Relationship between sexual position and severity of penile fracture.

The objective of the study was to evaluate the relationship between the sexual position and severity of penile fracture (PF). We studied 90 patients with PF. The mechanism of injury and the sexual position was assessed. We divided our sample by the etiology of the fracture in six groups: (a) masturbation or penile manipulation; (b) 'man-on-top' position; (c) 'doggy style' position; (d) 'woman-on-top' position; (d) blunt trauma; and (e) 'rolling over' fracture. We used the χ2-test for contingency analysis of the populations under study (P<0.05). The patient's age ranged from 18 to 66 years (mean 39 years). Investigation of the injury mechanism identified sexual trauma as the main etiological factor, involved in 69 cases (76.5%). The sexual position at the time of injury varied, with 23 cases (25.5%) occurring in the 'man-on-top', 37cases (41%) in the 'doggy style' and 9 cases (10%) in the 'woman-on-top'. We do not observe differences between the severity of the PF between the 'doggy style' and 'man-on-top' (P=0.9595), but the 'doggy style' had more severity of PF when compared with 'woman-on-top' (P=0.0396) and penile manipulation (P=0.0026). The 'man-on-top' and 'doggy style' positions showed more associations with bilateral fractures of the corpus cavernosum and urethral lesions.

Genetic imbalances in 26 cases of penile squamous cell carcinoma.

To obtain more information on chromosomal changes in the up-to-now poorly studied tumor class of penile squamous cell carcinoma (SCC), we performed a comparative genomic hybridization study of 26 cases of this rare tumor. DNA sequence copy number alterations (CNAs) very similar to those detected in other SCC types, such as oral and esophageal SCC, were noted. The most common copy number gains were found in 8q24, 16p11-12, 20q11-13, 22q, 19q13, and 5p15, and the most common deletions were detected in 13q21-22, 4q21-32, and along the X chromosome. Classifying the patients according to the number of CNAs showed a possible correlation with clinical outcome.

Determination of telomerase activity in squamous cell carcinoma of the penis.

Telomerase activity was studied in 51 penile carcinomas, and detected in all samples from 3 patients with verrucous carcinoma, in 85.4% (41/48) of invasive carcinomas, in 81.8% (9/11) of adjacent non-cancerous skin and in 80% (8/10) of adjacent non-cancerous corpus cavernosum. All skin and corpus cavernosum samples from patients with prostatic carcinoma were found to be telomerase negative. Our results indicate a correlation between frequency of telomerase activity and grade of penile carcinoma. The finding of telomerase activity in skin and corpus cavernosum samples adjacent to tumor suggests that unidentified local factors may modulate telomerase activity in normal tissues.

[Cancer of the urethra in women: experience of the National Institute of Cancer of Brazil: 1992-1997]. / Cancer de l'urètre chez la femme: expérience de l'Institut National du Cancer du Brésil: 1992-1997.

OBJECTIVE: Describe the results of surgery, radiation therapy and chemotherapy for treatment of primary malignant neoplasms of female urethra. PATIENTS AND METHODS: Since 1982, 31 patients with urethral cancer were evaluated at our institution (follow-up ranging from 0 to 127 months). Ten patients were treated with external beam irradiation and 1 patient received preoperative therapy after surgery. Two patients refused treatment and 1 received chemotherapy. Three patients presented with disseminated metastatic disease at the first examination received exclusively palliative treatment. RESULTS: Five patients have survived from 3 to 10 years following treatment without recurrence. Of 31 patients 18 developed distant metastases during the first 24 months of follow-up irrespective of treatment employed. CONCLUSION: With exception of primary melanoma, prognosis was not related to histologic features. Patients who underwent surgery and radiotherapy had a better survival rate than did those who received radiotherapy alone. Total urethrectomy with appendico-vesicostomy can be an alternative surgical method for entire urethral ivnasive lesions without cystourethrectomy and preserving urinary continence.

Clinical implications of natural killer cytotoxicity in patients with squamous cell carcinoma of the penis.

