Electronic data base systems support the evaluation of male infertility factors, example cryptorchidism.

BACKGROUND: A new data base system was applied to analyse our patient group with two aims: (a) to analyze the effects of former cryptorchidism on the fertility of OUR infertility patients in comparison with the data of the literature and (b) to evaluate this system in a clinical study. MATERIALS AND METHODS: Using the electronic data base Winsperm 2000, 1,648 infertility patients, 79 patients with testicular cancer and 201 healthy semen donors were examined. RESULTS: A history of cryptorchidism, treated at 6.8 +/- 3.3 years of life, was found in 10.1% of our infertility patient group. The routine spermiogram parameters, as well as basal hormone concentration of FSH, LH and testosterone, differed significantly from those of the healthy semen donor group. Comparison between patients with former unilateral and bilateral cryptorchidism differed significantly only in total sperm count. 27.7% of patients with a history of unilateral and 5.4% of patients with a history of bilateral cryptorchidism showed a sperm concentration within the normal range (p < 0.01). Azoospermia was detected in 13.1% of patients with unilateral cryptorchidism and in 29.7% of patients with former bilateral cryptorchidism (p < 0.05). The patients responding to our conception questionnaire realised a total conception rate of 46.1% in the 'non-cryptorchidism group' and of 20.6% in the 'cryptorchidism-group' (p < 0.05), whereas the conception rates did not differ between former unilateral and bilateral cryptorchidism (p > 0.05). Sixteen (20.3%) of the 79 patients with testicular neoplasm were previously treated for cryptorchidism. CONCLUSION: The results of our patient group underline the significance of former cryptorchidism for infertility and testicular neoplasm. The new data base system facilitates rapid data retrieval and examination.

An endogenous peptide is involved in internal control of metamorphosis in the marine invertebrate Cassiopea xamachana (Cnidaria: Scyphozoa).

In the metagenetic life-cycle of the scyphozoan Cassiopea xamachana metamorphosis of planula-larvae or larva-like buds to polyps is triggered by specific external cues which are transmitted inside the larva or bud where internal signals finally coordinate the initiation of metamorphosis. This study deals with an endogenous metamorphosis inducer present in planulae and buds of Cassiopea. The inductive cue is localized in the basal part of the buds and can be characterized as a peptide with an apparent molecular weight of about 7,000 Da. Further purification was performed via reversed phase HPLC on a C18 column. Additional inhibitor assays revealed that protein kinase C and PI3 kinase, two known elements of the metamorphosis-inducing signal transduction cascade in Cassiopea, may act downstream of the endogenous inducing peptide.

Men born in the region of Leipzig (Saxony, Germany) between 1960 and 1970 showed a significantly decreased sperm count (examination of 3432 individuals).

The routine spermiogram parameters of 3432 patients born between 1952 and 1971 in the region of Leipzig were determined between January 1975 and March 2000. The patient group aged 24-35 years was characterized by low mobility and relocation living in the main centre of chemical industry with enormous environmental pollution in Eastern Germany up to 1990. Sperm concentrations and total sperm counts were found to be significantly reduced in men born between 1960 and 1970 compared with men born before this period (52.38 +/- 1.21 versus 70.79 +/- 2.15 millions ml(-1) 139.51 +/- 3.66 versus 176.31 +/- 6.04 millions; mean +/- SEM; P < 0.01; 2410 versus 1022 patients) independently of the year of semen examination.

Association of lysozyme with phospholipid vesicles is accompanied by membrane surface dehydration.

Lysozyme is a globular protein which is known to bind to negatively charged phospholipid vesicles. In order to study the relationship between binding of the protein and the subsequent destabilization of the phospholipid vesicles a set of experiments was performed using phospholipid monolayers and vesicles. Using microelectrophoresis the binding of lysozyme to phospholipid vesicles made of PS was determined. At low ionic strength and mild acidic pH of the solution lysozyme reduced the magnitude of the negative zeta potential of PS vesicles at lower concentrations compared to neutral pH and high ionic strength. In contrast, the bound fraction of lysozyme to PS vesicles was nearly constant at acidic and neutral pH. At low pH, the binding of lysozyme was accompanied by a strong aggregation of the vesicles. Lysozyme binding to PS vesicles is accompanied by its penetration into the PL monolayer. This was measured by surface tension and film balance measurements at low pH and low ionic strength. The interaction of lysozyme with negatively charged vesicles lead to a decrease of the vesicle surface hydration as measured by the shift of the emission peak of the fluorescent probe DPE. The binding of bis-ANS increased at low pH after addition of lysozyme to the vesicles. This indicates that more hydrophobic patches of the lysozyme-PS complex are exposed at low pH. At low pH the binding process of lysozyme to PS vesicles was followed by an extensive intermixing of phospholipids between the aggregated vesicles, accompanied by a massive leakage of the aqueous content of vesicles.

