Does extended lymphadenectomy increase the morbidity of radical cystectomy?

OBJECTIVE

To report the events during and after radical cystectomy and urinary diversion for bladder cancer, in terms of major and minor complications, comparing a minimal with an extended lymphadenectomy, as more lymph nodes obtained during radical cystectomy may improve staging and thus the outcome.

PATIENTS AND METHODS

We reviewed 92 consecutive patients who underwent radical cystectomy from March 1998 to February 2002; 46 had a minimal (group A) and 46 an extended lymphadenectomy (group B). Cases were selected according to the American Society of Anesthesiologists classification, only including those graded 2 or 3. We specifically evaluated the incidence and type of complications within 30 days after surgery.

RESULTS

Because of extending the lymphadenectomy the operative duration was a median of 63 min longer in group B (P < 0.01). Complications requiring surgical interventions occurred in four (9%) patients in group A and five (11%) in group B (P = 0.28). Complications requiring no surgical intervention were also similar in both groups. Three patients died, two in group A and one in group B (P = 0.57).

CONCLUSION

Extended lymphadenectomy in radical cystectomy does not increase the morbidity within 30 days of surgery.

Marshall Urist Award. Interstitial collagenase gene expression correlates with in vitro invasion in human chondrosarcoma

Matrix metalloproteinases contribute to the processes of local invasion and metastasis by providing cells with the ability to traverse tissue boundaries. The levels of gene expression were quantitated for matrix metalloproteinases-1 and tissue inhibitors of metalloproteinases-1 in human chondrosarcoma cell lines, and the results were correlated with cell differentiation, collagenase activity, and in vitro invasion. Three well characterized human cell lines were used in this study, with the level of chondrocytic differentiation confirmed to be JJ012, FS090, and 105KC in increasing order on the basis of aggrecan and collagen gene expression. The matrix metalloproteinases-1/tissue inhibitors of metalloproteinases-1 ratio correlated with the level of differentiation in an inverse fashion. Collagenase activity paralleled matrix metalloproteinases-1/tissue inhibitors of metalloproteinases-1 gene expression and was associated with a more invasive phenotype in an in vitro assay. In this report, matrix metalloproteinase-1 and tissue inhibitors of metalloproteinases-1 expression in human chondrosarcoma tumor cell lines were quantitated, and it was shown that interstitial collagenase gene expression correlates inversely with chondrocytic differentiation. Differences in collagenase activity and in vitro invasion correlate inversely with the level of differentiation. These findings are consistent with the hypothesis that collagenase activity is associated with a poorer prognosis in chondrosarcoma by facilitating cell egress from the tumor matrix.

Detection of chlamydial antigenic material in ovarian, prostatic, ectopic pregnancy and semen samples of culture-negative subjects

PROBLEM

The pathogenesis of long-term sequelae in Chlamydia trachomatis infection is poorly understood. While serology indicates previous chlamydial infection, culture studies are frequently negative. We wanted to know whether in chronic cases the bacterium is absent or persists in a dormant state where it evades detection.

METHODS OF STUDY

Using immunoperoxidase (IP) staining and in situ hybridization (ISH), we examined tissues of culture-negative subjects. Ovarian biopsy specimens from 19 culture-negative women with pelvic adhesions and/or tubal infertility were analyzed by both methods. Samples of prostates from 10 culture-negative men undergoing prostatectomy for benign hypertrophy, two sets of semen samples from culture-negative sexual partners of 28 women with PID and/or bacterial vaginosis (BV), and ten endometrium-tube sample-pairs from ectopic pregnancies (EPs) were examined by IP only.

RESULTS

Seven of the nineteen ovarian specimens tested positive for Chlamydia antigen or deoxyribonucleic acid (DNA) (36%). Of the 10 hypertrophic prostates examined, 4 (40%) were positive. Of the 28 semen samples examined, 10 (35%) tested positive. Tissue samples of 3 cases of EP were positive by IP.

