[Ultrasonic videolaparoscopic cholecystectomy: evolution of a revolutionary technique]. / Colecistectomia videolaparoscopica a ultrasuoni: evoluzione di una metodica rivoluzionaria.

AIM: The present retrospective study, which lasted about six months from the beginning of March to the end of August 2008, involved 60 patients suffering from symptomatic calculosis of the gall bladder. METHODS: The patients were operated on with laparoscopy: 30 with traditional instruments, 30 using ultrasound multifunctional scissors. RESULTS: The numerous advantages for the patient and surgeon are immediately evident; in addition, from the economic viewpoint the procedure is advantageous compared to the traditional method because single-use material is employed exclusively. We found less tissue trauma and a lower incidence of short-term complications, such as reoperation for faulty closure of the cystic duct and the cystic artery. It was never necessary to use permanent haemostatic clips. The use of a single instrument for gripping, sectioning and closing haematic and biliary vessels permitted faster, safer and more accurate surgery in the absence of any production of smoke. CONCLUSIONS: In lithiasic pathology of the gall bladder, videolaparoscopy for cholecystectomy is presently considered the operation of first choice. The technique enables the surgeon to respect to the utmost the patient's physical and mental integrity. As the third millennium dawns, technological innovation is able to bring a significant improvement to this procedure. The ultrasound dissector Ultracision is symbolic of development and constant progress.

Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children.

BACKGROUND: The rationale for replacing racemic bupivacaine with the s-enantiomers levobupivacaine and ropivacaine is to provide a wider margin of safety with the same analgesic efficacy and less postoperative motor block. In a randomized, double-blind, phase III, controlled trial we compared the caudal administration of levobupivacaine 0.25% and ropivacaine 0.25% with bupivacaine 0.25% in children. METHODS: Ninety-nine ASA I-II children less than 10 yr old scheduled for elective sub-umbilical surgery were randomized to receive caudal block with bupivacaine 0.25%, ropivacaine 0.25% or levobupivacaine 0.25%. The primary outcome of the study was the clinical efficacy of the caudal block during the operation. Secondary outcome measures were analgesic onset time, pain relief after the operation and residual motor blockade. RESULTS: The proportion of children with effective analgesia during the operation was similar among groups. There were no significant differences in the analgesic onset time of the caudal block. Bupivacaine produced a significant incidence of residual motor block compared with levobupivacaine or ropivacaine at wake-up (P<0.01). There were no significant differences in the number of patients receiving rescue analgesia after surgery. However, analgesic block lasted significantly longer in patients receiving bupivacaine (P=0.03). CONCLUSION: During sub-umbilical surgery, caudal levobupivacaine, ropivacaine and bupivacaine provided comparable analgesic efficacy. Bupivacaine produced a higher incidence of residual motor blockade and a longer analgesic block than ropivacaine and levobupivacaine.

The possible macrophage role in seminal fluid.

The present report was designed to study the macrophage role and their association with percentage of spermatozoa showing DNA native, morphologically normal sperm and occurrence of antibody-coated spermatozoa. Human sperm samples from 31 patients were used in this study. All samples were evaluated for standard semen parameters according to World Health Organization criteria. The sperm heads with abnormal versus normal chromatin structure were specified as orange-red versus green by Acridine Orange method. Macrophage concentration was assessed with Neutral Red in Neubauer hemocytometer. The technique for the determination of sperm bound antisperm antibodies was sperm mixed antiglobulin reaction. In our study the presence of antisperm antibodies in associated to macrophages concentration (p < 0.05). The log of phagocytic cells were highly correlated with an increase of spermatozoa showing DNA denaturation (p < 0.05). The log of phagocytic cells were highly correlated with an increase of spermatozoa showing DNA denaturation (p < 0.05). There isn't significative association between the log macrophage concentration and morphologically normal sperm (p: 0.414). Thus, the present study further emphasizes the importance of immunosurveillance of the macrophages, and the contribution at the semen quality for the success of the fertilization.

