may be considered as an alternative to currently available therapies to treat recurrent metastatic disease due to endometrial carcinoma.

Optimal Management of Retroperitoneal Metastatic Nonseminomatous Testicular Cancer: Toward a Better Selection Between Scalpel and Needle

During the past decades, both surgery and systemic chemotherapy have emerged as critically important modalities in the treatment of nonseminomatous germ cell cancer. Before the advent of cisplatin-based chemotherapy, retroperitoneal lymph node dissection (RPLND) had been established to be potentially definitive treatment in many cases of low volume (stage IIA, 2 cm; stage IIB, 5 cm) retroperitoneal metastatic disease. A full, bilateral, or modified template RPLND is a technically demanding procedure and requires a skillful and experienced surgeon. Nonetheless, if uneventful and definitive, a RPLND is devoid of late toxicity. After the recognition of the high curative potential of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, even in the setting of widespread metastatic disease, many investigators have adopted primary chemotherapy also in stage IIA and IIB disease, reserving RPLND mainly to resect postchemotherapy residuals. At first glance, this approach seems straightforward given the greater than 90% disease-free survival and 95% disease-specific survival in good prognosis (low volume) metastatic disease by chemotherapy. Following primary RPLND, chemotherapy was also increasingly being used adjuvantly if pathologic stage II was confirmed, or to treat systemic relapse after RPLND. Hence, chemotherapy has increasingly been given as primary therapy. The prospect of primary chemotherapy to eradicate virtually all lowor limited volume retroperitoneal metastatic disease, and sparing most patients double treatment in terms of an additional RPLND, however, has not come true. Several studies using primary chemotherapy have demonstrated that up to 50% of patients with stage IIA and IIB retroperitoneal metastatic disease obtain no radiologic complete remission and even the tiniest remnants ( 5 mm in previously involved sites) may harbor remaining viable cancer, or residual mature teratoma. In the greater majority of patients who undergo postchemotherapy RPLND for radiologic residual disease, the resected specimens contain mature teratoma as the dominant histology. Although mature teratoma is considered benign, there is a lifetime risk of growth and secondary transition into malignancy. Therefore, mature teratoma should be considered potentially malignant, requiring surgical resection whenever feasible. Two large European databases have allowed determination of the incidence and histology of residual masses in the retroperitoneal area following full induction chemotherapy. In a study of the Medical Research Council in 287 patients, 222 of whom had stage IIA/B nonseminoma, viable cancer was found in 18% and mature teratoma was present in 51% of patients who underwent surgery for postchemotherapy residuals. The frequency of surgery and histological findings is summarized in Table 1. A subset analysis is also available of the stage IIA/B patients treated in the study led by the European Organisation for Research and Treatment of Cancer of three versus four cycles of BEP in good prognosis testicular cancer. Of the total 812 patients entered onto the study, 300 patients had stage IIA or IIB nonseminoma. Radiologic residual disease ( 1 cm) was reported in 132 patients (44%) after the completion of chemotherapy. Of these, 73 underwent surgery and 71 patients had complete resection of residual disease; in one

Clinical response to imatinib mesylate in recurrent and metastatic gastrointestinal stromal tumors

20528 Background: We analyzed the efficacy and safety of imatinib mesylate in GIST (Gastrointestinal Stromal Tumors) in various anatomic sites. Methods: Out of 24 patients with recurrent or metastatic disease receiving treatment, clinical and tomographic evaluation was possible only in 21 pts. RECIST criteria were used to evaluate response and NCI guidelines were used for evaluation of toxicity. The treatment given between March 2003 and December 2006 was imatinib mesylate 200mg twice daily until disease progression or drug intolerance. All included patients had histopathologic confirmation and CD 117 positive inmunohistochemistry. Results: Patient characteristics were as follows: 19 females, 2 males, average age: 37.8 years (range: 36 - 80), Functional status according to ECOG: 0 in 19 pts, 1 in one patient and 3 in one patient. Anatomic sites were: 4 stomach, 7 small intestine, 3 rectum-sigmoid, 4 carcinomatosis from unknown primary, 2 peripancreatic and one esophageal. Nine patients had recurrent disease, 12 unresectable disease and 11 pts had liver metastases and 13 had retroperitoneal metastatic disease. Comorbidities: 3 pts with Type 2 Diabetes Mellitus one patient with Systemic Hypertension, and deep vein thrombosis each, two patients with a previous diagnosis of cancer: Thyroid and Lung Cancer respectively. Responses:2 (9.5%)CR, 6 (28.5%) PR, 12 (57.1%) stable disease, one (4.7%) pt. with progressive disease. Toxicity: one patient had rash, one patient presented bone pain, one patient with face discoloration, one with cephalea and nausea, and two patients with bipalpebral edema. Median duration for response was 5.7 months (range 2–30) at the moment. Conclusions: Efficacy of imatinib mesylate in recurrent and metastatic GIST's is high with overall response rates of 95% and adequate tolerance. Studies as adyuvant and second line therapy are needed in our population. No significant financial relationships to disclose.

