Seminal Corynebacterium strains in infertile men with and without leucocytospermia.

This study aimed to identify seminal Corynebacterium strains in infertile men with and without leucocytospermia. Semen samples from 60 infertile men were allocated into two equal groups: semen samples with leucocytospermia and semen samples without leucocytospermia. Semen culture for Corynebacterium species was carried out on Columbia agar medium confirmed by Gram-stained film and biochemical tests followed by analytical profile index biotyping and antibiotic susceptibility. Bacterial isolates were detected in 20/60 semen cultures (33.3%) as Corynebacteria, Staphylococci, Alpha haemolytic streptococci and E. coli. In all, 12/60 (20%) had Corynebacterium positive semen culture, whereas C. seminal was the major isolated species followed by C. amycolatum, C. jekium and C. urealyticum. There was nonsignificant difference between patients with/without Corynebacterium positive culture regarding sperm concentration and normal sperm morphology; however, in positive cultures sperm motility was significantly lower compared with negative cultures. Antimicrobial sensitivity among Corynebacteria strains was highest for vancomycin, rifampicin then imipenem, ampicillin + sulbactam, ciprofloxacin. It is concluded that positive semen cultures for different Corynebacteria species were demonstrated in infertile men, whereas Corynebacterium seminale was the most common isolated species. Vancomycin, rifampicin then imipenem and ampicillin + sulbactam are recommended as sensitive antibiotics.

Modified Atkins diet vs classic ketogenic formula in intractable epilepsy.

OBJECTIVES: The study was designed to evaluate the efficacy, safety, and tolerability of the ketogenic diet (KD) whether classic 4:1 formula or the modified Atkins diet (MAD) in intractable childhood epilepsy. PATIENTS AND METHODS: Anthropometric measurements and serum lipid profile were measured upon enrollment and after 3 and 6 months in 40 patients with symptomatic intractable epilepsy. Fifteen were given MAD diet, ten were kept on classic 4:1 ketogenic liquid formula, and the rest were allowed to eat as desired. RESULTS: The liquid ketogenic formula group showed significantly higher body mass index compared with those who did not receive KD after 6 months. The lipid profile of KD patients was within normal limits for age and sex during the study period. The rate of change of frequency and severity of seizures showed best improvement in ketogenic liquid formula patients followed by the MAD group than the patients on anti-epileptic medications alone. CONCLUSION: The KD whether classic 4:1 or MAD is a tolerable, safe, and effective adjuvant therapy for intractable symptomatic childhood epilepsy with limited adverse effects on the growth parameters and accepted changes in the lipid profile. The liquid ketogenic formula patients showed better growth pattern and significantly more seizure control.

Nonmosaic 47,XYY syndrome presenting with male infertility: case series.

In this study, we describe nine patients with 47,XYY presenting with male infertility. All patients were subjected to history taking, clinical examination, duplex ultrasonographic examination of the scrotum, endocrinological investigations and cytogenetic analysis of peripheral lymphocytes. Two patients tried intracytoplasmic sperm injection (ICSI). Our results showed that seven patients were oligospermic and two patients were azoospermic. Bilateral varicocele was detected in seven patients. The hormonal levels in the majority of the patients were within normal range. Two patients showed improvement after varicocelectomy. The wife of one of the oligospermic patients became successfully pregnant after the first trial of ICSI. In conclusion, this report suggests that patients with XYY may present with primary infertility and may show oligospermia and nonobstructive azoospermia. Careful clinical, ultrasonographic, endocrinological and cytogenetic examinations should be a part of their diagnostic work-up for the proper management of these patients. In addition, ICSI may be a hope for some of these patients.

The advent of ECMO and pumpless extracorporeal lung assist in ARDS.