Impairment of natural cytotoxicity mediated by natural killer (NK) cells may play a role in the pathogenesis of penile carcinoma. The aim of this study was to examine the NK activity profile and its prognostic significance in patients with squamous cell carcinoma of the penis. The NK activity was measured in peripheral blood mononuclear cells (PBMCs) from 39 patients diagnosed histologically as having invasive squamous cell penile carcinoma and 4 patients with verrucous carcinoma of the penis. Of 39 patients with invasive squamous cell carcinoma, 4 had undergone previous penile amputation. According to the prognosis, the patients with invasive squamous cell carcinoma were divided into two groups: with metastasis and without metastasis. The patients were evaluated in relation to clinicopathologic variables using univariate analyses. NK cell activity was significantly decreased in all patients with penile carcinoma when compared with the control groups (p < 0.0001). There was no statistically significant difference between the groups with and without metastasis. We conclude that there is a decrease in NK activity in PBMCs from patients with penile carcinoma and that the presence of advanced disease or metastatic involvement is not responsible for this reduction.

[Use of the upper gastrointestinal endoscopy in dyspeptic patients]. / Emprego da endoscopia digestiva alta em pacientes dispépticos.

BACKGROUND AND AIMS: Dyspepsia is a common complaint that may signal the presence of diseases like cancer or peptic ulcer. The aim of our study was to assess if the clinical patterns of dyspepsia can be considered a valid guideline for the appropriate use of endoscopy. METHODS: According to the symptomatological patterns, our 243 patients were defined as sufferers from: ulcer-like (93 patients), reflux-like (25) and dismotility-like dyspepsia (125). Erosive gastritis and erosive duodenitis were regarded as minor inflammatory lesions. RESULTS: A negative endoscopy (normal or presenting minor inflammatory lesions) was found in 36.6% of ulcer-like dyspepsia patients: this rate was 52% in the reflux-like group, and 49.6% in the dismotility-like one. Duodenal ulcer was the most frequent abnormal lesion in the three groups. The frequency of negative endoscopies was significantly higher in dismotility-like than in ulcer-like (49.6% vs. 36.6%--P < 0.05) dyspepsia. In those patients with dismotility-like dyspepsia under 41 years, the rate of negative endoscopies was 72.7%, and neoplasms were not observed. CONCLUSION: Our data indicate that endoscopy could be considered inappropriate for patients under 41 years old with dismotility-like dyspepsia. These subjects account for 18.1% of the patients studied, what could lead to a good percentage of reduction in endoscopic service load.

[Intestinal parasitosis and hepatic cirrhosis]. / Parasitoses intestinais e cirrose hepática.

The authors describe their experience, in a prospective survey, with the prevalence rates of intestinal parasites in patients with hepatic cirrhosis admitted to the Gastroenterology Unit of University Hospital of Federal University in Juiz de Fora, Brazil, whose fresh stools were examined by Hoffman-Pons-Janner, Baermann-Moraes and Willis methods. They compare the results of stool exams with two control groups and look for a relation with cirrhosis' etiology. A higher prevalence of some parasites was observed in cirrhosis than in people with other digestive diseases (group I). mainly for the Strongyloides stercoralis, found in 40.2%, chiefly in alcoholic cirrhosis. Oddly no one of the group I admitted in the same period had strongyloidiasis. Another group including all the people who had stool samples examined in the same period at the hospital had 1.91% of that helmintic infection (group II). A comparison is also made with the prevalence in schoolchildren between the ages of 7 and 14 studies eight years before (13.16%). Other parasites were also observed in different incidence between those with cirrhosis and the other groups and the results are presented. They conclude that hepatic cirrhosis must be included in the list of conditions which increases the risk of Strongyloides stercoralis infection.

PIP: In a prospective study conducted between July 1995 and June 1996 the prevalence of intestinal parasites is described in 35 (32 male, 3 female) patients with hepatic cirrhosis, aged 13-77 years, who had been admitted to the gastroenterology unit of the Federal University in Juiz de Fora, Brazil. The causes of cirrhosis were: alcohol (19 cases), hepatitis B virus (HBV) (3 cases), hepatitis C virus (HCV) (5 cases), HBV and HCV (2 cases), cryptogenetics (3 cases), Wilson's disease (1 case), biliary cirrhosis (1 case), and Gaucher's disease (1 case). Another 45 patients who were hospitalized during this period served as controls (Group I). Group II was comprised of 1411 persons who underwent parasitological tests during December 1995 and May 1996. Comparison was also made with 7371 tests performed in children aged 7-14 years who had been studied in 1988. Stools were examined by the Hoffman-Pons-Janner, Baermann-Moraes, and Willis methods. The results of stool exams were compared with those of the two control groups. A higher prevalence of some parasites was observed in cirrhosis patients than in patients with other digestive diseases (Group I). Of the 35 cirrhosis patients, 19 presented with positive parasite tests. Strongyloides stercoralis was found in 40.2%, chiefly in alcoholic cirrhosis patients, which was significant when compared to the other two control groups, but not significant when compared to the patients with nonalcoholic cirrhosis (4 cases of strongyloidiasis out of 16 patients). None of the 45 patients in Group I had strongyloidiasis. Group II (including all the people who had stool samples examined during the same period in the hospital) had a 1.91% rate of helminthic infection. A rate of 13.16% was found in the children's group.

