Diagnostic accuracy of computer-assisted sperm motion analysis.

One retrospective and two prospective studies were conducted among 218 couples treated with in-vitro fertilization (IVF) to establish the reproducibility and diagnostic accuracy of computer-assisted sperm analysis (CASA) with swim-up spermatozoa for the prediction of the fertilization rate of oocytes in vitro. Based on the results of a preliminary retrospective analysis in 49 patients, the 'curvilinear velocity' (VCL) was chosen as the most distinctive motion parameter of sperm function and the median was used to represent the entire sperm population. The number of inseminated motile spermatozoa was then adjusted to median VCL during two subsequent prospective studies with clinical IVF. Whereas in the first prospective study (90 couples) the threshold values of VCL with regard to the number of spermatozoa inseminated were based on the results of the preliminary retrospective study (49 couples), in the second prospective study (79 couples) the settings were based on the results of the first prospective study. The reproducibility of CASA was tested by analysing the motion characteristics of spermatozoa at different intervals after termination of swim-up, by repeated analysis of the same video-recording of the incubated spermatozoa by different observers, and by the repeated video-recording of the freshly prepared sperm samples and analysis of both video-recordings by the same observer. Under these conditions the frequency of disagreement between two measurements varied between 2.0 and 8.2%. In both prospective studies the sensitivity of CASA for the prediction of fertilization was high (74.0%), whereas the specificity was low (40.0%). In contrast to successful fertilization, unsuccessful fertilization of oocytes in vitro could not be predicted reliably with CASA. However, the pregnancy rate per cycle among patients with predicted low fertilization rates was significantly lower (5.3%) than in couples with high predicted fertilization rates (24.3%, P < 0.001). Therefore, CASA of washed spermatozoa may still help to identify couples who would benefit more from intracytoplasmic sperm injection (ICSI) than from IVF. A definite threshold level could not be identified for any of the motion parameters to distinguish the motion characteristics of fertilizing and non-fertilizing spermatozoa. Using various algorithms for hyperactivated motility, the percentage of hyperactivated spermatozoa was significantly higher among the successfully fertilizing patients than among the nonfertilizing group. However, the absolute number of hyperactivated spermatozoa added to the oocytes was higher in non-fertilizing couples. Therefore, the lack of fertilization in some patients may be caused by a generalized defect in sperm function rather than by insufficient hyperactivation.

Prognostic value of male diagnostic profiles in intracytoplasmic sperm injection (ICSI).

Possible correlations between male hormone and semen parameters with pregnancy and oocyte fertilization rates following intracytoplasmic sperm injection (ICSI) were investigated. The study is based on 290 couples who underwent ICSI therapy for the first time. The parameters evaluated were male age, serum levels of follicle stimulating hormone (FSH) and testosterone, sperm concentration, sperm motility, normal sperm morphology, index of teratozoospermia (TZI) and sperm vitality. A marginal, barely significant association was found between the fertilization rate and serum FSH levels in the male partner (p = 0.046). There was no relevant association between male parameters and pregnancy rates. The study confirms that male hormonal and semen parameters are of low prognostic value for the outcome of ICSI.

Creatine kinase activity in human spermatozoa and seminal plasma lacks predictive value for male fertility in in vitro fertilization.

OBJECTIVE: To examine the predictive value of creatine kinase in human spermatozoa and seminal plasma from patients treated in an IVF program. DESIGN: Prospective, blind clinical study. SETTING: Male infertility clinic. PATIENT(S): Seventy-three patients and 32 fathers (age, <45 years). INTERVENTION(S): Determination of creatine kinase activity in seminal plasma, washed spermatozoa, and swim-up purified spermatozoa from patients treated in an IVF program. MAIN OUTCOME MEASURE(S): Creatine kinase activity in seminal plasma, washed spermatozoa, and swim-up purified spermatozoa. RESULT(S): Creatine kinase activity in washed spermatozoa correlated significantly with normal sperm morphology. No significant correlations were found between creatine kinase activity or creatine kinase isoenzyme ratio in seminal plasma, washed spermatozoa, or swim-up purified spermatozoa and success in the IVF program. The percentage of spermatozoa with normal morphology was significantly lower in patients whose sperm did not fertilize than in patients whose sperm did fertilize oocytes and in the control group of proven fathers. CONCLUSION(S): Total creatine kinase activity and creatine kinase isoenzyme distribution are not sperm function markers for prediction of male fertility in IVF treatment.

