Changes in the levels of various substrates of nitrogen metabolism and tricarboxylic acid cycle during experimental acidosis in calves

The effect of experimental metabolic acidosis and its correction for nitrogen and energy metabolism was studied in new-born calves. It was discovered that a change in the acid-base balance towards acidosis causes a sharp increase in "ammoniogenesis", urea formation and inhibition of the tricarboxylic acid cycle, which is also observed in calves suffering from dyspepsia with symptoms of acute diarrhea. Alongside with the use of therapeutic measures for treating dyspepsia of new-born calves, it is necessary to control the acid-base balance of blood in the calves and in case of revealing the acidosis state to use means of its correction.     

Varicocele and Infertility in Men

Varicocele is an important cause of infertility in men. The exact mechanism by which varicocele depresses spermatogenesis is unknown but probably the retrograde flow of blood rich in catecholamines into the testes plays a major role.Because subfertile semen qualities are present in a large percentage of men with varicocele and because the response to surgical procedures is very good, high ligation of the left internal spermatic vein is recommended in men with varicocele and infertility.     

Oxidative damage to proteins and decrease of antioxidant capacity in patients with varicocele

To examine oxidative damage to blood proteins in the spermatic vein and seminal plasma antioxidant capacity of patients with varicocele, 30 young male patients with varicocele (group 1), 25 young male patients with subclinical varicocele (group 2), and 15 normal young males without varicocele (group 3) were recruited in this study. Varicocele and subclinical varicocele were confirmed by physical examination and Doppler ultrasonography. Blood samples were drawn from peripheral and spermatic veins before varicocelectomy. Plasma protein carbonyls were measured by a spectrophotometric assay after reacting with 2,4-dinitrophenylhydrazine. Protein thiols and ascorbic acid of seminal plasma were measured by spectrophotometric methods. We found that plasma protein carbonyls in the spermatic veins were significantly higher than those of corresponding peripheral veins in all 30 patients in group 1 and 12 patients in group 2 receiving varicocelectomy. Protein carbonyls in the spermatic veins of patients with varicocele (3.72 +/- 0.56 nmole/mg protein) and patients with subclinical varicocele (3.50 +/- 0.30 nmole/mg protein) were found to be higher than those of the control (2.35 +/- 0.33 nmole/mg protein). Protein thiols were 0.97 +/- 0.96, 1.50 +/- 0.89, and 3.49 +/- 0.81 nmole/ml, and ascorbic acid levels were 1.87 +/- 0.42, 2.13 +/- 0.24, and 2.38 +/- 0.07 mg/dl, in seminal plasma of the patients in groups 1, 2, and 3, respectively. Seminal plasma protein thiols and ascorbic acid levels in group 1 were significantly lower than those in groups 2 and 3, respectively. These results indicate that oxidative stress in the patients with varicocele and subclinical varicocele was higher than that of the control. We suggest that plasma protein carbonyls, and protein thiols and ascorbic acid of seminal plasma are useful markers for the assessment of oxidative stress in patients with varicocele and subclinical varicocele.     

Progesterone, 17-OH-progesterone, androstenedione and testosterone plasma levels in spermatic venous blood of normal men and varicocele patients

Progesterone (P), 17-OH-progesterone (17-OH-P), Androstenedione (delta 4) and testosterone (T) plasma levels were measured in spermatic venous blood of twenty-nine varicocele patients (V) and in twelve normal subjects (N). Our data reveal a significant decrease of the mean testosterone in the spermatic blood of varicocele patients with respect to normal controls: (N = 1708.7 +/- 223.8 (SEM) nmol/l, n = 10. V = 1190.9 +/- 101.1 (SEM) nmol/l, n = 29. P less than 0.03). An inverse correlation has been observed between the age of varicocele patients and 17-OH-P (n = 29. y = -33.38x + 1384.70, r = -0.59, P less than 0.01) and delta 4 values (n = 23, y = -1.62x + 85.65, r = -0.49, P less than 0.05). The 17-OH-P/delta 4 ratio appears significantly augmented in varicocele patients with respect to normal controls (n = 4.80 +/- 0.86 (SEM), n = 12. V = 9.65 +/- 1.21 (SEM), n = 23.0.02 greater than P greater than 0.01). This indicates a deficiency in varicocele patients of 17-20 lyase activity. The positive correlation between the P/17-OH-P ratio and age of varicocele patients (n = 28, y = 0.007 x -0.090, r = 0.45, P less than 0.03) suggests a progressive impairment of 17-alpha-hydroxylase in such patients as they grow relatively older. These data demonstrated that the reduced spermatic levels of testosterone in varicoceles are due to the enzymatic impairment of testosterone biosynthesis, concerning firstly 17-20 lyase activity and secondly 17-alpha-hydroxylase activity. The latter enzymatic impairment is age related as is seen from the significant increase of the P/17-OH-P ratio in older patients.     

