睾丸切除联合最大雄激素阻断（MAB）治疗中晚期前列腺癌的疗效观察

目的：比较单纯睾丸切除与睾丸切除后联合最大雄激素阻断（ maximum androgen blockade,MAB）治疗中晚期前列腺癌的临床疗效。方法将38例中晚期前列腺癌患者划分为两组。第一组为单纯睾丸切除治疗,共17例;第二组为睾丸切除加最大雄激素阻断（ MAB）治疗,共21例,比较两组患者的血清前列腺特异性抗原（ PSA）、尿流率、前列腺大小及生存时间和质量。结果睾丸切除联合最大雄激素阻断组治疗后患者的生活质量明显优于单纯睾丸切除治疗组;而且两组在治疗12个月后,尿流率较治疗前均显著增高,血清PSA水平均显著降低,前列腺体积均明显缩小,睾丸切除联合最大雄激素阻断疗法降低血清中PSA水平效果更佳。结论睾丸切除联合最大雄激素阻断治疗中晚期前列腺癌,不仅可延长患者生存时间,还可以提高患者生存质量。     

2005年欧洲泌尿外科会议睾丸肿瘤诊断治疗指南

睾丸肿瘤诊断治疗指南是欧洲泌尿外科学会（EUA）制订的泌尿外科肿瘤诊治指南之一，并经EUA肿瘤外科工作组批准，于2005年在土耳其伊斯坦布尔召开的年会上通过。该指南的公布可以为我国治疗睾丸肿瘤提供诊断及治疗的参考依据，现将该指南翻译整理如下。     

去势对戊四氮点燃大鼠癫痫模型的行为学表现

目的 研究去势对戊四氮点燃大鼠癫痫模型行为学表现的影响.方法 采用戊四氮腹腔注射制作癫痫大鼠模型,对照研究去势大鼠同正常大鼠的潜伏期及持续时间等行为学表现.结果 大鼠癫痫模型全部点燃,去势组平均潜伏期(8.09±0.89) min((-x)±SD)长于非去势组的(3.94±0.65) min((-x)±SD).发作时间也有所缩短,去势组(19.16 ±3.06) min((-x)±SD)略短于非去势组的(26.37±2.90) min((-x)±SD) (P ＜0.05).非去势组点燃时间明显短于去势组,非去势组平均点燃时间(20.83±6.15) d((-x)±s),而去势组平均点燃时间(24.6±5.64) d((-x)±SD).结论 戊四氮点燃大鼠致痫模型是一种成熟的、较为安全的癫痫模型.去势后,SD雄鼠较正常非去势SD雄鼠相比致痫潜伏期延长、持续时间缩短、发作频率及程度减轻,点燃时间也明显长于正常SD雄鼠.     

睾丸脱位六例诊断及治疗分析

目的探讨创伤性睾丸脱位的诊断及治疗方案的选择。方法对6例创伤性睾丸脱位患者的临床资料进行回顾分析。结果6例患者首次就诊确诊仅1例。2例受伤早期(2 h和3 d)行手法复位成功;3例伤后1~6个月的患者行切开复位及睾丸固定;1例脱位于腹腔内的患者,睾丸萎缩,行睾丸切除。结论睾丸脱位漏诊率高,结合病史及体检可以早期确诊。受伤早期可首选手法复位,若手法复位不成功应尽早行切开复位;陈旧性病例,切开复位的时机宜选择在创伤3个月后;对于脱位时间较长,发生萎缩或可疑恶性变者,应行睾丸切除。     

Orchiectomy or testosterone receptor blockade reduces intestinal mucosal damage caused by ischemia-reperfusion insult

The aim of the present study was to investigate whether orchiectomy or administration of flutamide an antagonist of the testosterone receptor can reduce oxidative stress and histologic damage in the rat small bowel subjected to mesenteric ischemia/reperfusion (I/R) injury. A total of 32 Sprague-Dawley rats were divided into four groups. Group 1 was control (sham), group 2 was I/R, group 3 was I/R plus orchiectomy (orchiectomy was performed 14 days before I/R), group 4 was I/R plus flutamide (flutamide was given throughout 14 days before mesenteric IR). Rats were subjected to 45 min of mesenteric ischemia followed by 3 h of reperfusion. The levels of ileal malondialdehyde (MDA) and nitric oxide (NO) were found to be significantly lower in orchiectomy and flutamide treatment groups compared with I/R group (P < 0.05). The histopathological injury scores were consistent with the MDA and NO levels. These results suggest that castration or testosterone receptor blockade decreases the level of intestinal I/R injury in male rats and it is an another example for disease variations based on gender differences.     

