- Email: [email protected]
Enlargement of the breasts after prostatectomy
NEW SERIES VOL. IV, No. 5
Mann-Breast
EnIargement
American JournaI of Surgery
$49
ENLARGEMENT OF THE BREASTS AFTER PROSTATECTOMY * LEWIST.
MANN,
M.D.
NEW YORK
D
URING January, 1927, J. T., seventy years oId, Russian born, had a two stage prostatectomv. At that time no enIargement of the breasts was noted on physica examination. On November 2, 1927, he returned compIaining of his breasts enlarging, the right more than the Ieft. He noticed this three weeks ago because his suspenders were causing irritation by bearing pressure on the breasts, giving more of a sense of uneasiness than actuaI pain. He stated that the increase in size was graduaI and that IateIy he had to discard his suspenders for a beIt for comfort’s sake. On examination, the patient is seen to be an oId man of rather sIight buiId, showing the usua1 physica characteristics of seniIity, atrophied skin, pigmentation, white hair and beard, etc. The externa1 genitalia are apparentIy normaI. The Wassermann reaction is negative. The right breast is uniformaIIy enIarged, protruding about 6 cm. from the chest waI1 with a norma maIe nippIe from which no fluid can be expressed. On Iifting the breast there can be feIt an increase in the amount of gIanduIar tissue but no cyst formation. The enIargement is equa1 in a11 quadrants, of firm consistency and no isoIated distinct masses can be made out. There is no redness or heat and onIy a moderate amount of tenderness. On roIIing the breast under the hand, it is feIt to be moderateIy firm, not fixed nor indurated and no mass is paIpabIe. Some smaI1, firm, freeIy movabIe gIands can be feIt in the axiIIa. The Ieft breast presents the same picture but is smaIIer. KondoIeon’ reports two cases occurring in men, both seventy years oId. The first developed a sweIIing of the right breast the size of a waInut one month after prostatectomy and after one year it had entireIy disappeared. In the second case, the enIargement was noticed in the right breast three months, and in the Ieft four months after prostatectomy. The sweIIing receded on the right side in this case. * Read before Section of G&to-Urinary
Oppenheimer2 reports two cases of breast enIargement in men. The first was in a man of sixty-four folIowing prostatectomy. He was of the muscuIar maIe type and noticed enIargement of his breasts three months after operation. The right protruded 9.2 cm. and the Ieft 8 cm. from the chest waI1, and on picking up the breast an increase of breast tissue couId be made out but not by roIIing under the hand. He faiIs to describe the breasts in further detai1 but states that the externa1 genitaIia were normaI. The second case was a man of forty-eight, aIso of the muscuIar maIe type who had his breasts enIarge some months after sphincterotomy for contracture of the neck of the bladder. In attempting to expIain the etioIogy of this condition, which he terms “gynaecomastia foIIowing prostatectomy,” he states that gynaecomastia comes on after a change of the maIe hormone, especiaIIy after castration or atrophy of the testes. He cites Monaschkins who saw this occurring with tumor where greater part of the norma testicuIar tissue was destroyed. AI1 these men were of a feminine physica type, whereas both of Oppenheimer’s were of marked muscuIar maIe status. He points out that so-caIIed prostatectomy is not an extirpation of the gIand but generaIIy an enucIeation of the tumor mass, the prostatic tissue being Ieft behind with a capsule according to TandIer and ZuckerkandI,4 Marion” and others. The prostate is therefore not destroyed but rather given a chance to recover its function after the tumor is removed. On the other hand the manipuIation during enucleation and packing may injure the prostatic tissue outside of the tumor mass. In his cases the adenoma was easiIy sheIIed out in the first instance and in the second onIy muscuIar tissue was removed. He states that sexua1 function after prostatectomy is not necessariIy disturbed, quoting Joseph6 who says that such men after operation have norma sexua1 function for their age and that coitus is possibIe and that they have spermatozoa in their urine. Therefore the
Surgery, New York Academy
of Medicine, December
21,
1927.
