Are Antisperm Antibodies Really Associated with Proven Chronic Inflammatory and Infectious Diseases of the Male Reproductive Tract?

Background

It is debated whether chronic urogenital inflammations and infections may trigger the formation of antisperm antibodies (ASA) in semen.

Objective

To evaluate the formation of ASA in defined chronic inflammatory and infectious diseases of the male reproductive tract (MRT).

Design, setting, and participants

Three hundred sixty-five patients retrospectively enrolled in a single center were categorized as having National Institutes of Health (NIH) category II chronic prostatitis (n = 38), NIH category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (n = 59), NIH category IIIb CP/CPPS (n = 213), chronic epididymitis (n = 34), and chronic urethritis (n = 21). Forty-five age-matched men served as controls.

Measurements

All subjects underwent microbiologic and cytologic analysis for common bacteria, yeasts, and mycoplasma using the four-glass test. Urine samples, ejaculates, and urethral swabs were analyzed with polymerase chain reaction (PCR) for Chlamydia trachomatis and Neisseria gonorrhea. Semen analysis followed World Health Organization (WHO) standards. ASA in seminal plasma were analyzed using the mixed agglutination reaction (MAR) test.

Results and limitations

The overall positive detection rate of clinically significant levels (≥50% of spermatozoa coated by ASA) of IgG and IgA antibodies was 1.8% and 0.8%, respectively, in the patient group. No clinically significant levels of ASA were detected in the control group, and no statistically significant difference was observed between controls and patients (IgG, p = 1.0; IgA, p = 1.0). No difference was found between the different inflammatory and infectious diseases and the control group in the detection rate of ASA, even when the cut-point value was lowered to ≥1% (IgG, p = 0.4; IgA, p = 0.3). Moreover, in one selected subgroup of patients (n = 26) with persistent increased inflammatory parameters (peroxidase-positive leukocytes [PPL] ≥1 × 10⁶/ml and elastase ≥230 ng/ml), no significant difference in the levels of ASA was observed compared with the controls (IgG, p = 0.1; IgA, p = 0.8).

Conclusion

There is no association between chronic inflammatory or infectious diseases of the MRT and the presence of ASA in semen.     

Microvessel length density, total length, and length per neuron in five subcortical regions in schizophrenia

Recent studies (Prabakaran et al. in Mol Psychiat 9:684–697, 2004; Hanson and Gottesman in BMC Med Genet 6:7, 2005; Harris et al. in PLoS ONE 3:e3964, 2008) have suggested that microvascular abnormalities occur in the brains of patients with schizophrenia. To assess the integrity of the microvasculature in subcortical brain regions in schizophrenia, we investigated the microvessel length density, total microvessel length, and microvessel length per neuron using design-based stereologic methods in the caudate nucleus, putamen, nucleus accumbens, mediodorsal nucleus of the thalamus, and lateral nucleus of the amygdala in both hemispheres of 13 postmortem brains from male patients with schizophrenia and 13 age-matched male controls. A general linear model multivariate analysis of variance with diagnosis and hemisphere as fixed factors and illness duration (patients with schizophrenia) or age (controls), postmortem interval and fixation time as covariates showed no statistically significant differences in the brains from the patients with schizophrenia compared to the controls. These data extend our earlier findings in prefrontal cortex area 9 and anterior cingulate cortex area 24 from the same brains (Kreczmanski et al. in Acta Neuropathol 109:510–518, 2005), that alterations in microvessel length density, total length, and particularly length per neuron cannot be considered characteristic features of schizophrenia. As such, compromised brain metabolism and occurrence of oxidative stress in the brains of patients with schizophrenia are likely caused by other mechanisms such as functional disruption in the coupling of cerebral blood flow to neuronal metabolic needs.     

Seminal vesicle amyloidosis does not provide any protection from invasion by prostate cancer

OBJECTIVE

To determine whether seminal vesicle amyloidosis (SVA, an unusual finding in prostatectomy specimens, with deposits usually localized and asymptomatic) affects the extension of prostate cancer into the SVs.

PATIENTS AND METHODS

We identified 73 cases of localized SVA from 6575 prostatectomy specimens, that were removed because of clinically localized prostate cancer. All cases were confirmed by Congo red staining and polarization microscopy. The mean thickness of the amyloid band was measured in each case and correlated with clinicopathological characteristics. The frequency of SV involvement by prostate cancer in the presence of amyloid was compared with the percentage of pT3b classifications in the absence of amyloid.

RESULTS

The mean (range) age of the patients with localized SVAs was 64.4 (52–73) years. The mean thickness of the amyloid band did not correlate with patient age, preoperative prostate‐specific antigen levels, the weight of the prostates, or the Gleason score and T category of the prostate cancers. In the SVA group, seven cancers invaded the SVs (9.6%), which was not significantly different from the percentage of SV involvement by cancer in total sample (9.2%, P = 0.932).

CONCLUSIONS

The pathogenesis of localized SVA remains poorly understood, but SVA does not seem to provide an absolute or relative protection from SV involvement by prostate cancer.     

