Microsurgical treatment of varicocele in outpatients using the subinguinal approach.

BACKGROUND: The aim of this study is to analyze the results of a group of patients who underwent subinguinal microsurgical varicocelectomy using local anaesthesia in one-day-surgery. METHODS: From 1997 to 1998 150 patients were selected from the whole group of patients who underwent surgical treatment for varicocele. The varicocele was always on the left side and the mean age was 27.1 years (range: 16-43). The diagnosis was based on clinical features (testicular pain or scrotal sensation), physical examination and Doppler ultrasound. Where there was infertility with abnormal semen analysis and/or patient's intolerance to the symptoms, surgery was suggested. The patients underwent varicocelectomy by sub-inguinal approach using local anaesthesia. The microsurgical technique of dissection was performed. RESULTS: All operations were performed on an outpatient basis (post-operative stay: 3-7 hours) and the operating time was 20 to 45 minutes. Follow-up was performed by physical examination, doppler ultrasound and semen analysis. Immediate and long-term complications were: 7 (4.7%) transient pain, 3 (2.0%) ecchymosis, 1 (0.7%) transient hydroceles and 1 (0.7%) permanent hydroceles, 2 (1.3%) palpable recurrence, 2(1.3%) doppler recurrence and 1 (0.7%) long-term recurrence, 0 testicular atrophy. 120/150 (80%) patients showed an improvement of semen analysis and 19/41 (46.3%) patients with infertility achieved a pregnancy with the partner. CONCLUSIONS: Microsurgical treatment of varicocele in outpatients by subinguinal approach is a safe and reliable procedure. It is performed in local anaesthesia, preserves the lymphatics, spermatic artery and vas and in our experience showed an improvement of semen analysis and pregnancy rates with minimal morbidity.     

Phenotypic markers and BCL-1 gene rearrangements in B-cell chronic lymphocytic leukemia: a Cancer and Leukemia Group B study

The markers, CD11b, CD11c, CD14, CD21, CD23, CD25, CD38, and FMC7 were correlated with morphologic and other laboratory and clinical characteristics of 127 patients with untreated CD5+ chronic lymphocytic leukemia (CLL). Only CD38 and CD21 were significantly associated with atypical CLL morphology. The integrin associated markers CD11b and CD11c were associated with lower leukocyte count (white blood cell count [WBC]) and lower Rai stage. By contrast, the activation antigen CD23 was associated with a higher WBC, higher Rai stage, younger age group, and the presence of lymphadenopathy. Therefore, we conclude that CD23 positivity may reflect a more aggressive form of CLL, and CD11b and CD11c positivity a less aggressive form. The BCL-1 gene rearrangement was present in 5 of 84 (6%) CLL cases examined and was associated with atypical morphology and surface expression of CD11b. Patients with a BCL-1 gene rearrangement may represent a CLL subset or possibly a different B-cell disease.     

Interleukin-4 improves white matter integrity and functional recovery after murine traumatic brain injury via oligodendroglial PPARγ

Long-term neurological recovery after severe traumatic brain injury (TBI) is strongly linked to the repair and functional restoration of injured white matter. Emerging evidence suggests that the anti-inflammatory cytokine interleukin-4 (IL-4) plays an important role in promoting white matter integrity after cerebral ischemic injury. Here, we report that delayed intranasal delivery of nanoparticle-packed IL-4 boosted sensorimotor neurological recovery in a murine model of controlled cortical impact, as assessed by a battery of neurobehavioral tests for up to five weeks. Post-injury IL-4 treatment failed to reduce macroscopic brain lesions after TBI, but preserved the structural and functional integrity of white matter, at least in part through oligodendrogenesis. IL-4 directly facilitated the differentiation of oligodendrocyte progenitor cells (OPCs) into mature myelin-producing oligodendrocytes in primary cultures, an effect that was attenuated by selective PPARγ inhibition. IL-4 treatment after TBI in vivo also failed to stimulate oligodendrogenesis or improve white matter integrity in OPC-specific PPARγ conditional knockout (cKO) mice. Accordingly, IL-4-afforded improvements in sensorimotor neurological recovery after TBI were markedly impaired in the PPARγ cKO mice compared to wildtype controls. These results support IL-4 as a potential novel neurorestorative therapy to improve white matter functionality and mitigate the long-term neurological consequences of TBI.     

