Testicular torsion and subsequent testicular function in young men from the general population.

STUDY QUESTION: Is prior testicular torsion associated with testicular function (semen quality and reproductive hormones) in young men from the general population? SUMMARY ANSWER: In young men from the general population, no differences in semen parameters were observed in those who had experienced testicular torsion compared to controls and observations of higher FSH and lower inhibin B were subtle. WHAT IS KNOWN ALREADY: Testicular function may be impaired after testicular torsion, but knowledge is sparse and based on studies with small sample sizes and no control group or a less than ideal control group. STUDY DESIGN, SIZE, DURATION: A cross-sectional population-based study was carried out including 7876 young Danish men with unknown fertility potential, examined from 1996 to 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: All men (median age 19.0 years) had a physical examination, provided a blood and semen sample, and filled in a questionnaire including information about prior testicular torsion, birth, lifestyle and current and previous diseases. Markers of testicular function, including testis volume, semen parameters and reproductive hormones, were compared between men operated for testicular torsion and controls, using multiple linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: The average participation rate was 24% for the entire study period. In total, 57 men (0.72%) were previously operated for testicular torsion (median age at surgery 13.4 years) of which five had only one remaining testicle. Men with prior testicular torsion were more often born preterm (25% versus 9.5% among controls), and they had significantly higher FSH and lower inhibin B levels, and a lower inhibin B/FSH ratio than controls in crude and adjusted models. The association was mainly driven by the subgroup of men who had undergone unilateral orchiectomy. No differences in semen parameters were observed. LIMITATIONS, REASONS FOR CAUTION: A limitation is the retrospective self-reported information on testicular torsion. Also, results should be interpreted with caution owing to the high uncertainty of the observed differences. WIDER IMPLICATIONS OF THE FINDINGS: Overall, the results of our study are reassuring for men who have experienced testicular torsion, especially when treated with orchiopexy, for whom reproductive hormone alterations were subtle and without obvious clinical relevance. Our study found no differences in semen parameters, but follow-up studies are needed to assess any long-term consequences for fertility. STUDY FUNDING/COMPETING INTEREST(S): Financial support was received from the Danish Ministry of Health; the Danish Environmental Protection Agency; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); A.P. Møller and wife Chastine Mckinney Møllers Foundation; Svend Andersens Foundation; the Research Fund of the Capital Region of Denmark; and ReproUnion (EU/Interreg). The authors have nothing to declare. TRIAL REGISTRATION NUMBER: N/A.

Hypothermia at neonatal intensive care unit admission was not associated with respiratory disease or death in very preterm infants.

AIM: This study investigated the association between hypothermia and respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) or death in very preterm infants admitted to a Danish neonatal intensive care unit (NICU). METHODS: We studied 675 infants born at Aalborg University Hospital before 32 weeks and admitted to the NICU from April 1997 to December 2011. Hypothermia was defined as a core temperature of <36.5°C on admission. The primary outcome was severe RDS or death within the first three days of life, and the secondary outcome was BPD or death before 36 postmenstrual weeks. The multivariable logistic regression was adjusted for early-onset infection, gestational age, Apgar score, sex, treatment year and birth weight. RESULTS: Infants with hypothermia had a twofold increase (OR) in the odds for RDS or death (2.03), but the adjusted OR was not statistically significant (1.36). They also demonstrated a twofold increase (OR) in the odds for BPD or death (2.28), but again the adjusted OR was not statistically significant (1.03). CONCLUSION: After adjusting for confounders, we found that the association between hypothermia on admission to the NICU and RDS or death, or BPD or death was statistically insignificant.

Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men.

