Testicular sperm extraction after laparoscopic orchiectomy for bilateral postpubertal intra-abdominal cryptorchidism: What chance of sperm retrieval?

Infertility occurs in up to 54% of men with bilateral undescended testes. Orchiectomy is considered the best therapeutic approach, especially when cryptorchidism is diagnosed in adulthood, due to a high risk of malignancy. A 33-year-old man was referred with a clinical presentation of empty scrotum and an ultrasonography and magnetic resonance imaging evaluation of intra-abdominal bilateral cryptorchidism. Follicle-stimulating hormone was 23.20 IU/L, luteinising hormone was 14.10 IU/L, total testosterone was 12.1 nmol/L, and 17-beta-oestradiol was 0.16 nmol/L. Semen analysis showed absolute azoospermia. Tumour marker levels were in the normal range. Testicular volume was 4.0 ml for right testis and 4.6 ml for left testis. The patient underwent a laparoscopy bilateral orchiectomy and subsequently a testicular sperm extraction (TESE), in the purpose to finding mature spermatozoa. The biological examination revealed the presence of immature sperm cells, not efficient for a cryopreservation. The histologic analyses show a pattern of Sertoli cell-only syndrome and maturation arrest. TESE might be a good option for patients with absolute azoospermia and cryptorchidism, especially if bilateral. The procedure, performed after orchiectomy, is safe and does not have any impact on patient's health, although it is important to clarify the very low potential of sperm recovery.

Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review.

Azoospermia can be diagnosed in about 10%-15% of the infertile male population. To overcome the problem of failure to produce spermatozoa in the ejaculate in patients with nonobstructive azoospermia (NOA), testicular sperm extraction (TESE) may be performed to find the focal area of spermatogenesis. A 47-year-old man with NOA presented for treatment of secondary couple infertility. The patient underwent a first TESE 7 years earlier with cryopreservation, and an intracytoplasmic sperm injection-embryo transfer ended in a term pregnancy. He reported a history of repeated testicular traumas. At the present time, a complete medical workup was carried out, including clinical history, general and genital physical examination, scrotal and transrectal ultrasounds. Hormone measurements showed follicle-stimulating hormone level of 42.7 IU/L, luteinising hormone of 11.4 IU/L, total testosterone of 2.6 ng/ml and right and left testicular volume, respectively, of 4 and 3.9 ml. He underwent a second TESE, with successful sperm retrieval and cryopreservation. The histological pattern was hypospermatogenesis. In cases of extreme testicular impairment, although in the presence of very high follicle-stimulating hormone value and small testicular volume, estimating poor sperm recovery potential, the integration of clinical and anamnestic data, could help the surgeon to practise the more appropriate method of treatment.

Combining long-acting bronchodilators with different mechanisms of action: A pharmacological approach to optimize bronchodilation of equine airways.

The ultra long-acting ß2 -adrenoceptor agonist olodaterol plus the ultra long-acting muscarinic antagonist tiotropium bromide are known to relax equine airways. In human bronchi combining these drugs elicits a positive interaction, thus we aimed to characterize this information further in equine isolated airways stimulated by electrical field stimulation (EFS) and using the Concentration-Reduction Index (CRI) and Combination Index (CI) equations. The drugs were administered alone and together by reproducing ex vivo the concentration-ratio delivered by the currently available fixed-dose combination (1:1). The single agents elicited a significant (p < .05) concentration-dependent reduction in the EFS-induced contractility, that was synergistically improved (CI 0.18) when administered in combination (0.9 logarithms more potent, 24% more effective than the monocomponents). The drugs mixture allowed a reduction in the concentration of olodaterol from ≃1 to ≃2.3 logarithms. A favorable CRI was detected also for tiotropium bromide, whose concentration can be reduced ≃1 logarithm at medium effect levels, remaining positive up to submaximal relaxant effect in the presence of olodaterol. The combination of tiotropium bromide/olodaterol allows the reduction in the concentration of the monocomponents to achieve airway smooth muscle relaxation, thus potentially decreases the risk of adverse events when these drugs are used to treat severe asthmatic horses.

Clinical efficacy of bronchodilators in equine asthma: Looking for minimal important difference.

