X-ray illumination of the ejecta of supernova 1987A.

When a massive star explodes as a supernova, substantial amounts of radioactive elements--primarily (56)Ni, (57)Ni and (44)Ti--are produced. After the initial flash of light from shock heating, the fading light emitted by the supernova is due to the decay of these elements. However, after decades, the energy powering a supernova remnant comes from the shock interaction between the ejecta and the surrounding medium. The transition to this phase has hitherto not been observed: supernovae occur too infrequently in the Milky Way to provide a young example, and extragalactic supernovae are generally too faint and too small. Here we report observations that show this transition in the supernova SN 1987A in the Large Magellanic Cloud. From 1994 to 2001, the ejecta faded owing to radioactive decay of (44)Ti as predicted. Then the flux started to increase, more than doubling by the end of 2009. We show that this increase is the result of heat deposited by X-rays produced as the ejecta interacts with the surrounding material. In time, the X-rays will penetrate farther into the ejecta, enabling us to analyse the structure and chemistry of the vanished star.

Mumps orchitis: report of a mini-epidemic.

PURPOSE: The incidence of mumps orchitis has declined dramatically since the introduction of vaccination. While in the past cases of mumps have only been seen occasionally at our institution, recently there has been a sharp increase in the number of confirmed cases. MATERIALS AND METHODS: Between June 1995 and April 1996, 11 patients with severe mumps orchitis were hospitalized at our clinic. Medical history, therapeutic measures and clinical outcome were recorded for each patient. RESULTS: All patients showed marked scrotal swelling with a temperature above 38.5 C. Serum C-reactive protein was significantly elevated (mean 140 mg./l.). The vaccination status of 1 of the 11 patients (9%) was unknown. Medical records from the remaining 10 patients indicated that they had not been vaccinated. Nine patients (82%) had a typical mumps parotitis preceding the orchitis. In 2 patients the clinical diagnosis of parotitis was uncertain but mumps serology was positive. None of the patients showed other manifestations of mumps. Antibodies to the mumps virus (IgG and IgM) were determined in 6 patients and positive in all cases. The average interval between parotitis and onset of orchitis was 10 days. All patients were hospitalized for an average of 6 days. Treatment included bed rest with local cooling, scrotal support and systemic treatment with nonsteroidal anti-inflammatory drugs. Ciprofloxacin or clavulanic acid/amoxicillin was administered as bacterial orchitis could not be excluded at initial presentation. The mean time to cessation of fever was 3.6 days (range 3 to 5). Antibiotics were administered for an average of 8.8 days (range 7 to 13) and anti-inflammatory drugs were given an average of 8.6 days (range 7 to 11). One patient required scrotal exploration. CONCLUSIONS: Since the introduction of a vaccine against the mumps virus there is a diminished risk for mumps and its complications. However, in case of scrotal swelling mumps orchitis should still be considered. Despite vaccination mumps has not been erradicated. Therefore, continued vaccination should be considered an important step in minimizing clinical outbreaks and working towards a possible eradication of this disease in the future.

[Results of microsurgical reconstruction after vasectomy]. / Resultate der mikrochirurgischen Rekonstruktion nach Vasektomie.

Because of the increasing number of divorces surgical refertilisation by vasovasostomy has become increasingly important. Of 33 patients operated in the last decade, 32 could be reached for follow-up. The patency-rate was 86% and the pregnancy-rate 28%. Possible explanations for this discrepancy are discussed. The time lag between vasectomy and vasovasostomy was the most important prognostic factor. There was no difference in the results between one-layer and two-layer anastomosis. With an interdisciplinary approach the same patency rate as described in the literature was achieved.

Long-term results of varicocelectomy.

Between 1983 and 1985, 257 infertile men were examined for any present varicocele by means of the Doppler sonography, telethermography and palpation. Based on these findings, the spermiogram and the infertility history, high ligation of the spermatic vein was indicated in 89 patients with varicocele and a median duration of infertility of 36 months (6-88 months). Postoperative sperm examinations have shown a significant improvement in sperm count and morphology, but not in motility. The most significant drop was observed in germ cell concentration from 1.68 to 1.06 mio/ml (p less than 0.025 Wilcoxon signed rank sum test). The follow-up examination 6 years after the beginning of the study has shown that only 56 out of the 89 patients underwent surgery, whereas 33 patients refrained from it. Pregnancy rates were 42% (23 out of 55, 1 patient lost to follow-up) in the operated group and 45% (14 out of 31, 2 patients lost to follow-up) in the nonoperated group. The comparison of the two graphs showing pregnancy incidence clearly demonstrates that pregnancies in the nonoperated group occur earlier than in the operated group; it has to be noted, however, that several patients only refrained from being operated on because pregnancy had occurred before surgery was planned. On the one hand, our study confirms other authors' results, i.e. that pregnancy rates in the nonoperated group are relatively high despite present varicocele. On the other hand, the operated group achieved practically the same high pregnancy rate when monitored over a longer period of time.(ABSTRACT TRUNCATED AT 250 WORDS)

[Initial experiences with prostaglandin E1 and PGE1 prepared injections]. / Erste Erfahrungen mit Prostaglandin-E1 und PG-E1-Fertigspritzen.