American
550
Journd
of Surgery
IIIievitz-Foot
MAY, 1928
MaIformations
normaI sex hormone is evidentIy stiI1 present, but what role the prostate or its interna secretion, if it has one, pIays, is hard to say. As to proof that the prostate has an interna secretion, and if so how it wouId cause the breasts to grow or whether or not the Iack of such an endocrine in the maIe wouId do this, no proof is forthcoming. There have been investigations to determine whether or not the prostate has an interna SenaIach and Pares’ found that secretion. after tota extirpation of the prostate in animaIs that contraction of the ejacuIatory ducts and secretion of the preputia1 gIands ceased. Posner and Kohn and BiedP found intravenous injections of watery and gIycerine extracts of the prostate to be very toxic. Haberern says that after extirpation in animaIs function of the other genitaIia ceased. WaIdeye9 beIieves that if we ascribe an interna secretion to the prostate that the semina1 vesicIes also must have one. Bachrachg agrees with this. Oppenheimer2 is of the opinion that the prostate has an interna secretion. Granting then, that the prostate may have
an interna secretion, it is impossibIe to say what influence the presence or the Iack of it has on the growth of the breast, especiaIIy in an oId man after prostatectomy. REFERENCES I. KONDOLEON,E. Vergrosserung der Brustdriise nach Prostatektomie. Zentralbl. f. Cbir., Igzo, xlvii, 1098. 2. OPPENHEIMER, R. Gynakomastie nach Prostatektomie. Deutscbe med. Wcbnscbr., 1927, liii, 883. 3. MONASCHKIN, G. B. Gynecomasty and tumor of testis. Ztscbr. f. Ural., 1926, xx, 8-19. 4. TANDLER, J. und ZUCKERKANDL, 0. Stud&n zur Anatomie und Kiinik der Prostatahypertropie. BerIin, Springer, 1922. 5. MARION, G. Treatment of cancer of the prostate. J. d’urol., 1926, xxi, 385. 6. JOSEPH, A. Arch. f. Frauenkr. u. Konstits., 1926, .. 11I, 12. 7. BIEDL, A. Die Konstitution in ihrer endokriner Bedingtheit. Ztscbr. f. Sir&. Fortbild., 1927, xxiv, 273. WALDEYER-HART.. Uber “innere Sekretion und Sexuahtat.” Bscbr. f. Ural., 1921, xv, 153. g. BACHRACH, R. In Bayer, C. und von den VeIden, R., Klinisch Lehrbuch der Inkretologie und Inkretotherapie. Leipzig, 1927. 8.
VON
CONGENITAL MALFORMATIONS OF THE FEET REPORT WITH
OF A CASE OF CONGENITAL FUSION OF THE SCAPHOID THE ASTRAGALUS AND COMPLETE ABSENCE OF ONE TOE A, B.
ILLIEVITZ, MONTREAL,
A
BNORMALITIES
of
the
feet
are
comparativeIy rare. OnIy two cases of congenita1 fusion of the astragaIus with the navicuIar are reported in the Iiterature. HoIIandl reports one case of muItipIe fusion of the bones of the foot in a gir1 twenty-one years of age. The astragalus is compIeteIy fused with the scaphoid, but shows in the upper part an indication of demarcation; no absence of toes. Esau2 in 1926 reported a case where fusion of the astragaIus with the navicuIar and first cuneiform is noted. Two toes were absent on the right foot and one on the Ieft foot with no fusion on the Ieft foot.
M.K.,
M.D.,
CM.
CANADA
The rarity of the condition and further Iight it may bring on congenita1 maIformations are the reasons for describing the foIIowing case, which was observed by chance during a routine examination. CASE
REPORT
M. S., maIe, student, aged seventeen. AIways weI1. Parents, grandparents, one brother and one sister a11 normaI. Patient’s Ieft foot normaI. Tires more easiIy on the right foot. The right foot has onIy four toes and is narrower than the Ieft. Measurements: right 24 cm. Iong, 6 cm. wide and 20 cm. in circumference. Arch good. Left foot 26 cm. long, 8 cm. wide and 22 cm. in
Mann-Breast
EnIargement
American JournaI of Surgery
$49
ENLARGEMENT OF THE BREASTS AFTER PROSTATECTOMY * LEWIST.