BACKGROUND: Airway obstruction is the main trait of severe equine asthma that affects respiratory function and elicits detrimental effects on clinical presentation. Only few and underpowered clinical studies have investigated the impact of improvement in lung function induced by bronchodilators on the clinical signs of asthma-affected horses. OBJECTIVES: To identify the minimal important difference (MID) in lung function elicited by bronchodilator leading to a meaningful improvement in clinical signs. STUDY DESIGN: Pairwise meta-analysis and meta-regression analysis. METHODS: Literature searches were performed for studies that investigated the effect of bronchodilator therapy on lung function and clinical condition of asthmatic horses. The relationship between the change in lung function variables and clinical score was analysed via random-effect meta-regression. One-point change of the Improved clinically Detectable Equine Asthma Scoring System (IDEASS) score was used to identify the MID. RESULTS: A significant (P<0.05) relationship was found between the changes in IDEASS score and maximum change in transpulmonary pressure (ΔPplmax ) or pulmonary resistance (RL ). Since only the model resulting for RL passed through the origin (Y-intercept when X = 0: -0.31, 95% CI -0.75 to 0.14), this variable was used to identify the MID correlated with a meaningful improvement in clinical signs. The resulting MID value was a change in RL of 0.63 cm H2 O/L/s (95% CI 0.33-0.94), representing the slope of meta-regression model (high quality of evidence). MAIN LIMITATIONS: No long-term studies investigated the effect of bronchodilator agents on both lung function and clinical signs in asthmatic horses. CONCLUSIONS: In conclusion, bronchodilator pharmacotherapy in equine asthma elicits clinically meaningful effect when RL increases ≥1 cm H2 O/L/s, a value indicating the MID. Assessing the MID based on change in RL may improve the quality of evidence and the scientific impact of future clinical trials as it extends beyond the simple, and limiting, evaluation of statistical significance.

Influence of male human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection on the reproductive outcomes in serodiscordant couples: a case-control study.

BACKGROUND: Nowadays, serodiscordant couples (SDCs) with human immunodeficiency virus (HIV) or hepatitis C virus (HCV)-infected men have the chance to conceive safely, giving birth with a minimum risk of cross-infection. OBJECTIVE: To assess the impact of male HIV and HCV infection on the assisted reproductive technologies (ART) outcomes in SDCs, with HIV or HCV seropositive men and negative partners. MATERIALS AND METHODS: Of 153 couples: 24 in Group 1 (HIV-seropositive men), 60 in Group 2 (HCV-seropositive men) and 69 in Group 3 (controls). Sperm-washing procedure was performed using a three-step system. Fresh ICSI cycles were carried out in HIV SDCs, HCV SDCs and controls. Seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate per cycle (PR/C), miscarriage rate, implantation rate (IR) and live birth rate were evaluated. RESULTS: All the seropositive men have undetectable viral loads at the time of insemination, and both partners were free from co-morbid infections. The median number of embryos transferred was 2.0 (IQR 1.0-3.0), with no differences among groups. FR was significantly reduced in HIV and HCV SDCs compared to the controls (66%, 61% and 75%, respectively; p < 0.01). CR was similar between groups (p = 0.3). IR was 12.1%, 11.1% and 14.1%, respectively, in the three groups (p = 0.30). PR/C was 21.7%, 17.6% and 20.2% in HIV, HCV and controls, respectively. Live birth rate per cycle was 17.4%, 15.7% and 15.9%, respectively. There were no significant differences in clinical pregnancies per cycle, as well as miscarriages and live births (p = 0.30; 0.30; 0.60, respectively). CONCLUSIONS: The sperm-washing technique with ICSI may generate a promising way to improve pregnancy outcomes and to reduce the risk of viral transmission in these couples. In this setting, we can correctly counsel HIV- and HCV-infected men of SDCs with regard to the likelihood of father their own biological child.

Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study.

Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralph's shortened modified protocol. The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4-weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0-40)° or 42.9 (0-67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains). This prospective multicentric study confirms that the three-injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment.

Cervical ripening and induction of labor by prostaglandin E2: a comparison between intracervical gel and vaginal pessary.

OBJECTIVE: To compare the effectiveness and safety of two formulations of prostaglandin (PG) E2 (gel and pessary) for induction of labor. Primary outcomes were cervical ripening, initiation/duration of labor, and type of delivery. STUDY DESIGN: A total of 115 women with singleton gestations were consecutively enrolled and assigned to receive intracervical PGE2 (dinoprostone 0.5 mg) by gel (n = 66) or PGE2 (dinoprostone 10 mg) by intravaginal pessary (n = 49). RESULTS: Independently from parity, the vaginal pessary induced successful cervical ripening with a slightly higher but not statistically significant occurrence of vaginal delivery with respect to gel induction. The mean time interval from induction to vaginal delivery did not differ between groups, despite being shorter for the pessary group in inducation-delivery intervals > 12 h. No significant differences were found between the groups with respect to patients who required a second course of PGE2 (9% vs. 2%), as well as oxytocin (11% vs. 13%) induction. No significant difference was found in the incidence of uterine hyperstimulation and other adverse reactions in nulliparas, or in fetal and neonatal outcome. CONCLUSION: Independently from parity, both PGE2 administration routes appeared to be effective in achieving cervical ripening, initiation of labor and optimal type of delivery, and showed the same incidence of side-effects.

