Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus: a prospective, controlled study.

Retrograde ejaculation (RE) and erectile dysfunction may be caused by diabetes mellitus (DM), but the prevalence of RE among DM patients is unknown. A prospective, blinded case-control study comparing men with DM with matched controls according to RE and erectile dysfunction was performed. Twenty-seven men with DM matched the inclusion criteria and agreed to participate in the study, and of these 26 delivered an ejaculate. We were able to recruit 18 matching controls, and of these 16 delivered an ejaculate. Nine of 26 men with DM who delivered an ejaculate had RE, whereas none of 16 controls had RE (p < 0.01). The mean duration of DM was longer for DM patients with RE (20 years) compared with DM patients in whom RE could not be demonstrated (13 years), but the difference was not statistically significant. RE could not be associated with BMI, waist circumference, blood pressure, Haemoglobin A1c (HgbA1c), high-density lipoprotein HDL cholesterol, triglycerides, fasting glucose, or s-testosterone. Diabetics suffering from RE more frequently exhibited erectile dysfunction compared with non-diabetics and diabetics without RE, and the last-mentioned group again more frequently than controls. These findings could not be explained by use of antihypertensive drugs. Whereas none of the included control participants showed signs of abnormal ejaculation, every third man with DM exhibited retrograde ejaculation. It is important to be aware of this association, and that post-ejaculatory urine is routinely analysed from aspermic fertility clinic attendants and diabetics with low ejaculate volumes.

Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study.

BACKGROUND: There is preliminary evidence to suggest an impact of stress on chances of achieving a pregnancy with in-vitro fertilization (IVF). The majority of the available research has focused on stress related to infertility and going through IVF-treatment, and it is still unclear whether non-fertility-related, naturally occurring stressors may influence IVF pregnancy chances. Our aim was to explore the association between IVF-outcome and negative, i.e. stressful, life-events during the previous 12 months. METHODS: Prior to IVF, 809 women (mean age: 31.2 years) completed the List of Recent Events (LRE) and questionnaires measuring perceived stress and depressive symptoms. RESULTS: Women who became pregnant reported fewer non-fertility-related negative life-events prior to IVF (Mean: 2.5; SD: 2.5) than women who did not obtain a pregnancy (Mean: 3.0; SD: 3.0) (t(465.28) = 2.390, P = 0.017). Logistic regression analyses revealed that the number of negative life-events remained a significant predictor of pregnancy (OR: 0.889; P = 0.02), when controlling for age, total number of life-events, perceived stress within the previous month, depressive symptoms, and relevant medical factors related to the patient or treatment procedure, including duration of infertility, number of oocytes retrieved and infertility etiology. Mediation analyses indicated that the association between negative life events and IVF pregnancy was partly mediated by the number of oocytes harvested during oocyte retrieval. CONCLUSION: A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as oocyte retrieval outcome.

Vasculitis-like syndrome associated with Borrelia lusitaniae infection.

We report the isolation of Borrelia lusitaniae from a 13-year-old female child presenting with a vasculitis syndrome. The patient was treated with doxycycline, 100 mg bid for 20 days, and is in remission after a follow-up of 2 years. These results should alert clinicians to the fact that B. lusitaniae may be pathogenic in humans, highlighting that patients may be seronegative or present with minimal positive antibody titres and clinical signs that are not specific for Lyme borreliosis. In order to prevent the occurrence of more serious disease manifestations via timely treatment, the analysis by molecular methods may be a useful approach when antibody titres are uninformative.

Progesterone supplementation during early gestations after IVF or ICSI has no effect on the delivery rates: a randomized controlled trial.