LAPAROSCOPIC RADICAL NEPHROURETERECTOMY FOR UPPER TRACT TRANSITIONAL CELL CARCINOMA: THE CLEVELAND CLINIC EXPERIENCE

We report our single institutional experience with retroperitoneal laparoscopic radical nephroureterectomy in patients with upper tract transitional cell carcinoma and compare results to those achieved by the open technique. A total of 77 patients underwent radical nephroureterectomy for pathologically confirmed upper tract transitional cell carcinoma. Of these patients 42 underwent laparoscopic nephroureterectomy from September 1997 through January 2000 and 35 underwent open surgery. All specimens were extracted intact. Of the laparoscopic group the juxtavesical ureter and bladder cuff were excised by our novel transvesical needlescopic technique in 27 and radical nephrectomy was performed retroperitoneoscopically in all 42. Data were compared retrospectively with 35 patients undergoing open radical nephroureterectomy from February 1991 through December 1999. Laparoscopy was superior in regard to surgical time (3.7 versus 4.7 hours, p = 0.003), blood loss (242 versus 696 cc, p <0. 0001), specimen weight (559 versus 388 gm., p = 0.04), resumption of oral intake (1.6 versus 3.2 days, p = 0.0004), narcotic analgesia requirements (26 versus 228 mg., p <0.0001), hospital stay (2.3 versus 6.6 days, p <0.0001), normal activities (4.7 versus 8.2 weeks, p = 0.002) and convalescence (8 versus 14.1 weeks, p = 0.007). Complications occurred in 5 patients (12%) in the laparoscopic group, including open conversions in 2, and in 10 (29%) in the open group (p = 0.07). Followup was shorter in the laparoscopic group (11.1 versus 34.4 months, p <0.0001). The 2 groups were similar in regard to bladder recurrence (23% versus 37%, p = 0.42), local retroperitoneal or port site recurrence (0% versus 0%) and metastatic disease (8.6% versus 13%, p = 1.00). Mortality occurred in 2 patients (6%) in the laparoscopic group and 9 (30%) in the open group. Cancer specific survival (97% versus 87%) and crude survival (97% versus 94%) were similar between both groups (p = 0.59). In patients with upper tract transitional cell carcinoma who are candidates for radical nephroureterectomy the retroperitoneal laparoscopic approach satisfactorily duplicates established technical principles of traditional open oncological surgery, while significantly decreasing morbidity from this major procedure. Short-term oncological and survival data of the laparoscopic technique are comparable to open surgery. Although long-term followup data are not yet available, it appears that laparoscopic radical nephroureterectomy may supplant open surgery as the standard of care in patients with muscle invasive or high grade upper tract transitional cell carcinoma.