The Use of MRI in the Pre-surgical Evaluation of Patients with Androgen Insensitivity Syndrome

BackgroundPatients diagnosed with androgen insensitivity syndrome (AIS) need bilateral gonadectomy (orchiectomy) for malignancy risk reduction. Imaging of the gonads (testicles) prior to surgery is recommended. Ultrasonography has typically been used. However, magnetic resonance imaging (MRI) provides better localization of the gonads and pre-surgical planning.CasesIn this case series, we describe how MRI was utilized in planning surgical gonadectomy in 3 patients with complete AIS and to review the literature regarding MRI and AIS.Summary and ConclusionsMRI prior to surgery was helpful in localizing and planning for removal of the gonads while preventing injury to other structures. Surgical specialists with experience with inguinal dissection were appropriately consulted when an inguinal dissection was likely to be needed to complete the gonadectomy.     

Inguinal orchiectomy for the extra testis with suspected tumor in a polyorchidic patient: a case report

A 29-years-old male patient presented with complaint of the small size of his left testicle. The physical examination revealed a normal right testicle with 15 cc volume, a small left testicle (5 cc) and a 4 cc mass under the left testicle, which was thought to be a spermatocele. Ultrasonographic imaging was performed and the mass was defined as a third testicle with a heterogenic epididymis. Scrotal magnetic resonance imaging (MRI) confirmed the diagnosis. An inguinal exploration was performed, which resulted in a left orchiectomy and biopsy of the superior left testicle. The pathologic examination revealed hyperplasia with microcystic changes in the orchiectomy specimen and severe hypospermatogenesis in the biopsy sample. There were no significant changes in semen analysis after the operation.     

Pleomorphic spermatic cord liposarcoma: A case report and review of management

Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades.We present a case of a liposarcoma of the spermatic cord in a 45-year-old male complaining of a progressive painless swelling in the right inguinoscrotal region. Ultrasonography and computed tomography findings were compatible with liposarcoma of the spermatic cord. We performed a right radical orchiectomy with a wide resection of the mass. Histological examination confirmed the diagnosis and showed a pleomorphic subtype.The mainstay of management of spermatic cord liposarcoma is wide excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant radiotherapy should be considered in cases at high risk for local recurrence. Long-term surveillance is mandatory.Liposarcoma of the spermatic cord is an uncommon para testicular tumor which should be part of the differential diagnosis of inguinoscrotal mass. A radical inguinal orchiectomy with wide resection of the soft tissue mass and the spermatic cord are the key to longest local and systemic disease-free survival.     

Endosseous implant anchorage is critically dependent on mechanostructural determinants of peri‐implant bone trabeculae

Low bone mass is highly prevalent among patients receiving endosseous implants. In turn, the implantation prognosis in low‐density skeletal sites is poor. However, little is known about the mechanostructural determinants of implant anchorage. Using metabolic manipulations that lead to low bone density and to its rescue, we show here that anchorage is critically dependent on the peri‐implant bone (PIB). Titanium implants were inserted horizontally into the proximal tibial metaphysis of adult rats 6 weeks after orchiectomy (ORX) or sham ORX. Systemic intermittent administration of human parathyroid hormone (1–34) [iahPTH(1–34)] or vehicle commenced immediately thereafter for 6 weeks. The bone‐implant apparatus was then subjected to image‐guided failure assessment, which assesses biomechanical properties and microstructural deformation concomitantly. Anchorage failure occurred mainly in PIB trabeculae, 0.5 to 1.0 mm away from the implant. Mechanically, the anchorage performed poorly in ORX‐induced low‐density bone, attributable mainly to decreased trabecular number. iahPTH(1–34) rescued the PIB density and implant mechanical function by augmenting trabecular thickness (Tb.Th). However, implant biomechanical properties in low‐density bone were relatively insensitive to implant surface treatment that affected only the osseointegration (%bone‐implant contact). These results support a model wherein anchorage failure involves buckling of the weakest trabecular struts followed by sequential failure of the stronger trabeculae. Treatment with iahPTH(1–34) induced thicker struts, which were able to delay and even prevent failure of individual elements, thus implicating trabecular thickness as a prime target for enhancing implant anchorage by systemic bone anabolic therapy. © 2010 American Society for Bone and Mineral Research.