Cerebral amyloid angiopathy and plaques, and visceral amyloidosis in aged macaques.

In the present study, we report our extended data on the incidence of two types of cerebral amyloidosis (plaques and plaques associated with angiopathy) and visceral amyloidosis in late adult and aged captive rhesus monkeys (Macaca mulatta). In a total of 81 brains from animals ranging from 16 to 39 years old, beta-amyloid plaques were found in 38, 10 of which were associated with amyloid angiopathy. Brains from eight adults, 16 to 19 years, had no lesions. In aged groups, the rates were 20.8% in the 20- to 25-year group (24), 60.9% in the 26- to 31-year group (41), and 100% in the 33- to 39-year group (8). Twelve monkeys in these aged groups had an involvement of amyloidosis in either the liver, the adrenal, or the pancreatic islets, and 7 of 12 had amyloid plaques (5) and plaques associated with cerebral angiopathy (2). No neurofibrillary tangles were detected in these brain lesions. Amyloid in both plaques and cerebral angiopathy showed immunocytochemical crossreactivity with human amyloid beta (beta/A4) and precursor proteins (APP-A4), but visceral amyloid was negative. Ultrastructurally, amyloid initially appears as loose filaments in the perivascular or Disse space, and they further aggregate to produce dense interlacing bundles. Cerebral amyloid angiopathy associated with plaque appears to be a subclass of senile plaque lesions in aged monkeys as well as in aged humans, and it appears to have no pathogenetic correlation with visceral amyloidosis.

Brain damage induced by prenatal exposure to dexamethasone in fetal rhesus macaques. I. Hippocampus.

Neurotoxic effects of prenatal administration of dexamethasone were examined in the fetal rhesus monkey brain at 135 and 162 days of gestation (term is 165 days). In an experimental design mimicking human clinical trials, dexamethasone was given intramuscularly to pregnant monkeys on day 132 (single injection with doses of 0.5, 5, or 10 mg/kg maternal body weight) or on days 132 and 133 (multiple injections at 12-h intervals with 0.125 x 4, 1.25 x 4, or 2.5 mg/kg x 4). The fetuses were delivered by caesarean section on day 135 or day 162 and hippocampal slices were prepared for evaluation. Light and electron microscopic observation revealed decreased numbers of pyramidal neurons in the hippocampal CA regions and of granular neurons in the dentate gyrus associated with degeneration of neuronal perikarya and dendrites. Axodendritic synaptic terminals of the mossy fibers in the CA3 hippocampal region showed pronounced degeneration. Degeneration was dose-dependent and multiple injections induced more severe damage than single injections of the same total dose. Even the lowest dose (0.5 mg/kg, which is similar to the dose used in human clinical trials) produced these changes. Degenerative changes induced by dexamethasone treatment (5 mg/kg) on days 132 and 133 were also clearly evident in fetuses studied at 162 days. Therefore, caution is recommended in the use of prenatal corticosteroids in premature deliveries.

[Macrosomia of the fetus and clinical relevance]. / Makrosomie des Feten und klinische Relevanz.

The clinical relevance of foetal macrosomia (i.e. birth weight greater than or equal to 4000 gms) was investigated retrospectively using the 1987 figures of the "Bayerische Perinatalerhebung". 8591 (total n = 101931; 8.4%) newborns met the criterion for macrosomia and were compared with two groups of normosomic newborns (birth weight 2500-2999 gms and 3000-3999 gms). The problems, which may obscure correct prenatal diagnosis are discussed. The incidence of operative deliveries and birth injuries was increased. The duration of the deliveries was not prolonged in our study in contrast to published reports. The neonatal transfer-rate to a neonatal centre was higher in newborns, delivered by Caesarean section, compared with newborns delivered by the vaginal route. The perinatal and the maternal morbidity was higher, the perinatal mortality lower in the macrosomic newborn. According to our data, macrosomia represents and elevated perinatal risk.

Recurrence of peptic ulcer after selective proximal vagotomy and pyloroplasty in relation to changes in clinical signs and symptoms between 1969 and 1983.

