Three-dimensional Simulation on Patient-reported Outcomes Following Oncoplastic and Reconstructive Surgery of the Breast: A Randomized Trial.

Background: Three-dimensional (3D) imaging using computer simulations is an evolving technology. There is a lack of strong data on the use of this technology for oncoplastic (OP) and reconstructive surgery. Methods: A prospective, randomized, single-center trial including breast cancer patients undergoing OP or mastectomy with immediate breast reconstruction with implant (IBR) enrolled from November 2019 to October 2021 at the Hospital Nossa Senhora das Graças, Breast Unit in Curitiba, Brazil. Both patients undergoing OP and those in the IBR group were randomized to undergo 3D imaging and simulation of postoperative results (intervention group) or 3D imaging without simulation (control group). All patients were invited to complete a patient-reported outcome (BREAST-Q) expectations module and breast reconstruction or reduction/mastopexy module before and 6 months after surgery. Results: A total of 96 patients were enrolled. Sixty-nine patients (45 OP and 24 IBR) completed the pre- and postoperative questionnaires and were randomized for the simulation. Women in the OP group had higher expectations for breast appearance when clothed than those in the IBR implant group (93.4 ± 16.3 versus 82.9 ± 26.5; P = 0.03). The intervention group was more satisfied with information than the control group (P = 0.021). Both patients who underwent OP and IBR believed that the 3D simulation helped them understand the surgical process (86.6% and 75%, respectively). Conclusions: Preoperative 3D simulation significantly improved patient's satisfaction with information and did not decrease postoperative satisfaction with the outcomes. The incorporation of preoperative 3D simulation may be a valuable tool in breast reconstruction.

Effects of aging and the body mass index on male sex hormones: a cross-sectional study in 701 Brazilian men / Efeitos do envelhecimento e do índice de massa corporal sobre os hormônios sexuais masculinos: um estudo transversal em 701 homens brasileiros

Background: Some studies indicated that body mass index (BMI) is inversely proportional to serum testosterone concentrations in men. Purposes: This study aimed to analyze the effects of aging and obesity on total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) levels. Methods: A cross-sectional study was performed to assess the clinical and laboratory profiles of 701 patients treated at a private urology clinic in Ponta Grossa, Brazil, from January 2016 to December 2018. Results: Patients' age ranged from 16 to 88 years (mean, 56.9 ± 13.62 years). Age did not significantly influence serum TT concentrations, except compared to patients aged >70 years. However, changes were observed in FT and BT (p < 0.05). The mean SHBG increased with age (p < 0.05). A tendency toward LH elevation was observed in older patients, but it was not statistically significant. An inverse proportional relationship between TT, FT, and BT and the testosterone deficiency rate (TT < 300 ng/dL) was observed within BMI groups (p < 0.05). The testosterone deficiency rate was 21.5% in individuals with normal BMI, 29% in overweight individuals, and 37% in obese individuals. Conclusions: Aging affected the testosterone concentrations in men and became increasingly evident using FT and BT instead of TT. SHBG increased with age. Obesity was associated with a decrease in TT, FT, and BT but also increased the rate of hypogonadism. (AU)

