[Sarcoidosis of the spermatic cord and epididymus]. / Sarkoidose des Samenstrangs und des Nebenhodens.

INTRODUCTION: Sarcoidosis (Boeck's disease) is of unknown etiology with an incidence of 10 - 40/10(5) people. In 75% of the cases, pulmonary manifestations are found, with histological findings of noncaseating epithelial granulomas. Bilateral enlargement of the hilus lymph nodes are common and divided into three grades of enlargement. The initial symptoms are cough, fever and dyspnea. CASE REPORT: We report a man, 43 years old, first admitted to our hospital in 1988 with a tumor at the right spermatic-cord. Histological examination revealed a granulomatous inflammation, fitting to sarcoidosis, which was verified in the same year by mediastinoscopy. Partial resection of the left epididymal testis was performed in 2001 due to marked rigidity and histological fibrosis. CONCLUSIONS: Urological manifestation of Boeck's disease is rare. Approximately 30 cases have been described in literature with various urological associations. In most cases, urological sarcoidosis is found accidentally during examination of the most common form, pulmonary sarcoidosis.

[European Association of Urology guidelines on urinary and male genital tract infections]. / Synoptische Leitlinie der sexuell übertragbaren Erkrankungen (STD) mit Primärsymptomen im männlichen Genitale (S1). Leitinien der Deutschen Gesellschaft für Urologie.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

Human p120ctn catenin: tissue-specific expression of isoforms and molecular interactions with BP180/type XVII collagen.

Catenins, a family of structurally related proteins, are involved in epidermal keratinocyte cell-cell adhesion by interacting through their central Armadillo repeats with the intracellular domains of cadherins, transmembrane components of the adhesion junctions. p120ctn is a catenin expressed in different isoforms due to alternative splicing and multiple translation start sites. BP180 is a collagenous transmembrane protein (type XVII collagen) localized to hemidesmosomal attachment complexes in basal keratinocytes. In this study, we have delineated the molecular interaction between these two proteins utilizing the yeast two-hybrid system, which was confirmed by an in vitro protein-protein interaction assay. Specifically, it was shown that an amino-terminal segment of BP180 (aa. 13-25) contains the information necessary for binding to p120ctn isoforms 1-3, but not to the isoform 4, suggesting that the interacting domain is located immediately upstream from the Armadillo repeats and is encoded by exons 5 and 6, which are subject to alternative splicing only in a minority of transcripts. In addition to epidermal keratinocytes, p120ctn was shown to be expressed in a variety of adult and fetal tissues as well as in a number of human tumors. The expression pattern of various p120ctn transcripts, reflecting alternative splicing of the 5' exons, was strikingly similar between the corresponding adult and fetal tissues, while the expression patterns were discordant between certain tumors and their normal parental tissues, suggesting a functional role for the tissue-specific expression of the p120ctn isoforms. Finally, the tissue-specific expression of BP180 was shown to partially overlap with that of p120ctn, suggesting that the interaction of these two proteins may contribute to the modulation of cell-cell/matrix interactions in such tissues.

Human periplakin: genomic organization in a clonally unstable region of chromosome 16p with an abundance of repetitive sequence elements.

Periplakin, a member of the plakin family of proteins, has been recently characterized by cDNA cloning, and the corresponding gene, PPL, has been mapped to human chromosome 16p13.3 (Aho et al., 1998, Genomics 48: 242-247). Periplakin has also been shown to serve as an autoantigen in a malignancy-associated autoimmune blistering disease, paraneoplastic pemphigus (Mahoney et al., 1998, J. Invest. Dermatol. 111: 308-313). In this study, we have elucidated the intron-exon organization of human PPL and characterized its promoter region. The flanking 5' sequences were rich in G and C ( approximately 80%) and included multiple AP2 sites and a SP1 site, while no canonical TATA or CCAAT sequences were found. The functionality of the upstream sequences (-709 to +135) as a promoter in cultured epidermal keratinocytes was detected by a CAT reporter gene, and a limited region (-382 to +135) showed activity in cultured dermal fibroblasts, attesting to cell-type specificity of the promoter. The genomic organization, including the intron-exon borders, was determined by direct nucleotide sequencing of human genomic P1 clones. Comparative analysis of cDNA and genomic sequences revealed that PPL consists of 22 exons, with the distribution of exons in PPL being consistent with that of other plakin genes: 21 small exons, separated by large introns, encode the amino-terminal globular domain, and 1 large exon encodes the entire rod and the tail domains. Characterization of four P1 clones spanning the PPL locus revealed multiple Alu repeats, 20 of them within 33 kb of the entirely sequenced segments (0.60/kb), in addition to numerous MIR and L1 elements. These repetitive elements could lead to the clonal instability detected throughout the genomic P1 clones and may give rise to the genomic rearrangements possibly underlying the paraneoplastic pemphigus.

