The use of color duplex ultrasound and magnetic resonance imaging in the dissolution of idiopathic recurrent priapism in patient with congenital penile curvature--a case report.

Priapism, penile erection characterized as prolonged and devoid of sexual stimulation or excitement is a rare condition. It is critical to distinguish between low- and high-flow priapism, because the treatment algorithm differs markedly for these 2 conditions. The diagnosis is made clinically and confirmed with color Doppler ultrasonographic imaging (CDUS). We present a 21 year old men with high-flow priapism and left lateral congenital penile curvature. A duplex Winter shunt procedure was employed with corporeal irrigation of heparin solution and adrenalin solution instillation, but the priapism returned 12 hours after. Following several days slow instillation of phenilephrine or adrenaline solution accompanied by oral flutamide therapy resulted in complete detumescence. We used both CDUS and magnetic resonance imaging (MRI) before and after treatment of priapism. Although CDUS has been the primary modality for cross-sectional imaging of the penis, the superior soft-tissue contrast and spatial resolution afforded by MRI provide an opportunity to advance imaging evaluation of this organ.

Paraganglioma of the urinary bladder--clinicopathological, immunohistochemical and electron microscopy analysis--a case report.

Tumors that grow within the adrenal medulla are called pheochromocytoma; when located extra-adrenal, they are called paraganglioma. Paraganglioma of the bladder are very rare, with only 180 reported cases. Less than 30 were malignant. We report a case of a 72-years old man with bladder paraganglioma who presented with painless hematuria. Urgent transurethral resection (TUR) was performed. Definitive pathohistological diagnosis was confirmed to imunohistochemical and electron microscopy. Clinical diagnostic showed normal value of epinephrine and norepinehrine in the urine. Scintigraphy of entire body and targeted pictures of pelvis where taken 24, 48 and 72 hours after administration of RI. No loci of pathologic accumulation of 131-I MIBG where found. Computer tomography (CT) of pelvis and abdomen were normal. Considering staging and pathohistological analysis, we treated our patient with TUR and longtime follow-up afterworth.

Extracorporeal fertilization in the world and in Croatia.

AIM: To point out the dangers, side effects and risks of medical assisted fertilization, in vitro fertilization, embryo transfer and injection on sperm in ovum for mother and the child. RESULTS: On the one hand the negative side effects for women of an abrupt rising risk for the development of neoplasm under pharmaceutical therapy are mentioned. Especially under a therapy which has the purpose to stimulate the ovulation of the ovary it lies around 100%. An increased level of certain hormones, as for example HCG, which influences the ovulation, is closely related with the risk of developing ovarian cancer. Clinical studies at more than 12000 infertile women (primary and secondary acyesis), with an average age of 30 years, show an elevated risk for the development of a malignant tumor of 98%. Also the application of Gonadotrophin is connected with a risk of 146% for the occurrence of cancer after a period of 15 years. FDT involves a risk of about 12% for the occurrence of breast cancer and shows also an aggravation for the risk of cancer of the endometrium from 79% up to 1152%. On the other hand the risk of spontaneous miscarriages under MAF, which is near 20%, and serious illness of the children, including 47% with need of intensive care unit support after birth, need to be realized. Furthermore the investigation of naturally obtained twins and through ART obtained twins shows in the arrangement a slower and poorer development of the children in the ART group with also great differences in physical development. In total the number of inherent malformation of newborns under the use of ART rises from 47 to 177%. With an installment of 9% we notice that children who came into being by IVF and ICS also fall more frequently ill. (Teething troubles, more hospitalizations and operations, higher frequency of major inherent malformations). CONCLUSION: All women who want to undergo a medical assisted fertilization should be informed about the side effects and risks for mother and child.

Metastatic prostate cancer in an asymptomatic patient with an initial prostate-specific antigen (PSA) serum concentration of 21,380 ng/ml.

BACKGROUND: Prostate cancer is the second most common cause of cancer death in men, being responsible for approximately 13% of all cancer deaths. Due to the high specificity for prostate tissue, prostate-specific antigen (PSA) is the primary serum tumor marker for prostate cancer. To our knowledge, in published data, the highest reported PSA level on initial presentation was 5,666 ng/ml. CASE REPORT: We present a 64-year-old Caucasian man with no specific urologic or pain symptoms and with an initial PSA serum value of 21,380 ng/ml. Initial laboratory studies showed chronic anemia and elevated alkaline phosphatase, most likely from bone marrow infiltration due to metastatic disease. Prostate biopsies diagnosed an adenocarcinoma of the prostate (Gleason score 9). Computed tomography (CT) showed multiple liver metastases with retroperitoneal lymph nodes of up to 1 cm. The prostate was moderately enlarged (estimated weight 35 g). Both kidneys were normal (no hydronephrosis present). A bone scintigraphy demonstrated diffuse osseous metastasis. Treatment was initiated with bilateral subcapsular orchiectomy and bicalutamide therapy in an effort to create total androgen blockade. After 3 months of follow-up, the serum concentration of PSA was 29 ng/ml. CONCLUSION: This case presents an asymptomatic prostate cancer patient with bone and liver metastasis, enlarged retroperitoneal lymph nodes and the highest PSA level published to date.

Comparison of fetal plasma cortisol level between eutrophic and hypotrophic newborns.

We tested two groups of singletons born at term: fifty-six eutrophic newborns and 56 hypotrophic subjects. They were selected randomly from all newborns delivered by vaginal route between 8 and 14 hours. Excluded were preeclampsia, diabetes, labours longer than 12 hours and newborns with malformations. Written informed consent was obtained from all women and data were collected before and after labour. Umbilical cord blood samples were obtained immediately following the delivery and plasma cortisol concentrations were measured by radioimmunoassay. The groups did not differ significantly regarding maternal age, parity, gestational age and Apgar score, but birth weight was significant differed (p < 0.001). In addition, eutrophic newborns had significantly elevated cortisol levels (457.7 nmol/L, 321.8-696.6 nmol/L) compared with hypotrophic newborns (320.5 nmol/L, 215.1-578.7 nmol/L, p < 0.001). The role of fetal cortisol in intrauterine growth restriction (IUGR) pregnancy and labour is uncertain, but fetal plasma cortisol levels may be lower in IUGR newborns.