Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele: a possible role in male infertility

Varicoceles are a common cause of male infertility, but despite data from human studies some points of the pathophsiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with teratozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue

Methods: An ejaculate and blood sample were collected immediately before surgery from 45 infertile men with varicocele classified into 3 groups [group 1 included 12 oligospermic, group 2 included 14 asthenospermic and group 3 included 19 oligoasthenospermic men] followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. Blood samples were collected from 10 healthy fertile men as control group. In each specimen, cadmium and iron levels were determined by atomic absorption spectrophotometer and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma

Results: The cadmium level was found to be significantly higher in the hydrocele fluid than peripheral blood, while the increase in the iron level was found to be non significant in the 3 patients groups with bilateral varicocele. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes

Conclusions: 1- The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably drived from the increased transvascular fluid exchange which occurs with varicocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosomal insufficiency effect

Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele; a possible role in male infertility

Varicoceles are a common cause of male infertility, but despite data from human studies the pathophysiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with terat-ozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue. An ejaculate and blood sample were collected immediately before surgery followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. In each specimen, cadmium and iron levels were determined by atomic absorption and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma. The cadmium and iron levels were higher in the hydrocele fluid than the peripheral blood in 72% and 46% of patients with bilateral varicocele respectively. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes. 1-The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably derived from the increased transvascular fluid exchange which occurs with vaticocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosmal insufficiency effect. 4- Impregnation rate was higher after surgical correction of varicocele and removal of hydrocele fluid in those patients who presented with high preoperative levels of cadmium and iron

Pelvic and peripheral venous insufficiency: different presentation and common pathophysiology

Aim: varicose veins are related to other diseases including varicocele or utero-ovarian varices. On the base of close physio pathologic relationships between varicose veins and gonadal varicosity, we decided to evaluate the features of pelvic venous insufficiency in patients affected by varicose veins

Patients and Methods: seventy patients with different grades of chronic venous insufficiency [CVI] were included in the study. The patients were evaluated pre-operatively by color Doppler for grading of gonadal varicosity and assessment of valvular incompetence in the peripheral veins. Post-operatively, the number of valves in the stripped veins was correlated to the degree of gonadal varicosity

Results: thirty patients were proved to have both peripheral and pelvic venous insufficiency. Higher grades of gonadal varices were associated with lesser number of saphenous values. There was a significant relation between the Doppler grading of venous reflux in gonadal E. peripheral veins

Conclusions: the incidence of varicocele associated with CVI was higher than the incidence of isolated varicocele. The bilateral development of gonadal and peripheral varicosity in female patients refers to mechanical compression followed by axial reflux. The association of lesser number of valves in the saphenous veins with higher grades of varicocele raises the possibility of generalized valvular scarcity as a cause of venous insufficiency

Study of the alterations of total plasma homocysteine levels and atherogenic lipid profile in hypothyroidism

Hypothyroidism is associated with increased cardiovascular morbidity, which cannot be fully explained by the atherogenic lipid profile observed in these patients. Elevation of total plasma concentrations of homocystein [t-Hcy] is an important and independent risk factor for cardiovascular disease. Because hypothyroidism decreases hepatic levels of enzymes involved in the remethylation pathway of homocystein, we prospectively evaluated fasting t-Hcy in hypothyroid patients before and after recovery of euthyroidism. In the current study we examined 40 patients with peripheral hypothyroidism [12 with autoimmune thyroiditis, 10 with Graves’ disease, [treated surgically 0r carbimazole], 2 with toxic multinodular goiter [treated surgically], 12 surgically resected goiter, and 4 with idiopathic hypothyroidism] in comparison with those of 25 hyperthyroid patients and 25 euthyroid control subjects with the same age and sex attending the outpatient and the inpatient departments of general surgery, Mansoura University Hospital. In all cases, a detailed medical history was obtained and a thorough physical examination was performed with emphasis on the presence of symptoms / signs indicative of underlying thyroid disorders. In addition to plasma lipid parameters, thyrotropin [TSH], T3, T4 and t-Hcy levels were measured in a fasting blood samples. Fasting t-Hcy levels were higher in patients with hypothyroidism in comparison with those of hyperthyroid patients and euthyroid control subjects. Plasma t-Hcy in hypothyroidism was significantly correla ted with high TSH and lipoprotein [a] levels [r = 0.306, P = <0.01 and r = 0.476, P = <0.001, respectively]. The restoration of euthyroid state with levothyroxine therap [75 ug/day] was followed by a significant improvement of plasma lipid profile. Also, thyroid hormone replacement significantly decreased fasting t-Hcy. We confirmed the observation of hyperhomocysteinemia in hypothyroidism, which together with the elevated plasma lipoprotein [a] may contribute to an accelerated atherogenesis in these patients. As hypothyroidism may be a treatable cause of hyperhomocysteinemia, and as fasting t-Hcy is associated with a significant increased relative risk of coronary artery disease, measurement of t-Hcy to screen this dynamic association of cardiovascular riskfactors during hypothyroidism may be of interest