Posible rol de los macrófagos en fluido seminal / The possible macrophage role in seminal fluid

Este trabajo se realizó para estudiar el rol de los macrófagos en semen y su asociación con: el porcentaje de espermatozoides con DNA nativo, morfología espermática y presencia de anticuerpos antiespermáticos (AAE).Se utilizó muestras de semen de 31 pacientes y se evaluaron según los criterios de la Organización Mundial de la Salud. La cromatina nuclear se estudió con Naranja de Acridina, fluorocromo que discrimina el DNA nativo, color verde, del DNA desnaturalizado, color anaranjado. La concentración de macrófagos se determinó utilizando Rojo Neutro para teñir las células fagocíticas y cámara de Neubauer para contar. La presencia de AAE se investigó mediante reacción de aglutinación mixta.Se encontró asociación entre la presencia de AAE y concentración de macrófagos (p<0,05). Hubo correlación significativa entre presencia de macrófagos y espermatozoides con DNA desnaturalizado (p<0,05).Pero no hubo asociación significativa entre concentración de macrófagos y morfología espermática (p:0,414).Concluimos que existe un fuerte indicio de que los macrófagos presentes en plasma seminal participan en el mecanismo fagocítico contribuyendo a la calidad seminal, facilitando la fertilización (AU)

[Correlation between ABH glycolipids in sperm and functional test]. / Correlación entre glicolipidos ABH en espermatozoides y test funcionales.

OBJECTIVE: To determine the association, if any, between the human spermatic membrane integrity test and normal or altered membrane ABH glycosphingolipids expression. METHODS: Semen samples from 50 patients who consulted at the infertility services of the Provincial del Centenario and Eva Peron de Granadero Belgorria teaching hospitals in Rosario (Argentina) were collected and analyzed in accordance with WHO guidelines. The percentage of dead sperm was analyzed by the eosin test while the percentage of swollen sperm was analyzed by the hypoosmotic test. They were classified according to their ABH expression, either diminished or absent (group 1) or normal (group 2), by applying the hemagglutination inhibition and specific antibody consumption technique. For the statistical analysis the two groups were compared with both spermatic viability tests using the non parametric Mann-Whitney technique for independent samples, since the assumptions for the application of the parametric test (test t) were not fulfilled. RESULTS: A significant difference was found in the percentage of dead sperm (eosin test) of both groups (p < 0.001). However, there was no significant difference in the percentage of swollen sperm (hypoosmotic test) of the two groups. CONCLUSIONS: Our results and the data published in the literature indicate a relationship between a reduced ABH expression and spermatozoid membrane integrity, especially at the level of the head, which leads us to consider that ABH glycosphingolipids are mainly located in this segment of the human spermatozoon involved in the spermatozoon-ovum interactions.

[Immunology and deterioration of seminal parameters in varicocele]. / Inmunología y deterioro de parámetros seminales en varicocele.

OBJECTIVE: To investigate the occurrence of antisperm antibodies (ASAs) and their correlation to semen parameters in varicocele patients. METHODS: Semen samples from 137 patients with unilateral palpable clinical varicocele aged 15-35 years who consulted at the Infertility and Urology services of the Provincial del Centenario and Eva Peron teaching hospitals in Rosario (Argentina) were collected and analyzed according to the WHO standardized protocols and ASAs were tested with TAC II. Statistical analyses were performed using log linear models. RESULTS: Motility was impaired in 67.2% (p < 0.001) and morphology in 97.1%. Sperm concentration decreased in 19.7%, although it was not statistically different from that of the normal population. Of the infertile population with varicocele, 46.7% had positive ASAs with TAC II. CONCLUSIONS: We found a statistically significant correlation only between motility and sperm count (p < 0.01). Our study indicates that the severe dysspermia observed may be caused by autoimmune processes that trigger cellular and humoral mechanisms.