BACKGROUND: The aim was to study whether prolongation of luteal support during early pregnancy influences the delivery rate after IVF. METHODS: Dual centre study including 303 women who achieved pregnancy after IVF or ICSI was used. All were treated with the long protocol using GnRH agonists and given luteal support with 200 mg vaginal progesterone three times daily during 14 days from the day of transfer until the day of a positive HCG test. The study group (n = 150) withdrew vaginal progesterone from the day of positive HCG. The control group (n = 153) continued administration of vaginal progesterone during the next 3 weeks of pregnancy. RESULTS: The number of miscarriages prior to and after week 7 of gestation was seven (4.6%) and 15 (10.0%) in the study group and five (3.3%) and 13 (8.5%) in the control group respectively. The number of deliveries was 118 (78.7 %) in the study group and 126 (82.4 %) in the control group. The differences were not significant. CONCLUSIONS: Prolongation of progesterone supplementation in early pregnancy has no influence on the miscarriage rate, and thus no effect on the delivery rate. Progesterone supplementation can safely be withdrawn at the time of a positive HCG test.

Functional characterization of Pactolus, a beta-integrin-like protein preferentially expressed by neutrophils.

Murine Pactolus is a beta-integrin-like molecule expressed exclusively on the surface of granulocytes. Cell surface expression of Pactolus is dramatically increased following activation of bone marrow neutrophils with known agonists, and cross-linking of cell surface Pactolus, suggesting the bulk of the protein is in intracellular stores. The mature protein is found in two forms depending upon the extent of N-linked glycosylation. There is no evidence to suggest that Pactolus requires an associated alpha chain for expression. In some mouse strains, a truncated form of the protein is predicted based upon alternative splicing: this form, however, is unstable and rapidly degraded after synthesis. Differences in the quantities of these Pactolus mRNA isoforms have defined two alleles. BALB/c and C3H/HeJ mice possess allele B and preferentially express the truncated, unstable product, whereas C57BL/6 mice possess allele A and only produce the membrane-bound form. Sequence analysis has shown the difference between these two alleles is due to a single base pair difference at the splice acceptor site for the truncated product. The increased expression of the membrane form of Pactolus by granulocytes of C57BL/6 mice suggests a compensatory adhesion function that is reduced in cells from the low producing strains.

Friendly IVF: patient opinions.

BACKGROUND: The present trend towards low stimulation protocols in IVF calls for evaluation of patient attitudes. METHODS: This study compared results of a 23-item questionnaire mailed to 167 patients receiving a low stimulation type of regimen (LS-IVF) (unstimulated cycle or clomiphene) and to 116 patients treated by a standard protocol (S-IVF) (long-down regulation with gonadotrophin-releasing hormone analogue and FSH or human menopausal gonadotrophin). RESULTS: Around two-thirds of all responders in both groups deemed side-effects important, but side-effects and stress associated with hormone treatment were more prevalent in patients receiving S-IVF than LS-IVF. Stress due to cycle cancellation was acceptable, mild or not perceptible in significantly (P < 0.005) more patients receiving LS-IVF [48% (36/75)] compared with patients having S-IVF [26% (8/31)]. Of patients having tried the LS-IVF protocol, 93% (125/135) would suggest either LS-IVF or a sequence of this and S-IVF as a future treatment "package" compared with only 53% (33/63) in the S-IVF group (chi(2) = 43.08, P < 0.0001). The LS-IVF group showed a significant trend towards acceptance of higher number of treatment cycles. CONCLUSIONS: The patients seemed to prefer the simplicity and short duration of a low stimulation regimen in spite of drawbacks such as a high risk of cycle cancellations and accordingly the necessity for more treatment cycles.

A randomized study comparing IVF in the unstimulated cycle with IVF following clomiphene citrate.

The efficiency of IVF in unstimulated cycles was compared with that following ovarian stimulation with clomiphene citrate in a simple protocol with ultrasound monitoring only. A total of 132 couples with no previous IVF attempts, selected by female age <35 years, indication for intracytoplasmic sperm injection or infertility caused by tubal factor or unexplained infertility were randomized to the two protocols. Randomization yielded two comparable groups. The clomiphene group (68 couples) performed significantly better than the unstimulated group (64 couples) in terms of number of cycles with oocyte harvest (90/111 or 81% versus 65/114 or 57%; chi(2) = 9.21, P < 0.002), embryo transfers per started cycle (59/111 or 53% versus 29/114 or 25%; chi(2) = 18.14, P < 0.0001), live intrauterine pregnancy rate per started cycle (20/111 or 18% versus 4/114 or 4%; chi(2) = 12.42, P < 0.0001), live intrauterine pregnancy rate per embryo transfer (20/59 or 34% versus 4/29 or 14%; chi(2) = 3.96, P = 0.047), but not in terms of implantation rate (22/85 or 26% versus 4/29 or 14%; chi(2) = 1.65). Only two twin pregnancies occurred. Modest side-effects were recorded following clomiphene. Accordingly, a simple clomiphene citrate protocol, but not IVF in unstimulated cycles, seems compatible with the concept of 'friendly IVF', yielding a fair pregnancy rate both per cycle started and per embryo transfer in selected patients. The results do not substantiate any important negative anti-oestrogenic effects of clomiphene.

