Molecular and cytological analyses of Deschampsia cespitosa populations from Northern Ontario (Canada).

Deschampsia cespitosa is widely dispersed around the globe, particularly in the northern hemisphere. A high tolerance to adverse environmental conditions allows D. cespitosa to colonize and dominate plots of land that are uninhabitable by other plants. The main objective of the present study was to determine the degree of genetic variation and relatedness among D. cespitosa populations from heavy metal contaminated sites and uncontaminated sites in Northern Ontario, using RAPD markers. Genomic DNA samples from individual plants were analyzed using 35 oligonucleotides of random sequence. Twenty-eight of these primers allowed amplification of random polymorphic DNA (RAPD) loci. Overall, 90% of RAPD bands were polymorphic. Analysis of molecular variance revealed that 72% of the variation could be attributed to individual differences within each of the populations. The within- and among-region variations accounted for 14 and 15% of the total molecular variance, respectively. Population-specific RAPD markers were identified. RAPD markers specific to D. cespitosa were isolated, cloned, and characterized. Cytogenetic analysis revealed a high level of aneuploidy in all the populations from Northern Ontario, with chromosome numbers varying from 2n = 18 to 2n = 26.

Perinephric abscesses in the neurologically impaired.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To document the occurrence and management of large perinephric abscesses in neurologically impaired patients at high risk for this infectious complication. SETTING: US Veterans Affairs hospital. METHODS: The records, radiographs, operative findings and outcomes of all patients who presented with perinephric abscesses evident on physical exam within the last 5 years were reviewed. RESULTS: Four patients presented with large perinephric abscesses evident on physical examination. All had severe neurologic impairment with high sensory levels; three had spinal cord injuries, one had advanced multiple sclerosis. All had neurogenic bladders and recurrent urinary tract infections. The diagnosis was made through a combination of history, physical examination and computed tomography (CT) examination. All were found to have upper tract obstruction. All were managed with immediate abscess drainage and three had elective nephrectomy once the infection had resolved. No patients died of their perinephric abscess. CONCLUSIONS: These four cases illustrate that although advances in antibiotics, imaging and percutaneous management have improved the speed of diagnosis and reduced the mortality in patients with perinephric abscesses, the neurologically impaired population continues to remain at significant risk for the development and the delayed diagnosis of these morbid renal infections.

Current experience with computed tomographic cystography and blunt trauma.

We present our experience with computed tomographic (CT) cystography for the diagnosis of bladder rupture in patients with blunt abdominal and pelvic trauma and compare the results of CT cystography to operative exploration. We identified all blunt trauma patients diagnosed with bladder rupture from January 1992 to September 1998. We also reviewed the radiology computerized information system (RIS) for all CT cystograms performed for the evaluation of blunt trauma during the same time period. The medical records and pertinent radiographs of the patients with bladder rupture who underwent CT cystography as part of their admission evaluation were reviewed. Operative findings were compared to radiographic findings. Altogether, 316 patients had CT cystograms as part of an initial evaluation for blunt trauma. Of these patients, 44 had an ultimate diagnosis of bladder rupture; 42 patients had CT cystograms indicating bladder rupture. A total of 28 patients underwent formal bladder exploration; 23 (82%) had operative findings that exactly (i.e., presence and type of rupture) matched the CT cystogram interpretation. The overall sensitivity and specificity of CT cystography for detection of bladder rupture were 95% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 78% and 99%, respectively. CT cystography provides an expedient evaluation for bladder rupture caused by blunt trauma and has an accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography for patients undergoing CT evaluation for other blunt trauma-related injuries.

The National Lesbian Family Study: 3. Interviews with mothers of five-year-olds.

This third report from a longitudinal study of lesbian families presents data obtained from interviews with mothers of five-year-old children conceived by donor insemination. Results indicated that 87% of the children related well to peers, 18% had experienced homophobia from peers or teachers, and 63% had grandparents who frankly acknowledged their grandchild's lesbian family. Of the original couples, 31% had divorced. Of the remainder, 68% felt that their child was equally bonded to both mothers. Concerns of lesbian families are discussed.

Tricuspid valve metastasis from testicular carcinoma: a case report and review of the literature.

