The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia.

The dual 5alpha-reductase inhibitor, dutasteride has been shown to suppress serum dihydrotestosterone (DHT) by >90%. In the present study, the effect of dutasteride 0.5 mg/day on intraprostatic DHT levels was investigated. In this multicenter, double-blind trial, 43 men with benign prostatic hyperplasia (BPH) scheduled to undergo transurethral resection of the prostate (TURP) were randomized to receive dutasteride, 0.5 mg/day or placebo for 3 months before surgery. Intraprostatic DHT, testosterone and dutasteride levels were determined at the time of TURP. Changes in serum DHT and testosterone from baseline, and both serum and intraprostatic dutasteride levels at the time of TURP were also assessed. Dutasteride reduced intraprostatic DHT by 94% relative to placebo (P<0.001); the adjusted mean intraprostatic DHT concentration was 3.23 and 0.209 ng/g in the placebo and dutasteride groups, respectively. In the dutasteride group, serum DHT was reduced from baseline by 93% at month 3, a significantly greater reduction (P<0.001) than the 15% decrease observed in the placebo group. There was a reciprocal increase in intraprostatic testosterone but the level of intraprostatic testosterone in the dutasteride group tended to be lower than the intraprostatic DHT level in the placebo group (P=0.06). Significant intraprostatic DHT suppression was achieved in all subjects who received dutasteride, regardless of the level of intraprostatic dutasteride. There was a strong positive correlation between serum and intraprostatic dutasteride concentrations (R(2)=0.73). After 3 months of treatment, dutasteride 0.5 mg/day provided near-complete suppression of both intraprostatic and serum DHT in men with BPH.

Ectopic production of human chorionic gonadotropin by poorly differentiated transitional cell tumors of the urinary tract.

We performed a 5-year histopathological review of 41 consecutive cases of transitional cell carcinoma. Of these cases 8 were positive for human chorionic gonadotropin immunoperoxidase tissue staining. All tumors were grade III and stages ranged from A to D. Three patients presented with gynecomastia as the clinical manifestation of elevated serum levels of beta-human chorionic gonadotropin. These findings document the association of this phenomenon with lesions of an aggressive nature. As with the loss of cell surface antigens, the appearance of human chorionic gonadotropin within the tumor cells may be further evidence of dedifferentiation. Human chorionic gonadotropin production may be a potential marker to gauge tumor response to chemotherapy and, perhaps, a predictor of future aggressiveness and over-all progression.

Are acrosyringia involved in the pathogenesis of "dyshidrosis"?

Investigations of dyshidrotic eruptions of various causes were done by conventional and electron microscopy. In all cases, the histological patterns were identical. The dyshidrotic vesicle is an intraepidermal, spongiotic lesion. The intraepidermal part of the eccrine sweat duct (acrosyringium) is not altered even by spongiosis. As the acrosyringium does not take part in formation of a dyshidrotic vesicle, the term "dyshidrosis" has to be regarded as a misnomer. Dyshidrosis is nothing but spongiotic dermatitis modified by the distinctive characteristics of palmar and plantar skin.

Immunohistochemical demonstration of human chorionic gonadotropin in tumors of the urinary bladder.

All transitional cell carcinomas of the bladder diagnosed in male patients within a five year period were studied for human chorionic gonadotropin (hCG) production. Biotin-avidin immunoperoxidase analysis for hCG was performed on all paraffin blocks containing carcinoma-in-situ, grade I, grade II, and grade III transitional cell carcinoma. Of a total of 29 patients, one case of carcinoma-in-situ (1/5), and five cases of grade III transitional cell carcinoma (5/15) were found to have hCG-positive tumor cells. The findings indicate that transitional cell carcinoma should be added to the list of malignant tumors capable of producing hCG.

Dissolution of uric acid calculi with intravenous 1/6 molar lactate.

The use of intravenous 1/6 molar sodium lactate for dissolution of uric acid calculi is reported in 4 patients. All presented with a urine pH of 5. The calculi were located in the proximal ureter in 2 patients and in the renal pelvis in the other 2 patients. After infusion of 1/6 molar lactate, rapid alkalinization of the urine to pH 8 was achieved and maintained. The mean time required for dissolution of the calculi was 6.2 days precluding the need for surgical intervention. The mechanism of action of lactate is oxidative conversion to bicarbonate, providing a sustained alkaline urine. While our patients experienced no metabolic complications, one should monitor serum electrolytes, blood pressure, and fluid balance, particularly in cardiac-compromised patients.

[Pathogenesis of pyoderma gangraenosum]. / Uberlegungen zur Pathogenese des Pyoderma gangraenosum.

Pyoderma gangraenosum (Pg) is regarded as an indicator of internal primary diseases of mainly auto-immunological character. Gammopathies as basic diseases are very often of the IgA-type. In contrast to the characteristic clinical picture we have observed unspecific, cellular traits. New investigations have reported immunological findings such as deposition of IgG and IgM as well as C3-complexes at the vascular walls. A decreased function of T-cells is described. Pg often develops in consequence of minor traumata. In these cases the disproportion between the primary lesion and the ulcerous process becomes obvious. By presentation of a typical case in addition to a literature survey, it is discussed whether the primary disease is responsible for this development. Because of the close relationship between Pg and the underlying immunopathology it is proposed that Pg - in analogy to the neoplastic cutaneous syndrome - be classified dipolar-like as a paraimmunological syndrome.