MANN,
M.D.
NEW YORK
D
URING January, 1927, J. T., seventy years oId, Russian born, had a two stage prostatectomv. At that time no enIargement of the breasts was noted on physica examination. On November 2, 1927, he returned compIaining of his breasts enlarging, the right more than the Ieft. He noticed this three weeks ago because his suspenders were causing irritation by bearing pressure on the breasts, giving more of a sense of uneasiness than actuaI pain. He stated that the increase in size was graduaI and that IateIy he had to discard his suspenders for a beIt for comfort’s sake. On examination, the patient is seen to be an oId man of rather sIight buiId, showing the usua1 physica characteristics of seniIity, atrophied skin, pigmentation, white hair and beard, etc. The externa1 genitalia are apparentIy normaI. The Wassermann reaction is negative. The right breast is uniformaIIy enIarged, protruding about 6 cm. from the chest waI1 with a norma maIe nippIe from which no fluid can be expressed. On Iifting the breast there can be feIt an increase in the amount of gIanduIar tissue but no cyst formation. The enIargement is equa1 in a11 quadrants, of firm consistency and no isoIated distinct masses can be made out. There is no redness or heat and onIy a moderate amount of tenderness. On roIIing the breast under the hand, it is feIt to be moderateIy firm, not fixed nor indurated and no mass is paIpabIe. Some smaI1, firm, freeIy movabIe gIands can be feIt in the axiIIa. The Ieft breast presents the same picture but is smaIIer. KondoIeon’ reports two cases occurring in men, both seventy years oId. The first developed a sweIIing of the right breast the size of a waInut one month after prostatectomy and after one year it had entireIy disappeared. In the second case, the enIargement was noticed in the right breast three months, and in the Ieft four months after prostatectomy. The sweIIing receded on the right side in this case. * Read before Section of G&to-Urinary
Oppenheimer2 reports two cases of breast enIargement in men. The first was in a man of sixty-four folIowing prostatectomy. He was of the muscuIar maIe type and noticed enIargement of his breasts three months after operation. The right protruded 9.2 cm. and the Ieft 8 cm. from the chest waI1, and on picking up the breast an increase of breast tissue couId be made out but not by roIIing under the hand. He faiIs to describe the breasts in further detai1 but states that the externa1 genitaIia were normaI. The second case was a man of forty-eight, aIso of the muscuIar maIe type who had his breasts enIarge some months after sphincterotomy for contracture of the neck of the bladder. In attempting to expIain the etioIogy of this condition, which he terms “gynaecomastia foIIowing prostatectomy,” he states that gynaecomastia comes on after a change of the maIe hormone, especiaIIy after castration or atrophy of the testes. He cites Monaschkins who saw this occurring with tumor where greater part of the norma testicuIar tissue was destroyed. AI1 these men were of a feminine physica type, whereas both of Oppenheimer’s were of marked muscuIar maIe status. He points out that so-caIIed prostatectomy is not an extirpation of the gIand but generaIIy an enucIeation of the tumor mass, the prostatic tissue being Ieft behind with a capsule according to TandIer and ZuckerkandI,4 Marion” and others. The prostate is therefore not destroyed but rather given a chance to recover its function after the tumor is removed. On the other hand the manipuIation during enucleation and packing may injure the prostatic tissue outside of the tumor mass. In his cases the adenoma was easiIy sheIIed out in the first instance and in the second onIy muscuIar tissue was removed. He states that sexua1 function after prostatectomy is not necessariIy disturbed, quoting Joseph6 who says that such men after operation have norma sexua1 function for their age and that coitus is possibIe and that they have spermatozoa in their urine. Therefore the
Surgery, New York Academy
of Medicine, December
21,
1927.