[Screening for bacterial vaginosis in a population of pregnant women reporting to cardiotocographic tests]. / Screening delle vaginosi batteriche in una popolazione di gravide afferenti al servizio di cardiotocografia.

Of 753 patients repeatedly controlled by nonstress test the incidence of bacterial vaginosis amounted to 11.28%. As regards the bacterial kinds isolated we have not noticed expressive differences in relation to the different periods of pregnancy, with the exception of the Candida albicans that instead has been the more frequent and in constant increase. Before the 30th week of pregnancy until the 35th, more variety of bacterial flora, with prevalence of aspecific vaginitis has been observed. The incidence of premature birth has been 5.86% for positive cases only and 0.66% for all cases controlled by nonstress test. In the five cases observed the bacterial kinds Gardnerella vaginalis, Ureaplasma urealitycum and Streptococci beta hemol of B group in association with Candida a. have been isolated.

[Sexual activity, cardiotocographic findings and time of delivery in physiologic pregnancy. Survey of a population controlled by ambulatory cardiotocography]. / Attività sessuale, rilievi cardiotocografici ed epoca del parto in gravidanze fisiologiche. Osservazione su una popolazione di utenti del servizio ambulatoriale di cardiotocografia.

STUDY DESIGN: Out of 720 patients with physiological pregnancy coming weekly to the cardiotocography service, it was decided to verify if, in comparison with controls, sexual activity after the 37th week, might make some differences as regard to duration of pregnancy, incidence of PROM and cesarean section. RESULTS: Only a small minority was sexually active. From statistical tests it was observed that sexual intercourse coincided with a greater parity, a lower maternal age, a greater number of nonstress test with uterine contractions and an average duration of pregnancy, slightly lower than in controls (38.80 vs 39.76 weeks). Most of the pregnancies over the 40th week and the greatest incidence of cesarean sections due to fetal distress were observed in sexually inactive patients. A sexual activity after the 37th week did not indicate a greater incidence of PROM CONCLUSIONS: According to personal opinion and provided there is not an obstetric pathology, there are advantages and not disadvantages from a less prohibitionist habit concerning sex by the end of the period of pregnancy.

[The duration of the outpatient nonstress test (NST) and the diagnosis of fetal reactivity with noncomputerized cardiotocography, A critical review of 1160 tracings]. / Durata del non-stress test (NST) ambulatoriale e diagnosi di reattività fetale con cardiotocografia non computerizzata. Revisione critica di 1160 tracciati.

STUDY DESIGN: Our purpose was to verify the times of appearance and the relative percentage of fetal reactivity during a nonstress test. The minimum time for each control has been fixed at 30 minutes. To identify fetal reactivity we have observed the conventional patterns of fetal heart rate. MATERIALS AND METHODS: We have examined 1160 cardiotocograms of 483 patients with obstetric low risk controlled by ambulatory NST in the morning and by appointment. We have divided the tracings according to three different periods of pregnancy (< 37, between 37 and 40 and over 40 weeks) and each tracing in three periods of 10 minutes. In each period we have checked the mean values and standard deviations of accelerations, decelerations, uterine contractions and fetal movements. For each patient the total numbers of NST and the type of birth (spontaneous or caesarean section for fetal distress) has been considered. At statistic analysis we have employed "t"-Student test. RESULTS: We have observed a significative difference (p < 0.001) between the presence of fetal reactivity after 20 and 30 minutes and the number of doubtful cases after 30 minutes for the different periods of pregnancy. With minimum time of 30 minutes of NST, an incidence of doubtful cases of 4.48% and an incidence of caesarean section for fetal distress for the same group of 19.27% has been observed, while for all the cases with reactive NST this incidence intrapartum has been of 9.73%. CONCLUSION: Our experience confirms that the optimal duration of NST has been of 30 minutes. We think that this time must be suggested also from prudence, since the noncomputerized cardiotocography is often characterized by false positiveness and low predictability.

[The cardiotocographic service during pregnancy. Reports on operative procedures used at different centers of the National area]. / Il servizio di cardiotocografia in gravidanza. Osservazioni sui protocolli operativi adottati in diverse sedi del territorio nazionale.

