Megestrol acetate plus minidose diethylstilbestrol in the treatment of carcinoma of the prostate.

A multicenter randomized trial comparing megestrol acetate 120 mg/d, plus diethylstilbestrol (DES) 0.1 to 3 mg/d in patients with stage D2 prostate cancer was undertaken to compare the efficacy and toxicity of these two regimens. Pretreatment characteristics, including pathologic grade, performance status, age, and disease-related symptoms were similar in the two groups. Of 81 patients who have been entered in the study, 77 are evaluable for response and toxicity at a mean follow-up of 13.3 months. Using National Prostate Cancer Project (NPCP) criteria, no difference in response rate is noted (73% v 76%) or in disease-free survival and overall survival. The ability to suppress serum testosterone to castration levels and to maintain this suppression is equivalent in both treatment groups. However, treatment-related toxicity, including edema, hypertension, and gynecomastia, occurred at a significantly greater frequency, severity, and after a shorter treatment period in the DES-treated group. No difference in major cardiovascular events was noted. Since megestrol acetate plus minidose DES is equivalent to DES in achieving treatment responses in patients with carcinoma of the prostate, it is a preferable treatment because of its improved side-effect profile.

Vesicouterine fistula: a rare complication of cesarean section.

A vesicouterine fistula complicating a cesarean section is the least common of the urogenital fistulas. In this study, two patients are presented who developed this complication. The first patient was treated nonoperatively, with resolution of the problem. The second patient was treated surgically after failure of conservative management. The clinical features, etiologic factors, diagnostic procedures, and treatment modalities are discussed in relation to these cases and others reported in the literature.

Early removal of catheter after transurethral prostatectomy.

A prospective study of 100 patients with benign prostatic hypertrophy treated by transurethral prostatectomy with catheter removal as soon as possible after surgery was carried out. The results were compared with a retrospective review of 100 similar cases treated by long-term catheter drainage. Incidence of retention requiring recatheterization was equal (5 per cent versus 6 per cent); incidence of secondary hemorrhage was increased by early catheter removal (6 per cent versus 13 per cent); postoperative hospital stay was decreased by 50 per cent (8.2 versus 4.0 days); and patient comfort and acceptance were improved markedly.

Placenta percreta invading the bladder: report of 2 cases.

We report 2 cases of placenta percreta with invasion of the bladder that resulted in massive hemorrhage at cesarean section. Control was achieved by hysterectomy, bilateral internal iliac artery ligation, suture ligation of bleeding vessels and bladder repair, with no fetal or maternal mortality.

Epidermoid cysts of the testicle.

We report 4 cases of intratesticular cystic lesions. Three patients had epidermoid cysts and 1 had cystic mature teratoma initially diagnosed as an epidermoid cyst. In all cases an inguinal approach to testicular exploration was used.

Intraoperative ultrasound in the conservative resection of testicular neoplasms.

In a series of approximately 400 patients investigated for oligospermia 4 had small testicular tumors demonstrated by high resolution real-time ultrasound. The lesions ranged in size from 3 to 6 mm., were clinically impalpable and were demonstrated on repeated sonograms. Exploration was done in all 4 patients with the aid of intraoperative high resolution ultrasound. This procedure allowed for conservative resection of the tumor with preservation of the testicle. The pathological diagnosis in all cases was benign Leydig cell tumor.

Bilateral multilocular renal cysts.

Multilocular renal cystic disease is a rare, benign condition thought to occur unilaterally. We report a case of asynchronous, bilateral multilocular renal cystic disease, which suggests that unilaterality is not essential for diagnosis of this lesion.

Spontaneous hypoglycemia associated with hemangiopericytoma of the kidney.

We report the third case of renal hemangiopericytoma associated with spontaneous hypoglycemia. The clinical and pathological features suggest that excessive glucose storage by the tumor is an important factor in the pathogenesis of the hypoglycemia. Other possible mechanisms producing hypoglycemia associated with mesenchymal tumors are reviewed.