Primary diffuse large B-cell testicular lymphoma: magnetic resonance imaging findings.

Testicular lymphoma represents the commonest testicular malignancy in men older than 50 years. MR imaging of the scrotum is an efficient supplemental diagnostic tool in the evaluation of scrotal diseases. We report two cases of primary diffuse large B-cell testicular lymphoma, presented in men over the age of 50 years. MR imaging revealed the presence of a hypointense intratesticular mass lesion on T2-weighted images, strongly and heterogeneously enhancing after gadolinium administration.

Effects of phosphodiesterase-5 inhibitor vardenafil on testicular androgen-binding protein secretion, the maintenance of foci of advanced spermatogenesis and the sperm fertilising capacity in azoospermic men.

We evaluated the effects of vardenafil on testicular androgen-binding protein secretion (ABP). Bilaterally obstructed azoospermic (OA)-men (n = 19) (group A) underwent unilateral testicular biopsy. A group of nonobstructed azoospermic (NOA)-men (n = 68) (group B) underwent bilateral testicular biopsy. ABP secretion in vitro by testicular tissue was assessed in each participant of every group. In addition, intracytoplasmic sperm injection (ICSI) cycles were performed in several couples of group A or group B using frozen/thawed spermatozoa from the biopsy material. Ten OA-men (group A1), 14 NOA-men (group B1), and nine different NOA-men (group B2) had been positive for spermatozoa in the biopsy but pregnancies were not achieved in the respective female partners. Men of groups A1, B1 and B2 were treated with vardenafil, vardenafil and L-carnitine respectively. Then, the men of groups A1, B1 and B2 underwent a second testicular (unilateral) biopsy. Within the group A1 and within the group B1, ABP secretion rate was significantly larger after vardenafil treatment than prior to vardenafil treatment. In addition, fertilisation rates in ICSI cycles within groups A1 or B1 were not affected by vardenafil administration. Vardenafil administration in NOA-men increased ABP secretion and did not affect detrimentally the presence of testicular foci of advanced spermatogenesis.

Gynecomastia as a first clinical sign of nonseminomatous germ cell tumor.

INTRODUCTION: Gynecomastia is a common clinical sign in several diseases. In this report we present a case of gynecomastia with underlying testicular tumor which remained misdiagnosed for a prolonged period of time. CASE REPORT: A 16-year-old adolescent noticed unilateral painless swelling of the left breast. He was referred to the Department of General Surgery and examined by a breast surgeon. A diagnosis of mastitis was made and a treatment with an oral antibiotic drug began. After failure of the initial antibiotic treatment, the patient was referred to the Department of Endocrinology and left testicular cancer was diagnosed. Unilateral high inguinal orchidectomy and subsequent chemotherapeutic treatment were performed. CONCLUSION: Primary care physicians should be aware of the possibility of a concomitant presence of gynecomastia and testicular cancer. We suggest a physical examination as well as a laboratory investigation, and testicular ultrasonography of the testes in all patients with gynecomastia.

Simultaneous removal of ammonium nitrogen, dissolved chemical oxygen demand and color from sanitary landfill leachate using natural zeolite.

In this study, natural zeolite with maximum adsorption capacity of 3.59 mg g-1 was used for the simultaneous removal of ammonium nitrogen (NH4+-N), dissolved chemical oxygen demand (d-COD) and color from raw sanitary landfill leachate (SLL). Saturation, desorption and regeneration tests of zeolite were performed. Optimum adsorption conditions were found for particle size 0.930 µm, stirring rate of 1.18 m s-1, zeolite dosage of 133 g L-1 and pH 8. NH4+-N removal efficiency reached 51.63 ± 0.80% within 2.5 min of contact. NH4+-N adsorption follows mostly the linear pseudo-second order model, with intra-particle diffusion. NH4+-N desorption follows the linear pseudo-second order model. Adsorption data fitted to the Temkin Isotherm in linear and nonlinear forms. Saturation tests showed that zeolite can be efficiently used in three successive adsorption cycles. NH4+-N release from the saturated zeolite was not completely reversible, suggesting that the zeolite may be used as slow ΝΗ4+-Ν releasing fertilizer and an attractive low cost material for the treatment of SLL. NH4+-N removal with the regenerated zeolite exceeded 40% of the initial concentration in the fluid within 2.5 min. SEM analysis showed significant changes through saturation and regeneration. XPS revealed that adsorption of ΝΗ4+-Ν to the zeolite was accompanied by ion exchange.