American
550
Journd
of Surgery
IIIievitz-Foot
MAY, 1928
MaIformations
normaI sex hormone is evidentIy stiI1 present, but what role the prostate or its interna secretion, if it has one, pIays, is hard to say. As to proof that the prostate has an interna secretion, and if so how it wouId cause the breasts to grow or whether or not the Iack of such an endocrine in the maIe wouId do this, no proof is forthcoming. There have been investigations to determine whether or not the prostate has an interna SenaIach and Pares’ found that secretion. after tota extirpation of the prostate in animaIs that contraction of the ejacuIatory ducts and secretion of the preputia1 gIands ceased. Posner and Kohn and BiedP found intravenous injections of watery and gIycerine extracts of the prostate to be very toxic. Haberern says that after extirpation in animaIs function of the other genitaIia ceased. WaIdeye9 beIieves that if we ascribe an interna secretion to the prostate that the semina1 vesicIes also must have one. Bachrachg agrees with this. Oppenheimer2 is of the opinion that the prostate has an interna secretion. Granting then, that the prostate may have
an interna secretion, it is impossibIe to say what influence the presence or the Iack of it has on the growth of the breast, especiaIIy in an oId man after prostatectomy. REFERENCES I. KONDOLEON,E. Vergrosserung der Brustdriise nach Prostatektomie. Zentralbl. f. Cbir., Igzo, xlvii, 1098. 2. OPPENHEIMER, R. Gynakomastie nach Prostatektomie. Deutscbe med. Wcbnscbr., 1927, liii, 883. 3. MONASCHKIN, G. B. Gynecomasty and tumor of testis. Ztscbr. f. Ural., 1926, xx, 8-19. 4. TANDLER, J. und ZUCKERKANDL, 0. Stud&n zur Anatomie und Kiinik der Prostatahypertropie. BerIin, Springer, 1922. 5. MARION, G. Treatment of cancer of the prostate. J. d’urol., 1926, xxi, 385. 6. JOSEPH, A. Arch. f. Frauenkr. u. Konstits., 1926, .. 11I, 12. 7. BIEDL, A. Die Konstitution in ihrer endokriner Bedingtheit. Ztscbr. f. Sir&. Fortbild., 1927, xxiv, 273. WALDEYER-HART.. Uber “innere Sekretion und Sexuahtat.” Bscbr. f. Ural., 1921, xv, 153. g. BACHRACH, R. In Bayer, C. und von den VeIden, R., Klinisch Lehrbuch der Inkretologie und Inkretotherapie. Leipzig, 1927. 8.
VON
CONGENITAL MALFORMATIONS OF THE FEET REPORT WITH
OF A CASE OF CONGENITAL FUSION OF THE SCAPHOID THE ASTRAGALUS AND COMPLETE ABSENCE OF ONE TOE A, B.
ILLIEVITZ, MONTREAL,
A
BNORMALITIES
of
the
feet
are
comparativeIy rare. OnIy two cases of congenita1 fusion of the astragaIus with the navicuIar are reported in the Iiterature. HoIIandl reports one case of muItipIe fusion of the bones of the foot in a gir1 twenty-one years of age. The astragalus is compIeteIy fused with the scaphoid, but shows in the upper part an indication of demarcation; no absence of toes. Esau2 in 1926 reported a case where fusion of the astragaIus with the navicuIar and first cuneiform is noted. Two toes were absent on the right foot and one on the Ieft foot with no fusion on the Ieft foot.
M.K.,
M.D.,
CM.
CANADA
The rarity of the condition and further Iight it may bring on congenita1 maIformations are the reasons for describing the foIIowing case, which was observed by chance during a routine examination. CASE
REPORT
M. S., maIe, student, aged seventeen. AIways weI1. Parents, grandparents, one brother and one sister a11 normaI. Patient’s Ieft foot normaI. Tires more easiIy on the right foot. The right foot has onIy four toes and is narrower than the Ieft. Measurements: right 24 cm. Iong, 6 cm. wide and 20 cm. in circumference. Arch good. Left foot 26 cm. long, 8 cm. wide and 22 cm. in