TREATMENT OF PATIENTS WITH RETROGRADE EJACULATION IN THE ERA OF MODERN ASSISTED REPRODUCTION TECHNOLOGY

Purpose

We determined a rational strategy for treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology.

Materials and Methods

In 7 consecutive patients medical treatment or retrieval of spermatozoa from the bladder was performed at a male infertility clinic.

Results

Antegrade ejaculation was restored in 3 patients, and spermatozoa were retrieved from the bladder and used for assisted reproduction in 3. Spermatozoa with good oolemma penetrating ability were collected by seminal vesicle massage.

Conclusions

Modern assisted reproduction technology is a powerful treatment option for retrograde ejaculation when combined with a technique to retrieve spermatozoa of good quality from the bladder.     

MUC-1 mucin expression in invasive areas of intraductal papillary mucinous tumors of the pancreas

The expression of MUC-1 mucin (membrane-associated mucin) and MUG2 much (secretory mucin) were immunohistochemically examined in 46 invasive ductal carcinomas (IDC) and 16 intraductal papillary mucinous tumors (IPMT) of the pancreas. lntraductal papillary mucinous tumors usually reveal expansive growth. However, of the 16 IPMT examined in the present study, three showed an invasive growth pattern, which was similar to 'mucinous carcinoma', around the non-invasive growth areas. Of 46 IDC, MUCl much detected by monoclonal antibodies, DF3 and MY.1E12, was expressed in 44 cases (96%) and in 45 cases (98%), respectively, whereas MUC-2 mucin detected by polyclonal antibody, anti-MRP, was not expressed in any of the cases (0%). In contrast, in the non-invasive growth areas of the 16 IPMT, MUG1 much detected by DF3 and MY.1 E12 was expressed in four cases (25%) and in six cases (38%), respectively, whereas MUG2 mucin detected by anti-MRP was expressed in 13 cases (81%). The invasive growth areas of the three IPMT showed positive expression of MUG-1 mucins detected by DF3 and MY.1E12, although the non-invasive growth areas showed negative expression of MUG1 muclns, except for their focal positive expression in one of the three cases. These findings indicate that the invasive growth areas of IPMT acquire a characteristic of MUC-1 much expression that is usually seen In IDC.     

Developmental changes in mucosubstances revealed by immunostaining with antimucus monoclonal antibodies and lectin staining in the epithelium lining the segment from gizzard to duodenum of the chick embryo

The mucosubstances in the epithelium lining the segment from gizzard to duodenum during development of the chick embryo was studied histochemically using monoclonal antibodies against gizzard mucus and lectins, with attention to the regional differentiation of the epithelium in this segment. The anterior limit of epithelial CdxA mRNA expression detected by in situ hybridisation, which served as the position of the gizzard-duodenal boundary, was clearly found from d 3. Granules positive for some antibodies or lectins were found in the region ranging from the posterior part of the gizzard to the duodenum at d 3, which was followed by an increase in the number of granules and a gradual enlargement of the granule-positive area to the anterior part of the gizzard over 4–6 d. From d 4, the epithelia of the gizzard body and of the pyloric or duodenal region came to be differently stained with some antibodies or lectins. From d 10, each region showed a specific pattern of staining. The epithelia of the gizzard body and pyloric region contained abundant mucus granules with a different staining pattern. In the duodenum the number of stained granules was low except in occasional goblet cells. Thus the epithelia of the gizzard body, pyloric region and duodenum may produce different mucosubstances and the regional differentiation in these epithelia may start at rather early stages soon after the formation of digestive tube.     

Stromal invasion of the prostate following a complete response to bacillus Calmette-Guerin instillation therapy for carcinoma in situ of the ureter and the bladder

Bacillus Calmette-Guerin (BCG) instillation therapy is now a standard therapy for high-risk superficial bladder cancer patients. Although the complete response rate is approximately 70%, extra-vesical progression is sometimes observed. In particular, those patients who present a positive urinary cytology even after complete response from bladder lesion should be thoroughly examined. We present two cases of stromal invasion of the prostate after complete remission by BCG therapy of carcinoma in situ of the ureter and bladder found by transrectal prostate biopsy.     

