Smoking withdrawal dynamics in unaided quitters

Considerable research shows that withdrawal severity is inconsistently related to smoking cessation outcomes. This may result from measurement problems or failure to scrutinize important dimensions of the withdrawal experience. Two recent studies demonstrated that withdrawal elevation and variations in the time course of withdrawal were related to relapse in smokers treated with the nicotine patch (T. M. Piasecki, M. C. Fiore, & T. B. Baker, 1998). This article reports a conceptual replication and extension of those findings in unaided quitters. Evidence for temporal heterogeneity was found across different types of withdrawal symptoms. Patterns or slopes of affect and urge reports over time predicted smoking status at follow-up, as did mean elevation in withdrawal symptoms. These results suggest that affect and urge withdrawal symptoms make independent contributions to relapse and that relapse is related to both symptom severity and trajectory.

Splenic smooth-muscle tumors in children with acquired immunodeficiency syndrome: report of two cases of this unusual location with evidence of an association with Epstein-Barr virus

Smooth-muscle neoplasms are rarely located in the spleen. They have been previously reported in five cases of children with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). Two cases of children with HIV infection/AIDS with autopsy and surgical pathology evidence of multiple smooth-muscle neoplasms with splenic involvement are presented. DNA was extracted from histology slides in both cases for analysis for Epstein Barr (EB) virus. In both cases, the presence of EB virus was confirmed. This paper documents two additional cases of the unusual phenomenon of splenic involvement by smooth-muscle neoplasms in the setting of AIDS in childhood and further supports the role of EB virus in the development of these neoplasms.

HIV infection and patterns of risk among women drug injectors and crack users in low and high sero-prevalence sites

As AIDS cases among US women continue to increase, a better understanding of women's behavioural risk patterns is needed to inform intervention efforts. Data were from 2,945 women drug injectors and crack users. Statistical analyses compared sociodemographic variables, lifetime behavioural risk patterns, HIV sero-prevalence and history of sexually transmitted diseases, and determined predictors of HIV infection separately in 16 low and four high sero-prevalence sites. Based on risk patterns, four behaviourally-defined sub-groups were constructed, and rates of HIV sero-prevalence were compared. In comparisons between low and high sero-prevalence sites, there were significant differences on most variables examined, and in the relative importance of the sociodemographic characteristics and risk patterns predicting HIV. Drug injection and sex exchange were each independent, significant, behavioural predictors of infection, with no significant difference between the odds ratios attributed to each predictor. HIV sero-prevalence was significantly different among four sub-groups. Interventions must be tailored to address observed differences among women in low and high sero-prevalence sites. Injection drug use and exchanging sex each play a major role in the transmission of HIV infection to US women. Prevention efforts targeted at women should address differences in behavioural risk patterns. Aggressive and innovative interventions are needed for women who exchange sex. AIDS research must investigate how socioeconomic factors impact women's risk for HIV infection.

Development and implementation of a decision support system for carotid artery stenosis: the Carotid Ultrasound Report Enhancement (CURE)

The management of carotid artery stenosis is an art evolving into a science, increasingly informed by clinical trials of medical management versus carotid endarterectomy (CEA). Ideas about optimal management depend on the confluence of patient-specific variables, surgical expertise, and the state of medical knowledge. In this complex and progressing setting, an up-to-date decision support system could help physicians apply the latest evidence to patient care. Carotid ultrasonography (US) studies provide an excellent opportunity to aid in the therapy of carotid stenosis. We developed a Carotid US Report Enhancement (CURE) to augment carotid US reports with treatment-specific prognostic information and patient-specific portions of the American Heart Association's 1998 guideline for the management of carotid artery stenosis. In the process of designing and implementing the CURE software, we encountered and eventually solved a variety of problems. The first problem was that US test was not always precise enough to distinguish between a moderate and mild carotid stenosis. Likewise, the standard US reports did not elucidate several technical problems that decreased the reliability of the US result. Third, although 17 of 18 physicians agreed to receive the CURE reports, they requested non-incriminating wording. Fourth, vascular surgeons supervising the US laboratories were reluctant to support the CURE report if they thought it would be construed as prompting self-referral. Finally, information about some comorbid conditions (e.g. a history of atrial fibrillation) could not be obtained reliably from the patients. The result of responding to these problems is a decision support program that is increasingly robust, able to detect many of its own limitations, and capable of integrating data from multiple sources. A randomized controlled trial now in progress will evaluate the clinical impact of the CURE program.

A Department of Social Work uses data to prove its case [corrected]

The introductions of managed care with its emphasis on cost containment has led a Department of Social Work Services at a large urban teaching center to better document and justify its roles. A concrete result was the saving of social work positions during budget cutbacks and downsizing. There is also information in these data to help clarify the differential roles of social workers and utilization review nurses in the hospital case management/discharge planning processes. The system came about because of concerns around cost containment, the need for more systematic discharge planning and the advent of the Prospective Payment System and Diagnosis Related Groups (DRG's) as a means of reimbursement to hospitals.

Cilioretinal artery occlusion during coronary catheterization

PURPOSE

To report on a patient with cilioretinal artery occlusion during cardiac catheterization.

METHODS

A 51-year-old man complained of blurred vision in the left eye immediately following cardiac catheterization. Visual acuity was 6/12 and the eye had a dense central scotoma.

RESULTS

Mild retinal whitening of the posterior pole and segmented filling of the cilio-retinal artery established the diagnosis of cilioretinal artery occlusion. Immediate paracentesis was performed. Two weeks later, a tiny central scotoma could be observed and visual acuity was 6/6.

CONCLUSIONS

Cardiac catheterization may result in retinal infarction. Awareness to any visual symptoms, immediate diagnosis and prompt intervention may prevent permanent visual impairment.

Efficacy of jejunogram after jejunostomy insertion

The era of managed care has spawned a national debate over the allocation of health care resources. We hypothesized that routine postjejunostomy jejunogram rarely provides additional clinical information or changes patient management and, therefore, is unwarranted. We retrospectively reviewed the charts of 128 consecutive patients undergoing feeding jejunostomy tube insertion between January 1995 and December 1996. All patients had postinsertion jejunograms. Eighty-five (66%) of the jejunograms were performed after operative insertion of the jejunostomy, and 43 (33%) were performed after percutaneous reinsertion of a previously placed jejunostomy. Data extracted from the charts include age, sex, indication for jejunogram, length of time prior jejunostomy was in place at time of reinsertion, and results of jejunogram. There were no patients (0%) with misplaced jejunostomy or extravasation of dye, as noted on jejunogram. There were no management changes implemented as a result of jejunogram readings (P < <0.05). The use of routine jejunogram after operative insertion or reinsertion of a prior jejunostomy that has become dislodged or occluded does not alter patient management, incurs unnecessary costs, and, therefore, is unwarranted.

Valacyclovir inhibits recovery of ocular HSV-1 after experimental reactivation by excimer laser keratectomy

PURPOSE

The goal of this was to determine whether the systemic administration of valacyclovir (Valtrex) would reduce ocular shedding of herpes simplex virus 1 (HSV-1) after excimer laser ablation in the New Zealand rabbit latency model.