Between April and August 1989 we treated 50 patients with an erectile dysfunction. 23 patients (46%) had an organic, 17 (34%) a psychogenic and 7 patients (14%) a mixed origin of their impotence. In 3 patients the diagnosis has yet to be made. To induce pharmacological erections we used 20 micrograms of prostaglandin-E1 in a ready to use syringe. 64% (32 patients) achieved a full erection. Of the 18 patients insufficiently responding, 12 (67%) had an organic (in 11 patients vascular), 4 a psychogenic and 1 patient a mixed erectile dysfunction. In one patient the diagnosis has not been established at present. 14% (7) of the patients complained to have painful erections disturbing intercourse. The mean erection time was 2.5 hours (range 0.5-5.5). In one patient the intracavernous injection of prostaglandin-E1 resulted in a prolonged erection of more than seven hours, which was successfully treated by aspiration of blood from the corpora cavernosa and intracavernous injection of phenylephrine-hydrochloride. Nevertheless prostaglandin-E1 appears to be more physiological and to have less side-effects than papaverin-chloride.

Role of immunological factors in male infertility. Immunohistochemical and serological evidence.

Immunological deposits in the testis and circulating antibodies to spermatozoa are presented as a possible explanation for infertility in man. Testicular biopsy specimens from infertile patients (N = 52) as well as from fertile controls (N = 6) were analyzed immunohistochemically by using semithin sections. Immunoglobulin deposits were found in the testes of 21 patients. Antibody deposits were observed on the seminiferous tubule wall, on germ cells or in the interstitium. In two cases, the C3 complement component was detected on the tubular wall and in one case on atypical spermatogonia. Deposits of immunoglobulin class G were found most frequently, and were often attached to the seminiferous tubule wall. In addition, the occurrence of circulating antisperm antibodies in the sera of these patients was examined by a recently developed method, the immunobeads binding test. A significant number of patients with normal spermatogenesis had antibodies that exhibited a strong binding reaction to spermatozoa as observed by the immunobeads binding test. It is suggested that at least two different immunological mechanisms may be involved in pathological infertility: an immunoglobulin deposit, induced locally in the testis, in a manner specifically against the germ cells and the seminiferous tubular basement membrane, or in a manner nonspecifically against seminiferous tubular wall, and asystemically induced immunoglobulin production which is directed against spermatozoal antigens.

Autoimmune phenomena and cytogenetic findings in a patient with carcinoma (seminoma) in situ.

Routine examination of a testis biopsy from a patient with oligospermia and a large varicocele in his left testicle and who was childless for over 2 years showed carcinoma in situ (CIS) with atypic spermatogonia in his right testicle. Immunohistochemical investigations of this tissue revealed large intracellular deposits of immunoglobulin G (IgG) restricted to the atypical cells. By blot-immunobinding test of the patient's serum, circulating antibodies against a molecule with an approximate molecular weight of 60 kD were found. Such antibodies were not found in a total of over 500 infertile patients and fertile controls examined. This molecule was extracted from pooled normal human sperms by trypsin digestion and eluted out of a sodium dodecyl-sulphate polyacrylamide gel (SDS-PAGE). This elute is currently used for raising monoclonal antibodies. An analysis of the direct chromosome preparations from the testis biopsy showed both numerical and structural chromosomal aberrations. This might indicate that the atypical cells have already been transformed and hence could be considered as malignant.

The value of testicular biopsy in patients with varicocele.

