Tuberculosis of male genital system--myth or reality in 21st century.

To review literature and our clinical experience with tuberculosis (TBC) of male genital tract. To analyze the localization of the specific process, association with other forms of TBC and its impact on fertility. The study comprises 69 male patients, average age 40.32 +/- 1.64 years who were diagnosed to have TBC of genital system. All laboratory, imaging, immunological and biological methods for detection of TBC were used as well as sperm count in patients with fertile problems. Time to set up of the diagnosis was 1 day to 19 years (median 26.82 +/- 6.76 months). TBC of the epididymis was found to be present in 78.26% of all cases. In 68.12%, unilateral affection was evident and involvement of left and right sites were similar. In 40.58% of patients, different grade of sperm quality alterations were diagnosed. Almost one-third of cases showed co-morbidity and 36.24% association with TBC of other organs and systems. TBC of male genital tract has a considerable impact on fertility and still remains a challenging medical problem. There is a growing body of evidence that regardless of all measures we should ring the bell about the possibility of a new widespread of TBC. Strong efforts are mandatory especially in developing countries and countries in transition like Eastern European Countries. Management of the disease should involve measures in health promotion programs, medical education health policy makers, and international cooperation.

Current pathophysiological views on vibration-induced Raynaud's phenomenon.

This review attempts to summarize and discuss contemporary pathogenetic views on vibration-induced Raynaud's phenomenon assuming its multifactorial etiology. An increase in central and peripheral sympathetic nervous activity is discussed based on different physiological indicators of autonomic dysfunction and sympathetic hyperactivity. Local acral vasodysregulation is considered. Receptor and nerve endings dysfunction presented with predominance of alpha(2)-receptor function in the digital arteries and neuronal loss in those digital cutaneous perivascular nerves containing calcitonin gene-related peptide result in deficiency of endogenous release of this powerful vasodilator. Endothelial damage and dysregulation induced by vibration and increased shear stresses are demonstrated by the elevated plasma level of thrombomodulin and of von Willebrand factor and reduced endothelium-dependent vasodilator responses. The concentrations of endothelin-1 are high, the highest being in most advanced stages. Decreased plasma thiol level, indicating increased production and activity of free radicals, contribute to vasospastic paroxysms in vibration white finger patients. Dysbalance of local vasoactive factors with opposing effects on vascular smooth muscle like endothelin and nitric oxide, endothelin and calcitonin gene-related peptide, nitric oxide and superoxide anion are discussed. Disturbed smooth muscle response is supposed. Changes in hemostasis, fibrinolysis and hemorrheology, activation of blood cells with erythrocyte hyperaggregation and red cell hypodeformability, platelet aggregation with increased release of vasoconstricting thromboxane A(2) and serotonin as well as leukocyte activation, entrapment within capillaries and post-capillary venules and increased reactive oxygen species and lysosomal lytic enzymes release might also contribute to digital vasospasms and tissue damage. Elevated soluble intercellular adhesion molecule-1 levels involved in the adherence of leukocytes to endothelium and to other leukocytes have been found in patients with hand-arm vibration syndrome.

Pathophysiology of vibration-induced white fingers--current opinion: a review.

Vibration-induced white finger (VWF) is secondary Raynaud's phenomenon caused by vibrating hand tools. Initially described in 1911 by Loriga, the pathophysiology of VWF remains unclear. This review attempts to summarize the current common and the most modern theories of the pathogenesis of VWF and propose a model of multifactorial etiology. The role of vasoregulatory abnormalities--autonomic dysfunction, local vasoregulatory abnormalities, of the endothelial cell control, of hemostasis, fibrinolysis and hemorrheology, of the leukocyte activation and the levels cell adhesion molecules and pro-inflammatory cytokines have been reviewed.

Diagnosis of abdominal bilateral cryptorchidism: HCG stimulation test.

A diagnostic stimulation test with hCG (Pregnyl) was performed in clinically healthy boys and was used to diagnose cases of bilateral abdominal cryptorchidism. In clinical andrology, this test may be applied as a noninvasive and highly sensitive method.