Subcutaneous Ureteral Replacement: A Canine Model

There are several clinical situations in which extrinsic or intrinsic ureteral diseases necessitate extensive reconstructive surgery. Unfortunately, not all patients are candidates for such surgery (e.g., those with retroperitoneal metastatic disease). Ureteral replacement is indicated in this selected group of patients. A viable option is to establish a ureteral replacement using subcutaneous tubes. Among the problems associated with this method of urine diversion are selecting the proper material for the tubes, the timing of tube replacement, encrustation and occlusion, urine reflux, and renal function. There is an obvious need for an animal model to address these issues. The aim of this study was to establish a reproducible canine model for subcutaneous ureteral replacement, by using a combination of nephrostomy and cystostomy tubes joined together under the skin. The animal study was conducted in 6 dogs. A pigtail nephrostomy and a cystostomy were inserted through a midline abdominal incision and stab wounds in the abdominal wall. A subcutaneous tract was bluntly made toward the nephrostomy incision starting from the cystostomy incision. The nephrostomy was grasped with the clamp and brought through the subcutaneous tunnel to the cystostomy incision. Upon emerging through the cystostomy incision, the tubes were joined and buried under the skin. Intravenous urography at 4-6 weeks postoperatively in 4 dogs showed no deterioration of renal function, but some hydronephrosis was present. Using the technique described in this paper, it is possible to establish a subcutaneous ureteral replacement using nephrostomy and cystostomy tubes in dogs. This model may serve for further research of the various questions associated with subcutaneous ureteral replacement in humans.

Treatment of clinical stage I testicular cancer and a possible role for new biological prognostic parameters.

Three different treatment strategies for patients with stage I non-seminomatous testicular cancer are available that will all result in long-term survival in more than 98% of the patients: a "wait and see" strategy with follow-up and chemotherapy in cases of tumour progression, retroperitoneal lymphadenectomy, with or without application of systemic chemotherapy, in cases of retroperitoneal metastases (pathological stage II disease) or primary adjuvant chemotherapy following inguinal orchiectomy. Each treatment strategy is associated with specific side-effects. In several studies histological characteristics of the primary tumour, particularly the presence of vascular invasion and of embryonal carcinoma cells, have been demonstrated to be significant prognostic factors for the risk of occult retroperitoneal metastases in patients with stage I disease. In addition, new biological prognostic factors determined by flow cytometry, cytogenetic analysis or molecular-biological DNA or RNA analysis have been investigated, among which alterations of the p53 tumour-suppressor gene may represent a promising new prognostic factor. Although alterations of p53 gene expression seem to be associated with advanced tumour stage and may predict retroperitoneal metastatic disease, the independent role of these molecular genetic alterations needs to be prospectively studied. Currently a risk-adapted treatment strategy based on the histological criteria of vascular invasion and the presence of embryonal carcinoma can be used to stratify patients into a "high-" and "low-risk" group with respect to tumour progression. While primary-nerve-sparing retroperitoneal lymphadenectomy or adjuvant chemotherapy with two cycles of platinum, etoposide and bleomycin may be appropriate for patients with a high risk (above 40%) for tumour progression, a "wait-and-see" strategy can be used for "low-risk" (less than 15% risk of progression) patients. Molecular investigations of prognostic factors may be able to improve further the stratification of patients into these different risk categories.

Discordance Between Site of Primary Nonseminomatous Germ Cell Tumor of the Testis and Retroperitoneal Metastatic Disease Secondary to Anomalous Venous Drainage of the Testis

Discordance Between Site of Primary Nonseminomatous Germ Cell Tumor of the Testis and Retroperitoneal Metastatic Disease Secondary to Anomalous Venous Drainage of the Testis

Discordance Between Site of Primary Nonseminomatous Germ Cell Tumor of the Testis and Retroperitoneal Metastatic Disease Secondary to Anomalous Venous Drainage of the Testis

Discordance Between Site of Primary Nonseminomatous Germ Cell Tumor of the Testis and Retroperitoneal Metastatic Disease Secondary to Anomalous Venous Drainage of the Testis

Successful treatment of metastatic choriocarcinoma after DMP 840

A 17-year-old male with retroperitoneal choriocarcinoma metastatic disease in the lungs has had shrinking of pulmonary metastases and primary tumor with four treatment courses of DMP 840. β-HCG appeared normal prior to resection of the necrotic primary tumor and a single remaining pulmonary metastasis, which was also necrotic. The patient remains free of tumor recurrence of 8 months following surgery. Further evaluation of DMP 840 in patients with germ cell tumors is indicated.

Advances in the management of non-seminomatous germinal tumours of the testis.