Effect of sildenafil on arterial stiffness, as assessed by pulse wave velocity, in patients with erectile dysfunction

BACKGROUND: The problems of patients with erectile dysfunction have been recognized, leading to the emergence of sildenafil, which has led to successful treatment in many cases. The purpose of this study is to examine the effect of sildenafil on the pulse wave velocity of patients with erectile dysfunction. METHODS: Fifteen patients with erectile dysfunction were enrolled for this study. The brachial/ankle pulse wave velocity was determined before dosing and at 30, 60, 120, and 180 min after dosing with 25 or 50 mg of sildenafil citrate. Concurrently, the changes in blood pressure, heart rate, and brachial/ankle pulse wave velocity were measured. For the consideration of revised brachial/ankle pulse wave velocity by blood pressure, the systolic blood pressure-derived brachial/ankle pulse wave was also investigated, and we classified and examined those results with and without risk factors for arteriosclerosis. RESULTS: The systolic blood pressure decreased significantly at 60 min after dosing compared with the placebo control. The heart rate decreased at 120 min after dosing compared with the placebo control but that decrease was not significant. The brachial/ankle pulse wave velocity transiently decreased at 30 or 60 min after dosing compared with the placebo control, but the decrease was not significant; however, the systolic blood pressure-derived brachial/ankle pulse wave velocity decreased significantly. In those patients with risk factors for arteriosclerosis, the pulse wave velocity decreased significantly. CONCLUSION: In patients with erectile dysfunction who were administered sildenafil, the pulse wave velocity, along with blood pressure, tended to decrease transiently after dosing. There is a possibility that sildenafil affects the improvement of erectile dysfunction via the decrease of pulse wave velocity, especially in patients with risk factors for arteriosclerosis.     

Significance of renal function in changes in acid–base metabolism after orthotopic bladder replacement: Colon neobladder compared with ileal neobladder

BACKGROUND: The objective of this study was to determine whether renal function influences the acid-base metabolism in patients undergoing orthotopic bladder replacement using intestinal segment. METHODS: Acid-base balance, serum electrolytes and renal function were studied in 30 patients with colon neobladder and 18 patients with ileal neobladder. Mean follow up was 51 months. Effects of renal function on acid-base metabolism in both types of bladder replacement were compared. Therapeutic efficacy of the sodium bicarbonate administration was also evaluated in cases with hyperchloremic acidosis. RESULTS: No significant differences were observed in any of the variables examined between the colon and ileal neobladder groups, except for potassium concentration. Although metabolic acidosis was detected using the Siggard-Anderson acid-base nomogram in eight (26.7%) and seven (38.9%) patients in the colon and ileal neobladder groups, respectively, this difference was not significant. In both the colon and ileal neobladder groups, the serum creatinine concentrations in patients diagnosed with metabolic acidosis were significantly higher than in those diagnosed with a normal metabolic status. Furthermore, as a result of severe metabolic acidosis, three (10.0%) and three (16.7%) patients in the colon and ileal neobladder groups, respectively, were administered sodium bicarbonate and their metabolic status was fully normalized. CONCLUSIONS: Despite there being no statistical difference, patients with ileal neobladder may more easily develop metabolic acidosis compared with those with colon neobladder. In addition, a close association between the serum creatinine level and the degree of metabolic acidosis was observed in both groups. However, even if severe metabolic acidosis occurs, it is relatively easy to correct using sodium bicarbonate. These findings suggest that it might be safe to use a colon segment for orthotopic bladder reconstruction in patients with higher serum creatinine levels, despite no significant difference in acid-base metabolism and detection rates of metabolic acidosis between the colon and ileal neobladder groups.     

Benign and neoplastic eosinophilic staining cells: an immunofluorescence study

Deposition of immunoglobulins, complement and fibrinogen on eosinophilic staining cells was investigated using direct immunofluorescence techniques. Serum factor deposition was detected on benign epidermal eosinophilic cells seen in pityriasis lichenoides et varioliformis acuta, sunburn erythema and, in addition, on subepidermal hyaline bodies in lichen planus; no such deposition occurred on neoplastic eosinophilic cells in Bowen's disease and squamous cell carcinoma. The qualitative findings of immunofluorescence microscopy seem to be different in inflammatory and malignant dermatoses.     