Current Technique of Open Intrafascial Nerve-Sparing Retropubic Prostatectomy

Background

Open nerve-sparing retropubic prostatectomy (nsRP) is still the most common surgical approach for the treatment of localised prostate cancer. Even though the principles of the technique and its oncological efficacy have often been published, ongoing refinements allow further improvements in functional outcome and morbidity.

Objective

To describe our current technique of open nsRP with data addressing urinary continence, potency, cancer control rates, and perioperative morbidity.

Design, setting, and participants

Our analyses relied on 1150 patients who were treated with nsRP in the Martini-Clinic by two high-volume surgeons from April 2005 to December 2007.

Surgical procedure

Key elements are a selective ligation of the dorsal vein complex and early release of the neurovascular bundles using a high anterior tension- and energy-free intrafascial technique. During dissection of the urethra, its posterior insertion at Denonvilliers’ fascia (DF) is preserved. DF is left in situ, and it is selectively opened above the seminal vesicles (SV). The SV are completely removed inside DF, and five muscle-sparing interrupted sutures are used for anastomosis.

Measurements

Functional and oncological outcome data were prospectively assessed using validated questionnaires. Moreover, intra- and perioperative morbidity were evaluated.

Results and limitations

Age and extent of nerve-sparing approach influenced urinary continence and potency. Complete urinary continence 1 yr after nsRP was found in 97.4% (men <60 yr) to 84.1% (men >70 yr) of patients. In preoperative potent men, erections sufficient for intercourse were reported between 84–92% and 58.3–70% of patients following bilateral and unilateral nerve sparing, respectively. Median blood loss was 580 ml (range: 130–1800 ml), and the transfusion rate was 4.3%. Median operative time was 165 min (range: 85–210 min). In organ-confined cancers, recurrence-free survival and cancer-specific-survival 10 yr after retropubic prostatectomy were 87% and 98.3%, respectively.

Conclusions

Open intrafascial nsRP combines excellent long-term cancer control rates with superior functional outcome and a low morbidity.     

Prevalence of a Tertiary Gleason Grade and Its Impact on Adverse Histopathologic Parameters in a Contemporary Radical Prostatectomy Series

Background

The presence of a tertiary Gleason grade (TGG) pattern in radical prostatectomy (RP) specimens has been described as associated with adverse pathology and a higher biochemical recurrence (BCR) rate after RP.

Objective

To assess the prevalence of a TGG in a contemporary, consecutive, single-centre RP series and its association with adverse pathology.

Design, setting, and participants

From January to August 2007, 800 eligible patients (no prior neoadjuvant hormonal therapy) underwent RP for clinically localised prostate cancer (pCA) in our institution. The presence of the third most prevalent Gleason pattern was documented, regardless of whether it was better or worse than the two predominant Gleason grades.

Measurements

The overall prevalence of a TGG was described. Uni- and multivariate logistic regression analyses tested the association between the presence of a TGG <5% versus ≥5% of the whole tumour volume and extracapsular extension (ECE), seminal vesicle invasion (SVI), positive surgical margins (PSM), and lymph node invasion (LNI). Subanalyses were performed to assess the impact of different TGGs at various Gleason scores.

Results and limitations

A TGG was reported in 180 RP specimens (22.5%). In univariate analysis, the presence of a TGG ≥5% was significantly associated with ECE, SVI, PSM, and LNI (p < 0.001). In multivariate analysis, a TGG ≥5% showed an independent association with ECE and PSM (p < 0.05). Accordingly, in subanalyses, a significant association with adverse pathology was only documented if the amount of a TGG was at least 5% of the tumour volume. Our study is limited by the relatively low overall frequency of a TGG, thereby reducing the statistical expressiveness, especially for subanalyses.

Conclusions

Our findings confirm the association of the presence of a TGG with adverse pathologic features. Further follow-up is needed to assess the prognostic impact of a TGG on the risk of BCR and overall survival following RP.     

Neurochemical and structural correlates of executive dysfunction in schizophrenia

BACKGROUND: Executive dysfunction is a core feature of schizophrenia. The neurochemical and structural changes associated with this deficit are, however, largely unclear. This study tested the hypothesis that changes in glutamate, glutamine and N-acetyl-aspartate (NAA) in hippocampal and dorsolateral prefrontal (DLPFC) regions as well as hippocampal, amygdalar and DLPFC volume reductions are associated with executive dysfunction. METHODS: Twenty-nine subjects with schizophrenia and 31 healthy controls were examined by short-echo single voxel magnetic resonance spectroscopy of the left anterior hippocampus and the left DLPFC. Volumes of the hippocampi, amygdalae and DLPFC were measured bilaterally using manual volumetry. Executive functioning was assessed by the Wisconsin Card Sorting Test (WCST). RESULTS: Poor WCST performance was associated with increased hippocampal glutamate concentrations among subjects with schizophrenia, not among healthy controls. Glutamate in the DLPFC as well as NAA or glutamine in the hippocampus or the DLPFC were not related to executive functioning in schizophrenia or healthy controls. Reduced amygdalar volume was associated with impaired executive functioning in subjects with schizophrenia (p=.06) and healthy controls (p=.04). CONCLUSIONS: Altered hippocampal glutamatergic neurotransmission and amygdalar volume loss may be associated with executive dysfunction in schizophrenia.