Sonographic findings in the scrotum of infertile on-road cyclists

Exercise helps keep a man sexually fit, but Dr. Irwin Goldstein, a Boston University impotency specialist, says that bicycling is one workout to avoid. When a man uses a standard bike seat, his weight flattens the main penile artery temporarily occluding the blood flow required for erections. Goldstein believes that, over time, this pressure can permanently damage the vessel. He also detected -using X-rays, ultrasound and arterial pressure readings- a reduction in blood flow as high as 66% when a patient sat on a skinny bike saddle. Also some experts believe prolonged sitting on a bicycle seat could compress the arteries and nerves to the testicles, causing the overheating of the testicles and lower sperm conut. Add to this, the constant rubbing and pressure on the area of perineum from the bike saddle, these can diminish sperm production. To sonographically investigate whether infertile on-road bikers have a higher prevalence of scrotal abnormalities compared with that in non bikers. A reproductive health assessment study. National Hepatology and Tropical Medicine Research Institute [NHTMRI]. Forty-six infertile male on-road bikers [mean age, 30.5 years; age range, 24-37 years] and 46 infertile non-bikers [mean age, 24 years; age range, 21-45 years] were examined for scrotal findings at ultrasonography [US]. Only male subjects with a history of extensive on-road biking [> 2h/d 6/wk] were assigned to the group of on-road bikers, whereas the control group did not engage in bicycling. In addition to clinical evaluation, US examination of the scrotum was performed by using a linear-array transducer operating at a frequency of 8.0 MHz. Forty [86.96%] on-road bikers had abnormal findings at scrotal US. Abnormal findings at US included varicoceles 34/46 [73.91%], hydroceles in 16/46 [34.78%], spermatocele in 2/46 [4.35%], testicular micro-calcifications in 2/46 [4.35%] and epididymal cysts in 4/46 [8.70%]. In the control group abnormal findings were noted in 34/46 [73.913%]. Abnormal findings at US included varicoceles in 24/46 [52.174%] hydroceles in 12/46 [26.086%], and spermatocele in 2/46 [4.35%] The overall difference in the number of scrotal abnormalities in bikers compared with the number in nonbikers was significant. US show a higher prevalence of testicular disorders in those on-road bikers compared with non-bikers. The quality and the high percentage of testicular abnormalities in bikers could be an indication of a developing reproductive health problem. The nose of the bicycle saddle exerts excessive pressure to the perineum, which appears to affect the semen quality. Men who ride bicycles many hours a day should be concerned about the pressure exerted on the perineum. They should take rest breaks off the bicycle saddle when possible. They should also consider replacing their bicycle saddle with a design that does not have a protruding nose or replacing their bicycle with one that has a recumbent design. Whereas alternative saddle designs may decrease pressure applied to the perineum, the overall health effects of long-term use of these saddles is unknown and it needs to be evaluated

Study of pancreatic islet cell function in cirrhotic patients due to hepatitis C virus

The liver is of key importance in the proper functioning of most of the endocrine system. It is a major organ for metabolic degradation of many hormones. In chronic liver disease, there is a change in the concentrations of the main pancreatic hormones. Is to study the pancreatic islet cell secretory function of insulin, C-peptide, somatostatin and glucagon hormones in non ascitic non diabetic cirrhotic HCV patients by measuring these hormones basally and after intravenous glucose load with different concentrations at several intervals in order to evaluate the pattern of endocrine pancreatic hormonal response at increasing glucose concentration. The case-control study included 25 non ascitic non diabetic patients with cirrhosis due to HCV infection; their ages ranged from 28 to 60 years. They were selected from outpatient clinic of the National Hepatology and Tropical Medicine Research Institute [NHTMRI] in the period from June 2004 to January 2005. Fifteen age and sex matched apparently healthy control subjects from the same area were also included in the study. Assessment of pancreatic islet cell function was done by assaying insulin, C-peptide, somatostatin and glucagon hormones. All hormones were determined by radioimmunoassay [RIA] for both patients and controls. Basal serum insulin, basal plasma somatostatin and basal plasma glucagon levels were significantly higher than that of the control group [p<0.05], while basal serum C-peptide was significantly lower than that of the control group [p<0.05]. After intravenous glucose load with the different concentrations 5%, 10% and 25%, serum insulin level showed a significant increase than that of the controls [p<0.05]. while other hormones showed no significant difference as compared to the control group [p>0.05]. The study suggests pancreatic islet cell functional defects with liver cirrhosis due to HCV infection

Immunomodulatory therapy for hepatocellular carcinoma

Hepatocellular carcinoma is probably the most common solid human malignancy in the world and its incidence in Egypt has dramatically increased during the last decade. In spite of the availability of different strategies for treating hepatocellular carcinoma in the form of surgical resection, transarterial embolization, percutaneous ethanol injection therapy, radiofrequency wave ablation and chemotherapy, a considerable percentage of cases were found not fit to go into one of all these modalities. On the other hand, the aqueous extracts of the European mistletoe plant [Viscum album] have been used for years for systemic nonspecific stimulation of the immune system in cancer therapy. This study tried to assess the effect of mistletoe [Viscum album] on the natural history of unresected HCC, on one side, and its role in preventing postoperative recurrence after surgically resected cases, on the other side. Thirty-three patients with advanced unresectable HCC represented the first group in this study and 10 cases of post surgical resection were included in the second group. Mistletoe proved itself as a save medication easily tolerable with minimal side effects, it improves the quality of life through immunological pathway, but in this study it failed to demonstrate any significant effect in the progression or limitation of the size of the tumor nor on prevention of recurrence after postoperative resection

Management of encopresis in children

Background: Encopresis is incontinence of stool not resulting from organic defects or illness. Encopresis affects 1% to 3% of children

Objective: Current treatment of encopresis has been disappointing. In this study, emphasis was placed on treating and diagnosing children attending NHTMRI complaining of various forms of Encopresis. Design: Prospective study. The study was conducted from June 2001 to June 2002. Setting: National Hepatology and Tropical Medicine Research Institute [NHTMRI]

Materials and Methods: Sixty two children attending NHTMRI complaining of various forms of Encopresis ranging from mild fecal soiling of underwear to the passage of large amounts of fecal material were studied and treated over one year with use an approach consisting of three phases: cleanout phase, aimed to evacuate the colon using isotonic saline ,enemas and laxative [lactulose]. The 2[nd] phases aimed to prevention of reimpaction: for 6 month's consists of mineral oil 0.5 to 2.5 ounces twice daily depending on patients age between meals, diet modification and change dietary and behavioral habits, fiber diet 0.5 gm /kg/B.Wt. The phase aimed to establish a regular bowel habits through encouraging patients to sit on toilet for terminates after breakfast and after evening meal and is rewarded by star chart, successful toilet attendance is marked by a star with collaborative protocol between medical clinician, children and families. The patients were followed up 12 months to assess treatment outcome. While fifty patients cooperated in the study, 12 patients were excluded from the final statistics because they decided to discontinue the trial for unknown reason

Results: after 6 months, 58% of our children were successfully treated and 20% improved with the program applied in this study. By the end of the year success rate reached 92%

Conclusion: Most patients can be effectively treated as out patients with use of an approach consisting of colonic evacuation, stool softeners, dietary manipulations, bowel training and behavioral management