Early-stage sarcomatoid renal cell carcinoma: multidetector CT findings.

A 64-year-old woman was referred for multidetector CT examination of the abdomen due to an incidental right renal mass, found on routine sonographic examination. A lower pole renal mass was detected on CT, with no signs of invasiveness or metastatic disease. The mass was sharply demarcated and heterogeneously enhanced, the last finding suggestive of malignancy. Pathologically, the tumor was an early-stage sarcomatoid renal cell carcinoma. The patient remains well, with no signs of recurrence or metastases 18 months after surgery.

Effects of primary testicular damage on sperm DNA oxidative status and embryonic and foetal development.

We evaluated the development of embryos generated from the fertilisation of oocytes with spermatozoa isolated from animals with primary testicular damage (PTD). Embryos derived in vivo or in vitro from oocytes fertilised with spermatozoa produced by PTD rats that had undergone surgical treatment for the PTD (group A1), or PTD rats (group A2), or control rats (group B) were cultured and transferred to recipients. At the end of the experimental period, the fertilisation potential of each rat was assessed in vitro (IVF trials). Sperm 8-oxodG/dG ratio (a marker of DNA oxidative status) was significantly larger in group A2 than in groups A1 and B. Blastocysts of the group A2 transferred to recipients demonstrated a significantly larger loss before implantation than transferred blastocysts of groups A1 or B. In addition, the proportion of implanted blastocysts that could not complete the intrauterine development was significantly larger in group A2 than in groups A1 and B. This study reveals a post-fertilisation detrimental effect in animals with PTD on the capacity of oocytes (fertilised either in vitro or in vivo) to develop in vitro and implant after transferring them to recipients probably attributable to sperm DNA oxidative damage.

Effects of phosphodiesterase-5 inhibitors on sperm parameters and fertilizing capacity.

The aim of this review study is to elucidate the effects that phosphodiesterase 5 (PDE5) inhibitors exert on spermatozoa motility, capacitation process and on their ability to fertilize the oocyte. Second messenger systems such as the cAMP/adenylate cyclase (AC) system and the cGMP/guanylate cyclase (GC) system appear to regulate sperm functions. Increased levels of intracytosolic cAMP result in an enhancement of sperm motility and viability. The stimulation of GC by low doses of nitric oxide (NO) leads to an improvement or maintenance of sperm motility, whereas higher concentrations have an adverse effect on sperm parameters. Several in vivo and in vitro studies have been carried out in order to examine whether PDE5 inhibitors affect positively or negatively sperm parameters and sperm fertilizing capacity. The results of these studies are controversial. Some of these studies demonstrate no significant effects of PDE5 inhibitors on the motility, viability, and morphology of spermatozoa collected from men that have been treated with PDE5 inhibitors. On the other hand, several studies demonstrate a positive effect of PDE5 inhibitors on sperm motility both in vivo and in vitro. In vitro studies of sildenafil citrate demonstrate a stimulatory effect on sperm motility with an increase in intracellular cAMP suggesting an inhibitory action of sildenafil citrate on a PDE isoform other than the PDE5. On the other hand, tadalafil's actions appear to be associated with the inhibitory effect of this compound on PDE11. In vivo studies in men treated with vardenafil in a daily basis demonstrated a significantly larger total number of spermatozoa per ejaculate, quantitative sperm motility, and qualitative sperm motility; it has been suggested that vardenafil administration enhances the secretory function of the prostate and subsequently increases the qualitative and quantitative motility of spermatozoa. The effect that PDE5 inhibitors exert on sperm parameters may lead to the improvement of the outcome of assisted reproductive technology (ART) programs. In the future PDE5 inhibitors might serve as adjunct therapeutical agents for the alleviation of male infertility.

