Leptin promotes HLA-G expression on placental trophoblasts via the MEK/Erk and PI3K signaling pathways.

INTRODUCTION: The development of the human haemochorial placenta requires complex regulatory mechanisms to protect invasive trophoblast cells from cytotoxic responses elicited by maternal immune cells. Leptin, the adipocyte derived hormone encoded by the Lep gene, is synthesized by placental trophoblasts and exerts pleiotropic effects on the immune system, including the promotion of inflammation and the activation of T cell responses. METHODS: To address its possible involvement in the modulation of maternal immune responses during pregnancy, we investigated the effect of leptin on the expression of the class Ib histocompatibility antigen HLA-G as one of the chief immunosuppressive strategies used by trophoblast cells. RESULTS: In vitro incubation of the trophoblast derived Swan 71 and JEG-3 cell lines with 25-50 ng/ml recombinant leptin significantly boosted HLA-G mRNA and protein expression, and this effect was abrogated upon pharmacological inhibition of the PI3K-Akt and MEK-Erk signaling pathways. A similar stimulatory effect of leptin was observed in term placental tissue explants, though 10-fold higher doses were required for stimulation. Further, JEG-3 cells treated with a leptin antisense oligodeoxynucleotide displayed decreased HLA-G expression levels, which were partially recovered by addition of stimulating doses of exogenous hormone. Immunofluorescence and qPCR analysis confirmed leptin biosynthesis in placental tissue, further showing that invasive extravillous trophoblast cells were a main source of this hormone during the first trimester of normal pregnancies. DISCUSSION: Taken together, our results show that leptin acts as an autocrine/paracrine signal promoting HLA-G expression in placental trophoblasts suggesting an important role in the regulation of immune evasion mechanisms at the fetal maternal interface.

Fragmentation of sperm DNA using the TUNEL method.

OBJECTIVES: To establish the validity of the TUNEL assay in determining sperm DNA fragmentation, the relationship between the degree of fragmentation and the seminal parameters and the sample needed to conduct the test. MATERIAL AND METHODS: We used semen samples from healthy fertile men (n=33), patients who consulted for infertility with a prescription for the TUNEL assay (n=77) and patients with intracytoplasmic sperm injection failure (n=20), analyzed according to the 2010 WHO. The TUNEL/propidium iodide test was performed by flow cytometry, on baseline and post-swim-up samples. RESULTS: The cutoff value for the TUNEL assay (ROC curves) was 26%, with a sensitivity and specificity of 85% and 89%, respectively. The pre-swim-up and post-swim-up medians of the results from the TUNEL assay showed no significant differences (17.0% vs. 12.9%, respectively). However, 39.1% of the samples showed a difference greater than 15 in absolute value between the results of the baseline and post-swim-up TUNEL assays. The linear correlation study of the morphology, mobility and vitality using the post-swim-up TUNEL assay showed a greater correlation than preselection, with significant results (r: -0.394, P<.0001; r: -0.461, P<.0001; r: -0.526, P<.0001). CONCLUSIONS: The TUNEL assay is a valid test for clinical use. DNA fragmentation is a factor independent from traditional semen tests. We found a greater susceptibility to damage generated in the laboratory procedures in the samples with lower quality. The sample of choice for evaluating DNA fragmentation will depend on whether the clinician is treating a natural or assisted fertilization.

Epstein-Barr virus-positive diffuse large B-cell lymphoma association is not only restricted to elderly patients.

Diffuse large B-cell lymphoma (DLBCL), the most common group of malignant lymphomas, account for 30% of adult non-Hodgkin lymphomas. The 2008 World Health Organization (WHO) classification included a new entity, Epstein-Barr virus (EBV)+ DLBCL of the elderly, affecting patients aged 50 years or older. However, some reports of younger EBV+ DLBCL cases, without evidence of underlying immunosuppression, can be found. The role of EBV in tumor microenvironment composition in DLBCL is still not well understood. Our aim was to assess EBV presence and latency pattern as well as tumor T-cell population in an adult DLBCL series of Argentina. The study was conducted on biopsies from 75 DLBCL patients. EBERs expression was performed by in situ hybridization, while EBV gene expression was analyzed using real-time polymerase chain reaction. LMP1, LMP2A, EBNA2, EBNA3A, CD4, CD8 and Foxp3 expression was assessed by immunohistochemistry. Nine percent of cases showed EBV expression, with similar frequency among patients younger than 50 years and 50 years or older (13% and 8%, respectively). T-cell subsets were not altered by EBV presence. Latency type II was the most frequently observed, together with lytic gene expression in EBV+ DLBCL, with ≥20% of EBERs+ cells. These findings suggest that EBV+ DLBCL in our series was similar to the previously described in Asia and Latin-America, displaying latency II or III expression profile and no age-specific characteristics. Finally, EBV+ DLBCL may be an entity that is not only restricted to patients who are older than 50 years of age, in consequence the age cutoff revision may be a current goal.

