The incidence, presentation and management of prostatic cancer - abstract

Twenty-nine patients were seen for the first time with prostatic cancer over a 12-month period in the Urological Unit, Georgetown Hospital, Guyana. Twenty-five were Afro- or mainly Afro-Guyanese and four were Indo-Guyanese. The ages ranged from 54 to 88 years. The 70 to 80-year-old group was most commonly affected. Patients presented with painful dysuria, acure retention of urine, haematuria, back pain or a combination of these features. Rectal examination confirmed the diagnosis in all but one case. The prostate felt hard and fixed with evidence of infiltration. Haemoglobin levels tended to be low. Serum acid phosphatase levels were not always increased. The plain X-Ray film supplied useful confirmatory evidence in the presence of osteoblastic/osteolytic metastases in the absence of prostatic calculi in the palpably "hard" prostate. Bougienage for purposes of catheter introduction in the acutely distended bladder is of great diagnostic value if the prostate is grotty to the feel. Most patients were managed with low-dosage oestrogens. Some required Per Urethro-electro-resection (PUER) of the prostate in addition to stilboestrol therapy (AU)

Defective luteal phase - Measurement and evaluation of the ovarian hormone before and during cyclofenil (bis-p-acetoxyphenyl) cyclo-hexylidenemethane (compound 6066) treatment

Total urinary oestrogens and plasma progesterone were measured in 50 infertile patients with the diagnosis of defective Luteal Phase (D.L.P.). Before treatment with Cyclofenil commenced, these patients showed wide variations in their urinary oestrogen pattern; but the plasma progesterone was uniformly low. The result of treatment achieved was dependent on the dose of Cyclofenil and on the baseline oestrogen configuration of the patient. The author believes that the follicular dysmaturity precedes luteal insufficiency in the majority of cases. Treatment, therefore, should be aimed at correcting the hormonal imbalance both at hypothalamico pituitary axis level and at the ovarian level rather than simple substitution therapy. Cyclofenil possesses both of these qualities. The pregnancy rate was 28 per cent (AU)

Clinical aspects of defective luteal phase and its treatment with cyclofenil. Syn: bis-(p-acetoxyphenyl) cyclohexylidenemethane (compound F 6066)

Fifty patients with variable duration of infertility due to defective luteal phase have been studied during a total of 446 menstrual cycles. Variables of atypical basal body temperature in such patients have been analysed, and correlated between various abnormal temperature pattern in defective luteal phase on the one hand, and hormonal and endometrial histology on the other have been defined. While it is stressed that atypical basal body temperature is only a gross indicator of the abnormal corpus luteal function, the various abnormal basal body temperature can provide useful information of defective follicular maturation and functions. Cyclofenil, a Cycloalkylidine derivative, has been found to be a relatively effective drug in correcting the complex hormonal behaviour in these patients leading to successful pregnancy outcome. The success of such an encouraging result depended on the strength of the drug used, and also on the gonadotrophin make-up of individual patients, viz., endogenous oestrogen level, signifying an intact and inter-dependent hypothalmico pituitary axis on the one hand and gonad capable enough to respond to stimulation from the pituitary control on the other. The endometrial sensitivity and its maturation is the ultimate result depending largely for its response on such a plan (AU)

Alterations in secretion and fine structure of histamine stimulated stomach mucosa following administration of oestrogens

The observation that benign peptic ulceration is less common in females during the reproductive period and the suggestion that oestrogens have an inhibiting effect upon the activity of carbonic anhydrase led us to investigate volumetric and ionic (H+, K+, NA+, C1-.) changes in gastric secretion and also the fine structural changes in gastric oxyntic cells following administration of oestrogens. Fifteen male dogs after 24 hour fasting were anaesthetised with ketalamine hydrochloride and then subjected to a constant i.v. infusion of histamine phosphate, (approx. 14ug/Kg/hour). Twelve dogs underwent truncal vagotomy and ligation at the distal oesophagus. Gastric secretions were collected at 20 minute intervals via a tube introduced into the most dependant part of the stomach through a duodenotomy. The pylorus was ligated around the tube. Approximately 3 hours later, when three consecutive specimens were similar in volume, 4mgm/Kg Premarin (Eguine conjugated oestrogens) was injected i.v. into ten dogs. Further specimens were collected for three hours. Gastric mucosal biopsies were taken from three histamine stimulated dogs before and after injection of Premarin 4mgm/Kg. and were prepared for electron microscopy. The mean hourly volumes of secretion diminished at one, two and three hours after Premarin (ANOVA F 4.5; d.f. 3:33; p< 0.05) with an inhibition of 65.3 percent of the mean pre-Premarin value observed at the third hour. There was a significant rise in the mean pH one hour after Premarin in P<0.05, however, after this there was no significant variation. There was an apparent rise in the mean sodium concentration in the first two hours with a statistically significant rise at three hours after Premarin p<0.05. No significant changes were observed in the mean Potassium or Chloride concentration. The comparison of fine structure of 40 oxyntic cells, 20 before and 20 after Premarin injection, showed an apparent reduction in numbers of canaliculi, with lengthening of the canalicular microvilli. Except for the absence of demonstrable effects on Potassium and on cytoplasmic micro-vesicles these results are comparable with reported findings after inhibition of carbonic anhydrase by acetazolamide (AU)

Effects of oestrogens on carbonic anhydrase activity in human and canine gastric mucosa. The role of carbonic anhydrase inhibitors in the treatment of peptic ulcer - abstract

Carbonic anhydrase which is present in abundance in the mammalian gastric mucosa is concerned with the production of hydrochloric acid. The aim of the present study was to determine whether oestrogens had any effects on the activity of this enzyme in the gastric mucosa of man and dogs. Biopsies were taken from the body of the stomach of 20 male duodenal ulcer patients, 10 of whom had a pre-operative course of diethylstilboestrol. Ten male dogs were used in the animal experiments. Immediately after a biopsy was taken from the anerior wall of the stomach, midway between the cardiac end and the pylorus, 40 mg of equine conjugated oestrogens were injected intravenously in the dogs. Thirty minutes later a second specimen was collected from a site adjacent to the first one. The homogenate obtained from the mucosal layer of each specimen was used for the estimation of its carbonic anhydrase activity by the colorimetric method of Philpot and Philpot. Reaction times were also noted for various dilutions of pure hyophilized carbonic anhydrase. On the basis of a two-tailed test using a 't' distribution it was found that there is a significant difference in the results before and after injection of equine conjugated oestrogens and between the stilboestrol treated patients and the controls. A mean inhibition of 43.5 percent was achieved in man and 21.2 percent in dogs. One patient who was 14 weeks pregnant had an inhibition of 63.4 percent compared with the controls. Truelove and other workers were convinced that ulcer patients experienced symtomatic relief when put on a course of stilboestrol. Similar results were reported in dogs. On the basis of the present work the oestrogens seem to be carbonic anhydrase inhibitors and hence can account for the regular occurrence of hypochlohydria during pregnancy and the lower incidence of peptic ulcer in women of the child-bearing age. Although acetazalamide has been found to reduce the severity of ulcer symptoms, this beneficial action was overshadowed by a concomitant production of persistent acidosis and tingling and numbness in the fingers. The use of carbonic anhydrase inhibitors for the treatment of peptic ulcer merits further investigations. An ideal drug would be a non-feminizing steroid with good peptic ulcer healing powers (AU)

Management of hypoestrogenic states

During a two-year period at San Fernando Hospital 420 patients were seen with a variety of conditions thought to be due to estrogenic disorders. These were studied intensively and classified. The role of cytology in clinical assessment was discussed (AU)