Opportunities for integration into ordinary school of students with emotional and behavioral disorders and students with chronic cardiovascular diseases (representative study for Republic of Bulgaria).

This article reviews the results of a representative study on the opportunities for integration into mainstream school of students with emotional and behavioral disorders and students with chronic cardiovascular disease. The aim of the study is to clarify some important personal characteristics as well as some factors, related to the school and family environment of students with EBD and those with chronic CVD in order to assess their capacities for integration. Altogether 192 students aged 8-15 years with psychic disorders and 337 aged 15-18 years with cardiovascular diseases were followed for two and four years respectively. Results show that students with EBD are with limited cognitive capacities, emotionally unstable, introverts, with high level of psychotisicm and higher level of personal anxiety compared to their healthy coavals. Students with EBD, studying with the healthy children, compared to their coevals with the same diagnoses, but studying separately in recovery school "pure model of special school" are with better short-term memory, lower level of situation anxiety, better mental work capacity and as whole more successfully socialized. In the end of the second year of investigation their psychic health improves as well. All this allow us to draw the conclusion that the integrated education of pupils with EBD has a better effect on the psychic health and improves as a whole their learning potentialities. Beside some significant differences between the students with CVD and the healthy referents, in terms of social and family status, school performance, school relationships, personal and cognitive characteristics, they could successfully be integrated into the public school in the presence of a well organized and individualized health, social and pedagogic support.

Effect of vibrations on male reproductive system and function.

From data in the literature, the potential risk of mechanical vibrations on reproduction in experimental, clinical and epidemiological studies (in experimental animals, men occupied in transport and industry), as well as the influence on sexuality are summarised. Results of the authors own experimental and clinical studies on the influence of the vibration on the male reproductive system are also presented. In male rats, decreased sperm counts, spermatogenesis index and size of testes, changed character of their motion, chronic venous stagnation and dystrophic alterations in tubuli contorti, changed ScDH, ATP-ase, LDH and GL-6-PDH activity, germ cells structural damages were observed. Workers exposed to vibrations had an increased prevalence of oligozoospermia, asthenozoospermia and teratozoospermia. Sexual disorders are also observed. The authors suggest that reproductive disorders should be included in the list of non-specific effects of vibrations. The detected changes justify further investigations and development of mathematical models for early detection and prognosis of the unfavourable effect on male reproductive function.

Family and social determinants of school maladjustment in students with emotional disturbances and behavioral disorders from recovery schools in Bulgaria.

This inquiry study is part of a comprehensive investigation on the organization and the effect of the education of students with emotional disturbances and behavioral disorders in special recovery schools. The aim for conducting the inquiry is to reveal the characteristics of the family and social background which may affect the school adaptation. The investigated group includes 254 students--192 with emotional disturbances and behavioral disorders and 62 healthy children of the same age from the settlements where the recovery schools are based. Two types of questionnaires developed by the team are used for investigating the students' family and social status--one designed for the pupils and one--for the teachers and supervisors in the schools. The inquiry for the students contains 15 questions revealing family and school environment (family relations and problems; number of children and sequential number of the problem child; parents' education and employment; school training and curriculum; social contacts in the school; school results). The inquiry, engaging the class teachers, day and night supervisors in recovery schools, contains 19 questions. There are additional questions concerning students' specific learning difficulties as well. The results made it clear that parents' divorce is the most unfavorable family determinant for school maladjustment of students with emotional disturbances and behavioral disorders. Many other factors such as the poor educational qualification and social-professional status of the parents, children number, the sequential number of the problematic child additionally impedes the relationship with the parents, thus increasing the risk of school failure and the manifestations of school maladjustment. The determined peculiarities of the family environment of students with emotional disturbances and behavioral disorders suggest targeted psychocorrective work of the school psychologist individually with the student as well as with his/her family.

hCG stimulation test for diagnosis of androgen deficiency.

