Mitchell Edson

The value of serial measurement of both human chorionic gonadotropin and alpha-fetoprotein for monitoring germinal cell tumors

Quantitative serial serum measurements of human chorionic gonadotropin (hCG) and alpha‐fetoprotein (AFP) levels using sensitive double‐antibody radio‐immunoassays were performed in nine patients with germinal cell tumors before and during treatment. The sera of eight of the nine were found to have a hCG marker and five of the nine an AFP marker. The sera of four patients were found to have both. Serial serum levels of hCG, of AFP, or both were useful for monitoring disease activity during therapy in all nine patients. In two patients tumor masses failed to diminish during chemotherapy, but the tumor markers fell appropriately. At surgery one patient had a mature teratoma, the other a mature teratoma with a microscopic focus of an embryonal cell tumor. In one patient tumor reactivation was reflected by the emergence of only one of two previously elevated tumor markers. One patient had a rise in hCG, another a rise in both markers coincident with recurrence of tumor. Serial measurements of AFP and hCG are useful for following the response to therapy of germinal tumors, and can assist in making therapeutic decisions.

Plasma testosterone, luteinizing hormone, and follicle-stimulating hormone after vasectomy.

Plasma testosterone, LH, and FSH were measured in 24 healthy subjects prior to and after bilateral vasectomy. No significant changes were noted in any of the hormones 42 and 87 days after surgery; this indicated that normal testicular function persisted during the period of study.

Bone marrow acid phosphatase: another look.

Recent reports have indicated that bone marrow acid phosphatase is the most sensitive test in detecting bony metastases. The experience reported herein suggests that falsely positive results may be common, especially in patients with primary hematologic disorders. A plea is made that caution be given to the interpretation of this test so that some patients will not be denied appropriate therapy and the role of bone marrow acid phosphatase can be better defined by long-term followup in such patients.

Bilateral testicular dislocation with unilateral rupture.

A case of bilateral luxation of the testes associated with testicular rupture is presented. Bilateral traumatic dislocation of the testes is uncommon and its association with testicular rupture has not been reported previously. The etiology, classification and treatment of testicular luxation are reviewed briefly. Reports in the literature have indicated initial non-operative management but our case demonstrates the need for early surgical exploration.

Duraphase Penile Prosthesis-Results of Clinical Trials in 63 Patients

The Duraphase penile prosthesis was implanted in 63 patients at 4 investigative sites during clinical trials. This device is a semirigid rod that is bendable and provides good support to the erection. Mechanical complications included 4 instances of cable breakage rendering the device nonfunctional. Of 57 patients questioned 55 were pleased with the results after 4 months. Ease of insertion and exceptional bendability are other features that make this device attractive.

Testis Cancer: The Pendulum Swings. Experience in 430 Patients

A review of 430 patients with testis cancer followed for at least 3 years is presented. A protocol for actinomycin D therapy before and after node dissection had been instituted in 1966. In the 58 protocol cases studied there appeared to be an increase in the survival of patients with stage A disease and a significant increase in the survival of patients with stage B disease. There was an improvement in the survival of patients with stage C disease treated with actinomycin D alone. Since 1976 all patients with stages B and C disease have been treated with multiple drug regimens, showing dramatic results. The therapy of testis tumors is multimodal, using lymphadenectomy, radiation therapy and chemotherapy, but the pendulum has swung so that chemotherapy has assumed the vital role in management.

THE VALUE OF SERIAL MEASUREMENT OF BOTH HUMAN CHORIONIC GONADOTROPIN AND ALPHA- FETOPROTEIN FOR MONITORING GERMINAL CELL TUMORS

Quantitative serial serum measurements of human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) levels using sensitive double-antibody radioimmunoassays were performed in nine patients with germinal cell tumors before and during treatment. The sera of eight of the nine were found to have a hCG marker and five of the nine an AFP marker. The sera of four patients were found to have both. Serial serum levels of hCG, of AFP, or both were useful for monitoring disease activity during therapy in all nine patients. In two patients tumor masses failed to diminish during chemotherapy, but the tumor markers fell appropriately. At surgery one patient had a mature teratoma, the other a mature teratoma with a microscopic focus of an embryonal cell tumor. In one patient tumor reactivation was reflected by the emergence of only one of two previously elevated tumor markers. One patient had a rise in hCG, another a rise in both markers coincident with recurrence of tumor. Serial measurements of AFP and hCG are useful for following the response to therapy of germinal tumors, and can assist in making therapeutic decisions.