Tratamiento quirúrgico de la infertilidad masculina / Surgical treatment for male infertility

Dada la naturaleza de las múltiples causas de infertilidad masculina, algunas de ellas son «reversibles» y pueden manejarse con un procedimiento en cirugía para recuperar, en algunos casos, la capacidad fertilizante del tracto reproductivo masculino. Con la adecuada utilización de herramientas diagnósticas y del juicio clínico, el médico puede identificar candidatos ideales para estos procedimientos, y sumado a la pericia y experiencia del cirujano, conseguir resolver la barrera para retornar la posibilidad al varón para fecundar a su pareja. En este capítulo revisaremos algunos de los procedimientos quirúrgicos más utilizados en infertilidad masculina y realizaremos una breve descripción de sus detalles técnicos

Given the nature of the multiple causes of male infertility, some of them are «reversible» and can be managed with a surgical procedure to recover, in some cases, the fertilizing capacity of the male reproductive tract. With appropriate use of diagnostic tools and clinical judgement, the physician can identify the ideal candidates for these procedures. Together with the expertise and experience of the surgeon, these treatments can manage to resolve the barrier, and men may become fertile again. In this chapter, we will review some of the most commonly used surgical procedures for the treatment of male infertility and make a brief description of their technical details

Diagnóstico y tratamiento hormonal de la infertilidad masculina / Diagnosis and hormonal treatment of male infertility

La infertilidad masculina es una condición médica que se observa con alta frecuencia y que está relacionada con el funcionamiento de órganos extremadamente complejos como la hipófisis y las gónadas. El diagnosticar y dirigir adecuadamente el tratamiento de un hombre infértil es un reto para el médico moderno, dadas las altas expectativas y exigencias de los pacientes actuales, principalmente por los gastos económicos y emocionales que cursan con este problema de pareja. En muchos casos, los pacientes deben ser tratados con terapias no dirigidas a su problema de base, sino encaminados a mejorar el funcionamiento de ese eje hormonal complejo y buscan optimizar la producción de gametos de mejores condiciones, para mejorar las tasas de fertilización a veces de manera espontánea

Male infertility is a frequently observed medical condition that is related to the functioning of extremely complex organs such as the pituitary gland and the gonads. The diagnosis and proper management of infertile men is challenging for modern medicine, given the high expectations and demands of current patients, mainly due to the economic and emotional expenses aroused by this "relationship issue". In many cases, patients should receive therapies aimed at improving the functioning of that complex hormonal axis, instead of treating their underlying problem; thus, seeking to optimize the production of gametes with better conditions and improve fertilization rates without requiring assisted procedures

Relation between serum CC16 levels and asthma predictive index in pre-schoolers with recurrent wheezing

BACKGROUND: Low levels of serum CC16 were reported in asthmatic adults, but the studies on children were scarce and conflicting. The aim of this study was to compare serum CC16 levels in pre-school children with recurrent wheezing assessed using an asthma predictive index (API). METHODS: We performed a case-control study based on API, with all enrolled pre-school children who had recurrent wheezing episodes (>3 episodes/last year confirmed by a physician) and had presented at one paediatric clinic in Santiago, Chile. The population was divided according to stringent API criteria into positive or negative. RESULTS: In a one-year period, 60 pre-schoolers were enrolled. After excluding 12, 48 pre-schoolers remained (27 males, age range from 24 to 71 months) and completed the study; 34 were API positive and 14 were API negative. There were no significant differences in demographics between groups. The level of serum CC16 levels for pre-schoolers with a positive API and negative API were (median 9.2 [7.1-11.5] and 9.4 [5.5-10], p = 0.26, respectively). The area under the curve for the serum CC16 levels to predict a positive API was 0.6, 95% CI [0.43-0.77], p = 0.3. A correlation between serum CC16 levels and age was found (r = 0.36 [0.07-0.59], p = 0.01], but not between serum CC16 levels and peripheral eosinophils blood. CONCLUSION: There was no evidence that serum CC16 levels played a role in recurrent wheezing and a positive API in pre-school children. More studies are needed to confirm this finding

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Serum periostin is not related to asthma predictive index

