RESUMEN
Testicular cancer is a rare disease; however, cure rates are high for all tumor stages. Mostly, the disease is diagnosed in an early (local) stage. We report the case of a 47-year-old male patient with a giant nonseminomatous germ cell tumor. At the time of diagnosis, the patient demonstrated a necrotizing and ulcerating growing mass in the left scrotum with an approximate size of 22 × 18 cm. According to the prognostic classification of the International Germ Cell Cancer Collaborative Group (IGCCCG 1997), the patient exhibited a high-risk profile due to alpha-fetoprotein >10,000 ng/mL and lactate dehydrogenase >10× the upper limit of normal in serum. Primary orchiectomy was infeasible due to the tumor's size, the patient's poor general condition and initial intensive care unit treatment. Primary systemic chemotherapy was applied. After 3 cycles of cisplatin, etoposide and bleomycin, along with 1 cycle of cisplatin, etoposide and ifosfamide, tumor resection with histomorphological examination showed a complete pathological response. Despite the delayed initiation of the therapy, primary chemotherapy was completed timely and showed promising results. Reasons for the late hospitalization were personal responsibilities regarding his family. Better awareness and knowledge of testicular cancer among young men might prevent the here reported delay of medical consultation and avoid testicular tumors of such enormous size. Psychosocial assessment and distress management is important as an integral part of comprehensive care of testicular cancer patients.
RESUMEN
PURPOSE: To analyse the therapeutic efficacy of various phytotherapeutics and their antimicrobial compounds with regard to strain specificity and dose dependence. METHODS: A representative strain collection of 40 uropathogenic bacteria isolated from complicated and uncomplicated urinary tract infection was subjected to various virulence assays (bacterial growth, mannose-sensitive agglutination, and motility) to determine the therapeutic impact of various compounds with antimicrobial activity. We tested proanthocyanidins (PAC), D-mannose, rosemary extract (Canephron®), and isothiocyanates (Angocin®). RESULTS: D-mannose efficiently blocked the adhesive properties of all type 1 fimbriae-positive isolates in low concentration (0.2%), but showed no bacteriostatic effect. PAC also actively blocked agglutination, but the concentration varied considerably among isolates. Escherichia coli required the highest concentration (10%), while Enterobacter cloacae responded to low concentrations (0.1%). Allyl isothiocyanates not only impaired agglutination in all tested isolates, but also had a dramatic impact on flagella-mediated motility in Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (p < 0.001). The administration of rosemary extracts revealed a strong bacteriostatic effect in growth assays. All tested strains were strongly inhibited by the addition of 10 µg/ml or 1 µg/ml of purified rosemary extractions with the exception of Serratia marcescens. Morganella morganii responded only to 10 µg/ml. CONCLUSION: Phytotherapeutics and small-molecular compounds like mannosides have the potential to become an integral part in a multi-modal treatment concept for the treatment and prevention of urinary tract infections. Their efficiency can be optimised when strain specificities and therapeutic concentrations are taken into account.