Necrotizing cavernositis secondary to periodontal abscess.

Spontaneous cavernositis is a distinctly uncommon entity. Corporeal infection and abscess formation have been described in association with priapism, cavernosography, intracavernous injection therapy, trauma and penile prostheses. We report a case of acute necrotizing cavernositis in a diabetic patient, which presumably originated with hematogenous seeding from a periodontal abscess. Isolation of typical oral pathogens from corporeal cultures provides bacteriological evidence of a dental source for the corporeal infection.

Corpora cavernosa-glans penis shunt for priapism.

A corpora cavernosa-glans penis shunt was carried out to control priapism in eight patients in the past two years. Four of the five patients treated by sertion of a biopsy needle through the glans into the corpora and three patients treated by creation of a window in the tunica albugenia of the corpora through a glans penis incision experienced prompt detumescence and maintained potency. These observations support the efficacy of a venous shunt to achieve rapid detumescence and support the concept that potency is likely to be preserved if venous stasis is relieved promptly and its recurrence prevented. Surgical incision of the glans penis to permit creation of a shunt from each corpora cavernosum under direct vision is simple, safe and effective. This procedure warrants primary consideration as the initial treatment of priapism.

Renal vein thrombosis following puerperal ovarian vein thrombophlebitis.

A case of renal vein thrombosis following puerperal ovarian vein thrombophlebitis is reported. We review the syndrome of puerperal ovarian vein thrombophlebitis and emphasize the potential for renal vein and vena caval involvement. The utility of computed tomographic scanning for diagnostic confirmation of this postpartum complication is described.

The role of excretory urography and cystoscopy in the evaluation and management of women with recurrent urinary tract infection.

We examined the roles of excretory urography and cystoscopy in the evaluation and management of 153 otherwise healthy women seen consecutively with recurrent urinary tract infections. The excretory urograms were entirely normal in 89 per cent of the patients; the abnormalities were incidental findings with no influence on subsequent management. These results, combined with the known expense and risks inherent in the use of iodinated radiologic contrast material, suggest that excretory urography be limited to those patients possessing other risk factors. These include a history of unexplained hematuria, obstructive symptoms, neurogenic bladder dysfunction, renal calculi, analgesic abuse, severe diabetes mellitus or bacteriologic evidence of rapid recurrence suggesting bacterial persistence within the urinary tract or an enterovesical fistula. On the other hand, cystoscopy under local anesthesia has essentially no risks and occasionally will yield information helpful in future management.

Biochemical profiles of prostatic fluid from normal and diseased prostate glands.

The attempt to identify changes in the biochemical composition of prostatic fluid that might accompany and characterize disease states in the prostate was stimulated by two assumptions based on observations. First, the composition of prostatic fluid was judged to be likely to reflect the metabolic status of at least the epithelial cells accurately. Secondly, the metabolic changes preceding or associated with the development of carcinoma in the prostate seemed likely to be diffuse rather than limited to the histologically abnormal prostatic cells. As a consequence of these assumptions, prostatic fluid obtained from the urethra by digital massage of the prostate was evaluated microscopically and subjected to numerous analytical procedures. Differences in lactate dehydrogenase (LDH) isoenzymes, complement C3, and transferrin concentrations in the prostatic fluid of men with histologically identified carcinoma (Ca) and benign prostatic hyperplasia (BPH) have been observed. The ratio of LDH-5/ LDH-1 was found to have a mean value of 5.94 +/- 0.25(S.E.) in 98 determinations on 83 patients with Ca, and 1.84 +/- 0.14 in 212 determinations on 142 patients with BPH with 10 or less white blood cells per high power field (WBC/hpf) on microscopic examination of the prostatic fluid. Fluid from 52 patients with BPH with greater than 10 WBC/hpf (84 determinations) had a mean ratio of 5.85 +/- 0.88 and from 286 patients with greater than 10 WBC/hpf without an established histologic diagnosis (460 determinations) of 3.12 +/- 0.21. Two hundred twenty-two men under 45 years of age (255 determinations) judged to have a normal prostate clinically had a mean ratio of 0.67 +/- 0.05. The mean transferrin concentration in 44 patients (51 determinations) with Ca was 47.03 +/- 3.76mg/100 ml, in 59 patients with BPH (90 determinations) was 12.97 +/- 1.20, in 23 patients with BPH with > 10 WBC/hpf in the prostatic fluid (38 determinations) was 14.93 +/- 2.19, in 87 patients with > 10 WBC/hpf (92 determinations) was 13.42 +/- 1.41, and in 33 patients less than 45 years of age with clinically normal prostates (33 determinations) was 7.45 +/- 1.08. The mean complement C3 concentration in 46 patients with Ca (57 determinations) was 17.48 +/- 1.60, in 58 patients with BPH (85 determinations) was 3.83 +/- 0.55, in 24 patients with BPH with > 10 WBC/hpf (39 determinations) was 5.87 +/- 0.68, in 93 patients with > 10 WBC/hpf (98 determinations) was 4.47 +/- 0.53, and in 34 patients less than 45 years of age (34 determinations) was 2.06 +/- 0.43. The mean ratio of LDH-5/LDH-1 was significantly greater for Ca than BPH with 10 or less WBC/hpf in the prostatic fluid. The mean concentrations of transferrin and complement C3 were significantly greater in Ca than in all other groups studied. No obvious relationship between stage of disease and these findings was observed. These observations support the suggestion that determination of prostatic fluid composition assists in identifying men with a high risk of cancer of the prostate.