METHODS

The in vitro 50% inhibitory concentration (IC50) of HSV-1 W strain was determined by using a plaque-reduction assay to verify its sensitivity to acyclovir. Forty-seven NZW rabbits latently infected with HSV-1 W strain were divided into four groups: I, 50 mg/kg/day valacyclovir; II, 100 mg/kg/day valacyclovir; III, 150 mg/kg/day valacyclovir; and IV, saline control. One half of the total dose of valacyclovir was delivered via intraperitoneal injections twice daily for 7 days beginning with one dose before excimer laser keratectomy. HSV-1 ocular shedding was determined from eye cultures for 7 days after treatment.

RESULTS

The IC50 for HSV-1 W was determined to be 2.9 microg/ml. The administration of both 100 mg/kg/day (group II) and 150 mg/kg/day (group III) of valacyclovir significantly reduced the number of eyes from which latent HSV-1 was recovered compared with the control group. There was no difference between the control group and group I (50 mg/kg/day valacyclovir). However, all three valacyclovir dosages significantly reduced the total number of HSV-1 shedding days compared with the control group, and 100% HSV-1 TG latency was demonstrated for all four groups.

CONCLUSION

Systemic administration of valacyclovir significantly reduced HSV-1 ocular shedding in a dose-dependent manner after excimer laser keratectomy in the NZW rabbit latency model.

Pulsatile ocular blood flow in diabetic retinopathy

PURPOSE

To assess circulatory properties of eyes with progressive stages of diabetic retinopathy.

METHODS

The intraocular pressure, pulse amplitude (PA) and pulsatile ocular blood flow (POBF) were measured with a pneumatonometer (OBF Labs UK Ltd). The eyes were grouped: (a) normal control, n = 26, (b) diabetes with no observable diabetic retinopathy (NDR), n = 18, (c) mild to moderate non-proliferative diabetic retinopathy (NPDR), n = 20, and (d) very severe pre-proliferative and proliferative diabetic retinopathy (PPDR/PDR), n = 12.

RESULTS

The PA and POBF values were lower than normal values in the earliest stage (NDR). The POBF increased but was still below normal levels at the NPDR stage, and then increased to an above normal level in the PPDR/PDR stage of diabetic retinopathy. The PA was at normal levels in these later two stages.

CONCLUSION

An initial decrease in pulsatile ocular blood flow is present with the onset of diabetes where no diabetic retinopathy has yet occurred. Subsequently, the pulsatile ocular blood flow increases with the severity of the retinopathy.

Retinal vein occlusion associated with methylenetetrahydrofolate reductase mutation

OBJECTIVE

To report on the occurrence of methylenetetrahydrofolate reductase (MTHFR) deficiency in patients with retinal vein occlusion (RVO).

DESIGN

Prospective case series

PARTICIPANTS

Fifty-nine consecutive patients with newly diagnosed RVO seen at the Retina Unit in the Tel Aviv Medical Center during 1997. METHODS/TESTING: Interviews and multiple blood analyses were done. Data were compared to the reported incidence of MTHFR deficiency in the Israeli population at large.

RESULTS

Twenty-six patients (44.1%) were heterozygotes and 11 (18.6%) were homozygotes for 677C-T mutation in MTHFR. The MTHFR 677C-T homozygosity was documented as being present in 10.4% of healthy individuals in the Israeli population. The difference in homozygosity was found to be statistically significant (P = 0.038).

CONCLUSIONS

Retinal vein occlusion may be associated with a mutation in MTHFR.

The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients

OBJECTIVE

The purpose of this study was to analyze the effects of head and neck radiation therapy on jaw opening and mobility.

STUDY DESIGN

Maximum jaw opening and mandibular mobility were measured before and after radiation treatment in 58 patients presenting for angle down wedge, homolateral wedge pair, and parallel pair head and neck radiation treatment.

RESULTS

As dose to the temporomandibular joint and pterygoid muscles increased, maximal jaw opening decreased linearly. Mandibular dysfunction appeared to increase as radiation dose to the pterygoid muscles increased. Similar effects were not observed with temporomandibular joint irradiation. Irradiation of the pterygoid muscles appeared critical in the development of trismus. Angle down wedge treatment irradiated the temporomandibular joint and pterygoid muscles with clinical effects similar to those seen in homolateral wedge pair and parallel pair patients. Doses as low as 1493 cGy resulted in functional impairment.

CONCLUSIONS

Future investigations into radiotherapy delivery and appropriate postradiation trismus treatment may reduce head and neck radiation morbidity.

Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles

PURPOSE

The left varicocele is usually larger in men with bilateral varicoceles. We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele. To test this hypothesis we prospectively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large (grade III) or moderate (II) left varicocele associated with small but palpable (I) right varicocele.

MATERIALS AND METHODS

A total of 91 patients were prospectively followed and included in the study. Of the patients 65 underwent bilateral and 26 underwent unilateral left repair. All patients underwent preoperative and postoperative semen analysis.

RESULTS

Motile sperm concentration increased from 12.1+/-1.7 to 23.7+/-31.8 (95.8% change) in the bilateral group compared with an increase from 19.5+/-21.4 to 27.8+/-34.8 (42.6% change) in the unilateral group (p<0.05). Similarly, sperm concentration increased from 23.8+/-29.5 to 48.6+/-61.3 (157.6% change) in the bilateral group compared with an increase from 41.1+/-40.9 to 59.5+/-66.7 (44.8% change) in the unilateral group (p<0.05).

CONCLUSIONS

Bilateral varicocelectomy resulted in significantly greater improvement in post-operative seminal parameters than unilateral repair in patients with grades II to III left varicocele associated with grade I right varicocele. Even a small, unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function. Men with bilateral palpable varicoceles require bilateral repair.

Comparison of absorbable and nonabsorbable sutures for microsurgical vasovasostomy in rats

OBJECTIVES

At least 12% of initially patent vasovasostomies (VVs) shut down. Currently, only nonabsorbable sutures are used for VV. A synthetic, slowly absorbing, monofilament polyglactin suture has been developed that retains tensile strength for up to 6 months. We performed a prospective controlled randomized study comparing absorbable and nonabsorbable sutures for rat VVs.

METHODS

Bilateral microsurgical VV was performed in three groups of 36 Wistar male rats, with 10-0 nylon, 10-0 polypropylene, and 10-0 polyglactin sutures. Twelve control rats underwent sham operations. Three rats in each group were killed at 2, 6, 12, and 24 weeks. The abdominal end of the vas deferens was transected and the intraluminal fluid examined microscopically for presence of sperm. The segment of the vas deferens containing the anastomosis was excised. Fluid from the testicular end was examined for sperm to confirm spermatogenesis. Patency was confirmed by an antegrade indigo carmine vasogram of the anastomotic segment. Segments were randomly sent for histologic or tensile strength evaluation.