Despite advances in critical care facilities and ventilation therapies acute respiratory distress syndrome (ARDS) is associated with high mortality rates. The condition can stem from a multitude of causes including pneumonia, septicemia and trauma ultimately resulting in ARDS. ARDS is characterized by respiratory insufficiency with severe hypoxemia or hypercapnia. The treatment strategy depends on the knowledge of the underlying disease. But lung-protective ventilation with adjusted positive end-expiratory pressure remains the most effective therapeutic tool despite advances in prone positioning, inhalation of nitric oxide and the use of steroids. Newer modalities including extracorporeal membrane oxygenation (ECMO) and pumpless extracorporeal lung assist (PECLA) are being increasingly introduced in critical care settings as rescue therapies in patients who fail to respond to conservative measures. We describe here the introduction and advances of both ECMO and PECLA in the management of ARDS.

Role of penile vascular insufficiency in erectile dysfunction in renal transplant recipients.

The objectives of this study were to define the role and haemodynamic features of penile vascular insufficiency in impotent renal transplant recipients (RTR) as well as to establish the possible vascular risk factors for impotence in these patients. A total of 54 RTR (35 impotent and 19 potent) and 21 potent healthy subjects were included in this study. All patients were assessed clinically and by measurement of serum creatinine, serum bilirubin, cyclosporine blood levels, haemoglobin and total serum cholesterol. All subjects were subjected to intracavernous injection of 20 microg prostaglandin E1 followed by colour Duplex sonographic examination. Our results showed that impotent RTR were significantly more likely than potent RTR to have hypertension, diabetes and hypercholesterolaemia (P<0.05). Arterial occlusive disease was identified in 42.9% of impotent RTR. Findings suggestive of veno-occlusive dysfunction were found in 68.6% and 26.3% of impotent and potent RTR, respectively (P=0.003). Unilateral ligation of the internal iliac artery has a negative role on haemodynamic parameters compared to unilateral end-to-side anastomosis to external iliac artery in impotent RTR (P<0.05). Impotent RTR receiving more than one antihypertensive drug showed significant decrease in basal peak systolic velocity (PSV), dynamic PSV, erectile angle and cavernosal artery diameter compared to those receiving one drug (P<0.05). In conclusion, penile vascular insufficiency appears to play a substantial role in the pathogenesis of impotence in transplant patients. Anastomosis of the graft to external iliac artery could preserve the potency to some degree. Antihypertensives should be reduced as much as possible to avoid their negative effects on erectile function.

Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation.

The objective was to compare the efficacy and safety of the as needed use of clomipramine, sertraline, paroxetine, sildenafil and the pause-squeeze technique in treatment of primary premature ejaculation. A prospective double blind randomized crossover study involving 31 patients was performed. Treatment phases comprised five 4-week consecutive treatment periods, each separated by a two-week washout period. Patients were randomly assigned to receive each of the 4 drugs and use pause-squeeze on an as needed basis. Drugs were administered 3 to 5 hours before anticipated coitus. Anxiety score and ejaculation latency time were measured before treatment, after each treatment, and during washout periods. Sexual satisfaction score was measured after each treatment. The median ejaculation latency time was significantly increased from the pretreatment median of 1 minute to 4 minutes, 3 minutes, 4 minutes, 15 minutes and 3 minutes during treatment with clomipramine, sertraline, paroxetine, sildenafil and pause-squeeze technique, respectively (all P 0.0001). Sildenafil was superior to other modalities in terms of ejaculation latency and satisfaction (P = 0.0001). The three antidepressants were comparable to each other in terms of efficacy (P > 0.05). Paroxetine was superior to the pause-squeeze technique in terms of efficacy (P < 0.05). In conclusion, sildenafil appears to be superior to other modalities and a valid alternative in treatment of premature ejaculation. The 3 antidepressants were equivalent to each other in terms of efficacy and safety. Paroxetine was superior to pause-squeeze technique in terms of efficacy.

Epidemiology and control of scabies in an Egyptian village.