Glicoesfingolípidos de membrana y test de viabilidad espermática / Glicosfingolipides ABH and sperm viability test

Los espermatozoides presentan estructuras glicoesfingolipídicas asociadas a la membrana que son propias de los antígenos ABH. Los glúcidos que conforman estas moléculas participan en la adhesión, reconocimiento e inhibición del contacto celular. Por esta razón los antígenos de grupo sanguíneo podrían tener relevancia en los mecanismos moleculares del proceso reproductivo. El objetivo de este trabajo fue evaluar si exite asociación entre los tests de integridad de la membrana espermática y la alteración en la expresión de los glicoesfingolípidos ABH. Se seleccionaron 50 pacientes infértiles cuyas muestras de semen fueron procesadas según normas OMS. La expresión ABH en los espermatozoides se estudió por técnicas inmunohematológicas y se clasificó según estuviera disminuida o ausente (grupo 1), o normal (grupo 2). La integridad de la membrana se evaluó con Test de Burgos y De Paola y Test Hiposmótico. Se efectuó la comparación de los dos grupos respecto de ambos test de viabilidad espermática. El análisis estadistico demostró que: 1) Existe diferencia significativa en la variable porcentaje de muertos (Burgos De Paola) para los dos grupos (p<0.001). 2) No existe diferencia significativa en la variable porcentaje de hinchados (Test Hiposmótico) para los dos grupos. Sobre la base de los resultados obtenidos podemos concluir que existe asociación entre expresión ABH disminuida e integridad de la menbrana del espermatozoide, principalmente a nivel de la cabeza. Lo que nos lleva a pensar que los glicoesfingolípidos ABH, se localizan preferentemente en esta zona del espermatozoide, involucrada fundamentalmente en la interacción con el ovocito. Nos proponemos ampliar la población en estudio e investigar el gen responsable de la estructura final de los antígenos del ABO tratando de profundizar en las alteraciones del plasmalema a nivel molecular (AU)

Glicoesfingolípidos de membrana y test de viabilidad espermática / Glicosfingolipides ABH and sperm viability test

Los espermatozoides presentan estructuras glicoesfingolipídicas asociadas a la membrana que son propias de los antígenos ABH. Los glúcidos que conforman estas moléculas participan en la adhesión, reconocimiento e inhibición del contacto celular. Por esta razón los antígenos de grupo sanguíneo podrían tener relevancia en los mecanismos moleculares del proceso reproductivo. El objetivo de este trabajo fue evaluar si exite asociación entre los tests de integridad de la membrana espermática y la alteración en la expresión de los glicoesfingolípidos ABH. Se seleccionaron 50 pacientes infértiles cuyas muestras de semen fueron procesadas según normas OMS. La expresión ABH en los espermatozoides se estudió por técnicas inmunohematológicas y se clasificó según estuviera disminuida o ausente (grupo 1), o normal (grupo 2). La integridad de la membrana se evaluó con Test de Burgos y De Paola y Test Hiposmótico. Se efectuó la comparación de los dos grupos respecto de ambos test de viabilidad espermática. El análisis estadistico demostró que: 1) Existe diferencia significativa en la variable porcentaje de muertos (Burgos De Paola) para los dos grupos (p<0.001). 2) No existe diferencia significativa en la variable porcentaje de hinchados (Test Hiposmótico) para los dos grupos. Sobre la base de los resultados obtenidos podemos concluir que existe asociación entre expresión ABH disminuida e integridad de la menbrana del espermatozoide, principalmente a nivel de la cabeza. Lo que nos lleva a pensar que los glicoesfingolípidos ABH, se localizan preferentemente en esta zona del espermatozoide, involucrada fundamentalmente en la interacción con el ovocito. Nos proponemos ampliar la población en estudio e investigar el gen responsable de la estructura final de los antígenos del ABO tratando de profundizar en las alteraciones del plasmalema a nivel molecular

[Advantages of a new kit for the determination of antisperm autoantibodies]. / Ventajas de un nuevo kit para la determinación de auto anticuerpos antiespermáticos.

