Genital heat stress in men of barren couples: a prospective evaluation by means of a questionnaire

Exposure to genital heat stress among men of barren couples was evaluated in a prospective study. Five hundred and forty-two consecutive patients referred for andrological examination were asked to complete a specific questionnaire at their first visit. For 449 patients who answered all questions, the individual score values could be calculated by scoring each answer with points. Patients with 'idiopathic' oligoasthenoteratozoospermia had significantly higher score values when compared with men showing normozoospermia (P < 0.01), 'symptomatic' oligoasthenoteratozoospermia as a result of defined andrological disorders (P < 0.01), cryptozoospermia (P < 0.01) or other pathological semen profiles (P < 0.05). These data support the hypothesis that patients with 'idiopathic' oligoasthenoteratozoospermia are more exposed to genital heat stress than normozoospermic men. Moreover, in patients with a varicocele impairment semen quality was associated with significantly higher score values compared with the subgroup of men with normal semen profiles (P < 0.05). In contrast, the score values did not significantly differ between equivalent subgroups of men with a history of a retractile testis. Our observations indicate that the questionnaire used in the present study allows an integrative assessment of genital heat stress, which is superior to single factor analysis. Notably, the group of men with 'idiopathic' oligoasthenoteratozoospermia showed the highest mean score values for 10 of the 18 questions compared with the other groups. Prolonged sitting in a vehicle represented the only single factor with significantly different score values in patients with 'idiopathic' oligoasthenoteratozoospermia and those with normozoospermia (P < 0.05).     

Relationship between age and semen parameters in men with normal sperm concentration: analysis of 6022 semen samples

This study evaluates retrospectively the relationship between age and semen parameters among men with normal sperm concentration. It was based on computerized data and performed in an Academic Fertility and IVF Unit. Six thousand and twenty-two semen samples with sperm concentrations of >or=20 x 10(6) ml(-1) were examined according to WHO criteria and analysed in relation to patients' age. For each age group, mean values +/- SD of semen volume, sperm concentration, percentage of motile spermatozoa, normal morphology, acrosome index, total sperm count/ejaculate, total motile sperm count/ejaculate and sexual abstinence duration were examined. A peak semen volume of 3.51 +/- 1.76 ml(-1) was observed at age >or=30 to <35 years and a lowest volume of 2.21 +/- 1.23 ml(-1) was observed at age >or=55 years (P<0.05). Sperm motility was found to be inversely related to age with peak motility of 44.39 +/- 20.69% at age <25 years and lowest motility of 24.76 +/- 18.27% at age >or=55 years (P<0.05). A reduction of 54% was observed for total motile sperm, between values of 103.34 +/- 107 x 10(6) at age >or=30 to <35 years and 46.68 +/- 53.73 x 10(6) (P<0.05) at age >55 years. A statistically significant and inverse relationship was observed between semen volume, sperm quality and patient age, in spite of prolonged sexual abstinence duration. Top sperm parameters were observed at age >or=30 to <35 years, while the most significant reduction in sperm parameters occurred after the age of 55 years.     

Sperm chromatin integrity in young men with no experiences of infertility and men from idiopathic infertility couples

Damage to the genetic component of spermatozoa seems to play the main role in a majority of cases where current approaches fail to reveal the specific cause of male infertility. In this study, we compared semen quality in men assigned to two defined groups: men from couples with unexplained infertility – idiopathic infertility (A) and young men with no experiences of infertility (B). All samples were examined by standard ejaculate analysis and sperm chromatin structure assay (SCSA). Sperm chromatin damage was significantly higher in men from group A than in those from group B. Similar results were obtained by comparison of men from group A (all men were normozoospermic) with normozoospermic men from group B. According to these results, we can suppose that chromatin disorders may be the causal factor of subfertility or infertility in some of these men. No evidence for a strong association between chromatin disorders and standard parameters of ejaculates was found. We failed to confirm a relationship between smoking and sperm quality in men from any of the investigated groups. SCSA is a method that facilitates the identification of infertile men who otherwise show normal semen variables.     