Parental origin of the extra haploid chromosome set in triploidies diagnosed prenatally.

The parental origin of the additional chromosome complement in a total of 17 cases of triploidy was determined mainly using highly polymorphic microsatellites. Maternal origin of the triploidy was demonstrated in most cases. To the best of our knowledge, this is the first systematic evaluation of the parental origin of chromosome sets in fetuses who survived until a cytogenetic diagnosis was established. In contrast to previous investigations this study documented a predominance of maternal origin of the extra haploid set mainly due to longer survival time for digynic triploidies. The concept of 2 distinct fetal phenotypes in triploidy is clearly supported by this study.

[Venous diseases of the lower extremities--methods and results of phlebography of the lower extremity--the superficial and deep systems]. / Venenerkrankungen der unteren Extremitäten--Methoden und Ergebnisse der Phlebographie der unteren Extremität--oberflächliches und tiefes System.

The vena saphena magna is the most important arterial vascular substitute in today's vascular surgery. That is why modern varicose vein surgery is performed very carefully and cautiously with an aim to preserve the vessels as much as possible. This can be done only if the radiologist visualises both the healthy and the diseased superficial and deep venous systems as completely and a easily appreciable as possible when diagnosing varicosis. It is not enough to merely produce contrast images of the deep venous system when attempting to clarify varicosis via phlebography. The conditions obtaining at the points where the great saphenous vein and the small saphenous vein open into the femoral and popliteal veins, respectively, must be clearly visible. The maximum possible number of insufficient venae perforantes must be shown and the side branches of the great saphenous vein that have undergone varicose changes, must be visualised. It goes without saying that the deep venous system must be shown in a manner that it can be safely assessed. An extended thrombosis of the deep veins of the leg and pelvis does not present any diagnostic pitfalls when assessing the phlebogram. On the other hand, a beginning deep leg thrombosis is easily overlooked. Phlebographically it is quite difficult to clarify a relapsing thrombosis. This requires detailed knowledge of the patterns of signs in deep leg vein thrombosis.

[Axial and semi-axial views of the pelvis in bone scintigraphy. Technic, anatomy, limitations, possibilities]. / Axiale und halbaxiale Ansichten des Beckens bei der Skelettszintigraphie. Technik, Anatomie, Grenzen, Möglichkeiten.

A new method of skeletal scintigraphy offering axial views of the pelvis is described. The anatomy, method of examination, limits and advantages of the axial pelvis views are given by reporting on the scintigraphic examinations (167 axial pelvis views) of 50 patients with 52 increased uptakes of the isotope in the pelvis region. The standard ventral and dorsal pelvis views represented all increased uptakes. However, when employing the axial views the localisation and extent of the tracer accumulation could be more precisely determined in 73%. In 27% no additional information was given. This new method is characterized by the opportunity of distinguishing more clearly between the increased bone uptakes and the activity in the urinary bladder. This distinction was given in 24% of increased bone uptakes in the regions of the pubic bones, the symphysis, the sacrum and the coccyx.

[3-phase scintigraphy in the Sudeck syndrome. Comparison with the results of roentgenologic and clinical studies]. / Drei-Phasen-Szintigraphie beim Sudeck-Syndrom. Vergleich mit röntgenologischen und klinischen Untersuchungsergebnissen.

37 patients with clinically and radiologically proved reflex sympathetic dystrophy syndrome were scintigraphed by 99mTc-MDP (three-phase-scintigraphy). In 87% of the examinations (all three-phases) an increased tracer accumulation in the region of the affected limb could be seen scintigraphically. The majority of the positive results (92% resp. 87%) were found in the interval phase (phase II) and the late phase (phase III) of the scintigraphic examinations.--We recommend a staging of the increase of the tracer accumulation when examining the reflex sympathetic dystrophy syndrome. This staging doesn't significantly correlate with the familiar clinical and radiological stagings. However it may be useful when assessing the course of the syndrome.--Increased tracer accumulations could be observed in the case of clinically, radiologically and scintigraphically manifest reflex sympathetic dystrophy syndrome in the region of the foot, frequently in the ipsilateral knee region, rarely in the ipsilateral hip joint region, although clinically the syndrome could not be observed in these regions.