A 20-year-old man with Stage II nonseminomatous germ cell tumor underwent chemotherapy and multiple surgical resections of recurrent abdominal and supradiaphragmatic mature teratomas. Evaluation of a new heart murmur led to the diagnosis of tricuspid valve teratoma, which required complete valve excision and replacement. We present our experience with the first discrete tricuspid valve metastasis from testicular carcinoma and review the literature regarding cardiac metastases from germ cell neoplasms.

Computerized tomography cystography for the diagnosis of traumatic bladder rupture.

PURPOSE: We present our experience with computerized tomography (CT) cystography for diagnosing bladder rupture in patients with blunt abdominal and pelvic trauma, and compare the results of CT cystography with those of surgical exploration. MATERIALS AND METHODS: We identified all patients with blunt trauma diagnosed with bladder rupture from 1992 to September 1998. We reviewed the radiology computerized information system for all CT cystography performed to evaluate blunt trauma during the same period. We also reviewed the medical records and pertinent radiographic studies of patients with bladder rupture who underwent CT cystography as part of the hospital admission evaluation. Operative and radiographic findings were compared. RESULTS: CT cystography was performed in 316 patients as part of the initial evaluation of blunt trauma. Of the 44 patients with the ultimate diagnosis of bladder rupture CT cystography revealed bladder rupture in 42, while 23 of the 28 (82%) who underwent formal bladder exploration had operative findings that exactly matched the CT cystography interpretation in terms of the presence and type of rupture. In the 316 patients CT cystography detected bladder rupture with an overall sensitivity and specificity of 95% and 100%, respectively. For intraperitoneal rupture sensitivity was 78% and specificity was 99%. CONCLUSIONS: CT cystography provides expedient evaluation of bladder rupture due to blunt trauma and has accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography in patients undergoing CT for other injuries associated with blunt trauma.

Should vasectomy reversal be performed in men with older female partners?

PURPOSE: An assumption exists that men with older female partners who seek treatment of post-vasectomy infertility should undergo in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) rather than vasectomy reversal. Although several studies have reviewed ICSI success rates with advancing maternal age, to our knowledge none has compared them to outcomes for vasectomy reversal in men with older partners. MATERIALS AND METHODS: The records of all patients with ovulating partners older than 37 years who underwent vasectomy reversal from 1994 through 1998 were reviewed. Patients were contacted to establish pregnancy and birth rates. Costs of vasectomy reversal, testicular sperm extraction, IVF and ICSI were obtained from the financial office of our institution. RESULTS: A total of 29 patients underwent vasectomy reversal with a followup of 3 to 59 months (median 25). Median male age was 46 years (range 37 to 67) and median female age was 40 years (range 38 to 48). A total of 5 pregnancies and 4 live births were achieved. In the 23 patients followed for more than 1 year the pregnancy rate was 22% and live birth rate was 17%. Using this 17% birth rate at our $4,850 cost for vasectomy reversal the cost per newborn was $28,530. In comparison, using the 8% birth rate per cycle of ICSI for women older than 36 years at a cost of $8,315 for testicular sperm extraction and 1 cycle of IVF with ICSI, the cost per newborn was estimated at $103,940. CONCLUSIONS: Vasectomy reversal appears to be cost-effective to achieve fertility in men with ovulating partners older than 37 years.

Pain associated with testicular retraction treated with Gore-Tex external inguinal ring reconstruction.

We present our experience with three patients with chronic testicular pain due to retractile testes and propose a new operative solution to the problem. Three patients with chronic testicular pain associated with testicular retraction and relieved by pushing the testicle into the scrotum were identified. Full history and physical examinations were performed to rule out other causes of testicular pain. The patients underwent open inguinal exploration, aborted attempt at repair of an attenuated or obliterated external oblique aponeurosis, and construction of a neo-external inguinal ring with a Gore-Tex strip. The patients were reevaluated in the clinic postoperatively to determine change in physical examination and symptoms. All three patients had nonretractile testes on follow-up examination and reported improvement of their testicular pain. An attenuated or torn external oblique aponeurosis can result in a patulous external inguinal ring and painful retractile testicle. If traditional orchidopexy is insufficient to prevent severe retraction, reconstruction of the external inguinal ring with Gore-Tex mesh can correct the anatomical deficiency, reduce testicular retraction, and improve pain symptoms.