Andrology: Seminal volume and total sperm number trends in men attending subfertllity clinics in the Greater Athens area during the period 1977-1993

The trends for such Important parameters of male fertility asseminal volume and total sperm number were assessed in men livingpermanently in the Greater Athens area over a prolonged periodof time. To this end, the records of three andrological laboratoriesemploying the same method for semen evaluation were analysedretrospectively. Out of 23 850 men examined from 1977 to 1993(17 years) for couple subfertillty, a total of 2385 (10%) wereselected for evaluation by a randomization procedure. Analysisof the data included (i) estimation of mean seminal volume andtotal sperm number per year, (ii) assessment of percentage frequencydistribution for each seminal parameter and (iii) evaluationof seminal volume and total sperm number changes in relationto the year of observation and age of the subjects. A significantdecrease (P < 0.01) of total sperm number was observed overthe years with a mean (± SEM) of 154.3 ± 19.2x 10⁶ at the beginning (1977), dropping to 130.1 ± 13.3x 10⁶ in the final year (1993). Mean seminal volume was lowerin the final year of observation, but its difference from theinitial year value was not significant Frequency distributionanalysis showed a marked decline in the 240–400 x 10⁶sub-set of the range of sperm number values from 16.9 ±4.5% (1977) to 10.6 ± 1.6% in the final year (P <0.01). Multiple regression analysis of seminal volume, totalsperm number, age and year of assessment revealed a significantdecline of the two seminal parameters along the years of observation(P < 0.05 and P < 0.0001 respectively). Over the sameperiod, a marked deterioration of some air pollution indiceswas observed in that area. It is concluded that in this raciallyand ethnically homogeneous sample of men, living under the sameenvironmental conditions, a significant decline in seminal volumeand total sperm number occurred over the 17 years of observation.     

The Spatial QRS-T Angle: Implications in Clinical Practice

The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment of dispersion of repolarization, a key factor in arrythmogeneity.     

Bilateral Hypertensive Retinopathy Complicated with Retinal Neovascularization: Panretinal Photocoagulation or Intravitreal Anti-VEGF Treatment?

Purpose

To present the case of a patient with bilateral hypertensive retinopathy complicated with retinal neovascularization who received anti-VEGF intravitreal injection in one eye and panretinal photocoagulation (PRP) in the fellow eye.

Methods

A 33-year-old male patient presented with gradual visual loss in both eyes for the last 5 months. At that time, he was examined by an ophthalmologist and occlusive retinopathy due to malignant systematic hypertension was diagnosed. He was put on antihypertensive treatment but no ophthalmic treatment was undertaken. At presentation, 5 months later, best-corrected visual acuity (BCVA) was 0.1 in the right eye (RE) and 0.9 in the left eye (LE). Fundus examination was compatible with hypertensive retinopathy complicated with retinal neovascularization. Fluorescein angiography (FFA) revealed macular ischemia mainly in the RE and large areas of peripheral retinal ischemia and neovascularization with vascular leakage in both eyes. The patient was treated with two anti-VEGF (ranibizumab) injections with 2 months interval in the RE and PRP laser in the LE.

Results

Follow-up examination after 12 months showed mild improvement in BCVA, and FFA documented regression of retinal neovascularization in both eyes.

Conclusion

Hypertensive retinopathy can be rarely complicated with retinal neovascularization. Treatment with PRP can be undertaken. In our case, the use of an intravitreal anti-VEGF agent seemed to halt its progression satisfactorily.Key words: Hypertensive retinopathy, Retinal neovascularization, Panretinal photocoagulation, Anti-VEGF     

Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C(3)F(8) without Posturing

Purpose

To report a case of macular hole closure after the exchange of a silicone-oil tamponade with gas C₃F₈ 14%.

Method

A 64-year-old female patient with a stage IV macular hole underwent a three-port pars-plana vitrectomy and internal limiting membrane peeling. Due to the patient''s chronic illness (respiratory problems), a silicone-oil tamponade was preferred. However, the macula hole was still flat opened four months postoperatively. Therefore, the patient underwent an exchange of silicone oil with gas C₃F₈ 14%. No face-down position was advised postoperatively due to her health problems.

Results

Macular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas.

Conclusions

Macular hole surgery using a silicone-oil tamponade has been proposed as treatment of choice for patients unable to posture. In our case, the use of a long-acting gas (C₃F₈ 14%), even without posturing, proved to be more effective.Key Words: Internal limiting membrane peeling, Long-acting gas, Idiopathic macular hole, Vitrectomy, Silicone-oil tamponade     

European vs. Egyptian HCV-4 patients with elevated baseline HCV RNA, treated with PEG-IFN-α2a and ribavirin: the role of rapid and early virologic response

Background and Aims

Despite the recent spread of hepatitis C virus genotype 4 (HCV-4) into European countries, very little is known about the influence of ethnicity on treatment outcomes in patients with HCV-4. The aim of this study was to compare the virologic response (VR) rates of: rapid virologic response (RVR), early virologic response (EVR), VR at 24 weeks of treatment, at end of treatment (EoT), and sustained virologic response (SVR) of European and Egyptian HCV-4 patients.