CONCLUSIONS

1. C. trachomatis antigen and nucleic acid can be frequently demonstrated in asymptomatic, culture-negative men and women with chronic infection. 2. Chlamydia antigens may have an etiologic role in benign prostate hypertrophy and EP. 3. Antigenic material may be sexually transmissible. 4. IP and ISH identify temporarily inactive bacteria that may continue to act as immunostimulants and potentially reactivate as Chlamydia infection.

A novel model for the in vivo monitoring of uterine microcirculation and intracellular free calcium changes in rat

The aim of this work was to develop a model to study the microcirculation and relative levels of intracellular free calcium in the myometrium of pregnant rats. On Day 21 of gestation a lobe of uterus was prepared free, flipped over, and mounted in a superfusion chamber leaving the radix and thereby the innervation and circulation intact. RBC velocity and arteriolar diameters were determined by means of intravital video microscopy before and after stimulation (norepinephrine). To study intracellular free calcium changes, the fluorescent dye Indo-1 AM was added to the superfusate in the chamber. Fluorescence images were recorded and ratios of the images collected at 400 and 506 nm were calculated and changes thereof were assumed to represent intracellular free calcium changes. RBC velocity and arteriolar diameter did not change for at least 1 h, while the response to norepinephrine was similar at the beginning of the experiment and after 120 min. In four separate interventions, the uterus was challenged with 5 x 10(-4) IU/ml oxytocin, 4.5 mM calcium, 5 x 10(-4) IU/ml oxytocin with 4.5 mM calcium, and 5 microM ionomycin, resulting in an increase of the 400/506 nm ratio of 27, 31, 76, and 103%, respectively, representing a relative increase in intracellular free calcium. This novel in vivo model is suitable for monitoring intracellular free calcium changes and to record RBC velocities and blood vessel diameters in the myometrium of pregnant rats.

Cohesin's binding to chromosomes depends on a separate complex consisting of Scc2 and Scc4 proteins

Cohesion between sister chromatids depends on a multisubunit cohesin complex that binds to chromosomes around DNA replication and dissociates from them at the onset of anaphase. Scc2p, though not a cohesin subunit, is also required for sister chromatid cohesion. We show here that Scc2p forms a complex with a novel protein, Scc4p, which is also necessary for sister cohesion. In scc2 or scc4 mutants, cohesin complexes form normally but fail to bind both to centromeres and to chromosome arms. Our data suggest that a major role for the Scc2p/Scc4p complex is to facilitate the loading of cohesin complexes onto chromosomes.

Are there oxygen-deficient regions in resting skeletal muscle?

The purpose of this study was to determine whether there are local regions in resting skeletal muscle in which the oxygen delivery is insufficient to support oxidative metabolism. This hypothesis was tested by stopping the blood supply to the exteriorized cat sartorius muscle for 5 min while monitoring NADH fluorescence in localized tissue areas 15-25 microns in diameter. A rise in fluorescence was taken to indicate a shift to anaerobic metabolism. Tissue sites in the arteriolar and venular regions of the capillary network were selected for study. After flow stoppage, fluorescence did not change for an average of 48 +/- 22 (SD) s and then rose over a period of 61 +/- 27 s to an average value 55 +/- 19% above control for arteriolar and venular sites combined. Fluorescence began to rise within 5 s of flow stasis in only 1 of 61 sites and within 10 s in 2 sites. There was no difference in the time course or magnitude of fluorescence changes at arteriolar and venular sites. The data indicate that in resting skeletal muscle, oxygen supply appears sufficient to support oxidative metabolism in over 95% of the tissue.

The utility of a bilateral breast pumping system for mothers of premature infants

