[Development of a squamous cell carcinoma of the urinary bladder after intravesical condylomas]. / Entwicklung eines plattenepithelial-differenzierten Harnblasenkarzinoms bei unbehandelten Condylomen der Harnblase.

BACKGROUND: The occurrence of intravesical condylomata acuminata has been described as a fairly uncommon, benign epithelial lesion. Reports on progression into a muscle-invasive carcinoma of the bladder are rare. CASE: We present the case of a 68-year-old man who had a history of intravesical condylomata acuminata over several years and developed a muscle-invasive squamous cell carcinoma of the bladder. Having undergone several transurethral resections, but failed to receive intravesical instillation therapy or continuous follow-up examinations, the patient visited our department. After being diagnosed with ichthyosis vesicae, the patient had a rapid disease progress and developed a muscle-invasive squamous cell carcinoma of the urinary bladder within 3 months. He underwent radical cystectomy. SUMMARY: The carcinogenic potency of the human papilloma virus is well known for carcinomas of the male and female genitals. The occurrence of intravesical condylomata is rare. They are commonly perceived as benign lesions and, therefore, mainly treated symptomatically. Our case shows that progression to a highly aggressive muscle-invasive squamous cell carcinoma is possible. CONCLUSION: The diagnosis of intravesical condylomata acuminata requires stringent urologic follow-up examinations including biopsy of suspicious lesions and stage-appropriate surgical management in the case of an invasive carcinoma.

Diurnal variation of hypothalamic function and chronic subthalamic nucleus stimulation in Parkinson's disease.

BACKGROUND: Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life in patients with advanced Parkinson's disease (PD), but is associated with neuropsychiatric side effects and weight gain in some individuals. The pathomechanisms of these phenomena are still unknown. Considering anatomical and functional connections of the STN with the hypothalamic-pituitary (HP) system, we prospectively investigated whether chronic STN-DBS alters HP functioning in 11 PD patients. METHODS: Basal hormone levels of the HP-adrenal (HPA), HP-gonadal and HP-somatotropic axis were determined before surgery as well as 3 and 6 months after electrode implantation. In addition, 24-hour cortisol profiles and dexamethasone suppression tests were obtained. Postoperative hormone changes were correlated with individual neuropsychological test performance, psychiatric status and anthropometric measures. RESULTS: While PD patients experienced weight gain (p = 0.025) at follow-up, most neuropsychological data and basal HP hormone levels did not change over time. HPA regulation and diurnal rhythmicity of cortisol remained intact in all patients. The 24-hour mean cortisol levels decreased 6 months after surgery (p = 0.002) correlating with improved postoperative depression (p = 0.02). CONCLUSIONS: Chronic application of high-frequency electrical stimuli in the STN was not associated with HP dysfunction in patients with advanced PD. The diurnal variability of peripheral cortisol secretion as one important element of the endogenous biological clock remained intact. Evening cortisol levels decreased after surgery reflecting a favorable regulation of the cortisol setpoint. STN-DBS can be considered safe from a neuroendocrine perspective, but the origin of unwanted side effects warrants further elucidation.