The performance of vasectomy in an urban municipality. Practical considerations for follow-up.

OBJECTIVES: To establish an adequate follow-up protocol based on time to azoospermia achievement after vasectomy. Also, to review the rate of complications in our setting. METHODS: Retrospective analysis of 391 men who underwent vasectomy. Follow-up was performed by means of semen analysis 6 months after surgery, and then every 3 months until azoospermia was achieved. Data of visits to the emergency unit at our centre were obtained within the first 30 postoperative days. RESULTS: During follow-up 567 semen analysis were performed. From 391 vasectomy interventions, 275 had at least one semen sample available and valid for processing. After the first 6 months from surgery, 41.1%men still presented nonmotile rare sperm in semen analysis, 9.7% after 9 months, and 4.7% after 12 months. If semen analysis was postponed from 6 to 9 months after surgery, a total yearly saving of 6,153.23 Euro would be observed in our setting, but with the drawback of delaying the diagnosis of azoospermia in nearly 60% of men. Overall complication rate was 3.1%(only one man required hospital admittance and reintervention). No statistical difference was observed in operative time with regard to the presence or absence of urological complications. CONCLUSIONS: The percentage of men not achieving azoospermia 6 months after surgery is notorious. Vasectomy practice in our setting seems to be reliable and safe, with a limited rate of complications.

Práctica de la vasectomía en un municipio urbano. Consideraciones practicas para el seguimiento / The performance of vasectomy in an urban municipality. Practical considerations for follow-up

OBJECTIVES: To establish an adequate follow-up protocol based on time to azoospermia achievement after vasectomy. Also, to review the rate of complications in our setting.METHODS: Retrospective analysis of 391 men who underwent vasectomy. Follow-up was performed by means of semen analysis 6 months after surgery, and then every 3 months until azoospermia was achieved. Data of visits to the emergency unit at our centre were obtained within the first 30 postoperative days.RESULTS: During follow-up 567 semen analysis were performed. From 391 vasectomy interventions, 275 had at least one semen sample available and valid for processing. After the first 6 months from surgery, 41.1% men still presented nonmotile rare sperm in semen analysis, 9.7% after 9 months, and 4.7% after 12 months. If semen analysis was postponed from 6 to 9 months after surgery, a total yearly saving of 6,153.23 Euro would be observed in our setting, but with the drawback of delaying the diagnosis of azoospermia in nearly 60% of men. Overall complication rate was 3.1% (only one man required hospital admittance and re-intervention). No statistical difference was observed in operative time with regard to the presence or absence of urological complications.CONCLUSIONS: The percentage of men not achieving azoospermia 6 months after surgery is notorious. Vasectomy practice in our setting seems to be reliable and safe, with a limited rate of complications(AU)

OBJETIVO: Establecer un protocolo de seguimiento adecuado basado en el tiempo necesario para conseguir la azoospermia tras la realización de vasectomía, y revisar la frecuencia de complicaciones en nuestro entorno.MÉTODOS: Análisis retrospectivo de 391 vasectomías. Seguimiento mediante seminograma postvasectomía a los 6 meses de la intervención, y posteriormente con periodicidad trimestral hasta conseguir la azoospermia. Registro de las frecuentaciones en el Servicio de Urgencia de nuestro centro dentro de los 30 días del postoperatorio.RESULTADOS: Durante el seguimiento se han llevado a cabo 567 seminogramas. De las 391 vasectomías realizadas, 275 presentaron al menos una muestra válida para su procesamiento. Al finalizar los 6 meses tras la cirugía un 41,1% presentaron espermatozoides aislados inmóviles en el seminograma, 9,7% tras los 9 meses, y 4,7% al finalizar los 12 meses. El retrasar el primer seminograma de los 6 a los 9 meses tras la intervención supondría un ahorro de 6153,23 Euros anuales en nuestro entorno, con la desventaja de diferir el alta de casi el 60% de los pacientes intervenidos. La tasa de complicaciones se situó en el 3,1% (sólo un paciente requirió reintervención e ingreso). No existió diferencia significativa en cuanto al tiempo operatorio en los pacientes con o sin complicación urológica.CONCLUSIONES: La proporción de pacientes que no alcanzan la azoospermia tras los 6 meses postcirugía es notable. La práctica de la vasectomía parece fiable y relativamente segura en nuestro entorno, con una contenida tasa de complicaciones

Cannabinoid CB1 receptors are expressed by parietal cells of the human gastric mucosa.