RESULTS

The mean tensile strength of the anastomoses performed with nylon was slightly higher than in polypropylene and polyglactin sutures, although the difference was not statistically significant. Polyglactin consistently maintained tensile strength throughout 6 months without significant fluctuations. The mean patency rate in the polyglactin group was 96%, in nylon 81%, and in polypropylene 61%. Although polyglactin had a consistently higher patency rate compared with nonabsorbable sutures, the difference was not statistically significant (P = 0.11) but indicated a strong trend. The occurrence of microscopic sperm granuloma, muscle layer injuries, intimal fibrosis, and adventitial fibrosis of the vas deferens was not significantly different between suture types.

CONCLUSIONS

The three suture materials appear equivalent with respect to overall tensile strength of anastomosis; with histologic evaluation, the trend was toward better patency with polyglactin. Polyglactin 10-0 microsurgical suture is a viable alternative to nonabsorbable sutures in microsurgical VVs, although further studies are indicated to assess long-term results.

"The disappearing lens": failure of CT to image the lens in traumatic intumescent cataract

The CT scans of three patients whose eyes were lacerated by trauma failed to demonstrate the lens. A slit-lamp examination of those eyes clearly indicated that the lenses were present behind the iris but that they were swollen and opaque (intumescent cataract). Apparently, a shift of water into the injured lens had reduced the expected hyperdense CT image of the lens to a level that it was no longer discernible.

The effects of mesh bioprosthesis on the spermatic cord structures: a preliminary report in a canine model

PURPOSE

The use of mesh bioprosthesis during inguinal herniorrhaphy is now considered routine. To our knowledge, no studies have examined the effects of mesh induced fibrosis on the structure and function of the adjacent spermatic cord. We present our experience in a canine model.

MATERIALS AND METHODS

Unilateral inguinal hernia defects were created in 12 male beagle dogs. Half were repaired using Marlex mesh and half using a classic Shouldice technique. The inguinal anatomy was then re-examined at 6 and 12 months. Testicular temperature and volume, peripheral and testicular vein testosterone levels, testicular blood flow, vasography, testicular and cord histology, and sperm motility/morphology were recorded. Groups were compared with each other as well as to the non-operated (control) side.

RESULTS

Although post-operative testicular volumes from both the mesh and Shouldice groups were similar to controls (p >0.05), there was a downward trend after mesh repair (17.8 cc pre versus 12.6 cc post) but this did not reach statistical significance (p = 0.17). Testicular temperatures and blood flow did not differ between experimental groups and controls. While testicular vein testosterone levels were significantly higher than peripheral venous levels after Shouldice repair, this difference was lost after mesh repair. Contralateral (control) testicular vein testosterone levels were higher in animals repaired with mesh than by an anatomic Shouldice repair (p <0.05). There was a significant decrease in cross sectional vasal luminal diameter in both the anatomic and mesh repair groups versus their respective contralateral controls (p <0.05). This was correlated with a marked foreign body reaction to the mesh in the soft tissues surrounding the vas in spermatic cords exposed to Marlex. All vasograms demonstrated patency. Gross pathology was abnormal in 3/6 dogs with mesh repair (2 hydroceles and 1 ischemic testis) and 0/6 animals after Shouldice repair. A traumatic neuroma was identified in the mesh group. Sperm morphology and motility did not differ between the two groups.

CONCLUSIONS

Half of the testicles had gross abnormalities after mesh repair versus none in the control and Shouldice dogs. Although all vasograms were patent, vasal luminal size was significantly decreased with a marked soft tissue foreign body reaction identified after mesh repair. A traumatic neuroma was identified suggesting nerve entrapment in the fibrotic mesh reaction, which may account for post-operative pain seen in some patients. Marlex mesh may adversely affect spermatic cord structure and function and further work is required to fully elucidate its effects.

Antibacterial skin preparation decreases the incidence of false-positive semen culture results

PURPOSE

Antibacterial skin preparation was used before obtaining semen cultures to assess whether true seminal pathogens could be isolated with greater specificity.

MATERIALS AND METHODS

A total of 14 paired semen cultures were obtained from men evaluated for infertility. The first set (group 1) was obtained without preparation and the second set (group 2) was obtained after using an antibacterial skin preparation consisting of a shower followed by perineal, penile and hand wash with 4% chlorhexidine and 10% povidone-iodine. The sets were compared and statistical analysis was performed using the paired t test.

RESULTS

In group 1, 25 total bacterial isolates were detected compared to 13 in group 2, which was statistically significant (p <0.002). In group 1, 11 enteric organisms were isolated compared to 5 in group 2, which was also statistically significant (p <0.05). These data suggest that the source of most enteric organisms isolated from semen is genital and perineal skin.

CONCLUSIONS

A significant reduction in enteric contaminants, which would otherwise be erroneously treated, can be achieved with an effective antibacterial skin preparation. We were able to isolate true pathogens with greater specificity with (80%) than without (63%) an antibacterial skin preparation. An antibacterial skin preparation reduces false-positive cultures by at least 50%, which would lead to a significant reduction in costs and morbidity.

On the distribution patterns of D1, D2, tyrosine hydroxylase and dopamine transporter immunoreactivities in the ventral striatum of the rat

The distribution of dopamine D1 and D2 receptor immunoreactivities in the nucleus accumbens and the olfactory tubercle of adult and postnatal male rats were compared with the distribution of tyrosine hydroxylase and dopamine transporter immunoreactivities. An overall co-distribution of D1 and D2 receptor immunoreactivities with tyrosine hydroxylase immunoreactivity was found in the nucleus accumbens and the olfactory tubercle. However, the major finding in this study was, following a more detailed analysis in coronal sections of the shell part of the nucleus accumbens, the existence of nerve cell patches of strong D1 receptor immunoreactivity associated with low D2 receptor, dopamine transporter and tyrosine hydroxylase immunoreactivities. These patches were mainly surrounded by areas of strong D2 receptor, tyrosine hydroxylase and dopamine transporter immunoreactivities and could be found also in the olfactory tubercle. Similar observations were made in postnatal rats. Serial reconstructions of the patches of strong D1 receptor immunoreactivity in the rostrocaudal direction were made. The patches formed a continuous tubular nerve cell system in the shell part of the nucleus accumbens. Since this nerve cell system was found to be surrounded by a high density of dopamine terminals, it may represent a compartment where dopamine transmission mainly acts on D1 receptors via local diffusion (i.e. via volume transmission). However, it must be noted that the D1 receptor rich patches constitute only a small fraction of the nucleus accumbens and the overall density of tyrosine hydroxylase immunoreactive terminals correlates with the density of both D1 and D2 receptors in the nucleus accumbens. In conclusion, the present paper gives new aspects on the chemical microarchitecture of the nucleus accumbens.

