Subclavian-Brachial Bypass for Chronic Limb Threatening Ischemia Associated with an Old Motorcycle Accident.

Chronic limb-threatening ischemia is rarely associated with previous traumatic injury. We present a case of a 28-year-old male with progressive digit ulcers, a weak pulse, cyanosis, and a cold limb. Eight months prior, he had a motorcycle accident resulting in a right clavicle fracture and brachial plexus injury. Computed tomography angiography revealed occlusion of the right subclavian artery near a surgically implanted reduction plate. The patient underwent an open subclavian-brachial bypass with a reversed saphenous vein graft. His postoperative recovery was uneventful. After 3 months, he had a euthermic right hand with a palpable pulse and his ulcers had completely healed. This case reinforces the need for patients with a neurological deficit in the upper extremity caused by blunt trauma to undergo thorough vascular examination to identify potential arterial injury and compromised perfusion.

Functional evaluation of sperm in Colombian fertile men.

OBJECTIVE: The aim of the present study was to evaluate in 111 ejaculates from fertile men membrane integrity of spermatozoa before selection and sperm motility, and sperm concentration and chromatin integrity before and after selection of motile spermatozoo. METHODS: We evaluated the membrane integrity (using hypoosmotic swelling test and Eosin-Y) before separation and chromatin integrity (using acridine orange), concentration and motility before and after separation by migration sedimentation technique. All individuals had pregnant wives or had procreated a baby during the last year. RESULTS: The data of sperm membrane integrity by the eosin-Y and hypoosmotic swelling tests did not show significant statistical differences and the correlation between them was low. The percentage of motile sperm (grades a + b) increased from 57% to 87% (p < 0.001), the concentration decreased from 89 to 31 x 10(6) sperm/ mL (p < 0.001) and chromatin integrity increased significantly (p < 0.0001) after separation of semen. CONCLUSIONS: The great variation in the values obtained in the functional test in fertile males requires a re-evaluation of the use of these tests in clinical practice of infertility.

[Sperm parameters in 113 subjects after recent fatherhood did not correlate with WHO standards]. / Los valores espermáticos de 113 individuos con fertilidad reciente no mostraron correlación con los parámetros establecidos por la OMS.

OBJECTIVES: This is a descriptive prospective study of semen analysis in 113 men who were candidates for vasectomy as an option for fertility control after a recent event of fertility. METHODS: Each subject provided a semen sample for the analysis of volume, pH, spermatozoid concentration, mobility, and morphology. The results were compared with the reference values established by WHO. RESULTS: Different from what was expected, a great proportion of these fertile subjects, 54.9%, showed at least one altered parameter in comparison to minimal values established by WHO. Generally, median values for the whole group were normal: volume 2.4 ml, spermatozoid concentration measured in Makler and Neubauer chambers 89 and 91 millions/ml, respectively; sperm mobility (A + B) 56%; vitality 78%; and normal morphology 79%. CONCLUSIONS: In this group of fertile subjects we found a high probability to have altered semen parameters, which argues questions the real value and significance of sperm analysis in the diagnosis of a subfertile patient.