Paraneoplastic limbic encephalitis in a patient with extragonadal choriocarcinoma--significance of onconeural antibodies.

BACKGROUND: Paraneoplastic limbic or brainstem encephalitis is considered to be an autoimmune-mediated disorder of the nervous system associated with different types of cancer including germ cell tumors. CASE REPORT: We report on a 31-year-old patient presenting with eye motility dysfunction, dysarthrophonia, lethargy, depression, slow mentation, disorientation, dysgraphia, and retarded motion sequence. Neurologic tests, brain imaging, and blood chemistry tests failed to determine the cause of the symptoms. Further examinations including ultrasound of the abdomen led to the detection of a retroperitoneal mass. The biopsy of this mass showed fractions of a choriocarcinoma. The patient underwent curative chemotherapy, but although the cancer therapy was successful, the neurologic disorders did not improve. Concurrent examination for anti-Ma2 antibodies in the serum was positive and confirmed the paraneoplastic origin of these symptoms. CONCLUSIONS: Patients with symptoms of limbic or brainstem encephalitis, especially young men, should be tested for anti-Ma2 antibodies in the serum to elucidate their origin. The detection of these antibodies supports the diagnosis of a paraneoplastic syndrome, and may lead to the earlier identification of an otherwise hidden extragonadal germ cell tumor.

Diagnostic yield of touch imprint cytology of prostate core needle biopsies.

Touch imprint cytology may provide additional information to core needle biopsy interpretation according to previous reports. The aim of this study was to investigate the diagnostic yield of this method in the diagnosis of prostate carcinoma. For this purpose, 452 transrectal prostate needle biopsies were evaluated from 56 patients. All patients were clinically suspicious of having prostate carcinoma. Two touch imprints were prepared from each fresh biopsy cylinder. Results of the standard histology and of the touch imprint evaluation were compared. Histologically negative biopsy cylinders were further evaluated for prostate carcinoma by fine step serial sectioning. The standard histological examination showed adenocarcinoma in 27 patients. Touch imprint cytology revealed atypical cells suspicious of carcinoma in 38 patients. This group included all 27 patients with positive standard histology and further 11 patients with initially negative core biopsy. Following serial sectioning, in three out of these 11 samples, histological evidence of a carcinoma could be proven. Fine step serial sectioning of all 29 core biopsies negative for carcinoma by standard histological examination, 26 patients remained negative. All three core biopsies initially negative by standard histology but positive after serial sectioning had cytology findings suspicious of carcinoma. We conclude, that in problematic cases the additional use of touch imprint cytology and serial sectioning of prostate core needle biopsies significantly improve the diagnostic accuracy.

Cystic lesions of the prostate gland: an ultrasound classification with pathological correlation.

PURPOSE: Cysts of prostate tissue are common. Most cases are diagnosed accidently during ultrasound but they sometimes have clinical relevance when related to lower urinary tract symptoms, infertility or the expression of neoplastic disorders. Clinical relevance is linked to the differential diagnosis of the different types of cysts. We provide an updated classification of prostate cyst disorders and indicate how these disorders appear on transrectal ultrasound based on our experience and a literature review. MATERIALS AND METHODS: We retrospectively analyzed the ultrasound database and surgical specimen archives. We performed a MEDLINE(R) search of the peer reviewed literature on the diagnosis and classification of prostate cysts. RESULTS: Cysts of the prostate gland can be classified into 6 categories, including 1) isolated medial cysts, 2) cysts of the ejaculatory duct, 3) simple or multiple cysts of the parenchyma, 4) complicated infectious or hemorrhagic cysts, 5) cystic tumors and 6) cysts secondary to parasitic disease. Cysts of the prostate are related to atrophy of the prostate gland as well as to other well-known factors, such as inflammatory disease, benign prostatic hyperplasia, ejaculatory duct obstruction and cancer. The differential diagnosis and diagnostic criteria are shown for each category. A possible limitation of this classification is that the quantitative aspect of the cyst was not evaluated. This is the initial step toward a more detailed classification and the basis for further pathological studies. CONCLUSIONS: This comprehensive classification could be a useful tool in urological and andrological clinical practice, and for research purposes.

Liposomal recombinant human superoxide dismutase for the treatment of Peyronie's disease: a randomized placebo-controlled double-blind prospective clinical study.

OBJECTIVE: To demonstrate the efficacy and safety of a topical gel containing liposomally encapsulated recombinant human Superoxide Dismutase (lrhSOD) in the treatment of painful Peyronie's Disease. The theoretical background is that lrhSOD, by scavenging of free oxygen radicals, might interrupt inflammatory cascades and thereby limit further disease progression. METHODS: In a placebo-controlled randomized clinical trial, 39 patients with Peyronie's Disease and significant pain symptoms were treated with lrhSOD or placebo for a 4 week period. At this time, statistical evaluation of pain resolution was performed as primary study endpoint. Patients then were continued in a cross-over study design to ensure a total of 8 weeks of lrhSOD therapy for all study participants. Pain, plaque and curvature assessment was performed at study entry and every 4 weeks until week 12. RESULTS: LrhSOD treatment resulted in a statistically significant reduction of pain (p=0.017) compared to placebo already after 4 weeks. At week 12 pain was significantly reduced in 89% of patients who all had received 8 weeks of lrhSOD therapy at that time. Response to other disease parameters was assessed at week 12: plaque size was reduced in 47% of patients, as was plaque consistence in 38%. Penile curvature was improved at 5-30 degrees in 23% of patients. The expected spontaneous disease progression rate of up to 40%, as reported by several investigators, was significantly reduced to <10% under lrhSOD therapy, and patients satisfaction was high, also consequent to the lack of therapy-related side effects observed in the present study. CONCLUSION: LrhSOD is an easily administrable, safe and effective local therapeutic for the painful phase of Peyronie's Disease.

The etiology of erectile dysfunction and mechanisms by which drugs improve erection.

Following the National Institutes of Health (NIH) consensus conference in 1988, erectile dysfunction is defined as the consistent inability to maintain a penile erection sufficient for adequate sexual relations (1). The advances in basic and clinical research during the last two decades have led to the development of several new treatment options for erectile dysfunction, including new pharmacological agents for intracavernosal, intraurethral and oral use. The recent advent of medical therapy and the poor results of long-term follow-up in reconstructive vascular surgery, have significantly modified the medical management of this disorder. Discussion of erectile dysfunction has increased, information about erectile dysfunction is increasingly available, training in erectile dysfunction was improved and last, but not least, the number of patients seeking help for erectile dysfunction is growing, because satisfactory sexual function is an important part of a couple's healthy relationship and ongoing quality of life.