Subtotal thyroidectomy and cervical block dissection: its effect on graves ophthalmopathy and thyroid function

The thyroid gland and or cervical lymph nodes have been implicated as the major source of synthesis and secretion of TSAb responsible for the hyperthyroidism of Graves disease [GD]. Although an immunogenic pathogenesis of Graves ophthalmopathy [GO] has been proposed, the actual mechanisms of retrobulbar involvement are not well defined. To determine whether cervical lymph nodes might have a role in the development of GO and whether these nodes participate in the activation of thyroid tissue remnant following sub total thyroidectomy and hence recurrence of hyperthyroidism, we examined the effect of cervical lymphadenectomy on GO and thyroid function after subtotal thyroidectomy. A series of 30 patients who had GD with varying degrees of GO were included in this study. Subtotal thyroidectomy and excision of cervical lymph nodes as well as lymphatic trunks was carried out in 15 patients [group A]. While subtotal thyroidectomy alone was done in the other 15 patients [group B]. Exophthalmometry, TSAb level and magnetic resonance imaging [MRI] of the orbit were done before surgery and also 1 months, 6 months and yearly for 3 years thereafter. There was a statistically significant reduction in exophthalmometric measures, 6 months postoperatively in group A compared to group B. There was a further reduction at 1 year and was the same at subsequent periods. One month after surgery, TSAb levels decreased significantly in group A compared to group B. A further decrease of TSAb levels was observed at 6 months and almost normalized at 1 year in group A. Six months after surgery, TSAb levels in group B were higher than those in group A, but still lower than the values before surgery. MRI of the orbit in the presurgical period showed extraocular muscle enlargement of all patients with GD even those with no clinical opthalmopathy. Six months postoperatively, there was a significant reduction in extraocular muscle thickness as well as the individual muscle/optic nerve ratio in group A compared to group B. There was a further reduction at 1 year and remained unchanged thereafter. Recurrence of hyperthyroidism was observed in one patient of group B, 3 years after surgery but in none of group A. A larger size of lymphatic trunks and greater number of lymph nodes was excised from the side of the neck corresponding to higher grade of exophthalmopathy. [1] The observed improvement of exophthalmos following cervical lymph node dissection, implies the potential role of these nodes in the initiation of retrobulbar immunological process responsible for GO. Support for this observation comes from the fact that the side with greater pxophalmos had a larger number of lymph nodes and lymphatic trunks in the neck than on the contralateral side. [2] The significant reduction of TSAb level following hymphnode dissection points to these nodes as a major source of TSAb which when reaches a pathological level in the circulation it could lead to recurrence of hyperthyroidism. [3] Subtotal thyroidectomy and cervical hymphadenetomy seems to be a logic alternative to the standard thyroidectomy in concern of its ameliorating effect on GO, moreover, it can be used to prevent progression of the process in patients without clinical evidence of GO [4] This operation could be used to prevent the recurrence of hyperthyroidism especially in patients with high preoperative TSAb titer

Efficacy of cyclosporin on behcet's disease vasculopathy: a comparative study of cyclosporin and corticosteroid on long-term prognosis

Behcet's disease is a vasculitis typified by intimal hyperplasia, internal elastic membrane disruption with medial thining, and an advential periadvential infiltrate of plasma cells and neutrophils. It is more common in the Mediterranean and is seen slightly more often in males. This mulisystem vasculitis is characterized by clinical triad of oral ulcerations that recur at least 3 times a year, recurrent genital ulceration and uvietis. Vasculo-Behcet's disease affect veins more often than arteries. Arterial complications occur in about 10% of those affected, and venous thrombosis occurs in about 30%. Thirty- five patients with vasculo-Behcet's disease were included in the study. Diagnosis was based on the clinical criteria, namely, recurrent oral ulceration and involvement of the skin, eye or genitalia in addition to positive pathergy test and duplex scan. Twenty patients [group A] were given Cyclosporin [5mg/kg daily for 6 months] and 15 patients [group B] were give, corticosteroid [60 mg daily for 6 months]. Eighteen patients of group A had complete reversion of the disease process without further vascular complications and 2 patients developed iliofemoral and caval thrombosis although they were on anticoagulation therapy. Seven patients of group B underwent revascularization surgery for peripheral aneurysms and developed anastomotic disruption. Two patients developed aortic aneurysms. One patient had pseudoaneyrysm at the puncture site for angiography. One patient had progressive ocular deterioration ended with blindness. 1- Cyclosporin is acting by suppressing HLA expressions which is an initial step in triggering the immune system to the vessel wall, a mechanism that is different from that achieved by cortiosteroids 2-C'yclosporin should be used as a first option in the treatment of Behcet's disease as the goal of therapy is to minimize systemic complications by the use of appropriate immunosuppressive agents. 3-patients with complex aphthosis should be monitored for the onset of Behcet's disease through close follow-up and investigations of systemic complaints. 4-Revascularization should be deferred until acneiform eruption subsides because these eruptions significant the disease activity during which operative tasks will carry a high risk of complications