Comparison of direct radionuclide cystography with micturating cystourethrography for the diagnosis of vesicoureteric reflux, and its correlation with cystoscopic appearances of the ureteric orifices.

Forty-eight patients with strong clinical suspicion of vesicoureteric reflux (VUR) as the cause for their renal disease; were subjected to direct radionuclide cystography and roentgenographic micturating cystourethrography for its detection. Forty-four of them underwent cystoscopy under local anaesthesia to document the position and appearance of the ureteric orifices. Of the 92 kidney-ureter 'units' available for study, 20 had reflux positive on micturating cystourethrography and 22 had direct radionuclide cystography positivity. Two of the three units picked up on direct radionuclide cystography but missed on micturating cystourethrography were severe refluxes up to the renal pelvis. On the other hand, one unit missed on direct radionuclide cystography but picked up on micturating cystourethrography was a lower ureteric reflux. The sensitivity and specificity of direct radionuclide cystography to detect VUR as compared to micturating cystourethrography is 95% and 95.8% respectively. The localization and appearance of ureteric orifices which were classified as per Lyon's classification greatly enhanced the predictive value of determining past or present VUR. Patients with golf-hole orifices placed laterally had 100% incidence of reflux. Thus, combining direct radionuclide cystography with cystoscopy may enhance the predictive value for diagnosis of VUR even higher than a micturating cystourethrography study.

Transurethral incision versus transurethral resection of the prostate. A subjective and objective analysis.

A prospective study was undertaken comparing transurethral incision of the prostate (TUIP) with transurethral resection (TURP) in the treatment of 220 patients with urinary obstruction caused by a small, benign prostate. Patients were managed alternately by TUIP and TURP, and their symptoms and urodynamic findings evaluated before and after surgery. Subjectively and objectively, the results were comparable in both groups. Pre- and post-operative complications were significantly less for the TUIPs than the TURPs. TUIP was significantly better than TURP in terms of shorter operating time, duration of hospitalisation and reduced need for transfusion. We recommend TUIP as the operation of choice for the relief of obstruction in the presence of a small, benign prostatic enlargement.

Endoscopic removal of retained bile duct calculi via T-tube tract.

A simple and safe technique for removal of retained bile duct calculi using a flexible fibreoptic choledochoscope and rigid nephroscope via the T-tube tract has been described. The technique allowed removal of large impacted calculi under direct vision without damage to the bile duct.

De novo biosynthesis of FSH like peptide by the human prostate.

Human benign prostatic hyperplasia tissue is able to synthesize immunoreactive FSH (IR FSH) in vitro. The prostatic FSH is similar to pituitary FSH as evident by co-elution on Sephadex G-100. High performance gel filtration chromatography and Western blot analysis. Immunocytochemical localization studies indicate positive staining in the cytoplasm of prostatic epithelial cells. There is a two fold increase in the concentration of immunoreactive FSH in benign hyperplastic tissue as compared to normal prostate.

Hypothalamic-hypophyseal-testicular abnormalities and erectile dysfunction.

Forty-five men presenting with erectile dysfunction were evaluated through history and nocturnal penile tumescence, Doppler, and EMG studies. Fifteen were classified as having organic and 30 as having psychogenic impotence. Three men had mild hypergonadotropism with low testosterone levels. One had hyperprolactinemia. No case of hypogonadotropic hypogonadism was detected. Six patients who had psychogenic impotence had low levels of testosterone.

Seminal plasma concentration of glycerylphosphorylcholine before and after vasectomy and vas reanastomosis.

The concentration of glycerylphosphorylcholine (GPC) was determined in semen obtained from normal fertile, vasectomized, and vas-reanastomosed subjects. Concentrations of GPC were markedly lower in the semen of vasectomized men. GPC levels observed in vas-reanastomosed subjects were similar to those found in normal fertile men. Vasectomy may not affect GPC synthesis significantly.