Fundamentos: Alguns estudos indicam que o índice de massa corporal (IMC) é inversamente proporcional à con-centração de testosterona sérica em homens. Objetivos: O objetivo deste estudo é analisar o efeito do envelhe-cimento e da obesidade na testosterona biodisponível total e livre, bem como nos níveis de hormônio luteinizante e globulina ligadora de hormônio sexual. Métodos: Foi realizado um estudo transversal abordando o perfil clínico e laboratorial de 701 pacientes atendidos em uma clínica privada de urologia em Ponta Grossa, Brasil, de janei-ro de 2016 a dezembro de 2018. Resultados: A idade dos pacientes variou de 16 a 88 anos (média de 56,9 ± 13,62 anos). A idade não influenciou significativamente as concentrações séricas de testosterona total, exceto quando comparada a pacientes com mais de 70 anos. No entanto, foi observada diferença na testosterona livre e biodisponível (p <0,05). A média de globulina de ligação aos hormônios sexuais aumentou com a idade (p <0,05). Embora uma tendência à elevação da luteinização tenha sido observada em pacientes mais idosos, ela não foi significativa. Relação inversa entre testosterona total, livre e biodisponível e taxa de deficiência de testosterona (testosterona total <300 ng / dL) foi observada dentro dos grupos de índice de massa corporal (p <0,05). A taxa de deficiência de testosterona em indivíduos com índice de massa corporal normal foi de 21,5%, indivíduos com sobre-peso foi de 29% e em indivíduos com obesidade foi de 37%. Conclusões: O envelhecimento afetou a concentração de testosterona em homens, mais evidente ao avaliar testosterona livre e biodisponível em vez de testosterona total. A globulina de ligação aos hormônios sexuais aumentou com a idade. A obesidade foi associada à redução da testosterona total, livre e biodisponível e ao aumento da taxa de hipogonadismo. (AU)

Prepectoral Direct-to-Implant Breast Reconstruction without Placement of Acellular Dermal Matrix or Mesh after Nipple-Sparing Mastectomy.

BACKGROUND: The aim of this study was to report the results of prepectoral direct-to-implant reconstruction in nipple-sparing mastectomy without acellular dermal matrices or mesh. METHODS: A multicenter cohort of patients undergoing prophylactic or therapeutic nipple-sparing mastectomy was included from 2013 to 2020. All sizes and types of breasts were included, except those with previously failed reconstruction, previous radiotherapy with severe skin damage, locally advanced breast cancer, gigantomasty, severe degree of ptosis, tumors close to the nipple-areola complex (<1 cm on magnetic resonance imaging), or combined autologous-based reconstruction. RESULTS: A total of 280 immediate breast reconstructions were performed in 195 patients. The mean age was 45 years and 32.8 percent of patients were postmenopausal. The mean follow-up period was 16.5 (±17.43) months. Eighty-five patients (43.6 percent) underwent bilateral mastectomy; 116 mastectomies (41.4 percent) were prophylactic and 164 (58.6 percent) were therapeutic. Sixty-eight reconstructions (24 percent) had at least one acute complication, the most common being implant explantation (9.2 percent), which was more frequent in smokers. Late complications included rippling (grades 3 and 4) in seven cases (3.8 percent) and capsular contracture (Baker II through IV) in 29 cases (15.7 percent) [22 Baker II (11.9 percent), six Baker III (3.3 percent), and one Baker IV (0.5 percent)]. One implant rotation was observed. No deformity animation was observed. Cosmetic results were considered good or excellent in 87.3 percent of patients. CONCLUSIONS: Overall complications were similar to those reported in acellular dermal matrices, mesh, or subpectoral series, except for a higher explantation rate. This technique is safe and economically advantageous, as it is a one-stage technique without acellular dermal matrices and mesh. These are preliminary data and larger and comparative studies are needed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Percepção de barreiras à prática de atividades físicas por pacientes diabéticos tipo 2 / Perception of barriers to the practice of physical activities by type 2 diabetic patients

O diabete melito está entre as principais causas de mortalidade no mundo e pode ser agravada pela inatividade física. O objetivo deste estudo descritivo transversal foi identificar as barreiras percebidas para a prática de atividade física sob a perspectiva dae pacientes diabéticos tipo 2. Participaram 220 pacientes (111 mulheres e 109 homens), com média de idade de 62,9 anos. Foram coletados índice de massa corporal, dados sociodemográficos e informações relacionadas ao histórico de doenças preexistentes. Para a análise das barreiras percebidas para a prática de atividades físicas, utilizou-se um questionário estruturado e validado para a população adulta brasileira proposto por Martins&Petroski. As barreiras foram analisadas individualmente e agrupadas em domínios ambiental, comportamental, físico e social. Em conclusão, as barreiras percebidas foram a falta de interesse (38,6%), cansaço físico (32,3%) e jornada de trabalho extensa (26,3%) e, assim, medidas devem ser adotadas visando minimizar os efeitos dessas barreiras e promover a atenção primária à saúde à essa população

