The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics.

BACKGROUND: Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. OBJECTIVES: To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. METHODS: A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. RESULTS: The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. CONCLUSIONS: The present findings will help in better understanding male infertility pathophysiology, improving its management.

KDIGO 2012 Clinical Practice Guideline CKD classification rules out creatinine clearance 24 hour urine collection?

OBJECTIVES: The recent guideline for the evaluation and management of Chronic Kidney Disease recommends assessing GFR employing equations based on serum creatinine; despite this, creatinine clearance 24-hour urine collection is used routinely in many settings. In this study we compared the classification assessed from CrCl (creatinine clearance 24h urine collection) and e-GFR calculated with CKD-EPI or MDRD formulas. DESIGN AND METHODS: In this retrospective study we analyze consecutive laboratory data: creatinine clearance 24h urine collection, serum creatinine and demographic data such as sex and age from 15,777 patients >18 years of age collected from 2011 to 2013 in our laboratory at Careggi Hospital. The results were then compared to the estimated GFR calculated with the equations according to the recent treatment guidelines. Consecutive and retrospective laboratory data (creatinine clearance 24h urine collection, serum creatinine and, demographic data such as sex and age) from 15,777 patients >18 years of age seen at Careggi Hospital were collected. RESULTS: Comparison between e-GFR calculated with CKD-EPI or MDRD formulas and GFR according CrCl determinations and bias [95% CI] were 11.34 [-47,4/70.1] and 11.4 [-50.2/73] respectively. The concordance for 18/65 years aged group when compared with e-GFR classification between MDRD vs CKDEPI, MDRD vs CrCl and CKD-EPI vs CrCl were 0.78, 0.34, and 0.41 respectively, while in the 65/110years aged group the concordance Kappas were 0.84, 0.38, and 0.36 respectively. CONCLUSIONS: The use of CrCl provides a different classification than the estimation of GFR using a prediction equation. The CrCl is unreliable when it is necessary to identify CKD subjects with decrease of GFR of 5ml/min/1.73m(2)/year.

Caregiver time use in ALS.

The authors evaluated the caregiver time for 70 patients with ALS. The mean number of caregivers per patient was 2.0 (SD 1.3). Caregiver time increased with worsening of disability (p = 0.0001). The most time-consuming duties were housekeeping, feeding, and toileting. With worsening of patients' disability, families relied increasingly on paid caregivers. Caregiver time is a hidden cost of ALS care and is a major burden for caregivers.

Serous cutaneous glands of the Pacific tree-frog Hyla regilla (Anura, Hylidae): patterns of secretory release induced by nor-epinephrine.

The serous (poison) cutaneous glands of the Pacific tree-frog Hyla regilla were induced to release their product by 10(-3)M nor-epinephrine stimulation. After discharge structural and ultrastructural features of the cutaneous glands involved in release were observed. Furthermore, the discharged product, consisting of discrete, secretory granules, was collected and processed for transmission electron microscope analysis. As indicated by patterns found in the myoepithelium encircling the syncytial secretory unit, gland discharge is caused by contraction of the peripheral myocytes. Muscle cell compression dramatically affects the syncytium and results in degenerative changes, including expulsion of the secretory unit nuclei. Therefore, the structural collapse in depleted glands has been ascribed to the mechanical activity performed by the myoepithelium during discharge, rather than cytoplasm involution described in conventional, holocrine glands. TEM investigation revealed that the secretory granules collected after discharge maintain their peculiar traits: they consist of recurrent patterns of thin subunits, acquired during serous maturation and provided with remarkable structural stability.

Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS.

BACKGROUND: Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. OBJECTIVE: To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. METHODS: 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure. RESULTS: The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02). CONCLUSIONS: PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.

Development of serous cutaneous glands in Scinax nasica (Anura, Hylidae): patterns of poison biosynthesis and maturation in comparison with larval glands in specimens of other families.