[Dysplasia epiphysialis multiplex--scintigraphic, roentgenologic and clinical correlation]. / Dysplasia epiphysialis multiplex--szintigraphische, röntgenologische und klinische Korrelation.

Seven patients with various clinical, radiological und scintigraphic manifestations of dysplasia epiphysealis multiplex were examined by three-phase scintigraphy using 99mTc-NDP and also radiologically. A comparison of the results is shown; radiological investigation showed some abnormalities which were not demonstrated scintigraphically. No lesions were demonstrated by scintigraphy where the radiograph was normal. Increased uptake of the isotope during a three-phase scintigram is a sensitive indicator of activity of the disease. However, the extent and intensity of the uptake of the isotope did not always correlate well with joint pain and reduction in the range of joint movement.

[Chronic hypophosphatemic osteopathy (author's transl)]. / Chronische hypophosphatämische Osteopathie.

The process of chronic hypophosphatemic vitamin D-resistant rickets--observation of two cases. With the male patient--our first case--the disease was sporadic and had not been recognized for a long time. In his early adulthood it manifested itself as Umbauzonen (pseudofractures) in the larger context of active osteomalacia. It was possible to observe the pseudofractures before and while the patient was treated with drugs. High doses of vitamin D 3 and dosage of phosphate mitigated the complains although with respect to the radiological, scintigraphic, humoral and histological findings there was only slow improvement or no improvement at all.--The patient's daughter is affected by the disease as well. In her case the pathological signs of her bones became better when treated with vitamin D 3.

[Smith-McCort syndrome (author's transl)]. / Smith-McCort-Syndrom.

An 13-year-old mentally normal boy with short-trunked dwarfism is discribed as a case of the Smith-McCort syndrome (SMC-syndrome). His disease has been observed radiologically, clinically an histologically for many years. According to Spranger (23) this disorder differs from the Dyggve-Melchior-Clausen disease (DMC-syndrome) by lacking oligophrenia. Beside a characteristic flattening of the vertebral bodies both syndromes show a lacelike appearance of the iliac crest (crest sign) as a significant radiological sign. Both syndromes appear to be inherited as an autosomal recessive trait.

[Gray-scale-sonography of gallbladder and bileducts, especially in case of a negative cholecystoradiogram (author's transl)]. / Gray-scale-Sonographie der Gallenblase und Gallenwege insbesondere bei negativem Cholecystoradiogramm.

The importance of ultrasonography (gray-scale-B-scan sonography) in cases with gallbladder and bileduct disease is reviewed, especially in patients with non visualization of the gallbladder. Major emphasis is put on the differential diagnosis of gallbladder stones and exophytic intraluminal tumors of the gallbladder. The efficacy of the lost shadow sign is pointed out. The sonoanatomy as well as the sonographical examination method is shortly described. In model experiments some aspects of cholecystosonography are explored.

[Gray-scale ultrasound B-scanning in case of cholelithiasis, especially with negative cholecystoradiogram (author's transl)]. / Grauwertsonographie bei Cholelithiasis, besonders bei negativem Cholezystoradiogramm. Vergleich mit operativen und radiographischen Ergebnissen.

Report on the accuracy of gray-scale B-scanning concerning cholelithiasis. In 37 cases out of 43 examined patients sonographical results could be compared to operative and radiological results. In the case of 20 patients with a negative cholecystangiogram the results of sonography could be compared to operative results. Sonographically the gallbladder was shown in 89% of the cases. Gallstones were diagnosed at a high percentage (sensitivity 80%, specificity 88%). There were 20% false-negative diagnoses and 13% false-positive diagnoses.

[Osteogenic sarcoma combined with non-ossifying fibroma in one bone (author's transl)]. / Monostotische Kombination eines osteogenen Sarkoms mit einem nicht-ossifizierenden Knochenfibrom

In a 15 year old girl a combination of osteogenic sarcoma and non-ossifying fibroma in the distal shaft of femur is reported and discussed.