Arthroscopic treatment of glenohumeral instability in soccer goalkeepers.

The aim of this study was to report epidemiologic data and results of arthroscopic treatment of glenohumeral instability in soccer goalkeepers. We included 12 soccer goalkeepers with a mean age of 28.9 years (range 18-45 years) with acute or recurrent traumatic anterior instability who underwent an arthroscopic anatomic capsulolabral repair with bone anchors. Patients who underwent surgery within 4 weeks of the first episode of dislocation were classified as acute instability. The results were evaluated using the Rowe Scale and analyzed according to stability, range of motion and function. The mean follow-up was 3.8 years. The most common mechanism of injury (90% of the cases) was abduction, external rotation and extension. Associated injuries were present in 57.2% of recurrent cases and 20% of acute cases (p<0.293). Excellent or good results were observed in 80% of the cases of acute instability and in 57.2% of cases in the group with recurrent instability (p<0.586). From a total of 12 soccer goalkeepers who underwent the arthroscopic capsulolabral repair, good or excellent results were obtained in 66.6% of cases of glenohumeral instability. Surgical arthroscopic repair was possible in all cases of acute or recurrent instability based on well-established inclusion criteria, i. e., with well-defined exclusion criteria, such as HAGL lesion and significant glenohumeral bone loss, the arthroscopic capsulolabral repair can be carried out in soccer goalkeepers.

Dose selection for a direct and selective factor IXa inhibitor and its complementary reversal agent: translating pharmacokinetic and pharmacodynamic properties of the REG1 system to clinical trial design.

We performed detailed pharmacokinetic and pharmacodynamic modeling of REG1, an anticoagulation system composed of the direct factor IXa (FIXa) inhibitor pegnivacogin (RB006) and its matched active control agent anivamersen (RB007), with a focus on level of target inhibition to translate phase 1 results to phase 2 dose selection. We modeled early-phase clinical data relating weight-adjusted pegnivacogin dose and plasma concentration to prolongation of the activated partial thromboplastin time (aPTT). Using an in vitro calibration curve, percent FIXa inhibition was determined and related to aPTT prolongation and pegnivacogin dose and concentration. Similar methods were applied to relate anivamersen dose and level of reversal of pegnivacogin anticoagulation. Combined early-phase data suggested that ≥0.75 mg/kg pegnivacogin was associated with >99% inhibition of FIX activity and prolongation of plasma aPTT values ≈2.5 times above baseline, leading to selection of a 1 mg/kg dose for a phase 2a elective percutaneous coronary intervention study to achieve a high intensity of anticoagulation and minimize intersubject variability. Phase 2 validated our predictions, demonstrating 1 mg/kg pegnivacogin yielded plasma concentrations ≈25 µg/ml and >99% inhibition of FIX activity. The relationship between the anivamersen to pegnivacogin dose ratio and degree of pegnivacogin reversal was also validated. Our approach decreased the need for extensive dose-response studies, reducing the duration, complexity and cost of clinical development. The 1 mg/kg pegnivacogin dose and a range of anivamersen dose ratios are being tested in the phase 2b RADAR study (NCT00932100).

Prognostic value of germ cells in the ejaculate: a case study.