Experimental data suggest that the endogenous cannabinoid system is involved in gastric function in different animal species. In most of them, CB(1) receptors have been localized on vagal terminals innervating the external wall of the stomach. We aimed at studying the putative presence and distribution of these receptors in the human gastric mucosa. To this end, we first performed Western blotting, RT-PCR, in situ hybridization, and immunohistochemical analysis of CB(1) protein distribution in biopsy samples of healthy individuals. To determine the precise cell populations expressing CB(1) receptors, we performed double immunofluorescence plus confocal microscopy analysis of the same samples. Our results show that CB(1) receptors are present in the gastric epithelium of the mucosa. Specifically, they are expressed by a subpopulation of mucosal cells, the acid-secreting parietal cells, as shown by double immunohistochemical staining and by their differential abundance in subregions of the gastric mucosa. These results reinforce the notion of a prominent role for the endocannabinoid system in the gastric function in humans and postulate the use of cannabinoid CB(1) receptors in parietal cells as new therapeutic targets for the regulation of gastric acid production.

Undifferentiated carcinoma of the jejunum with extensive rhabdoid features. Case report and review of the literature.

Malignant rhabdoid tumor, first described in the kidney of young infants, is a rare and highly aggressive neoplasm of controversial histogenesis that has been reported at many other sites, including the gastrointestinal tract. However, malignant rhabdoid tumor of the small intestine is very rare, with only seven cases published to date. We report a 70-year-old man who presented with abdominal pain and weight loss, and showed a perforated jejunal mass with disseminated metastases by imaging. The patient underwent partial jejunectomy and biopsy of a liver metastasis. Microscopically, the tumor was characterized by neoplastic cells with vesicular nuclei, large nucleoli and abundant eccentric cytoplasm with hyaline globular intracytoplasmic inclusions. Immunohistochemically, the neoplasm coexpressed vimentin and epithelial antigens (AE1/AE3, Cam 5.2, CK34betaE12, CK19 and EMA), most of them showing a peculiar immunostaining pattern in relation to the globular inclusions. Ultrastructurally, the inclusions corresponded to paranuclear whorls of intermediate filaments. The patient received postoperative chemotherapy but died 9 months after surgery. In summary, we report the exceptional case of an undifferentiated carcinoma of the jejunum with rhabdoid phenotype. As with tumors at other sites, recognition of rhabdoid morphology in small intestine neoplasms is of significance because the prognosis is extremely poor.

Expression of the antiapoptotic proteins clusterin and bcl-2 in laryngeal squamous cell carcinomas.

Bcl-2 and clusterin genes have been related to the inhibition of apoptosis, an event that plays a key role in malignant transformation and in invasive disease. In this work, we determine the significance of clusterin and bcl-2 expression in a large series of laryngeal carcinomas. We used immunohistochemical methods and in situ hybridization to examine the expression of these proteins. Nontumoral epithelial laryngeal tissues did not express clusterin and bcl-2 proteins. However, 9% (14 out of 154) and 25% of these tumors (39 of 154) had positive clusterin and bcl-2 staining, respectively. Clusterin expression was significantly related to the degree of local invasion and higher bcl-2 expression was found in these clusterin-positive tumors (p < 0.05). Bcl-2 expression was significantly correlated with supraglottic localization, nodal metastases, invasion in depth, and poorly differentiated tumors. However, by multivariate analysis, bcl-2 was shown to be an independent predictor of good prognosis in these tumors (OR = 0.12, 95% CI = 0.02-0.91). These findings indicate that clusterin and bcl-2 are upregulated in laryngeal carcinomas and their expression is related to the invasiveness of these tumors.

Factors influencing the rate of fibrosis progression in chronic hepatitis C.

Alcohol consumption, age at infection, and male gender have been identified as risk factors for faster fibrosis progression in patients with chronic hepatitis C (CHC). Yet the influence of liver steatosis, light to moderate alcohol consumption, or iron overload on this progression remains controversial. To analyze the effect of individual risk factors and their interaction on fibrosis progression in a group of patients with CHC and a definite date of infection, we studied 133 consecutive untreated patients. Covariates included were age, body mass index (BMI), gender, age at infection, alcohol intake, serum lipids, glycemia, serum ALT, AST, GGT, iron, and ferritin, grade and stage (METAVIR and Scheuer), and hepatic stainable iron (Perl's stain). The rate of fibrosis progression was inferred from the METAVIR score. By logistic regression analysis, hepatic steatosis (odds ratio [OR], 3.035; 95% confidence interval [CI], 1.16-7.93), serum ferritin levels higher than 290 ng/ml (OR, 5.5; 1.6-18.65), and light to moderate ethanol intake (1-50 g/day) (OR, 5.22; 1.5-17.67) were independently associated with faster fibrosis progression. There was no effect of interaction between these variables on the rate of fibrosis progression. Liver steatosis, serum ferritin levels, and light to moderate alcohol intake are associated with faster fibrosis progression in chronic hepatitis C. Combination of these factors did not further accelerate this progression. The impact of modification of these factors on progression should be tested in longitudinal studies.