Mothers of premature infants have difficulty maintaining their milk supply as a result of the separation that occurs between the mother and the baby. The hypothesis in the present investigation is that use of a bilateral (simultaneous) breast pumping system will increase the volume of milk expressed in these mothers. Thirty-two breastfeeding mothers of premature infants were randomly assigned to either the control (single) or the experimental (bilateral) breast pump group. Mothers pumped at least four times a day. Data collection included a daily milk production log, weekly serum prolactin levels, and a weekly State-Trait Anxiety Inventory (STAI). Participation lasted from four to six weeks. Data analysis included average STAI scores; average prolactin levels; and weekly averages for number of pumping sessions, hours of pumping, and milk production in milliliters. The two groups did not differ on several demographic characteristics, STAI scores, prolactin levels, number of pumping sessions per week, or weekly milk production. The amount of time spent pumping, however, was statistically less for mothers who used the bilateral pump (7.6 +/- 3.0 hours/week) versus those who used the single pump (11.1 +/- 3.1 hours/week) (p = .003). Although use of either the single pump or the bilateral electric pump resulted in similar milk production, the bilateral pump significantly reduced the time invested in pumping. Health professionals should advocate use of the bilateral pump for mothers of premature infants. Additional studies are needed to determine strategies for increasing milk production in this population.

Protection of immunosuppressed mice against translocation of Pseudomonas aeruginosa from the gut by oral immunization with recombinant Pseudomonas aeruginosa outer membrane protein I expressing Salmonella dublin

AroA Salmonella dublin was used as recipient for a plasmid coding for the outer membrane protein I (OprI) of Pseudomonas aeruginosa. Oral immunization of Balb/c mice with recombinant S. dublin induced serum IgG and IgA antibodies against P. aeruginosa. In spleen and Peyer's patches anti-P. aeruginosa IgG- and IgA-secreting cells could be measured by the ELISPOT technique. In an oral challenge of immunosuppressed mice with P. aeruginosa the orally immunized animals had a 58-fold higher LD50 than control animals.

Sumatriptan injection is superior to placebo in the acute treatment of migraine--with regard to both efficacy and general well-being

The efficacy of subcutaneous injection of sumatriptan in the acute treatment of migraine was assessed in a double-blind, randomized, placebo-controlled cross-over study of 27 migraine patients. In addition, the patients were asked to give information about their well-being and subjective symptoms by means of a self-administered standardized questionnaire. A total of 22 migraine sufferers received a subcutaneous (sc) injection of 8 mg of sumatriptan and 24 received placebo. Of these patients, 19 received both treatments and thus completed the study. The primary efficacy end-point was a reduction in headache severity from severe or moderate to mild or no headache at 30, 60, 90 and 120 min. An effective response to treatment was achieved within 30 min in 63% and within 60 min in 84% of patients when treated with 8 mg sumatriptan sc, compared with 11% for placebo (p less than 0.001). Sumatriptan also provided significant relief from nausea and photophobia as compared with placebo. The proportion of patients that needed rescue medication after 120 min was significantly lower (p less than 0.001) with active treatment when compared with placebo. Sumatriptan was well tolerated and the majority of adverse events were mild and transient. The most frequent symptoms were those of malaise/fatigue or numbness. No changes in blood pressure or ECG readings were observed during the treatment. Compared with placebo, subcutaneous 8 mg sumatriptan also caused a substantial improvement in general well-being as revealed by the Minor Symptoms Evaluation Profile-acute (MSEP-acute) questionnaire.(ABSTRACT TRUNCATED AT 250 WORDS)

A multipurpose instrument for quantitative intravital microscopy

An in vivo microscope system has been developed that can measure fluorescence emission and/or light absorption at up to five wavelengths in a tissue area of 18-30 microns diam while imaging adjacent microcirculatory vessels with a video system. The system also incorporates a computer-controlled stage and data acquisition system for rapid and repeated measurements from a number of tissue sites. The tissue area monitored for fluorescence or absorption can be defined further by a confocal arrangement of the microscope optics. Tests of the system for NADH fluorescence measurements show good agreement between the fluorescence at 450 nm and NADH concentration in vitro and in skeletal muscle. The instrument can also be used simultaneously for spectrophotometric determination of O2 saturation and hematocrit in microcirculatory vessels. In vitro tests indicate suitable accuracy for such measurements. The open architecture and modular arrangement of the instrument facilitates its use for a variety of simultaneous measurements of parenchymal cell and microcirculatory function.

