Gonadal and sexual function in men treated for childhood cancer.

BACKGROUND: Insofar as a majority of children with malignant diseases are cured, the late effects of treatment are of major importance. PROCEDURE: A retrospective study was conducted of gonadal and sexual function of 77 adult male survivors of childhood malignancies treated and cured at a single center from 1970 to 1989 and followed for a median of 13 years. The study included an interview, physical examination, sperm test, and hormonal analyses. RESULTS: One-third of the patients were treated for hematological malignancies, one-third for CNS tumors, and one-third for other malignancies. Eleven patients required androgen substitution after treatment for tumors of the pituitary-hypothalamic region or acute lymphoblastic leukemia including testicular irradiation and/or orchiectomy. In three patients the testicles were removed. The other eight had small testicles, and those providing sperm samples had azoospermia, and sexual function was disturbed in most of them. Most of the remaining 66 patients had small testicles. Normozoospermia was found in 63%, oligozoospermia in 20%, and azoospermia in 17%. Although there was a highly significant correlation between testicular volume and sperm test, 25% of patients with testicles of <10 ml had normozoospermia. Sexual function was normal in 46 patients, and they were married at a frequency comparable to the normal population. Twenty-one patients had no signs of gonadal dysfunction. CONCLUSIONS: Patients treated for tumors in the hypothalamic-pituitary region or treated with testicular irradiation or with high doses of alkylating agents had severe gonadal and sexual dysfunction. Most of the other patients had good prospects for preserved gonadal and sexual function.

The bacterial flora of the genitourinary tract in healthy fertile men.

The clinical significance of microorganisms in semen is unclear, as they may signify contamination rather than infection. Specimens from six locations in 97 healthy men scheduled for vasectomy were analyzed. Totally 1033 strains, aerobic or anaerobic, were isolated. Of 61 intraoperatively obtained vas deferens cultures, only one was positive. Of the 97 semen samples, 83% contained bacteria, 140 aerobes and 113 anaerobes; 44% of the strains found in semen and 58% of those in prostatic secretion were also identified in the urethra. The finding that 71% of the strains colonizing the coronal sulcus were present in the urethra indicates that the distal part of the urethra is colonized by a bacterial flora similar to that in the sulcus. The urethral flora may then contaminate semen and prostatic secretion. Presence of multiple bacterial species in semen was not associated with abnormal sperm function.

Patterns of glycosaminoglycan/proteoglycan immunostaining in human skin during aging.

Proteoglycans and their component glycosaminoglycans are involved in such cell-cell and cell-matrix interactions as cell adhesion and migration, processes that are essential for embryonic and fetal development. As definitive organs such as skin emerge, structurally different proteoglycans partition into highly defined compartments. In skin, these compartments correspond to morphologically and functionally distinct layers. However, during the normal aging process, the relative amounts of structurally distinct proteoglycans apparently varies independently in each of these layers. This was demonstrated, in an indirect immunocytochemical study, through the use of monoclonal antibodies that detect structurally distinct domains in glycosaminoglycan chains of proteoglycans. Using samples of normal human skin obtained from individuals ranging in age from 20 weeks of gestation to 98 years of age, we determined that a common distribution pattern existed in skin. The epidermis contained chondroitin 4- and keratan sulfates, the basal lamina was the only layer that contained chondroitin 6-sulfate, the papillary and reticular dermis contained principally dermatan sulfate. In addition, antibodies that recognize native domains in chondroitin sulfates identified proteoglycan subsets that partitioned into distinct layers. An important new finding was that the relative amounts of specific types of glycosaminoglycans varied in an age- and layer-dependent manner. In the epidermis there was a notable increase in keratan sulfate beginning at age 50. Chondroitin 6-sulfate, found principally in the basal lamina, decreased after age 60. In the papillary dermis, the amount of dermatan sulfate increased after age 50, whereas the amount of novel chondroitin sulfate epitope, detected by antibody 4C3, decreased with age. Thus, age-related changes in proteoglycan distribution exist and correlate with morphologic and functional changes that occur in the intrinsic process of aging in human skin.

Esthesioneuroblastoma: cerebrospinal fluid rhinorrhea and widespread metastasis.

Esthesioneuroblastoma, a tumor of neural crest origin arising in the nasal cavity, is uncommon, may be difficult to diagnose, and frequently is not cured. We report a case that was originally diagnosed as an inflammatory polyp and recurred with extension into the anterior cranial fossa. Surgery and radiotherapy were followed by local recurrence and cerebrospinal fluid rhinorrhea. Despite initial negative results of investigation for metastases, recurrence appeared in cervical nodes and was followed by widespread bone, soft tissue, and cerebral metastasis. There was no response to multiple-agent chemotherapy. The results of surgery, radiation, and chemotherapy in this rare and lethal tumor are reviewed.