精子质量参数分析的标准化与质量控制的研究进展

精液分析是评价男性生育能力的最基本测试。最近几年,对精液分析标准化的迫切需求已引起男科学家的广泛重视。本文对精子质量参数———精子密度、活动率和形态学分析的标准化及质量控制进行了综述。精子密度分析的关键是计数池的标准化,因此Cell-VU计数池应该是最佳的选择;精子活动率和精子形态学的分析由于主观性太强,CASA系统可能是其标准化的最终选择。精液质量参数分析的质量控制主要是质量控制材料的选择,以及在男科学实验室实施EQC和IQC项目,而一些监测质量控制的图表和计算方法应被相应地建立。     

精子质量参数分析的标准化与质量控制的研究进展

精液分析是评价男性生育能力的最基本测试。最近几年,对精液分析标准化的迫切需求已引起男科学家的广泛重视。本文对精子质量参数———精子密度、活动率和形态学分析的标准化及质量控制进行了综述。精子密度分析的关键是计数池的标准化,因此Cell-VU计数池应该是最佳的选择;精子活动率和精子形态学的分析由于主观性太强,CASA系统可能是其标准化的最终选择。精液质量参数分析的质量控制主要是质量控制材料的选择,以及在男科学实验室实施EQC和IQC项目,而一些监测质量控制的图表和计算方法应被相应地建立。     

Testicular cancer trends as 'whistle blowers' of testicular developmental problems in populations

Recently a worldwide rise in the incidence of testicular germ cell cancer (TGCC) has been repeatedly reported. The changing disease pattern may signal that other testicular problems may also be increasing. We have reviewed recent research progress, in particular evidence gathered in the Nordic countries, which shows strong associations between testicular cancer, undescended testis, hypospadias, poor testicular development and function, and male infertility. These studies have led us to suggest the existence of a testicular dysgenesis syndrome (TDS), of which TGCC, undescended testis, hypospadias/disorders of sex differentiation and male fertility problems may be symptoms with varying penetration. In spite of their fetal origin, most of the TDS symptoms, including TGCC and poor semen quality, can only be diagnosed in adulthood. Data from a Danish-Finnish research collaboration strongly suggest that trends in TGCC rates of a population may be 'whistle blowers' of other reproductive health problems. As cancer registries are often of excellent quality - in contrast to registries for congenital abnormalities - health authorities should consider an increase in TGCC as a warning that other reproductive health problems may also be rising.     

吸烟对重庆主城区成年男性精子凋亡及精液质量的影响

目的:探讨吸烟对重庆市主城区健康成年男性精子凋亡和精液质量的影响。方法:235例健康成年男性根据吸烟习惯分为吸烟组和不吸烟组。不吸烟组89例,吸烟组146例。采用计算机辅助精液分析系统检测精液常规参数;流式细胞术结合Annexin V-FITC/PI荧光染色检测精子凋亡(AN-/PI-、AN+/PI-、AN+/PI+、AN-/PI+精子比率),并对吸烟组和不吸烟组的各项参数进行比较研究。结果:与不吸烟组比较,吸烟组的早期凋亡精子(AN+/PI-)率高于不吸烟组[(8.1±5.1)%vs(6.8±3.8)%,P=0.039],而晚期凋亡精子(AN+/PI+)率两组间差异无显著性[(5.6±5.2)%vs(5.5±5.1)%,P=0.87];两组间精液量、精子密度、精子活动率、活力和正常形态精子率等精液常规指标的差异均无显著性(P=0.30;0.82;0.37;0.81;0.84)。结论:吸烟者早期精子凋亡率较不吸烟者高,提示吸烟可能诱导精子出现早期的细胞损害。精子凋亡可作为较精液常规指标更为敏感的生物标志物反映吸烟对男性精子造成的损伤。     