Pharmacokinetics of ceftriaxone in liver-transplant recipients

The disposition of ceftriaxone was studied after a single 2 g intravenous dose in seven patients 3 to 5 days after liver transplantation. Ceftriaxone concentrations in plasma, urine, and bile were measured by HPLC, and plasma protein binding was determined by equilibrium dialysis. Plasma protein binding was nonlinear, and the unbound fraction varied between 0.05 and 0.56. Both capacity and affinity were markedly different from reported values for normal subjects. The pharmacokinetic parameters obtained were: total body clearance (TBC), 11.2 +/- 7.8 mL/hr/kg total and 44.8 +/- 29.1 mL/hr/kg unbound; volume of distribution (V(area)), 224 +/- 76 mL/kg total and 767 +/- 432 mL/kg unbound; steady-state volume of distribution (Vss), 212 +/- 68 mL/kg total and 651 +/- 368 mL/kg unbound; terminal disposition half-life (t1/2), 21.6 +/- 14.3 hour total and 16.3 +/- 11.1 hour unbound. TBC for both total and free drug was considerably lower than literature values for normal subjects. V(area) for total drug was greater than normal, whereas the corresponding value for free drug was smaller than normal. The plasma ceftriaxone concentrations at 12 and 24 hours were above the reported minimum inhibitory concentration (MIC). The fraction of the administered dose excreted in urine over 24 hours was 38 +/- 29% and did not differ markedly from that reported for normal subjects. Less than 2% of the administered dose was excreted in 24-hour bile; however, biliary concentrations were always above MIC. Ceftriaxone can be administered once or twice daily at a dose of 2 g/day for prophylaxis in liver transplant recipients.

Effect of doxycycline on pre-menstrual syndrome: a double-blind randomized clinical trial

Thirty patients with well-defined symptoms of pre-menstrual syndrome were randomly treated with the antibiotic doxycycline or placebo. The antibiotic-treated group showed a highly significant reduction of symptoms. Subsequent antibiotic treatment of the original placebo group similarly diminished the symptoms in this group. A 6-month follow-up demonstrated that the improvement in symptom scores was permanent and independent from the presence of the antibiotic. Luteal phase endometrial biopsies showed a high incidence of out-of-phase endometrium. An unexpectedly high percentage of endometrial biopsy cultures yielded positive findings for mycoplasma, Chlamydia trachomatis and anaerobic bacteria. There were no characteristic hormonal changes in this study group. An infectious aetiology, possibly a sub-clinical endometrial or ovarian infection, behind certain cases of pre-menstrual syndrome is postulated.

Outcome of subsequent pregnancies following antibiotic therapy after primary or multiple spontaneous abortions

The course of the subsequent pregnancy and the maternal and fetal complications were evaluated in 254 couples who were seen in an infertility clinic after primary or multiple spontaneous abortions. The 100 couples who were treated with antibiotics after pregnancy loss showed a significantly better chance of achieving a subsequent pregnancy. The outcome of pregnancy was significantly better in the antibiotic treated group and the rate of spontaneous abortion recurrence was significantly lower (10 versus 38 per cent). The number of maternal complications was significantly less in the treated group--premature rupture of membranes, three (4 per cent) versus 30 (46 per cent), and postpartum fever, three (4 per cent) versus 23 (35 per cent), respectively. The untreated group experienced a significantly lower percentage of vaginal delivery (56 versus 69 per cent) (p less than 0.001). In the antibiotic treated group, there were significantly lower rates of fetal complications, including fetal distress, meconium, respiratory distress syndrome, neonatal infection and hyperbilirubinemia. The mean birth weight of infants in the antibiotic treated group was significantly higher (3,529 versus 3,090 grams; p less than 0.001). Prematurity and postdatism were significantly less frequent in the antibiotic treated group, and the corresponding Apgar scores were significantly better. We, thus, postulate that certain spontaneous abortions may be caused by bacteria present in the genital tract at the time of conception. These bacteria may have an adverse effect on the course of pregnancy and result in increased maternal and fetal complications.

