M. Hatzinger

Standard operating procedures for vascular surgery in erectile dysfunction: revascularization and venous procedures.

INTRODUCTION The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the 20th century first results of penile venous ligation were published and in 1973 the first surgical attempts to restore penile arterial inflow were undertaken. Numerous techniques were published in the meantime, but inclusion criteria, patient selection, and success evaluation differed extremely between study groups. AIM To develop evidence-based standard operating procedures (SOPs) for vascular surgery in erectile dysfunction, based on recent state of the art consensus reports and recently published articles in peer-reviewed journals. METHODS Based on the recent publication of the consensus process during the 2009 International Consultation on Sexual Medicine in Paris, recommendations are derived for diagnosis and surgical treatment of vascular erectile dysfunction. In addition several recent publications in this field not mentioned in the consensus statements are included in the discussion. MAIN OUTCOME MEASURE The Oxford system of evidence-based review was systematically applied. Due to the generally low level of evidence in this field expert opinions were accepted, if published after a well-defined consensus process in peer-reviewed journals. RESULTS Referring to penile revascularization it may be concluded, that in the face of missing randomized trials, only recommendations grade D may be given: this kind of surgery may be offered to men less than 55 years, who are nonsmokers, nondiabetic, and demonstrate isolated arterial stenoses in the absence of generalized vascular disease. The evidence level for recommendations concerning penile venous ligations may be even lower. Too many unsolved controversies exist and universal diagnostic criteria for patient selection as well as operative technique selection have not been unequivocally established. This kind of surgery is still considered investigational but may be offered in special situations on an individualized basis in an investigational or research setting after obtaining written consent, using both pre- and postoperatively validated measuring instruments of success evaluation. CONCLUSIONS SOPs for penile revascularization procedures can be developed, concerning a highly selected patient group with isolated arterial stenoses. Based on the available data it is not yet possible to define SOPs for surgical treatment of corporal veno-occlusive dysfunction.

Ultrasound in endourology.

Ultrasonography was first used as a therapeutic aid in endourology in the early 1970s. Since that time, ultrasound has played an important role, and nowadays, interventional ultrasonography is an established procedure in urology. Procedures on the kidney, bladder, and prostate, which require different puncture techniques, are performed under ultrasound guidance. Today, extracorporeal shockwaves for the treatment of stones and Peyronies disease are applied under ultrasonic control. Furthermore, high-intensity focused ultrasound (HIFU) is used experimentally for the treatment of renal tumors and, clinically, for the treatment of prostate cancer. In urologic emergencies, diagnostic and interventional ultrasonography is an important tool. Interventional ultrasound in urology has become an outstanding tool for the planning and performance of a variety of procedures, and every urologist should be able to use these technologies.

Castrati Singers—All for Fame

INTRODUCTION The phenomenon of castration is very closely associated with the baroque era. In a period that placed emphasis on pure sensual pleasure, castrati singers, with their angelic voices, were a perverted outcome of this ambition. It was the intention that these castrato voices with their supernatural sound would mesmerize audiences. At that time, it could be said that within certain society circles, an addiction to these voices existed. Equally, they were oblivious to the spiritual side of the lives of the castrati. Farinelli, Caffarelli, and Senesino, three of the most famous castrati, were the first musical superstars of the 18th century. Their voices moved decadent audiences to tears and standing ovations. The price for this fame was, however, high. AIM The aim of this review is to provide an overview of castrati singers, especially in the baroque era, their sexuality and the effects of castration on their physical development. METHODS A literature search of relevant databases, books, and articles in journals was performed and compared with current data concerning androgen suppression and endocrine aspects of male sexual dysfunction. RESULTS The effects of castration on physical development were notoriously erratic. Much depended on the timing of the operation: boys pruned before the age of 10 or so very often grew up with feminine features; smooth, hairless bodies, incipient breasts, infantile penis, and often a complete lack of sex drive. CONCLUSION The peak success of the castrati ended with the end of the 18th century. The last castrato was Alessandro Moreschi, a solo singer in the choir of the Sistine Chapel of the Vatican. Following the ban on castration, Pope Pius X sent him into retirement in 1912, thus putting an end to a very impressive part of the history of music.

Prostatic metastasis from Intrahepatic Cholangiocarcinoma.

Background: Common tumor metastasis sites for intrahepatic cholangiocarcinoma (ICC) include regional lymph nodes as well as liver metastasis as an indication of tumor recurrence. The main route for the spread of tumor cells is generally via lymph vessels. This lymphatic pathway could be responsible for a rapid spread of the disease and the high lethality associated with ICC. Here we present a case report of the first described prostatic metastasis from primary ICC. Case presentation: A 77-year-old patient with a history of ICC who received mesohepatectomy (MH) with positive resection margins (R1) after initial surgery for a centrally located liver tumor presented to a tertiary hospital due to intermittent episodes of gross hematuria and obstructive micturition. During transurethral resection of the prostate (TUR-P) a large suspicious mass involving the left prostate lobe of prostate occurred. The histopathology report revealed a carcinoma showing the same histopathological and immunophenotypical features as the primary hepatic tumor. The patient develops an early tumor recurrence with metastases to the prostate, local lymph nodes and the liver after the primary surgical resection. He is now going to receive systemic chemotherapy as well as stereotactic radiofrequency ablation (SRFA) of liver for the liver metastases. Conclusion: This case report represents to our knowledge the first case of prostate metastasis from primary ICC.

WOLFGANG AMADEUS MOZART. THE DEATH OF A GENIUS

The early and unexpected death of Wolfgang Amadeus Mozart (Salzburg, 1756 - Vienna, 1791) was a mystery from the very first day and the subject of wildest speculations and adventurous assertions. Over the last 100 years, medical science has investigated the physical sufferings and the mysterious death of Mozart with increasing intensity. The aim of this article was to recreate Mozarts pathography relying on the his correspondence with father Leopold and sister Nannerl and on reports from his physicians and contemporaries. The rumour that Mozart was poisoned followed shortly after his death on 5 December 1791, at the age of 35, and has survived to this day. The alleged culprits were his physician van Swieten, Mozarts freemasons lodge, and the Imperial Chapel Master Salieri. Mozart however died of chronic kidney disease and ultimately of uraemia. If kidney damage reaches a critical point, even a minimum additional stress can lead to its failure. This usually occurs in the fourth decade of life. Next time we listen to Mozart, we should remember that this apparently happy person was actually a precocious boy, ripped of his childhood, whose short life was an endless chain of complaints, fatigue, misery, concern, and malady.