Biomedical subjects
Publications and source records attributed to A Steg.
Twenty one patients suffering from carcinoma of the prostate, confirmed histologically and previously untreated, received treatment in the form of 17 beta-estradiol administered percutaneously. At a dose of 6 mg of estradiol per day, testosterone levels fell to a mean of 1 ng/ml. No change in lipids, lipoproteins nor cholinesterase were detected.
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It has now been clearly demonstrated that cryptorchidism is accompanied by a very marked increase in malignancy of the ectopic testis as well as in that in place. Amongst 80 patients undergoing surgery for carcinoma of the testis 14 (17.5%) had a past history of unilateral undescended. The risk of malignancy developing in an ectopic testis is 12 to 48 times greater than that of a testis which has descended normally. It would appear that the higher the position of the testis, the greater is the risk. Orchidopexy may decreased the risk if performed before the age of 11. When the tumour is situated in an ectopic testis, the clinical picture is often misleading. When the ectopic testis has been brought down the special feature of these tumours is the frequency of spread to inguinal lymph nodes. In terms of its basic principles the treatment of these tumours does not differ from that of those affecting normal testis. The aetiology of these tumours remains uncertain. There would seem to be a consensus in favour of a disgenetic origin, possible secondary to hormonal deficiency.
Two cases of epididymotesticular metastases are reported: one epididymal from a carcinoma of the kidney by retrograde venous spread and the other testicular secondary to a carcinoma of the prostate and apparently by arterial spread. Epididymotesticular metastases of carcinomas are rare. When the initial carcinoma is known, or even treated, the development of a large testis should lead to consideration of the possibility. Treatment should consist of inguinal orchidectomy with ligation of the spermatic cord as high as possible.
Combined abdominoperineal prostatocystectomy was described eighty years ago but has fallen into disuse. The authors performed this operation, two surgeons working simultaneously, in 14 patients with deeply infiltrating bladder carcinoma. Although 1 patient died postoperatively, morbidity has been minimal. The combined approach makes the cystectomy easier and allows excellent drainage through the perineum.
A natural estrogen, 17 beta-estradiol, was given percutaneously to 21 patients with untreated cancer of the prostate. The follow-up lasted three to six months, and the results of the survey were encouraging. The hormonal controls showed good plasma diffusion of estrogen, a significant drop in plasma testosterone, and decreased hypophyseal secretion as shown by lower follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Triglycerides and very low density lipoproteins (VLDL) which are considered to be good indicators of cardiovascular risk were unchanged.
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The authors report a series of 194 operations for urethral stenosis, carried out in 162 patients between 1971 and 1977, and give the indications for various operative procedures. In the absence of chronic prostatitis and changes in the corpora spongiosa, limited stenosis should now be treated by endoscopic urethrotomy. Extensive stenosis or penoscrotal stenosis should be treated by vaginal urethroplasty, the other cases by urethroplasty in two stages. The quality of the results which may and ought to be satisfactory in 8 cases out of 10 depends on the judicious choice of the operative procedure, care in execution and the quality of the postoperative supervision.
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A case of obstruction on a localized kidney zone is reported. Obstruction was considered a precipitating factor in the morphogenesis of diverticula on the distal tubules and the simple cyst, found exclusively in the adjacent renal parenchyma to the obstruction.
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The simple cyst in the adult seems to be mainly an acquired disorder. Microdissection of the nephron in the adult kidney points to the presence of diverticula on the distal tubule as the starting point of the affection. A degree of obstruction in the urinary tract together with normal involutional phenomena of the basal membrane, both typical of the aging process, are believed to be precipitating factors.
Whereas the outlines of nephrons and collecting ducts in kidneys from subjects less than 20 years old age regular, the number of diverticula on the distal tubule in kidneys from adults increase with age. An embryogenic progression from diverticula to microscopic and macroscopic cysts to radiologically detectable cysts can be established from morphological anomalies found in kidneys from adults. Therefore, a diverticulum on distal and collecting tubules and collecting tubules is postulated as the precursor of a simple cyst.
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