BACKGROUND: Some studies have addressed the epidemiology of scabies among rural populations in developing countries; however, the epidemiology of scabies among the rural population in Egypt is unknown. We sought to determine the magnitude of scabies infestation in an Egyptian village and to evaluate the control measures after 1 year. METHODS: This study was carried out on 3147 residents of Mit-Moaned village in Dakahlia govemorate, Egypt. It was a cross-sectional follow-up study where the same individuals examined in round I were re-examined in round III. The two rounds were separated by a period of 1 year, during which infested patients were followed up and new cases were discovered (round II). Patients and their household contacts received treatment with topical permethrin. Patients showing resistance to permethrin received a single oral dose of ivermectin. RESULTS: In round III, the overall prevalence rate of scabies was reduced from 5.4% in round I to 1.1%. The incidence of new cases among susceptible persons during round II was 1.1%. Scabies was significantly (P < 0.05) more prevalent among families of large size, high crowding index at night, low socioeconomic standards, and those receiving their water supply from a hand pump. Children younger than 10 years showed the highest prevalence. CONCLUSIONS: Our data provide the first complete picture of the epidemiology of scabies in rural Egypt. The epidemiologic characteristics of the disease should be considered in the design of disease control programs for other villages with scabies epidemics. Our findings revealed that good control was achieved with the following: increased awareness and better case finding, education of the staff at the rural health unit, improved hygiene measures, and massive treatment campaigns using effective drugs such as topical permethrin and oral ivermectin.

Khite: a non-Western technique for temporary hair removal.

BACKGROUND: Khite (also known as fatlah in Egypt) is a manual technique of temporary vellus hair removal that is widely performed in the Middle East. METHODS: The technique of khite is reviewed as illustrated. RESULTS: Khite is an effective method of removing unwanted vellus hairs. CONCLUSIONS: Dermatologists in all parts of the world should be familiar with khite, because the ease of international travel may bring patients to their attention who have khite-association complications such as erythema, folliculitis, and secondary pigmentary changes.

Assessment of sperm motion characteristics in infertile renal transplant recipients using computerized analysis.

A total of 34 kidney transplant recipients (18 infertile and 16 fertile) and 31 nontransplant persons (15 infertile and 16 fertile) were included in this study. All subjects were assessed clinically and by measurement of basal concentrations of total testosterone, FSH, cyclosporine whole blood trough levels, serum creatinine, haemoglobin and semen analysis using computer-aided sperm analysis (CASA) as well as scrotal ultrasonography to evaluate testicular dimensions. Our results demonstrate a significant decrease (p < 0.05) in sperm concentration, the percentage of motile spermatozoa, straight line velocity (VSL), linearity (LIN) and velocity of average path (VAP) among infertile transplant patients in comparison with the fertile transplant group. Serum testosterone, FSH levels and testicular dimensions did not differ significantly (p > 0.05) between fertile and infertile transplant recipients. Both sperm concentration and VSL were inversely correlated to the cyclosporine whole blood trough levels (p < 0.05). The time spent on haemodialysis was inversely correlated (p < 0.05) with the percentage of motile spermatozoa and the amplitude of lateral head displacement (ALH). In conclusion, CASA is valuable in evaluation of sperm motility in infertile renal transplant patients. Stabilization of the cyclosporine whole blood trough level within the target therapeutic level and correction of anaemia (if any) could improve the fertility potential in kidney transplant recipients.

Transaortic repair of ruptured aneurysm of sinus of Valsalva. Fifteen-year experience.

