Role of spermatic vein inhibin B and LDH activity as predictors of testicular dysfunction in varicocele patients

lnhibin B generated by Sertoli cells provides negative feedback on FSH secretion. In men, inhibin B seems to be physiologically important form of inhibin. Lactic dehydrogenase [LDH], an intracellular enzyme that indicates cellular damage. Varicocele has been associated with infertility and disturbed spermatogenesis. We aimed to investigate the relationship between varicocele, LDH and inhibin B. This study was conducted on forty infertile men with varicocele and twenty age matched control men. LDH and inhibin B were measured in the blood samples of these 40 patients with varicocele which were obtained synchronously from spermatic and peripheral veins during operation and in peripheral vein of control men. Varicocele patients were classified into two groups: group I twenty patients with normal sperm concentration [> 20 million /ml], and group II twenty patients with low sperm concentration [< 20 million /ml]. FSH and testosterone were measured by chemilurninescence while inhibin B was measured by enzyme immunoassay method. LDH enzyme activities were assayed by enzymatic U.V methods. Sperm counts ranged from 3.9 to 60 million/ml, while motility ranged from 15 to 48%. LDH level and inhibin B in spermatic vein were significantly higher than the level in peripheral vein. There was no correlation between sperm counts and LDH level in spermatic vein. lnhibin B concentrations in spermatic vein correlated significantly with serum concentration of FSH [r= -0.63, p < 0.001] and free testosterone [r= 0.34, p<0.05] and also correlated significantly with sperm counts [r= 0.44, p < 0.01] and total testicular volume [r= 0.56, p< 0.01]. lnhibin B showed significant reduction in patients with varicocele than in control men, while LDH showed no significant difference. There were significant increases in inhibin B and LDH in both peripheral vein and spermatic vein of men with sperm count > 20 million /ml when compared with men who had count < 20 million/ml. Significant increase in spermatic vein LDH and inhibin B levels were observed in varicocele. These findings suggest that inhibin B may be offer an improved diagnosis of testicular dysfunction. Consequently, spermatic vein LDH activity and inhibin B level can be predictors of testicular dysfunction in varicocele

diagnostic value of circulating tumor necrosis factor alpha [TNF-alpha] versus alpha fetoprotein [AFP] in patients with hepatocellular carcinoma

The aim of the present work is to assess the level of serum tumor necrosis factor alpha [TNF-alpha] in patients with hepatocellular carcinoma [HCC] and compare the sensitivity of this marker with conventional used marker, alpha-fetoprotein [AFP]. This study was done on sixty five patients attending the Gastroenterology Surgical Center, Mansoura University. 25 patients with HCC, 20 patients with liver cirrhosis, 20 patients with chronic hepatitis in addition to 15 apparently healthy controls [both patients and controls were age and sex matched]. Serum AFP was estimated by an immunoenzymatic assay. Serum TNF-alpha was assayed by a solid phase enzyme amplified sensitivity immunoassay. Results show that serum AFP and TNF-alpha levels were significantly elevated in hepatocelluar carcinoma, cirrhosis and chronic hepatitis groups in comparison to control group. AFP and TNF-alpha showed no significant difference in cirrhosis group in comparison to chronic hepatitis group. No significant correlation was found between HCC stages and both AFP and TNF-alpha. TNF-alpha had a higher sensitivity [100%] than AFP [80%] and lower specificity [40% for TNF-alpha and 64% for AFP] in patients with HCC. In conclusions, serum TNF-alpha is nonspecific marker as it increases in different and stage of liver diseases. TNF-alpha could be used in association with APF in diagnosis of HCC cases. TNF-alpha has higher sensitivity than AFP, but lower specificity as it was elevated in benign inflammatory diseases. TNF-alpha could be used as a marker for early detection of HCC by following up of its level in patients with cirrhosis and chronic hepatitis

Prediction of the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility

Background: Laparoscopic ovarian drilling [LOD] has been commonly used for the treatment of clomiphene citrate [CC]-resistant women with polycystic ovarian syndrome [PCOS]. However, about 20-30% of anovulatory women with PCOS fail to respond to LOD. So, identifying factors that can predict the outcome of this modality of treatment may help the clinician for proper selection and counseling of those women about their chances for the success of WD

Objective: The aim of this study is to determine the clinical, endocrinologic, biochemical and ultrasonographic factors that can predict the success of treatment following LOD in CC-resistant women with PCOS. Design: A prospective designed study. Setting: Departments of Obstetrics and Gynecology, Mansoura and Benha University Hospitals

Patients and Methods: Sixty-seven CC-resistant PCOS patients were included in the study. Preoperative evaluation of the known clinical, endocrinologic, biochemical and ultrasongraphic factors associated with PCOS were done initially. Then, all patients included in the study underwent LOD using the triple-puncture technique. Post-operatively, all women were followed-up for the occurrence of either ovulation or pregnancy. Those with persistent anovulation after LOD were offered CC. The effect of the different pre-operative characteristics on the ovulation and pregnancy rates after LOD was assessed. Moreover, women were divided into two or three categories according to the severity of each of the known factors associated with PCOS. The success rates were compared between the categories of each factor. Multiple logistic regression analysis was used to identify independent predictors of success of LOD. Main outcome measure: Ovulation and pregnancy rates