The first approach to assessing male fertility is to study a spermiogram, where special attention is given to sperm count, motility and morphology, while less attention is given to other cells in the ejaculate. Normal spermatogenesis requires a balance between cell death and proliferation; therefore, the number of germ cells (GC) in the ejaculate is less than the number of sperm. We propose a new index for altered spermatogenesis, i.e., the rate GC/sperm. We investigated a patient with oligozoospermia and a GC/sperm ratio greater than one, which indicated that spermatogenesis had been damaged. Complementary cytological tests were employed to characterized GC status: Papanicolaou stain, transmission electronic microscopy (TEM), vitality test, AgNOR and TUNEL assay. We also correlated cell morphology with ultrastructure studies that showed apoptosis. Nuclear apoptosis is characterized by vacuolization, misshapen nuclei, and "half moon," dispersed, uncondensed, disrupted and smudged chromatin. Cytoplasmic apoptosis is characterized by vacuolization, cytoplasmic protrusions, lamellar bodies, and swollen endoplasmic reticulum and mitochondria. To date, only testicular biopsy has been used to diagnose complete or incomplete testicular arrest. Our investigation is the first to determine a cytological feature in semen samples that could be used as a biological marker for abnormal spermatogenesis and for predicting the transition from oligospermia to azoospermia.

Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study.

OBJECTIVES: To assess the influence of vitamins B1, B6 and B12 on the analgesia success achieved by diclofenac in subjects with acute lumbago. RESEARCH DESIGN AND METHODS: A randomised, double blind controlled clinical study in parallel groups, in which subjects received twice-daily oral administration of either the combination therapy, Group DB (50 mg diclofenac plus 50 mg thiamine, 50 mg pyridoxine and 1 mg cyanocobalamin) or diclofenac monotherapy, Group D (50mg diclofenac). The study period lasted a maximum of 7 days. If sufficient pain reduction was achieved (defined as Visual Analogue Scale <20 mm and patient's satisfaction), subjects could withdraw from the treatment after 3 or 5 days. All subjects gave written informed consent to participate in the study. MAIN OUTCOME MEASURES: The primary confirmatory study objective was to determine the number of patients with sufficient pain reduction after 3 days of treatment. RESULTS: Three hundred and seventy-two subjects were allocated at random to either treatment group: Group DB - 187 subjects and Group D - 185 subjects. After 3 days of treatment, a statistically significant higher proportion of subjects in Group DB (n = 87; 46.5%) than in Group D (n = 55; 29%) terminated the study due to treatment success (chi(2): 12.06; p = 0.0005). Furthermore, the combination therapy yielded superior results in pain reduction, improvement of mobility and functionality. Drug safety monitoring profile throughout the trial was within the expected safety profile of diclofenac. CONCLUSIONS: The combination of diclofenac with B vitamins was superior to diclofenac monotherapy in lumbago relief after 3 days of treatment. As a study drawback, daily VAS measurements were only recorded until subject withdrawal from treatment, whether after 3, 5, or 7 days. There were no differences in safety profile between the two study groups.

Glycosaminoglycan loss from cartilage after anterior cruciate ligament rupture: influence of time since rupture and chondral injury

OBJECTIVE: To quantify the concentration of sulfated glycosaminoglycans (GAGs) concentration in the synovial fluid (SF) of knees with chronic anterior cruciate ligament (ACL) rupture and to identify possible associations between GAG concentration in SF and the time elapsed since rupture and degree of chondral injury. METHOD: Fourteen adult male subjects with total unilateral ACL rupture, which had occurred between 5 and 144 months earlier, were assessed. All subjects underwent joint aspiration; it was possible to collect SF from ten individuals. The samples were quantified to determine the GAG concentration using dimethylmethylene blue (DMMB) staining. The degree of chondral injury was macroscopically evaluated using the modified Mankin histological scale. Spearman correlation test (< 0.05) was used to evaluate the association between GAG concentration and chondral injury, and Pearson correlation test (< 0.05) was used to evaluate the association between GAG concentration and the time elapsed since rupture. RESULTS: The GAG concentration in SF showed a mean variation of 73.84 ± 40.75 µg/ml, with a mean time of 40.4 ± 40.3 months since the rupture. There was no correlation between GAG concentration and time since the rupture (r= -0.09, p= 0.81). The chondral injury grades found were 0, 1, 4 and 5. There was no correlation between chondral injury grade and GAG concentration in SF (r= -0.41, p= 0.24). CONCLUSION: After at least 5 months, the GAG concentration in SF from knees with ACL rupture is independent of the time elapsed since rupture and/or the severity of chondral injury.