Increased site-specific phosphorylation of tyrosine hydroxylase accompanies stimulation of enzymatic activity induced by cessation of dopamine neuronal activity

Activation of striatal dopamine (DA) neurons by neuroleptic treatment or by electrical stimulation of the nigrostriatal pathway increases the activity of tyrosine hydroxylase (TH). The increase is mediated by phosphorylation of the enzyme. However, abolition of DA neuronal activity [by gamma-butyrolactone (GBL) treatment or transection of the nigrostriatal pathway] also increases TH activity. Quantitative blot immunolabeling experiments using site- and phosphorylation state-specific antibodies to TH demonstrated that GBL treatment (750 mg/kg, 35 min) significantly increased phosphorylation at Ser19 (+40%) and Ser40 (+217%) without altering Ser31 phosphorylation. Concomitantly, GBL treatment [along with the 3,4-dihydroxyphenylalanine (dopa) decarboxylase inhibitor NSD-1015, 100 mg/kg, 30 min] increased in vivo striatal dopa accumulation and in vitro TH activity 3-fold. Likewise, cerebral hemitransection of the nigrostriatal pathway significantly increased phosphorylation of TH at Ser19 (+89%) and Ser40 (+158%) but not at Ser31; dopa levels were increased accordingly (+191%). Kinetic analysis of TH activity established that GBL treatment and hemitransection primarily decreased the Km for the cofactor tetrahydrobiopterin (3-fold). The effects of GBL and hemitransection were abolished or attenuated by pretreatment with the DA agonist R-(-)-N-n-propylnorapomorphine (NPA; 30 microgram/kg, 40 min), presumably via stimulation of inhibitory presynaptic DA autoreceptors. NPA dose-response curves for reversal of GBL-induced dopa accumulation and Ser40 phosphorylation were identical; however, only the highest dose of NPA reversed the small and variable increase in Ser19 phosphorylation. Thus, TH activity seems to be regulated by phosphorylation in both hyper- and hypoactive striatal DA neurons; in the latter case, activation seems to be caused by selective phosphorylation of Ser40.

Restoration of spermatogenesis after scrotal replacement of experimentally cryptorchid rat testis: assessment of germ cell apoptosis and eNOS expression

OBJECTIVES

Cryptorchidism has been shown to induce germ cell apoptosis. Nitric oxide (NO), a ubiquitous free radical produced by the nitric oxide synthases (NOSs), has been associated with apoptosis in a number of cell types. We examined the effect of experimental cryptorchidism and subsequent orchidopexy on germ cell apoptosis and endothelial NOS (eNOS) expression.

METHODS

Prepubertal rats were rendered unilaterally cryptorchid, and 14 days later, orchidopexy was performed on a subset of these rats. Forty days after the initial procedure, testes were harvested from experimental and sham-operated rats for immunohistochemical studies. Apoptosis was detected by in situ 3'-end-labeling of DNA with digoxigenin-ddUTP, and eNOS protein was detected using an eNOS monoclonal antibody.

RESULTS

Cryptorchid testes were characterized by diffuse hypospermatogenesis and had a 25-fold increase in apoptotic germ cells per cross-sectional area compared with sham-operated testes (P < 0.05). By contrast, the number of apoptotic germ cells per cross-sectional area in orchidopexied testes was not significantly different from that of sham-operated testes. In addition to its known expression in Leydig, Sertoli, and vascular endothelial cells, eNOS was detected in the cytoplasm of degenerating germ cells. Consecutive testis sections stained for eNOS and cellular DNA fragmentation demonstrated co-localization of eNOS protein and germ cell apoptosis.

CONCLUSIONS

In our experimental model, cryptorchidism induced germ cell apoptosis, and orchidopexy lowered the levels of germ cell apoptosis. Our data also support a role of eNOS in germ cell degeneration.

Effect of methylene blue, indigo carmine, and Renografin on human sperm motility

OBJECTIVES

To evaluate the effect of commonly used intraoperative vasography and tissue staining agents, indigo carmine, methylene blue, and Renografin, on sperm motility.

METHODS

Semen from 20 healthy men was obtained after 2 to 4 days of abstinence. Sperm motility was initially evaluated in each specimen. Standard solutions of indigo carmine, methylene blue, and Renografin-60 were diluted 2x and 4x with lactated Ringer's solution. Equal aliquots of sperm were mixed with undiluted and diluted drugs, and sperm motility was assessed.

RESULTS

Initial mean sperm motility was 70.3%+/-3.0%. Undiluted methylene blue and Renografin severely depressed sperm motility to 1.1%+/-0.5% and 2.3%+/-0.7%, respectively (P <0.05). Diluted methylene blue depressed motility to 4.9%+/-1.8% and 11.2%+/-3.0% (P < 0.05). Diluted Renografin depressed motility to 25.1%+/-4.1% and 55.3%+/-3.3% (P < 0.05). Although undiluted and 2x-diluted indigo carmine moderately decreased sperm motility (48.9%+/-3.2% and 61.7%+/-3.0%, P < 0.05), 4x-diluted indigo carmine had minimal effect on sperm motility (67.3%+/-2.8%, P > 0.05). Lactated Ringer's solution had no effect on sperm motility.

CONCLUSIONS

We found a severe, immediate reduction in sperm motility after exposure to undiluted standard solutions of methylene blue and Renografin. Dilution of Renografin significantly decreased its negative impact on the sperm motility, whereas the adverse effect of methylene blue remained fairly constant even with increasing dilution. Sperm motility should be assessed prior to application of these agents. Sperm should be aspirated for immediate use and/or cryopreservation prior to the use of these agents. Indigo carmine may be safely used as a tissue stain or vasography agent with a minimal effect on sperm motility in dilutions of 4x and higher.

Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia: testicular histology can predict success of sperm retrieval

PURPOSE

We present treatment results of testicular sperm extraction with intracytoplasmic sperm injection for men with nonobstructive azoospermia and reevaluate the role of testicular histology on open diagnostic testicular biopsy as a predictor of sperm retrieval success.

MATERIALS AND METHODS

We evaluated 75 men diagnosed with nonobstructive azoospermia. Cases were categorized into 3 groups of hypospermatogenesis, maturation arrest or Sertoli-cell-only based on the most advanced pattern of spermatogenesis seen on histology. A total of 81 testicular sperm extractions with intracytoplasmic sperm injection were performed for these 75 men. The main outcome measures reviewed included sperm retrieval, fertilization and pregnancy rates with intracytoplasmic sperm injection. Sperm retrieval success rates for men in the 3 histological categories were compared.

RESULTS

Spermatozoa were successfully retrieved during 47 of 81 (58%) testicular sperm extraction attempts, with subsequent fertilization of 268 of 439 (61%) injected metaphase II oocytes using intracytoplasmic sperm injection. Clinical pregnancies were obtained in 26 of 47 (55%) cycles when sperm were retrieved, with ongoing pregnancies or live deliveries for 20 of 47 (43%). Of 39 men with hypospermatogenesis on diagnostic biopsy 31 (79%) had successful sperm retrieval, compared to 9 of 19 (47%) with maturation arrest and 5 of 21 (24%) with a pure Sertolicell-only pattern.

CONCLUSIONS

Critical examination of the most advanced pattern of spermatogenesis from open diagnostic testis biopsy allows prediction of sperm retrieval success with testicular sperm extraction. In this study population spermatozoa were retrieved in 58% of attempts. When this testicular sperm was used with intracytoplasmic sperm injection, clinical pregnancy rate was 55% for men with nonobstructive azoospermia.

