Cisplatin, etoposide, ifosfamide, vincristine and bleomycin combination chemotherapy for far advanced testicular carcinoma.

Forty-eight patients with advanced testicular cancer, defined as abdominal mass greater than 10 cm, mediastinal mass greater than 5 cm, more than 20 lung metastases, or visceral organ involvement were treated with an intensive, alternating five-drug regimen consisting of cisplatin 50 mg/m2 d 1-3, etoposide 170 mg/m2 d 1-3, ifosfamide 5 g/m2 d 15, vincristine 2 mg weekly, bleomycin 15 mg/m2 weekly, q d 28. Thirty-four (71%) of the patients attained tumor-free status. This was achieved by chemotherapy alone in 14 patients and by surgical resection of residual disease in the remaining 20 patients (histology of resected tissue: necrosis 12, mature teratoma 7, viable carcinoma 1). Patients with pure seminoma responded better than patients with nonseminoma (CR 100% vs. 67%, respectively). In a univariate analysis only the value of HCG (less than vs greater than 10,000 U/L) and the number of involved organ sites (less than or equal to 2 vs greater than to 2) had significant influence on the response rate. After a minimum follow-up of 24 months 3 patients (9%) have relapsed. The survival rate is 76% after 36 months, with 61% remaining disease-free. Though this intensive regimen might bestow some of the therapeutic advantages of standard three-drug protocols in far advanced testicular cancer, the results are still less than optimal and warrant the exploration of new therapeutic strategies.

[Primary sonographic diagnosis of pancreatic duct calculi: the non-uniform aspect]. / Primär sonographische Diagnose von Pankreasgangkonkrementen: Uneinheitlicher Aspekt.

Four cases of sonographically visualised intraductal pancreatic calculi are reported. In three of these cases the calculi had been caused by chronic pancreatitis, and in one case by carcinoma of the head of the pancreas. The calculi did not present a uniform sonographic pattern, especially as regards echogenicity. A dorsal echo extinction was observed in three cases only. The non-uniform sonographic aspect of intraductal pancreatic calculi can probably be ascribed to differences in the lime content.

Reproductive functions in young fathers and grandfathers.

Testicular functions were investigated in 23 grandfathers [60--88 yr old; 67 +/- 7.8 (mean +/- SD)], i.e. men with fertility proven earlier in life. They were recruited from a nonpatient population and led an active life, most of them with a permanent partner. The grandfathers were compared with a group of 20 unrelated healthy fathers, 24--37 years old (29.2 +/- 3.2). Whereas sperm density was higher in the older group, there were no significant differences in ejaculate volume and sperm morphology between the younger and older men. Sperm motility and seminal fructose, however, decreased with age. The fertilizing capacity of sperm as assessed in the heterologous ovum penetration test using zona pellucida-free hamster eggs did not decrease significantly with age. Whereas the basal serum testosterone and estradiol levels were not different between the younger and older men, the response to 2 days of hCG stimulation decreased significantly with age. This decrease was observed in older men whether they had frequent or infrequent sexual activity. Basal serum LH and FSH levels were elevated in the older men. The LH response to GnRH stimulation relative to basal; values was significantly reduce, while FSH responses did not change with age. We conclude that sperm counts and fertilizing capacity of sperm are not negatively influenced by old age, at least not in men with sustained sexual activity. However, the pituitary as well as the testis show signs of decreased endocrine reserve capacity in old age.