Concepts of the physiology of erection in the 16th and 17th century

493 URINARY LITHIASIS BENLLOCH GINER

IN THE UROLOGIC

WORK

OF DR. NICASIO

494 CONCEPTS OF THE PHYSIOLOGY I7TH CENTURY

OF ERECTION

CBnovas J.‘, Tramoyeres A.‘, Cao E.‘, L6pez A.‘, L6per P.‘, Zaragoza J.‘, PCrer M.’

Schlote N. Schultheiss ->

‘Hospital Universitario “Virgen Arrixaca”, Urologia, General Universitario, Urologia, Valencia, Spain

Hannover Medical School, Urology, Hannover,

Murcia,

Spain, ‘Hospital

INTRODUCTION

& OBJECTIVES: In the first half of the 20th Century Dr. Benlloch develops his educational and professional activity in Valencia. He obtains the title of medical specialist in Urology in the School Hospital Necker of Paris, together with the out-standing professor George Marion. He returns to Valencia, and as teacher of the faculty of Medicine of the above mentioned city and as boss of service of general Surgery, he exercises widely the urology and writes all his scientific work, in which is very significant the paragraph of the urinary lithiasis.

MATERIAL

& METHODS: All his scientific work has been analysed with the consistent analysis of his texts published in the principal medical magazines, especially “Policlinica” (“Polyclinic”), “Revista de Medicina, Cirugia y Especialidades” (“Magazine of Medicine, Surgery and Specialities”), where almost all his work has been published, as well as “Cateterismo Urinario, evacuatorio and exploratorio” (“Urinary catheterism, emptying and exploration”) that is a chapter of the book “Medicina Exploratoria” (“Exploratory Medicine) (Valencia, 1942), that constitutes his most famous work.

RESULTS: According to Dr. Benlloch, the treatment of the lithiasis is still an subject of doubt, since an organ as the kidney must be looked with respect and only to extirpate it when inevitable. There are three types of surgeries that can be practised in case of renal lithiasis: nefrolithotomy, pyelotomy and nephrectomy. His studies conclude that the kidney has the capacity to improve its function when a renal lithiasis has been removed, and that the nephrectomy must be used only for cases of advanced disease. In the paragraph of the functional exploration of the urinary system, Dr. Benlloch exposes the indications and contraindications of the intravenous pyelography. Finally, it is important to emphasise that Dr. Benlloch realized, together with Dr. Salvador Pascual Rios, the first ureterolithectomy in Spain. CONCLUSIONS:

Dr. Benlloch must be considered to be one of the principal prominent figures of Urology of the 20th century, given the extension of his work and his important medical activity, contributing to the development and consolidation of the Urology in Valencia in the years 1950.1970.

495 SIR HENRY THOMPSON: SCIENTIST, GOURMET, TRAVELER, CREMATIONIST UROLOGIST

Goddard J.C.‘. &born

ARTIST, MOTORIST, AND SUBSPECIALIST

IN THE 16TH AND

D., Stief C.G., Jonas U Germany

INTRODUCTION

& OBJECTIVES: Scientists of the early 16th century started off with contradictory knowledge of antique authors. Concepts of the physiology of erection were still based on the concept of erection being a result of pneuma. “Pars pro toto”. This presentation will highlight three “researchers” who changed the understanding of the erectile penis at that time.

RESULTS: Leonardo da Vinci (1452-1519) is known as one of the eminent artists of Renaissance as well as a genius of other sciences. His anatomical studies, although only in very few cases based on anatomical studies in the human body, are highly attractive because of their artistic quality. His understanding of human reproduction was inadequate but concerning erection of the penis he probably wrote the first scientific text suggesting a vascular mechanism of erection. His drawings and texts remained unpublished and therefore unknown for the next centuries. They did not influence further scientific development and are therefore only of historical interest. Costanzo Varolio (1543-1575) can be addressed as a true rediscoverer of the “musculi erectores penis”. These structures had already been described by Galen, but as this part of his writings was lost the knowledge again was also not available. Reading Varolio’s words on erection one will be amazed by his clear and modem concept of arterial blood inflow causing an erection. Regnier de Graaf (16411673) finally confirmed these ideas by performing a remarkable physiological experiment. The basis of this was the invention of the syringe and its use for intravasal injection of fluids. De Graaf produced an erection in a corpse by simply injecting water into the hypogastric arteries. His work was published in “De vivorum organis generationi inservientibus” in 1668. CONCLUSIONS: The knowledge on the physiology of erection demonstrates that the period of the 16th and 17th century was not only a rebirth of old knowledge but also the rise of modem science. Conclusions, at least for a good part, were made on anatomical and experimental observations, although this did not result in an effective treatment of erectile dysfunction at that time. 012 B~DERSPARING~DADJUV~T~~~OF~V~CEDURO~E~~MOU~ Friday,hkti 14,15.30-17.00 hrs,RonmNlD4