Effect of antimicrobial agents on root surface caries, alveolar bone loss, and microflora in rice rats

Two antimicrobial agents, 9-aminoacridine (0.2%) and minocycline (0.2%), were evaluated for their efficacy in inhibiting root surface caries, bone loss, and microflora in rice rats. A solution of 5000 ppm fluoride was used as a positive control for the inhibition of root surface caries, and double-distilled water was used as a negative control group. Each rat was treated by having its molar teeth swabbed 2 X per day with the prescribed agent in its group for nine weeks. Root caries reduction in the minocycline and fluoride groups was not significantly different, but the reduction was significantly greater than in the 9-aminoacridine group, with the caries score in all three groups being significantly less than that in the water control. Bone loss reduction for the minocycline group was significantly greater than that for any other group.

The development of infections of the genitourinary tract in the wives of infertile males and the possible role of spermatozoa in the development of salpingitis

Genitourinary tract infections developing in wives during marital life in 1,350 infertile couples were examined. Women married to men with a history of genital tract infection had a significantly higher incidence of vaginitis, urinary tract infection, salpingitis and genital herpes when compared with women whose husbands did not have genital tract infections before the marriage. Of the variables examined, the two factors that showed the most significant association with the tendency to develop salpingitis were the sperm count and the length of time the couple had been trying to achieve a pregnancy. The wives of azoospermic males did not have pelvic inflammatory disease develop but had the same incidence of infection of the lower part of the genital tract as the other studied groups. It is suggested that the bacterial flora of the seminal fluid can play a role in developing salpingitis in the female and that spermatozoa may be involved in delivering bacteria to the higher genital tract structures.

Detection and characterization of immune complexes in the circulation of infertile women

The incidence of circulating immune complexes (CICs) was evaluated in sera from 39 female partners of infertile marriages and from 38 fertile women. Fifteen (38%) of the infertile women had CICs, as determined by the Raji cell assay, in levels ranging from 300 to 8000 micrograms/ml; whereas only 1 (3%) of the fertile women displayed CICs (P less than 0.001). Analysis of the CICs from nine of the women following polyethylene glycol precipitation and acid dissociation revealed that four contained C1q and three contained an antigen reactive with rabbit antibody to human spermatozoa. These latter three women all lacked free sperm antibody, as determined by enzyme-linked immunosorbent assay and agglutination. Thus, CICs are not uncommon as a manifestation of infertility in females. Their presence may lead to an underestimation of sperm antibody levels and may be indicative of underlying infection or autoimmunity.

The center of the umbilicus as the Veress needle's entry site for laparoscopy

Transumbilical laparoscopy was performed on 217 patients for diagnostic purposes. The center of the umbilicus was chosen as the entry site for both the Veress needle and the trocar. Two years of follow-up on 92 patients, including 29 who carried full-term pregnancies, did not reveal any damage to the umbilicus or any hernia formation. Beyond cosmetic advantages, the procedure proved to be easier for creating a pneumoperitoneum. No false passage or obstructive bleeding occurred during the procedures.

Long-term study of cloprednol in asthmatic patients

Cloprednol was used in 18 steroid-dependent patients with chronic reversible bronchial obstruction over a period of 2 years with respect to HPA-axis function and effect on their clinical status. Patients were treated with a single morning dose of 5-12.5 mg orally. 16 patients were maintained clinically satisfactorily with little change in their steroid status. It was concluded that cloprednol was a satisfactory oral steroid in this group of patients when given as a one-daily morning dose.

Relationship between genital tract infections, sperm antibodies in seminal fluid, and infertility

To explore possible relationships between genital tract infections, sperm antibodies, and infertility, seminal fluid from 100 men was analyzed. Sperm antibodies, measured by an enzyme-linked immunosorbent assay, were detected in 14 of 29 men (48%) with culture-positive asymptomatic infections, 8 of 17 men (47%) with a history of prostatitis or urethritis, 11 of 33 men (33%) with either a varicocele or an abnormal semen analysis, and only 1 of 21 men (5%) with no infection and a normal semen analysis. The incidence of sperm antibodies in the men with infections or urethritis or prostatitis was significantly higher than in the control subjects (P less than 0.005). The sperm antibody isotype in men with infections was mainly IgA, although IgG or IgM were also sometimes present. Of the men with asymptomatic infections, urethritis or prostatitis, significantly (P less than 0.025) more men without sperm antibodies (12 of 24, 50%) were fertile than were those with sperm antibodies (3 of 22, 13%). Men with genital tract infections have a high incidence of antibodies, reactive with spermatozoa, which is associated with reduced fertility.