Diabetes is among the leading causes of mortality in the world and can be aggravated by physical inactivity. This descriptive cross-sectional study aimed to identify the perceived barriers to the practice of physical activity from the perspective of type 2 diabetic patients. 220 diabetic patients participated in the research (111 women and 109 men), with a mean age of 62.9 years. Body mass index, sociodemographic data and information related to the history of preexisting diseases were collected. For the analysis of perceived barriers to the practice of physical activities, a structured and validated questionnaire for the Brazilian adult population proposed by Martins&Petroski was used. Barriers were analyzed individually and grouped into environmental, behavioral, physical and social domains. In conclusion, the main barriers perceived were lack of interest (38.6%), physical fatigue (32.3%) and long working hours (26.3%) and, them, measures should be taken to minimize the effects of these barriers, in order to promote primary health care in this population

Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol.

OBJECTIVE: Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. METHODS: We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. RESULTS: Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. CONCLUSION: Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.

OBJECTIVO: Infecção e exposição da prótese são algumas das complicações mais comuns e preocupantes após reconstrução da mama com implantes. Atualmente, ainda não há consenso quanto ao manejo destas complicações. O objetivo deste estudo foi o de revisar os casos da nossa instituição e apresentar um protocolo clínico. MéTODOS: Realizou-se uma revisão retrospectiva de todos os casos consecutivos submetidos a reconstrução mamária imediata com prótese entre 2014 e 2016. Todos os casos foram conduzidos de acordo com um protocolo específico e estruturado. RESULTADOS: A exposição do implante ocorreu em 33 de 227 reconstruções (11,9%). Dentre estas, duas pacientes tinham histórico de radioterapia, e foram submetidas a remoção da prótese e posterior reconstrução com retalho miocutâneo. Sinais de infecção local grave foram observados em 12 pacientes, e, em 5, necrose extensa de tecido, e todas foram submetidas a remoção dos implantes; destas, 8 foram reconstruídas com expansor, e 2, com retalho miocutâneo. As 14 pacientes remanecentes não haviam sido submetidas previamente à radioterapia, não tinham sinais de infecção, nem necrose extensa; portanto, foram submetidas a sutura primária em uma tentativa de salvar a prótese. Dessas, 8 pacientes (57,1%) conseguiram manter os implantes originais. CONCLUSãO: Nosso protocolo clínico é baseado em três pontos principais: histórico de radioterapia, infecção grave, e necrose extensa de tecido. Ele constitui um método prático e potencialmente reprodutível de manejo de uma das complicações mais comuns da reconstrução mamária com implantes.

Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol / Exposição de prótese após reconstrução imediata da mama: apresentação e análise de protocolo clínico

Abstract Objective Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. Methods We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. Results Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the Conclusion Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.

Resumo Objectivo Infecção e exposição da prótese são algumas das complicações mais comuns e preocupantes após reconstrução da mama com implantes. Atualmente, ainda não há consenso quanto ao manejo destas complicações. O objetivo deste estudo foi o de revisar os casos da nossa instituição e apresentar um protocolo clínico. Métodos Realizou-se uma revisão retrospectiva de todos os casos consecutivos submetidos a reconstrução mamária imediata com prótese entre 2014 e 2016. Todos os casos foram conduzidos de acordo com um protocolo específico e estruturado. Resultados A exposição do implante ocorreu em 33 de 227 reconstruções (11,9%). Dentre estas, duas pacientes tinham histórico de radioterapia, e foram submetidas a remoção da prótese e posterior reconstrução com retalho miocutâneo. Sinais de infecção local grave foram observados em 12 pacientes, e, em 5, necrose extensa de tecido, e todas foram submetidas a remoção dos implantes; destas, 8 foram recons truídas com expansor, e 2, com retalho miocutâneo. As 14 pacientes remanecentes não haviam sido submetidas previamente à radioterapia, não tinham sinais de infecção, nem necrose extensa; portanto, foram submetidas a sutura primária em uma tentativa de salvar a prótese. Dessas, 8 pacientes (57,1%) conseguiram manter os implantes originais. Conclusão Nosso protocolo clínico é baseado em três pontos principais: histórico de radioterapia, infecção grave, e necrose extensa de tecido. Ele constitui um método prático e potencialmente reprodutível de manejo de uma das complicações mais comuns da reconstrução mamária com implantes.

