Fertility after autotransposition of vas: a comparative study of absorbable and nonabsorbable suture material in rats.

The anastomosis patency after autotransposition of vas (ATV) using an absorbable and a nonabsorbable suture material (10-0 Vicryl vs Ethilon) and the fertility have been investigated in a rat model. The patency rate and fertility in the absorbable group were 84% and 48%, respectively, compared with 93% and 59% in the nonabsorbable group. Sperm granulomas occurred in 60% and 48%, respectively. Sperm antibodies were present in 36% of the cases but did not have an impact on the fertility. The fertility after ATV seems to be comparable to the fertility in experimental and clinical vasovasostomy series. Further, the two suture materials appear equivalent with respect to patency and fertility in ATV.

Experimental vas replacement by either vas or a vascular graft.

An experimental model for vas replacement by transplantation of either vas or a vascular graft in attempt to restore patency in cases of a substance loss of vas that cannot be overcome by vasovasostomy was developed. Three transplant lengths, representing 10, 20 and 30% of the entire vas length, were used. The results showed an overall patency of 43% but for the transplant length representing 10% of the vas patency was achieved in approximately 75% of the cases regardless of the type of transplant used. Unpatency was usually due to occlusion of the proximal anastomosis, which in turn was considered to be due to a combination of unfavourable nutritional, neural and surgical factors. It is concluded that vas replacement by transplantation using either vas or a vascular graft is possible to perform experimentally and gives acceptable patency rates up to a transplant length of 10% of the entire vas length.

Obstructing inflammatory fibroid polyp in pelvic ileal reservoir after restorative proctocolectomy in ulcerative colitis. Report of a case.

PURPOSE: This study was designed to describe clinical, endoscopic, and histopathologic features of an inflammatory fibroid polyp occurring in the pelvic ileal reservoir after restorative proctocolectomy in ulcerative colitis. METHOD: A case report describing the clinical course of such a patient is presented. RESULTS: Three years postoperatively, the patient developed diarrhea, anemia, weight loss of 10 kg, and symptoms of obstructed defecation. Ileoscopy showed pouchitis and a polypoid tumor filling the pouch. Biopsies revealed chronic inflammation without signs of malignancy. At laparotomy, a 5 cm x 3.5 cm x 3.5 cm submucosal, solid, circumscribed tumor was found within the pouch, and histopathologic examination yielded the diagnosis. The pelvic pouch was resected and replaced by a Brooke ileostomy. During 18 months of follow-up, the course has been uneventful. CONCLUSION: Inflammatory fibroid polyp is a rare, reactive, non-neoplastic lesion, which, for the first time, is reported in a pelvic ileal reservoir. It may cause pouch dysfunction. It is always benign but may masquerade as a malignant tumor.

Autotransposition of vas in a 2-stage procedure. An experimental study in the rat.

The patency rate of vasovasostomy in autotransposed vas has been studied using a technique set up in a rat model. In a two-stage procedure, 1 cm of the vas deferens was transposed to the opposite side. The anastomoses were performed with a simplified microsurgical suturing technique. On final examination, 9 of 15 rats operated upon showed good sperm passage over the transposed vas segment. Sperm granulomas were recorded in four of fifteen cases. Sperm antibodies were demonstrated in eight of fifteen cases.

Flutamide--an antiandrogen inhibiting prostatic cancer and prostatic secretion with retention of potency.

Ten men with prostatic cancer, stage T3M0 Nx or more, who were anxious to maintain sexual potency, were treated with flutamide. The eight metastasis-free tumours remained stable during treatment periods of 3-48 months. The two tumours with metastasis at the start of treatment showed growth inhibition for 3 and 7 months, respectively, but thereafter progressed, leading to change of treatment. Nine of the ten men claimed maintained potency during flutamide therapy. Seven delivered ejaculate for biochemical analysis during or after flutamide therapy, as further evidence of potency. Biochemical analyses of the pre-flutamide ejaculates revealed higher values for markers of prostatic secretion in cases with high level of tumour differentiation. Significant reduction in the secreted amount of prostatic and seminal vesicle parameters was found in all the studied cases during flutamide therapy.

Automatic analysis of Papanicolaou smears by digital image processing.

Papanicolaou smears from 378 patients were analyzed in a fully automated microscope system using an image analysis technique. The logic of the system subdivided the smears into "normal" (63%), "not possible to analyze in the machine" (17%) and "positive" (20%). The results have been compared with the conventional screening method available today taking into consideration the definition problems of a true diagnosis, cytopathological and histopathological consensus, reproducibility, sample-taking and interpretation mistakes, etc. As 37% (rejected and positive) of the smears in this particular study were analyzed visually after machine prescreening, it could be demonstrated that the false-negative rate among the remaining 63% of the specimens was significantly lower among the machine-screened smears when compared with visual screening if the results were correlated with histopathological consensus. The results clearly indicate that the technology required to build computerized microscope systems, which are able to automatically sort out at least two thirds of Papanicolaou smears is available today. The only limiting factor is the cost-benefit relationship.

Combination of clinical examination, mammography and aspiration cytology in the diagnosis of carcinoma of the breast (179 cases).

In 179 histologically confirmed cases of carcinoma of the breast the diagnostic values of clinical examination, mammography and aspiration biopsy were compared. The effect of combining these three diagnostic methods was evaluated. Clinical examination and mammography each produced a positive diagnosis in 89% of the cases, and in 88% aspiration biopsy. A combination of these three methods enabled a positive diagnosis of carcinoma of the breast in 99% of the cases. Fine needle biopsy and mammography carried out by the clinician seem to be as effective as when done by the cytologist and diagnostic radiologist. A combination of clinical examination, mammography and aspiration biopsy increases the diagnostic accuracy of breast cancer.

The value of mediastinoscopy--experience of 374 cases.

The diagnostic value of 374 mediastinoscopies with biopsies from 1958-1971 is shown. The procedure has been evaluated earlier. The observation period in this report is so long that the clinical diagnoses are very reliable and give the material special interest. Over 90 per cent of sarcoidosis cases were diagnosed. The procedure is also shown to be of great value in investigating doubtful radiographic changes in the lungs and mediastinum. Mediastinoscopy showed tumor invasion of the mediastinal lymph glands in 79 of 216 patients with lung cancer so that 79 patients were spared thoracotomy. Mediastinoscopy can also be used to assess tumor spread in the planning of radiotherapy. In order to carry out a satisfactory lung diagnosis it is necessary to use mediastinoscopy.

Fine-needle biopsy of the thyroid gland: a cytohistological comparison in cases of goiter.

At the ENT Clinic of the Regional Hospital in Orebro, cytological investigation of fine-needle biopsy specimens has been carried out to a steadily increasing extent for more than ten years as a complement to clinical methods in investigation and laboratory tests in cases of goiter. Evaluated here are the method's diagnostic accuracy and its value in investigatory work. The material consists of 303 patients with goiter who were operated from 1964 to 1971 following fine-needle biopsy. Cases where biopsy only was undertaken are not included. Assessable cytological material was obtained in 284 cases (94%). Although not less than 15 doctors carried out the fine-needle biopsies there was approximately a 93% agreement between the cytological and histological diagnoses. In 15 of 28 cases of thyroid carcinoma it was possible to make a definite diagnosis preoperatively, while in 12 of the remaining cases atypia suspected of malignancy was found. The possibility of being able to demonstrate or suspect a carcinoma preoperatively is of greate importance for the surgeon, as a more extensive intervention can be planned in advance and the patient informed before the operation.