Value of radio-active brain scans in the diagnosis of brain tumors as compared with other methods

Summary The physical and clinical properties of two recently introduced radioactive tracers, the mercury²⁰³ and mercury¹⁹⁷ labeled Neohydrin were discussed. Both gave scans of adequate quality. The advantage of Hg¹⁹⁷ is the considerably lesser kidney radiation as compared with Hg²⁰³. The value of the photoscan was stressed as compared to the dot scan. The simplicity, safety and lack of discomfort of the radioactive brain scan was emphasized. The difficulties in the detection of brain tumors at the base of the skull and in the posterior fossa were pointed out. In our series of 90 consecutive intracranial tumors the overall evidence of positive and localizing scans was 75.6%. The supratentorial tumors were more readily detected (83%) as compared with the infratentorial ones (47.3%).Of a total of 80 angiographic studies performed on the same group of tumors 71.2% were positive, localizing the lesion accurately in 55% of cases.Pneumoencephalography and ventriculography were less frequently employed in brain tumor diagnosis. The results were satisfactory. The electroencephalograms were of little localizing value in the diagnosis of our series of brain tumors (12 out of 30).The glioblastomas (92%) and meningiomas (94.1%) have most consistently given accurately localizing findings with this technique. High incidence of positive and localizing scans was also obtained with intracranial sarcomas and metastatic tumors. The more benign and less vascular tumors such as astrocytomas and acoustic neurinomas have shown a lesser tendency to pick up the radioactive material. Completely benign and avascular tumors such as the epidermoids did not display increased pick up of the radioactive substance. No differential diagnosis as to the tumor type is possible on the basis of the scan alone. Since other lesions than brain tumors have shown up in the radioactive brain scan, the differential diagnosis as to the type of the lesion can not be made safely with this technique. The unquestioned value of a good history, thorough neurological examination and classical contrast studies in the diagnosis of brain tumors was emphasized. Although the brain scan is the best single localizing procedure in brain tumor diagnosis it should not be used as a screening test for presence or absence of brain tumors, since a positive scan, generally speaking, means only a lesion (neoplastic or non-neoplastic) with a certain localization and a negative scan has no diagnostic value whatsoever.