OBJETIVO: Quantificar a concentração de glicosaminoglicanas sulfatadas (GAGs) no líquido sinovial (LS) de joelhos com ruptura crônica do ligamento cruzado anterior (LCA) e identificar uma possível correlação entre a concentração de GAGs no LS e o tempo pós-ruptura e grau de lesão condral. MÉTODOS: Foram avaliados 14 indivíduos adultos do sexo masculino com ruptura total unilateral do LCA, ocorrida entre cinco a 144 meses. Todos os sujeitos foram puncionados, sendo possível a coleta de LS em dez indivíduos. As amostras foram quantificadas para determinar a concentração de GAGs usando a coloração azul de dimetilmetileno, método descrito por Farndale21. O grau de lesão condral foi macroscopicamente avaliado pela escala histológica de Mankin modificada por Messner14. As correlações entre concentração de GAGs e lesão condral foram feitas pelo teste de correlação de Sperman (p< 0,05) e a concentração de GAGs e tempo pós-ruptura pelo teste de correlação de Pearson (p< 0,05). RESULTADOS: Concentração de GAGs no LS apresentou variação média de 73,84 ± 40,75µg/mL, sendo o tempo médio pós-ruptura de 40,4 + 40,3 meses. Não houve correlação entre concentração de GAGs e o tempo pós-ruptura (r= -0,09, p= 0,81). Os graus de lesão condral encontrados foram de 0, 1, 4 e 5. Não houve correlação entre grau de lesão condral e a concentração de GAGs no LS (r= -0,41, p= 0,24). CONCLUSÕES: Após no mínimo cinco meses, a concentração de GAGs no LS de joelhos com ruptura do LCA independe do tempo pós-ruptura e/ou do grau de lesão condral.

Risk factors for hepatitis C virus infection in individuals infected with the HIV.

BACKGROUND: Except for injecting drug use, other routes of transmission for hepatitis C virus among HIV-AIDS patients have not been consistently described, and risk estimates are often not adjusted for confounding factors. AIMS: To evaluate characteristics associated with hepatitis C virus infection in individuals infected with the HIV. PATIENTS: Cases were patients co-infected by HIV and hepatitis C virus, and controls were infected only by HIV. METHODS: Cases and controls were consecutively enrolled at a public health care outpatient HIV-AIDS reference centre in Porto Alegre, Southern Brazil. RESULTS: A total of 227 cases (63% men; 40.3+/-8.7 years) and 370 controls (44.6% men; 38.9+/-9.8 years) were enrolled in the study. In a multiple logistic regression model, male gender (odds ratio 1.9; 95% confidence interval 1.3-2.7), age between 30 and 49 years (odds ratio 2.1; 95% confidence interval 1.2-3.7), elementary school education (odds ratio 4.2; 95% confidence interval 1.9-9.6), lower family income (odds ratio 1.7; 95% confidence interval 1.1-2.7), sharing personal hygiene objects (odds ratio 2.0; 95% confidence interval 1.3-3.3), using injected drugs (odds ratio 21.6; 95% confidence interval 10.8-43.0) and crack cocaine (odds ratio 2.8; 95% confidence interval 1.1-6.9) were independently associated with co-infection by hepatitis C virus. CONCLUSION: These results confirm the risk profile for hepatitis C virus-HIV infection and suggest that sharing personal hygiene objects might explain the transmission of virus C to those not infected by the usual routes, which may be of relevance for developing preventive strategies.

Vasoespasmo cerebral secundario a hemorragia subaracnoidea por ruptura de aneurisma intracerebral / Cerebral spasmus

La enfermedad cerebrovascular (ECV) es la tercera causa de muerte en países industrializados. De todos los tipos de EVC, la hemorragia subaracnoidea (HSA) es responsable de 22 por cien a 29 por cien de la mortalidad. Alrededor de 30 por cien de los pacientes con hemorragia subaracnoidea (HSA) secundaria a ruptura de aneurisma cerebral, desarrollan vasoespasmo arterial y con ello el déficit neurológico asociado aumenta. Esta complicación empeora el pronóstico de los pacientes, puesto que un 25 por cien de ellos mueren y otro 30 por cien a 35 por cien sufren de déficit neurológico permanente. Entonces, el vasoespasmo cerebral es el factor modificable más importante para mejorar la tasa de morbimortalidad en pacientes con hemorragia subaracnoidea secundaria a ruptura de aneurisma. Estos puntos nos obligan a definir esquemas de intervención bien desarrollados y esquematizados, en donde el primer objetivo sea la prevención, permitiendo hacer un diagnóstico ultra temprano y que incluya un esquema de intervención bien definido que pueda ayudar a frenar el curso de la devastadora historia natural de esta complicación.