Varicocele in Youth

Thirty boys 8 to 18 years of age seen in a general urologic practice with emphasis on pediatrics had palpable varicoceles. A concomitant finding was that 77 percent of these patients had a smaller testis on the left side. Because the small testis is present before maturity, its size appears due to arrest of testicular growth rather than to atrophy.Surgical correction is advisable when the varicocele is pronounced, the involved testis is distinctly smaller or there is scrotal pain.     

Clinico-roentgenologic diagnosis of chronic venous insufficiency of the ovaries

The paper is devoted to clinico-roentgenological correlations of venous reno-gonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinico-laboratory investigation was followed by visceral and parietal phlebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. A retrograde blood flow along the internal ovarian vein with the development of venostasis and secondary pelvic varicocele was diagnosed in 67 women with disturbed reproductive function. In 17 women without disorders of reproductive function a reno-gonadal venous reflux was undetectable. Clinico-roentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele.     

Roentgeno-endovascular surgery of hypofunctional ovaries in varicosities of the ovarian veins]

Three degrees of ovarian varicocele in sterile women or women with menstrual disturbance were described on the basis of analysis of 62 superselective ovariophlebograms. A nonsurgical pathogenetic method for correction of ovarian hypofunction in disturbed circulation in the venous region of the pelvic organs was developed by cutting off the ovarian vein from the pathological renocaval vascular shunt with the help of roentgenovascular intervention. It is based upon transcatheter occlusion of the left ovarian vein and directly follows diagnostic phlebography. Roentgenoendovascular occlusion of the left ovarian vein was performed in 41 patients Ivanissevich's operation--in 8 patients. In 4-18 months after intervention, improved results of a clinical picture and functional diagnostic tests were observed in 46 patients. Of 19 women with passable uterine tubes 14 got pregnant.     

Changes in the Level of Neuronal Cell Adhesion Molecule in the Brain of Male Rats under Conditions of Suppression of Production of Testosterone

Under conditions of experimental varicocele in rats, we observed suppression of production of testosterone and significant drops in the level of this hormone in the blood serum. Such a decrease resulted in a two-fold (or even greater) rise in the amount of the membrane-bound fraction of neuronal cell adhesion molecule (NCAM) in the hypothalamus and hippocampus, while the levels in the cerebellum and neocortex remained stable, and also in appreciable redistribution of the soluble form of this molecule in different cerebral structures in the course of development of varicocele.     

Températures et varicocèles

Varicocele is considered to be responsible for male infertility by several authors, while varicocele may also exist in fertile men. Hyperthermia or “raised” testicular temperature is one of the pathophysiological mechanisms proposed to explain impaired spermatogenesis when a varicocele is present in infertile men. The reported clinical data in humans and experimental results of surgically-induced varicocele in animals indicate the following findings. In most studies, mean testicular and scrotal temperatures are bilaterally increased in populations of men with unilateral left varicocele compared to control populations. Similar results are observed following surgical induction of experimental left varicocele in animals. In the case of bilateral varicocele, the increase in mean temperature is similar to that observed in unilateral varicocele. Data concerning the effects of varicocelectomy on testicular or scrotal temperatures are still inconclusive in humans because of the discordant results in the small number of studies dealing with this topic. However, experimental data indicate that varicocelectomy results in recovery of normal mean temperature in animals submitted to surgically-induced varicocele, but experimental animal models of varicocele have failed to provide any explanation for the increase in temperature. In conclusion, although there is a relationship between varicocele and testicular temperature, testicular temperature is not increased in every case of varicocele.     

Color Doppler sonography of normal male genitalia and varicocele

The present paper reports on the results of complex sonographic examination of scrotum organs in 116 patients. The study was performed with Siemens sonographic unit. According to clinico-laboratory data and results of operative intervention, the patients were divided into two groups. The 1st group (8 persons) had no pathology in the scrotum organs, the 2nd group (98 patients) had diagnosis of varicocele. In norm capsular, centripetal and transmeridian arteries were visualized in the projection of testis in colour Doppler sonography. Resistancy index was measured. The group with varicocele in colour Doppler sonography with Valsalva test showed a prolonged retrograde wave of blood flow during the whole period of tension. To determine the stage of pathologic process, a scale system had been used. Doppler sonography enables to reveal various types of reflux. The character of reflux determines a pathogenetic cause of varicocele that effects on the choice of the method of operative intervention. Parameters of colour Doppler sonography allow to determine the stage of the disease and reveal subclinical varicocele in cases when pampiniform plexus is absent, but significant hemodynamic changes take place. The data of Doppler sonography have been confirmed by the results of operative intervention.     

