L'angiographie et la maladie thrombo-embolique pulmonaire: Indications et contre-indications

Pulmonary angiographic studies were performed on 100 patients with suspected pulmonary embolic disease.In the majority, the contrast medium was injected through a catheter located in the outflow tract of the right ventricle or the pulmonary trunk.Pulmonary embolic disease should be suspected in the presence of the following unexplained symptoms or signs: (1) dyspnea, (2) thoracic pain, (3) hemoptysis, (4) left ventricular failure, (5) global ventricular failure, and (6) pulmonary function deterioration.Pulmonary angiography is a simple, specific and objective method by which to diagnose thromboembolic disease of the lung. Acute myocardial infarction and terminal illness were the only contraindications to the procedure.     

Azoospermie et microinjection

In cases of azoospermia, testicular biopsy combined with cryopreservation of spermatozoa allows ICSI to be performed under good conditions. In this study, the authors present their results by emphasizing three major aspects:

- Retrieval of testicular spermatozoa by open biopsy or percutaneous needle aspiration: 40 patients with obstructive azoospermia underwent epididymal or testicular retrieval by open biopsy and 37 by percutaneous needle aspiration. All biopsies were positive. 133 patients with nonobstructive azoospermia underwent percutaneous needle aspiration and spermatozoa were successfully retrieved from 50 patients (38%).

- The freezing process was performed with a cryoprotective medium devoid of egg yolk after dilaceration of the testicular tissue using two sterile glass slides. No significant difference in the outcome of the ICSI procedure was observed between fresh and frozen-thawed spermatozoa. In cases of obstructive azoospermia, 13 pregnancies out of 41 ICSI cycles (31%) were obtained with the use of fresh testicular or epididymal spermatozoa and 24 pregnancies out of 115 ICSI cycles (20%) were obtained with the use of cryopreserved spermatozoa. In cases of non-obstructive azoospermia, 6 pregnancies out of 31 ICSI cycles (19%) were obtained with the use of fresh testicular spermatozoa and 12 pregnancies out of 33 ICSI cycles (36%) were obtained with the use of frozen-thawed spermatozoa.

- After the freezing-thawing process, the percentage motile testicular spermatozoa is very low (about 4%), with a weakly shaking motility making selection of live spermatozoa very long and difficult. The addition of pentoxifylline (3 mM) significantly increases this motility within 15 minutes, as 30% of spermatozoa have a progressive motility. Selection of viable motile spermatozoa is therefore easier and more rapid. Fertilization and pregnancy rates are comparable to those generally reported. No malformation was observed on 51 live births.