[Why is andrology part of dermatology]. / Warum Andrologie in der Dermatologie.

Andrology evolved more than 100 years ago in order to create an equivalent to gynecology for specific male problems in reproductive medicine. The first stimuli for the clinical and scientific development of this specialty in Germany arose from dermatologists. Andrology thus appears as a moiety of dermatology. In 2003 the visibility of andrology among the medical disciplines was accentuated by the introduction of an additional specialty specification for dermatologists, endocrinologists and urologists, since the other two disciplines also worked on andrological problems. Today, the majority of the members of the Society of Andrology are urologists and also urologists form the majority of medical practioners with this additional specialty. Besides reproductive medicine, there are several other topics which underline the conjunction of dermatology and andrology. Hence andrology should be observed as a part of dermatology not only for historical reasons. Andrology is a living subspecialty of dermatology and young dermatologists should be motivated to become engaged in it.

Drug-induced hperpigemntation: a systematic review.

BACKGROUND: Acquired hyperpigmentation of the skin is sometimes interpreted as an adverse effect of drugs. Systematic studies are rare in the literature; predominantly case reports have been published. The present review provides evaluates the evidence for a causal relation. METHODS: The reports on a relationship between hyperpigmentation and drugs from 1970 until June 2012 found in MEDLINE and EMBASE were rated according to the SIGN grading system for clinical studies. In this system, the grade of evidence of each report is rated. The highest grade of evidence for each drug is cited. RESULTS: 306 publications were included. They were predominantly case reports; only a small number of case series was available. Only very few case-control-studies and randomized controlled trials (RCT) were found. For the majority of drugs, there was a low level of evidence for a causal relationship in drug-induced hyperpigmentation. A causal relationship is likely only for prostaglandins, minocycline, phenothiazine, nicotine, and antimalarial drugs. CONCLUSIONS: There is little evidence for drug-induced hyperpigmentation. A causal relationship appears liklely only for a limited number of drugs.

THORACOLOMBAR BURST FRACTURES: SHORT FIXATION, WITHOUT ARTHRODESIS AND WITHOUT REMOVAL OF THE IMPLANT.

Objectives: To present the functional outcomes, through the first case series in our country, of patients with thoracolumbar burst fractures (A3,A4), submitted to short posterior fixation, without arthrodesis and without removal of the implants, until the end of the minimum follow-up of one year. Methods: Fifty five patients consecutively treated between January/2010 and January/2019 were evaluated through medical records and imaging exams. Radiographic analysis was performed by mea suring local and segmental kyphosis using the Cobb method. Functional assessment was analyzed using the non-specific SF-36 questionnaire and the 1983 Denis pain and work-specific questionnaire, applied after 12 months of follow-up. Results: With a loss of five patients (9%), 22 (44%) patients reported having minimal and occasional pain and 8 (16%) patients reported having no pain. Three (6%) patients responded that they were completely incapacitated. Patients had a mean score of 73.16 points in the SF-36 domains. There was a significant reduction in kyphosis in 12 months (9.1±5.2 [min-max 0-22]) compared to the preoperative period (14.9±7.8 [min-max 0-32]) ( p≤0.01). One patient required implant removal due to the symptomatic prominence of the implant. Conclusion: This case series suggests that the technique leads to satisfactory functional results, without implant failure or significant kyphosis after a minimum follow-up of 12 months of treatment. Evidence Level IV; Case series.

Objetivo: Apresentar os desfechos funcionais, mediante primeira série de casos no nosso meio, de pacientes com fratura toracolombar do tipo explosão (A3, A4), submetidos a fixação posterior curta, sem artrodese e sem retirada dos implantes, até o final do acompanhamento mínimo de um ano. Métodos: Foram avaliados, por meio de prontuários e exames de imagem, 55 pacientes consecutivamente tratados entre Janeiro/2010 e Janeiro/2019. A análise radiográfica foi realizada medindo a cifose local e segmentar, pelo método de Cobb. A avaliação funcional analisada por meio do questionário inespecífico SF-36 e questionário específico de dor e trabalho de Denis de 1983, aplicados após os 12 meses de seguimento. Resultados: Com perda de cinco pacientes (9%), 22 (44%) pacientes relataram ter dor mínima e ocasional e 8 (16%) pacientes responderam não ter dor. Três (6%) pacientes responderam que estavam completamente incapacitados. Os pacientes tiveram uma pontuação média de 73,16 pontos nos domínios do SF-36. Houve redução significativa da cifose em 12 meses (9,1±5,2 [min-máx 0-22]) na comparação com o pré-operatório (14,9±7,8 [min-máx 0-32]) (p≤0,01). Um paciente necessitou de retirada do implante em razão da proeminência sintomática do implante. Conclusão: Esta série de casos sugere que a técnica leva a resultados funcionais satisfatórios, sem falha do implante ou cifose pós-traumática após acompanhamento mínimo de 12 meses de tratamento. Nível de Evidência IV; Série de casos.

