[Castrati--everything to achieve fame]. / Kastraten--alles für den Ruhm.

The phenomenon of castration is wedded to the baroque era. This epoch stands for pure sensual pleasure. Those who could afford it tried to arrange their earthly days to be as enjoyable as possible. A perverse bloom of this ambition was the angel-like voices of the castrati. The supernatural sound of the voice was meant to let the opera visitors escape into another world. High society was almost addicted to those voices. On the other hand nobody showed any interest in the spiritual life of the castrati. Farinelli, Nicolini, and Senesino, three of the most famous castrati, were the first musical superstars of the eighteenth century. Their voices moved the decadent baroque audience to tears and enraptured them to the point of standing ovations. But the price for this fame was high. Only through castration in their early boyhood could this bell-like voice be kept. Because of the sensational success of the castrati, a huge wave of castration swept over Italy. Ambitious parents had their boys castrated, hoping that they would also become famous opera stars. It is estimated that in Italy alone over half a million boys were victims of this mutilating procedure during the eighteenth century. Because castration was officially forbidden it was done"behind closed doors" by untrained barbers and of course was associated with a high morbidity and mortality rate. The height of the castrati ended with the fading eighteenth century. The last castrato, Alessandro Moreschi, was engaged as a chorister and soloist at the Sistine Chapel in the Vatican. He was pensioned off by Pope Pius X in the year 1912 after an official ban on castrated singers was imposed. With that a very impressive part of music history had ended.

[Manifestation of malakoplakia in a urethral diverticulum in a female patient]. / Manifestation einer Malakoplakie im Urethraldivertikel der Frau.

We report about a rare case of malakoplakia in a female urethral diverticulum. A 25-year-old patient with a long history of recurrent urinary tract infections and a plum-sized, painful swelling on the vaginal roof presented for operative treatment. In the anamnesis the patient reported about two spontaneous perforations, emptying several millilitres of pus each time. After total operative excision using a vaginal approach the histology showed malakoplakia in a urethral diverticulum. We found the typical intracytoplasmatic "Michaelis-Gutmann bodies" as well as "von Hansemann cells". Postoperatively we excluded an underlying tumour disease or a chronic infection. The further urological diagnostics (cystoscopy and MRI) were without any pathological findings. In patients with atypical cystic tumours of the urogenital tract, especially with an immune deficiency, malakoplakia should be taken in consideration. The preferred therapy is surgical management followed by long-term antibiosis as well as a close follow-up as recurrences are frequent.

Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic.

PURPOSE: Pelvic lymphadenectomy remains the most reliable method to prove lymph node metastases in prostate cancer. However, evaluation of lymphadenectomy to be complete and sufficient as judged by the number of removed lymph nodes in hampered by the fact that, in contrast to other malignancies (for example breast or gastric cancer), anatomical studies investigating the regular and average number of pelvic lymph nodes are missing. We established an anatomically based standard for pelvic lymphadenectomy. MATERIALS AND METHODS: Standard pelvic lymphadenectomy was performed on 30 human cadavers and 59 consecutive patients with clinically organ confined prostate cancer during radical retropubic prostatectomy. Number, size and topography of the lymph nodes were noted separately for each anatomical region of both iliac fossas. RESULTS: The mean number of lymph nodes removed in the autopsy series plus or minus standard deviation (22.7 +/- 10.2, range 8 to 56) was nearly identical to that from patients with prostate cancer (20.5 +/- 6.6, range 10 to 37) but striking interindividual differences were observed. Patients with prostate cancer demonstrated enlarged nodes regardless of whether they did or did not contain tumor. Interestingly, pelvic lymph node metastases were more common on the left side regardless of the primary tumor site. CONCLUSIONS: Approximately 20 pelvic lymph nodes may serve as a guideline for a sufficient standard pelvic lymph node dissection. Lymphadenopathy in prostate cancer patients is not always a result of metastases but, rather, hyperplastic or regressive alterations. A preferential distribution of lymph node metastases along the left iliac vessels regardless of the primary tumor site in the prostate warrants further investigation.