Abstract A case of neuroblastoma involving the ovaries bilaterally at diagnosis is reported. A review of previous cases of neuroblastoma at Johns Hopkins Hospital revealed no previous occurrence of ovarian metastatic disease at diagnosis, but involvement in about one‐third of cases at autopsy. This appears to be a more common site of metastatic disease than has been previously recognized. The significance of this site of metastases in neuroblastoma is unknown.
A total of 11 men (mean age 51.4 years, 1-year followup) with venous leakage impotence underwent surgical venous ligation. Of the men 8 had erections twice per week immediately after the procedure but at 3 months only 2 remained potent. Dynamic pharmacological cavernosography and cavernosometry were repeated 3 months postoperatively and 6 of the 11 men had venous leakage. These men with venous leakage underwent percutaneous embolization with platinum coils and 4 had successful results. Three additional men became potent after embolization. Of the 11 men 9 are documented to have normal dynamic cavernosography and cavernosometry findings after the combination of an operation and embolization, and 5 are potent. The postoperative and post-embolization dynamic cavernosometry data show that all 11 men have a marked decrease in the flow to maintain erection. Eight men have erections with papaverine or prostaglandin E1 intracorporeal injections. Postoperative dynamic cavernosography and cavernosometry can be diagnostic as well as therapeutic with embolization.
This atlas-formatted urologic surgical text emphasizes those surgical manoeuvres critical to the success of each procedure. Topics covered include patient positioning, the use and manipulation of surgical instruments, use of staples, sewing techniques and types of stitches, relevant anatomical information, illustrated step-by-step procedures, key points and potential problems. There are illustrations of three-dimensional anatomical models showing how to approach various areas.
Abstract Background: The prostate gland synthesizes a host of hormones, prostaglandins and growth factors. It is not clear if such biochemical factors modulate the hypothalamic/pituitary (H-P) gonadal axis.To determine the influence of the prostate gland on the hypothalamic-pituitary axis feedback system and changes in circulating hormone levels before and after cryoablation of the entire prostate.In 37 consecutive patients with localized prostate cancer who underwent total cryoablation we investigated the circulating levels of testosterone, estradiol, progesterone, sex hormone binding globulin (SHBG) luteinizing hormone (LH), follicle stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEAS), prolactin, insulin-like growth factor-1(IGF-1) and prostatic specific antigen (PSA) from 3 years prior to diagnosis to 3 years after initiating treatment.The levels of LH and FSH were significantly elevated in most patients up to 3 years after surgery. No significant changes were observed for the other hormones, with a decrease in PSA as expected.LH and FSH levels rise after ablation of the prostate gland and the levels remain high for up to 3 years after surgery, which suggests that the prostate gland may influence the H-P feedback axis.
We describe a modification of an existing technique for antirefluxing ureterocolonic anastomosis. This technique has been used in 6 patients (12 ureters) and has been uniformly successful in creating an antirefluxing anastomosis.
A shift from respiration to fermentation is a common metabolic hallmark of cancer cells. As a result, glucose and glutamine become the prime fuels for driving the dysregulated growth of tumors. The simultaneous occurrence of "Press-Pulse" disturbances was considered the mechanism responsible for reduction of organic populations during prior evolutionary epochs. Press disturbances produce chronic stress, while pulse disturbances produce acute stress on populations. It was only when both disturbances coincide that population reduction occurred. This general concept can be applied to the management of cancer by creating chronic metabolic stresses on tumor cell energy metabolism (press disturbance) that are coupled to a series of acute metabolic stressors that restrict glucose and glutamine availability while also stimulating cancer-specific oxidative stress (pulse disturbances). The elevation of non-fermentable ketone bodies protect normal cells from energy stress while further enhancing energy stress in tumor cells that lack the metabolic flexibility to use ketones as an efficient energy source. Mitochondrial abnormalities and genetic mutations make tumor cells vulnerable metabolic stress. The press-pulse therapeutic strategy for cancer management is illustrated with calorie restricted ketogenic diets (KD-R) used together with drugs and procedures that create both chronic and intermittent acute stress on tumor cell energy metabolism, while protecting and enhancing the energy metabolism of normal cells. Optimization of dosing, timing, and scheduling of the press-pulse therapeutic strategy will facilitate the eradication of tumor cells with minimal patient toxicity. This therapeutic strategy can be used as a framework for the design of clinical trials for the non-toxic management of most cancers.
