Use of methenamine hippurate in male infertility.

In sperm-freezing for infertility patients with low sperm counts, we found that semen containing high numbers of white blood cells, greater than 15 to 20 per high-power field, was both poor in quality and difficult to freeze. In examining these patients carefully, we found that many had smoldering prostatitis and some an overt history of prostatitis. We treated them with methenamine hippurate using various methods and found that by decreasing the white blood cell count in their semen, we could frequently improve the semen quality, particularly sperm motility, also achieve pregnancies in some cases.     

Chronic mononucleosis--it almost never happens

Obviously, a great deal of further research is needed into the effects of latent viral infections. A better understanding of the interaction between psychobiologic disorders and the immune system may also shed light on many of the unanswered questions concerning the role of Epstein-Barr virus (EBV) as well as other latent viruses in clinical disease. At this time, however, there is no convincing evidence that chronic EBV infection is a cause of clinical disease, except in rare instances.     

Direct effects of the adrenergic neurotoxin DSP4 on central opiate receptors: implications for neuroendocrine studies

Summary We have shown that the noradrenergic neurotoxin DSP4 can acutely abolish naloxone-induced secretion of LH in the rat. A part of this influence is clearly related to an unexpected interaction with hypothalamic opiate ([³H]-naloxone) binding sites. Injection of DSP4 (50 mg/kg) can severely reduce opiate binding assayed in vitro. In addition, the drug is very potent in blocking opiate receptors in vitro, as determined in slice and homogenate assays. Consideration must now be given to the possibility that many previous studies on acute effects of DSP4 undoubtedly involved the opiatergic system in addition to noradrenergic terminals. Thus, DSP4 is not the drug of choice for experiments designed to probe catecholamine-opiate interactions in the control of LH release.     

Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy

At the University Hospital, Lund, Sweden, laparoscopy has been routinely used as a diagnostic aid in cases for acute pelvic inflammatory disease since 1960. No significant complications have been encountered. The material of the study comprises 905 cases covering an 8 year period, 1960-1967. The operation was always performed under general anesthesia. The laparoscope was inserted in the midline below the umbilicus and a cannula inserted 10 cm laterally to manipulate the pelvic organs. A previous clinical diagnosis was required. In 814 cases acute inflammatory disease was suspected on clinical grounds. In 532 of these cases (65%) acute salpingitis was visually confirmed. Observation through the instrument was seldom difficult or uncertain. In 98 cases (12%) laparoscopy revealed other pathologic conditions. In 184 cases (23%) no pathologic changes were found. In another 91 cases acute salpingitis was found unexpectedly at laparoscopy (or in some cases by exploratory laparotomy) undertaken on other provisional clinical diagnoses. Altogether 623 patients were visually diagnosed as having acute salpingitis. Acute appendicitis was found in 24 cases, ectopic pregnancy in 11 cases, pelvic endometriosis in 16 cases, and several other pelvic disorders occasionally. In the total series of 623 confirmed cases of acute salpingitis 223 (365) were of gonococcal origin. These were mostly in the younger, unmarried, and nulliparous patients. Previous curettage was responsible for most othe r cases. The authors conclude that the diagnosis of acute adnexal inflammation based on commonly accepted clinical criteria was found inaccurate to an unsatisfactory high degree as 12% proved to have other disorders, several of a serious nature. Also 23% had no inflammatory reaction of the tubes or other pelvic structures leaving 65% of cases correctly diagnosed on clinical grounds. The prognosis as to later tubal patency varied with the stage of development of the salpingitis. Later studies show that patency was more frequent in cases of salpingitis diagnosed and treated early before adnexal swelling or mass was diagnosed clinically. Gonococcal cases showed a lower subsequent bilateral occlusion than others. 5 of the salpingitis patients were later operated on for ectopic pregnancy.     

Drusen characteristics in patients with exudative versus non-exudative age-related macular degeneration

The drusen characteristics of 38 eyes from 38 patients with bilateral drusen associated with age-related macular degeneration (AMD) were compared in a masked fashion to 89 fellow eyes from 89 patients with unilateral exudative AMD (disciform scarring or choroidal neovascularization). The average age of the drusen group (67.4 years) was significantly less (P = 0.01) than the average age of the unilateral exudative group (72.6 years). Multiple logistic regression was used to compare the drusen characteristics in the two groups, controlling for the age and sex of the patients. Among patients 75 years of age and younger, patients with confluent drusen had an increased risk of having a fellow eye with exudative AMD compared with patients without confluent drusen. Among patients older than 75 years of age, confluent drusen did not significantly differentiate the two study groups, although confluent drusen in this older age group were more often associated with the bilateral drusen group. Focal hyperpigmentation of the retinal pigment epithelium was also associated with the unilateral exudative group. These drusen characteristics should be evaluated in future prospective studies designed to determine which eyes with drusen are at greatest risk for developing the blinding complications of choroidal neovascularization.     