Explanations for the clinical and microscopic localization of lesions in pemphigus foliaceus and vulgaris.

Patients with pemphigus foliaceus (PF) have blisters on skin, but not mucous membranes, whereas patients with pemphigus vulgaris (PV) develop blisters on mucous membranes and/or skin. PF and PV blisters are due to loss of keratinocyte cell-cell adhesion in the superficial and deep epidermis, respectively. PF autoantibodies are directed against desmoglein (Dsg) 1; PV autoantibodies bind Dsg3 or both Dsg3 and Dsg1. In this study, we test the hypothesis that coexpression of Dsg1 and Dsg3 in keratinocytes protects against pathology due to antibody-induced dysfunction of either one alone. Using passive transfer of pemphigus IgG to normal and DSG3(null) neonatal mice, we show that in the areas of epidermis and mucous membrane that coexpress Dsg1 and Dsg3, antibodies against either desmoglein alone do not cause spontaneous blisters, but antibodies against both do. In areas (such as superficial epidermis of normal mice) where Dsg1 without Dsg3 is expressed, anti-Dsg1 antibodies alone can cause blisters. Thus, the anti-desmoglein antibody profiles in pemphigus sera and the normal tissue distributions of Dsg1 and Dsg3 determine the sites of blister formation. These studies suggest that pemphigus autoantibodies inhibit the adhesive function of desmoglein proteins, and demonstrate that either Dsg1 or Dsg3 alone is sufficient to maintain keratinocyte adhesion.

Desmoglein 3 anchors telogen hair in the follicle.

Little is known about the function of desmosomes in the normal structure and function of hair. Therefore, it was surprising that mice without desmoglein 3 (the autoantigen in pemphigus vulgaris) not only developed mucous membrane and skin lesions like pemphigus patients, but also developed hair loss. Analysis of this phenotype indicated that hair was normal through the first growth phase ('follicular neogenesis'). Around day 20, however, when the hair follicles entered the resting phase of the hair growth cycle (telogen), mice with a targeted disruption of the desmoglein 3 gene (DSG3-/-) lost hair in a wave-like pattern from the head to the tail. Hair then regrew and was lost again in the same pattern with the next synchronous hair cycle. In adults, hair was lost in patches. Gentle hair pulls with adhesive tape showed that anagen (growing) hairs were firmly anchored in DSG3-/- mice, but telogen hairs came out in clumps compared to that of DSG3+/- and +/+ littermates in which telogen hairs were firmly anchored. Histology of bald skin areas in DSG3-/- mice showed cystic telogen hair follicles without hair shafts. Histology of hair follicles in early telogen, just before clinical hair loss occurred, showed loss of cell adhesion (acantholysis) between the cells surrounding the telogen club and the basal layer of the outer root sheath epithelium. Electron microscopy revealed 'half-desmosomes' at the plasma membranes of acantholytic cells. Similar acantholytic histology and ultrastructural findings have been previously reported in skin and mucous membrane lesions of DSG3-/- mice and pemphigus vulgaris patients. Immunoperoxidase staining with an antibody raised against mouse desmoglein 3 showed intense staining on the cell surface of keratinocytes surrounding the telogen hair club in normal mice. Similar staining was seen in human telogen hair with an anti-human desmoglein 3 antibody. Finally, a scalp biopsy from a pemphigus vulgaris patient showed empty telogen hair follicles. These data demonstrate that desmoglein 3 is not only critical for cell adhesion in the deep stratified squamous epithelium, but also for anchoring the telogen hair to the outer root sheath of the follicle and underscore the importance of desmosomes in maintaining the normal structure and function of hair.

[Laser therapy of penile carcinoma]. / Lasertherapie des Peniskarzinoms.