Methods

Sixty (30 Europeans – Group A; and 30 Egyptians – Group B) chronic HCV-4 subtype A adult patients with elevated baseline viral load (>800 000 IU/m L) were treated for a fixed period of 48 weeks with pegylated interferon α2a (PEG-IFN- α2a) and ribavirin. During the study, HCV-RNA levels were measured at weeks 4,12,24,48 and 72.

Results

Baseline characteristics, including liver histology, were similar in the two groups. RVR, EVR and HCV-RNA at week 24 in Groups A and B were (RVR 26.7% vs. 30.0%) (EVR 23.3% vs. 16.7%) (in week 24 13.3% vs. 16.7%). Overall SVR rates were 36.7% (11/30) for Group A and 26.7% (8/30) for Group B (P = 0.59). For group B, RVR was the weakest indicator for SVR as compared with RVR of group A, where RVR was the best SVR indicator

Conclusions

The overall response to treatment was similar, but ethnic origin or previous history and treatment of schistosomiasis may influence intermediate response rates of chronic HCV-4a infected patients with elevated baseline HCV-RNA.     

Doubtful association of antipsychotic polypharmacy and high dosage with cognition in chronic schizophrenia

Despite consistent recommendations for antipsychotic monotherapy, antipsychotic polypharmacy (the use of two or more antipsychotic agents) and the administration of excessive doses (higher than 1000 mgr/day of chloropromazine equivalents) is a common practice in schizophrenia. The therapeutic and adverse effects of this practice are poorly studied, in particular with regards to the cognitive symptoms of the disease. In this cross-sectional study we investigated the cognitive effects of antipsychotic polypharmacy and excessive doses in 53 patients with chronic schizophrenia using non-verbal cognitive tasks involving speed of movement, memory and executive functions. No significant difference in performance scores was found between the groups under polypharmacy and monotherapy, or the groups receiving either excessive or normal doses of antipsychotics. Since these groups did not also differ in demographic, clinical, other pharmacologic parameters, in the relative anticholinergic potency of antipsychotics, or in intelligence scores, we raise doubts about the association of polypharmacy and excessive doses with non-verbal cognitive performance in chronic schizophrenia.     

Device-associated nosocomial infection rates in intensive care units in Greece.

Site-specific, risk-adjusted incidence rates of intensive care unit (ICU)-acquired infections were obtained through standardized surveillance in 8 ICUs in Greece. High rates were observed for central line-associated bloodstream infection (12.1 infections per 1,000 device-days) and ventilator-associated pneumonia (12.5 infections per 1,000 device-days). Gram-negative microorganisms accounted for 60.4% of the isolates recovered, and Acinetobacter species were predominant. To reduce infection rates in Greek ICUs, comprehensive infection control programs are required.     

Lowering of furosemide dosage after clinical stabilization in patients with congestive heart failure

OBJECTIVES: This study was performed to examine the safety of reducing the long-term doses of furosemide administered to patients with congestive heart failure (CHF) stabilized on a standard medical treatment. METHODS AND RESULTS: Twenty-nine patients with advanced CHF were treated with enalapril, digoxin, nitrates, and furosemide, as needed to alleviate their symptoms, and remained clinically stable for at least 3 months on those doses. Subsequently, the daily dose of furosemide was reduced to 1/3 of the previous dose, while the concomitant therapy was unchanged. All patients underwent a thorough clinical evaluation and right-heart catheterization before and 2 months after the furosemide dose reduction. After the treatment optimization the NYHA functional class decreased from 2.3 +/- 0.6 to 1.4 +/- 0.6 (p = 0.000), and the left ventricular ejection fraction increased from 22 +/- 10% to 32 +/- 13%, (p = 0.000). Clinical and haemodynamic evaluation before and after 2 months of treatment with lower furosemide doses showed that 24 of the 29 patients (83%) remained in a stable NYHA functional class and maintained a stable haemodynamic status. In the remaining 5 patients (17%), mean NYHA functional class increased from 1.8 +/- 0.4 to 2.4 +/- 0.6 (p = 0.07), accompanied by a significant increase of the right and left ventricular filling pressures from 4.2 +/- 2.7 to 9.0 +/- 3.0 mm Hg, p = 0.018 and from 8.6 +/- 3.0 to 19.8 +/- 3.6 mm Hg, p = 0.017, respectively. These 5 patients returned to a stable clinical status upon resumption of the prior doses of furosemide. CONCLUSIONS: Most patients with chronic CHF who were clinically stabilized on high doses of furosemide remained stable on a maintenance dose equal to one-third of the dose needed for their stabilization. Patients unable to tolerate the dose reduction regained their previous clinical status following the resumption of the prior diuretic doses.