Dolor y satisfacción: vivencias originarias de la mente: el "proyecto de psicología": primer modelo de aparato mental freudiano (II): conexión con neurociencias / Pain and satisfaction: original experiences of the mind: the psychology project: the first freudian mental apparatus model: (II) connection with neurosciences

El Proyecto de Psicología es el primer modelo de aparato mental construido por Freud (1895). Como se sabe contiene conceptos fundamentales de la teoría psicoanalítica de la psique. El presente trabajo es coincidente y prolongación de uno nuestro, anterior (Cohen, 2002). Retomamos la exposición de algunas de las ideas centrales del "Proyecto..." y el modelo de organización de las funciones del aparato en varios niveles. Agregamos, con el propósito de acentuar el carácter dinámico de los procesos, una ordenación en fases de acuerdo al ingreso, salida y procesamiento de las cantidades. A diferencia del texto del año 2002, nos enfocamos en la exploración de las "vivencias de satisfacción" y de las "vivencias de dolor", engramas originarios y estructurantes de la organización yoica. Incluimos en esta ocasión afirmaciones de una serie de psicoanalistas contemporáneos con el propósito de apoyar nuestra creencia en el valor de este centenario texto. En la actualidad algunos de los conceptos presentados por Freud en el "Proyecto..." pueden relacionarse con investigaciones y hallazgos neurofisiológicos contemporáneos, por lo cual, y en esa misma línea, en diferentes puntos de nuestro trabajo, establecemos conexiones entre algunos elementos del modelo freudiano con ciertos datos de las neurociencias modernas.

Sacral stress fracture: an unusual cause of low back pain in an amateur tennis player.

Stress fractures are common in athletes, and their incidence in sport is estimated at 2-4%. A case is reported of a stress fracture of the sacrum in an amateur tennis player. The patient was treated with rest and physiotherapy, focusing on stretching programmes and analgesic treatments, followed by an educational programme of tennis training and muscle strengthening. This appears to be the first report of this pathology in a tennis player.

Bilateral renal metastases from osteosarcoma - a case report and review of the literature

Improvements in multimodal therapy for osteosarcoma (OS) have increased event-free and overall survival. But have also led to a greater number of recurrences in uncommon sites. We report a young adult with OS who developed late bilateral renal relapse. Late recurrences to the kidneys have a more aggressive clinical behavior and poor prognosis documented by 15 cases of OS metastastic to the kidney in the literature. Two of those patients had a long survival after chemotherapy and surgery. This suggests that the disease can be controlled with early detection and treatment.

Expression of cytokeratins 7 and 20 in Helicobacter pylori-associated chronic gastritis in children.

Helicobacter pylori gastric infection induces structural changes in the gastric epithelium. Among them, variations in the expression of cytokeratins have been reported in adult patients. In the present study, we describe the expression of CK7 and CK20 in gastric samples taken from the antrum in three groups of pediatric patients: (A) Helicobacter pylori-associated chronic gastritis (mean age: 11.4 years); (B) previous H. pylori chronic gastritis patients (mean age: 9.4 years); and (C) controls (mean age: 8.8 years). In all, the presence of sulfomucins was assessed with Alcian blue-periodic acid-Schiff pH 1.0. Immunoreactivity was graded as absent (0), weak (1+), moderate (2+), or intense (3+), in accordance with the intensity of the staining, and its distribution as focal or diffuse. CK7 reactivity was 2+ either focal or diffuse in all group A biopsies. The reactivity was more evident in the cells at the neck of the glands, in the areas with more inflammatory infiltrates, decorating long vertical segments of epithelium. In groups B and C, CK7 reactivity was also focal and 1+ at the cells of the necks of the glands. However, group B presented longer vertical segments of positive cells as compared to group C, and shorter than those of group A. The deeper glandular structures were focally 1+ in both groups. CK20 expression was comparable in all three groups, depicting a 2+ diffuse reactivity at the surface epithelium and interposed pits with absence or focal reactivity at the neck and coiled gland areas. Ki-67 immunostaining paralleled that of the CK7. Staining for sulfated mucosubstances was positive in two of five cases of groups A and B, and in none of the cases of group C. We conclude that: (1) the long segments of CK7-positive glandular necks in H. pylori cases most probably indicate intense regenerative activity during active inflammation; (2) eradication of H. pylori does not warrant ad integrum restitution since long segments of Ki-67+, CK7+ cells at the germinative compartment of the glands (as well as cells with sulfomucins) were still recognizable in ex- H. pylori patients; (3) finally, differing from what happens in adults, children somehow manage to maintain fully differentiated CK20+ superficial epithelium while the H. pylori is in action.

