Endoscopy in colonic volvulus.

Flexible fiberoptic gastrointestinal endoscopy has greatly simplified the diagnosis and treatment of colonic volvulus. The management of 39 patients with colonic volvulus treated over 9 years was reviewed. Five per cent were treated with rectal tube decompression alone, 23% were treated with either sigmoidoscopic or colonoscopic reduction, and 26% were treated exclusively with operation. Endoscopic reduction was attempted in nearly half of the patients in preparation for operation. Recurrent volvulus occurred in 57% of patients initially treated with endoscopic reduction alone. Sigmoidoscopic examination did not confirm the diagnosis in 24% of instances in which it was used, although colonoscopy was always diagnostic. The overall mortality rate was 8%, but increased to 25% in patients with gangrene of the colon. Three patients who later proved to have gangrene of the colon had a normal initial sigmoidoscopic examination. Two of these patients died of intra-abdominal sepsis from a perforated colon. In five patients an accurate endoscopic diagnosis of gangrene prompted immediate exploration. None of these patients died. Endoscopy is a safe and effective diagnostic tool for the initial evaluation of patients with suspected colon volvulus. In addition, endoscopy may result in therapeutic decompression and may provide visual assessment of the viability of the bowel mucosa, thus assisting in the timing of appropriate operative treatment.     

Induced luteolysis in the primate: rapid loss of luteinizing hormone receptors

The molecular mechanisms involved in luteolysis are still unclear in the primate. This study aimed to investigate the effect of induced luteolysis on the ovarian luteinizing hormone (LH) receptor and the steroidogenic enzyme, 3beta-hydroxysteroid dehydrogenase (3beta-HSD) in the marmoset monkey. Luteolysis was induced in the mid-luteal phase either directly by systemic prostaglandin F2alpha (PGF2alpha), or indirectly by LH withdrawal using systemic gonadotrophin releasing hormone antagonist (GnRHant) treatment. The LH receptor was studied by isotopic mRNA in-situ hybridization and in-situ ligand binding and 3beta-HSD expression was studied using isotopic mRNA in-situ hybridization and immunohistochemistry. Induced luteolysis was associated with a reduction in the expression of LH receptor (P < 0.0001) and 3beta-HSD mRNA, closely followed by a reduction in the LH receptor (P < 0.05) and 3beta-HSD protein concentrations within 24 h. There were no differences in the findings whether luteolysis was induced with PGF2alpha or GnRHant. This study shows that disparate mechanisms to induce luteolysis in the primate result in an identical rapid loss of the LH receptor and 3beta-HSD. In conclusion, induced luteolysis leads to rapid loss of the steroidogenic pathway in luteal cells.      

Semen parameters and testicular pathology in men with testicular cancer and contralateral carcinoma in situ or bilateral testicular malignancies

We evaluated 14 patients with bilateral testicular tumour, one-sided tumour and contralateral carcinoma in situ (CIS) of the testis or testis tumour in single testis with respect to their fertility. We analysed semen parameters, serum hormones [follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone], testicular sonography, testicular volumes and testicular histology prior to further anti-cancer treatment. Ten out of 14 patients showed normal or reduced sperm concentrations, while 4/14 patients were azoospermic. Serum FSH levels showed a significant negative correlation with sperm concentrations in patients with testicular malignancies (r = -0.64, P = 0.025). Testicular volumes revealed a significant positive correlation with semen parameters in patients with testes that were affected by CIS (r = 0.733, P = 0.038). We conclude that even bilateral testicular cancer and/or CIS do not preclude fertility and, therefore, patients should be offered andrological investigation and therapy, including possibly surveillance strategy or the chance for cryopreservation of the semen prior to further treatment in order to preserve their chances for paternity.