Experience in the management of 146 consecutive patients with non-seminomatous tumours of the testis has led to a plan of management based on retroperitoneal lymph node dissection as the primary treatment modality, with use of adjuvant therapy dependent on pathological findings. Chemotherapy has proved to be the most important adjuvant with postoperative radiation therapy reserved only for patients with extensive retroperitoneal metastatic disease. 3-year crude survival for patients with all stages of disease was 78% and in those in whom the disease was confined to below the diaphragm the survival rate was 85%.

Surgical treatment of non-seminomatous germinal testes tumors.

Surgical management of germinal testis tumors other than seminoma is presented. Phase I consists of removal of the primary tumor; phase II, the surgical removal of retroperitoneal metastatic disease, and phase III, surgical management of chest metastasis. Seventy-two patients were explored with the intent of performing a simultaneous bilateral retroperitoneal lymphadenectomy. Each had a radical orchiectomy prior to exploration. Seven patients were found unresectable because of extensive disease above the renal pedicle and lymphadenectomy was not performed. The remaining 65 were found resectable and a transabdominal bilateral retroperitoneal lymphadenectomy was done. Of this number, 20, or 30%, had metastatic nodes. No other treatment was used. All had a 3-year follow-up and 53 were followed for 5 years or more. The 3-year survivals for stage I is 93%, and for stage II, 75%. Survivals of 5 or more years in stage I are 86% and in stage II, 70%. Thus, this experience with pathologic stage II cases clearly demonstrates the capability of surgery as a primary treatment to control 70% of patients with retroperitoneal lymph node metastases. This surgical technique is therfore recommended as primary therapy in stage I and II non-seminomatous geminal testis tumors.

Immune evaluation with skin testing. A study of testicular, prostatic, and bladder neoplasms.

Fifty patients with testicular carcinoma, 45 with prostatic neoplasm, 84 with bladder carcinoma, and 13 with benign bladder papilloma were evaluated for skin reactivity to DNCB and other intradermal antigens. Correlation between pathologic staging and skin-test reactivity was sought. Reaction to DNCB among patients with testis tumors was more significantly depressed by chemotherapy than by the extent of retroperitoneal or distant metastatic disease indicating that skin testing as a means of following the course of disease or of predicting survival may be limited by alterations caused by chemotherapy. DNCB reactivity did not correlate with the prognosis for the different stages of disease, but follow-up studies of individual patient survival are needed for substantiation. Depression of DNCB reactivity exists among patients with prostatic carcinoma whether the disease is localized or widely metastatic. Only lengthy follow-up will determine if there is any correlation of reactivity with survival in individual patients. DNCB reactivity among patients with bladder tumors shows progressive reduction with increasing stage disease and lends support to the evidence suggesting immune deficiency in patients with bladder neoplasm.

Roentgenographic Visualization of Human Testicular Lymphatics: A Preliminary Report