在印度献血者中真正的HIV血清阳性率

在1992年印度政府筹建了国家AIDS病控制署(NACO),它从属于卫生部,作为国家预防AIDS传播的一个关键机构。NACO近期报告表明在一些人群中HIV感染已经到了非常高的警戒水平。如异性性乱者中HIV阳性率38.2％,献血者中8.2％,疑似AIDS病例17.5％,静脉注射毒品者4.9％和其他27.7％。这些数据来源于国内55个HIV血清监测中心。印度一般人群中HIV总血清阳性率,1995年为7/1000,1996年16.5/1000,1997年21.1/1000。HIV感染的增长趋势表明该疾病在社会上迅速传播。然而上面有此数据多和难以置信。例如献血员中达到8.2％。但这些献血者可能不是真正的自愿献血者。由于仅作HIV EIA一次检测,就可能出现假阳性。但是,HIV感染率存     

ISOENZYME CHANGES OF LACTATE DEHYDROGENASE IN PSORIATIC ERYTHROCYTES

SUMMARY. The distribution of LDH-isoenzyme fractions in erythrocytes in psoriasis was investigated. The results indicate a shift of enzymatic activity towards the anodic isocomponents LD₂ and LD₁ and thus to enhanced energy production by oxidation in psoriatics as compared with normal controls. The authors claim that these findings support their previous reports describing metabolic deviation with enhanced glucose-degradation through the oxidative processes of the pentose (hexosemonophosphate) cycle.     

Carpal avascular necrosis: MR imaging

The authors evaluated the use of magnetic resonance (MR) imaging in diagnosis of avascular necrosis (AVN) of carpal bones by examining 21 patients with wrist pain and two healthy volunteers. MR images were compared with conventional radiographs in every case and with bone scintigrams in 18 cases. MR imaging was slightly less sensitive than bone scintigraphy in depicting AVN, but in patients who were imaged with long repetition time (TR)/long echo time (TE) sequences in addition to short TR/short TE sequences, MR imaging was found to be more specific. While the authors believe that bone scintigraphy remains the screening test of choice for patients with wrist pain and normal plain radiographs, MR imaging promises to add significant diagnostic information in cases in which bone scans are abnormal.     

Routine quantitation of white cells as low as 0.001 per microL in platelet components

A method is described for routine quantitation of very low numbers of white cells (WBCs) in platelet components, using flow cytometry and dual nucleic acid stains. The WBC quantitation is based on the detection of nucleated cells labeled with propidium iodide and thiazole orange, with chicken red cells added as an internal counting standard. Platelet concentrates containing 0.001 to 1500 WBCs per microL (2 × 10(2)-3 × 10(8) WBCs/component) and 600 to 2800 × 10(3) platelets per microL were analyzed for the number of contaminating WBCs. The method was found to be linear throughout the 7 log10 range and to have sufficient reproducibility and sensitivity for routine analysis of WBC- reduced platelet concentrates.     

Minimally invasive surgery for esophageal cancer

Background: Esophageal cancer is among the most deadly cancers worldwide, and esophagectomy remains the standard of care in trying to cure this. Efforts to decrease the incidence of complications in esophagectomy without compromising the efficacy of the procedure have stimulated interest in minimally invasive esophagectomy (MIE), and a wide variety of MIE techniques have been refined by surgeons at specialized centers worldwide. Data sources: Systematic PubMed searches identified articles related to MIE technique, complications, and outcomes. Conclusions: Several techniques have been developed for MIE, none of which has been deemed superior, but as a whole, they represent a safe alternative to open surgery. Available results from case series and comparative studies suggest trends towards improved short‐term outcomes with equivalent efficacy but without definitive advantages.