Between 1978 and 1993 a total of 25 cases of ruptured aneurysm of the sinus of Valsalva underwent transaortic repair at the Railway Hospital and the Institute of Cardiovascular Diseases at Madras, India. The aneurysms ruptured into the right ventricle in 20 patients, into the right atrium in 2, into the left ventricle in 1, and into the interventricular septum in 2. They originated from the right coronary sinus in 22 patients and from the noncoronary sinus in 3. Associated congenital anomalies included ventricular septal defect in 21, tetralogy of Fallot in 1, and pulmonary stenosis in 1. All 25 patients underwent transaortic repair of the ruptured sinus of Valsalva, and in patients with a ventricular septal defect the defect also was closed via this route. The patient with associated pulmonary stenosis had a pulmonary valvotomy. The patient with tetralogy of Fallot had infundibular resection, ventricular septal defect closure via a transatrial route, and a right ventricular outflow patch. No intraoperative deaths occurred, but one early death resulted from septicemia and multiorgan failure after rupture of the aneurysm into the interventricular septum with consequent development of extensive intramyocardial and epicardial abscesses. One late death occurred as a result of recurrent subacute bacterial endocarditis and septicemia. Transaortic repair of ruptured aneurysm of the sinus of Valsalva can be accomplished with a low risk of mortality and has the advantage that an associated ventricular septal defect, which frequently accompanies this condition, can be conveniently closed via the same route.

Unifocalization of major aortopulmonary collateral arteries in pulmonary atresia and ventricular septal defect using antibiotic sterilized pulmonary homograft: a case report.

A unifocalization procedure in a 9-year-old girl with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries (MAPCAs) was performed using an antibiotic sterilized pulmonary homograft. A tailored pulmonary homograft was used as an interposition graft to anastomose the pulmonary artery to the larger MAPCA after a side-to-side anastomosis had been done between the two MAPCAs. The pulmonary homograft was connected to the right subclavin artery with a 6-mm Gore-Tex shunt. Postoperative oxygen saturation (SaO2) levels were satisfactory and a postoperative angiogram showed good unifocalization of the pulmonary vasculature.

Early experience with the two patch technique for complete atrioventricular septal defect.

A total of 12 cases underwent repair of complete atrioventricular (AV) septal defect utilising the two-patch technique. There were 4 males and 8 females. The mean age at repair was 9.6 months (range, 3 to 49 months). The average weight was 5.4 kg (range, 3.5 to 13 kg). Five had associated patent ductus arteriosus. A Gore-Tex patch and glutaraldehyde preserved pericardium was utilised for the ventricular and atrial portions of the defects respectively in all patients. Four of these were done under hypothermic circulatory arrest. There were no intra-operative deaths. Early mortality comprised of 2 patients (2/12, 16.6%). One due to a pulmonary hypertensive crisis and the other to septicemia. The mean duration of ventilatory support was 62 hours (range, 24 to 192 hours). The mean duration of inotropic support was 57 hours (range, 24 to 192 hours). Primary repair of AV septal defects using the two-path of technique can be accomplished with a low early mortality in carefully selected patients.

Early experience in the surgical treatment of the univentricular heart.

Eighteen patients under went surgical treatment of univentricular hearts between April 1989 till October 1992. All 18 had palliative operations in the form of: a modified Blalock-Taussig shunt (5), pulmonary artery banding (2), bidirectional Glenn shunts (2), conventional Fontan repair (1) and total cavo pulmonary connection (8). There were 11 males and 7 females. The mean age at operation was 4.5 years (range, 1 month to 24 years). The average weight at operation was 12.2 kg (range 2 to 43 kg). Associated anomalies included: transposition of the great arteries (4), pulmonary stenosis (9), pulmonary atresia (1), mitral atresia (1), atrioventricular septal defect (1) and patent ductus arteriosus (3). There were no intra operative deaths. There were 5 early deaths (27.7%). Causes of death were due to: blockage of a modified Blalock-Taussig shunt (1), respiratory failure (1), persistent ventricular arrhythmias (1) and low output syndrome (2). Treatment in the form of a systemic to pulmonary arterial shunt or an operation based on the Fontan principle may offer an initial palliative or definitive correction for this condition.

Total cavopulmonary connection--early results.