Effects of galanin on dopamine release in the central nervous system of normotensive and spontaneously hypertensive rats

Galanin is a 29-amino acid peptide and widely distributed in the brain, although its significance in the control of neural activities is undefined. In the present study, we describe the effects of galanin on the electrically evoked release of dopamine in the rat central nervous system. In addition, to elucidate a possible role of galanin in the regulation of dopaminergic transmission in hypertension, we examined whether the effect of galanin on dopamine release might be altered in the central nervous system of spontaneously hypertensive rats (SHR). Galanin (1 x 10(-8) to 1 x 10(-7) mol/L) inhibited the stimulation (1 Hz)-evoked [3H]dopamine release by a comparable amount in striatal slices of Sprague-Dawley rats, although the basal release of dopamine was not affected by the peptide. In the striatum of SHR, the electrical stimulation (1 Hz)-evoked [3H]dopamine release was significantly smaller than in the striatum of Wistar-Kyoto (WKY) rats. However, the inhibitory effect of galanin on the stimulation-evoked [3H]dopamine release was significantly more pronounced in SHR than in WKY rats. These results show that galanin significantly reduced the release of dopamine in rat striatum. Furthermore, the greater inhibitory effect of galanin on dopamine release in SHR suggests that galanin might actively participate in the regulation of dopaminergic nerve activity in hypertension.

The RET/PTC3 oncogene: metastatic solid-type papillary carcinomas in murine thyroids

Our research goal is to better understand the mechanisms controlling the initiation and progression of thyroid diseases. One such disease, papillary thyroid carcinoma (PTC), is the leading endocrine malignancy in the United States. Recently, a family of related fusion proteins, RET/PTC1-5, has been implicated in the early stages of PTC. Although all five members of this family have the c-RET proto-oncogene kinase domain in their COOH terminus, little is known about how these genes alter follicular cell biology. Consequently, to answer questions related to the mechanism of the RET/PTC fusion protein action, we have devised a molecular genetic strategy to study PTC using a mouse model of thyroid disease. A new member of this fusion oncogene family, RET/PTC3, which has been implicated in more cases of solid tumor carcinoma (79%) than PTC1 or PTC2 and predominates (80%) in radiation-induced thyroid cancer of children, was investigated in our study. We have generated transgenic mice expressing human RET/PTC3 exclusively in the thyroid. These mice develop thyroid hyperplasia, solid tumor variants of papillary carcinoma and metastatic cancer. This new transgenic line will be useful in deciphering the molecular and biological mechanisms that cause PTC and histological variations in humans.

Preoperative screening for genetic abnormalities in men with nonobstructive azoospermia before testicular sperm extraction

PURPOSE

Men with nonobstructive azoospermia may be treated with testicular sperm extraction and assisted reproduction. However, in men with severely impaired spermatogenesis genetic anomalies may be a cause of low sperm production. We present the results of genetic screening of men with nonobstructive azoospermia who are testicular sperm extraction candidates.

MATERIALS AND METHODS

Genetic evaluation was performed in a sequential series of 190 men with nonobstructive azoospermia who were candidates for testicular sperm extraction, including standard peripheral karyotypic analysis and detailed polymerase chain reaction based evaluation of the Y chromosome. All men found to harbor genetic defects were referred for genetic counseling.

RESULTS

Of the 190 patients 33 (17%) had genetic abnormalities. Of the 101 men who underwent karyotyping 21 (21%) had cytogenetic abnormalities, including 13 with Klinefelter's syndrome. Of the 183 men who underwent Y chromosome partial deletion analysis defects were detected in 17 (9%). Five men had karyotypic anomalies as well as evidence of partial Y chromosome deletions on polymerase chain reaction based analysis. Genetic counseling was done in 31 men with defects before testicular sperm extraction. Knowledge of the specific genetic defect resulted in a change of clinical management in 7 of the 33 couples (21%) in which the man had a genetic abnormality.

CONCLUSIONS

These results indicate that preoperative genetic screening is important in men with nonobstructive azoospermia who are candidates for testicular sperm extraction with intracytoplasmic sperm injection. Genetic testing provides men with reassuring etiological information regarding the infertile condition as well as a means to assess the risk of passing infertility traits to male offspring. It allows specific preimplantation genetic testing of embryos during assisted reproduction to minimize the risk of transmitting genetic defects to offspring.

The diagnostic interview schedule for deaf patients on interactive video: a preliminary investigation

OBJECTIVE

The authors investigated the feasibility of translating the National Institute of Mental Health Quick Diagnostic Interview Schedule-III, Revised, computer version, for deaf individuals.

METHOD

The study involved translation of selected scales into American Sign Language, Signed English, and speech reading; review by an advisory panel and back translator; and collection and analysis of deaf individuals' reactions to translations.

RESULTS

Focus groups responded favorably, translation problems were revealed, and solutions were suggested.

CONCLUSIONS

The findings support the feasibility of translation of the Quick Diagnostic Interview Schedule-III, Revised, into American Sign Language, Signed English, and speech reading for deaf patients.

Captopril inhibits both dopaminergic and cholinergic neurotransmission in the central nervous system

1. The present study was performed to investigate the effects of captopril on both dopaminergic and cholinergic neurotransmission in the rat central nervous system. 2. Slices of rat striatum were prepared and prelabelled with [3H]-dopamine or [3H]-choline. Slices were continuously superfused with Krebs'-Ringer solution and electrical stimulation (1 Hz) was performed. 3. Captopril significantly inhibited stimulation-evoked [3H]-dopamine release from rat striatal slices in a concentration-dependent manner (S2/S1 ratios: control 0.835 +/- 0.018 (n = 6); 1 x 10(-5) mol/L captopril 0.597 +/- 0.035 (n = 6; P < 0.05); 5 x 10(-5) mol/L captopril 0.561 +/- 0.041 (n = 6; P < 0.05)). However, the basal release of [3H]-dopamine was not affected by captopril. 4. Captopril also reduced stimulation-evoked [3H]-acetylcholine release in the striatum (S2/S1 ratios: control 0.891 +/- 0.016 (n = 6); 1 x 10(-5) mol/L captopril 0.794 +/- 0.011 (n = 6; P < 0.05)). 5. These results show that captopril inhibits the release of both dopamine and acetylcholine in the rat striatum. Although the mechanisms underlying the neurosuppressive effects of captopril remain to be determined, the findings suggest that the inhibition of dopaminergic and cholinergic neurotransmission may be related to the central action of the angiotensin-converting enzyme inhibitor.

Characteristics of patients adhering to a hospital's no-smoking policy

OBJECTIVES

The purpose of this paper is to examine the characteristics of smokers who adhere to a hospital smoking ban, compared to those who do not.

DESIGN

The data presented in this paper are baseline and discharge survey data collected among hospitalized smokers.

SETTING

This study was conducted in two teaching hospitals in a northeastern city.

PATIENTS/PARTICIPANTS

The subjects were 358 smokers who participated in a larger smoking intervention trial.

