Successful management of infertility due to retrograde ejaculation using assisted reproductive technologies: a report of two cases

Although retrograde ejaculation is a relatively uncommon cause of infertility, it is nonetheless the most common cause of ejaculatory dysfunction. Retrograde ejaculation is characterized by either all or part of the seminal fluid going into the bladder. The initial management of patients with ejaculatory dysfunction is medical therapy. In couples who have failed medical therapy, assisted reproductive techniques using sperm harvested from either the urine or the male reproductive tract would be the ultimate option. We report successful management of two couples, both men with advanced age and complete retrograde ejaculation, by intrauterine insemination in one and in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI) in the other using sperm harvested from urine. The cases reported herein suggest that male infertility due to retrograde ejaculation may be successfully treated in men significantly older than the usual reproductive age and that traditional methods of hydration and urine alkalinization allow for the successful recovery of fertile sperm for ART. The selection of the method of ART must be individualized to the needs of each couple based upon both male and female factors.     

Assessment of cardiac wall motion and ejection fraction with gated PET using N-13 ammonia

BACKGROUND: Cardiac gating is not routinely used in cardiac positron emission tomography (PET). The aim of this study was to determine the feasibility of assessing regional wall motion, ejection fraction (EF), cardiac volumes, and mass with nitrogen-13 ammonia (N-13 ammonia) at the time of PET myocardial perfusion imaging. METHODS: We studied 12 healthy volunteers (mean age, 28 +/- 8 years) and 53 patients with documented coronary artery disease (CAD) (mean age, 59 +/- 11 years). All subjects received a single administration of approximately 600 MBq (16 mCi) of N-13 ammonia intravenously. A 6-minute dynamic scan was performed for quantitative assessment of myocardial perfusion at rest, followed by a separate, 13-minute static scan acquired in the gated mode (8 equal bins). Gated data was imported into the Emory Toolbox. Wall motion was evaluated by dividing the myocardium into 9 anatomic regions graded semiquantitatively. RESULTS: Healthy volunteers had a normal EF (61 +/- 6), end systolic volume (ESV) (37 +/- 15 mL), end diastolic volume (EDV) (89 +/- 25 mL), and cardiac mass (116 +/- 18 g). In contrast, patients with CAD showed reduced EF (32 +/- 13%) and increased ESV (129 +/- 56 mL), EDV (188 +/- 68 mL), and cardiac mass (173 +/- 45 g) (P < 0.001 for each). In patients with CAD, EF measured by gated PET correlated significantly to independent measurements of EF (P < 0.001). CONCLUSIONS: Gating of cardiac perfusion images obtained after administration of N-13 ammonia is feasible and appears to be an accurate means of evaluating regional and global cardiac function. Gating can provide important additional diagnostic and prognostic information.     

Diagnosis of orthopedic infection in clinical practice using Tc-99m sulesomab (antigranulocyte monoclonal antibody fragment Fab'2)

OBJECTIVE: The aim of the study was to analyze the use of Tc-99m-labeled antigranulocyte monoclonal antibody fragment Fab'2 (SMab, Leukoscan) in the diagnosis of acute osteomyelitis and articular prosthesis infection. One hundred seventeen patients (118 studies) have been included, 92 women and 25 men. Thirty-seven had a suspicion of osteomyelitis and 81 with suspicion of infection of a hip (35 patients) or a knee (45 patients) prosthesis. The mean age was 64 years. A 3-phase bone scan and a SMab scan were obtained in all patients. Antigranulocyte scans were obtained within 3 and 8 hours postinjection of 20 mCi (740 MBq) of Tc-99m-labeled antibody. Diagnosis of infection was based on bone biopsy in 8 cases and on at least 2 positive cultures in the remaining cases. Infection was ruled out with negative cultures or 1-year patient follow up with negative C-reactive protein and normal erythrocyte sedimentation rate. RESULTS: Sensitivity, specificity, accuracy, and negative predictive value of Tc 99m-SMab scintigraphy were: 75%, 95%, 87%, and 92% for long bone osteomyelitis and 80%, 89%, 87%, and 91% for articular prosthesis infection, respectively. Positive predictive values were 83% and 63%, respectively. CONCLUSION: Tc-99m-antigranulocyte monoclonal antibody fragment Fab'2 scintigraphy seems to be a useful method in the diagnosis of osteoarticular infection.     