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Zusammenfassung Die physikalischen und klinischen Eigenschaften zweier kürzlich eingeführter radioaktiver Substanzen, das Quecksilber 203 und Quecksilber 197 markierte Neohydrin, wurden diskutiert. Beide ergeben Scannings gleicher Qualität. Der Vorteil von Quecksilber 197 liegt in der bedeutend geringeren Strahlenbelastung der Nieren im Vergleich zum Quecksilber 203. Der Wert des Photoscannings im Vergleich zum Punktscanning wurde herausgestellt. Die Einfachheit, Sicherheit und das Fehlen von Beschwerden beim radioaktiven Hirnscanning wurde betont. Die Schwierigkeiten des Nachweisens von Hirntumoren an der Scl ädelbasis, der hinteren Schädelgrube und parasagittaler Lokalisation wurden beschrieben.In unserer Serie von 90 intrakraniellen Tumoren war der Gesamtnachweis durch positive und lokalisierende Scannings 75,6%. Die supratentoriellen Tumoren konnten leichter nachgewiesen werden (83%), wenn man sie mit den infratentoriellen vergleicht (47,3%).Von insgesamt 80 angiographischen Untersuchungen, die an der gleichen Tumorgruppe vorgenommen wurden, waren 71,2% positiv, der Tumor wurde in 55% der Fälle richtig lokalisiert. Pneumenzephalographien und Ventrikulographien wurden weniger häufig zur Hirntumordiagnostik durchgeführt. Die Ergebnisse waren befriedigend. Elektroenzephalogramme hatten einen geringen lokalisatorischen Wert in der Diagnostik unserer Serie von Hirntumoren (12 von 30).Glioblastome (92%) und Meningeome (94,1%) ließen sich am häufigsten mit dieser Technik lokalisieren. Intrakranielle Sarkome und metastatische Tumoren konnten ebenfalls mit einer großen Wahrscheinlichkeit durch positive und lokalisatorische Scannings nachgewiesen werden. Gutartigere und wenig vaskularisierte Tumoren, wie Astrocytome und Akustikusneurinome, zeigten eine geringere Tendenz, das radioaktive Material aufzunehmen. Völlig gutartige und avaskuläre Tumoren, wie Epidermoide, ergaben keine erhöhte Aufnahme der radioaktiven Substanz. Durch das Scanning allein konnte keine Differentialdiagnose des Tumortyps erzielt werden. Da andere Läsionen als Hirntumoren sich in dem radioaktiven Hirnscan dargestellt haben, kann die Differentialdiagnose in bezug auf die Art der Läsion mit dieser Technik nicht sicher gestellt werden. Der unbestrittene Wert einer guten Anamnese, gründlichen neurologischen Untersuchung und der klassischen Kontrastmitteluntersuchung in der Diagnostik der Hirntumoren wurde betont. Obwohl das Hirnscanning als solches die beste lokalisierende Untersuchung in der Hirntumordiagnostik ist, sollte es doch nicht als genereller Test für das Vorhandensein oder Fehlen eines Hirntumors benutzt werden, da ein positiver Scan — um es allgemein auszudrücken — nur eine Läsion (neoplastisch oder nicht neoplastisch) in einer bestimmten Lokalisation darstellt und ein negativer Scan absolut keinen diagnostischen Wert hat.

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Resumen Se discuten las propiedades físicas y biológicas de dos indicadores radioactivos recientemente presentados, el mercurio²⁰³ y el mercurio⁹⁷, llamado Neohydrine. Ambos proporcionan examenes de igual calidad. La ventaja del Hg¹⁹⁷ es su considerable menor radiación en comparación con la del Hg²⁰³. El valor del examen fotográfico quedó reforzado en relación con el examen local. La simplicidad, seguridad y facilidad del examen radio-activo del cerebro son subrayadas. También se destacan las dificultades de detección de los tumores de la base del craneo y de la fosa posterior así como aquellos de las localizaciones parasagitales.En nuestra serie de 90 tumores cerebrales consecutivos los diagnósticos evidentes, positivos y topográficos, fueron del 75,6%. Los tumores supratentoriales fueron detectados con más seguridad (83%) que los infratentoriales (47%).En un total de 80 estudios angiográficos practicado en el mismo grupo de tumores un 71,2% fueron positivos localizando la lesión con precisión en un 55% de los casos.La encefalografia gaseosa y la ventriculografía se emplearon menos frecuentemente para el diagnóstico de los tumores cerebrales. Los resultados fueron satisfactorios. El electroencefalograma fué de escaso valor localizador en el diagnóstico de nuestra serie de tumores cerebrales (12 en 30).Los glioblastomas (92%) y los meningiomas (94,1%) han proporcionado de un modo más consecuente localizaciones precisas con esta técnica. Un gran número de examenes positivos y localizadores pudo obtenerse también en los casos de sarcomas intracraneales y de metástasis.Los tumores más pequeños y menos vascularizados, como los astrocitomas y los neurinomas del acústico demostraron una menor tendencia para fijar los cuerpos radio-activos. Los tumores pequeños y avasculares, como los epidermoides, no aparecìan aumentados y llenos de substancia radio-activa. No pudo hacerse ningún diagnóstico diferencial por lo que se refiere al tipo de tumor con este registro. El valor indiscutable de un buen interrogatorio, lo mismo que el examen neurológico y los estudios clásicos de contraste se ponen de manifiesto. Aunque la gammaencefalografía cerebral sea el procedimiento de localización más sencillo para el diagnóstico de los tumores del cerebro no puede emplearse como un test eliminatorio para la presencia ó ausencia de tumores cerebrales, ya que un examen positivo, hablando en términos generales, demuestra solamente una lesión (neoplásica ó no neoplásica) con una localización segura pero un examen negativo no tiene ningún valor diagnóstico.