Silencing of Transposable Elements Mediated by 5-mC and Compensation of the Heterochromatin Content by Presence of B Chromosomes in Astyanax scabripinnis.

The way in which transcriptional activity overcomes the physical DNA structure and gene regulation mechanisms involves complex processes that are not yet fully understood. Modifications in the cytosine-guanine sequence of DNA by 5-mC are preferentially located in heterochromatic regions and are related to gene silencing. Herein, we investigate evidence of epigenetic regulation related to the B chromosome model and transposable elements in A. scabripinnis. Indirect immunofluorescence using anti-5-mC to mark methylated regions was employed along with quantitative ELISA to determine the total genomic DNA methylation level. 5-mC signals were dispersed in the chromosomes of both females and males, with preferential accumulation in the B chromosome. In addition to the heterochromatic methylated regions, our results suggest that methylation is associated with transposable elements (LINE and Tc1-Mariner). Heterochromatin content was measured based on the C-band length in relation to the size of chromosome 1. The B chromosome in A. scabripinnis comprises heterochromatin located in the pericentromeric region of both arms of this isochromosome. In this context, individuals with B chromosomes should have an increased heterochromatin content when compared to individuals that do not. Although, both heterochromatin content and genome methylation showed no significant differences between sexes or in relation to the occurrence of B chromosomes. Our evidence suggests that the B chromosome can have a compensation effect on the heterochromatin content and that methylation possibly operates to silence TEs in A. scabripinnis. This represents a sui generis compensation and gene activity buffering mechanism.

Erectile Dysfunction, Testosterone Levels and Disease Activity in Ankylosing Spondylitis Patients.

OBJECTIVE: To study erectile function in male patients with Ankylosing Spondylitis (AS) trying to correlate it with sexual hormonal profile and disease activity. METHODS: We included 35 AS patients and 104 controls. Patients and controls answered the IIEF (International Index of Erectile Dysfunction) and had dosing of total testosterone, free testosterone (FT), bioavailable testosterone (BT), SHBG (serum hormone binding globulin), albumin and LH (luteinizing hormone). AS patients had epidemiological, clinical and treatment data obtained from the charts. AS disease activity was measured simultaneously with blood collection through Bath AS Disease Activity Index, ASDAS (AS Disease Activity Score) -ESR (using erythrocyte sedimentation rate) and ASDAS-CRP (using C reactive protein). RESULTS: The IIEF results were worse in AS patients than controls (P = .02). Total testosterone and SHBG were higher in AS (with P = .01 and P <.0001 respectively). Between the 2 groups, no differences in LH, FT, BT levels (all with P = ns) were found. In AS patients, the IIEF results did not correlate with total testosterone, SHBG, LH, FT, and BT but a negative association was found with Bath AS Disease Activity Index (P = .001) and ASDAS-CRP (P = .02). CONCLUSION: AS patients had worst sexual performance than controls that was linked to disease activity but not to male sexual hormonal profile.

