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Following prostate or bladder cancer surgery or pelvic radiation, a man's erection can be impaired at least temporarily by the procedure.  With cancer surgery (such as radical prostatectomy or radical cystectomy), or radiation in the pelvic area (called brachytherapy, “seeds”, or external beam radiation), there can be damage to at least some of the cavernosal nerves which run beneath the prostate and supply the penis. The patient’s age, erection ability before surgery, and general health (diabetes is not helpful for erectile function) will predict erection postoperatively.  In addition, if the surgeon needs to remove additional tissue to control cancer, then nerves may need to be sacrificed partially or totally. It is essential that all patients planning for pelvic surgery or radiation visit a urologist to discuss beginning a training or rehabilitation program for the penis.  This program ideally begins 2 weeks prior to surgery or otherwise immediately following surgery. The above penile rehab program is typically done for 1 year following surgery or two years following radiation therapy to the pelvic area.
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The symptoms of pancreatic cancer vary depending on the area where cancer cells have developed.
Pancreatic cancer is manifested through symptoms like weight loss, fatigue, appetite loss, upper abdominal pain, etc. Pancreatic cancer located on the head of the organ shows early symptoms -- jaundice, light stool color (white or yellow), dark urine, enlarged gallbladder and liver, itchy skin, bleeding, slow heart rate, etc.
The genus streptococcus is comprised of many species of Gram positive cocci arranged in chains. These organisms are further divided into serologic subgroups called Lancefield groups designated by capital letters A, B, C etc. Streptococcus pneumoniae is also alpha-hemolytic but must not be confused with the viridans streptococci. The most important non-hemolytic streptococci are now not in the genus Streptococcus at all. This organism is one of the most important human pathogens and is responsible for a wide variety of clinical manifestations.
Group specific carbohydrate is an integral part of the cell wall and is the moiety that is detected in Lancefield serotyping of beta-hemolytic Streptococci. Systemic Pyrogenic Exotoxins (SPEs) are produced by some strains and are responsible for the rash of scarlet fever. GAS is the only bacterium that causes significant pharyngitis in immunocompetent individuals. Scarlet fever is said to occur when GAS infection is accompanied by a, very characteristic, diffuse exanthem and enanthem.
An infection of mainly the epidermis with significant lymphatic involvement, erysipelas is distinguished from cellulitis by its sharply demarcated, slightly raised borders.


Impetigo is a benign but unsightly condition commonly affecting the face of children that manifests as honey-colored crusts of exudate on an erythematous base. Since about 1987 there has been an increase of severe GAS infections that are often rapidly progressive and have a high rate of mortality.
Though now very rare in industrialized countries, Rheumatic Fever is still a feared complication of GAS pharyngitis.
Post Streptococcal Acute Glomerulonephritis (AGN) Characterized by edema, hypertension, hematuria and proteinuria approximately 2 weeks after a GAS infection, Post Streptococcal AGN is a fairly common complication of both pharyngitis and skin infections especially in children. Babies most at risk include those that are premature or are born to mothers with prolonged rupture of membranes.
The genus Enterococcus includes organisms that are normal inhabitants of the human gut that were formerly included within the genus Streptococcus. Tumors on the body and tail create difficulties that distract the attention from the pancreas.
They are distinguished from the other major genus of Gram-positive cocci – Staphylococcus by their cellular arrangement and their inability to produce the enzyme catalase. The two most important types of beta-hemolytic streptococci, by far, are Group A beta-hemolytic streptococcus (GAS) or Streptococcus pyogenes and Group B beta-hemolytic streptococcus (GBS) or Streptococcus agalactiae. They have been separated into the genus Enterococcus and have gained importance as pathogens in recent years. The only reservoir is human beings and it may be found in a proportion of the oropharynges of healthy individuals referred to as carriers. It is a relatively infrequent cause accounting for approximately 10% of sore throats assessed in a physicians office, the majority of cases being viral in origin. The rash is a generalized, fine raised red rash, prominent on the face and trunk and, late in its course, is said to feel like sandpaper. Commonly affecting the lower legs, especially in persons with chronically edematous extremities, it can occur on any part of the skin and is often associated with severe systemic toxicity.
Approximately two weeks after infection patients develop an acute inflammatory state with heart, joints, subcutaneous tissues and CNS bearing the brunt of the assault. Thought to immunologically mediated, it is usually self limited and fairly benign but may result in permanent renal damage requiring dialysis or transplantation.
Though also involved in many kinds of infections in adults particularly in debilitated individuals, it is disease in newborns that is most important.
Infections similar to those caused by GAS are occasionally caused by Group C and G beta-hemolytic streptococci.
However, there are approximately 80 distinct M types and because immunity is type specific, repeat infections with different serotypes occur.


Diagnostic microbiology laboratories restrict the processing of throat cultures to determining if GAS is present or not. The distinction between the two may be difficult and is clinically moot as investigation and therapy are the same. The effects of carditis with deformity of heart valves makes up the major long term morbidity associated with the condition.
Strategies to identify pregnant women who are colonized with GBS and then treat them with intra-partum (during labor) antibiotics if risk factors are present has reduced the incidence of serious GBS disease and is an area of active research and controversy.
Until recent times they were viewed as relatively inconsequential, low virulence organisms that are involved mostly in mixed organism infections related to gut disruption.
This is generally a fairly mild self limiting illness, though local complications can occur e.g. Systemic pyrogenic exotoxins are responsible and disease is generally no more severe than GAS pharyngitis unaccompanied by Scarlet Fever rash.
Diagnosis is made clinically using the revised (1992) Jones Criteria which state that Rheumatic Fever is highly likely if supported by evidence of a preceding GAS infection and the presence of two major OR one major and two minor manifestations.
This is an excellent example of the need for extremely prudent antibiotic prescribing practices. However, it is the association of GAS pharyngitis with Rheumatic Fever that has made this illness far more important than it otherwise would be as discussed below. There were fears that a clone of GAS with increased virulence had re-emerged, was spreading and this was responsible for the change in epidemiology. However clinical microbiology laboratories generally do not have the ability (or the interest) to differentiate one species from the other. However, as with most infectious diseases, the circumstance seems considerably more complicated and organisms of many M types producing all three types of SPEs have now been implicated.
Subacute Bacterial Endocarditis (SBE) is an infection of heart valves that is commonly caused by this group of organisms.
This is the reason that people with abnormal heart valves are advised to receive prophylactic antibiotics prior to dental manipulation. Clinically, patients present with pain and systemic complaints disproportionate to their soft tissue infection. They progress rapidly to shock and death without interventions in the form of aggressive surgical debridement and antibiotics.



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