Norfloxacin-induced DNA cleavage occurs at the dif resolvase locus in Escherichia coli and is the result of interaction with topoisomerase IV.

The dif locus is a site-specific recombination site located within the terminus region of the chromosome of Escherichia coli. Recombination at dif resolves circular dimer chromosomes to monomers, and this recombination requires the XerC, XerD and FtsK proteins, as well as cell division. In order to characterize other enzymes that interact at dif, we tested whether quinolone-induced cleavage occurs at this site. Quinolone drugs, such as norfloxacin, inhibit the type 2 topoisomerases, DNA gyrase and topoisomerase IV, and can cleave DNA at sites where these enzymes interact with the chromosome. Using strains in which either DNA gyrase or topoisomerase IV, or both, were resistant to norfloxacin, we determined that specific interactions between dif and topoisomerase IV caused cleavage at that site. This interaction required XerC and XerD, but did not require the C-terminal region of FtsK or cell division.

[Menstrual cycle and surgery of breast cancer. Point of time for the surgery of primary breast cancer in connection with menstrual cycle is without prognostic significance]. / Menstruationscyklus og operation for mammacancer. Tidspunktet for operation for primoer mammacancer i forhold til menstruationscyklus er uden prognostisk betydning.

From 1977 to 1989 6488 patients under fifty years with primary breast cancer were registered in the nationwide Danish Breast Cancer Cooperative Group (DBCG). Among these information on last menstrual period prior to surgery was available in 1635 cases which constitute the study group of the present analysis. The group was representative of the total group with regard to prognostic factors and survival. In the study group time of surgery in relation to last menstrual period was found to have no influence on five- and ten year survival.

Timing of surgery in relation to menstrual cycle does not predict the prognosis in primary breast cancer. Danish Breast Cancer Cooperative Group.

From 1977 to 1989 6488 patients under 50 years with primary breast cancer were registered in the nationwide Danish Breast Cancer Cooperative Group (DBCG). Among these, information on last menstrual period prior to surgery was available in 1635 cases which constitute the study group of the present analysis. The group was representative of all women operated upon during the period with regard to prognostic factors and survival. In the study group time of surgery in relation to last menstrual period was found to have no influence on 5 and 10 years survival.

[Spontaneous esophageal rupture during the 3rd trimester]. / Spontan esophagusruptur i tredje trimester.

A 30-year-old woman, 35 weeks pregnant, developed spontaneous rupture of the oesophagus following severe vomiting, probably caused by treatment with Ritodrin (Utopar). The symptoms, diagnosis and treatment of spontaneous oesophageal rupture are discussed.

[Bladder leukoplakia]. / Blaereleukoplaki.

Leukoplakia of the bladder is a rare condition. It is characterized by squamous metaplasia of the transitional epithelium and keratinization. The etiology and possible pathogenetic factors are discussed. Up to 42% develop carcinoma which makes early diagnosis important. The clinical diagnosis is difficult. The patients present with symptoms of vesical irritation and the passage of flakes is pathognomonic. Diagnosis is made by cystoscopy with biopsies. Characteristic cystoscopic findings are described. Treatment and a follow-up programme are outlined. As conservative treatment remains unsatisfactory radical extirpation or cystectomy is recommended for extensive lesions.

Trigger finger: report of an unusual case.