Interventions for tears of the rotator cuff in adults.

BACKGROUND: Tears of the rotator cuff tendons, which surround the joints of the shoulder, are one of the most common causes of pain and disability in the upper extremity. OBJECTIVES: To review the efficacy and safety of common interventions for tears of the rotator cuff in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised trail register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library issue 2, 2002), MEDLINE (1966 to December 2001), EMBASE (1974 to December 2001), Biological Abstracts (1980 to December 2001), LILACS (1982 to December 2001), CINAHL (November 1982 to December 2001), Science Citation Index and reference lists of articles. We also contacted authors and handsearched conference proceedings focusing on shoulder conditions. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials involving tears of the rotator cuff were the focus of this review. All trials involving conservative interventions or surgery were included (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, and open or arthroscopic surgery). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed suitability for inclusion, methodological quality and extracted data. Dichotomous data were presented as relative risks (RR) and 95% confidence intervals (CI), using the fixed effects model. MAIN RESULTS: Eight trials involving 455 people were included and 393 patients analysed. Trials were grouped in eight categories of conservative or surgical treatment. The median quality score of all trials combined was 16 out of a possible 24 points, with a range of 12-18. In general, included trials differed on diagnostic criteria for rotator cuff tear, there was no uniformity in reported outcome measures, and data which could be summarised were rarely reported. Only results from two studies comparing open repair to arthroscopic debridement could be pooled. There is weak evidence for the superiority of open repair of rotator cuff tears compared with arthroscopic debridement. REVIEWER'S CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for tears of rotator cuff in adults. As well as the need for further well designed clinical trials, uniform methods of defining interventions for rotator cuff tears and validated outcome measures are also essential.

Medical assistance at the Brazilian juniors tennis circuit--a one-year prospective study.

A prospective study was conducted during one year to evaluate injuries in Brazilian Junior tennis players during the national circuit, in 2001. Male and female athletes in the age categories under 12, under 14, under 16 and under 18 years, all members of The Brazilian Tennis Confederation, participated in the study. Two physiotherapists and/or one physician evaluated the athletes. A total of 280 medical examinations were performed in 151 tennis players who needed medical treatment during the tournaments. The 151 athletes had 1-6 medical treatments during the tournaments and the mean was 1.8 treatment per athlete. The overall incidence was 6.9 medical treatments for every 1,000 games played. Medical assistance tothe athletes was performed on court in 83 (29.6%) occasions, 185 (66.1%) at the medical department and in both in 12 (4.3%) occasions. Retirement of the match was reported in 9 (3.2%) lesions. The most frequent injuries were: muscle contractures (76 - 27.14%), muscle pain/fatigue (36-12.85%), muscle strain (35-12.52%), tendinopathies (20 - 7.14%), cramps (16 -5.71%), ankle sprain (12 -4.28%) and low back pain (10-3.57%). Muscle pathology was the major source of injuries causing the athlete to seek medical assistance. Preventative measures are important to reduce the number of injuries, which may include muscle stretching programs and adequate nutrition and hydration.