O que o profissional da saúde precisa saber a respeito do atendimento às pessoas transexuais ou transgênero / What does the health professional needs to know about the care of transgender people

RESUMO: Introdução: As pessoas transexuais encontram uma série de dificuldades no atendimento médico, tanto na rede privada como na pública no Brasil. Objetivo: Demonstrar aos profissionais da área da saúde a realidade vivida pelas pessoas transexuais, quando necessitam de atendimento médico no Brasil, visando aprimorar os conhecimentos sobre o atendimento a este grupo populacional. Métodos: Coleta de dados realizada em fevereiro de 2020 com buscas nas bases eletrônicas: PubMed, Scielo, Lilacs e Google Scholar. Utilizou-se os descritores em associação: transgender; medical care; transexual; cross-sex hormone therapy, no período entre 2000 a 2020. Resultados: Encontramos 720 publicações com as palavras-chave transgender persons e medical care, 30 com as palavras-chave transgender, medical care e cross-sex hormone therapy, sendo escassos os estudos feitos no Brasil. Conclusão: Para que ocorra uma melhora no atendimento à saúde das pessoas transexuais é necessário que sejam inseridas disciplinas específicas sobre este tema na grade curricular dos cursos técnicos, de graduação e de pós-graduação da área da saúde. (AU)

ABSTRACT: Introduction: Transsexual people encounter a series of difficulties in medical care, both in the private and public health systems in Brazil. Objectives: Demonstrate to health professionals the reality experienced by transsexual people when they need medical care in Brazil, in order to improve knowledge about the care of this population group. Methods: Data collection was carried out in February 2020 with searches in electronic databases: Pubmed, Scielo, Lilacs and Google Scholar. The following descriptors were used: transgender; medical care; transsexual; cross-sex hormone therapy from 2000 to 2020.Results: We found 720 publications with the keywords transgender persons and medical care, 30 with the keywords transgender, medical care and cross-sex hormone therapy, with few studies conducted in Brazil Conclusion: To improve the health care of transgender people, it is necessary to insert specific disciplines on this topic in the curriculum of technical, undergraduate and graduate courses in the health area. (AU)

Marking axillary nodes with 4% carbon microparticle suspension before neoadjuvant chemotherapy improves sentinel node identification rate and axillary staging.

BACKGROUND AND OBJECTIVES: Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. METHODS: A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. RESULTS: Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). CONCLUSION: The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.

Immunolocalization of IP3R and V-ATPase in Ameloblastomas.

The goal of this study was to investigate the immunolocalization of inositol 1,4,5-trisphosphate receptor (IP3R) and vacuolar ATPase (V-ATPase) in ameloblastomas with special attention to the invasive front. Thirty-seven cases of previously diagnosed formalin-fixed paraffin-embedded (FFPE) human ameloblastoma samples were selected for this study. The samples were grouped according to the predominant histologic pattern and comprised twelve plexiform, eighteen follicular, and seven unicystic ameloblastomas. Of the unicystic variants, six demonstrated purely luminal and intraluminal growth, and one displayed mural extension. One granular cell variant was included in the follicular ameloblastoma group. All specimens were evaluated for IP3R and V-ATPase expression by immunohistochemistry (IHC). IP3R was positive in columnar cells, similar to ameloblasts, and non-peripheral cells in all samples. In the area of tumor protrusion and front of invasion, membranous and cystoplasmic IP3R expression was observed. In contrast, areas adjacent to tumoral protrusion demonstrated only membranous staining patterns. V-ATPase was not expressed in peripheral columnar cells of the unicystic and granular cell variants of ameloblastoma; however, strong staining was present in these cells in plexiform ameloblastomas, follicular ameloblastomas, and areas of mural growth of unicystic ameloblastomas. In areas of tumor protrusion, reactivity for V-ATPase was observed with both membranous and cytoplasmic staining, while other areas showed only membranous V-ATPase. These findings suggest that concomitant immunolocalization of IP3R and V-ATPase, with both cytoplasmic and membranous expression in the peripheral columnar cells, may indicate the invasive potential of ameloblastomas. Furthermore, these results suggest the tumoral spread of ameloblastomas may be correlated with the autophagy process and channelopathy. The expression of these proteins could establish a baseline for future research and provide therapeutic targets for treatment of ameloblastomas.

