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Ritual circumcision in males is regarded as one of the oldest surgical procedures. Whereas their medieval illustrations are mostly interpreted within a religious context, this study tries to prove the influence of the political and social situation of the above-mentioned period.Selected iconography of ritual male circumcision in the Middle Ages from Germany, France, Italy, and the Byzantine Empire was critically examined. Special attention was paid to the stained glass windows recently returned to St. Mary's Church in Frankfurt/Oder, where circumcision of the so-called Antichrist is also shown. Up to now we could not find any medical historical information about this subject. Clerical fine art of the fifteenth and sixteenth centuries shows more frequently than before illustrations of ritual circumcision, which evidently demonstrate the political, economic, and social tensions and controversies of that period. In many cases this iconography indicates a rejection of this old Jewish tradition and its confessors. Also the stained glass image of the Antichrist posthetomy could be interpreted as criticism or aversion.This study expands our approach to medieval illustrations of ritual circumcision that have hitherto mostly been interpreted in religious terms. The influence of changing political and social situations in the Middle Ages is evident.

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OBJECTIVES: Computer-assisted simulation of trauma is supposed to improve protective systems in traffic and risky leisure activities. In case of blunt renal injury biomechanical data being concerned with kidneys as a whole are extremely sparse. To enable three-dimensional simulations this study should supply important data of the renal biomechanics and elucidate the relationship between force distribution and origination of renal lesions. MATERIALS & METHODS: The present study investigated 66 isolated uninjured porcine kidneys using a drop impactor. Changes in deformation, brake force of power, deceleration and intrapelvic pressure are depicted while varying energy application between 1.4 and 14.2J. Lesions were detected by cross-dissecting the organs into slices. RESULTS: The measured values reflect a high correlation between load energy or brake force of power and deformation. Except the intrapelvic pressure all biomechanical parameters rise under increasing energy load. Comparing the different parameters over time a simultaneous concurrence of maximum brake force of power, deceleration and intrarenal pressure can be shown, the peak of deformation was reached belatedly. CONCLUSIONS: The paths of biomechanical curves prove a viscoelastic behaviour of the kidney. In contrast to the literature the region principally bearing the load seems to be the collision zone between renal pelvis and cortex where first lesions appear. This is mainly caused by the fluid filled pelvis, an incompressible support, that is supposed to change its shape after exceeding energy application of about 4J.

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Heparin-induced priapism constitutes a special form of pharmaco-induced prolonged erection, but the pathophysiological principles are not yet definitely clear. Heparin-induced antiplatelet-antibodies may lead to the aggregation of thrombocytes and thus alter the penile blood flow leading to low-flow priapism. Alternatively, this condition may be explained by initial high-flow priapism that later turns into ischemic priapism. The question remains whether hemorrhage with subsequent organisation of the hematoma and late fibrosis constitutes a pathogenetic factor. Besides this pathogenetic discussion, this paper presents the differential diagnosis of priapism as well as diagnostic and therapeutic procedures.

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545 male patients with a tentative diagnosis "urethritis" were examined between November 1984 and December 1994 in the Department of Dermatology and Venerology of the Military Hospital in Ulm. The patients, aged from 18 to 58 years (mean age 24.1 years), were examined according to a standardized diagnostic procedure: Smear preparations from the urethra with subsequent gram staining, bacterial cultures for aerobic bacteria, Neisseria gonorrhoeae (cultures and Phadebact gonococcus test), mycoplasma cultures (Mycoplasma hominis (M. hom.); Ureaplasma urealyticum (U. u), and Chlamydia trachomatis using several methods, primarily DIFT (Syva Micro-Trak). Trichomonas vaginalis counts in urine sediment 441 patients (81%) had 4 or more leukocytes per high-power (x1000) field in the gram stained specimens. In these 441 urethritis-patients the following germs could be detected: Trichomonas vagin 3 (1%), N. gonorrhoeae 80 (18%), Mycoplasma 94 (21%) [U. u. 59, M. hom. 24, both 11], C. trachomatis 114 (26%), other pathogenic bacteria 135 (31%). In 114 patients (26%) no bacteria could be identified. A single infection was diagnosed in a total of 242 patients (55%), a double infection was determined in 71 patients (16%) while a triple infection was found in 14 patients (3%). The spectrum determined in the single infection included the following: N. gonorrhoeae 41 (9%), Mycoplasma 45 (10%), C. trachomatis 67 (15%), other pathogenic bacteria 89 (20%) (most frequently found germs were Enterococcus, beta-hemolytic Streptococcus, Escherichia coli, Staph. aureus). In the double infections combinations with aerobic bacteria dominated. In triple infections, mycoplasma were most common. During the investigation period the number of patients with urethritis symptoms declined at a constant rate.