Hepatic allograft arterialization by means of the gastroduodenal bifurcation (branch patch) as a prognostic factor

INTRODUCTION: Because of the current shortage of cadaveric organs, it is important to determine preoperatively those variables that are readily available, inexpensive, and noninvasive that can predict a higher incidence of hepatic artery thrombosis (HAT). MATERIAL AND METHODS: From April 1986 to October 2001, 717 patients underwent 804 liver transplants. All the arterial reconstructions were performed with fine (7-0) monofilament sutures in an interrupted fashion. Two methods were used: group I, end-to-end arterial anastomosis, and group II, the gastroduodenal branch patch. RESULTS: After a mean follow-up of 72 (range 3-174) months, HAT was observed in 19 patients (overall incidence 2.4%). End-to-end anastomosis (group I) was performed in 39.50% (316) of cases, and HAT developed in 14 (4.4%) cases. Branch-patch anastomoses (group II) were carried out in 60.5% (488) of the patients; the presence of HAT was detected in five cases (1.03%) (P = 0.03, P < 0.05). A total of 21 variables were selected in the univariate analysis; however, after the multivariate analysis, all but two of the factors lost statistical significance, and these corresponded to the type of arterial reconstruction (gastroduodenal branch patch vs. end-to-end) and the ABO compatibility. CONCLUSIONS: Liver transplantation with compatible grafts using branch-patch anastomosis for the arterialization (both manipulative by the transplant team) reduces HAT-derived loss of grafts, with the consequent increase in graft availability and reduced mortality rate on the waiting list.     

Organs transplanted from intoxicated donors

PURPOSE: The purpose of our study was to evaluate short- and long-term results of transplants from cadaver donors who have died of poisoning by various substances. MATERIALS AND METHODS: The actuarial survival rate of organs from intoxicated donors was calculated using the Kaplan-Meier method. RESULTS: Among the 507 donors between January 1998 and December 2002, 5 (0.98%) had a cause of brain death of poisoning, namely, organo-phosphates (n = 2), methanol (n = 1), cyanide (n = 1) and acetylsalicilic acid(n = 1), from whom were procured 10 kidneys, 1 liver, 2 corneas, and 1 set of bones. The follow up for patients receiving solid organs was 15.2 months (range, 0-48 months). At 3 months, 90% of kidneys had normal function. No delayed graft function rejection episodes or major complications were reported in any recipient. None showed evidence of acute or chronic poisoning. Two died, 1 early mortality was due to anesthetic complications and the other at 17 months to an unknown cause. Actuarial kidney survival rates were 90% and 80% at 12 and 24 months, respectively. The liver recipient was well at the end of follow up. CONCLUSION: Using organs of poisoned donors is feasible with comparable graft survival rates to other recipient.     

Do we need living unrelated organ donation in Brazil?

The remarkable success achieved by organ transplantation has also engendered the major problem of organ shortage. As a consequence, the use of living unrelated donors (LURD) has been proposed as an ethically justifiable alternative for developed nations to minimize their waiting lists for organ transplantation (OTx). This change in attitude has caused an ethical dilemma for developing countries like Brazil, which is struggling to increase the cadaver donor pool. Due to a huge socioeconomic gap of values and needs among nations, the incentive to use LURD in developed countries may not only produce a disincentive to cadaver organ donation but also stimulate organ trade in developing countries. In this paper we aimed to show that in Brazil, we do not need to use LURD because we have not optimized our cadaver donor pool. The exploitation of LURD might be a good option for developed countries, but it is not useful for developing countries. The Transplantation Society urgently needs to solve and clarify this problem by establishing basic ethical and justice principles that can serve as a guide for every country, throughout the entire process required, to achieve an adequate pool of cadaver donors.     

Xenotransplantation of human decay accelerating factor transgenic porcine kidney to non-human primates: 4 years experience at a Canadian center

From July 1999 to December 2002, a total of 27 baboons underwent transplantation with human decay accelerating factor (hDAF) transgenic porcine kidneys. The immunosuppressive protocol included combinations of 1 or more of the following immunosuppressive agents: cyclosporine, TPC, cyclosphophamide, methylprednisolone, GAS914 (a polymeric alpha-Gal), rabbit antithymocyte serum (RATS), and rapamycin derivative (RAD). The animals were followed up clinically with monitoring of renal function based on daily creatinine and urinary output. Histopathological examination of the tissue samples was performed after paraffin embedding. Electron microscopy was performed on occasion. All pathology was read blindly with a semiquantitative scoring method to assess the presence or absence of histological features of xenotransplant rejection. Mean survival time was 20.7 days (range, 4-75 days) with 15 animals dying of classic humoral rejection and 12 dying of complications unrelated to rejection. The most frequent complications were as follows: chronic diarrhea with malabsorption, bleeding diathesis, infections, and drug toxicity. Irrespective of the immunosuppressive regimen, a significant number of baboons (10) developed untreatable diarrhea and gastrointestinal bleeding. Samples of their gastrointestinal tracts showed evidence of varying degrees of necrotizing vasculitis with immunoglobulin (Ig)G,IgM, and fibrin deposition. The survival in pig-to-baboon kidney xenotransplantation continues to be limited by acute xenograft rejection and complications of immunosuppression. Although significantly increased survivals have been obtained, an ideal protocol has not yet been achieved. Efforts will continue in an attempt to develop a protocol with minimal complications and long-term survival beyond 90 days.