Results: Of the 67 women, 36 [53.7%] ovulated spontaneously and a further 14 women ovulated after the addition of CC, giving an overall ovulation rate of 74.6% [50 out of 67]. From those ovulated spontaneously [36], 26 [38.8%] conceived spontaneously, and the overall pregnancy rate after the help of CC was 49.2% [33 out of 67]. Women with duration of infertility > 6 years, marked obesity [BMI 35 Kg / m[2]], marked hyperandrogenism [serum testosterone >/= 1.8 ng /dL], and insulin resistance [serum fasting insulin >/= 20 uU/ mL, and/or a fasting glucose insulin ratio 10 IU/L] did not reach statistical significance to affect the outcome, but once ovulation was achieved, it appeared to be associated with higher pregnancy rate

Conclusion: Longer duration of infertility, marked obesity, marked hyperandrogenism and marked insulin resistance seemed to be associated with high probability of LOD failure. On the other hand, a high pretreatment LH level appeared to be associated with a high probability of pregnancy once ovulation is achieved

role of serum vascular endothelial growth factor in the prediction of ovarian hyperstimulation syndrome in women with polycysic ovarian syndrome

Background: Ovarian hyperstimulation syndrome [OHSS] is an iatrogenic and potentially life-threatening complication of treatment with fertility drugs. Women with polycystic ovaries [PCO] and polycystic ovarian syndrome [PCOS] are at a particularly higher risk of developing OHSS. The traditional determinants viz, serum estradiol [E2] concentrations and the number of follicles on the day of human chorionic gonadotrophin [hCG] administration are not only increasingly recognized that they do not adequately define the risks for this syndrome but also do not accurately predict its occurrence. On the other hand, numerous reports now emphasized the role of vascular endothelial growth factor [VEGF] as an important mediator of the syndrome and that it provides a nonsteroidal index of the ovarian response to gonadotrophin simulation

Objective: The aim of this study was to examine the possible role of the circulating serum VEGF concentration pattern during ovarian stimulation as a method of predicting OHSS in women with PCOS and hence its possible real prevention. Design: A prospective designed study. Setting: Outpatient women's clinics, Departments of Obstetrics and Gynecology, Benha and Mansoura University Hospitals

Patients and Methods: A total of ninety-six women with anovulatory infertility due to PCOS were included in the study. All women underwent controlled ovarian stimulation and were followed-up for the development of OHSS. Cases who developed mild OHSS [n=6] were excluded from the study, while those who developed either moderate [n=6] or severe OHSS [n=2] were only included. Consequently, the remaining studied women [n=90] were divided into two groups: an "OHSS group" [moderate, n = 8] and a "non OHSS group" [n = 82]. Serum was collected from all patients in the early follicular phase before the initiation of the treatment, on the days of hCG injection and 48 hours after hCG injection and was assayed for VEGF concentration

Results: The serum VEGF concentration increased significantly in all the studied women during ovarian stimulation irrespective of whether OHSS developed or not. The rise was significantly higher on the day of hCG administration than in the early follicular phase at the beginning of ovarian stimulation in both groups [it increased from 156.3 +/- 45.2 to 257.4 +/- 108.6 pg/mL in women in whom OHSS developed and from 145.4 +/- 39.8 to 168.2 +/- 36.5 pg/mL in women in whom it did not] [P < 0.01].There was a further increment in the VEGF concentration 48 hours after hCG administration in both groups [up to 398.5 +/- 112.9 and 186.2 +/- 42.8 pg/mL respectively]. The levels of serum VEGF on both the day of hCG administration and 48 hours after hCG administration were significantly higher in women with OHSS than those without OHSS. A cut-off value of 240 pg/mL for serum VEGF concentration on the day of hCG administration offered a sensitivity of 76.8%, negative predictive value [NPV] of 82.2% and positive predictive value [PPV] of 73.4%. The rise in the serum VEGF concentration that occurred between the day of the beginning of cycle stimulation and the day of hCG administration [referred to as the "VEGF rise before hCG administration"] and that occurred between the day of hCG administration and 48 hours after hCG administration [referred to as the "VEGF rise after hCG administration"] were significantly higher in women in whom OHSS developed than in those without OHSS [P < 0.05]. Both were found to be good markers for the development of OHSS. The sensitivity, NPV and PPV for "VEGF rise after hCG administration" at a cut-off value of 100 pg/mL were 96.6%, 93.8% and 65.4% respectively in the prediction of OHSS. Similar values, although slightly lower were obtained for the "VEGF rise before hCG administration" at a cutoff value of 70pg/ mL [90.2%, 91.4% and 62.3% respectively]