With the use of semi-thin sections of 88 testicular biopsies from 44 patients, we were able to separate a relatively uniform group of patients with idiopathic left varicocele and infertility into 4 groups with different pathophysiological conditions. Group 1 patients had atrophy of the Leydig cells, decreased Leydig cell ratio, low plasma testosterone, and normal luteinizing and follicle-stimulating hormone levels. Surgery resulted in a significant improvement in sperm count. Group 2 patients had undergone attempted repair of Leydig cells, and had a normal Leydig cell ratio, and normal testosterone, luteinizing hormone and follicle-stimulating hormone plasma values. Group 3 patients demonstrated hyperplasia and an increased Leydig cell ratio, high luteinizing and follicle-stimulating hormone values, and relatively high testosterone values. Group 4 patients had an increased Leydig cell ratio but severe atrophy of the Leydig cells and tubuli, indicating burned out testes with high luteinizing and follicle-stimulating hormone but low testosterone levels. A successful operation failed to increase the sperm count in the latter groups. The technique used should allow better patient selection for medical treatment, as well as lead to a better understanding of the etiopathogenesis of infertility in varicocele patients. Therefore, the histological technique has an important role in the evaluation of patients suffering from infertility in general.

Blot-immunobinding test for the detection of anti-sperm antibodies.

A blot-immunobinding test was used to detect anti-sperm antibodies in human sera and to identify the corresponding auto- or iso-antigens on human sperm. A high proportion of sera at a 1:100 dilution from fertile persons, as well as infertile patients, contains antibodies reactive with sperm. This phenomenon might be physiological. At 1:2,000 dilution, a higher binding capacity was detected in the sera from infertile groups, but a few fertile persons were also positive. Antibodies to a single antigenic determinant with Mr of approximately 14,000 were found in a significantly higher proportion among males with unexplained infertility.

[Vasectomy for contraception]. / Vasektomie zur Empfängnisverhütung.

In order to obtain more information about possible sequelae of vasectomy, a follow-up examination was conducted in 247 men who had been vasectomized between one and ten years previously. A high degree of satisfaction with this method of family planning was found, and negative reactions were few. The relatively wide indication adopted at the University Hospital in Basel for vasectomy as a method of preventing pregnancy is therefore confirmed. Lack of objective information about possible physical or psychosexual reactions appears to be the most important reason why this method of contraception has not yet received due recognition.

[Problems posed by successive bilateral cancers of the testicles]. / Problèmes posés par les cancers bilatéraux successifs der testicules.

Six new cases of bilateral sequential germ cell tumors of the testis are reported. They were observed between 1960 and 1980 among 161 cases of testicular cancers. The incidence was 3.7%. One patient showed atypical germ cells in a testicular biopsy specimen 8 months before the second tumor arose. The importance of the seminoma in situ as an increased risk of a second testicular tumor and specific modalities of diagnosis, therapy or prognosis are discussed. We insist on the need for an accurate and extended follow-up because the success in management depends primarily on early diagnosis.

[Value of the meiosis test in male infertility]. / Bedeutung der Meiose-Untersuchung bei männlicher Infertilität.

The histological evaluation of testicular biopsy in the investigation of infertility was supplemented by cytogenetic analysis of spermatogenesis in 72 patients from 1976--1978. The results show meiosis analysis to be a practical aid in the assessment of male infertility. It enables the point of interruption in the meiotic process to be accurately identified. A review of relative populations of meiotic and of interphase nuclei (the meiotic index) permits evaluation of a quantitative disturbance of spermatogenesis, a finding that is of particular value when establishing a patient's prognosis. Moreover, meiotic analysis makes it possible to recognize cytogenetic anomalies which could be responsible for the infertility state and which were chiefly seen in patients whose so-called primary infertility was hitherto classified as being of unknown origin. In two patients we thus identified a small additional chromosome in a fraction of the germinal cells, and also an abnormal pairing of all chromosomes, or the sex chromosomes alone, during the first meiotic division.

[Long-term observations on different methods of nephropexy]. / Langzeitergebnisse bei unterschiedlicher Nephropexietechnik.

In 29 patients with nephroptosis two different methods of nephropexy were compared; nephropexy using sutures passing through the parenchyma (n = 16) and nephropexy using tissue adhesives (n = 13). The first group was mobilized 3.5 days after operation, whereas the second group was mobilized one day after operation. On later follow-up 79% of the patients had no or minor complaints. Those patients who had the same disturbances as preoperatively had all been treated by nephropexy using sutures passing through the parenchyma. In 56% of this group radiological recurrence was seen, whereas in the group using tissue adhesives there was only 8% radiological recurrence. We think therefore that the nephroxepy using tissue adhesive is the simplest and least traumatic method.

[Rectosigmoidovesical fistula]. / Rektosigmoidovesikale Fisteln.

The symptomatology of vesico-colonic fistulae is presented and their differential diagnosis discussed. Management should be tailored to the individual case. Whenever possible, we perform a radical primary operation. An additional by-pass colostomy is indicated if it is felt that the integrity of the anastomosis is jeopardised.