THE SIGNIFICANCE OF THE DIFFERENCE IN BACTERIAL ADHERENCE BETWEEN BLADDER AND ILEUM USING RAT ILEAL AUGMENTED BLADDER

OBJECTIVES: Intestinal segments are frequently used in the reconstruction of the urinary tract. Chronic bacteriuria is frequently observed in these patients, but the reason is not clearly understood. Therefore, we studied the difference in bacterial adherence between bladder and ileum using the rat ileal augmented bladder model to investigate the cause of chronic bacteriuria. MATERIALS AND METHODS: Augmentation of the bladder using ileum and a sham operation were performed under sodium pentobarbital in 102 and 10 Sprague-Dawley rats, respectively. At three months after the operation, urinary pH and plasma concentration of sodium, chloride and potassium were measured and urinary culture was done. Urovirulence factors of Escherichia coli aspirated from augmented bladder were detected by polymerase chain reaction (PCR). Five to six rats with negative urinary cultures after the augmentation were used for each experimental cystitis. E. coli with type I pili aspirated from augmented rats and three clinically isolated strains of E. coli, C5 (type I pili, aerobactin), C92 (type I pili, aerobactin, P fimbriae), and C189 (type I pili, aerobactin, P fimbriae, CNF), were transurethrally inoculated into the augmented bladder of rats. Fourteen days after inoculation, rats were sacrificed and colony-forming units (CFU) per mg. of tissue of bladder and ileum were measured. RESULTS: After operation, urinary pH and the serum level of chloride in all augmented groups were higher than those of the controls. Bacterial colonization was observed in 56 of 89 rats. Most of them were E. coli having only type I pili as a virulence factor. In contrast, the sham operated group revealed no bacterial colonization. In experimental cystitis, E. coli with only type I pili aspirated from augmented rats and E. coli C5 were clearly adhered to ileum rather than to bladder, but E. coli C92 and C189 showed no significant difference with respect to adherence to the two tissues. In experimental cystitis II, E. coli C5 with D-mannose were washed out in 3 of 5 rats by 14 days, while E. coli C5 without D-mannose were not washed out in all rats by 14 days. CONCLUSIONS: These results suggested that the difference in bacterial adherence due to urovirulence factors, especially type I pili, is one of the main causes of asymptomatic bacteriuria after urinary reconstruction.     

Infertility and HLA Antigen — Male Infertility and Infertile Couples —*

Infertilität und HLA-Antigene — männliche Sterilität und unfruchtbare Ehepaare — Aufgrund der Vorstellung, daß immunogenetische Faktoren beim Auftreten unerklärter männlicher Sterilität, der sog. idiopathischen Sterilität, eine Rolle spielen, wurden HLA-Antigenanalysen durchgeführt (1) an Fällen von Azoospermie bei unfruchtbaren männlichen Patienten, bei denen Hodenbiopsien die Diagnose einer Keimzellenaplasie ergaben, und (2) an ungeklärten Fällen unfruchtbarer Ehepaare. Die Ergebnisse waren wie folgt: (1) Die Erfassungshäufigkeit der verschiedenen HLA-Antigene am Locus A der Azoospermie-Fälle mit Keimzellenaplasie unterschied sich nicht von jener der Kontrollfälle, es zeigte sich jedoch ein signifikanter Anstieg vom BW 35 am Locus B (korrigierter p-Wert < 0,017). (2) Bei unerklärten Fällen unfruchtbarer Ehepaare stimmte die Häufigkeit der Antigene am Locus B weitgehend mit der der Kontrollfälle überein, aber es ergab sich eine signifikant höhere Häufigkeit von BW 35 am Locus B. Einen wichtigen Untersuchungsgegenstand hinsichtlich der Korrelation zwischen Sterilität und HLA-Antigenen werden daher in Zukunft die HLA-D Loci auf der Grundlage ihrer Beziehung zu BW 35 bilden.