[Mortality from cancer, arsenic, and nitrates in drinking water and cropland in ArgentinaMortalidade por câncer, arsênio e nitratos na água para consumo humano e em áreas semeadas na Argentina]. / Mortalidad por cáncer, arsénico y nitratos en aguas de consumo y superficies sembradas en Argentina.

Objective: Cancer mortality in the central region of Argentina is among the highest in the country. Two possible environmental factors could explain this situation: agricultural activity and drinking water quality. The objective of the study is to evaluate the interaction between these variables. Methods: This is a retrospective ecological study. Total cropland over 10-year periods as well as the percentage of the population exposed to high levels of arsenic and nitrates in drinking water were analyzed and compared to total mortality rates (TMR) and organ-specific mortality rates (SMR); the Spearman's rank correlation coefficient was then calculated. Results: Positive and significant correlations were found between the first two 10-year periods of total cropland and the first 10-year period of TMR, as well as correlations with lung, pancreatic, and colon cancers in men and colon cancer in women. Elevated arsenic levels are associated with TMR in both sexes across all 10-year periods but are specifically associated with lung cancer in men. No significant correlation was found with nitrates. Conclusions: The association between total cropland and TMR/SMR is stronger with proximity over time, with greater impact from the oldest crops. The association between TMR and consumption of water containing arsenic, as well as the association with lung SMR in men and colon SMR in women, show that exposure over time is essential to understanding regional epidemiological conditions. The synergy between these variables should be explored.

Objetivo: A mortalidade por câncer na região central da Argentina está entre as mais elevadas do país. Dois possíveis cenários ambientais poderiam explicar esta situação: a atividade agrícola e a qualidade da água para consumo humano. O objetivo do estudo é avaliar a interação entre essas variáveis. Métodos: Estudo ecológico retrospectivo. Foram analisadas a área semeada total (AST) em decênios e a porcentagem da população exposta a níveis elevados de arsênio e nitrato na água para consumo humano em relação às taxas de mortalidade total (TMT) e específica por órgão (TME). A correlação foi analisada mediante cálculo de coeficientes de Spearman. Resultados: Foram constatadas correlações positivas e significativas entre os dois primeiros decênios de AST e o primeiro decênio de TMT, bem como correlações com câncer de pulmão, de pâncreas e colorretal nos homens e com câncer colorretal nas mulheres. Níveis elevados de arsênio apresentaram associação com a TMT em ambos os sexos e em todos os decênios e, mais especificamente, com a mortalidade por câncer de pulmão em homens. Não foram constatadas correlações significativas com nitratos. Conclusões: A associação entre AST e as taxas de mortalidade total e específica por órgão é tanto mais forte quanto mais próximas estão uma da outra no tempo, e expressa um maior impacto dos cultivos mais antigos. A associação entre TMT e o consumo de águas arsenicais, bem como a associação encontrada na TME por câncer de pulmão em homens e na TME por câncer colorretal em mulheres, mostra que esta exposição histórica é fundamental para compreender as condições epidemiológicas regionais. Forças sinérgicas entre estas variáveis devem ser exploradas.

Mortalidad por cáncer, arsénico y nitratos en aguas de consumo y superficies sembradas en Argentina

[RESUMEN]. Objetivo. La mortalidad por cáncer en la región centro de Argentina está dentro de las más elevadas del país. Dos posibles escenarios ambientales podrían explicar esta situación, su actividad agrícola y la calidad del agua de consumo. El objetivo del estudio es evaluar la interacción existente entre estas variables. Métodos. Estudio retrospectivo de diseño ecológico. Se analizaron decenios de superficies sembradas totales (SST) y el porcentaje de población expuesta a niveles elevados de arsénico y nitratos en aguas de consumo en relación con las tasas de mortalidad total (TMT) y órgano-específicas (TME); se calculó el coeficiente de correlación de Spearman. Resultados. Se hallaron correlaciones positivas y significativas entre los dos primeros decenios de SST y el primer decenio de TMT, así como correlaciones con cáncer de pulmón, páncreas y colon en hombres; y con cáncer de colon en mujeres. Los niveles elevados de arsénico se asocian con las TMT en ambos sexos y en todos los decenios, aunque de manera específica con cáncer de pulmón en hombres. No se hallaron correlaciones significativas con nitratos. Conclusiones. La asociación entre las SST y las TMT y TME presentan mayor intensidad cuanto más cerca están entre ellas temporalmente, y expresan un mayor impacto de los cultivos más antiguos. La asociación entre las TMT y el consumo de aguas arsenicales, así como la hallada en TME de pulmón en hombres y colon en mujeres, muestran que esta exposición histórica es central para entender las condiciones epidemiológicas regionales. Se deben explorar fuerzas sinérgicas entre estas variables.