Percutaneous testicular sperm aspiration (TESA) has been known for decades as a simple, minimally invasive approach to sperm retrieval in azoospermic men. Because of lower reported sperm retrieval rates (SRR) when compared with microdissection testicular sperm extraction (mTESE), many centers now use mTESE as the first choice for retrieving spermatozoa in nonobstructive azoospermia (NOA). Objectives of this study were to evaluate the outcome and safety of TESA and mTESE in the treatment of azoospermia and to investigate the usefulness of a prognostic TESA to individualize protocols for couples and limit the use of invasive testicular procedures. IRB approval was obtained to retrospectively evaluate 208 patients undergoing multiple needle-pass TESA between 1999 and 2014. Prognostic TESA was performed on 125 men with NOA and 82 with obstructive azoospermia (OA). Nine NOA men and 31 OA men with previously demonstrated spermatozoa had a subsequent therapeutic TESA while nine NOA men with a failed TESA proceeded to mTESE. Main outcome measures were complication rates and SRR. SRR of the prognostic TESA was 30% (38/125) for NOA men and 100% (82/82) for OA men. Eight/nine NOA men and 31/31 OA men had spermatozoa found for intracytoplasmic sperm injection in a subsequent therapeutic TESA. In nine NOA men in whom a TESA produced no spermatozoa, only one had spermatozoa found with mTESE. Overall complication rates of TESA and mTESE were 3% (7/267) and 21% (3/14), respectively. TESA provides reasonable SRR and is a safe procedure. Successful prognostic TESA indicates future success with therapeutic TESA. Men with a failed TESA have a limited chance of sperm retrieval using mTESE. Approaching azoospermic men with an initial prognostic TESA followed by either therapeutic TESA and/or mTESE is an efficient algorithm in the management of azoospermia and limits the use of more invasive procedures.

Sodium lactate and hypertonic sodium chloride induce equivalent panic incidence, panic symptoms, and hypernatremia in panic disorder.

BACKGROUND: Although experimental induction of panic by infusion of 0.5 mol/L sodium lactate in persons with panic disorder was described three decades ago, the mechanism underlying this observation remains unclear. Here we asked if the rapid administration of the large sodium load contained in the 0.5-mol/L sodium lactate infusion might be involved in panic induction. METHODS: We compared in panic disorder and healthy subjects behavioral, electrolyte, endocrine, and acid-base responses to three double-blind randomly ordered equal volume 20-min infusions: 0.5 mol/L sodium lactate, hypertonic saline (3% sodium chloride), and normal saline placebo. RESULTS: Sodium lactate (0.5 mol/L) and hypertonic saline produced the same high incidence of panic and equivalent increases in panic symptoms, serum sodium, and plasma vasopressin in the panic disorder subjects. Neither hypertonic infusion increased cortisol or adrenocorticotropin. No normal subject experienced panic in any condition. The 0.5-mol/L sodium lactate infusion induced alkalosis, whereas hypertonic saline and normal saline induced a mild acidosis. CONCLUSIONS: Hypertonic sodium solution containing either chloride or lactate anion induces panic in panic disorder. The large sodium loads delivered by hypertonic saline and 0.5 mol/L sodium lactate may be involved in the mechanism of panic induction.

Response to sodium lactate infusion in alcoholics with panic attacks.

The authors studied the response to sodium lactate infusion of 12 alcoholics with a history of panic attacks, 10 alcoholics without a history of panic attacks, and 16 nonalcoholic patients with panic disorder. The rate of lactate-induced panic was significantly higher in alcoholics with panic attacks than in alcoholics without panic attacks. Alcoholics with panic attacks were similar to nonalcoholic patients with panic disorder in their response to lactate. These findings support the specificity of lactate-induced panic for panic states and suggest that panic attacks in alcoholics resemble those in nonalcoholics. Lactate infusion may prove useful in the diagnosis of panic disorder in alcoholics.

Prevalence, onset, and clinical recognition of panic states in hospitalized male alcoholics.

Alcoholism has been associated with a high prevalence of anxiety and phobic disorders. The authors ascertained the current prevalence of panic disorder and the lifetime prevalence of infrequent panic attacks in 154 male alcoholics in an inpatient alcohol treatment program. Thirteen percent (N = 20) gave a lifetime history of panic attacks and 45% (N = 9) of these had current panic disorder. Panic attacks preceded or coincided with the onset of problem drinking in 50% (N = 9) of the 18 patients with both diagnoses. Only two patients with histories of panic had been previously diagnosed, and none had been treated. Clinical implications of these findings are discussed.

