Relationship between semen quality and the seminal plasma components carnitine, alpha-glucosidase, fructose, citrate and granulocyte elastase in infertile men compared with a normal population.

The seminal plasma components neutral alpha-glucosidase, carnitine, fructose, citrate, and polymorphonuclear granulocyte (PMN) elastase in 253 men were determined. The seminal plasma of 221 infertile men, a control group with proved fertility and 13 patients after vasectomy were investigated. The concentrations of free carnitine (212 versus 521 micromol/l, n = 219, P < 0.001), total carnitine (437 versus 743 micromol/l, n = 219, P < 0.001), and the activity of neutral alpha-glucosidase (15.1 versus 23.4 IU/l, n = 236, P < 0.05) were significantly reduced in the infertile patient group as compared to the fertile control group, the concentration of PMN elastase (102 versus 48 microg/l, n = 234, P < 0.05) being significantly increased in the infertile patients. In the patients after vasectomy the activity of neutral alpha-glucosidase was the only epididymal marker that was significantly reduced (4.3 versus 9. 8 IU/l, n = 35, P = 0.002) in comparison with the patients with testicular azoospermia. At a limit of 6 IU/l the sensitivity of the method was 92% and the specificity was 72%. Altogether, the epididymal markers were reduced in subfertile patients compared with the control group. For the differential diagnosis of azoospermia only the determination of the neutral alpha-glucosidase activity is useful.

The value of magnetic resonance imaging in the diagnosis of suspected penile fracture with atypical clinical findings.

PURPOSE: We studied the use of magnetic resonance imaging (MRI) in the diagnosis of suspected penile fracture. MATERIALS AND METHODS: Penile fracture diagnosis was based on classic history and typical physical signs in 8 patients who were treated surgically without any further diagnostic procedure. Sonography, cavernosography and MRI were performed in 4 patients with equivocal findings. RESULTS: Only MRI identified rupture of the corpus cavernosum in all 4 cases. CONCLUSIONS: MRI is the most accurate imaging procedure when penile fracture is suspected but clinical findings are unusual.

Quality of semen after extracorporeal shock wave lithotripsy for lower urethral stones.

PURPOSE: We investigated whether extracorporeal shock lithotripsy (ESWL) of stones in the distal ureter can cause decreased in male fertility. MATERIALS AND METHODS: In vivo and in vitro examinations were performed to clarify possible changes in semen after ESWL of lower urethral stones. For the in vivo examination semen from 10 patients was examined on the day before and 3 days after ESWL. For the in vitro examination semen from 12 healty volunteers was divided into 2 portions after ejaculation, with half immediately examined according to World Health Organization criteria and half directly exposed to the ESWL focus. RESULTS: The in vitro and in vivo examinations revealed a decrease in sperm density and sperm motility after ESWL. Macroscopic analysis revealed hemospermia in 30% of the patients after ESWL compared to 0% before ESWL. In addition, after ESWL all patients had microscopic hemospermia compared to 10% before ESWL. CONCLUSIONS: The in vivo and in vitro examinations demonstrated deterioration in semen quality. Sperm density and sperm motility returned to normal 3 months after ESWL, indicating at least a transitory decrease in male fertility may occur.

Results of ofloxacin therapy in andrologic patients suffering from therapy-requiring asymptomatic infections.

In 1990, microbiological ejaculate analyses were carried out on a routine basis on 125 andrological patients, in addition to the determination of the concentration, motility and morphology of the spermatozoa. Fourteen patients (11.2%) with therapy-requiring asymptomatic infections (TAI) > 10(4) CFU (colony-forming units) ml-1 were effectively treated with Ofloxacin (Tarivid) at 2 x 200 mg d-1 for a period of 20 d. Concentration, motility and morphology of the spermatozoa were determined before the Ofloxacin treatment and controlled 1, 3, and 6 months later and correlated to the values obtained before the treatment. Over the entire period of observation, the morphology did not change significantly, whilst initially 1 month after the treatment the concentration and the motility decreased significantly (P < 0.05). Three months later they again reached the starting values. After 6 months, a significant improvement occurred with regard to the motility, as compared to the starting values (P < 0.01), whilst the concentration remained at the level of the starting values. By this, Ofloxacin has been proved to be an effective medication for the treatment of TAI. In the end, it still remains an open question whether the improvement in sperm motility is primarily related to the Ofloxacin therapy.

Carcinoma of the breast and heart transplantation: a case report.

A 35-year-old woman underwent heart transplantation in 1986 because of dilated cardiomyopathy that developed after mitral valve replacements in 1971, 1975, and 1982. Additionally, a carcinoma of the left breast was diagnosed in 1984, leading to mastectomy, and in 1985 a local recurrent tumor had to be resected. In 1988 her gallbladder was removed after repeated episodes of biliary colic. Despite her eventful history, the patient is in good physical condition with normal heart performance and no signs of progression of the breast cancer under triple-drug immunosuppression.

Mediastinitis and mycotic aneurysm of the aorta after orthotopic heart transplantation.

After cardiac transplantation, bacterial mediastinitis is a rare but dangerous early complication. Of the 113 patients who underwent heart or heart-lung transplantation at our hospital from August 1981 to April 1989, 8 developed purulent mediastinitis. Treatment involved surgical débridment, local irrigation, drainage, and high-dose systemic antibiotics. No patient died of an acute mediastinal infection. In 2 cases, however, chronic mediastinitis led to the formation of a huge mycotic aneurysm of the ascending aorta. Eleven days after surgical intervention for rupture, 1 patient died of aneurysmal rerupture; the 2nd patient remains well 16 months after prosthetic replacement of the ascending aorta and reconstruction of the necrotic proximal portion of the left coronary artery with a saphenous vein patch.

[Benign prostatic hyperplasia]. / Benigne Prostatahyperplasie (BPH).

More than 40% of men, aged 50 years and more, develop a benign prostatic hyperplasia. There is some evidence that a disturbance of the testosterone and estrogene metabolism within the prostate is involved in the pathogenesis. In relation to the symptoms, either a conservative therapy or a surgical treatment and resection of the prostate is performed. Retrograde ejaculation is a frequent consequence of surgical treatment.