[ABSTRACT]. Objective. Cancer mortality in the central region of Argentina is among the highest in the country. Two possible environmental factors could explain this situation: agricultural activity and drinking water quality. The objective of the study is to evaluate the interaction between these variables. Methods. This is a retrospective ecological study. Total cropland over 10-year periods as well as the percentage of the population exposed to high levels of arsenic and nitrates in drinking water were analyzed and compared to total mortality rates (TMR) and organ-specific mortality rates (SMR); the Spearman's rank correlation coefficient was then calculated. Results. Positive and significant correlations were found between the first two 10-year periods of total cropland and the first 10-year period of TMR, as well as correlations with lung, pancreatic, and colon cancers in men and colon cancer in women. Elevated arsenic levels are associated with TMR in both sexes across all 10-year periods but are specifically associated with lung cancer in men. No significant correlation was found with nitrates. Conclusions. The association between total cropland and TMR/SMR is stronger with proximity over time, with greater impact from the oldest crops. The association between TMR and consumption of water containing arsenic, as well as the association with lung SMR in men and colon SMR in women, show that exposure over time is essential to understanding regional epidemiological conditions. The synergy between these variables should be explored.

[RESUMO]. Objetivo. A mortalidade por câncer na região central da Argentina está entre as mais elevadas do país. Dois possíveis cenários ambientais poderiam explicar esta situação: a atividade agrícola e a qualidade da água para consumo humano. O objetivo do estudo é avaliar a interação entre essas variáveis. Métodos. Estudo ecológico retrospectivo. Foram analisadas a área semeada total (AST) em decênios e a porcentagem da população exposta a níveis elevados de arsênio e nitrato na água para consumo humano em relação às taxas de mortalidade total (TMT) e específica por órgão (TME). A correlação foi analisada mediante cálculo de coeficientes de Spearman. Resultados. Foram constatadas correlações positivas e significativas entre os dois primeiros decênios de AST e o primeiro decênio de TMT, bem como correlações com câncer de pulmão, de pâncreas e colorretal nos homens e com câncer colorretal nas mulheres. Níveis elevados de arsênio apresentaram associação com a TMT em ambos os sexos e em todos os decênios e, mais especificamente, com a mortalidade por câncer de pulmão em homens. Não foram constatadas correlações significativas com nitratos. Conclusões. A associação entre AST e as taxas de mortalidade total e específica por órgão é tanto mais forte quanto mais próximas estão uma da outra no tempo, e expressa um maior impacto dos cultivos mais antigos. A associação entre TMT e o consumo de águas arsenicais, bem como a associação encontrada na TME por câncer de pulmão em homens e na TME por câncer colorretal em mulheres, mostra que esta exposição histórica é fundamental para compreender as condições epidemiológicas regionais. Forças sinérgicas entre estas variáveis devem ser exploradas.

Mortalidad por cáncer, arsénico y nitratos en aguas de consumo y superficies sembradas en Argentina / Mortality from cancer, arsenic, and nitrates in drinking water and cropland in Argentina / Mortalidade por câncer, arsênio e nitratos na água para consumo humano e em áreas semeadas na Argentina

RESUMEN Objetivo. La mortalidad por cáncer en la región centro de Argentina está dentro de las más elevadas del país. Dos posibles escenarios ambientales podrían explicar esta situación, su actividad agrícola y la calidad del agua de consumo. El objetivo del estudio es evaluar la interacción existente entre estas variables. Métodos. Estudio retrospectivo de diseño ecológico. Se analizaron decenios de superficies sembradas totales (SST) y el porcentaje de población expuesta a niveles elevados de arsénico y nitratos en aguas de consumo en relación con las tasas de mortalidad total (TMT) y órgano-específicas (TME); se calculó el coeficiente de correlación de Spearman. Resultados. Se hallaron correlaciones positivas y significativas entre los dos primeros decenios de SST y el primer decenio de TMT, así como correlaciones con cáncer de pulmón, páncreas y colon en hombres; y con cáncer de colon en mujeres. Los niveles elevados de arsénico se asocian con las TMT en ambos sexos y en todos los decenios, aunque de manera específica con cáncer de pulmón en hombres. No se hallaron correlaciones significativas con nitratos. Conclusiones. La asociación entre las SST y las TMT y TME presentan mayor intensidad cuanto más cerca están entre ellas temporalmente, y expresan un mayor impacto de los cultivos más antiguos. La asociación entre las TMT y el consumo de aguas arsenicales, así como la hallada en TME de pulmón en hombres y colon en mujeres, muestran que esta exposición histórica es central para entender las condiciones epidemiológicas regionales. Se deben explorar fuerzas sinérgicas entre estas variables.