Behavioral and neuroendocrine responses to sodium lactate infusion in subjects with posttraumatic stress disorder.

OBJECTIVE: Sodium lactate infusion has induced flashbacks accompanied by panic attacks in male combat veterans with posttraumatic stress disorder (PTSD) and concurrent panic disorder. This study addressed whether sodium lactate induces flashbacks or other intrusive PTSD symptoms in PTSD patients free of concurrent panic disorder. METHOD: Behavioral, cardiovascular, catecholamine, and cortisol responses to infusion of 0.5 M sodium lactate were compared among seven subjects with PTSD without panic disorder, seven subjects with panic disorder only, and seven healthy subjects. RESULTS: Six of the seven PTSD subjects but no panic disorder or healthy subjects reported flashbacks or other intrusive PTSD symptoms during lactate infusion. Flashbacks were accompanied by substantial anxiety symptoms. Cortisol levels were low in the PTSD subjects. CONCLUSIONS: Sodium lactate induces flashbacks in persons with PTSD without comorbid panic disorder. The relationship between anxiety responses accompanying a PTSD flashback and those in a panic attack remains unclear.

Drug preferences of alcoholic polydrug abusers with and without panic.

Manifestations of anxiety, including panic disorder, are more common in the alcoholic population than in the general population. Alcoholics frequently abuse other drugs. The authors hypothesized that alcoholic subjects with panic attacks would abuse anxiolytic drugs more and panic-inducing drugs less frequently than nonanxious alcoholic subjects, and that their abuse of panic-inducing drugs would predate the age at panic onset. Findings indicate that alcoholic subjects with panic attacks (but not panic disorder) abused opiates and sedatives to a greater degree than nonanxious alcoholic subjects and abused marijuana, a panic-inducing drug, at a younger age. More alcoholic subjects with panic disorder than with panic attacks abused cocaine. The prevalence of abuse and the ages at onset of abuse of other drugs were similar for both the panic and the nonpanic group.

Control issues and body image in panic disorder.

Mean perceived emotional control and body image were compared for 7 subjects with and 6 without panic disorder, all physically healthy. The former had a lower mean on sense of emotional control and showed greater emphasis on the back of the body. These preliminary data encourage replication with a larger group.

Body-image correlates of anxiety in a sample of male alcoholics.

Body-image testing of 10 male alcoholics with and 7 without anxiety disorders showed those with panic disorder had low barrier scores. Those with phobias emphasized their hearts and those with Posttraumatic Stress Disorder emphasized their backs. The barrier score correlated positively with both intensity of physical symptoms and with sense of blocked body openings.

[Methotrexate treatment of ectopic pregnancy. A pilot study]. / Methotrexatbehandling af ektopisk graviditet. Et pilotstudium.

The incidence of ectopic pregnancy is rising but the clinical presentation of the disease has changed simultaneously. Nowadays, the majority of ectopic pregnancies are diagnosed before rupture. This stimulated us to attempt methotrexate therapy (1 mg/kg body weight injected locally or 50 mg given orally) in 12 cases verified by transvaginal ultrasound and presenting with increasing beta-hCG values. The treatment proved successful in 67% of the cases, even though high levels of beta-hCG and foetal heart activity were accepted as inclusion criteria. Eight patients later achieved intrauterine pregnancies, and seven healthy babies were delivered. Randomized, controlled studies are needed.

[Endovascular treatment of uterine fibromas]. / Endovaskulaer behandling af uterusfibromer.

Uterine artery embolisation represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. The procedure is performed under local analgesia and intravenous sedation. Both uterine arteries are selectively catheterised under fluoroscopic control. Microparticles suspended in contrast medium are used to embolise the uterine vascular bed. Ischaemic pain during the first day is treated with intravenous morphine. Patients treated with embolisation can expect excellent results with respect to menorrhagia, pelvic pain, and reduction in the fibroid tumour volume. Women undergoing uterine embolisation retain their potential for future pregnancies. The procedure is well tolerated by patients, and possesses the advantages of shorter hospitalisation and recovery time, as compared to hysterectomy.