Trends in breast cancer surgery in private patients under opportunistic screening / Tendências na cirurgia de câncer de mama em pacientes de um serviço privado sob rastreio oportunístico

Objective: This study aims to determine the evolution of staging and surgical treatment in patients with breast cancer in a private clinic over the last 40 years. Methods: Retrospective descriptive observational study, through statistical analysis of the medical records of 2105 patients treated at a private clinic in Curitiba, Paraná, between 1977 and 2017. Results: Data analyzed from 2,105 patients diagnosed with breast cancer revealed that, over time, radical surgeries predominated when compared to conservative ones. However, when analyzed proportionally over the years, it is possible to observe an inversion of the surgical modalities. It was demonstrated that from 1977 to 2017, there was a 273% increase in the number of conservative surgeries and a 45.5% decrease in mastectomies. In addition to this data, there was a decrease in the number of axillary emptying and, consequently, of positive sentinel lymph nodes. In addition, tumors diagnosed early (T1) have increased over the years. Conclusion: Patients had an early diagnosis of the disease, resulting in less invasive surgical treatments and, consequently, lower morbidity and mortality.

Objetivo: A pesquisa visa determinar a evolução do estadiamento e do tratamento cirúrgico em pacientes com câncer de mama em uma clínica privada, nos últimos 40 anos. Métodos: Estudo observacional descritivo retrospectivo, por meio da análise estatística dos prontuários de 2105 pacientes atendidas em clínica privada em Curitiba, Paraná, entre 1977 e 2017. Resultados: Dados analisados de 2.105 pacientes diagnosticadas com câncer de mama revelaram que, ao longo do tempo, as cirurgias radicais predominaram quando comparadas às cirurgias conservadoras. No entanto, quando analisadas proporcionalmente ao longo dos anos, é possível constatar uma inversão das modalidades cirúrgicas. Demonstrou-se que de 1977 a 2017, houve aumento de 273% do número das cirurgias conservadoras e queda de 45,5% das mastectomias. Associado a esse dado, notou-se diminuição do número de esvaziamento axilar e consequentemente de linfonodos sentinela positivos. Além disso, os tumores diagnosticados em fase inicial (T1) aumentaram ao longo dos anos. Conclusão: As pacientes tiveram um diagnóstico em estadiamento mais precoce da doença, proporcionando tratamentos cirúrgicos menos invasivos e, consequentemente, menor morbidade.

The role of enzymatic antioxidants detected in the follicular fluid and semen of infertile couples undergoing assisted reproduction.

The follicular fluid environment surrounding the oocytes may play a critical role in fertilization and subsequent embryo development. The goal of our study was to evaluate the oxidative stress markers in the semen, blood serum, and follicular fluid of couples undergoing Intracytoplasmic Sperm Injection (ICSI). Two hundred and eight infertile couples underwent ICSI and the levels of superoxide dismutase (SOD) and catalase and lipid peroxidation (LPO) were evaluated. Semen Catalase was highly correlated with fertilization and cleavage rates, but not with pregnancy rates. Fertilization and cleavage rates were correlated with the levels of SOD and Catalase in the follicular fluid. After adjusting for age, a negative correlation was detected between LPO levels in follicular fluid and pregnancy rates. Follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy.

Effect of cigarette smoking on antioxidant levels and presence of leukocytospermia in infertile men: a prospective study.