Alternative causes of pelvic inflammatory disease

Seminal fluid from asymptomatic men reveals a wide variety of aerobic and anaerobic bacteria. The number of bacteria tends to correlate with the sexual experience of the individual. Experimental evidence has shown that these bacteria can attach themselves to moving spermatozoa and travel through ovulatory-phase cervical mucus. Exogenously added bacteria also exhibit the same potential. These experimental results suggest a rational explanation for the development of pelvic inflammatory disease in promiscuous women with multiple sexual partners. In addition, the findings help to explain the marked difference observed in the rate of pelvic inflammatory disease among patients using barrier-type birth control and oral contraceptives as compared with the rate among women who use intrauterine devices, with which the ovulatory-phase cervical mucus is unprotected.

Ureaplasma urealyticum and infertility: the effect of different antibiotic regimens on the semen quality

Objectives criteria of semen quality were evaluated in 243 men treated for Ureaplasma urealyticum genital tract infection with 1 of 4 different antibiotic regimens. Significant improvement was observed in motility, quantity, quality, and percentages of oval and small forms. Doxycycline, whether used for 2 or 4 weeks, at a dosage of 100 mg, twice daily resulted in the same cure rate (79 and 81 per cent, respectively). Tetracycline regimens of 500 mg. 3 times daily for 2 or 4 weeks had significantly inferior cure rates (17 and 55 per cent, respectively). These findings suggest that antibiotic therapy could be valuable in improving semen quality when Ureaplasma is isolated, and that followup culture for the organism should decide the endpoint in therapy, since resistant strains for doxycycline and tetracycline are emerging.

Further clinical experience with testis hypothermia for infertility due to poor semen

Chronic scrotal hypothermia to 25 patients with infertility and elevated testis temperature resulted in varying degrees of improvement over their pretreatment poor semen in 16/25. Pregnancy occurred in 6/25 "hard core" infertile couples (mean period of infertility 6.0 years) after wearing an evaporative scrotal cooling device for sixteen hours daily for a mean of 14.5 weeks. The offspring of such hypothermia-treated fathers appear to be normal. Varicocele, failed varicocelectomy, and "idiopathic infertility" are conditions suitable for such noninvasive hypothermic treatment. Discontinuance of hypothermia resulted in a return to pretreatment poor semen. Elevated temperature plays a role in poor semen.

Evidence for microbial transfer by spermatozoa

Ovulatory-phase cervical mucus columns demonstrate that microorganisms migrate in the cervical mucus with moving spermatozoa. Cultures obtained from the distal end of the mucus column after spermatozoal migration was complete yielded the same aerobic and anaerobic microbial isolates that were originally recovered from the seminal fluid. Exogenous aerobic bacteria added to the seminal fluid. Exogenous aerobic bacteria added to the seminal fluid also appeared at the top of the mucus column. After removal of the spermatozoa, no bacteria were observed migrating through the mucus. It is concluded that spermatozoa may provide a vehicle for bacteria present in the seminal fluid prior to ejaculation and for those already present in the cervix or vagina. The significance of this finding is discussed, and one mechanism for the development of salpingo-oophoritis in the female is proposed.

Use of oral metronidazole HCl (Flagyl) for posturethritis syndrome

Six men with nongonococcal urethritis (NGU) who remained symptomatic after specific therapy with different antibiotic regimens were empirically treated with either of two regimens of oral metronidazole: 500 mg., three times a day for ten days, or 2.5 Gm. (10 x 250 mg.) orally in one dose. All patients had pretreatment seminal fluid cultures. No significant pathogen could be isolated. Side effects included generalized weakness, gastrointestinal symptoms, and a characteristic metallic taste. All patients became asymptomatic after therapy. The single-dose therapy seemed to be more effective in persistent cases. Since metronidazole is active only against anaerobic bacteria, it is postulated that currently unidentified anaerobic bacteria may play a role in at least some cases of posturethritis syndrome.