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Metastatic lesions represent 1-8% of all malignant tumors of the mouth and jaws, with rare sites of metastasis originating from different primary tumors, especially the lung and breast. The vast majority of these lesions (up to 90%) have been observed in the mandible and maxilla (5-20%). Another rare type of cancer that usually metastasizes to the lungs, lymph nodes, bones, liver or brain may occasionally also show spread to the paranasal sinuses. In the present paper we report our management of a 50-year-old male with renal cell carcinoma who developed metastases to the frontal and ethmoid sinuses.

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Although renal cell carcinoma is known to metastasize mainly to lungs, lymph nodes, bone, liver, brain or adrenal glands, unusual metastatic spread has been published in many case reports and autoptical studies. The gallbladder is rarely the site of distant metastases, and in most cases of gallbladder metastasis malignant melanoma is the primary tumor. A review of the literature revealed only 7 cases of renal cell carcinoma metastasizing to the gallbladder, and these were mainly found at necropsy. The case of a clinically detected gallbladder metastasis is presented.

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The case of a 26 years old patient with a primary paraaortic extragonadal yolk sac tumor is presented. After operative reduction of the tumor polychemotherapy with PEB was performed. Following chemotherapy testicular biopsy did not show histological changes typical for testicular intraepithelial neoplasia (TIN). Three years after the initial manifestation of the yolk sac tumor, a malignant tumor of the testis with components of undifferentiated teratoma and yolk sac tumor was observed. In this paper the problems of development of testicular malignancy after polychemotherapy and the validity of a small exploratory excision of testicular tissue in retroperitoneal germ cell tumors and following chemotherapy are discussed.

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In 60 patients with non-seminomatous testicular germ cell tumours in clinical stages I, IIa and IIb inguinal orchiectomy was performed as primary treatment, followed by modified retroperitoneal lymphadenectomy (RLA). In stage II disease chemotherapy was given in addition. After a follow-up period of at least 24 months only 5% of the patients showed progression of disease. Normal ejaculatory function was preserved in 88% of our patients. Modified RLA seems to be a safe procedure with an acceptably low rate of complications not only in stage I disease, but also in metastatic stages IIa and IIb.

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OBJECTIVE: To evaluate the extent of diagnostic evaluation that is necessary in young men with asymptomatic microscopic haematuria. PATIENTS AND METHODS: A group of 157 men (mean age 24.8 years [range 18-53]) who presented with asymptomatic haematuria were investigated with repeated urine analysis. Addis count, urinary cultures, blood tests, ultrasonography, pyelography, cystourethroscopy and finally renal biopsy. RESULTS: The results showed pathological findings in 31.2% of patients. Of the 157 individuals, 33.1% did not complete the study. In 14.6% urological disease was found, including two patients with urothelial cancer. Renal biopsy detected glomerulopathy in 16.5% of all patients. IgA nephritis being the most common diagnosis (42% of all biopsies). CONCLUSION: Even in young patients, microscopic haematuria should be investigated and followed thoroughly. Renal biopsy seems to be optional: once a diagnosis is established repeated and unnecessary examinations can be avoided.

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A follow up study of 603 patients with chronic erectile failure was carried out concerning the long term effects of intracavernous injection therapy with papaverine/phentolamine (n = 172 evaluable) and venous surgery (n = 134 evaluable). Injection therapy was effective in 95.8% of injections. Side effects included prolonged erections in 0.15% of injections and fibrotic palpable indurations in 3.4%. Acceptance of therapy was high among patients and their partners and improvement of self image or partnership was reported in 77.8% and 79.5% respectively. Results of venous surgery were not satisfactory. Only 19.4% of patients achieved sufficient spontaneous erections and 35.1% needed adjuvant injections. Spongiosolysis yielded better results. Patients with neurological impairment, diabetes mellitus, postoperative onset of erectile dysfunction and age above 40 years showed poorer surgical results. Venous surgery should only be offered to a highly selected group of patients.

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In an open study, 22 patients with genito-urinary infection by Chlamydia trachomatis were treated with oral fleroxacin in varying dosage. Symptoms were relieved and cultures became negative in 19 patients, with three patients not assessable. Adverse reactions, affecting the central nervous system, the gastrointestinal tract and the skin (photosensitivity), were reported in seven patients.

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