Renal oncocytoma and renal pelvis carcinoma: a rare coexistence of double renal tumors.

We report a case of renal oncocytoma which was found incidentally during the nephroureterectomy for renal pelvis carcinoma. The coexistence of two tumors on the kidney with absolutely different origin one from the other is extremely rare and interesting. Herein we discuss the clinical, morphological, histological, ultrastructural and angiographical characteristics of oncocytoma.

Benign fibroepithelial ureteral polyps. Report of 3 cases.

Three rare cases of benign ureteral polyps are presented. The rareness of benign mesenchymal ureteral tumors and the difficulty in pre-operative differential diagnosis from malignant epithelial are remarkable. The diagnosis is made on characteristic appearance at operation and is confirmed by frozen section and histological examination.

The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens.

This 6-month double-blind, randomized, parallel-group study compared two dose regimens of Libeprosta, the lipidosterolic extract of Serenoa repens in 100 male outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The patients received two 80-mg tablets twice daily or two 80-mg tablets three times daily. Baseline evaluations included maximum and mean urinary flow rates, postvoid residual urine volume, and International Prostate Symptom Score (I-PSS) total and quality-of-life scores. Both regimens significantly reduced the I-PSS mean total score from baseline values (P<.001); improvements achieved statistical significance after month 3 and were maintained for the duration of the study. Significant improvements from baseline also occurred in quality-of-life scores, maximum and mean urinary flow rates, and residual urine volume (P<.05). The decrease in residual urine with both regimens was highly significant (P<.001). No significant differences in efficacy were noted between the two dose groups, and no treatment-related complications or clinical adverse events occurred. In this clinical study, the lipidosterolic extract of Serenoa repens was a well-tolerated agent that may significantly improve lower urinary tract symptoms and flow measurements in men with BPH.

[Urinary retention due to acquired closure of labia minor in a female with Sjögren syndrome]. / Verschluss der kleinen Labien bei Sjögren-Syndrom mit konsekutiver Harnsperre.

A case of a 70 year old woman with acute urinary retention and primary Sjögren-Syndrome is presented. On clinical examination a total closure of labia minor was diagnosed. Surgical detachment of labia minor was performed and full recovery was achieved.

[Ureteropelvic stenosis, agenesia of the contralateral kidney and sinistral inferior vena cava]. / Nierenbeckenabgangsenge, Agenesie der kontralateralen Niere und V. cava inferior sinistra.

INTRODUCTION: Ureteropelvic stenosis occurs as a result of intraluminal or extraluminal alterations at the ureteropelvic junction. It is the most common cause of upper urinary tract obstruction. CASE REPORT: We report about a rare case of a man with ureteropelvic junction obstruction and a renal pelvic stone accompanied by other congenital anomalies, including a sinistral inferior vena cava and agenesis of the opposite kidney. Multiple vessels were present in front of the renal pelvis, while the renal vein itself was situated dorsal to the left renal pelvis, resulting in compression and obstruction of the ureteropelvic junction. Dismembered pyeloplasty using the Anderson-Hynes technique was performed placing the ureter dorsal to the renal vein. CONCLUSION: Various vascular anomalies, especially in the region of the vena cava, can result in renal vasculature abnormalities and development of secondary ureteropelvic stenosis. Ureteropelvic stenosis may coexist with other congenital defects.

Small cell carcinoma of the urinary bladder: virtual CT cystoscopic findings.

A 74-year-old man underwent multidetector CT virtual cystoscopy due to macroscopic hematuria. A large, irregularly-surfaced, solid bladder mass was detected, infiltrating the perivesical fat, the seminal vesicles and the prostate. CT examination of the chest and abdomen showed no distant metastases. Radical cystectomy was performed and pathology reported pure small cell carcinoma of the urinary bladder.