Asymptomatic bacteriospermia in fertile and infertile men

Bacterial flora of the seminal fluid were examined in 430 asymptomatic men. Fertile men had significantly fewer positive cultures than any other group selected from the infertile population. Significantly more bacterial isolates were obtained from patients with a history of genital tract infection than from infertile men without a history of genital tract infection. Asymptomatic bacteriospermia was significantly more common among patients with a history of gonorrhea infection than in any other studied groups. Ureaplasma was isolated with the highest frequency from patients with nonspecific urethritis and/or with gonorrhea. It is proposed that follow-up seminal fluid cultures should be used to determine the end-point in treating male genital tract infections.

Chronic scrotal hypothermia as a treatment for poor semen quality

Six men with infertile marriages associated with poor semen and raised testicular temperature were treated by an experimental appliance which exploits evaporation to obtain normal testicular temperatures. This was worn with little discomfort for as long as 24 h a day and for periods as long as 20 weeks. Three wives became pregnant while their husbands were on treatment. Semen analysis at the time of the missed menses showed improvements in all three men. In two patients who did not achieve a pregnancy, semen improvements were also seen after 12 weeks. The improvements in semen quality cannot be attributed to any agency other than the hypothermia; this strengthens the theory that raised temperature plays a role in male infertility. Scrotal hypothermia seems to be a suitable treatment in men with varicocele, varicocelectomy failure, and idiopathic infertility where intrascrotal temperature is raised.

Asymptomatic bacteriospermia in infertile men

The aerobic and anaerobic flora of the semen was examined in 109 men visiting our infertility clinic. Not one specimen was sterile and 107 specimens contained two or more different bacterial species. Anaerobic organisms were found in 63.3% of specimens. We were able to isolate various organisms that have been shown to be spermicidal in vitro (viridans and hemolytic streptococci, Proteus vulgaris and Escherichia coli) from a large number of samples. If the presence of microorganisms in the semen is associated with infertility, it is likely that only certain organisms are involved or that the numbers of organisms must be high for an effect to be seen. The presence of organisms in the semen may also be related to gynecologic infections.

Site of bronchospasm in exercise-induced asthma

Bronchoconstriction induced by a bicycle ergometer reached a maximum at the 3rd and 6th minutes after exercise. The values of maximal expiratory flow measured at 25, 50 and 75% of forced vital capacity, peak expiratory flow and specific airways conductance, in cases of exercise-induced asthma, indicated that the obstruction of the large airways precedes and, in intensity, surpasses that of the small ones. Bronchial lability index was used for the comparison of the changes in the different parameters. Bronchoconstriction provoked by exercise is considered as a suitable model for the general study of the pathophysiology of bronchial asthma.

Ureaplasma urealyticum and human infertility: the effect of antibiotic therapy on semen quality

Semen characteristics were evaluated in 64 men visiting our infertility clinic before and after the eradication of genital infection with Ureaplasma urealyticum. Semen quality was also analyzed in 9 men who were unsuccessfully treated for genital Ureaplasma infection, 11 men who had negative cultures and received no treatment, and 11 men who had negative cultures but received empirical antibiotic therapy. A significant improvement in spermatozoal motility (both the speed of forward progession and the percentage of motile cells) was found in the group that was successfully treated for Ureaplasma infection. Improvements were not demonstrated in any of the other patient groups. A correlation was found between improved motility and a decrease in certain abnormal features of seminal cytology that appear to be associated with Ureaplasma genital infection.

Reversible toxic effect of salicylazosulfapyridine on semen quality

The semen qualities of six patients with salicylazosulfapyridine-treated chronic ulcerative colitis are discussed. Over-all poor parameters were observed during the treatment period. Reduced motility and a shift in morphology were the most significant abnormalities in the specimens. A characteristic megalo cell type occurred in the morphology with a frequency of 3% to 8%. In three patients when no medical contraindication existed, discontinuation of the drug resulted in a dramatic improvement in the semen quality, and all three reported pregnancies within the ensuing 3 months. A possible reversible toxic effect of salicylazosulfapyridine on semen quality is discussed.