ABSTRACT Objective. Cancer mortality in the central region of Argentina is among the highest in the country. Two possible environmental factors could explain this situation: agricultural activity and drinking water quality. The objective of the study is to evaluate the interaction between these variables. Methods. This is a retrospective ecological study. Total cropland over 10-year periods as well as the percentage of the population exposed to high levels of arsenic and nitrates in drinking water were analyzed and compared to total mortality rates (TMR) and organ-specific mortality rates (SMR); the Spearman's rank correlation coefficient was then calculated. Results. Positive and significant correlations were found between the first two 10-year periods of total cropland and the first 10-year period of TMR, as well as correlations with lung, pancreatic, and colon cancers in men and colon cancer in women. Elevated arsenic levels are associated with TMR in both sexes across all 10-year periods but are specifically associated with lung cancer in men. No significant correlation was found with nitrates. Conclusions. The association between total cropland and TMR/SMR is stronger with proximity over time, with greater impact from the oldest crops. The association between TMR and consumption of water containing arsenic, as well as the association with lung SMR in men and colon SMR in women, show that exposure over time is essential to understanding regional epidemiological conditions. The synergy between these variables should be explored.

RESUMO Objetivo. A mortalidade por câncer na região central da Argentina está entre as mais elevadas do país. Dois possíveis cenários ambientais poderiam explicar esta situação: a atividade agrícola e a qualidade da água para consumo humano. O objetivo do estudo é avaliar a interação entre essas variáveis. Métodos. Estudo ecológico retrospectivo. Foram analisadas a área semeada total (AST) em decênios e a porcentagem da população exposta a níveis elevados de arsênio e nitrato na água para consumo humano em relação às taxas de mortalidade total (TMT) e específica por órgão (TME). A correlação foi analisada mediante cálculo de coeficientes de Spearman. Resultados. Foram constatadas correlações positivas e significativas entre os dois primeiros decênios de AST e o primeiro decênio de TMT, bem como correlações com câncer de pulmão, de pâncreas e colorretal nos homens e com câncer colorretal nas mulheres. Níveis elevados de arsênio apresentaram associação com a TMT em ambos os sexos e em todos os decênios e, mais especificamente, com a mortalidade por câncer de pulmão em homens. Não foram constatadas correlações significativas com nitratos. Conclusões. A associação entre AST e as taxas de mortalidade total e específica por órgão é tanto mais forte quanto mais próximas estão uma da outra no tempo, e expressa um maior impacto dos cultivos mais antigos. A associação entre TMT e o consumo de águas arsenicais, bem como a associação encontrada na TME por câncer de pulmão em homens e na TME por câncer colorretal em mulheres, mostra que esta exposição histórica é fundamental para compreender as condições epidemiológicas regionais. Forças sinérgicas entre estas variáveis devem ser exploradas.

In Utero Chlordecone Exposure and Thyroid, Metabolic, and Sex-Steroid Hormones at the Age of Seven Years: A Study From the TIMOUN Mother-Child Cohort in Guadeloupe.

Background: Chlordecone is an endocrine-disrupting chemical with well recognized estrogenic and progestagenic properties. This organochlorine insecticide was extensively used in the French West Indies from 1973 to 1993 to control the banana root borer. Due to its poor degradation in the environment, permanently polluted soil is responsible for the current contamination of the food chain and human beings. We aimed to examine the relationship of in utero exposure to chlordecone and thyroid (thyroid stimulating hormone [TSH], free tri-iodothyronine [FT3], free thyroxine [FT4]), metabolic (insulin growth-factor 1, leptin, adiponectin), and sex-steroid (dehydroepiandrosterone [DHEA], total testosterone [TT], dihydrotestosterone [DHT], estradiol [E2]) hormone levels in children at the age of seven years who participated in TIMOUN, an ongoing birth cohort in Guadeloupe. Methods: Chlordecone concentrations were measured in cord-blood at delivery. Thyroid, metabolic, and sex-steroid hormone levels were determined in the blood of children at seven years of age. Associations between in utero chlordecone exposure and hormone levels at seven years of age were assessed by multiple linear or logistic regression, controlling for confounding factors. Results: Among the study population (210 boys and 228 girls), chlordecone and hormone measurements were available for 124 boys and 161 girls. We found the third quartile of in utero chlordecone exposure relative to the lowest quartile to be associated with elevated TSH levels in girls and elevated DHEA, TT, and DHT levels in both sexes. Complementary non-linear analysis (spline regression) confirmed a significant non-linear trend for TSH in girls and DHEA and DHT in boys. Conclusion: In utero chlordecone exposure was associated with elevated levels of selected thyroid (TSH) and sex-steroid (DHEA, TT, and DHT) hormones at seven years in a non-monotonic dose response (inverted U) relationship. The implications for future health and reproductive function in puberty and adulthood should be determined.