OBJECTIVE: To evaluate the effect of cigarette smoking on antioxidant levels and the presence of leukocytospermia in infertile men. DESIGN: Prospective study. SETTING: Academic medical center. PATIENT(S): Ten fertile donors and 112 infertile patients were included in the study. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen analysis was performed according to the World Health Organization guideline. The activity of the superoxide dismutase was based on the adrenochrome concentration, and the catalase activity was determined by the velocity of hydrogen peroxide consumption. RESULT(S): Lower levels of superoxide dismutase and catalase were seen in infertile patients compared with fertile donors. Superoxide dismutase was significantly correlated with sperm concentration and negatively correlated with leukocytospermia. In addition, leukocytospermia was inversely correlated with sperm motility. Superoxide dismutase levels were negatively related to cigarette smoking. CONCLUSION(S): Cigarette smoking may impair sperm motility and decrease the antioxidant activity (negative correlation with superoxide dismutase) in the seminal plasma.

High percentage of abnormal semen parameters in a prevasectomy population.

OBJECTIVE: To evaluate semen characteristics, testicular volume, and hormonal levels of normal fertile men requiring vasectomy for sterilization. DESIGN: Retrospective study. SETTING(S): Academic medical centers. PATIENT(S): A total of 889 patients underwent a vasectomy for sterilization. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen volume, sperm concentration, motility, and morphology according to the World Health Organization (WHO); complex motion parameters evaluated by computer-assisted semen analyzer; FSH, LH, and T levels; and both testicular volumes. RESULT(S): When compared with the WHO values, 87.2% of the patients presented normal sperm morphology below the normal level. The other semen parameters (semen volume, pH, sperm concentration, and sperm motility) differed from the WHO parameters in 6%-32.2% of patients. Semen volume and sperm concentration presented a progressive increase according to the duration of sexual abstinence. However, patients with 5 days or more of abstinence had a decrease in sperm motility. Mean testicular size had the strongest correlation with serum FSH levels, total sperm count, and sperm concentration. CONCLUSION(S): Low sperm motility and morphology were found in men who request a vasectomy for sterilization. Semen volume and sperm concentration present a progressive increase and sperm motility a decrease according to the duration of sexual abstinence. Sperm concentration had stronger correlations with testicular size than did sperm quality. Therefore, the WHO normal values need to be reconsidered.

Clinical diagnosis in men undergoing infertility investigation in a university hospital.

INTRODUCTION: It was the aim of this study to assess whether the changes in the diagnostic techniques and treatment modalities have altered the epidemiology of male factor infertility in the last decade. MATERIAL AND METHODS: From September 1999 to July 2003, 822 patients were evaluated for infertility in a University Hospital. We divided our infertility patients according to the clinical diagnosis. RESULTS: Most of the patients presented with varicocele (n = 282, 34.3%), idiopathic infertility (n = 260, 31.6%), or had had seminal tract obstruction (n = 85, 10.34%). Least common but equally important causes found were mumps (n = 43, 5.23%), pyospermia (n = 37, 4.5%), systemic diseases (n = 36, 4.37%), testicular failure (n = 34, 4.13%), cryptorchidism (n = 14, 1.7%), ejaculatory dysfunction (n = 11, 1.3%), genetics (n = 9, 1.1%), endocrinopathies (n = 4, 0.5%), testicular cancer (n = 4, 0.5%), and testicular torsion (n = 3, 0.36%). CONCLUSIONS: Even with the changes in reproductive healthcare in the last years, varicocele and seminal tract obstruction remain the leading causes of male infertility. However, clinicians should not forget other treatable causes of male infertility such as pyospermia, systemic diseases, or testicular cancer.

Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update.

OBJECTIVE: To assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns. DESIGN: Prospective study. SETTING: Academic medical centers. PATIENT(S): Medical records of 27 azoospermic men, who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and May 2004, were reviewed. INTERVENTION(S): Twenty-seven azoospermic men underwent testis biopsy and microsurgical repair of clinical varicocele. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses postoperatively. MAIN OUTCOME MEASURE(S): Semen analysis after varicocelectomy. RESULT(S): Hypospermatogenesis was identified in 9, maturation arrest in 8, and germ cell aplasia in 10 men. Induction of spermatogenesis was achieved in nine men (33.3%). Of these, four had germ cell aplasia, three had maturation arrest, and two had hypospermatogenesis. The improvement in sperm concentration and motility ranged from 1.2 x 10(6)/mL to 8.9 x 10(6)/mL, and from 24% to 75.7%, respectively. Of these nine patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established pregnancy. CONCLUSION(S): Azoospermic patients may have an improvement in semen quality after varicocelectomy. Semen samples may be cryopreserved after an initial improvement after varicocelectomy.