We examined the development of serous (poison) cutaneous glands in larval and juvenile Scinax nasica (Hylidae) at the ultrastructural level. We describe the biosynthesis and maturation of the cutaneous poison in comparison with the corresponding processes in representatives of Discoglossidae, Leptodactylidae, Pelobatidae and Pipidae. Serous biosynthesis in S. nasica starts in discrete adenoblasts and continues in the syncytial secretory unit. Biosynthetic processes involve rough endoplasmic reticulum and the Golgi apparatus, that releases membrane-bounded material, varying from fine grained to flocculent. During the post-Golgian secretory phase, this material undergoes initial maturation, and two products are formed: dense granules and larger vesicles holding a thin substance that will later be structured into a three-dimensional, honeycomb-like net. Both the secretory granules and vesicles change into glomerular-like aggregates of bowed, rod-shaped subunits (modules). In adult frogs, formation of dense granules is bypassed. The modular granule substructure seems to be related to the merocrine release of small amounts of poison, involved in regulating skin homeostasis. Comparison with maturational changes in larval glands of species representing four anuran families discloses similar patterns in the Leptodactylidae, but production of opaque homogeneous granules occurs in the Discoglossidae, clear vesicles in the Pelobatidae and aggregates of dense bars in the Pipidae.

Amyotrophic lateral sclerosis among the migrant population to Piemonte, northwestern Italy.

Recent surveys indicate a decreasing north-to-south gradient in the mortality and incidence rates of amyotrophic lateral sclerosis (ALS) in Italy, possibly indicating a different susceptibility to ALS in these populations. Piemonte, a region of northwestern Italy, experienced a considerable migration from other regions in Italy between 1940 and 1975; we therefore analyzed the effects of place of birth and migration upon the risk of developing ALS. Data on all ALS cases occurring in Piemonte during the period 1971-1990 were collected. Standardized incidence ratios (SIRs) for patients born outside Piemonte were calculated, using the Piemonte-born population as reference. A total of 962 ALS cases were identified during the study period, corresponding to a mean annual crude incidence rate of 1.37/100,000 population (95% confidence interval, 1.29-1.46). The SIRs of patients born in three southern Italian regions and of foreign-born persons were significantly higher than those of persons born in Piemonte and or other regions in Italy, and increased with age. This observation may be explained by an interaction between environmental and genetic factors or by selective migration.

[Arteriovenous fistulas for hemodialysis: transposition of the cephalic veins, a personal experience]. / Fistole artero/venose per emodialisi. La trasposizione della vena cefalica nella nostra esperienza.

BACKGROUND: Vascular access for hemodialysis has remarkably developed during these years. Since 1966 we have the Brescia-Cimino fistula which is considered nowadays the best choice for angioaccess. The transposed cephalic vein is the "variant" which has been evaluated in a single stage surgical technique. METHODS: A prospective and randomized study regarding 23 patients submitted to operation for first fistula during 1998. With a median follow-up of 10 months, these fistulas have been studied with echocolordoppler in order to verify their primary patency, diameter and blood flow in artery, in vein and anastomosis. RESULTS: Fistulas have been patented in all cases (15 males e 8 females) and used for dialysis after 3 weeks. No early or late complications have been observed. Mean diameter has been 1.2 cm with mean velocity of 1.8 m/sec, in artery mean velocity 2.3 m/sec and in vein 1.1 m/sec. CONCLUSIONS: Increasing length of life even for high critical patients like these with chronic renal failure underlines the need of surgical strategies which may improve the quality to life. This technique of transposed cephalic vein has the same advantages of direct fistulas also for those patients in which we should have used prosthetic grafts.

Reduced glutathione in amyotrophic lateral sclerosis: an open, crossover, randomized trial.