Análisis y tendencia de la mortalidad por cáncer en la Región Centro de Argentina, 1992-2016 / Cancer mortality analysis and trend in the Central Region of Argentina, 1992-2016

El cáncer es una causa importante de mortalidad en el mundo; la Región Centro (RC) de Argentina concentra las mayores tasas del país. El objetivo del estudio fue describir las tasas de mortalidad por cáncer en la RC y su comportamiento en un período de tiempo prolongado. MÉTODOS: Se efectuó un estudio descriptivo. Se calcularon tasas de mortalidad por neoplasias malignas de cada quinquenio por sexo y ajustadas por edad, expresadas por 100 000 habitantes durante 1992-2016. Para las tendencias se aplicó el Porcentaje de Cambio Anual Estimado. La distribución espacial se realizó según quintiles de la distribución conjunta de períodos. RESULTADOS: Tanto las tasas provinciales como departamentales se encontraron por encima de las nacionales para su respectivo quinquenio (la más alta, en hombres de Entre Ríos en 1992-1996; la más baja, en mujeres de Córdoba en 2007-2011). Se observó una tendencia en descenso de las tasas provinciales para ambos sexos. Los departamentos mostraron un predominio de tendencias decrecientes. DISCUSIÓN: Las altas tasas de mortalidad encontradas en la RC ya habían sido observadas en la década del 80 y aún persisten. Se hallaron marcadas diferencias de la mortalidad entre las provincias, entre los departamentos y entre sexos. La graficación permitió resumir los hallazgos y observar un movimiento de la concentración de la mortalidad en la región, con localización en la frontera norte de Entre Ríos y Santa Fe al final del período

Mechanochemical Endovenous Ablation of Varicose Veins in Pediatric Patients with Klippel-Trénaunay Syndrome: Feasibility, Safety, and Initial Results.

PURPOSE: To evaluate feasibility, safety, and results of endovenous mechanochemical ablation (MOCA) for treatment of persistent embryonic and dysplastic veins in pediatric patients with Klippel-Trénaunay syndrome (KTS). MATERIALS AND METHODS: Thirteen MOCA procedures were performed in 11 patients (age range, 4-16 years) with KTS and symptomatic persistent embryonic or dysplastic veins during a 24-month period. All patients were evaluated with color Doppler (CD) ultrasound (US), contrast-enhanced MR imaging, and venography to assess the anatomy of the target vessels and patency of the deep venous system. All procedures were performed under general anesthesia with a ClariVein catheter and liquid sodium tetradecyl sulfate as the sclerosing agent. US and fluoroscopic guidance were used in all cases. Technical success rate, primary occlusion rate, adverse effects, and recanalization rates were evaluated. Clinical and radiological (CD US) controls were performed 1 day, 7 days, 1 month, and 6 months after the procedure and once a year thereafter, with a mean follow-up of 16 months (range, 6-25 months). RESULTS: Technical success and primary occlusion were achieved in all patients with no adverse events. During the follow-up period, CD US demonstrated partial recanalization and symptom recurrence in 2 patients (18%), 14 and 18 months after the initial procedure. These 2 patients had a second ablation procedure with no recanalization or symptom recurrence during the subsequent follow-up period. CONCLUSIONS: MOCA is feasible and appears to be a safe and effective technique for treatment of varicose veins in pediatric patients with KTS.