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Résumé Les propriétés physiques et biologiques de deux traceurs radio-actifs récemment présentés, le mercure²⁰³ et le mercure¹⁹⁷ nommé Neohydrine furent discutés. Tous les deux donnent des examens d'une qualité égale. L'avantage du Hg¹⁹⁷ est sa considérablement moindre radiation par rapport à celle du Hg²⁰³. La valeur de l'examen photographique fut renforcée par rapport à l'examen local. La simplicité, la sûreté, la facilité de l'examen radio-actif du cerveau sont soulignées. Les difficultés de détection des tumeurs de la base du cerveau et dans la fosse postérieure sont signalées.Dans notre série de 90 tumeurs cérébrales consécutives, les diagnostics positifs et topographiques évidents furent de 75,6%. Les tumeurs supratentorielles furent plus surement détectées (83%) que les tumeurs infratentorielles (47,3%).Sur un total de 80 études angiographiques pratiquées dans le même groupe de tumeurs, 71,2% furent positives, localisant les lésions avec précision dans 55% des cas.L'encéphalographie gazeuse et la ventriculographie furent moins souvent employées dans le diagnostic des tumeurs cérébrales. Les résultats furent satisfaisants. Les electroencéphalogrammes furent de peu de valeur localisatrice dans le diagnostic de notre série de tumeurs cérébrales (12 sur 30).Les glioblastomes (92%) et les méningiomes (94,1%) ont donné de façon plus conséquente des localisations précises avec cette technique. Un grand nombre d'examens positifs et localisateurs furent aussi obtenus dans les cas de sarcomes intracrâniens et de metastases. Les tumeurs plus petites et moins vasculaires telles que les astrocytomes et les neurinomes de l'acoustique ont montré une tendance moindre à fixer les corps radio-actifs. Les tumeurs tout à fait minimes et avasculaires telles que les tumeurs epidermoïdes n'apparaissent pas grossies et pleines de substance radio-active. Aucun diagnostic différentiel pour ce qui est du type de la tumeur n'est possible sur la seule base de l'enregistrement. Depuis que d'autres lésions que les tumeurs du cerveau ont été mises en évidence lors d'examens radio-actifs du cerveau, le diagnostic différentiel sur le type de la tumeur ne peut être fait sûrement avec cette technique. La valeur incontestée d'un bon interrogatoire de même que l'examen neurologique et des examens de contraste classiques est soulignée. Quoique la gammaencéphalographie cérébrale soit le procédé de localisation le plus simple dans le diagnostic des tumeurs du cerveau, elle ne peut pas être employée comme un test éliminatoire pour la présence ou l'absence de tumeurs cérébrales, puisque un examen positif, généralement parlant, désigne seulement une lésion (néoplastique ou non néoplastique) avec une localisation certaine et qu'un examen négatif n'avait aucune valeur diagnostique quoi qu'il en soit.