[Hepatic puncture biopsy in the outpatient clinic]. / Biopsia hepática por puncão em ambulatório.

The authors present the results of a prospective study on percutaneous needle biopsy of the liver conducted at the Hepatology Outpatients' Ward of the Gastroenterology Unit of the University Hospital -" Universidade Federal de Juiz de Fora", MG, Brazil. In 16 months 61 biopsies were made in patients with chronic liver disease according to the technique described by menghini. The inclusion criteria were established by The Patient Care Committee of The American Gastroenterological Association. Abdominal ultrasound was done before and after the procedure. The patients stayed six hours under control (blood pressure and pulse rate) in the hospital. After 24 hours other clinical, laboratorial and ultrasonic control were performed. The main complication was local pain or in the right shoulder (32 patients--52.5%). Abdominal ultrasound after 24 hours revealed only one hematoma of the abdominal wall (1.8%). This study shows that the outpatient needle liver biopsy is a safe procedure with low complication rate when performed in a judicious way, by specialized personnel and under strict clinical control.

Verrucous carcinoma of the penis: retrospective analysis of 32 cases.

Between 1972 and 1987, 34 patients with verrucous carcinoma of the penis were referred to our national cancer institute. We analyzed retrospectively the followup of 32 patients treated by surgery, exclusive radiotherapy and neoadjuvant chemotherapy. No patient died or had recurrent verrucous penile carcinoma. Lymph nodes removed from 15 patients without previous treatment did not reveal metastatic invasion. Neoadjuvant chemotherapy allowed for more limited surgery in 3 of 6 patients treated.

Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases.

Between 1960 and 1987, 414 patients with invasive squamous cell carcinoma of the penis were referred to the Brazilian National Cancer Institute. Inguinal metastases were demonstrated by lymphadenectomy in 39% of the 23 patients with stage N0, 49% of 92 with stages N1 and N2, and 100% of 18 with stage N3 disease. We analyzed the followup of 350 patients who underwent surgical treatment. In 224 patients (64%) amputation or some form of penile surgery was done initially, while 102 (29%) underwent amputation and lymphadenectomy, and 24 (7%) underwent palliative surgery for advanced squamous cell carcinoma. The statistics revealed a better 5-year survival rate for the patients who underwent lymphadenectomy concomitantly with penile surgery compared to those who underwent delayed lymphadenectomy (p < 0.001). Patients in whom systematic lymphadenectomy was negative had a better prognosis than those with positive systematic lymphadenectomy results (p < 0.001). The latter patients had a better prognosis compared with those in whom delayed lymphadenectomy was positive (p = 0.0103). Patients with well and moderately differentiated carcinoma had a higher survival rate at 5 years than did those with poorly differentiated carcinoma (p < 0.001 and p = 0.003, respectively). All deaths from metastatic disease occurred within 24 months among the patients who underwent systematic lymphadenectomy and within 5 years after simple penile surgery. In the short term, surgical debulking combined with reconstruction techniques allowed for improved quality of life in patients with advanced local-regional disease.

Analyses of 200 lymphadenectomies in patients with penile carcinoma.

From 1972 to 1987, 200 consecutive lymphadenectomies were performed in 112 patients with squamous cell carcinoma of the penis. A Gibson incision provided exposure of the iliac and inguinal lymph nodes with a low morbidity rate (5% flap necrosis, 15% wound infection, 16% lymphedema and 9% lymphocele). The controversy surrounding the necessity of iliac lymphadenectomy is discussed, since 305 iliac lymph nodes examined did not have metastatic invasion.