Anomalías congénitas, su relación ecoepidemiológica con variables ambientales y sociodemográficas / Congenital anomalies, their ecoepidemiological relationship with environmental and sociodemographic variables

INTRODUCCIÓN Las anomalías congénitas (AC) presentan una prevalencia al nacimiento de un 3% a 5%. Las AC son la segunda causa de mortalidad infantil, representando más del 25%. Existen factores, de muy difícil registro, que juegan como variables de estas patologías, que hacen incierto el conocer las causas y evoluciones de estos cuadros. En general, en el origen de estas enfermedades hay una interacción entre condiciones genéticas y factores ambientales y/o sociodemográficos. Hay dos maneras de analizar estos patologías, prevalencias y mortalidad. OBJETIVOS Describir la distribución de prevalencias y mortalidad por AC en Argentina, explorando la relación de las éstas con factores ambientales y sociodemográficos. MÉTODOS. Tres bases de datos de AC fueron utilizadas, dos de prevalencias y una de mortalidad; se calcularon tasas medias expresadas por nacimientos evaluados, para las prevalencias; y por tasa de mortalidad infantil por AC. Se analizaron las representatividades de cada uno de los registros. Se construyeron tres variables ambientales (superficies sembradas totales, hectáreas sembradas por habitante y porcentaje de población expuesta a arsénico elevado en aguas); y, tres variables sociodemográficas (condiciones de vida, educación y cobertura desalud). Se utilizaron métodos de correlaciones (buscando asociaciones) y probabilidades de riesgos (OR). RESULTADOS Las tasas de prevalencia y mortalidad mostraron provincias por encima de las nacionales. Las representatividades de prevalencias se presentan bajas. Asociaciones y aumentos de riesgos significativos, en relación a variables ambientales y sociodemográficas, particularmente con mortalidad. DISCUSION En Argentina, las bases de datos de prevalencia tienen una baja representatividad, no así las de mortalidad; lo que permite mostrar asociaciones contradictorias en las primeras, y muy significativas en las segundas.

Maternal smoking during pregnancy, semen characteristics and reproductive hormone levels in men consulting for couple infertility.

The aim of our study was to evaluate the relationship between maternal tobacco consumption during pregnancy and sperm parameters and sexual hormonal levels of their sons in adulthood. We conducted a cross-sectional study in four medical institutions in Argentina, between June 1999 and June 2015, among male partners of couples consulting for infertility. At inclusion, a structured interview was conducted to obtain information on the basic demographic, medical, surgical and reproductive history, personal tobacco consumption and that of their parents during pregnancy. Two semen analyses at an interval of 2-4 weeks and a blood hormone evaluation (FSH, LH, prolactin, total testosterone and oestradiol) were then ordered. Analyses using multivariate models adjusted for potential confounders were performed for 537 men. Maternal tobacco consumption during pregnancy was associated with a significantly higher risk of reduced sperm count and elevated total testosterone levels. We did not find any significant association between maternal smoking and other sperm parameters nor other hormone levels. Our study adds evidence concerning the association between maternal tobacco consumption during pregnancy and reduced sperm counts of their sons in adulthood. The results showing an association between elevated total testosterone levels and maternal tobacco consumption need to be replicated.

Chronic epididymitis and Grade III varicocele and their associations with semen characteristics in men consulting for couple infertility.

Chronic epididymitis and varicocele are frequently observed genital disorders in men consulting for couple infertility, but their impact on semen characteristics at the time of infertility consultation is still a matter of debate. We investigated 652 male partners of couples who had their first infertility consultation between 1999 and 2015 in Argentina. Men with chronic epididymitis (n = 253), Grade III varicocele (n = 106), and both conditions (n = 125) were compared with a control group (n = 168) composed of men without these disorders or any other recognized causes of male infertility. We showed that men who presented isolated chronic epididymitis were more likely to have high percentages of low sperm motility and abnormal sperm morphology as well as a high number of white blood cells. Men with isolated Grade III varicocele had low sperm production and motility and an increased percentage of abnormal sperm morphology. Finally, men who simultaneously presented chronic epididymitis with Grade III varicocele had a low sperm motility and increased percentage of abnormal sperm morphology as well as a high number of white blood cells. Physical examination of the genital organs may identify common disorders, potentially involved as causal factors of patient's infertility. These disorders are associated with specific seminal profiles that should help in identifying the best treatment from the available therapeutic options, effectiveness, safety, and allowing as much as possible natural conception.

Persistent organochlorine pollutants with endocrine activity and blood steroid hormone levels in middle-aged men.