496

ADJUVANT CISPLATIN PLUS METHOTREXATE VERSUS METHOTREXATE, VINBLASTINE, EPIRUBICIN, AND CISPLATIN FOR LOCALLY ADVANCED BLADDER CANCER: RESULTS OF A RANDOMISED, MULTICENTER PHASE III STUDY IN GERMANY

D.E.’ Lchmann J.L.‘. Retz M.R.‘. Wcllck S.W.‘, Stb;ckle MS.’ and Trial Participanta

‘Pilgrim Hospital, Urology, Boston, United Hospital, Urology, Leicester, United Kingdom

Kingdom,

‘Leicester

General

The successful lithotrity of The King of the Belgians’ bladder stdne made Henry Thompson famous in 1863 and it is what he is remembered for now. This however, belittles the career and life of a most fascinating polymath. Born in Framingham in 1820 he took up his father’s career as a tallow chandler and it was not until he was 28 that he entered University College to pursue his chosen vocation as a doctor. Twice awarded the Jacksonian prize for essays on urethral stricture (1852) and prostate disease (1860), he had a distinguished life as a surgeon. Studying under Civiale in Paris he learnt the use of the lithotrite for closed removal of bladder stones and his specialist interest remained the lower urinary tract. Thompson’s fame was not only due to his skill as a surgeon; a man of many interests he aspired to become a notable expert in almost every one. As a prolific writer he aimed to spread his knowledge. His prize essays were expertly illustrated but Thompson’s proficiency in art was not contained within medicine; he exhibited paintings at The Royal Academy of Art no less than thirteen times. After collecting the finest collection of blue and white Nanking porcelain in Europe he jointly illustrated a catalogue with the artist Whistler. His interest in astronomy was such that after it waned his telescopes were eagerly accepted by Greenwich Observatory. After hearing a lecture on cremation he quickly took up the cause forming the Cremtion Society and was instrumental in legalizing the practice in the United Kingdom. Thompson was famed throughout Europe and entertained a huge circle of artistic, literary and influential friends. Having a great interest in food and diet in general he published widely in this area and exercised his passion by throwing his famous Octave dinner parties. Based on the musical scale, eight men were invited at eight o’clock to a meal of eight courses to promote a “feast of reason and the flow of soul.” As an old man his energy for new ideas did not diminish. In 1901, he bought a motorcar. Within a year he had worked out its “anatomy and physiology” and published an instructive book on the subject. Very much the Victorian Englishman, Sir Henry Thompson’s fame and friendships spread all over Europe. He soon became master of any hobby or cause he took up. In medicine though, his interest and expertise narrowed focusing on the lower urinary tract and indeed lithotrity making Thompson, to all intents and purposes a Victorian sub specialist urologist. European Urology Supplements 2 (2003) No. 1, pp. 126

Saarland liniversity, Dcpt of Urology and Paediatric Urology. HomburgiSaar, Germany, ‘Mannheim University, Zentralinstitut fiir Seelischc Gesundheit, Mannheim, Germany 1NTRODUCTION & OBJECTIVES: Comparing cisplatin plus methotrexate (CM) to methotrexate, vinblastine, epirubicin, and cisplatin (MVEC) as adjuvant systemic chemotherapy after radical cystectomy for locally advanced bladder cancer. MATERIAL & METHODS: Patients with pT3a-pT4a, and/or pN+ urothelial carcinoma of the bladder undergoing radical cystectomy were randomised to adjuvant systemic chemotherapy with 3 cycles of CM (cisplatin 70 mg/qm2 day 1, methotrexate 40 mgiqm2 day 8, and IS of a 21 day cycle) or 3 cycles MVEC (methotrexate 30 mg/qm2 day 1, 15, and 22, vmblastine 3 mgiqm2 day 2, 15, and 22, epirubicin 45 mg/qm2 day 2, cisplatin 70 mgiqm2 day 2 of a 28 day cycle). Progression-free survival and study drug related toxicity (WHO grading) were compared as primary and secondary objectives.

RESULTS: Between O/l994 and 0912000 325 patients (71 female, 254 male: median age 61) from 40 German uro-oncologic centers were randomly assigned to CM (n=162) or MVEC (n=l63). Intent-to-treat analysis calc$ated a median progression-free survival of 47 months for CM, and ,101 months for MVEC (relative hazard 1.20; 95% confidence interval 0.88-1.71; log rank test p-0.22). The 5-year progression-free survival rate was 44% in the CM arm, and 5 1% in the MVEC arm, respectively. Of 304 patients evaluable for dose intensity 75% received the planned treatment (CM n=ll9, MVEC n=l IO),11% received only two cycles (CM n=15, MVEC n= I7), 7% received only one cycle (CM n=5, MVEC n= I7), and 7% did not receive any adjuvant chemotherapy (CM n=8, MVEC n=l3). Haematopqietic WHO grade 3rd toxicity was noted in 7% of CM, and in 24% of MVEC treated patients, respectively (Fisher’s exact test, p