Lethal somatostatin analog-induced acute necrotizing pancreatitis in a patient with hormone-refractory prostate cancer.

We report a fatal case of acute pancreatitis which developed in a 76-year-old male with hormone-refractory prostatic carcinoma who was being treated with lanreotide, a slow-release somatostatin analog.

Bilateral tumors of the testis in 21-alpha hydroxylase deficiency without adrenal hyperplasia.

Congenital 21-alpha hydroxylase deficiency is a syndrome characterized by a cortisol synthesis deficiency and, rarely, by testicular masses. We present a case of bilateral nodular hyperplasia of the testis without adrenal hyperplasia in a patient affected by 21-alpha hydroxylase deficiency. This mass mimicked a testicular tumor and made differential diagnosis with a Leydig cell tumor extremely difficult. Multiple hard nodules (1 cm in diameter) could be palpated in both testes but were more prominent on the right. After an unsuccessful 30-day trial of an adrenocorticotropic hormone suppression regimen with dexamethasone (0.5 mg/qid), a right total orchifunicolectomy was performed. The final histological diagnosis was that of multiple, well-circumscribed nodules consisting of cord-like and microalveolar-like gonadal stroma, typical of an adrenogenital syndrome, and fibrosis. Differential diagnosis between testicular nodules in patients with congenital adrenal hyperplasia and Leydig cell tumors is a major clinical challenge. In cases of cortisol suppression resistant testicular masses, a serum adrenal hormone profile obtained from the gonadal vein and histology of the testicular nodule (with parenchyma sparing surgery) are recommended to obtain a correct diagnosis.

Incidental discovery of ano-rectal disease during transrectal ultrasound performed for prostatic disease.

Transrectal ultrasound (US) has long been a routine investigation for the study of various diseases of the prostate. The use of 360 degrees transverse scanning probes and recently, of 3D probes, has been proposed as a suitable means of studying the rectal wall. Between January 1997 and February 2004, 3758 subjects suffering from lower urinary tract symptoms associated with micturition disturbances underwent transrectal ultrasound (TRUS) with a multiplane probe having a variable frequency ranging up to 7.5 MHz and, in the later period, with a transrectal 3D volumetric probe. In 489 patients (13%) TRUS yielded suspicious images of the rectal wall. This finding was verified by a proctologic and rectoscopic examination. In 132 cases (27%) it was shown to be a false positive, mainly due to imperfect cleansing of the anal canal; in 284 cases (58%) benign disease was demonstrated (hemorrhoids in 192 patients, abscesses in 21, perianal fistulas in 18, inflamed lymph nodes in 27, polyps in 16). In 34 patients (7%) a malignant tumor was found (infiltration of the anterior rectal wall by a prostatic adenocarcinoma in 13, and a primitive adenocarcinoma of rectal origin in the remaining 21). It can be concluded that transrectal US does not permit a certain diagnosis of the nature of rectal disease, but does raise a diagnostic suspicion that can orient the surgeon to schedule more invasive diagnostic investigations.

Clinical Evidence Supporting the Role of Lonidamine for the Treatment of BPH.

Glandular prostate epithelial cells of the peripheral zone are unique among normal cells in their dependence on glycolysis for energy production, due to a zinc-mediated enzymatic block in the citric acid cycle. Lonidamine (LND), a derivative of indazole-3-carboxylic acid, is thought to disrupt energy metabolism by interfering with glycolysis and to cause cell apoptosis. We evaluated the efficacy of oral LND treatment in subjects with symptomatic benign prostatic hyperplasia (BPH). The following reports the findings of an open-label study of orally administered LND. Thirty subjects with symptomatic BPH received oral LND (150 mg/day) once daily for 28 days. Subjects were assessed at baseline, at active-therapy assessment visits (days 14, 28), and 1, 2, 3, and 6 months post-therapy, for prostate volume (PV) by transrectal ultrasound (TRUS), maximum flow rate (Q(max)) on uroflowmetry, postvoid residual urine volume (PVR), International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, serum chemistry, and adverse events.

[Significance of scrotal Doppler color ultrasonography in the postoperative control of patients treated with varicocelectomy]. / Valore dell'eco colorDoppler scrotale nel controllo post-operatorio di pazienti operati di varicocelectomia.

ColorDoppler Ultrasound (CDU) is one of the principle methods in the post-operative diagnosis of recurring varicoceles. Aim of this study was valuate modifications of seminal parameters related to scrotal CDU results. In order to clarify varicoceles effect on fertility, these parameters have been related to pregnancy rate. We have studied 93 patients with varicoceles, undergone to venous "en bloch" legature from november 1994 to december 2000. Recurrence rate was 3.1% at post-operative scrotal CDU after 3 months. In patient with negative CDU, seminal quality improved (statistically significant results) and pregnancy rate was 41.4%. CDU has an important role in varicoceles, both at diagnosis and in post-operative follow-up. It is a quick and simple test, non-invasive and well-tolerated by patients. If associated with spermiogram, it is useful in order to show post-operative recurrences and surgical complications in patients treated with varicocelectomy.