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Riassunto Vengono discusse le proprietà fisiche e cliniche di due traccianti radio-attivi recentemente introdotti in clinica, la neoidrina marcata con il mercurio 203 e con il mercurio 197. Ambedue i traccianti danno delle scansioni di ottima qualità. Il vantaggio del Hg 197 è rappresentanto dalla minor irradiazione renale rispetto al Hg 203. Il valore della scansione fotografica è confrontato con quello della scansione a punti. Viene anche sottolineata la semplicità, la sicurezza e la mancanza di danni per il paziente rappresentati da questa tecnica. Vengono poi discusse le difficoltà di diagnosi dei tumori della base cranica e della fossa posteriore e di quelli a localizzazione parasagittale.Nella serie presentata di 90 scansioni consecutive per tumori endocranici la diagnosi è stata possibile nel 75,6% dei casi. Questa percentuale è stata più alta per i tumori sopratentoriali (83%) dei casi, rispetto a quelli sottotentoriali (47,3%).Su di un totale di 80 angiografie praticate sugli stessi pazienti il 71,2% è risultato positivo, mentre la lesione è stata localizzata accuratamente solo nel 55% dei casi.La pneumoencefalografia e la ventricolografia sono state usate meno frequentemente nella diagnosi dei tumori cerebrali. I risultati sono soddisfacenti. L'EEG è stato di scarso valore localizzatorio per la diagnosi dei tumori cerebrali (12 su 30).I glioblastomi (92% dei casi) ed i meningiomi (94,1%) sono stati localizzati molto accuratamente. Un'alta incidenza di localizzazioni è stata ottenuta in casi di sarcomi intracranici e di tumori metastatici. I tumori più benigni e meno vascolarizzati come gli astrocitomi ed i neurinomi dell'acustico hanno una minor tendenza a concentrare del materiale radioattivo,Dei tumori completamente benigni ed avascolari come gli epidermoidi non manifestano alcuna concentrazione elettiva del materiale radioattivo. Nessuna diagnosi differenziale del tipo di tumore è possibile mediante la scansione. Anche lesioni diverse da quelle tumorali possono essere localizzate mediante questa tecnica. Il valore di una buona storia clinica accompagnato da evidenze neurologiche e dai classici studi con mezzi di contrasto è sottolineato. Malgrado che la scansione con isotopi radioattivi sia la miglior tecnica singolarmente intesa, per la diagnosi dei tumori cerebrali, essa non deve essere presa in considerazione con test di screening per la presenza o l'assenza di tumori cerebrali, in quanto una scansione positiva, in senso generico, significa solamente la presenza di una lesione (neoplastica o non-neoplastica), con una certa localizzazione ed una scansione negativa non ha comunque valore diagnostico.

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Presented at the Congress of Neurological Surgeons, Miami, Florida on November 19, 1964.

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Aided in part by Training Grant No. NB-5408 from the National Institute of Neurological Diseases and Blindness of the U. S. Public Health Service.     

男性血液和精液中微量元素含量与精子活力的相关性研究

目的:探讨男性血液和精液中微量元素的分布及其与男性精液参数的相关性。方法:采用BH-5100五通道原子吸收仪、YY-1001血铅仪和伟力彩色精子自动分析仪,对113例男性血液和精液进行钙、镁、铜、锌、铁、铅的测定及精液常规分析,以了解微量元素和精液参数的相互关系。结果:①血液与精液中铅、铜、锌、铁含量显著相关,其中以铜的相关系数最大;钙、镁没有相关性。②血液和精液中铅、铜、锌、钙、镁、铁6种微量元素分布存在显著性差异。③精液中钙与精子活率、直线运动精子活率、曲线速度、平均移动角度、活跃精子密度、直线速度、平均路径速度、侧摆幅度等指标显著正相关;铅与精子活率、直线运动精子活率、活跃精子密度、活动精子密度、直线运动精子密度等指标呈显著负相关;镁元素与精子活率、直线运动精子活率、直线运动精子密度呈显著负相关;精液酸碱度与钙、镁、铁3种元素呈显著负相关。④血液中的锌与精子活率和直线运动精子活率呈显著负相关,镁与精子活率、直线运动精子活率、平均路径速度呈显著负相关,铅与侧摆幅度呈显著正相关。结论:不同体液中的微量元素分布和精子的运动功能存在不同的相关性。     

Examination of the semen quality of patients with uraemia and renal transplant recipients in comparison with a control group