Conclusion: The "VEGF rise after hCG administration" might offer a good single marker for prediction but not real prevention of the development of OHSS in PCOS women during ovarian simulation. Worthily "VEGF rise before hCG administration" might offer a similar good single marker for its prediction and also a real chance for its prevention at the same time both in in vitro fertilization [TVF] and non-IVF stimulated cycles. Prevention can be achieved by withholding hCG administration, canceling the cycle, lowering the dose of hCG or withholding hCG for a couple of days [coasting] and thus ultimately avoiding a life- threatening complication in such at risk group of women

Second trimester plasma homocysteine assay in prediction of pre-eclampsia

Homocysteine, the demethylated derivative of the essential amino acid, methionine, is regulated by several factors. Elevated levels during pregnancy are associated with an increased incidence of spontaneous abortion, intrauterine growth restriction, placental infarction and neural tube dejects. Pre-eclampsia was added to this list of homocysteine-related pregnancy complications. The aim of this study was to determine the value of second trimester plasma homocysteine levels in the prediction of pre-eclampsia. This prospective study included 168 healthy primigravidae with singleton gestation from those attended the antenatal care clinic at Mansoura and Benha University Hospitals. Blood samples were obtained at their antenatal visits between 16 - 20 weeks. Plasma homocysteine was measured by enzyme immunoassay. The participants were followed up clinically till delivery for subsequent development of preeclampsia. The mean [ +/- SD] homocysteine level at 18.4 +/- 2.0 weeks gestation in women who developed pre-eclampsia [Group I] was significantly higher than those who did not develop pre-eclampsia [Group II] [10.2 micromol/ L +/- 3.6 micromol /L versus 8.2 micromol / L +/- 1.6 micromol/L respectively: p < 0.001]. Those patients with plasma homocysteine level of> 12 micromol / L in early pregnancy had an increased risk for developing pre-eclampsia by almost two and half folds. Also, plasma homocysteine level showed significant negative correlation with serum folic acid. An elevated second trimester plasma homocysteine level is associated with increased risk for subsequent development of pre-eclampsia. Also, the significant negative correlation between plasma homocysteine and serum folic acid levels may offer a hope for the use of folic acid supplements to prevent the development of pre-eclampsia in high risk pregnancies

Effects of passive cigarette smoking on serum lipid profile, some apolipoproteins and lecithin cholesterol acyl transferase enzyme activity in exposed children

In this study, serum concentration of total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein cholesterol, apolipoproteins A and B as well as plasma lecithin cholesterol acyl transferase [LCAT] activity were assayed in 61 passive cigarette exposed children vs 20 non-exposed children of matched age and sex. The results provided a further evidence for a definite disturbance of lipid metabolism and reduced level of LCAT enzyme activity in the plasma of exposed children is an important contributing risk factor in lipoprotein abnormalities in those children

Decreased serum levels of insulin - like growth factor - 1 [I G F - 1] and insulin - like growth factor binding protein - 3 [I G F B P - 3] in children with underscended testes

This study was carried out on 65 boys with undescended testes [22 bilateral and 43 unilateral] in comparison with 20 apparently healthy normal controls of a matched age. All of them were subjected to hormonal estimation follicle stimulating hormone [FSH], LH, growth hormone [GH], testosterone in addition to IGF-1 and IGFBP-3 and sonographic evaluation for an accurate localization of testes. The serum levels of FSH, LH and GH were determined using solid phase, two- site chemiluminescent enzyme immunometric assay. Total testosterone was measured by the electrochemiluminescence immunoassay. Free testosterone and IGFBP-3 were measured by radioimmunoassay technique, while IGF-1 was measured by active non-extraction ELISA technique

Serum interleukin-8 levels in patients with chronic hepatitis C: correlation with histological activity index

Interleukin-8 [IL-8] is a proin Immatory chemokine that induces trafficking of neutrophils across the vascular wall Its release is triggered by inflammatory signals from a large variety of cells including monocytes, rnacrophages, Kupffer cells and hepatocytes. Our aim is to study the IL-8 levels in the serum of patients with chronic hepatitis C [HCV-CH] and whether these levels could be correlated with histological activity index [HAl]. The study included 20 patients with HCV-CH [all +ve for anti-HCV antibodies and RT-PCR] were selected from Mansoura University Hospital [Medical Outpatient Clinic]. All were subjected to thorough history taking, physical examination, routine laboratory investigations, IL-8 levels [measured with commercial ELISA systems], abdominal ultrasound and liver biopsy for HAl according to the grading and staging system of ihak et al. 1995. 10 healthy subjects with equally-matched age and sex were selected as a control group for serum IL-8 levels. IL-8 was significantly elevated in HCV-CH versus control [91.2 +/- 31.38 pg/ml versus 5.77 +/- 1.17 pg/mI]. This elevation correlates with serum bilirubin [r = 0.769, p = 0.01]. ALT [r = 0.764, p = 0.01], and AST [r = 0.620, p = 0.01], It also correlates with HAI grade [r = 0.816, p = 0.01] but not HAI stage [r = 0.108, p = 0.649]. Serum IL-B levels could be considered as a measure of the severity of HCV-CH [significant correlation with HAI grade] but -not the disease progression [insignificant correlation with HAI stage]