Urethral duplication, with associated agenesis of left kidney and right ureteral ectopia.

We report an unusual case of an accessory or duplicated urethra. This case is unique because of its association with multiple urologic anomalies which made management and diagnosis of this condition unusual. The unusual combination of right ectopic ureter and left renal and ureteral agenesis in association with the accessory urethra is presented, along with the diagnostic and surgical management particular to this case.

Adenocarcinoma of rete testis.

Adenocarcinoma of the rete testis is a very rare malignant neoplasm originating in the epithelium of the rete testis. Histologically, it appears as a papillary adenocarcinoma. The first case was reported in the literature in 1853 and since that time only 16 additional cases have been reported. This report represents the eighteenth case.

Nonoperative management of renal artery embolus.

Two cases of renal artery emboli were treated nonsurgically with intravenous heparin. Both patients experienced prompt and total relief of the apparent embolization.

Results of ligation of internal spermatic vein in the treatment of infertility in azoospermic patients.

Ten azoospermic men treated by ligation of the internal spermatic vein are reported. Treatment of two of the ten resulted in pregnancies. The advisability of thorough evaluation of the azoospermic patient is well demonstrated by the finding of one patient with Klinefelter's syndrome. In our judgement, based on this small series, azoospermia should not be considered a contraindication to surgery. Complete evaluation of the azoospermia is essential. Indeed, the varicoceles seen in patients 9 and 10 were an incidental finding and in all likelihood played no role in the azoospermia.

A clinical evaluation of a new Silastic seminal fluid collection device.

A new Silastic seminal fluid collection device has been tested clinically and comparison studies have been made with both the polyethylene sheath and commercial latex condoms. In a series of 100 patients, the Silastic seminal fluid device has been found to be superior to the polyethylene sheath with regard to patient comfort and also has had greater reliability. In comparison with the latex device, the Silastic seminal fluid collection device is nearly as comfortable and has been found to be far more reliable.

Chorionic gonadotropins in the treatment of the subfertile male.

Sixty-four men with idiopathic subfertility were given human chorionic gonadotropin, 50,000 units in 10 divided doses. Sixty-nine per cent of the men demonstrated significant improvement in semen quality in response to the medication, and thirty-six per cent achieved a pregnancy. Eight patients have achieved a second pregnancy without additional therapy.

Laparoscopic internal spermatic vein ligation: report of a new technique.

Over the past 22 months, 51 laparoscopic internal vein ligations have been performed to determine its application and practicality in treating the infertile male with varicoceles. Of the 33 cases available for a follow-up of greater than 6 months, 16 pregnancies are reported. Five patients reporting pregnancies refused to submit a postoperative semenogram. Of the reportable series, 17 of 33 had significant improvement in sperm density (51%), 15 of 33 (45%) in sperm viability, and 15 of 33 (45%) in sperm motility. No major complications were seen and minor complications were few and transient. Morbidity was extremely low. Laparoscopic internal spermatic vein ligations would appear to be a reasonable, practical, and effective method to correct varicoceles.

Meiotic indices in the oligospermic male.

Thirty-four oligospermic males were evaluated by determining the meiotic index in testicular biopsy specimens. Only 1 patient of 10 with a meiotic index of less than 15 achieved pregnancy, whereas 16 of 24 patients with a meiotic index of more than 15 had a successful outcome. Corresponding increases in the semenogram were also noted to be related to the meiotic index.

Meiotic figures in the testicular biopsy of subfertile males.

The phases and sequence of meiotic division are herein reviewed and illustrated as they occur in the human testis. Normally all phases of meiosis can be identified, and arrest at a phase is indicative of faulty spermatogenesis. The correlation of these arrest patterns with the clinical course and response to clinical therapy is now in progress. These meiotic studies can be undertaken in any laboratory with cytogenetic capabilities, and this study is intended to serve as a base line illustration of the normal.

Maximizing medication adherence in low-income hypertensives: a pilot study.