MAIN RESULTS

Seventy-six percent of the subjects reported adhering to the smoke-free policy during their hospital stay. In a multivariate model, demographic factors that predicted adherence included being older, having shorter length of stay, not reporting recreational drug use in the previous 12 months, and not having alcohol-related problems. Smoking history variables that predicted adherence included having had at least 24 h of abstinence in the 7 days prior to hospitalization; self-efficacy variables (e.g., confidence in ability to quit smoking in 1 month and less anticipated difficulty refraining from smoking during hospitalization) also predicted adherence.

CONCLUSIONS

Understanding the factors that predict adherence to health care policies can provide useful information for health promotion interventions in a medical setting. The implications of these findings are discussed.

Capsular bag distension associated with sulcus implantation of intraocular lenses

Capsular bag distension syndrome after endophacoemulsification and in-the-bag intraocular lens (IOL) implantation has been reported. We describe 2 cases in which sulcus implantation of a posterior chamber IOL caused marked capsular bag distension. Both cases resolved with conservative treatment or a neodymium:YAG posterior capsulotomy.

Role of serine-19 phosphorylation in regulating tyrosine hydroxylase studied with site- and phosphospecific antibodies and site-directed mutagenesis

The effects of depolarization by elevated potassium concentrations were studied in PC12 cells and in stably transfected AtT-20 cells expressing wild-type or [Leu19]-recombinant tyrosine hydroxylase (rTH). Changes in the phosphorylation states of Ser19 and Ser40 in tyrosine hydroxylase (TH) were determined immunochemically using antibodies specific for the phosphorylated state of each site and compared with changes in TH activity in PC12 cell lysates and with changes in L-DOPA biosynthesis rates in intact AtT-20 cells. Treatment of either PC12 cells or AtT-20 cells expressing wild-type rTH with elevated potassium produced a transient increase in the phosphorylation state of Ser19 (up to 0.7 mol of phosphate/mol of subunit) in concert with a more gradual and sustained increase in Ser40 phosphorylation. Elevated potassium treatment also increased TH activity in PC12 cell lysates, but these increases paralleled the temporal course of Ser40, as opposed to Ser19, phosphorylation. Similarly, increases in DOPA accumulation produced by elevated potassium in AtT-20 cells expressing wild-type rTH paralleled the increases in the phosphorylation state of Ser40 but not Ser19. Moreover, elevated potassium produced comparable increases in DOPA accumulation in AtT-20 cells expressing rTH in which Ser19 phosphorylation had been eliminated (by substitution of Leu for Ser19). Thus, depolarization-induced increases in the stoichiometry of Ser19 phosphorylation do not appear to influence directly the activity of TH in situ.

Benign fat necrosis simulating bilateral breast malignancy after reduction mammoplasty

Fat necrosis follows many forms of trauma to the breast, including surgery. In unusual cases, it may be extensive enough to present as a palpable mass on physical examination with mammographic features suggestive of cancer. In these instances, regardless of patient age, surgical history, or multifocality, a biopsy must be done to exclude carcinoma. We describe a young woman who was evaluated for bilateral breast masses with highly suspicious imaging characteristics 2 years after having reduction mammoplasty.

Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia

OBJECTIVE

To characterize treatment outcome after varicocele repair in men with azoospermia and severe oligoasthenospermia.

DESIGN

Prospective nonrandomized study.

SETTING

University-based medical center.

PATIENT(S)

Seventy-eight men with a palpable varicocele and absolute azoospermia (n = 22) or severe oligoasthenospermia (n = 56).

INTERVENTION(S)

Microsurgical varicocelectomy.

MAIN OUTCOME MEASURE(S)

Sperm count and pregnancy rate.

RESULT(S)

Twelve (55%) of the 22 men with azoospermia and 35 (69%) of the 51 men with zero motile sperm before surgery had motile sperm observed in their ejaculate after varicocele repair. The total number of motile sperm per ejaculate increased from 0.08 +/- 0.02 x 10(6) before varicocelectomy to 7.2 +/- 2.3 x 10(6) afterward. Twenty-four men (31%) contributed to pregnancies leading to live births (15 unassisted [19%]), including 3 men with azoospermia preoperatively.

CONCLUSION(S)

Varicocele repair resulted in the induction or enhancement of spermatogenesis for most men with azoospermia or severe oligoasthenospermia. Unassisted pregnancies after varicocele repair in men with profound abnormalities of spermatogenesis are possible. Varicocele repair should be considered for all men with azoospermia and severe oligoasthenospermia.

Microsurgical repair of the adolescent varicocele

PURPOSE

Since clinically apparent varicoceles may affect testicular volume and sperm production, early repair has been advocated. However, repair of the pediatric varicocele with conventional nonmagnified techniques may result in persistence of the varicocele after up to 16% of these procedures. Also testicular artery injury and postoperative hydrocele formation can occur after nonmagnified repair. The microsurgical technique has been successfully completed in a large series of adults with a dramatic reduction in complication and recurrence rates. We report our experience with the microsurgical technique in boys.

MATERIALS AND METHODS

A total of 30 boys (average age 15.9 years) underwent 42 microsurgical varicocelectomies (12 bilateral). All patients had a large left varicocele. Indications for repair included testicular atrophy (size difference between testicles of greater than 2 ml.) in 20 boys, pain in 5 and a large varicocele without pain or testicular atrophy in 5. Six boys were referred following failure of conventional nonmicrosurgical techniques. All boys were examined no sooner than 1 month postoperatively (mean followup 12).

RESULTS

Preoperative volume of the affected testis averaged 13.0 ml., and an average size discrepancy between testicles of 2.8 ml. was noted before unilateral varicocelectomy. No cases of persistent or recurrent varicoceles were detected, and 1 postoperative hydrocele resolved spontaneously. After unilateral varicocelectomy the treated testes grew an average of 50.1%, while the contralateral testes grew only 23%. Overall, 89% of patients with testicular atrophy demonstrated reversal of testicular growth retardation after unilateral varicocelectomy. In contrast, both testes showed similar growth rates after bilateral varicocelectomy (45% left testis, 39% right testis).

CONCLUSIONS

The meticulous dissection necessary to preserve arterial and lymphatic supply, and to ligate all spermatic veins in the pediatric patient is readily accomplished using a microsurgical approach, and results in low recurrence and complication rates. Rapid catch-up growth of the affected testis after microsurgical varicocelectomy suggests that intervention during adolescence is effective and warranted.

Germ cell apoptosis and endothelial nitric oxide synthase (eNOS) expression following ischemia-reperfusion injury to testis

There is evidence to suggest that reactive oxygen species (ROS) are involved in ischemia-reperfusion injury to the testis. Nitric oxide (NO), a ubiquitous free radical produced by the nitric oxide synthases (NOS), has been implicated in physiologic and pathologic interactions with ROS. We examined the effect of testicular ischemia on germ cell apoptosis and endothelial NOS (eNOS) expression. Adult rats were subjected to unilateral 720 degrees testicular torsion for 1 or 3 hours and 24 hours later, testes were harvested for immunohistochemical studies. Apoptosis was detected by in situ 3' end-labeling of DNA with digoxigenin-ddUTP and eNOS protein was detected using an eNOS monoclonal antibody. Tests subjected to 3 hours of torsion had a threefold increase in apoptotic germ cells per cross-sectional area compared to sham testes (P < .05). In addition to its known expression in Leydig, Sertoli, and vascular endothelial cells, eNOS was detected in the cytoplasm of degenerating germ cells. Consecutive testis sections stained for eNOS and cellular DNA fragmentation demonstrated co-localization of eNOS protein and germ cell apoptosis. The detection of strong immunostaining in apoptotic germ cells supports a role of eNOS in germ cell degeneration after testicular ischemia-reperfusion and suggests that NO is associated with germ cell apoptosis.