Ultrasound studies in varicocele

Renal function, the anatomic and functional status of the vena cava inferior, renal arteries and veins, and spermatic veins were evaluated in healthy individuals and patients with varicocele before and 12 months after laparoscopic ligation of the left spermatic vein. The renal vessels were assessed by color Doppler ultrasonography and renal function was examined by complex radionuclide study with 99mTc-pentatech. There were no significant changes in the diameter of renal arteries and vena cava inferior and the right arterial blood flow velocities in healthy individuals and patients. No difference were found in the diameter of renal veins and in the blood flow velocity in renal arteries and veins. The enlarged renal veins and decreased mean blood flow velocity in the left renal vein in healthy persons and patients with varicocele and lower blood flow in the left renal artery than in the right one indicate left-sided renal hypertension that is attributable to left renal vein overload due to a great variety of collaterals and to compression at the site of "a forcepts". At the same time 12-month postoperative ultrasonic, Doppler and complex radionuclide studies revealed no significant changes in the diameter and blood flow velocity in the left renal vein.     

Change in immune response in children suffering from opisthorchosis and attempt at its correction using Levamisol

The number of circulating T-, B- and O-lymphocytes, the activity of non-specific T-suppressors, the ability of lymphocytes to blasttransformation with PHA and the levels of M, G and A immunoglobulins in blood serum were studied in 40 children suffering from chronic opisthorchosis and in 18 virtually healthy children (mean age 9 years). The affected children were studied before and after treatment with Levamisol. It has been established that the number of T-lymphocytes is reduced and the activity of non-specific T-suppressors decreases considerably in children suffering from chronic opisthorchosis which by its nature is a heavy allergosis. Through a similar factor, the inhibition of the activity of T-helpers is reduced and conditions are created for increased antibody production in the organism of the patients without an increase in the level of B-lymphocytes. Consequently, manifestations of autoimmune and allergic reactions of the immediate and delayed type can be expected to occur in such patients. Treatment of the affected children with Levamisol (2 mg/l kg body mass every other day, 3 administrations of the preparation in one course) showed an immunoregulative effect characterized by intensification of the formerly reduced activity of T-suppressors (P less than 0.001), decrease in the number of B-lymphocytes in the peripheral blood and normalization of IgA concentration in blood serum. It is recommended to include Levamisol, together with anthelminthics, in complex opisthorchosis therapy so as to realize its immunoregulative effect because the antiparasitic therapy using Chloxil (anthelmithic), while showing good dehelminthizing results, failed to promote correction of immune disturbances observed during opisthorchis invasion and in opisthorchosis convalescents.     

Reversible meiotic abnormalities in azoospermic men with bilateral varicocele after microsurgical correction.

Because of a possible relationship between microenvironmental disturbances and meiotic abnormalities and of a straight relationship between lower-quality semen in patient carrying a varicocele and first meiotic non-disjunction, bilateral bipolar testicular biopsies are realized according the thermic differential gradient described in varicocele. Systematic meiotic studies of multiple testicular biopsies from 65 azoospermic men with bilateral varicocele were done in a multi-centric study on microsurgical correction of bilateral varicocele with microthermic intra-operative evaluation using minimally invasive thermal microsensors (Betatherm 10K3MCD2). In the present study abnormal temperature raising, histomorphometric abnormalities (spermatocyte arrest) and meiotic abnormalities (class IIC) are strongly correlated. In the ten patients submitted to another testicular biopsy procedure six months after surgery for TESE, normal thermal differential is registered and no meiotic abnormalities recurrences are found.     

Cryocrystalglobulinemia: pH-dependent precipitation of a monoclonal IgG-kappa-immunoglobulin

Cryoglobulinemia is seen in a minority of patients with plasma cell dyscrasias and can be of clinical relevance if intravascular gelling or precipitate formation occurs at low temperatures. We observed a patient suffering from IgG-kappa multiple myeloma which was complicated by instability of the immunoglobulin forming crystalline precipitates at low pH and low temperature. Short exposure to extreme cooling initiated an unusual course terminating in disseminated vascular occlusion and fatal outcome which was connected with an adverse effect of blood exchange. Crystal formation was noticed in anticoagulated blood samples even at 37 degrees C. In vitro studies showed a critical pH dependency of solubility of the immunoglobulin close to the physiological pH of the blood. These observations suggest that the fatal outcome was due to a vicious circle of ischemia, metabolic acidosis and intravascular precipitations, initiated not only by low acral temperatures but by cold-induced ischemic tissue acidosis as well. Serum of patients with monoclonal gammopathy and cryoglobulinemia should be tested for pH dependent immunoglobulin insolubility.     