BACKGROUND: Studies relating long-term exposure to persistent organochlorine pollutants (POPs) with endocrine activities (endocrine disrupting chemicals) on circulating levels of steroid hormones have been limited to a small number of hormones and reported conflicting results. OBJECTIVE: We examined the relationship between serum concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulphate, androstenedione, androstenediol, testosterone, free and bioavailable testosterone, dihydrotestosterone, estrone, estrone sulphate, estradiol, sex-hormone binding globulin, follicle-stimulating hormone, and luteinizing hormone as a function of level of exposure to three POPs known to interfere with hormone-regulated processes in different way: dichlorodiphenyl dichloroethene (DDE), polychlorinated biphenyl (PCB) congener 153, and chlordecone. METHODS: We collected fasting, morning serum samples from 277 healthy, non obese, middle-aged men from the French West Indies. Steroid hormones were determined by gas chromatography-mass spectrometry, except for dehydroepiandrosterone sulphate, which was determined by immunological assay, as were the concentrations of sex-hormone binding globulin, follicle-stimulating hormone and luteinizing hormone. Associations were assessed by multiple linear regression analysis, controlling for confounding factors, in a backward elimination procedure, in multiple bootstrap samples. RESULTS: DDE exposure was negatively associated to dihydrotestosterone level and positively associated to luteinizing hormone level. PCB 153 was positively associated to androstenedione and estrone levels. No association was found for chlordecone. CONCLUSIONS: These results suggested that the endocrine response pattern, estimated by determining blood levels of steroid hormones, varies depending on the POPs studied, possibly reflecting differences in the modes of action generally attributed to these compounds. It remains to be investigated whether this response pattern is predictive of the subsequent occurrence of disease.

Serum sex steroids measured in middle-aged European and African-Caribbean men by gas chromatography-mass spectrometry.

BACKGROUND: Differences in circulating steroid hormone levels have been hypothesized to explain ethnic differences in steroid-related diseases. The aim of this study was to determine the serum levels of a wide panel of steroid hormones, both androgens and estrogens, in healthy middle-aged African-Caribbean and European men. DESIGN AND METHODS: Serum steroid hormone levels were determined in men participating in a systematic public health study funded by the French National Health Insurance system. Blood was collected in the morning from 304 healthy African-Caribbean and European men aged between 40 and 69 years. Serum steroids were measured by mass spectrometry-gas chromatography, except for DHEAS and sex hormone-binding globulin, which were determined by RIA. Data were analyzed in 10-year age intervals by analysis of covariance, with adjustment for age, body mass index, waist-to-hip ratio, tobacco and alcohol consumption, and season of sampling. RESULTS: Compared with Europeans, African-Caribbean men presented significantly higher serum levels of measured bioavailable testosterone, 4-androstenedione (4-dione), and estrone (E1) regardless of the age group, of 5-androstenediol (5-diol) in those aged 40-49 and 50-59 years, and of testosterone (TT) and dihydrotestosterone in those aged 40-49 years. In contrast, European men aged 40-69 years showed significantly higher serum levels of DHEA and DHEAS. CONCLUSIONS: Significant differences in serum steroid hormone levels were observed in middle-aged African-Caribbean and European men. Whether such differences could contribute to ethnic differences in disease risk in adult men remains to be investigated. Some steroids, such as bioavailable TT, 4-dione, 5-diol, and E1, deserve particular attention.

Pentoxifylline and antioxidants improve sperm quality in male patients with varicocele.

We examined the effect of 12 weeks of daily oral administration of pentoxifylline with zinc and folic acid on the semen quality of 36 men with varicocele-associated infertility in an open, uncontrolled study. After 4 weeks of treatment, the proportion of morphologically normal sperm cells was significantly increased; these changes persisted until at least 4 weeks after the end of treatment.

[Is there any relationship between rural environmental factors and reproductive health in the Pampa Humeda in Argentina?]. / Existen relaciones entre los factores ambientales rurales y la salud reproductiva en la Pampa Húmeda Argentina?

The relationship between environmental factors and health is well known. Rural environmental influences on reproductive health have been properly proved, both in animals and humans. In Latin America, few studies have been conducted in this area. The current project is based on the description of relationships between reproductive health and environmental factors in rural populations, characterized by specific environmental characteristics. Three variables were evaluated: male-to-female birth ratio, male urogenital malformations (cryptorchidism and hypospadias), and endocrine-related cancer incidence. Five rural communities in the Pampa Humeda in Argentina were selected, and the data were compared to the national mean. Biomedical data and environmental risk factors were correlated through a geographic information system. The ratio of male to female births did not show any differences. Malformations showed very significant differences. Endocrine-related cancers showed higher incidence rates compared to the national mean, particularly in some communities. In conclusion, there is a relationship between environmental factors and reproductive health conditions in this region.