To examine the semen quality of patients with uraemia and renal transplant recipients, 40 patients with uraemia and 40 renal transplant recipients were included. According to their interval of post-transplantation, renal transplant recipients were subdivided into group A (22) ≤2 years and group B (18) >2 years. A total of 40 healthy men with normal fertility were included as the controls. Semen samples from all subjects were collected and analysed. The fertility index (FI) value was calculated. The FI value of the normal fertility men was 13.02 (14.26), that of the renal transplant recipient groups A and B were 5.53 (8.30) and 9.27 (22.49) respectively, while the FI of the patients with uraemia was 0.23 (0.76). Compared with the uraemia group, the FI values of renal transplant recipient group either group A or group B were significantly better ( P  <   0.01). However, compared with the normal control group, the FI values of renal transplant recipient group A were lower ( P  <   0.01), while there was no significant difference between group B and the control group ( P  >   0.05). In conclusion, the FI of renal transplant recipients was recovered close to the level of healthy men with normal fertility 2 years after transplantation.     

Decreased polyunsaturated and increased saturated fatty acid concentration in spermatozoa from asthenozoospermic males as compared with normozoospermic males

The lipid composition of the sperm membrane has been shown to exert a significant effect upon the functional quality of spermatozoa. We have studied fatty acid composition of the phospholipids in spermatozoa in asthenozoospermic and normozoospermic men and determined the ratio of polyunsaturated fatty acids (PUFAs) to saturated fatty acids of spermatozoa of these two groups. Fatty acid concentration of spermatozoa was determined in 15 asthenozoospermic and eight normozoospermic semen samples by thin layer chromatography and gas chromatography. The most abundant polyunsaturated and saturated fatty acids in normozoospermic samples were docosahexaenoic acid (DHA 22 : 6 omega3, 98.5 +/- 4.5 nmol per 10(8) spermatozoa, mean +/- SE) and palmitic acid (103 +/- 17 nmol per 10(8) spermatozoa) respectively. The mean +/- SE values of DHA and palmitic acid in asthenozoospermic samples were 53.9 +/- 11.6 and 145 +/- 14.7 nmol per 10(8) spermatozoa respectively. Compared with normozoospermic samples, asthenozoospermic samples showed lower levels of PUFA and higher amount of saturated fatty acids. The mean +/- SE ratios of sperm PUFA/saturated fatty acids in asthenozoospermic and normozoospermic samples were 0.66 +/- 0.06 and 1.45 +/- 0.16 (P < 0.001) respectively. This study demonstrates that spermatozoa of asthenozoospermic men have lower levels of PUFA compared with saturated fatty acids. This may be contributory to the poor motility noted in samples from these men.     

Health-related quality of life measurements in elderly Canadians with osteoporosis compared to other chronic medical conditions: a population-based study from the Canadian Multicentre Osteoporosis Study (CaMos)

The objective of this research was to determine the relative decrement in health-related quality of life, as measured by the health utilities index mark 3 (HUI3), in osteoporosis compared to other chronic medical conditions. The impact of chronic medical conditions other than osteoporosis on HUI3 measurements had been previously established in the 1996/1997 Canadian National Population Health Survey (NPHS). The Canadian Multicentre Osteoporosis Study (CaMos) is a national population-based study in which regional participants were randomly recruited, regardless of presence of osteoporosis. We analyzed data from participants aged 65 years who completed a baseline HUI3 questionnaire and provided information on their medical history (n=3,750). We determined the age- and gender-adjusted mean decrement in HUI3 for several chronic medical conditions, including osteoporosis. The mean changes in HUI3 adjusted for age and gender (with 95% confidence intervals) were as follows: arthritis –0.10 (–0.11, –0.09), chronic obstructive pulmonary disease (COPD) –0.07 (–0.09, -0.05), diabetes mellitus –0.05 (–0.08, –0.03), heart disease –0.06 (-0.08, –0.04), hypertension –0.02 (-0.03, –0.01), and osteoporosis –0.08 (–0.11, –0.06), respectively (model r²=0.17; P<0.0001). These findings were comparable to those observed in the NPHS, with the exception of osteoporosis, which had not been previously studied in this fashion. The decrement in HUI3 score seen in participants with osteoporosis was comparable to that observed in other chronic medical conditions, such as arthritis, COPD, diabetes mellitus or heart disease.This article was written with the participation of the CaMos Investigators: T. Anastassiades, L. Bissette, J.P. Brown, L. Joseph, R.G. Josse, C. Joyce, S. Kaiser, S. Kirkland, N. Kreiger, T.M. Murray, W.P. Olszynski, J. Prior, K. Siminoski, S. Poliquin, A. Tenenhouse     