Viscoelastic properties of whole blood. Influence of fast sedimenting red blood cell aggregates

Red blood cell (RBC) aggregation is known to be of deciding influence on erythrocyte sedimentation-rate (ESR) and on whole blood viscoelastic properties. The rheological behaviour of blood collected from a control-group with normal ESR is compared to the viscoelastic behaviour of blood collected from two groups with high to very high ESR, whose individuals are suffering from chronical polyarthritis and Morbus Bechterew, respectively. The rheological properties are evaluated by means of an oscillating-flow capillary-rheometer where the viscous (eta') and elastic (eta") component of the complex viscosity (eta) is measured at a constant frequency of 2 Hz. Correcting for the varying hematocrit of the different blood samples according to an exponential equation, the viscoelastic data are found to be elevated in the groups with high ESR. For the viscous properties this is only due to the increase of the plasma viscosity. A correction for the plasma viscosity, however, shows that the viscous properties at low shear- rates (2s-1) are significantly reduced, whereas elastic properties in a range of medium shear-rates (10s-1 to 50s-1) are significantly increased (P less than 0.001, t-test of Student). This result is discussed to be due to the high packing density of the RBC in fast sedimenting aggregates. High packing density reduces the effective volume of the RBC but increases the stiffness of the aggregates.     

Current management of adolescent varicocele

The finding of varicocele in an adolescent male is common. Varicocele rarely causes symptoms and is often diagnosed on the routine physical examination. There is clear association between varicocele and male factor infertility; however, there is debate about whether, when, and whom to treat when present in adult or adolescent males. This review of the epidemiology, etiology, pathophysiology, and treatment of the adolescent with varicocele will provide the reader with tools to make appropriate decisions in dealing with this condition.     

New methods of X-ray surgical diagnosis and treatment of varicocele in children and adolescents

The authors studied 520 patients with left-sided varicocele by left-sided phleborenotesticulography of Doppler ultrasonography, tensiometry of the left renotesticular venous system, blood gas composition, hormonal parameters, and etc. They present rationale for and evidence illustrations of aortomesenteric compression of the left renal vein, left-sided phleborenal hypertension prior to and after surgery for endovascular occlusion of the left testicular vein, before and following intervenous proximal testiculoiliac venous bypass surgery. The data of andrological dysfunction in patients with varicosis of the pampiniform plexus and spermatic cord (varicocele) are presented. An algorithm of examination and treatment of this cohort of patients, by using both miniinvasive techniques (for X-ray endovascular occlusion of the temporal veins under local anesthesia) and high tech operations using microsurgical techniques (testiculoiliac venous anastomosis), is outlined.     

Intravascular coagulation and fibrinolysis syndrome (ICF) in acute non-promyelocytic leukemia

Three cases of acute non-promyelocytic leukemia complicated with intravascular coagulation and fibrinolysis syndrome were described. The blood clotting system and fibrinolysis studies in all 3 cases revealed a significant increase of FDP level and shortening of fibrinolysis time as well as a decrease of fibrinogen content in 2 cases. In one patient the recovery from ICF syndrome and complete acute leukemia remission of 8 months duration was obtained. The further 2 cases failed to improve: in one of them the ICF syndrome appeared in relapse of acute myelocytic leukemia after 2 years of its duration and in the remaining one acute undifferentiated cell leukemia of fulminating course developed in the patient suffering from bone marrow aplasia.     

Low-dose heparin in the management of acute myelocytic leukaemia.

The effectiveness of heparin in acute leukaemia complicated by disseminated intravascular coagulation (DIC) is still controversial. In this regard low-dose heparin was found to be therapeutically effective in three patients suffering from acute myelocytic leukaemia and DIC. With respect to the contraindication of high-dose heparin in these conditions the low dose regimen appears to be a valuable alternative.     

Place de l’embolisation percutanée de la varicocèle dans le traitement de l’infertilité

Objectives

To describe percutaneous embolization of varicocele and to evaluate the effect on fertility disorders.

Materials and methods

One hundred nineteen patients, aged 11 to 48 years, underwent percutaneous embolization for varicocele indicated by a fertility disorder in 23% of cases. Correction of the varicocele and resolution of associated pain, improvement of testicular trophicity and the effect on fertility were studied and a review of the literature was performed.

Results

Percutaneous embolization was performed using neuroleptanalgesia on an outpatient basis. The technique combined venous sclerotherapy and placement of coils in the gonadal vein. The technique was successful in 95% of cases and one complication was observed. At 3 months, the varicocele and related pain had resolved in 98% of treated patients. According to previous reports in the literature, the relations between varicocele and fertility disorders are still unclear, but improvement of fertility (semen quality and conception rates) after varicocele repair has been established.

Conclusion

Although the consequences of varicocele on fertility have not been fully elucidated, treatment of varicocele appears to be beneficial. Percutaneous embolization of varicocele is a safe and effective alternative to surgery. This technique, based on a urological and radiological consensus, is the first-line treatment for varicocele in our institution.