¿Existen relaciones entre los factores ambientales rurales y la salud reproductiva en la Pampa Húmeda Argentina? / Is there any relationship between rural environmental factors and reproductive health in the Pampa Humeda in Argentina?

La relación entre factores ambientales y salud es un hecho reconocido. La influencia de ambientes rurales sobre la salud reproductiva ha sido fehacientemente probada en diferentes regiones del mundo, tanto en la fauna como en humanos. En América Latina pocas investigaciones han sido realizadas en este campo. El presente proyecto se establece sobre la base de la describir las relaciones entre salud reproductiva y factores ambientales en poblaciones rurales, caracterizada por aspectos ambientales particulares. Tres variables han sido evaluadas: relación de nacimientos masculinos/femeninos; incidencia de malformaciones uro-genitales masculinas (hipospadias y criptorquidias); e incidencia de cánceres hormono-dependientes. Se seleccionaron cinco comunidades rurales de la Pampa Húmeda de Argentina, comparándose los datos obtenidos con medias nacionales. Los datos bio-médicos y las fuentes ambientales de riesgo fueron relacionados entre sí a través de un sistema de geo-referenciación. La relación de nacimientos no mostró significación. Las malformaciones presentaron una muy significativa incidencia. Los cánceres hormono-dependientes presentaron incidencia mayores a las medias nacionales, particularmente en algunas de las comunidades estudiadas. Se concluye que existe una relación entre condiciones de salud reproductiva y factores ambientales en esta región.

The relationship between environmental factors and health is well known. Rural environmental influences on reproductive health have been properly proved, both in animals and humans. In Latin America, few studies have been conducted in this area. The current project is based on the description of relationships between reproductive health and environmental factors in rural populations, characterized by specific environmental characteristics. Three variables were evaluated: male-to-female birth ratio, male urogenital malformations (cryptorchidism and hypospadias), and endocrine-related cancer incidence. Five rural communities in the Pampa Humeda in Argentina were selected, and the data were compared to the national mean. Biomedical data and environmental risk factors were correlated through a geographic information system. The ratio of male to female births did not show any differences. Malformations showed very significant differences. Endocrine-related cancers showed higher incidence rates compared to the national mean, particularly in some communities. In conclusion, there is a relationship between environmental factors and reproductive health conditions in this region.

Ketotifen improves sperm motility and sperm morphology in male patients with leukocytospermia and unexplained infertility.

In an open, uncontrolled study, the effect of 12 weeks of daily administration of ketotifen, an antihistamine-like drug with a mast cell stabilizing effect, on the semen quality of 55 men with leukocytospermia and unexplained infertility was examined. After 4 weeks of treatment, white blood cell count dramatically diminished and was accompanied by a significant improvement in sperm motility. A significant increase of morphologically normal sperm cells was observed at 8 weeks of treatment, and these changes remained until at least 4 weeks after the end of treatment.

Reemplazo total de disco intervertebral de columna lumbar / Total replacement of intervertebral disc of low spine

El dolor lumbar secundario a la discopatía degenerativa es un problema creciente en nuestra sociedad. El tratamiento conservador no es efectivo en algunos de estos casos y la degeneración del disco adyacente a la fusión la complicación más frecuente. el reemplazo total de disco interventebral, es la mejor opción de las técnicas quirúrgicas actuales (disectomía y fusión), para el tratamiento del dolor lumbar de origen discogénico, ya que mantiene o restaura la anatomía y función del disco intervertebral, minimizando así la degeneración del disco adyacente, como se observa en la fusión espinal. En los últimos 10 años se han realizado progresos significativos, con varias prótesis de disco intervertebral mostrando resultados clínicos alentadores. Es nuestra opinión que la artroplastia de disco intervertebral es una parte importante y significativa del tratamiento de los problemas de columna. A continuación, es resumida la técnica quirúrgica y nuestros resultados de los 24 casos de disco intervertebral artificial realizados, estos son presentados

Micro disectomía lumbar video endoscópica posterior: Técnica quirúrgica y resultados preliminares / Micro-discecptomy lumbar the posterior video endoscopic: surgery technic and results preliminary