Diseases of the male nipple and areola.

The male nipple-areola-complex (NAC) is a residual organ without physiologic functions in the male. It possesses similar hormone sensitivity and sexual sensitivity as the female organ. The location of the NAC on the chest wall with respect to other surface features is relevant for the male appearance. All known disseminated skin diseases may involve the nipple and areola. A number of specific localized diseases have been described in the literature, such as mammillary eczema, demodicidosis, lymphadenosis cutis benigna, nevoid hyperkeratosis, and thelalgia. Special attention is required if nipple discharge is observed. Areolar sebaceous hyperplasia and nearly all kinds of benign cutaneous tumors occur on the nipple and areola. Malignant tumors such as basal cell carcinoma, melanoma, Paget disease and other forms of breast cancer may also be found. In addition, aberrant mammary tissue may occur with a broad clinical spectrum, while absence of the nipple is an unusual observation and occurs in rare syndromes. The association of aberrant mammary tissue with urinary tract malformations has not been confirmed.

Genital Paget's disease in a man.

Pagetoid cells are large intraepidermal cells which spread intraepidermally. We report a 67-year old Caucasian male, who presented for the first time in 1993 with a long-standing pruritic lesion at the scrotum. He was treated for several years by antiinflammatory ointments. Only in July 2003 was a biopsy taken for the first time. The histopathological evaluation revealed the diagnosis of an extramammary Paget's disease (EMPD). Pagetoid cells are large intraepidermal cells with a large nucleus and ample cytoplasm. EMPD consists of primary malignant cells of epidermal origin, but in rare cases, pagetoid cells may also originate from carcinomas with epidermotropic growth. EMPD is a slowly progressing disease, but invading and metastasing tumors may also develop. Considering the good prognosis with long-term survival, nonsurgical modalities should be considered as primary treatment for noninvasive EMPD.

Association of skin hyperpigmentation and drug use: a systematic review.

INTRODUCTION: Part of the acquired hyperpigmentations of the skin are interpreted as adverse effect of drugs. However, systematic studies are rare in the literature, as case reports have predominantly been published. The present systematic review attempts to provide a contribution to the body of evidence for a causal relation. EVIDENCE ACQUISITION: The reports on an association of hyperpigmentation and drugs from 1970 until April 2016 found in Medline and EMBASE were rated according to the SIGN grading system for clinical studies. EVIDENCE SYNTHESIS: A total of 352 evaluated publications were found, which mainly consist of reports of single cases, only a small number of larger case series were available. Case-control-studies and randomized controlled studies have rarely been found. The level of evidence for a causal relation to hyperpigmentation is low for the major part of drugs as quoted in order to the Anatomical Therapeutic Chemical Classification System with Defined Daily Doses. A causal relation is likely only for prostaglandins, minocyclin, phenothiazine, nicotine, and anti-malaria drugs. CONCLUSIONS: There is paucity of evidence for an induction of hyperpigmentation by drugs. A causal relationship is likely only in a small number of drugs.

The role of antisperm antibodies during fertilization and for immunological infertility.

Antisperm antibodies (ASA) occur in men and in women. In the male they may cause an autoimmune disease, 'immune infertility'. In order to understand the functional relevance of ASA it is necessary to characterize the cognate antigens of ASA by different methods. In the literature, several immunologically characterized sperm proteins--as cognate antigens of naturally occurring ASA or of artificially produced antibodies--are quoted with respect to different sperm functions in the course of fertilization: cervix mucus penetration, zona binding, zona penetration, oolemma binding, and pronucleus formation. In a number of these functions, sperm proteins were already identified as cognate antigens of ASA. As practical consequences of the research on ASA-related sperm proteomics those ASA will be identified, which decrease male fertility by inhibiting sperm functions that are essential for fertilization.

