The effects of varicocele and its surgical correction on vas deferens motility.

Varicocele is the abnormal dilation of venous pampiniform plexus and internal spermatic vein. Its prevalence in the adolescent period is almost equal to the prevalence of adult age. That is why the disease is accepted to appear in early adolescence and does not disappear spontaneously. Varicocele is established to be the most common cause of infertility in the adulthood period in terms of the testicular and/or epididymal damages it causes. Besides, malfunctioning of testis and/or epididymis cannot be blamed as the one and only reason of infertility. One major reason of the male infertility is vas deferens motility disorders. There is limited data in the literature investigating the effects of varicocele on the vas deferens motility. The aim of the study is to evaluate not only the motility defects of vas deferens for the period of varicocele, but also the effects of surgical varicocele correction on vas deferens motility. Thirty male Wistar-Albino rats were allocated to five groups. In the control group (Gr C, n = 6) bilateral vas deferens strips were harvested without any surgical intervention. Using the partial left renal vein obstruction technique, the experimental varicocele model was performed for the other four groups. Varicocele was apparent for these animals after the fourth week of the venous ligation. Bilateral vas deferens strips of varicocele group (Gr V, n = 6) were harvested. The rest of the animals having varicocele underwent relaparotomies. Three different surgical procedures were performed to these animals. The animals of group P (Gr P, n = 6) and group I (Gr I, n = 6) underwent Palomo and Ivanissevich procedures, respectively, for varicocele correction. And the animals of group S (Gr S, n = 6) underwent sham operation. After 4 weeks of relaparotomies, bilateral vas deferens strips of all three groups harvested. The electrical field stimulation (EFS) induced responses of all vas deferens strips as well as exogenous drug induced responses were recorded and analysed. The results of the study showed that the varicocele significantly inhibited the first phase of biphasic response of vas deferens in the ipsilateral side. However the correction of varicocele, free from surgical technique, ameliorated the affected first phase of EFS induced biphasic response in the ipsilateral side. The results of this study suggest that varicocele can be the reason of male infertility by not only causing testicular and/or epididymal damages but also triggering vas deferens motility defects. The correction of varicocele free from surgical technique may reverse the damaging of the vas deferens. Therefore when indicated surgical correction of varicocele is essential. It seems that varicocele surgery does not only prevent late term testicular and/or epididymal damages but also avoids vas deferens motility defects.

Stobadine protects rat kidney against ischaemia/reperfusion injury.

1. Ischaemia-reperfusion (I/R) injury, one of the main causes of acute renal failure, still needs satisfactory treatment for routine clinical application. Stobadine, a novel synthetic pyridoindole anti-oxidant, has the ability to reduce tissue injury induced by mechanisms involving reactive oxygen species during I/R. The aim of the present study was to determine the effects of stobadine on renal I/R injury. 2. Forty male Wistar rats were randomly divided into four groups as follows: sham, I/R, stobadine treated and I/R + stobadine treated. Stobadine (2 mg/kg, i.v.) was given intravenously to two groups of rats. The stobadine-treated group was treated with stobadine following sham operation before the abdominal wall was closed, whereas the I/R + stobadine group received stobadine at the beginning of reperfusion. Renal I/R was achieved by occluding the renal arteries bilaterally for 40 min, followed by 6 h reperfusion. Immediately thereafter, blood was drawn and tissue samples were harvested to assess: (i) serum levels of blood urea nitrogen and creatinine; (ii) serum and/or tissue levels of malondialdehyde (MDA), glutathione (GSH), glucose 6-phosphate dehydrogenase (G-6PD), 6-phosphogluconate dehydrogenase (6-PGD), glutathione reductase (GR) and glutathione peroxidase (GPx); (iii) renal morphology; and (iv) immunohistochemical staining for P-selectin. 3. Stobadine was able to significantly attenuate the renal dysfunction as a result of renal I/R injury. Ischaemia-reperfusion resulted in a significant increase in serum and kidney MDA levels and a decrease in serum and kidney GSH. Stobadine treatment at the beginning of reperfusion attenuated both the increased MDA levels and decreased GSH secondary to I/R injury. In addition, the decreased G-6PD activity observed after I/R was significantly attenuated by stobadine treatment. Stobadine did not alter 6-PGD activity after I/R. Neither GR nor GPx activity was significantly changed in the I/R alone or the I/R + stobadine groups compared with the sham group. In addition, stobadine decreased the morphological deterioration and high P-selectin immunoreactivity secondary to renal I/R injury. 4. A pyridoindole anti-oxidant, stobadine exerts a renal protective effect in renal I/R injury, which is probably due to its radical-scavenging and anti-oxidant activities.