BACKGROUND: In contrast to adult asthmatic patients, studies on the role of serum periostin levels in schoolchildren with asthma are still conflictive, and very few studies have been performed in pre-schoolers. The aim of this study was to compare serum periostin levels in recurrent wheezer pre-schoolers according to their asthma predictive index (API) condition. METHODS: We performed a case-control study enrolling pre-schoolers with recurrent wheezing episodes (>3 episodes confirmed by physician) presented at one paediatric clinic in Santiago, Chile. The population was divided according to stringent API criteria into positive or negative. RESULTS: In a one-year period, 60 pre-schoolers were enrolled. After excluding 12 (due to not fulfilment of inclusion criteria or refusal of blood sample extraction), 48 remaining pre-schoolers (27 males, age range from 24 to 71 months) completed the study; 34 were API positive and 14 were API negative. There were no significant differences in demographics between groups. The level of serum periostin levels for pre-schoolers with positive API and negative API were (median 46.7 [25.5-83.1] and 67.5 [20.5-131.8], p = 0.9, respectively). The area under the curve for the serum periostin levels for predict positive API was 0.5, 95% CI [0.29-0.70], p = 0.9. No significant correlation between serum periostin levels and peripheral blood eosinophils was found. CONCLUSION: Serum periostin levels were no significantly different between wheezer pre-schoolers with positive and negative API. More studies are needed to confirm this finding

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Tortícolis muscular congénita: punto de vista del cirujano plástico / Congenital muscular torticollis: point of view of plastic surgeon

La tortícolis muscular congénita es una entidad frecuente, presente al nacimiento como una banda fibrosa o tumor en la región del músculo esternocleidomastoideo, que produce cambios restrictivos reflejados en trastornos progresivos del crecimiento y posición de la cabeza y en la rotación y flexión del cuello. El diagnóstico y tratamiento oportunos con fisioterapia y aparatología pueden evitar su secuencia de asimetría craneofacial y daño ocular, de difícil corrección una vez instaurados. Los casos que no responden al tratamiento médico inicial se benefician de cirugía. Presentamos la experiencia quirúrgica con 16 pacientes entre 9 y 32 años con seguimiento de entre 10 semanas y 15 años. El tratamiento quirúrgico consistió en 3 tenotomías de las inserciones del músculo esternocleidomastoideo a través de abordaje directo por dos incisiones pequeñas. Cuantificamos la mejoría de la posición de la cabeza por mediciones angulares en las fotografías pre y postoperatorias en vistas anterior y posterior, demostrando correcciones de entre el 53 y el 100% con promedio del 83% . En algunos casos medimos la movilidad del cuello con un transportador de ángulos confeccionado en consulta. En todos los casos logramos mejoría sustancial, sin complicaciones y con cicatrices aceptables; la columna lateral del cuello en el sitio del músculo seccionado recuperó su continuidad, sin percepción de corte abrupto, depresión o hundimiento. No observamos correlación entre la mejoría lograda y la severidad de la deformidad, ni tampoco con la edad del paciente en el momento de la cirugía, ya que a pesar de que en algunos casos había finalizado el crecimiento y el estado era avanzado, la mejoría fue buena (AU)

Congenital muscular torticollis is a relatively common disorder, presenting at birth as a fibrous band or tumor in the sternocleidomastoid muscle, which causes progressive restrictive changes reflected in head and face growth disorders, abnormal posturing, and deficits in rotation and lateral flexion of the neck. Timely diagnosis and treatment can prevent sequelae, such as amblyopia and craniofacial asymmetry, which are difficult to correct once established. Clinical cases that do not respond to conservative treatment may benefit from surgery. We present our experience of surgical treatment of torticollis reporting 16 cases ranging from 9 to 32 years of age, with follow-up ranging from 10 weeks to 15 years. Surgical treatment involved 3 tenotomies of the sternocleidomastoid muscle insertions accomplished through two small incisions. Positional results were quantified by comparing angular measurements in preoperative and postoperative photographs, using frontal and posterior views, demonstrating corrections between 53 and 100% with an average of 83% . In some cases, neck mobility measurements were performed during consultation using a handmade protractor. In all cases, substantial improvement was achieved. There were no wound-healing complications and scars were acceptable. The appearance of the lateral neck column at the sites of the muscle incisions regained its continuity without a visible sharp step-off. There was no correlation betwe en severity of the deformity (measured in degrees) or patient age and the degree of correction achieved. Despite older age and increased severity in some cases, the improvement remained substantial (AU)