OBJECTIVES: It has been widely demonstrated that there is an increased level of sperm autoantibodies (SAA) in infertile than in normal fertile men, suggesting this could be a cause of infertility. This study was designed to correlate the direct agglutination methods of TAC II (a kit developed and validated by our staff) and the MAR-Screen (Fertility Technologies, Natick M.A., Bioscreen Inc.). METHODS: 645 semen samples from patients who consulted for infertility at the Infertility and Urology services of the Provincial del Centenario and Eva Perón de Granadero Baigorria teaching hospitals in Rosario (Argentina) and 30 fertile controls were analyzed. RESULTS: Statistical analysis showed a sensitivity of 87%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 98% for TAC II. CONCLUSIONS: We recommend the use of TAC II. It has similar methodological characteristics as the MAR-Screen method and offers some advantages, such as the possibility to perform analysis on frozen sperm samples and oligospermic patients, since it is not necessary for the spermatozoa to be moving. Furthermore, the test has a higher immunological specificity because spermatozoa are washed.

[Round cells in semen and genital infections]. / Células redondas en semen e infecciones genitales.

OBJECTIVE: The correlation between leukocytospermia and genital infections remains controversial. Similarly, it is inaccurate to consider the increase of round cells (RC) in semen as leukocytospermia. The purpose of this study was to determine the possible association between round cells, leukocystospermia and bacterial infections in infertile patients. METHODS: 410 semen samples were analyzed to determine sperm concentration, motility, morphology and round cells according to standard WHO citeria. Immature germ cells were differentiated by the Papanicolau stain, while the Nahoum-Cardozo method was used for polymorphonuclear leukocytes (PMN). Bacteriological studies in semen first urine sprout and urethral secretion were performed. Gram-Nicolle stain was utilized for the direct examination. Cultures were made in enriched blood Columbia agar and Thayer Martin agar was used for common germs. For mycoplasma identification, both A7 Sheppard solid and liquid media were used. Presence of Chlamydia trachomatis in urethral secretion was investigated by direct immunofluorescence. RESULTS: 79% (324) of the samples were dispermic, 9.02% presented more than 10(6) RC/ml. Of these, only 29.7% (11) presented leukocytospermia. Spearman's ranked correlation, used to measure association between RC/field and PMN leukocytes/ml, showed a value of 0.2705 with an associated probability of 0.1046, indicating a non-significant association between variables. Bacteriological studies performed in 32 samples showed 13 were positive, but only 4 (30.7%) presented leukocytospermia. Of the 19 samples with negative bacteriology, 15.78% were leukocytospermic. There was no statistically significant correlation between increased RC and the presence of germs (chi 2: 0.14965, p < 0.05) or between PMN and germs (chi 2: 1.01390, p < 0.05). CONCLUSIONS: These data suggest the convenience of performing bacteriological studies in semen in spite of the presence of RC in the direct examination.

Cytochemical profile of lymphocytes in haemophilia patients at risk of AIDS.

We report the cytochemical and immunologic features of lymphocytes of 31 patients (26 with haemophilia A and 5 with haemophilia B) chronically treated with commercial clotting factor concentrates. 6 patients, asymptomatic for AIDS were anti-HIV positive. In comparison to aged cross-matched male controls, significant increases of absolute number of lymphocytes and of T and B cell subpopulations with significant reduction of the percentages of CD3, CD4, CD2, CD5, sIg, and CD16 cells was found in haemophiliacs. PAS reaction showed a lower grading score in haemophiliacs and the staining for NBE, AP, NABG revealed a significant reduction of the percentage of the lymphocytes with dot-like positivity in the same patients. The percentage number of AP reactive lymphocytes with dot-like positivity was directly related to the percentage of CD3, and CD4 cells. The anti-HIV positive patients presented lower percentages of CD4 and of dot-like reactive lymphocytes.

Manometric study of the sphincter of Oddi in patients with and without common bile duct stones.

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile duct stones; nine of whom had undergone cholecystectomy, and seven had gall bladder stones. Length and amplitude of the resting sphincter pressure as well as frequency, duration, amplitude, and propagating pattern of phasic contractions did not significantly differ in patients with and without common bile duct stones. Sphincter of Oddi motor activity did not appear to be influenced by the variation in the diameter of the common bile duct or by previous cholecystectomy.