A pilot study was conducted to examine the association between free medication and comprehensive care on blood pressure control for 60 adults with uncontrolled essential hypertension (mean blood pressure = 157/96 mm Hg) referred from a variety of primary care clinics at a public teaching hospital. Subjects received comprehensive care, free antihypertensive medication dispensed in the clinic, and patient education regarding hypertension and medication compliance. Matched-pair t-tests revealed average drops in blood pressure of 22 mm Hg systolic and 13 mm Hg diastolic for the entire sample from baseline to 6 months post-enrollment (both P's < .001). The comprehensive hypertension management program with education and free medication was significantly related to reduced blood pressure across the 6 months of the study period.

Malignant tumor of the colon metastatic to the epididymis as a first sign of recurrence of colon cancer.

Metastatic tumors to the epididymis are rare. Most reported cases represent another occurrence of widespread disease. This is a report and review of the literature of a case of adenocarcinoma of the colon three years post resection in which the only site of recurrence was in the epididymis.

Testicular biopsies in 101 cases of varicocele.

Testicular biopsies were done on 101 patients who underwent ligation of the internal spermatic vein as primary treatment for infertility. Retrospective analysis included evaluation of tubular thickening, Leydig cell hyperplasia, premature sloughing, maturation arrest and decreased spermatogenesis. A comparison was made of biopsy profiles, sperm counts and pregnancies in an attempt to determine further the value of testicular biopsy in the subfertile man. The pregnancy rate was 40 per cent over-all, with 32 per cent of the patients with tubular thickening reporting pregnancies. There was only 1 pregnancy in patients with Leydig cell hyperplasia. The controversial finding of premature sloughing had no consistent relationship to results.

Human chorionic gonadotropin in the treatment of the infertile man.

We have treated 128 men with proved infertility with human chorionic gonadotropin. Excellent results were obtained in the patients who underwent varicocelectomy but who did not respond to the operation. Good results were obtained in the idiopathic oligospermic men, that is with sperm density less than 20 million. Indeterminate results were obtained in patients with sperm values more than 20 million. However, therapy was deemed inappropriate in those patients who either had elevation of follicle-stimulating hormone, an untreated varicocele or biopsy findings of hyalinization, or atrophy, which would preclude success of therapy.

Simultaneous laparoscopic varicocelectomy and removal of an intrascrotal atrophic testicle.

We report on the concomitant removal of an atrophic intrascrotal left testicle secondary to mumps orchitis and a right varicocelectomy for athenospermia done laparoscopically. The procedure proved to be quite simple to complete, avoiding the need for secondary incisions, which would have been required otherwise if a standard open approach was chosen. The convalescence period was uneventful with the patient returning to regular activities within 72 h of the procedure. We feel that in selected cases a laparoscopic orchiectomy offers distinct advantages to conventional open surgical approaches.

A study of meiotic preparation of human spermatocytes and their relationship to infertility.

Although our experience is based on a small series of 50 cases we believe that several points can be made. Meiotic preparations can be performed in any competent cytogenetic laboratory. These preparations appear to yield more specific information as to the site of arrest and may be more reliable than the static testicular biopsy to appraise the true status of spermatogenesis. With these facts in mind a more accurate prognosis and therapeutic regimen can be realized.

Minor stressors and generalized anxiety disorder among low-income patients attending primary care clinics.

The total number of minor life events and subjective ratings of distress associated with these events were assessed for individuals with generalized anxiety disorder (GAD) and for nonanxious controls. Participants consisted of 256 randomly selected, low-income patients from primary care medical clinics. Diagnoses were obtained using the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). An analysis of variance revealed that GAD individuals reported significantly more minor life events than did nonanxious controls (F = 50.97, p < .001). An analysis of covariance indicated that persons with GAD perceived their minor stressors as significantly more stressful than did nonanxious controls, even after the total number of events was controlled (F = 42.07, p < .001). These findings are consistent with cognitive theories of GAD and current revisions to the definition of the disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Implications for theory and research on GAD are discussed.