Role of estrogens in the secondary hormonal manipulation of hormone refractory prostate cancer

To evaluate the role of Estrogens [Honvan] in the secondary hormonal manipulation of patients with hormone refractory prostate cancer [HRCP]. Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days [Fosfestrol, a synthetic phosphorylated estrogen derivative], followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen [PSA] level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were recorded. The morbidity and mortality of the treatment was also recorded. A drop in PSA of > 50% was classified as major responder. The drop of < 50% was defined as minor responders. Treatment failure was defined as a rise in PSA > the level prior to the start of treatment. The mean age at diagnosis of prostate cancer was 66.6 + 5.4 years [range 57-73]. At the time of initial diagnosis only 3 patients [25%] had localized disease and 9 [75%] had metastatic prostate cancer. Six patients each opted for surgical or medical castration [LHRH analogs] as the mode of androgen ablation. The mean initial PSA at diagnosis was 340 + 728.1 ng/ml [range 4.1-2375, Median 94]. After development of HRPC, six patients [50%] had major response, four [33%] had minor response to estrogen administration. Two patients [17%] did not respond to estrogens. The mean PSA before receiving Fosfestrol was 60.5 + 82 ng/ml [range 0.013-246]. The PSA [nadir] after treatment was 24.3 + 33.2 ng/ml [range 0.9-81.3]. One patient developed gynaecomastia and one had congestive cardiac failure. Two patients died of non cancer related deaths and one patient died of cancer related death. Synthetic estrogens are well tolerated, in-expensive agents and could be considered for palliative use against hormone resistant prostate cancer

prevalence of silent kidney stones - an ultrasonographic screening study

Silent and not yet discovered stones of the upper urinary tract are potentially dangerous, since in due course they may cause infection, obstruction and renal damage. The aim of this study was to determine the prevalence of such silent kidney stones in a representative Pakistani population of Karachi. Subject and We studied 201 consecutive subjects at our hospital who underwent additional kidney screening whilst undergoing abdominal ultrasound. All these subjects did not have a history or symptoms of urolithiasis. We found silent kidney stones in 3% of subjects. All stone bearers were males. Most stones were in the left kidney. Notably, multiple stones and stones of a considerable size went unnoticed. In addition to the usual figures of incidence and prevalence of stone disease drawn from patient data, there is a prevalence of 3% silent stones that may only be discovered incidentally or by screening. This is true for a '"stone country" like Pakistan. Figures for other regions have yet to be determined. Due to socio-economic reasons, we believe that a general kidney screening for urolithiasis is, however, not indicated, at least in our country

Decreased ability of human plasma to inhibit lipid peroxidation in uremia

Blood samples from normal healthy volunteers and uremic patients were obtained and plasma were prepared. The effects of these plasma samples on lipid peroxidation [LP] in rabbit homogenate were determined. Both plasma samples inhibited LP activity in our experiments. The percent inhibition of LP produced by normal plasma, concentration 1 and 10%, v/v, was 21.78 +/- 4.15 and 75.5 +/- 2.39 [Mean +/- S.E.M. n=20] respectively. The corresponding values of LP inhibition obtained using the uremic plasmas, concentrations 1 and 10% v/v, were 6.85 +/- 7.04 and 57.12 +/- 13.71 respectively. These data show that there was a significant reduction in LP inhibitory activity in plasma of uremic patients. This suggests that there may be an increased production of associative LP products in uremic patients. Since LP products profoundly affect blood clotting it can be inferred that aberrant levels of LP inhibitor in uremic plasma could contribute to increased bleeding in uremia

Congenital obstruction of the ureterovesical junction

An unusual case of unilateral congenital ureterovesical junction obstruction leading to recurrent urinary tract infection and renal parenchymal damage is reported. Following radiological diagnosis, the five years old patients underwent a distal right ureterectomy and a ureteronecystostomy. The patient is asymptomatic and off all medications 8 months following surgery

Biopsy for suspected testicular cancer

The current practice of radical orchidectomy for any lesion in the testis, suspected of being malignant is not keeping with an important principle of surgery, viz., that one should always biopsy before radical surgery. This paper discusses the risk of blind orchidectomy, and of testicular biopsy done after clamping the chord. Methods of preventing warm ischaemia are discussed and the possibilities of obtaining a firm diagnosis without biopsy are explored. An attempt has been made to identify the groups of individuals at risk for testicular cancer. These should be kept under surveillance and the testis subjected to biopsy at the slightest suspicion of a mass