A novel technique for vas deferens transection repairs.

The purpose of this study is to describe a technique, that is as successful as microsurgery in terms of patency rates and histopathologic assessments, and can be performed even by untrained hands in microsurgery, for repairing vas deferens injuries that can be perceived during inguinal herniorrhaphy. Thirty male Wistar-Albino rats were randomly allocated to five groups. In control group, the vas deferens was harvested without any surgical intervention (Group 1) and in sham group the vas was harvested after a limited dissection (Group 2). Three suture approximation technique was carried out in Group 3, and a novel vasovasostomy technique was carried out by using a hypodermal needle in Groups 4 and 5, with polypropylene and polyglactin 910 (rapid vicryl), respectively. Results were evaluated in terms of operative time, patency and flow rates, inflammation and sperm granuloma. The mean operative times for hypodermal needle assisted approximation of Groups 4 and 5 were found significantly less than Group 3. The compared results of the groups in terms of patency, flow rate, inflammation and spermatic granuloma indicated Group 4 to be superior to the other groups. We have found the hypodermal needle assisted approximation technique to be easier, less time consuming and cost effective. With these promising results, this modus operandi can be described as an appropriate technique for vas deferens transection repairs.

A novel mutation in the vascular Ehlers-Danlos syndrome: a case presenting with colonic perforations.

A 15-year-old girl who had chronic constipation presented with peritonitis caused by sigmoid colon perforation. After her sigmoid colon was resected and an end colostomy performed, as there were no apparent causes for perforation, she was followed-up. After the second colonic perforation proximal to the end colostomy, as the pathologic findings revealed myopathic changes, the connective tissue disorders were evaluated. Her molecular biology studies revealed an undefined missense mutation in the COL3A1 gene, confirming the diagnosis of vascular Ehlers-Danlos syndrome (EDS). As she refused a permanent stoma, total colectomy and ileorectal anastomosis were performed, but the postoperative complications resulted in a fatal progression. The typical progression of vascular EDS will be discussed with the presented case by means of a review of the English medical literature on children diagnosed with vascular EDS.

Mitomycin C prevents strictures in caustic esophageal burns in rats.

BACKGROUND: Caustic esophageal injuries lead to stricture formation. Although a number of agents have been tried experimentally to prevent strictures, few have gained clinical application. The purpose of this study was to investigate the effectiveness of Mitomycin C (MMC), which inhibits fibroblastic proliferation in preventing caustic esophageal strictures. MATERIAL AND METHODS: Fifty-six rats were allocated into four groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured and untreated. Groups C and D were injured and received topical MMC at 0.02 and 0.04% concentrations, respectively. At 28 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were done. RESULTS: Mean SI in Group B was significantly higher than others (P < 0.05). Mean SI was statistically higher in Group C than A and D and similar between groups A and D. The greatest accumulation of collagen was found in Group B, followed by Group C, D, and A, respectively. Collagen deposition in Group D was statistically lower than Group B (P < 0.01) and similar to Group C. Mean HP in Group B was statistically higher than others (P < 0.05), significantly higher in Group C than Group D (P = 0.047), and similar between Groups A and D (P = 0.73). CONCLUSION: MMC was effective in preventing strictures following experimental caustic esophageal injury, in a dose-dependent manner. We consider that it can gain clinical utilization with the establishment of effective mode, dose, and timing of therapy.