Case report. Tuberculous epididymo-orchitis: MRI findings.

A 70-year-old man presented with fever, left flank pain and scrotal enlargement. CT scan of the thorax and abdomen revealed findings compatible with pulmonary and kidney tuberculous involvement. Sonographic and MRI examination of the scrotum showed bilateral testicular enlargement and the presence of multiple nodules involving both the testis and the epididymis. Urine cultures obtained from a percutaneous left nephrostomy were positive for tuberculous bacilli, and the patient was placed on anti-tuberculous treatment.

Multi-detector row CT urography on a 16-row CT scanner in the evaluation of urothelial tumors.

The purpose of this study was to assess the role of multi-detector row CT urography (MDCTU), on a 16-row CT scanner in the evaluation of patients with painless hematuria, with emphasis placed in the detection of urothelial tumors. We retrospectively reviewed the MDCT urographies of 75 patients, referred for painless hematuria. The CT protocol included unenhanced images, obtained with a detector configuration of 16x1.5 mm and pitch of 1.2, nephrographic and excretory-phase images, obtained with a detector collimation of 16x0.75 mm and pitch of 1.2. Axial and coronal reformatted images were evaluated. Three-dimensional reformation of the excretory-phase images was performed using the volume-rendering technique. The standard of reference included clinical and imaging follow-up, cystoscopic, surgical and histologic findings. In 55 (73%) of 75 patients, the cause of hematuria was identified on MDCTU; the most common cause was urothelial cancer, including seven tumors with a diameter equal or smaller than 0.5 cm in diameter. Sixteen-row MDCTU provided satisfactory results in the investigation of patients with painless hematuria. The main advantage of the technique is its ability to detect uroepithelial malignancies.

In vitro spermatogenesis as a method to bypass pre-meiotic or post-meiotic barriers blocking the spermatogenetic process: genetic and epigenetic implications in assisted reproductive technology.

Pregnancies achieved by assisted reproduction technologies and particularly by ooplasmic injections of either in vivo or in vitro generated immature male germ cells are susceptible to genetic risks inherent to the male population treated with assisted reproduction and additional risks inherent to these innovative procedures. The documented, as well as the theoretical risks, are discussed in this review. These risks represent mainly the consequences of genetic abnormalities underlying male infertility and may become stimulators for the development of novel approaches and applications in the treatment of infertility. Recent data suggest that techniques employed for in vitro spermatogenesis, male somatic cell haploidization, stem cell differentiation in vitro and assisted reproductive technology may also affect the epigenetic characteristics of the male gamete, the female gamete, or may have an impact on early embryogenesis. They may be also associated with an increased risk for genomic imprinting abnormalities. Production of haploid male gametes in vitro may not allow the male gamete to undergo all the genetic and epigenetic alterations that the male gamete normally undergoes during in vivo spermatogenesis.

Efforts to create an artificial testis: culture systems of male germ cells under biochemical conditions resembling the seminiferous tubular biochemical environment.

Induction of meiotic and post-meiotic alterations of male germ cells in vitro has been the target of several research efforts since 1960. However, to date, the establishment of an ideal culture system in which spermatogonial stem cells can be maintained and directed to proliferate and undergo meiosis and complete spermiogenesis does not exist. This is attributed to the difficulties concerning the isolation and purification of defined subpopulations of germ cells and the establishment of male germ cell lines. In addition, there is no adequate knowledge regarding the optimal biochemical conditions that promote the survival and differentiation of germ cells in long-term cultures. This review focuses on the methodologies that have been proved sufficient to achieve differentiation of cultured male germ cells. Furthermore, the factors regulating spermatogenesis and the technical prerequisites to achieve differentiation of cultured male germ cells are described. Finally, the role of in vitro cultures of immature diploid germ cells in the therapeutic management of men negative for haploid cells in their testes and the subsequent potential genetic and epigenetic risks are discussed.

