Lars Dæhlin

Direct effects of oestradiol on growth and morphology of the dunning R3327H prostatic carcinoma

SummaryMale Copenhagen x Fischer F1 rats were implanted with Dunning R3327H prostatic carcinoma, castrated when the tumours became palpable and were then treated with testosterone, testosterone in combination with oestradiol or oestradiol alone for four weeks. Treatment with oestradiol produced the smallest tumours. The testosteronestimulated growth of tumours was inhibited by oestradiol. The adenocarcinoma was moderately to well-differentiated. Morphometric analysis of the composition of the tumours showed that oestradiol stimulated tumour stroma and inhibited glandular epithelium. These effects were produced concomitantly with decreased overall tumour growth. Testosterone stimulated all cell types of the tumour.

Transurethral microwave thermotherapy in the management of lower urinary tract symptoms from benign prostatic obstruction: follow-up after five years.

Objective: This study reports on a 5-year follow-up after transurethral microwave thermotherapy (TUMT) from benign prostatic obstruction using a lower power treatment protocol. Material and methods: Ninety-one patients with uncomplicated benign prostatic obstruction were treated in a 1-h session using the PRIMUS U + R device. Results: Twenty-nine (32%) of the patients were evaluable after 5 years, while 42 had received additional treatment for their lower urinary tract symptoms. In the 29 patients without additional therapy after TUMT, the decrease in the International Prostate Symptom Score was 37% compared with the pretreatment value. A moderate increase in peak uroflow, seen 1 year after TUMT, was not confirmed in an extended follow-up. Patients still on TUMT monotherapy after 5 years had smaller prostates from the outset than the group receiving additional treatment. No serious side-effects were observed. Conclusion: Lower power TUMT has a symptomatic effect of limited duration in most cases; in the long-term perspective only a minority of patients will benefit from this treatment.

Direct Inhibitory Effects of Natural and Synthetic Oestrogens on Testosterone Release from Human Testicular Tissue in Vitro

Human testicular slices were incubated in vitro in order to examine the direct effects of natural and synthetic oestrogens on testosterone secretion. In the presence of human chorionic gonadotrophin (10 IU per ml), oestradiol-17 beta (1 or 10 micrograms per ml) and ethinyl oestradiol (0.1, 1 or 10 micrograms per ml) inhibited testosterone release into the media in a dose dependent manner. The addition of estramustine phosphate, estromustine, diethylstilboestrol or diethylstilboestrol diphosphate in comparable concentrations produced no significant effects on testosterone release.

Depressed Testosterone Release From Testicular Tissue in Vitro After Withdrawal of Oestrogen Treatment in Patients with Prostatic Carcinoma

Bilateral orchiectomy was performed in patients with prostatic carcinoma after oestrogen treatment for different periods of time. Testicular slices were incubated in vitro to examine the effect of previous oestrogen treatment on testosterone production. After short-term treatment, the testicular tissue responded to human chorionic gonadotrophin by testosterone production. This was in contrast to long-term administration of oestrogen which induced arrest of testosterone synthesis. The results suggest irreversible changes of Leydig cell function after long-term oestrogen treatment.

Effects of Oestradiol-17β and Ethinyl Oestradiol on Human Testicular Steroidogenesis in Vitro

The inhibition of human testicular testosterone production in vitro by oestrogen was studied by measuring effects of oestradiol-17 beta and ethinyl oestradiol on the 3 beta-hydroxysteroid dehydrogenase/isomerase and the delta 4-pathway of testosterone synthesis. Progesterone, 17 alpha-hydroxyprogesterone, androstenedione and testosterone concentrations of incubation media were all depressed after oestrogen addition. To minimize differences in substrate amounts between incubations, 3H-labelled pregnenolone, progesterone, 17 alpha-hydroxyprogesterone or androstenedione was added to the incubation media. The conversion of pregnenolone, progesterone and 17 alpha-hydroxyprogesterone was inhibited by oestrogen. It is concluded that oestrogen inhibits 3 beta-hydroxysteroid dehydrogenase/isomerase, 17 alpha-hydroxylase and C17-20-lyase enzyme activities of human testicular tissue in vitro while 17 beta-ketosteroid reductase activity is unaffected.

Surgical management of chylous fistula after retroperitoneal lymph node dissection.

Conservative treatment with low-fat diet, medium-chain triglyceride or total parenteral nutrition, depending on the general condition of the patient, is the mainstay in the treatment of chylous ascites. In patients with persistent chylous fistula direct surgical closure is a valid treatment option.

Interstitial laser coagulation and transurethral needle ablation in the management of lower urinary tract symptoms due to benign prostatic obstruction.

Interstitial laser coagulation and transurethral needle ablation, two different techniques for heat-treatment of symptomatic benign prostatic hyperplasia, are outlined. Both treatments have been performed in sedoanalgesia. The results of this research and data from the literature show that both treatment modalities have a marked effect on symptoms. Objective parameters, such as uroflow, are moderately changed postoperatively. The side-effect profiles appear favourable, especially with respect to bleeding per- and post-operatively. However, further long-term data is required.Interstitial laser coagulation and transurethral needle ablation, two different techniques for heat-treatment of symptomatic benign prostatic hyperplasia, are outlined. Both treatments have been performed in sedoanalgesia. The results of this research and data from the literature show that both treatment modalities have a marked effect on symptoms. Objective parameters, such as uroflow, are moderately changed postoperatively. The side-effect profiles appear favourable, especially with respect to bleeding per- and post-operatively. However, further long-term data is required.

Effects of ethinyl oestradiol/polyoestradiol phosphate and estramustine phosphate on some proteins related to haemostasis in prostatic carcinoma patients

Twenty-four previously untreated patients with carcinoma of the prostate were prospectively randomized to one of the following treatments: (1) ethinyl oestradiol combined with polyoestradiol phosphate (EE/EP); (2) estramustine phosphate (EM); (3) bilateral orchiectomy. The effects on some plasma proteins related to haemostasis were studied by measuring the concentrations of alpha-1-antitrypsin, orosmmucoid, haptoglobin, antithrombin III, C1-inhibitor and von Willebrand’s factor before and 3 months after the start of treatment. Orchiectomy induced a reduction of alpha-1-antitrypsin and haptoglobin, while the other studied proteins were unaffected. It was found that both EE/EP and EM treatment induced significant decreases of orosomucoid, haptoglobin, antithrombin III and C1-inhibitor, while the same treatment increased the plasma concentration of alpha-1-antitrypsin. None of these treatments showed any influence on the plasma concentration of the von Willebrand factor. No differences were observed between EE/EP and EM for any of the studied proteins, suggesting comparable oestrogenic effects of these forms of treatment in patients with prostatic carcinoma. The findings are discussed in relation to the proposed difference in thromboembolic complications between EE/EP and EM treatments of prostatic carcinoma patients.