Utilidad del mapeo testicular en pacientes azooespérmicos no obstructivos / Benefit of the sperm FNA in patients with azoospermia

Objetivos: Ante la presencia de un paciente azoospérmico no obstructivo comienza un verdadero desafío que consiste en localizar y obtener una muestra de tejido testicular donde se haya producido espermatogénesis con el fin de ser utilizada en una técnica de reproducción asistida. Los objetivos del presente trabajo son estimar el peso relativo de la FSH sobre la posibilidad de hallar espermatozoides en una biopsia utilizando la técnica de mapeo testicular con respecto a la biopsia convencional. Material y Métodos: Estudio retrospectivo, comparativo a muestras relacionadas de pacientes a quienes se le realizó mapeo testicular bilateral. Se incluyen 35 pacientes con diagnóstico de azoospermia no obstructiva operados en nuestro Servicio, entre diciembre de 1999 y diciembre de 2000 A todos los pacientes se les realizó mapeo testicular bilateral con seis tomas de cada lado, además se les practicó biopsia convencional con el fin de comparar los hallazgos entre ambos métodos Fueron evaluados también los valores preoperatorios de FSH con el fin de estimar el peso relativo sobre la posibilidad de hallar espermatozoides. Resultados: Los bajos valores de FSH fueron un valor predictivo positivo en la posibilidad de hallar espermatozoides. Con la biopsia convencional se encontraron espermatozoides en un 34,3 por ciento de las muestras mien- tras que el mapeo logró hallarlos en un 48,6 por ciento. Conclusiones: Los valores preoperatorios de FSH podrían desempeñar un valor predictivo sobre la posible obtención de espermatozoides. Se presenta el mapeo testicular como un método que potencialmente podría aumentar el porcen- taje de hallazgos de material espermático en pacientes azoospérmicos no obstructivos evitando tener que cancelar ciclos de fecundación in vitro de no hallarse espermatozoides.

Utilidad del mapeo testicular en pacientes azooespérmicos no obstructivos / Benefit of the sperm FNA in patients with azoospermia

Objetivos: Ante la presencia de un paciente azoospérmico no obstructivo comienza un verdadero desafío que consiste en localizar y obtener una muestra de tejido testicular donde se haya producido espermatogénesis con el fin de ser utilizada en una técnica de reproducción asistida. Los objetivos del presente trabajo son estimar el peso relativo de la FSH sobre la posibilidad de hallar espermatozoides en una biopsia utilizando la técnica de mapeo testicular con respecto a la biopsia convencional. Material y Métodos: Estudio retrospectivo, comparativo a muestras relacionadas de pacientes a quienes se le realizó mapeo testicular bilateral. Se incluyen 35 pacientes con diagnóstico de azoospermia no obstructiva operados en nuestro Servicio, entre diciembre de 1999 y diciembre de 2000 A todos los pacientes se les realizó mapeo testicular bilateral con seis tomas de cada lado, además se les practicó biopsia convencional con el fin de comparar los hallazgos entre ambos métodos Fueron evaluados también los valores preoperatorios de FSH con el fin de estimar el peso relativo sobre la posibilidad de hallar espermatozoides. Resultados: Los bajos valores de FSH fueron un valor predictivo positivo en la posibilidad de hallar espermatozoides. Con la biopsia convencional se encontraron espermatozoides en un 34,3 por ciento de las muestras mien- tras que el mapeo logró hallarlos en un 48,6 por ciento. Conclusiones: Los valores preoperatorios de FSH podrían desempeñar un valor predictivo sobre la posible obtención de espermatozoides. Se presenta el mapeo testicular como un método que potencialmente podría aumentar el porcen- taje de hallazgos de material espermático en pacientes azoospérmicos no obstructivos evitando tener que cancelar ciclos de fecundación in vitro de no hallarse espermatozoides. (AU)

Effects of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure.

The effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been reported by several investigators, without any consensus being reached. Acute neurological and neurosurgical patients suffer intracranial hypertension and acute lung injury with hypoxemia. Since PEEP may improve hypoxemia but elevate ICP and decrease CPP, it is important to determine the influence of varying levels of PEEP on ICP and CPP. The aim of the study was to investigate the changes in ICP and CPP associated with different levels of PEEP. Twenty patients requiring ICP monitoring and mechanical ventilation were enrolled. Patients had severe head injury (n = 10), spontaneous intracerebral haemorrhage (n = 5), and subarachnoid haemorrhage (n = 5). PEEP was raised from 5 (basal) to 15 cm H2O in steps of 5 cm H2O. After at least 10 minutes of each new PEEP setting, ICP and CPP were measured. PEEP at 10 and 15 cm H2O produced a significant (p < 0.05) increase in intracranial pressure 11.6 +/- 5.6 and 14.6 +/- 6.28 mm Hg, respectively; no significant (p = 0.819) change occurred in CPP.