BACKGROUND: Aim of the paper is to verify the presence of operative procedures and their differences in the use of cardiotocography during pregnancy by some sample Centres in the national area. METHODS: From the year-book AOGOI 1997, 50 Operative Units of Obstetrics and Gynecology were chosen and sent a questionnaire, duly prepared, in order to get the following information: presence of a specific Cardiotocographic Service during pregnancy and its supply; number of patients and way of making appointments; duration and frequency of controls; type of reporting; type of cardiotocographs used; behaviour in emergency cases and possible combined diagnostics. RESULTS: Most of the Centres interviewed (64%) have their own Cardiotocographic Service which may be used in the morning by appointment. The patients have generally physiological pregnancies at term. Some differences were observed among the Centres concerning the period of the first control and the frequency of the following ones. The average number of antepartal non-stress tests has been of 3.9 with a very wide range (1-10). Only in 23.5 and in 12.7% of the cases a cardiotocographic control is required starting from the 40th and 41st week respectively. In the remaining cases (63.8%) controls are to be effected between the 34th and the 39th week. The average duration of the cardiotocographic recording changes if computerized appliances are used; in any case, the most likely duration is between 21 and 30 minutes. Doubtful reports per year were more when using non-computerized cardiotocography (10.8% vs 7.08%). In most of the Centres, a system of reporting on a final evaluating form, enclosed to the cardiotocogram, is used and in 72% of the cases the Centre may give an echographic and echofluximetric combined evaluation. Almost the total of the sample interviewed solved the problem of "emergencies" by entrusting the medical and paramedical staff of the Obstetrics Department, with controls. CONCLUSIONS: Antepartal Cardiotocography has nowadays become a means of control widely spread also in physiological pregnancy. In fact, most of the sample Centres have their own ambulatory Service. The same operative procedures were not followed by these Services and the solution of running problems (admission of users) varies in each Centre according to the number of users and the availability of means and staff.

Moderately increased hemolysis in newborn infants with hyperbilirubinemia of unknown etiology.

Serial determinations of carboxyhemoglobin (COHb) levels were performed in full-term newborn infants during the first few days of life and their mothers. A close correlation was found between COHb in the mother and that determined in the cord blood. The correlation between COHb in the mother at delivery and that found in the neonate disappeared after 48 h of life. The determination of COHb after this period demonstrated significantly higher values of COHb levels in jaundiced neonates compared with normal infants. Determinations of erythrocyte age-dependent enzyme activities carried out at birth and after 5 days of life did not demonstrate any significant difference between the mean values in jaundiced and normal infants. However, the normal infants demonstrated a decrease of glucose-6-phosphate dehydrogenase and pyruvate-kinase activities from birth to the 5th day which is not appreciable in neonates with hyperbilirubinemia of unknown etiology. The results are discussed in relation to the role of hemolysis in neonatal hyperbilirubinemia.

[Variations in erythrocyte enzymatic activity in the first days of life]. / Variazinni di attività enzimatiche eritrocitarie nei primi giorni di vita.

The erythrocyte activities of glucose 6-phosphate dehydrogenase, pyruvate kinase and glucose phosphate isomerase decrease during the first days of life. Furthermore the level of these enzymatic activities is higher in newborn infants with higher percentage of carboxyhemoglobin. It is likely that a premature and rapid fall of reticulocytes causes a decrease in enzymatic activities sensitive to aging and that the higher hemolysis can represent a disappearance of oldest erythrocytes which present lower enzymatic activities. These data therefore confirm the block in erythropoiesis in the first hours of life.

[Scanning electron microscopic studies of the umbilical arteries and veins of newborn infants of smoking mothers]. / Osservazioni in microscopia elettronica a scansione dell'intima di arterie e vene ombelicali di neonati da madri fumatrici.

We have examined the umbilical cord of ten newborn children of nonsmoking (five) and of smoking (five) mothers (10-20 cigarettes/day). The patients chosen for the study resulted "normal" before and during pregnancy. Immediately after delivery the umbilical cords were tied (to avoid collapse) and cut about 10 cm from the placenta. Umbilical cords were submitted to pressure-perfusion-fixation according to Kjelsen and Thomsen (7). Three randomly chosen specimens for SEM were cut and postfixation was performed in 1% buffered osmium tetroxide (pH 7.4) and after dehydration, were submitted to critical point drying (CO2), coated with gold palladium (sputtering technique), and observed by means of a Super ISI Mini SEM at 7,5 Kv. Luminal surfaces of umbilical arteries and veins from non-smoking mothers revealed a regular endothelial layer all over the surface. Large disendothelialised areas were instead found not only in arteries (1) but also in veins from newborn children of smoking mothers.