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C B Brendler

Publications and source records attributed to C B Brendler.

83 records · Page 5Linked to original sources
PubMed1984

Penile gangrene: a complication of secondary hyperparathyroidism from chronic renal failure.

We present the third case and first reported survivor of penile gangrene due to secondary hyperparathyroidism from chronic renal failure. The patient was treated with distal penectomy and subtotal parathyroidectomy. This case stimulated us to review the metabolic and vascular changes associated with secondary hyperparathyroidism in chronic renal failure. Secondary hyperparathyroidism may cause diffuse vasculitis and vascular calcification, which can lead to widespread ischemic necrosis and gangrene. Early medical therapy, including oral phosphate binders, is crucial to maintain the serum calcium-phosphate product below precipitation level. Subtotal parathyroidectomy is indicated for patients in whom progressive arterial and soft tissue calcification develops despite medical therapy.

Gangrene↗
PubMed1984

The use of multiple variables to predict response to endocrine therapy in carcinoma of the prostate: a preliminary report.

We are attempting to develop a method to predict hormonal response in patients with carcinoma of the prostate. We have measured multiple biochemical variables and determined Gleason grade in prostatic needle biopsies obtained from 16 patients immediately before castration or initiation of estrogen therapy. Biochemical variables included 6 enzymes (3 enzymes involved in androgen metabolism and 3 hydrolytic enzymes), androgen receptor content, and tissue testosterone and dihydrotestosterone content. The 16 patients were followed prospectively and the response of each patient to hormonal therapy was assessed clinically. Two groups of patients were identified: 1 group of 7 patients in which the mean duration of response was 7.7 plus or minus 1.5 months (plus or minus standard error) and in which all patients have relapsed and died of their disease, and a second group of 9 patients in which the mean duration of response was 18.6 plus or minus 1.6 months (plus or minus standard error) and in which 7 of the 9 patients (78 per cent) are still responding. The 2 groups were statistically different (p less than 0.001) in terms of duration of response. The 2 groups could not be distinguished by Gleason grade, single enzymatic activities or tissue androgen content. The mean value of nuclear salt extractable androgen receptor was statistically different between the 2 groups (p less than 0.05) but with considerable overlap of individual patients between the 2 groups. An index was developed based on multiple enzymatic activities, which separated the 2 response groups better than any single variable alone (p less than 0.02). When salt extractable nuclear androgen receptor was included in the numerator of this index the 2 groups were separated almost completely. This preliminary study suggests that the measurement of multiple biochemical variables may be useful in predicting hormonal response.

Aged↗
PubMed1983

Spontaneous benign prostatic hyperplasia in the beagle. Age-associated changes in serum hormone levels, and the morphology and secretory function of the canine prostate.

This paper is a cross-sectional study of spontaneous benign prostatic hyperplasia (BPH) in a single canine species. The effects of aging and hormonal changes on the growth, histology, and glandular secretory function of the canine prostate were studied in 42 male beagles ranging in age from 8 mo to 9 yr. The beagle prostate enlarges for at least 6 yr, whether normal or hyperplastic. In contrast, prostatic secretory function, determined by ejaculate volume and total ejaculate protein, declines markedly after 4 yr of age. These reciprocal growth and functional changes in the prostate are closely associated with a progressive increase in the incidence of BPH, which is already apparent in some dogs by age two. With age there is a modest decrease in serum androgen levels with no apparent change in serum 17 beta-estradiol levels. This suggests that the growth and functional changes that are associated with the development of BPH and are initiated very early in life reflect an altered sensitivity of the prostate to serum androgens or a response to the relative decrease in the serum androgen to estrogen ratio.

Aging↗
PubMed1983

Changes in the metabolism of dihydrotestosterone in the hyperplastic human prostate.

It has been well established that hyperplastic human prostatic tissue is characterized by a 3- to 4-fold elevation in the content of dihydrotestosterone (DHT) compared to that in normal prostatic tissue. However, the exact mechanism responsible for DHT accumulation has not been established. One hypothesis for the abnormal elevation of DHT content in hyperplastic prostatic tissue is that changes occur in the tissue itself which shift the overall balance of androgen metabolism favoring the increased accumulation of DHT. To test this hypothesis, the metabolic activities that produce and remove DHT were determined in a series of normal as well hyperplastic human prostates. The results of these studies demonstrated that in each of the eight separate hyperplastic prostatic tissues assayed, there was a significant increase in 5 alpha-reductase activity producing DHT concomitant with significant decreases in the 3 alpha- and 3 beta-hydroxysteroid oxidoreductase reductase and 17 beta-hydroxysteroid oxidoreductase oxidase activities removing DHT. These specific alterations result in a major shift in the overall balance of androgen metabolism which favors an increase in the net formation of DHT in hyperplastic prostatic tissue. Such a shift in androgen metabolism is, therefore, at least one mechanism for the well documented increase in DHT content found in hyperplastic human prostatic tissue.

17-Hydroxysteroid Dehydrogenases↗
PubMed1980

Experience with Gleason's histopathologic grading in prostatic cancer.

The inaccuracy of clinical staging as a predictor of the biologic potential of prostatic cancer has prompted evaluation of additional methods of assessment. We reviewed 228 patients with prostatic adenocarcinoma who presented during a 4-year period. Of the 228 patients 144 with no detectable bony disease underwent staging pelvic lymphadenectomy with or without preliminary bilateral pedal lymphangiography. Histopathologic specimens of the primary diagnostic prostatic biopsy were classified with Gleason's grading system of tumor differentiation. Of the patients with Gleason's sum of 8, 9 or 10, 93 per cent had regional nodal metastases, regardless of preliminary clinical stage. Furthermore, no patient with Gleason's sum of 2, 3 or 4 had nodal metastatic disease. The incidences of falsely positive and falsely negative lymphangiograms were 29 and 35 per cent, respectively, reflecting the unreliability of pedal lymphangiography to predict nodal involvement accurately in patients with prostatic cancer. The Gleason system of histopathologic grading was reliable and reproducible, and afforded an accurate prediction of the surgical stage of disease.

Adenocarcinoma↗
PubMed1980

Staging pelvic lymphadenectomy for carcinoma of the prostate risk versus benefit.

A total of 125 patients underwent limited staging lymphadenectomy for adenocarcinoma of the prostate. Of these patients 19 per cent with clinical stage B1 disease, 52 per cent with clinical stage B2 disease and 59 per cent with clinical stages C disease had positive nodes. There was 1 death secondary to myocardial infarction and postoperative complications occurred in 7.2 per cent of the 125 patients. Limited staging pelvic node dissection provides information regarding nodal dissection similar to that identified after more extensive dissection and it can be accomplished with little morbidity.

Adenocarcinoma↗
PubMedDate not supplied

The role of radical prostatectomy in the treatment of prostate cancer.

Recent advances in our understanding of the surgical anatomy of the prostate have led to an improved operative technique for radical prostatectomy. This technique achieves excellent results in terms of urinary continence and preservation of sexual function without compromising cancer control. It is therefore reasonable to offer radical prostatectomy for the cure of localized prostate cancer to patients who are otherwise well and have a life expectancy of more than 10 years.

Adult↗