Only those patients who were examined endoscopically were evaluated. Concomitant examinations, such as biopsy, histologic studies, roentgenograms, scintiscanning, acid secretion, serum gastrin and review of the operative reports, were done. Duodenal ulcers (1,219) and gastric ulcers (421) were examined preoperatively. Of these, selective proximal vagotomy and pyloroplasty and excision of the ulcer were performed for 1,018 duodenal ulcers. Forty-three per cent were examined postoperatively. Selective proximal vagotomy and pyloroplasty and excision of ulcer were performed for 315 gastric ulcers. Thirty-nine per cent were examined postoperatively. Recurrence was calculated in relation with the patients examined postoperatively. Recurrence of duodenal ulcer occurred in 6.3 per cent; of these, 0.9 per cent had duodenal ulcers develop into gastric ulcers. The recurrence rate of gastric ulcer is 8.1 per cent; of these, 0.8 per cent developed into duodenal ulcers, and 0.8 per cent to carcinoma of the stomach. Data of recurrent ulcers were compared with the data for the total number of patients who underwent surgical treatment. The possible causes for a recurrence are demonstrated. In duodenal ulcers, 79 per cent of recurrences are due to technical error (inadequate vagotomy and incomplete drainage); in gastric ulcers, 90 per cent of recurrences are due to technical error. In both duodenal and gastric ulcers, causes are partly based on advanced clinical symptoms. Recurrence rates showed a tendency to increase between 1969 and 1975 and 1976 and 1983. This correlated directly with the deterioration of the clinical signs and symptoms between 1969 and 1983, shown in increased acid secretion, increase and shift of ulcers and stenoses, increase in bleeding and changed epidemiologic findings.

[Patients of advanced age from the viewpoint of dental and medical students]. / Patienten im höheren Lebensalter aus der Sicht von Stomatologie- und Medizinstudenten.

Medical students and students of dentistry was interviewed with regard to their opinions about old people and the value of the studies under the aspect of preparation for the medical care of old patients. From 1.006 students, 238 was random selected. The investigation was carried out with help of a questionnaire, contained 53 parameters. In the majority of students positive opinions about old peoples found. On the other hand defects in the education was demonstrated. Concluding proposals are given for the improvement of studies.

Relation between the frequency of colorectal adenoma and the serum cholesterol level.

Several investigators have reported an association between low serum cholesterol levels and an increased frequency of colorectal cancer. Because low cholesterol levels may be a result of an established cancer, we have investigated the relation between serum cholesterol levels and the frequency of colorectal adenomas, which are thought to be precursors of colon cancer. We prospectively studied 1083 consecutive patients who underwent colonoscopy (241 of whom were excluded because of malignant disease, chronic inflammatory bowel disease, familial polyposis, or partial colectomy). In the remaining 842 patients, analysis of covariance was performed to evaluate the contribution of serum cholesterol to the risk of colorectal adenoma. Serum cholesterol levels were significantly and positively associated with the frequency of colorectal adenoma in subjects of both sexes. After adjustment for age and body-mass index, this positive association remained significant between the top quintile and the lowest quintile for serum cholesterol, with regard to the total study group (odds ratio, 2.0; 95 percent confidence limits, 1.1 and 3.6) and men only (odds ratio, 2.2; 95 percent confidence limits, 1.0 and 4.8). We conclude that there is not an inverse correlation between serum cholesterol levels and the risk of colorectal adenomas; on the contrary, there appears to be a small positive association.

[Interdiction and guardianship--a comparative analysis from the neurologist's viewpoint]. / Entmündigung und Pflegschaft--Eine vergleichende Analyse aus nervenärztlicher Sicht.

After expositioning of legal basis for proposal and initiation of interdiction and guardianship a report is given concerning an analysis of all cases of infirmity guardianships of Dresden - City and of procedures of interdiction within the districts of Dresden - City, Dresden - Country, and Bischofswerda during 1975-1980. Some characteristic differences between these two particularities are worked out. The task of psychiatrist as expert is specified, and in conclusion the indispensibility of close cooperation between state notary and psychiatrist is emphasized.

[Skeletal scintigraphy in the follow-up of breast cancer. Statistical and epidemiological viewpoints]. / Die Skelettszintigraphie in der Nachsorge des Mammakarzinoms. Statistische und epidemiologische Gesichtspunkte.

As shown by model calculations skeletal scintigraphy in the follow-up of mammary carcinoma results in an expected predictive value of a positive scan in asymptomatic patients of 6.6%, assuming a sensitivity of 100%, a specificity of 95% and a 5-year disease-free survival rate of 55%. Divided according to clinical stages I-III, the values are 2.1% for stage I, 5.8% for stage II, and 10.7% for stage III. From a statistical and epidemiological point of view, therefore, bone scans are of questionable value in the follow-up of mammary carcinoma, at least in the favourable stages. Scientific assessment of the ever-widening range of follow-up activities is of crucial importance; for this general demand skeletal scintigraphy in mammary carcinoma is but an example.

Prognostic significance of serum bile acids in cirrhosis.