Los métodos minimamente invasivos eran, hasta hace poco, técnicas percútaneas a ciegas, donde se incluían la quimionucleolisis, la nucleotomía percutanea automatizada, y la descompresión con láser, radiofrecuecia o térmica. Estos abordajes percutaneos eran muy controvertidos, debido a sus limitadas indicaciones, y demostraron no ser tan efectivos como los procedimientos abiertos Standard. El desarrollo de las ópticas quirúrgicas, ha permitido crear métodos mucho más avanzados en los últimos años, pero la Disectomía Video Endoscopica, ha sido la más prometedora. En la actualidad, existen métodos de cirugía video endoscopica espinal, que nos permiten tratar, no solo hernias díscales contenidas como los artiguos métodos percutaneos, si no también fragmentos discales libres en el canal raquídeo y estenosis de recesos laterales. La técnica quirúrgica es resumida a continuación y nuestros resultados preliminares en 46 casos, con una media de seguimiento de 6 meses, es presentado

Environmental agents and erectile dysfunction: a study in a consulting population.

We evaluated chemical and physical environmental agents as risk factors for erectile dysfunction among a consulting population. We studied 199 men who sought medical help for erectile disorders between 1996 and 1998 in 3 andrology units in the Litoral Sur region of Argentina. Patients were evaluated by monitoring nocturnal penile tumescence and rigidity, and were classified as having normal (n = 26), irregular (dissociation, short episode or low amplitude, n = 146), or flat erectile pattern (n = 26). Exposure to environmental agents was assessed by a detailed interview, and 4 groups were constituted: nonexposed, pesticide-exposed, solvent-exposed, and heat-exposed. A multivariate polytomous logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for association between quality of nocturnal erections and exposure groups adjusted for confounding factors. Exposure to environmental agents was a risk factor for a flat erectile pattern (OR 7.1, 95% CI 1.5-33.0 for pesticides; OR 12.2, 95% CI 1.2-124.8 for solvents; and OR 1.7, 95% CI 0.3-9.4 for heat). Associations were much weaker for an irregular erectile pattern (OR 1.8, 95% CI 0.5-6.7 for pesticides; OR 2.1, 95% CI 0.3-17.9 for solvents; and OR 1.2, 95% CI 0.4-4.0 for heat). Our results suggest that environmental agents constitute a risk factor for erectile dysfunction by interfering with erectile ability.

Secular variations in sperm quality: fact or science fiction?

O debate sobre o possível declínio na qualidade dos espermatozóides humanos começou nos anos 70, foi reativado no início dos anos 90 e continua mobilizando a comunidade científica desde então. Desde a meta-análise realizada por Carlsen et al. (1992), demostrando um declínio na qualidade do sêmen humano ao longo dos ultimos 50 anos, vários grupos investigaram as caracterísitcas dos espermatozóides de grupo mais ou menos homogêneo de homens que forneceram amostras de sêmen para o mesmo centro ao longo de 10 a 20 anos. Alguns estudos, mas não outros, relataram uma diminuição significativa na concentração de espermatozóides. Enquanto isso, há um número crescente de relatos sugerindo que fatores físicos e químicos antropogênicos possam ter contribuído para a deterioração dos espermatozóides. Até o final do século XX, ainda havia se encerrado o debate sobre a queda na qualidade do sêmen humano. A falta de certeza e as graves conseqüências que tal declínio teriam sobre a fertilidade de populações humanas tornam esta questão prioritária para a saúde pública no início do século XXI. portanto, é necessário um enorme esforço de pesquisa básica e epidemiológica, particularmente na América do Sul, onde a poluição industrial e agrícola representa uma grave ameaça à população.

Secular variations in sperm quality: fact or science fiction?

The debate concerning the possible degradation in human sperm quality began in the 1970s, was revived at the beginning of the 1990s and has continued to mobilize the scientific community ever since. After the meta-analysis by Carlsen et al. (1992) showing a decline in human semen quality over the last 50 years, several groups investigated the sperm characteristics of more or less homogeneous groups of men who had provided semen at the same center for 10 to 20 years. A significant decrease in sperm concentration was reported in some studies, but not in others. Meanwhile, there is an increasing number of reports suggesting that physical and chemical factors introduced and spread by human activity in the environment may have contributed to sperm decline. At the end of the 20th century the debate on declining semen quality is not closed. The lack of certainty and the serious consequences that such a decline would have on the fertility of human populations make this an important public health issue at the start of the 21st century. For this reason, intensive research should be developed in both fundamental and epidemiological domains, particularly in South America, where industrial and agricultural pollution pose a serious threat to the population.