The conventional treatment for superficial penile cancer is amputation of the penis. In contrast, the use of the neodymium-YAG laser yields better survival rates without mutilation. In a long-term follow-up (7 years) we found a survival rate of 95%. There may be an additional advantage in combined use of the laser in the treatment of advanced cases of penile cancer. We conclude that the neodymium-YAG laser should be used as first-line therapy.

[Interstitial laser coagulation of benign prostatic hyperplasia]. / Die interstitielle Laserkoagulation der benignen Prostatahyperplasie.

We report on the new method of interstitial laser coagulation for the treatment of benign prostatic hyperplasia (BPH). The procedure is based on the interstitial application of Nd:YAG laser irradiation, delivered through a new light guide system. Such light applicators coagulate constant tissue volumes in a homogeneous manner, as proven by in vitro studies in different tissues, including surgically removed prostate adenoma. The extent of the coagulation is determined by laser power and irradiation time. At 5 W, for example, and during a 10-min period, this zone reached a diameter of up to 20 mm. Temperatures generated in the process were over 100 degrees C, as measured by time/space resolution. These results were confirmed by in vivo studies in canine prostates. In the course of 7 weeks, the coagulated areas formed scars with degeneration and fibrosis, accompanied by marked shrinking. Neighbouring organs were not affected. The method was successfully transferred to clinical practice. The application of the light guides to the lateral lobes was performed percutaneously from the perineum under transrectal ultrasound guidance. The median lobe was punctured transurethrally under direct vision. Twenty-seven patients with an average age of 67.7 years were treated between July 1991 and March 1992. At the time of evaluation 15 patients had a follow-up of more than 2 months. They experienced a mean increase of peak flow rate from 6.6 to 15.2 ml/s and a mean decrease of residual volume from 206 to 38 ml. This was accompanied by a marked lessening of symptoms. The average prostate weight decreased from 63 to 44 g. Sexually active patients did not experience retrograde ejaculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulated high frequency diathermy for bipolar electrocoagulation--a new method for the treatment of carcinoma of the bladder.

In the endoscopic treatment of bladder cancer, especially for stages beyond T2, transurethral resection does not seem to be sufficient. The risk of bladder wall perforation, the possibility of incomplete resection, seeding of tumor cells and high recurrence rates support the former statement [6]. Results of a multicentre prospective randomised study have exemplified that irradiation with the Neodymium-YAG Laser has been a reasonable alternative in the therapeutic approach to bladder cancer [2]. Diathermy coagulation must produce a sufficiently deep, homogeneous and well demarcated tissue necrosis. The coagulation depth has to be adjustable and heat production during coagulation should not lead to bladder wall perforation and consequent damage to the bowel. These criteria were investigated using regulated bipolar high frequency diathermy. The innovation in this method is, that thermal side effects on the tissue, e.g. vaporisation and carbonisation are prevented by a protective relay with constant current flow. Animal experimental studies have shown that this method meets all postulated requirements and therefore clinical trials can proceed.

Penile cancer. Aspiration biopsy cytology for staging.

Appropriate management and prognosis of patients with penile carcinoma depends on an accurate knowledge of the regional node status. The usefulness of clinical and radiologic examinations in detecting the nodal spread of the disease is limited by the high rates of false-positive and false-negative results. On the other hand, routine or prophylactic lymphadenectomy is associated with 30% to 50% of the major morbidity and 3% of the mortality rate, so that caution is advisable for its use in patients with disease-free nodes. Even bilateral sentinel lymph node biopsy, as proposed by Cabanas, does not warrant an adequate selection of patients candidates to surgical treatment. The role of aspiration biopsy cytology in the management of penile carcinoma was evaluated in a study of 29 cases from the authors' institutions. Aspiration under fluoroscopic or computed tomographic guidance was performed using a 22-23-gauge Chiba needle. The accuracy of aspiration biopsy cytology in identifying the true stage of the disease was 100%. On histologic control, only one node contained malignant cells that were not detected by aspiration biopsy cytology, but this finding did not alter the stage of the patient. Positive cytology is conclusive of Stage III disease and, in this case, a curative lymphadenectomy may be attempted. Negative aspirations do not warrant the absence of metastatic nodal involvement as can be seen in two patients in this series. In such cases, however, a policy of "wait and watch" may be adopted, with repeated aspiration biopsies or surgical biopsy of the sentinel node area.

