Totally transanal laparo-endoscopic single-site proctocolectomy-lleoanal j-pouch [TLPC-J]: an experimental study of a novel approach

Background: The natural orifice transluminal endoscopic surgery [NOTES] has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch [TLPC-J] is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy

Method: Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA and sutured to the rectal wall

Results: All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis

Conclusion: The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early

Overweight and obese men are more prone to infertility-myth or fact?

To investigate the association of sub-fertility/ infertility with increased BMI in overweight and obese men and in control group in Karnataka, South India. In this pilot study 20 overweight and obese men, aged 25-45, and 10 normal-weighed men with proven fertility were included. Both groups were married. All cases and controls were evaluated for different semen parameters according to World Health Organization [WHO] standards. Statistical analysis was performed using the SPSS software, version 16.0. P-values less than 0.05 were considered statistically significant. Different infertile conditions are evident among overweight and obese individuals recruited for this study. Variations in the semen parameter are significant in obese men compared to controls but sperm function test does not show statistical significant values in overweight and obese men when compared with control group. In case of oligoasthenospermic subjects pH shows a significant increase [p=0.002] compared to controls. Also the levels of Fructose show a significant decline in both azoospermic [p<0.001] and oligoasthenosermic [p=0.002] groups when compared to control group. With reference to the data obtained from this pilot study we found that increased BMI in men affects the semen quality which ultimately results in decreased fertility rate in men

Rare association of multiple etiologies in a severe oligoasthenospermic male

We report a rare case of a 30 year old man diagnosed with severe oligoasthenospermia, where the infertile condition is traced back to a multiple etiologies. Routine semen analysis and sperm function tests followed by hormone analysis are carried out to diagnose the condition as well as the severity. The initial findings prompt us to perform Ultrasound scanning of testis and Trans Rectal Ultrasound Scanning [TRUS] to check the anatomical and functional status of the accessory reproductive organs. Semen analysis and sperm function tests provide an insight into the severity of the condition. The hormonal analysis, Ultrasound scanning of testis and TRUS of accessory reproductive glands confirms the association of hormonal imbalance, testis and accessory gland defects which results in the observed infertile condition with severe sperm defects. A thorough investigation of infertile subjects is essential for appropriate diagnosis and effective personalized treatment owing to the probability of multiple etiologies. Incomplete diagnosis can have adverse effects in treatment and Assisted Reproductive Techniques [ART]

Association of phenylthiocarbamide taste blindness trait with early onset of childhood obesity in Mysore

Ability to taste Phenylthiocarbamide [PTC] a bitter compound is widely used to know the heritable trait in both genetic and anthropological studies. The study is based on the ability of a person to sense the taste of PTC. Inability to taste has also been associated with medical illness not typically with taste impairment, so far no study has yet proved whether PTC blindness correlates with childhood obesity. This study is the first attempt to examine PTC sensitivity in obese children and healthy children to determine variation in the perception of bitter tastes which is associated with eating behavior, body mass index, and childhood obesity. The present investigation is carried out in Mysore, during years 2008 - 2009. Phenylthiocarbamide taste sensitivity was measured by administering PTC solution for obese and control children by modified method of Harris and Kalmus. The result focused that tasters were significantly more frequent [67%] than non-tasters [33%] in control population. A higher proportion of non-tasters were observed in obese children [72%] when compare to non-obese subjects [28%]. These differences were not explained by alterations in perception of basic taste sensitivity or age. Increased frequency of non-taster allele is evident in children with obese condition. This could be due to lack of preference for food among non-tasters. As the phenotypic variation in PTC sensitivity is genetic in origin, it may represent a surrogate risk factor for the development of childhood obesity

Diminished fertility in men with increased BMI

The incidence of obesity as a risk factor for normal life is increasing worldwide. Its impact on hypertension, cardiovascular diseases, osteoporosis, insulin resistance and diabetes mellitus, is well recognized. Previous studies have proved the association between female obesity and infertility and several linked genes have been worked out. However, a little is known about the effect of obesity on male reproductive system and infertility. Recently some clinical studies have reported diminished semen parameters like sperm count, sperm motility and vitality and changing in reproductive hormones in over weight and obese men. Lack of such study in Asian countries and particularly in Indian population who are genetically more prone to obesity necessitates picking up this research to achieve robust findings in this regard