Behavioural studies of spatial vision in cats reared with convergent squint: Is amblyopia due to arrest of development?

Summary Visual acuity and contrast sensitivity were measured behaviourally in normal adult cats and cats reared with monocular convergent squint from 3, 6, 8, 12, and 24 weeks of age. The visual acuity of the squinting eye was significantly lower than that of the non-squinting eye in cats with squint from 3, 6, and 8 weeks of age. No significant difference in acuity between eyes was found in the 12- and 24-week squinting cats and in the controls.Contrast thresholds at all spatial frequencies tested (range 0.13–2.0 c/ °) were higher in the squinting eye than in the non-squinting eye of cats with squint from 3 and 6 weeks of age, but differences were greater at the higher spatial frequencies. In the 8-week squinting cat, contrast thresholds were increased only at higher spatial frequencies. No significant differences in contrast sensitivity were found in the cat with squint from 24 weeks of age and in the controls.The degree of disturbance of spatial vision in squinting cats was most related to the age at onset of the squint, i.e., the earlier the onset, the more profound the amblyopia. The period of susceptibility extended from about 3 to 12 weeks of age. When compared with data on the development of visual acuity in kittens, the pattern of results from the present study suggests that convergent squint can arrest the development of spatial vision.This work was supported by the M. R. C.     

Posperative radiation therapy for carcinoma of the breast: Improved results with elective irradiation of the chest wall

A review was conducted of all patients with primary cancer of the breast treated by the Radiation Therapy Department of Mount Sinai Medical Center from 1966–1978. The initial surgical procedure was radical mastectomy or modified radical mastectomy for 926 patients. The mean follow-up for this group was 6.42 years, the range was 1–13 years. All postoperative therapy was given with megavoltage equipment. Treatment was directed to either the peripheral lymphatics (internal mammary chain, supraclavicular and axillary apex) or to the peripheral lymphatics fossa and chest wall. The decision to include the chest wall within the treatment volume was based upon the extent of disease at the primary site and the degree of involvement of the axilla. Curves were generated to compare, by stage, control of disease for both postoperative radiotherapy techniques. The expected enhancement of local (regional) control was seen for patients with more advanced disease who received chest wall irradiation. Differences favoring the more comprehensively irradiated group were also seen in disease-free and overall survival for all three stages of disease, with statistically significant benefit in survival analysis for patients with Stage II and III disease. (Stage II-peripheral lymphatic group: 5 years = 54%; 10 years = 36%. Peripheral lymphatic plus chest wall group: 5 years = 71%; 10 years = 49 %.Stage III-peripheral lymphatic group: 5 years = 32%; 10 years = 15%. Peripheral lymphatic plus chest wall group: 5 years = 51 %; 10 years = 38%.) These results imply that microscopic residual disease within the soft tissues of the chest wall can metastasize without necessarily manifesting as regionally recurrent disease. Postoperative irradiation of the chest wall imparts additional survival advantage to a significant percentage of patients treated by radical surgery. Criteria for the inclusion of the chest wall within postoperative radiotherapy fields should be broadened.     

Physiology of the splanchnic circulation

The splanchnic circulation is composed of gastric, small intestinal, colonic, pancreatic, hepatic, and splenic circulations, arranged in parallel with one another. The three major arteries that supply the splanchnic organs, cellac and superior and inferior mesenteric, give rise to smaller arteries that anastomose extensively. The circulation of some splanchnic organs is complicated by the existence of an intramural circulation. Redistribution of total blood flow between intramural vascular circuits may be as important as total blood flow. Numerous extrinsic and intrinsic factors influence the splanchnic circulation. Extrinsic factors include general hemodynamic conditions of the cardiovascular system, autonomic nervous system, and circulating neurohumoral agents. Intrinsic mechanisms include special properties of the vasculature, local metabolites, intrinsic nerves, paracrine substances, and local hormones. The existence of a multiplicity of regulatory mechanisms provides overlapping controls and restricts radical changes in tissue perfusion.