Cigarette smoking is related to a decrease in semen volume in a population of fertile men.

OBJECTIVE: To evaluate the semen quality and hormonal levels in fertile men according to their level of cigarette smoking. SUBJECTS AND METHODS: We evaluated 889 fertile men who came for a vasectomy for sterilization purposes. The men included 522 non-smokers, 143 mild smokers (<10 cigarettes/day), 154 moderate smokers (11-20/day), and 70 heavy smokers (>20/day). We evaluated sperm concentration, motility, motion variables and hormonal levels in these men. RESULTS: There were no significant differences among the groups in sperm concentration or motility, or in levels of follicle-stimulating hormone, luteinizing hormone, or serum total testosterone. Also, sperm motion characteristics did not differ across the groups. Semen volume was the only semen variable which tended to decrease according to the number of cigarettes smoked. CONCLUSIONS: Cigarette smoking had no apparent effect on sperm concentration, motility or reproductive hormonal levels, but tended to reduce semen volume.

Sperm concentration and normal sperm morphology decrease and follicle-stimulating hormone level increases with age.

OBJECTIVE: To assess hormone levels, testicular volume, and semen characteristics of fertile men of various age groups. PATIENTS AND METHODS: The records of 889 men who sought a vasectomy between September 1999 and March 2003 were reviewed. Patients were divided into five groups by age; we evaluated semen volume, sperm concentration, motility, morphology and complex sperm motion variables. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels and both testicular volumes were compared. RESULTS: There were no differences among the groups in the levels of LH, testosterone, or right and left testicular volumes. There were differences among the five groups in FSH levels, semen volume, sperm concentration and motility. Normal morphology according to the World Health Organisation criteria was significantly lower in patients aged > 45 years. From a linear regression analysis, semen volume, sperm concentration and motility decreased by 0.01 mL, 2.1%, and 0.27%, respectively, per year, and the FSH level increased by 0.27%. CONCLUSIONS: Sperm concentration and motility decrease and FSH levels increase with age. Normal sperm morphology decreases from 45 years old. Thus, the ageing effect should be considered when proposing standard values for semen characteristics in routine semen analysis.

Is it worthwhile to operate on subclinical right varicocele in patients with grade II-III varicocele in the left testicle?

PURPOSE: To determine whether repair of subclinical varicoceles in the right testicle results in significant seminal improvement in patients with clinical left varicocele. METHODS: Patients were divided into two groups: Group I (unilateral varicocelectomy) and Group II (bilateral varicocelectomy-subclinical left varicocele). The mean sperm concentration before treatment was higher in Group I (21.01 +/- 19.1) compared to Group II (5.7 +/- 10.7) (p = 0.04). RESULTS: An increase in volume was detected in the left testicle of patients in Group I (17 +/- 7.9 vs. 22.81 +/- 8.2; p = 0.04) and in the right testicle of patients in Group II (18.4 +/- 6.2 vs. 22.3 +/- 6.5; p = 0.04). Although the mean postoperative sperm concentration in Group I increased slightly (25.7 +/- 22.8), the mean sperm concentration in Group II increased significantly (30.32 +/- 9.8; p = 0.03). Pregnancy rate was higher in Group II (66.7%) compared to Group I (33.3%). CONCLUSIONS: Even a small, subclinical unrepaired varicocele continues to have a detrimental effect on bilateral testis function in a patient with grade II-III left varicocele.