No AccessJournal of Urology1 Jan 1963Roentgenographic Visualization of Human Testicular Lymphatics: A Preliminary Report Frederick M. Busch, and Emile S. Sayegh Frederick M. BuschFrederick M. Busch More articles by this author , and Emile S. SayeghEmile S. Sayegh Present address: U. S. Naval Hospital, Portsmouth, Va. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)64508-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1963 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByBarroso U, Andrade D, Novaes H, Netto J and Andrade J (2018) Surgical Treatment of Varicocele in Children With Open and Laparoscopic Palomo Technique: A Systematic Review of the LiteratureJournal of Urology, VOL. 181, NO. 6, (2724-2728), Online publication date: 1-Jun-2009.KOČVARA R, DVOŘÁČEK J, SEDLÁČEK J, DÍT˘E Z and NOVÁK K (2018) LYMPHATIC SPARING LAPAROSCOPIC VARICOCELECTOMY: A MICROSURGICAL REPAIRJournal of Urology, VOL. 173, NO. 5, (1751-1754), Online publication date: 1-May-2005.Ohyama C, Chiba Y, Yamazaki T, Endoh M, Hoshi S and Arai Y (2018) Lymphatic Mapping and Gamma Probe Guided Laparoscopic Biopsy of Sentinel Lymph Node in Patients With Clinical Stage I Testicular TumorJournal of Urology, VOL. 168, NO. 4 Part 1, (1390-1395), Online publication date: 1-Oct-2002.Nash P and Donohue J (2018) Discordance Between Site of Primary Nonseminomatous Germ Cell Tumor of the Testis and Retroperitoneal Metastatic Disease Secondary to Anomalous Venous Drainage of the TestisJournal of Urology, VOL. 155, NO. 4, (1393-1394), Online publication date: 1-Apr-1996.Donohue J, Thornhill J, Foster R, Rowland R and Bihrle R (2018) Retroperitoneal Lymphadenectomy for Clinical Stage a Testis Cancer (1965 to 1989): Modifications of Technique and Impact on EjaculationJournal of Urology, VOL. 149, NO. 2, (237-243), Online publication date: 1-Feb-1993.Szabo R and Kessler R (2018) Hydrocele Following Internal Spermatic Vein Ligation: A Retrospective Study and Review of the LiteratureJournal of Urology, VOL. 132, NO. 5, (924-925), Online publication date: 1-Nov-1984.Klein F, Whitmore W, Sogani P, Batata M, Fisher H and Herr H (2018) Inguinal Lymph Node Metastases from Germ Cell Testicular TumorsJournal of Urology, VOL. 131, NO. 3, (497-500), Online publication date: 1-Mar-1984.Donohue J, Zachary J and Maynard B (2018) Distribution of Nodal Metastases in Nonseminomatous Testis CancerJournal of Urology, VOL. 128, NO. 2, (315-320), Online publication date: 1-Aug-1982.Lanteri V, Choudhury M, Pontes J, Wajsman Z, Beckley S and Murphy G (2018) Treatment of Testicular Tumors Arising in Patients with Previous Inguinal and/or Scrotal SurgeryJournal of Urology, VOL. 127, NO. 1, (58-59), Online publication date: 1-Jan-1982.Raghavaiah N (2018) ProstatographyJournal of Urology, VOL. 121, NO. 2, (174-177), Online publication date: 1-Feb-1979.Herr H, Silber I and Martin D (2018) Management of Inguinal Lymph Nodes in Patients with Testicular Tumors following Orchiopexy, Inguinal or Scrotal OperationsJournal of Urology, VOL. 110, NO. 2, (223-224), Online publication date: 1-Aug-1973.Sayegh E, Brooks T, Sacher E and Busch F (2018) Lymphangiography of the Retroperitoneal Lymph Nodes through the Inguinal RouteJournal of Urology, VOL. 95, NO. 1, (102-107), Online publication date: 1-Jan-1966.Fraley E, Clouse M and Litwin S (2018) The Uses of Lymphography, Lymphadenographyand Color Lymphadenography in UrologyJournal of Urology, VOL. 93, NO. 2, (319-325), Online publication date: 1-Feb-1965.Busch F, Sayegh E and Chenault O (2018) Some Uses of Lymphangiography in the Management of Testicular TumorsJournal of Urology, VOL. 93, NO. 4, (490-495), Online publication date: 1-Apr-1965.Pomerantz M and Kiser W (2018) Lymphangiography: Its Use in the Diagnosis and Treatment of Urologic DisordersJournal of Urology, VOL. 91, NO. 2, (190-194), Online publication date: 1-Feb-1964.Whitesel J (2018) Lymphography: Its Place in UrologyJournal of Urology, VOL. 91, NO. 5, (613-618), Online publication date: 1-May-1964. Volume 89Issue 1January 1963Page: 106-110 Advertisement Copyright & Permissions© 1963 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Frederick M. Busch More articles by this author Emile S. Sayegh Present address: U. S. Naval Hospital, Portsmouth, Va. More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Effect of Large Dosages of Irradiation on Gastric Acidity

IN PREVIOUS articles cases of gastric ulceration and the complications of hemorrhage and perforation incident to abdominal irradiation have been reported.1 2 In 6 cases, 4 of which are illustrated in Table 1, it was necessary to perform gastric resection. In these cases, as well as in many others of a similar type, treatment was given at the Radiation Therapy Section, Walter Reed General Hospital, for retroperitoneal metastatic disease or as a prophylaxis Therefore in cases of testicular tumor. A 1,000,000-volt machine was used, and with the technics devised by Lieutenant Colonel Milton Friedman the dosage delivered to the stomach could be . . .