Prednisolone for post torsional azoospermia

A 24 year old medical student showed azoospermia on semenalysis performed after testicular fixation done within 12 hours of torsion. Patient's anxiety demanded treatment. Prednisolone rapidly improved the count to 30 million per ml at four weeks and though Prednisolone was discontinued, the count continued to rise and was 56 million per ml 6 months later

Sertoli cell only syndrome [SECOS]: lessons from case studies

Between June 85 and December 87, 69 testicular biopsies were submitted for histopathological examination during investigation of infertility; ten [14%] patients had a Sertoli cell only syndrome. The history, clinical features, and hormonal profiles were analyzed in an attempt to categorize these patients on aetiological basis. Two followed treatment of malignancy - one by radiation for testicular cancer and one by cyclophosphamide for a lymphoma. One had unilateral cryptorchidism. Mumps was etiological factor in one patient. FSH levels determined in 6 patients were elevated in all suggesting a possible dependence of [sick] Sertoli cells on spermatogenic cells for production of inhibin. Alternative explanations include changes in sertoli cell enzymes or FSH receptors. Testosterone levels are in the low normal range suggesting that Leydig cells may also be affected by the etiological factor producing the syndrome. Two patients who had earlier received a higher Johansen score were found to have a sertoli cell only syndrome on expert review of testicular biopsies. It is suggested that the condition is more common than hitherto reported and is often confused with maturation arrest. Testicular histopathology should be done by specialists in testicular pathology

Indomethacin in male infertility: effectiveness and predictors of response

Prostaglandins [PG] inhibit testosterone synthesis and spermatogenesis. Indomethacin [a PG synthase inhibitor] has been used in male infertility but improves the sperm count in only a proportion of patients. The present study was done to determine parameters which will predict a favourable response to Indomethacin [In]. 21 infertile males were given 25 mg. In three times a day for 12 weeks. Pre and post treatment semenanalysis levels were compared. Pre treatment FSH, LH and Prolactin [PRL] levels and level of Endogenous Inhibitors of Platelet Aggregation [EIPA] and endogenous inhibitors of lipooxygenase [EILO] were also determined. In 11 [52.4%] patients sperm counts improved. 19.1% patients showed improvement at six weeks with a decline of sperm count at 12 weeks. 6 [29%] patients showed improved motility. Oligospermics responded better than azoospermics. Of the three patients with varicocele who were not treated by operation, two responded. The mean FSH and LH were lower [and in the normal range] in the responders to In therapy. The mean T was lower [and the lower end of T range] in patients who responded. Only one azoospermic responded to therapy. There was no statistical difference in the mean EIPA and EILO levels of responders and non-responders. Indomethacin raised sperm counts in patients with normal FSH and LH and low T levels. EILO and EIPA do not have predictor value. Indomethacin will be ineffective in most patients with azoospermia, and raised FSH levels. The role of In in varicocele therapy needs to be explored

persistent mullerian duct syndrome - a management problem

Two patients with internal male pseudoherma-phroditism, characterized by the persistence of mullerian derivatives in phenotypic male are reported, and current literature reviewed

Nutritional parameters predicting postoperative infections

Thirteen nutritional parameters viz body mass index [BMI], mid arm circumference [MAC], mid calf circumference [MCC], triceps skin fold thickness [TST], abdominal skin fold thickness [ASFT], abdominal girth at umbilicus [AGU], haemoglobin [Hb], total leucocytes count [WBC], absolute lymphocyte count [ALC], serum proteins [Prot], serum albumin [Alb], serum total iron binding capacity [TIBC] and serum iron [Fe] were estimated in 52 [36 male and 16 female] consecutive patients admitted to a surgical service at the Abbasi Shaheed Hospital, Karachi. Nine males and one female developed surgical infections whilst the wounds of 27 males and 15 females healed by primary intent. There was a significant difference in the values of BMI, MCC, ASFT, Prot., and Alb between the patients with infected and clean wounds. Whilst MCC was significantly different, MAC was not as good a differentiator. Whilst Prot. and Alb were lower in the infected group, BMI, MCC, TST, ASFT were higher in the patients whose wounds healed by primary intent

Pediatric surgical admissions at the Holy Family Hospital [1970-1979]

The pattern of pediatric surgical admissions to a privately owned 225 bed hospital without a specialized pediatric surgeon was studied over a ten year period [1970-1979]. Of the total 87,876 admissions, 24% [17,574] were pediatric and 6% [1,186] of these were admitted for surgical reasons. The most common admissions were for tonsillectomy and adenoidectomy [66 patients], circumcision [134 admission; excludes circumcisions done on outpatients and newborns], closed and open reduction for fractures and dislocations [110], incision and drainage of abscesses [82], operations for hernia, hydroceles and undescended testes [71], burns [60], crush injuries [39] and intestinal obstruction [43]. Diseases of the kidney and ureter accounted for 31, hydrocephalus and meningocele for 31, head injuries for 27, cleft lip and palate for 26 and appendicitis for 26 admissions. It is felt that a study of the spectrum of disease affecting children [and needing admission to surgical ward in a general hospital] will be helpful in evolving curricula and training strategies for comprehensive [general] surgeons

Low cost nutritional assessment of surgical patients in third world countries

Nine nutritional parameters, viz; height, weight, maximal arm circumference [MAC], triceps skin fold thickness [TST], maximal calf circumference [MCC], abdominal girth at umbilicus [AGU], hemoglobin, total WBC count and absolute lymphocyte count were measured in 22 male and 16 female surgical inpatients admitted to the surgical and gynaecological services of the Holy Family Hospital. These variables were compared with the values obtained from 22 male and 19 female volunteer controls, and with Western norms. Randomisation was ensured by including all patients present in a ward area or subdivision on a particular day of study. The only exclusions were patients on traction, patients with plasters, and critically ill patients. Patients admitted to general ward, semi-private rooms and private rooms were all included in the study