PIP: Glycerlphosphorylcholine (GPC), an organic component of major consequence in human seminal plasma, was assayed in 3 population groups for comparison: normal fertile men, vasectomized men, and vas reanastomosed men. Subjects were matched for socioeonomic status and age. Long-term effects of vasectomy were apparent: the levels of GPC were significantly lower (P .001) in the vasectomized subjects. When these subjects were divided into various post vasectomy periods and were compared with each other, no significant difference was seen in the level of GPC. Vas reanastomosed seminal fluid showed similar levels of GPC as the levels among normal fertile subjects, even though no sperm were seen in the 1st ejaculate from the reanastomosed men. GPC levels, therefore, may be useful in the evaluation of the surgical success of reversible procedures for male sterilization.

Metronidazole ("Flagyl") in dracunculiasis: a double blind study.

Two-hundred and twenty-nine cases dracunculiasis were selected for a double-blind trial of metronidazole against placebo. A cure rate of 85% was observed with metronidazole. A dosage of 400 mg metronidazole three times daily for 10-20 days appears suitable. Even with secondarily infected lesions, it was unnecessary to administer any other chemotherapeutic agent. In most cases symptomatic relief, especially of pain and pruritus, was obtained within two weeks. In patients with only subcutaneous worms, metronidazole did not apparently prevent the development of lesions and seemed to stimulate the worm to emerge quickly, with resultant less severe lesions. Complete cure was delayed in patients with multiple lesions, where worms reached the emergence state at different times. There did not appear to be any direct relationship between severity of the disease and response to metronidazole. If the worm was broken during treatment with metronidazole, no abscess formed nor was there any local inflammation. Metronidazole was very well tolerated even when administered for 20 to 25 days. No serious side-effects or toxic effects were observed.

Effect of an indigenous drug (Speman) on accessory reproductive functions of mice.

PIP: The effects of an indigenous drug preparation, Speman (Himalaya Drug Company), on the accessory reproductive organs were studied in castrated adult mice and immature intact mice. Oral administration of Speman to castrated adults markedly increased the weights of the seminal vesicles and ventral prostate, as well as the level of fructose and maltase activity. These increases were dose-dependent and highly significant (p less than .001). The results indicate that Speman possesses both androgenic and anaboliclike activities.^ieng

Some gross observations of the epididymides following vasectomy: a clinical study.

In 114 vasectomized men, 220 epididymides were grossly examined during vasovasostomy. Fullness, distention, turgidity, thickening, induration, and other gross changes of the epididymides, including the formation of cystic spermatic granuloma, or spermatocele, indicated inadequate removal of spermatozoa and testicular fluid from the sequestrated proximal seminal ducts and the epididymis. Further studies are necessary to determine whether the epididymal changes following vasectomy have any effect on sperm morphology and sperm physiology. The information obtained from these studies possibly may explain the poor pregnancy rates in the spouses of successfully vasanastomosed patients.

Effect of administration of a single dose of testosterone oenanthate on constituents of human seminal plasma and serum gonadotropins.

Testosterone oenanthate was administered intramuscularly in six infertile men with oligozoospermia and its effects on serum gonadotropins and some constituents in the seminal plasma were studied. One week after injection the mean serum FSH level was decreased to about 50%. Serum LH levels did not change. The mean ornithine decarboxylase activity in human semen was increased by 100% after the testosterone administration. The androgen dependent nature of ODC, fructose and sialic acid have been demonstrated.

PIP: The effect of a single im injection of testosterone enanthate (TE) on serum gonadotropins and constituents of seminal plasma was studied in 6 oligospermic men. Within 1 week of injection, mean serum follicle stimulating hormone (FSH) levels were reduced by 50%, while luteinizing hormone (LH) levels were unaltered. Treatment increased the mean ornithine decarboxylase activity in seminal plasma by 100%. The citric acid content and maltase activity of seminal plasma were not markedly altered. Fructose concentrations were significantly (p less than .05) higher during the 3rd and 4th weeks after injection, while sialic acid concentrations were significantly (p less than .05) elevated during the 2nd week. The results indicate that ornithine decarboxylase activity in seminal plasma may be a useful indicator for evaluating the secretory function of the accessory sex glands.