Moderate head injuries in children as compared to other age groups,including the cases who had talked and deteriorated

Summary Patients defined as having a moderate head injury on the basis of Glasgow Coma Scale scores within the ranges of 9 to 13 after acute nonsurgical procedures were selected. Almost 1600 cases were hospitalized in the Neurosurgery Department. The cases were admitted through the Emergency Unit of Gaz University Medical School, Ankara, Turkey during the period between 1979 and 1992.The group studied consisted of 231 selected patients assessed separately in paediatric, adult and elderly age groups. Possible risk factors such as: GCS score, anisocoria, unilateral or bilateral fixed pupils, impaired oculocephalic reflexes, presence of multiple systemic injuries, aetiology of head trauma, presence of linear or depressed skull fractures, space occupying mass on CT or operation was also assessed.Subarachnoid haemorrhage turned out to be the only independent significant risk factor in predicting mortality. The data about the patients who have talked and deteriorated were also reported so as to assisst physicians charged with the care of trauma victims.     

数字化图像与原始IVU诊断泌尿系统疾病的比较

目的探索数字化图像诊断泌尿系统疾病的应用及意义。方法将ＩＶＵ胶片通过扫描仪转换为数字化图像，对１００例泌尿系统疾病的诊断作数字化图像与原始ＩＶＵ的比较，其中结石２９例、肿瘤４２例、囊肿５例、结核２例、先天性畸形５例、前列腺增生９例、其它８例。结果数字化图像与原始ＩＶＵ的诊断正确率分别为８８％和９１％，差异无显著性（Ｐ＞０．０５）。诊断可信度分别为４．６分和４．８分，图像质量为４．６分和４．８分，诊断难度为１．７分和１．５分，差异均有非常显著性（Ｐ＜０．０１）。结论数字化图像与原始ＩＶＵ胶片对泌尿系统疾病诊断正确率无明显差别，有益于远程会诊和教育。     

Characteristics of biliary reconstruction, using a T-tube, as compared to those with other methods, in left-lobe adult living-donor liver transplantation

Background/Purpose Postoperative biliary tract complications remain one of the most serious problems facing patients who undergo living-donor liver transplantation. The aim of this study was to analyze the clinical implications of three different methods of biliary reconstruction in left-lobe adult living-donor liver transplantation. Methods We retrospectively compared three groups of patients: those who had Roux-en-Y hepaticojejunostomy (HJ; n = 11) biliary reconstruction, those who had duct-to-duct hepaticohepaticostomy (HH) with external stent (n = 11), and those who had HH with a T-tube (n = 6). Median follow-up for each group was 31, 30, and 10 months, respectively. Results Bile leaks were observed in 45.5% of the patients in both the HJ group and the HH with external stent group. Biliary anastomotic strictures occurred in 9% of the Roux-en-Y HJ patients and in 27.2% of those who had HH with external stent. No biliary complications were observed in the HH with a T-tube group (P = 0.049). Conclusions Biliary reconstruction using HH with a T-tube may decrease the incidence of biliary complications. Despite the relatively short follow-up period, these encouraging preliminary results may warrant further studies of this biliary reconstruction technique in left-lobe adult living-donor liver transplantation.