The value of serum bile acid concentrations for predicting prognosis in cirrhotics was compared with the prognostic significance of clinical and laboratory findings in a prospective 1-year study of 76 patients with cirrhosis. A commercial radioimmunoassay for total serum-conjugated primary bile acids was used. Of 76 patients, 16 died within the follow-up period. The concentration of bile acids in serum more closely correlated with mortality in cirrhosis than the commonly used clinical and laboratory parameters such as the Number Connection Test, ascites, albumin, pseudocholinesterase, bilirubin, prothrombin time and nutritional state. Serum bile acids alone yielded a prediction of mortality comparable to the Child classification. When logistic regression analysis was performed, optimal prediction of prognosis was achieved with the combination of serum bile acids and the Number Connection Test. Serum bile acid levels alone or in combination with the Number Connection Test may be a clinically useful prognostic index in cirrhosis.

Adenomas of the large intestine after cholecystectomy.

The frequency of adenomas of the large intestine in 331 cholecystectomised patients who underwent total colonoscopy was compared with that of a control group of patients with asymptomatic cholelithiasis who were matched for age and sex. Whereas no significant difference in the frequency of adenomas was found between two groups, a subgroup of patients aged 60-80 years with a postcholecystectomy interval of 10 years or greater exhibited a significantly (p less than 0.05) greater frequency of adenomas (38.5%) than matched patients with a postcholecystectomy interval of less than 10 years (21.8%) and matched controls with cholelithiasis (23.7%). This increase in the frequency of adenomas was primarily accounted for by an increase in the percentage of tubular adenomas (p less than 0.05) and corresponded to an increase in the frequency of cancer (p less than 0.05) of the large bowel.

A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease.

Irritable bowel syndrome is a very common clinical problem for which there are no established diagnostic criteria. The two aims of the present study were first, to create a scoring system for the diagnosis of irritable bowel syndrome incorporating features from the case history, physical examination, and some basic investigations including erythrocyte sedimentation rate and blood count; and second, to estimate the diagnostic accuracy of this scoring system in terms of its sensitivity and specificity, and of its predictive value in patients diagnosed as having irritable bowel syndrome by conventional methods. A group of 479 consecutive outpatients referred to a gastrointestinal clinic was studied by the usual extensive routine workup practiced at the clinic, including numerous laboratory tests, endoscopy of upper and lower gastrointestinal tract, and ultrasound. In 209 patients, symptoms were related to an underlying organic disease and in 108 patients irritable bowel syndrome was diagnosed without any recognizable organic disease. As a separate exercise, a scoring system including the answers of a questionnaire and the results of eight basic investigations was established. After completion of the study, the score was weighted by means of a logistic regression analysis. Using the weighted score, at a sensitivity of 64%, the specificity for the diagnosis of irritable bowel syndrome was 99%, and at a sensitivity of 83%, the specificity was 97%. Patients with organic diseases such as malignant tumor or inflammatory bowel disease were well discriminated by the score. It is concluded that a detailed history, physical examination, and basic laboratory tests are sufficient in most patients for the positive diagnosis of irritable bowel syndrome and the exclusion of any underlying organic diseases.

Evaluation of the immune status in vivo by the 2,4-dinitro-1-chlorobenzene contact allergy time (DNCB-CAT).

The time interval from starting continuous application of 2,4-dinitro-1-chlorobenzene (DNCB) epicutaneously until the appearance of an allergic contact reaction, i.e. 'contact allergy time' (CAT), was determined. In 34 patients initially 2.0% DNCB ointment was administered for 2 days, then 0.05% DNCB ointment was applied daily (group I). In 39 patients only the 0.05% DNCB preparation was used (group II). The median of DNCB-CAT was 11.2 +/- 0.8 days in group I and 22.3 +/- 3.7 days in group II (p less than 0.01). In patients older than 55 years DNCB-CAT was significantly longer than in younger patients. The medians of DNCB-CAT did not differ in male and female patients. In contrast to the conventional DNCB-sensitization procedures, the CAT method allows one to measure induction and elicitation phase quantitatively.

[Tumor register: information system for tumor centers (author's transl)]. / Tumorregister: Informationssysteme für Tumorzentren.

The different activities in the scope of the tumor center already shows in the multiplicity of concepts for which incidence register, therapy register, clinical register or the supplies register are only a few examples. Such terms circumscribe a few interests from the therapeutic, epidemiologic or clinical and scientific aspects, which are projected on tumor centers as an expectation or a duty. From the compilation of these interests a bundle of unspecific aims results for which a classification according to various levels of information is suggested. Only cooperation of all levels makes possible a tumor register as an information system for medicine which supports the tasks of all those involved and makes the questions of the population more easily and more quickly answerable.