The present study set out to define the possible effect of reduced glutathione (GSH), the substrate of glutathione peroxidase (GSH-Px), a free radical inactivating enzyme, in amyotrophic lateral sclerosis (ALS). Thirty-two patients affected by definite ALS seen in our institution between August 1993 and July 1994 were admitted to the study. The effect of GSH was studied in an open, crossover, randomized study. GSH was given at the dose of 600 mg each day intramuscularly for 12 weeks. The patients, taken sequentially, were randomly assigned to two groups. The first group received the drug while the second received only symptomatic therapies for 12 weeks. After a week of washout, the second group received GSH and the first only symptomatic therapies for 12 weeks. The rate of progression of the diseases was compared in the two groups. Clinical evaluation included manual test for muscle strength, Norris scale, bulbar scale, and forced vital capacity (FVC) percent. No significant difference was found in the progression of ALS in the two periods, although a slight slowing of the disease progression rate was found during the period of treatment, probably related to the open design of the study. Our data do not show any significant effect of reduced glutathione in modifying the progression of ALS.

Disseminated Dactylaria gallopava infection in a diabetic patient with chronic lymphocytic leukemia of the T-cell type.

A 62-year-old male with a 20-year history of diabetes and three-year history of adult T-cell lymphocytic leukemia developed a systemic infection with Dactylaria gallopava. At autopsy the fungus was found in the brain, lungs, liver, spleen, and kidney. The organism has caused disease in chickens and turkey poults and has been found in chicken litter, hot springs, and the effluent of a thermonuclear reactor. This report documents the second human infection and the first case of disseminated human dactylariosis.

Candida lusitaniae septicemia in a patient on extended home intravenous hyperalimentation.

This is a report of the successful therapy of a case of Candida lusitaniae septicemia in a patient with short bowel syndrome who had been on home intravenous hyperalimentation for approximately 3 months when the infection developed. C. lusitaniae was isolated from multiple blood cultures taken over the course of 2 days.

Red-pigmented Histoplasma capsulatum--an unusual variant.

An unusual variant of Histoplasma capsulatum was isolated from a canebrake. The mycelial form produced a red pigment that diffused into the medium and which was also present in the cell walls of the mycelium, microconidia and macroconidia. The yeast cells were not pigmented nor did they produce any pigment.

Epidermophyton floccosum infection in a dog from the United States.

Epidermophyton floccosum was isolated from a lesion of dermatophytosis on a dog with hyperadrenocorticism. This report is, to our knowledge, the first unequivocally documented case of canine infection in the United States.

Evaluation of commercial reagents to identify the exoantigens of Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma species cultures.

Commercially available individual serologic reagents (Nolan/Scott Biological Laboratories, Inc.) and an "exoantigen identification system" (a kit supplied by Immuno-Mycologics, Inc.) were evaluated at two laboratories for their possible application in the microimmunodiffusion test to identify Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma species. Both laboratories accurately identified all the cultures, and comparison of the results obtained with the commercial products and those established with the conventional methods performed by a third control laboratory demonstrated full agreement. The use of these two commercial products is recommended for the immunologic identification of cultures suspected of being B. dermatitidis, C. immitis, and Histoplasma species. It was observed, however, that the exoantigen reactions for four B. dermatitidis and two C. immitis isolates were much sharper and more readable with the individual reagents than the reactions observed with the kit.

Use of the exoantigen test to identify blastomyces dermatitidis, coccidioides immitis, and Histoplasma capsulatum in mixed cultures.

Cultures of Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum were inoculated with each of five saprophytes to simulate contaminated cultures. The cultures were extracted and tested in the immunodiffusion exoantigen test. Twenty-nine of 30 cultures were correctly identified. The saprophytes did not appear to interfere with the exoantigen test.

[Scanning electron microscopy study of rat lung tissue]. / Contribution a l'étude du tissu pulmonaire de rat par le microscope électronique a balayage.

Parts of rat lung tissue have been examined by means of a scanning electron microscope after either chemical or physical fixage. Chemical fixage produces retraction on the tissue structures and the alveoles appear of irregular shape. Physical fixage gives the possibility to observe lung morphology without distorsions; details reproduced are in this case very clear and in a shape which appears very close to the original conditions.