Stress reduction in male infertility patients: a randomized, controlled trial.

OBJECTIVE: To assess the impact of preparatory information about the fertility workup on the patients' well-being. DESIGN: Two-group, randomized controlled study. SETTING: An andrology clinic. PATIENT(S): Two hundred fifty men enrolled for fertility workup. INTERVENTION(S): A two-page leaflet with preparatory information about the fertility workup, which was mailed to half of the participants after they had made an appointment. MAIN OUTCOME MEASURE(S): Questionnaire score for infertility-related distress at clinic attendance, proportion of participants that still had not attended 6 months after the scheduled appointment. RESULT(S): Distress scores and the proportion of nonattendees were significantly reduced in the group receiving the leaflet. An additional analysis revealed that 55% of the receivers did not know that the andrology clinic has its own web site, which was mentioned in the leaflet several times. CONCLUSION(S): Although it is uncertain how many patients actually read a routinely sent leaflet, preparatory information in written form is beneficial, at least for a significant subgroup of men who consider undergoing fertility workup. Fertility services might reduce the number of nonattendees by sending out leaflets.

Serum levels of inhibin B and follicle-stimulating hormone may predict successful sperm retrieval in men with azoospermia who are undergoing testicular sperm extraction.

To evaluate the predictive power for sperm retrieval in testicular sperm extraction of inhibin B and FSH levels in the peripheral blood in association with the testicular histology. Clinical study. Departments of andrology and urology at a university hospital.Fifty-two patients with azoospermia. Determination of serum levels of FSH and inhibin B in men with azoospermia. Testicular incision and histological investigation as well as testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection were performed. Comparison of hormone levels with different histological features of seminiferous tubules (normospermatogenesis, hypospermatogenesis, and Sertoli cell-only syndrome) and TESE outcome.With respect to the histological proof of spermatozoa, the sensitivity of the FSH levels >10 mU/mL was 82%, and of inhibin B levels, <79 pg/mL, 78%; the specificity was 80% for both hormone levels. With respect to the successful sperm extraction in the TESE procedure, the sensitivity of the FSH levels was 58% and the specificity was 50%; and the sensitivity of inhibin B levels was 52.5% and the specificity was 60%. Inhibin B and FSH levels are correlated with spermatogenetic activity. The combination of the two parameters is currently the best predictor for the presence of sperm, which may be found in TESE. However, the prediction is not absolutely reliable: TESE can be also successful when both hormone levels are outside the threshold levels.

Distress of infertile males after fertility workup: a longitudinal study.

OBJECTIVE: Former research has revealed that distress declines after fertility workup. It was the aim of the present study to explore whether this decline depends on such aspects as the diagnosis or the former usage of fertility services. METHODS: Patients attending an andrological clinic filled out questionnaires on distress and coping behaviour at clinic attendance as well as 4 months later. RESULTS: For distress scores there was an interaction between time and former usage of infertility services, indicating that only first-time consulters show a decline in distress after fertility workup. No impact of diagnosis on distress scores could be detected. Generally, patients showed a decrease of active coping behaviour after fertility workup, along with a greater tendency to accept infertility as one's fate. CONCLUSION: The findings indicate that there are different processes working in first-time and repeat consulters with respect to the course of distress.

Seasonal variations in human seminal parameters.

OBJECTIVES: To obtain data on seasonal variations of sperm parameters in an andrology laboratory. STUDY DESIGN: Semen parameter values and hormone values of 2454 patients attending our infertility clinic between 1990 and 1997 were analysed. Seasonal trends were calculated using the method of Edwards [Ann. Hum. Genet. 25 (1961) 83]. RESULTS: The total group of mean sperm count did not show a significant variation, but a significant circannual trend occurred of patients born in the groups 1950-1954, 1955-1959 and 1965-1969. A significant variation of acrosin activity occurred with a maximum in March. The other parameters did no show significant variations. CONCLUSIONS: The knowledge on circannual variation of semen parameters and hormone values may be of value in diagnostic and therapeutic decisions in reproductive medicine.