Wet heat exposure: a potentially reversible cause of low semen quality in infertile men

OBJECTIVE: To evaluate the recovery of semen quality in a cohort of infertile men after known hyperthermic exposure to hot tubs, hot baths or whirlpool baths. MATERIALS AND METHODS: A consecutive cohort of infertile men had a history remarkable for wet heat exposure in the forms of hot tubs, Jacuzzi or hot baths. Clinical characteristics and exposure parameters were assessed before exposure was discontinued, and semen parameters analyzed before and after discontinuation of hyperthermic exposure. A significant seminal response to withdrawal of hyperthermia was defined as > 200 percent increase in the total motile sperm count (TMC = volume x concentration x motile fraction) during follow-up after cessation of wet heat exposure. RESULTS: Eleven infertile men (mean age 36.5 years, range 31-44) exposed to hyperthermia were evaluated pre and post-exposure. Five patients (45 percent) responded favorably to cessation of heat exposure and had a mean increase in total motile sperm counts of 491 percent. This increase was largely the result of a statistically significant increase in sperm motility from a mean of 12 percent at baseline to 34 percent post-intervention (p = 0.02). Among non-responders, a smoking history revealed a mean of 5.6 pack-years, compared to 0.11 pack-years among responders. The prevalence of varicoceles was similar in both cohorts. CONCLUSIONS: The toxic effect of hyperthermia on semen quality may be reversible in some infertile men. We observed that the seminal response to exposure elimination varies biologically among individuals and can be profound in magnitude. Among non-responders, other risk factors that could explain a lack of response to elimination of hyperthermia should be considered.

Candidiasis esofagica / Esophageal candidiasis

La candidiasis esofagica es una infección oportunista que se esta diagnosticando con frecuencia creciente en determinados grupos de pacientes, sobre todo en personas afectas de enfermedades neoplasicas, en pacientes sometidos a antibioticoterapia prolongada y en individuos con SIDA. Los defectos de la inmunidad celular pueden predisponer al paciente a colonizacion de la mucosa esofagica, mientras que la granulocitopenia inducida por la quimioterapia puede ser un factor de riesgo de candidiasis diseminada. La candidiasis esofagica debe sospecharse en pacientes susceptibles que presentan odinofagia subesternal o disfagia. El diagnostico se confirma mediante la biopsia de la mucosa realizada durante la endoscopia. Al tiempo con la candidiasis esofagica se puede desarrollar esofagitis por otras causas. El tratamiento depende del estado clinico e inmunologico del paciente. La anfotericina B se administra a pacientes inmunosuprimidos con riesgo de candidiasis diseminada o profundamente invasora y esta indicada en pacientes no granulocitopenicos cuyos sintomas impiden una administracion eficaz de antimicoticos orales. Los pacientes no granulocitopenicos y clinicamente estables que presentan candidiasis esofagica limitada a la mucosa, pueden ser tratados con ketoconazol. Los enfermos de SIDA y con antecedentes de candidiasis esofagica generalmente se favorecen con un tratamiento antimicotico preventivo a largo plazo.