Urban crack users: gender differences in drug use, HIV risk and health status

This study assessed gender differences in drug use, HIV risk, and health status in a sample of urban crack users. Using targeted sampling, 1434 crack users (66% male and primarily African-American and Puerto Rican), were recruited from the streets of East Harlem, New York City. A standardized, structured interview was administered, drug use was validated by urinalysis, and HIV testing was offered. Gender differences were observed on sociodemographic variables and patterns of drug use. Other than welfare, men and women cited different major sources of income. Women reported greater use of crack, and men were more likely to use injection drugs as well as crack. Data on sexual risk indicated that women had more sexual partners than men, but the percentage of unprotected vaginal sex for both men and women was greater for those who did not exchange sex for drugs and/or money. The number of persons already infected with HIV was substantial. Many reported histories of other sexually transmitted diseases which were generally higher among men. Future research should investigate the relationship between gender and other factors (e.g., ethnicity, geographic location) associated with HIV risk.

The acid-fast stain is a superior stain for use in the mean mature spermatid count for testicular biopsies

The mean mature spermatid count (MMSC) provides a useful, simplified quantitative evaluation of human spermatogenesis that is based on the number of mature spermatids in histological sections of testicular biopsies. Here, the activity of the acid-fast (AF) stain was compared to that of the usual hematoxylin and eosin (H&E) stain in performing the MMSC. Thirty bilateral testicular biopsies showing normal spermatogenesis were chosen retrospectively from 15 subfertile patients with obstructive azoospermia or severe oligospermia. The MMSC was determined on each biopsy by utilizing both H&E and AF stains. The AF stain proved to be specific for the mature spermatids normally counted for the MMSC. It simplified recognition of mature spermatids, thereby shortening the overall time required for the procedure. The mean AF MMSC was lower than the mean H&E MMSC, and the mean interobserver differences were decreased. The AF stain is a superior stain for the MMSC when used in conjunction with the H&E stain for descriptive histology.

Morphometric and electron-microscopic analyses of the effects of gonadotropin-releasing hormone agonists on uterine leiomyomas

OBJECTIVE

Reports on the histologic effects of gonadotropin-releasing hormone agonists on uterine leiomyomas provide conflicting results. Most previous studies used qualitative methods of analysis. Using quantitative and semiquantitative stereologic methods of analysis, we assessed volume density of hyalinized areas, cell density, nuclear volume, and cytoplasmic cross-sectional areas of smooth muscle cells in histologic sections and also measured diameters of collagen fibrils in electron micrographs of uterine leiomyomas.

DESIGN

Thirty leiomyomas from patients treated with gonadotropin-releasing hormone agonists (10 different patient samples), age-matched control patients (10 different patient samples), and postmenopausal women (10 different patient samples) were used. Hyalinization was assessed using a microscope with a projection head and affixed morphometric grid. Cell size and density were evaluated using a video-based, computerized system attached to the microscope, for which morphometric ad hoc programs were written. Diameters of collagen fibrils were measured from electron micrographs.

SETTING

The study was conducted in the Department of Pathology, Mount Sinai Medical Center, New York, NY.

PATIENTS

A total of 30 patient samples were studied, with three groups comprising 10 samples each, including patients treated with gonadotropin-releasing hormone agonists, age-matched control patients, and postmenopausal women.

RESULTS

Myomas from patients treated with gonadotropin-releasing hormone agonists exhibited more hyalinization, greater cell density, slightly smaller cell sizes, and larger collagen fibrils than those of age-matched control patients and postmenopausal women.

CONCLUSIONS

Shrinkage after treatment with gonadotropin-releasing hormone agonists is attributed to smaller cell size and increased collagenization in myomas.

Indications for corticosteroids prior to epididymal sperm retrieval

OBJECTIVE

To evaluate the effectiveness of low-dose intermittent prednisone treatment designed to reduce antisperm antibodies for men prior to epididymal sperm retrieval and in vitro fertilization.

STUDY DESIGN

This was a retrospective review of 75 subfertile men with reproductive obstruction due to congenital absence of the vas deferens, or other reproductive tract obstruction, who underwent a total of 98 episodes of microsurgical epididymal sperm aspiration (MESA) with in vitro fertilization.

RESULTS

For couples in whom the man was pretreated with prednisone, better fertilization rates (39% vs. 21%, P < .0001) and pregnancy rates (48% vs. 26%, p = 0.06) were obtained than in couples in whom the man was not pretreated. The benefit of prednisone treatment was most noticeable for men with preoperatively detectable antisperm antibodies. Prednisone-treated men with preoperative antisperm antibodies showed improved fertilization rates (40% vs. 9%, p = 0.005). Men without antibodies who were treated with prednisone showed a decrement in fertilization rate, from 73% to 24% (fertilizations per oocyte, P < .0005). Success of prednisone treatment could not be correlated with specific assisted-reproduction technique (IVF, PZD, SuZI, or ICSI).

CONCLUSIONS

Preoperative evaluation of antisperm antibody status and treatment of antibody-positive men prior to epididymal sperm retrieval may play a role in improvement of the fertilization and pregnancy results achieved by centers that provide MESA with assisted reproduction. These results are most important when MESA is performed without the assistance of intracytoplasmic sperm injection. Empiric treatment with prednisone may be detrimental to the fertility of men who have no antisperm antibodies.

In vivo quantification of glucose uptake and conversion to glycogen in individual muscles of the rat following exercise

Glycogen depletion is thought to be a potent stimulus for the substantially increased glucose fluxes observed in skeletal muscle following exercise. The aim of this study was to establish the relationships between the glycogen mass and the rates of glucose uptake (Rg') and glucose incorporation into glycogen (Rgly) in individual muscles of conscious adult Wistar rats following moderate nonexhausting treadmill exercise (15 m/min at a 10 degree slope for 45 minutes, approximately 65% VO2max). Muscle glycogen content was determined at 0, 20, 45, 90, or 135 minutes following exercise and compared with Rg' and Rgly measurements at matched times. Muscle types varied in the rate of glycogen resynthesis. Glycogen depots of glycolytic muscle (white gastrocnemius) were still significantly (P < .01) lower than preexercise levels after 135 minutes; red oxidative muscles (soleus and red gastrocnemius) were essentially repleted by 90 minutes. Immediately following exercise, Rg' and Rgly in red gastrocnemius and soleus were 42 +/- 4 and 42 +/- 5 and 36 +/- 2 and 33 +/- 7 micromol/(min . 100 g), greater than the rates induced by maximal insulin stimulation in previous studies. In red muscles, there was a strong inverse relationship between Rgly and tissue glycogen content, consistent with a dominant role for the glycogen mass in the regulation of glycogen resynthesis.