Value of the neodymium-YAG laser in the therapy of penile carcinoma.

Mutilation with associated functional losses characterizes current therapy of penile carcinoma. In addition, the recurrence rate is extremely high. Treatment with the neodymium-YAG laser provides a new therapy concept for T1 and T2 tumors, namely devitalization of all tumor cells with minimal tissue ablation. Following excision of the actual tumor, the base and margins of the excision are subjected to deep thermal denaturation without tissue removal. Over a mean observation period of 5 years, no local recurrence was found in 17 patients treated with this technique; only 1 patient died of metastases that remained undetected during primary staging.

Prevention of anaphylactoid reactions after radiographic contrast media infusion by combined histamine H1- and H2-receptor antagonists: results of a prospective controlled trial.

In a prospective randomized trial, 800 patients undergoing intravenous urography were pretreated with either intravenous prednisolone (group I), the H1-antagonist clemastine (group II), a combination of clemastine and the H2-antagonist cimetidine (group III) or 0.9% saline (group IV). There was an overall incidence of 18 - 19% side reactions, when subjective and objective symptoms were regarded together. There was no significant difference between the four groups in the total incidence. The same applies when considering subjective side effects including the symptom 'heat sensation' that occurred in 10 - 12% of all patients. However, when side effects excluding the symptom 'heat sensation' were regarded and the individual groups were compared, there was a significant difference in frequency between the control group (12%) and the combined H1/H2 group (6%). Prednisolone and clemastine did not produce a significant reduction of side effects. The combined application of histamine H1- and H2-antagonists might be useful in prophylaxis of radiographic contrast media-induced adverse reactions.

Controlled bipolar high-frequency coagulation for transurethral application: a new method for the destruction of urinary bladder tumors.

The coagulation of small bladder papillomas or of the resection base after transurethral resection by unipolar high-frequency current has turned out not to be sufficiently radical so far. There is no definite and reproducible correlation between the achieved biological effect. Bipolar high-frequency current produces the desired necrosis in the deeper layers of tissue. When providing the high-frequency generator with a new experimental automatic control equipment, reproducible deep and homogeneous necrosis of the tissue can be achieved without taking a great deal of time. Moreover, adherence of the probe and carbonization are prevented. First, the experiments had been carried out in vitro on livers of cattle and secondly, in vivo on canine livers. By the conventional unipolar high-frequency coagulation a reproducible and homogeneous necrosis cannot be achieved. With the regulated high-frequency coagulation, however, we are able to produce homogeneous tissue necroses up to a depth of 7 mm, the extension of which can definitely be assigned to the adjusted technical parameters. The electrodes do not adhere, since carbonization does not occur because of the automatic control. Premature interruption of the coagulation process, even if the generator is adjusted too high by mistake, can be considered a further advantage of this protective switch. A first clinical experience is reported.

Transurethral laser coagulation for treatment of urinary bladder tumors.

Owing to the biophysical properties involved, the Nd:YAG laser is most suited for coagulation of even inhomogeneous tissue. We determined the optimal laser parameters for therapy of urinary bladder tumors. Deep homogeneous necroses can be obtained without perforation risk of the bladder wall, and the procedure does not cause dangerous damage to the intestinal loops. We have studied animal experiments by close examination and systematic inquiry, and thus we were able to determine sufficient laser parameters in dependence on tissue thickness. Clinical studies verified these results for living human tissue. After some years of clinical use of the Nd:YAG laser we can make the first statistical statements.

[Differential diagnosis of testicular neoplasms. Tumorous and clinically tumor-like diseases of the scrotum]. / Differentialdiagnose des Hodentumors. Tumoröse und klinisch tumorartige Erkrankungen des Skrotalfachs.

The observation of a case of inguinal omental hernia with marked peritoneal carcinosis treated by operation for suspected testicular tumor leads us to discuss systematically the differential diagnosis of tumors and tumor-like conditions of the scrotal region. In order to analyse the frequency and importance 420 cases of ours were reconsidered. Of these 30 had been admitted to our hospital because of suspicion of tumors of the testis. The diagnosis on admission and after morphological analysis by the pathologist are compared.