Analysis of specific proteins in prostatic fluid for detecting prostatic malignancy.

In an attempt to identify an indicator(s) specifically associated with prostatic cancer prostatic fluid was collected by rectal massage from patients with prostatic cancer, prostatitis, benign prostatic hyperplasia and from those without recognized prostatic lesions in order to measure various immunoproteins. The proteins examined were IgG, IgA, IgM, complements C3 and C4, and transferrin. Prostatic fluid samples were subjected first to immunoelectrophoresis. Distinct differences in C3, C4 and transferrin concentrations were noted between patients with prostatic cancer and other patients. These proteins were stained heavily in the electrophoresis gels of fluid from cancer patients but were either missing or lightly stained in all other groups. These qualitative determinations were replaced subsequently by a quantitative measurement using the radial immunodiffusion technique. Results of the latter study confirmed the aforementioned observations and indicated that the levels of C3, C4 and transferrin in the prostatic fluid of cancer patients were elevated significantly when compared to all other patient groups. These observations indicate that the measurement of complements C3 and C4, and transferrin in the prostatic fluid may assist in the identification of patients with a high risk of prostatic cancer.

Analysis of prostatic fluid in prostatic disease.

The current studies of expressed prostatic fluid tend to confirm our previous reported pilot observations of a shift in lactic dehydrogenase (LDH) isoenzymes to a predominance of LDHV in patients with prostatic malignancy. They also suggest a decrease in concentration of acid phosphatase and an increase in concentration of protein in the presence of carcinoma of the prostate. These observations suggest a diffuse metabolic alteration of the prostate in the presence of prostatic carcinoma.

Lactate dehydrogenase isoenzymes in human prostatic fluid: an aid in recognition of malignancy?

A total of 1,435 specimens of prostatic fluid were collected from 1,076 patients by rectal massage. Lactate dehydrogenase isoenzymes in the fluid were separated by acrylamide disk electrophoresis and the ratio of lactic dehydrogenase-5/lactic dehydrogenase-1 was used as the parameter for the test. There were significant differences in the ratio among patients with a normal prostate, benign prostatic hyperplasia and prostatic carcinoma. The mean values of lactic dehydrogenase-5/lactic dehydrogenase-1 ratios were 0.48 +/- 0.09, 1.36 +/- 0.17 and 5.21 +/- 0.79, respectively. Of 30 patients with histological evidence of prostatic carcinoma 25 (85 per cent) had a ratio greater than 2 in the prostatic fluid. On the other hand the ratio was less than 2 in 50 of 57 men (88 per cent) with a histological diagnosis of benign prostatic hyperplasia devoid of inflammation. When prostatic fluid contained white blood cells a positive correlation was observed between the ratio and the number of white blood cells per microscopic field (r equals 0.289, p less than 0.001). The results indicate that a lactic dehydrogenase-5/lactic dehydrogenase-1 ratio exceeding 2 in the prostatic fluid in the absence of inflammation should be regarded as an indication of high risk of the presence of carcinoma of the prostate.