Presently total cavopulmonary connection is used as an alternative in complex congenital disorders requiring atriopulmonary connection. From January 1989 till November, 1992, a total of 18 cases underwent total cavopulmonary connection. There were 8 males and 10 females. The mean age at operation was 92 months (range 5 to 504 months). The average weight was 19.6 kg (range 5.25 to 42 kg). Diagnoses included: tricuspid atresia (6); univentricular heart (7); pulmonary atresia with intact interventricular septum (1); double outlet right ventricle, pulmonary stenosis with uncommitted ventricular septal defect (2); corrected transposition of the great arteries with multiple ventricular septal defects (1) and complete atrioventricular septal defect with double outlet right ventricle (1). The mean duration of ventilatory and inotropic support was 127 hours (range 12 to 528 hours) and 140 hours (range 24 to 528 hours) respectively. The average duration of hospital stay was 17.9 days (range 5 to 30 days). There was no intra-operative mortality. Early mortality was 22.2% (4/18). Pre-operative diagnoses of patients who died were: tricuspid atresia (1), univentricular heart (1), complete atrio-ventricular septal defect with double outlet right ventricle (1) and double outlet right ventricle, pulmonary stenosis with uncommitted ventricular septal defect (1). The causes of death were: low-output syndrome (3) and septicemia (1). Although these initial results with total cavopulmonary connection suggest a lower early mortality compared to other modifications of the Fontan principle, long-term follow-up would be necessary to assess the late implications of this procedure.

Histocompatibility antigens in Egyptians with cutaneous leishmaniasis: a preliminary study.

The frequency of human leucocytic antigens (HLA) were studied in 27 patients with cutaneous leishmaniasis to evaluate the role of HLA antigens as genetic markers in the pathogenesis of this protozoal skin infection. A significant statistical association was observed between HLA-A11, -B5 and -B7 antigens and diffuse cutaneous leishmaniasis. In conclusion, study of immune response genes could be of value to understand the pathogenic mechanisms responsible for cutaneous leishmaniasis.

Effect of erythropoietin on sexual potency in chronic haemodialysis patients. A preliminary study.

Six male dialysis patients were submitted to a Doppler study of the deep penile arteries and intracavernosal injection of 30 mg papaverine under basal conditions before and after erythropoietin therapy. Penile tumescence was recorded after 15 min by measuring the length and the circumference of the penis as well as the erectile angle between the penis and the legs with the patient in standing position. Haematocrit was raised by erythropoietin therapy from 19.3 +/- 4.5 to 31.2 +/- 5.5 within 3 months. Five patients completed the study. We encountered a significant improvement in the frequency of sexual intercourse per month from 1.3 +/- 0.5 to 2.3 +/- 0.8 (p = 0.014). Furthermore, an increase was observed in the penile brachial index (from 0.87 +/- 0.1 to 0.91 +/- 0.1) and in the papaverin induced increase in penile length (4.6 +/- 1.4 cm versus 5.2 +/- 1.1 cm), penile circumference (2.7 +/- 0.14 cm versus 2.7 +/- 0.27 cm) as well as in the erectile angle (61.7 +/- 37.1 versus 80 +/- 23.5 degrees). These changes were not statistically significant. There was a significant correlation between the increase in the erectile angle and the increase in frequency of intercourse (p = 0.04). In conclusion, erythropoietin treatment could improve the sexual potency in uraemic patients under chronic haemodialysis therapy.

Intralesional injection of bleomycin sulphate into resistant warts in renal transplant recipients versus non-transplant warty patients.

Sixteen adult renal transplant patients and 20 non-transplant patients with warts underwent intralesional therapy with bleomycin sulphate. One unit/ml bleomycin sulphate was injected in 93 warts in renal transplant recipients and 100 warts in non-transplant patients with proven resistance to conventional treatment for at least 6 months. The treatment was compared with a normal saline placebo injected into the paired warts in the same patient. Thirty-four out of 93 warts (37%) in renal transplant recipients vs. 59 out of 100 warts (59%) in non-transplant patients were completely cured after one to three injections. We found bleomycin completely ineffective in 56 warts (60%) in renal transplant recipients, but ineffective in only 17 warts (17%) in non-transplant warty patients. None of the patients treated experienced any side effects except for local pain which was well tolerated, especially by non-transplant patients.