Immunohistochemical studies on phosphorylation of tyrosine hydroxylase in central catecholamine neurons using site- and phosphorylation state-specific antibodies

Antibodies raised to phosphorylated forms of tyrosine hydroxylase, the first and rate-limiting enzyme in the catecholamine biosynthesis, were applied in immunohistochemical studies on rat brain slices incubated in vitro with a phosphodiesterase inhibitor (3-isobutyl-1-methylxanthine, IBMX) and on forskolin on formalin-perfused rat brains. Four antisera/antibodies were used: polyclonal rabbit antisera to (i) tyrosine hydroxylase phosphorylated at serine 40 (THS40p antiserum), (ii) tyrosine hydroxylase phosphorylated at serine 19 (THS19p antiserum), (iii) the native enzyme (pan-tyrosine hydroxylase antiserum), and mouse monoclonal antibody to (iv) native tyrosine hydroxylase. In the in vitro studies THS40p-like immunoreactivity was not observed unless slices were treated with IBMX-forskolin after which a dense fibre network was found in the striatum, and immunoreactive cell bodies were found in the ventral mesencephalon, especially in the ventral tegmental area. Although these cells were pan-tyrosine hydroxylase-positive, several of them were not stained with the tyrosine hydroxylase-monoclonal antibody. Moreover, there was a marked reduction of tyrosine hydroxylase-monoclonal antibody-immunoreactive fibres in drug-treated slices, suggesting that this tyrosine hydroxylase-monoclonal antibody does not recognize the serine 40-phosphorylated form of tyrosine hydroxylase. Treated slices did not show any THS40p-immunoreactive cell bodies in the dopaminergic A11 cell group and only a few, weakly fluorescent neurons were observed in locus coeruleus. However, a sparse fibre plexus was observed in locus coeruleus, possibly reflecting epinephrine fibres. In the perfused brains THS40p-like immunoreactivity could be visualized in some dopamine neurons in the ventral mesencephalon, especially the A10 area, and in noradrenergic locus coeruleus neurons, whereas THS19p-like immunoreactivity was found in all catecholamine groups studied, similar to the results obtained with the pan-tyrosine hydroxylase antiserum and the tyrosine hydroxylase-monoclonal antibody. In forebrain areas known to be innervated by mesencephalic dopamine neurons, no THS40p-positive fibres were observed, whereas THS19p-immunoreactive fibres were found in subregions of the striatum, olfactory tubercle and nucleus accumbens, essentially overlapping with dopamine fibres previously shown to contain cholecystokinin-like immunoreactivity. The present results suggests that antibodies directed against phosphorylated forms of tyrosine hydroxylase can be used to evaluate the state of tyrosine hydroxylase phosphorylation in individual neuronal cell bodies and processes both in vitro and in vivo.

Microsurgical vasovasostomy: the microdot technique of precision suture placement

PURPOSE

A technique of vasovasostomy that facilitates precision suture placement is presented.

MATERIALS AND METHODS

The technique involves mapping of the planned suture exit points with "microdots" placed on the cut ends of the vas deferens with a microtip marking pen. Microdots are placed at 12, 3, 6 and 9 o'clock positions. Four additional dots are placed between each of the previous 4 dots. Exactly 8 mucosal sutures (double armed 10-zero monofilament sutures) are used for each anastomosis. The anastomosis is completed with 8 muscularis sutures (9-zero monofilament) and 6 to 8 sutures (6-zero monofilament) approximating the vasal sheath.

RESULTS

In a series of 194 consecutive vasovasostomy procedures using this technique a patency rate of 99.5% was achieved. Pregnancy rates of 54% (crude) and 64% (excluding female factor infertility) were observed for the first 100 subjects of this cohort.

CONCLUSIONS

The microdot technique ensures precision suture placement and facilitates the anastomosis of lumens of discrepant diameters by exact mapping of each planned suture. The microdot method separates the planning from the placement. Patency rates using the microdot technique approach 100%.

Microsurgical repair of iatrogenic injury to the vas deferens

PURPOSE

We determined the incidence of iatrogenic injuries to the vas deferens at a tertiary care university infertility center and the results of surgical repair.

MATERIALS AND METHODS

Records of 472 patients surgically explored for obstructive azoospermia between 1984 to 1996 were reviewed. Enrollment criteria included history of inguinal, pelvic and scrotal (other than vasectomy) surgery. Conventional ipsilateral and crossover vasovasostomies and vasoepididymostomies were performed. Patency rate was defined as presence of complete sperm with tails in a postoperative semen analysis. Followup included a minimum of 2 semen analyses. Only naturally conceived pregnancies were included.

RESULTS

Of 472 patients 34 (7.2%) had an iatrogenic injury to the vas deferens with a mean obstruction interval of 20.5 +/- 1.9 years. Mean patient age was 36.7 +/- 1.8 years. Iatrogenic injury to the vas deferens was secondary to bilateral inguinal hernia repair in 19 patients, unilateral hernia repair in 11, renal transplantation in 2, appendectomy in 1 and spermatocelectomy in 1. Pediatric inguinal hernia repair was the most common etiology of the vasal injury (20 patients), followed by adult inguinal hernia repair (10). A total of 36 microsurgical reconstructive procedures were performed, including 20 ipsilateral and 16 crossed vasovasostomies and vasoepididymostomies. There were 26 patients (29 procedures) available for followup (mean 21.0 +/- 3.7 months). Total patency rate per procedure was 65% and pregnancy rate was 39%. Patency and pregnancy rates per conventional ipsilateral procedures were 62.5 and 35.7% and per crossover procedures 64.2 and 42.8%, respectively.

CONCLUSIONS

Pediatric inguinal hernia repair is the most common cause of iatrogenic injury to the vas deferens. Results of treatment of iatrogenic injury to the vas deferens are somewhat lower than for patients with obstructive azoospermia due to vasectomy. Iatrogenic injuries are associated with longer vasal defects, impaired blood supply and longer obstructive intervals frequently resulting in secondary epididymal obstruction. Crossover reconstruction is particularly useful when contralateral testicular atrophy is present. Intraoperatively aspirated sperm should be cryopreserved for later use in case the reconstruction fails.

A specimen positioning device for dental radiographic identification--image geometry considerations

Preventative dental treatment has reduced caries incidence and thereby rendered dental identification, in caries-free individuals, more difficult. An alternate method comparing spatial relationships of dental structures in digitized superimposed antemortem and postmortem radiographs has been previously developed. This paper examined the limitations of this technique and demonstrates a positioning device suitable for reproducing antemortem radiographic image geometry. The paper also examined three specific aspects of image geometry namely horizontal angulation, vertical angulation and focal film distance. Deviations in horizontal angulations between antemortem and postmortem radiographs by as little as 5 degrees makes identification difficult. Changes in vertical angulation or focal-film distance had no affect. This procedure, and the positioning device used to accurately replicate antemortem image geometry is an economical, easy to use adjunct to current methods of dental identification.