Locking of a finger is a common condition usually caused by tightness of the fibrous sheaths around the flexor tendons. A case of a locking finger with an unusual traumatic cause and perioperative findings is presented. Different causes of trigger fingers, especially traumatic, reported in the literature are briefly discussed, and the importance of differing between traumatic and nontraumatic causes for locking phenomena is emphasized.

A case of vesical leukoplakia.

A 54-year-old woman who had earlier been treated for cervical dysplasia complained of recurrent cystitis, urgency and frequency, but without signs of genital prolapse. At cystoscopy with biopsies, leukoplakia of the bladder was diagnosed. We describe how the condition is distinguished from squamous metaplasia of the trigone as seen in normal premenopausal women. An association between leukoplakia and cancer is widely accepted. Against this background, a follow-up program is outlined. The possibility of leukoplakia as a multicentric disorder of the genito-urinary tract is briefly discussed.

[Peptic ulcer in children]. / Ulcus pepticum hos børn.

Peptic ulceration in children is a rare condition. Primary ulcers, representing 70% of ulcers in children greater than 6 years are predominantly duodenal in location. A positive family history for peptic ulcers is common. Immunosuppressive therapy, severe infections and intracranial lesions are important etiologic factors associated with secondary ulcers. The mortality is approximately 80%. The clinical characteristics of both groups are described. Treatment of children's ulcers and associated complications are described with emphasis on reserving surgical treatment for ulcers not responding to medical therapy and complicated ulcers. We recommend increased attention to this notoriously difficult diagnosis and increasing use of upper gastrointestinal fiberoptic endoscopy.

[Fatal acute stomach ulcer perforation in a 4-year-old child]. / Akut ventrikelulcus med perforation og letal udgang hos 4-årigt barn.

A fatal case of perforation of a gastric ulcer in a 4 1/2-year-old child is presented and discussed.

[Recurrent secondary stomach ulcer in a boy 3 months of age with osteogenesis imperfecta]. / Recidiverende sekundaert ulcus ventriculi hos en tre måneder gammel dreng med osteogenesis imperfecta.

A case is described where a 3-month-old boy who had osteogenesis imperfecta with multiple fractures presented with vomiting and bleeding. A gastric ulcer was diagnosed by endoscopy but could not be visualized by repeated radiography. In spite of adequate treatment with H2-antagonists and antacids the bleeding recurred three months later. Development of hypertrophic pyloric stenosis was diagnosed and pyloromyotomy was performed after which the patient recovered without further recurrences. This case suggests that multiple ulcerogenic factors should considered and treated in pediatric patients with recurrent secondary ulcers in spite of appropriate treatment.

Abdominal abscess following asymptomatic pelvic osteomyelitis. Case report.

In a 23-year-old woman, an intramuscular abscess of the ventral abdominal wall in the right iliac fossa was found to have an extraperitoneal fistula to a focus of asymptomatic osteomyelitis of the iliac ala. Pelvic osteomyelitis should be suspected in cases of abdominal wall abscess without pathologic intra-abdominal findings.

Rhabdomyolysis and acute renal failure following an overdose of doxepine and nitrazepam.

A 50-year-old woman developed rhabdomyolysis and myoglobinuric renal impairment after an oral dose of 250 mg nitrazepam and 1,250 mg doxepin. Serum creatinine increased from 70 mumol/l to 472 mumol/l in two days. Serum creatine phosphokinase reached a maximal level of 391 mu kat/l (reference range less than 2.5 mu kat/l) on the third day and serum myoglobin was maximally 910 nmol/l (reference range less than 4.5 nmol/l) on the fourth day after the overdose. Passive and active movements of the knees and ankles became increasingly restricted, but the patient felt no muscle pain. Diuresis decreased to 20-22 ml/hour in spite of repetitive doses of furosemide, but was enforced to greater than 100 ml/hour by vigorous infusion of saline. Haemodialysis was avoided on this regimen. It is suggested that in patients intoxicated with nitrazepam and/or doxepin, rhabdomyolysis should be suspected when a rapidly increasing serum concentration of creatinine is found, even in the absence of muscle pain.