[Internal urinary diversion in pelvic cancers and quality of life. Value of double "J" endoprosthesis]. / Dérivation urinaire interne en cancérologie pelvienne et qualité de vie. L'intérêt des endoprothèses double "J".

The ureteral double pigtail stents are versatile and valued for proper urinary drainage in the setting of trauma, fistula formation, after extra-corporeal shock wave lithotripsy (ESWL) and surgical manipulations of the upper urinary tract. Also they are used for prolonged urinary drainage in patients with chronic tumor-induced ureteral obstruction, and present an exceptional patient tolerance. The authors' experience is based upon 54 patients treated for ureteral obstruction of malignant origin between January 1989 and October 1995. Complications of this method as well as the quality of life of these patients are analysed and the results compared with those of the literature. The patient tolerance was excellent. Mean survival time after ureter catheterisation was 18 months. Complete urine diversion was achieved and hydronephrosis disappeared soon after stent placement in 42 patients (80%). In addition hydronephrosis persisted in 12 cases (20%), despite orthotopic positioning of the catheter and numerous stent changes for larger caliber stents. The palliative use of the double pigtail stent when no other treatment is possible for malignant ureteral obstruction, precludes the need for ureterostomy and offers the patient a comfortable quality of life. Bladder disease is a contraindication to the use of these catheters, although their insertion is rarely impossible. In case of acute obstruction, it is better to prepare the pathway with a standard ureteral catheter, which is easier to manage. It is always possible to insert the pigtail stent after some time has elapsed.

Effects of paternal cigarette smoking on testicular function, sperm fertilizing capacity, embryonic development, and blastocyst capacity for implantation in rats.

We evaluated the effects of paternal smoking on testicular function, sperm fertilizing capacity, embryonic development, and blastocyst capacity for implantation. Rats of group A were exposed to cigarette smoke for 10 weeks. Rats of group B were exposed to the smoke of incense sticks for 10 weeks. Rats of group C served as a control group. Rats of group D were exposed to cigarette smoke for 7 weeks only. Experimental period was 10 weeks in all groups. At the end of the experimental period serum testosterone responses to human chorionic gonadotropin stimulation, androgen-binding protein activity in testicular cytosols, epididymal sperm motility, and oocyte fertilization rate, oocyte cleavage rate, and blastocyst development rate after in vitro fertilization (IVF) trials were significantly smaller in group A compared with groups B and C. In contrast, fertilization rate, cleavage rate, and blastocyst development rate after intracytoplasmic sperm injection (ICSI) procedures were not significantly different among groups A, B, C, and D. Both after IVF trials and ICSI techniques, the proportion of the alive offspring to the number of transferred oocytes was significantly smaller in group A than in groups B and C. Cigarette smoke-exposure results in a secretory deficiency of Leydig and Sertoli cells leading to an impaired epididymal sperm maturation process and diminished capacity of spermatozoa to penetrate oocytes. In addition paternal cigarette smoke exposure affects the embryonic ability for implantation.

[Results of treatment of cystinuria and cystine lithiasis with alpha-mercaptopropionylglycine. Apropos of 40 patients]. / Résultats du traitement de la cystinurie et de la lithiase cystinique par l'alpha-mercaptopropionylglycine. A propos de 40 patients.

From 1987 to 1990, 719 subjects (385 males and 334 females) were screened, by means of urocystin-kit, for cystinuria and cystine lithiasis, in Epirus district (North-West Greece). The positive results were confirmed by chromatographic analysis of urine amino acids and laboratory tests. Forty patients, belonging to six cystinuric families, were identified. These patients were excreting 3.1 +/- 1.7 mmol/24 h of cystine in urine. All patients were treated by per os administration of alpha-MPG in daily doses of 400-1,200 mg/24 h). We therefore report the results of a 4 +/- 2 year follow-up of these patients. We conclude that treatment with alpha-MPG is very effective with minimal side effects in patients suffering from cystinuria or cystine urinary calculi.