A diagnostic-stimulation test with hCG (Pregnyl, Organon) was developed for demonstration of latent testicular deficit. The test was worked out on clinically healthy men and was used to diagnose cases of anorchidism and cryptorchidism. This stimulation test may be applied in clinical andrology as a noninvasive and highly sensitive method.

Etiopathogenesis of cryptorchidism and male infertility.

A retrospective study was performed 2.60 +/- 1.14 years after ochidopexy on 124 patients with cryptorchidism. Complex spermatological, hormonal, and histomorphological investigations were carried out which demonstrated the existence of disturbances in the exo- and endocrine functions of the testes of these patients. The results juxtaposed to the ages when the orchidopexy was accomplished revealed the necessity of early surgical intervention prior to 5 years of age. After this age there were severe changes in the histomorphological characteristics of the testicular tissue.

Male reproductive function in workers exposed to vibration.

Male infertility is a significant health problem. Increasing attention has been paid to the use of semen analysis as an indicator of exposure to potential reproductive hazards. The aim of the current paper was to study the effects of vibrations on the spermatogenesis in workers of different occupational groups (professional drivers, miners, engine drivers, etc.). Semen samples were analyzed for pH, volume, turbidity, sperm density sperm count and sperm morphology. Workers had an increased prevalence of oligospermia and azoospermia. The semen volume and percentage of motile spermatozoa decreased significantly and the incidence of sperm malformation increased in exposed workers.

Detection of antibodies toward epididymal sperm antigens--an obligatory step in evaluation of human immunologic infertility?

PROBLEM: To test the relative impact of epididymal versus ejaculated sperm in immunologic infertility. METHOD: Human antibody binding to epididymal and ejaculated spermatozoa was compared by flow cytometry (FCM) since it allows quantitative analysis of viable sperm while ignoring nonsperm cells. To select sera for FCM, GAT, TAT, and ELISA were applied on 145 sera from fertile men, idiopathically infertile and varicocele patients. RESULTS: All GAT/TAT-positive infertile patients, a representative group of varicocele patients and the fertile control, were assessed by FCM. Higher reactivity toward epididymal sperm revealed 18/22 sera while only four out of them bound to ejaculated sperm stronger than the control. All varicocele sera were positive against epididymal while negative against ejaculated spermatozoa. CONCLUSIONS: Epididymal sperm antigens may play a predominant role in some cases of immunologic infertility. Such patients might not be adequately diagnosed and respectively treated due to the limitations of diagnostic procedures applying only ejaculated spermatozoa.

Congenital anorchism: diagnostic and therapeutic aspects.

Eight patients with congenital anorchism were examined and treated. Plasma LH, FSH, and testosterone concentrations and the saliva testosterone level were measured by RIA in 3 patients. The results showed a 2.75 times increase in LH level, a 1.66 times increase in FSH level, and hardly measurable serum and saliva testosterone amounts. A dynamic provocating test was applied in 4 patients by Pregnyl (2000 and 4000 IU) and the results showed absence of the gonads. The semen quality control manifested a low volume of ejaculate and aspermia. Scyntiscanning of 6 patients demonstrated no functional testicular parenchyma. Substitute androgen therapy in patients with diagnosed anorchism gave good results, which suggests that this treatment is appropriate and promising. Implantation of testiculo-prostheses by using silicon alloplastic material corrects the cosmetic defect and overcomes the physiological barrier caused by the biological inferiority complex.

Vibration disease: plasma electrolytes and trace elements.

102 patients with vibration disease (mean age 46 +/- 7, length of service in different jobs using vibration tools 17 +/- 7 years) were studied. Plasma electrolytes and trace elements (sodium, potassium, calcium, magnesium, phosphorus, chloride, iron, copper, zinc, cobalt and manganese) and plasma osmolality were investigated, as well as some specific tests indicative of vibration exposure--cold provocation test, vibration sense, thermoasymmetry (left/right hand), skin electric resistance and hand and finger blood flow (Doppler-ultrasound sonometry). In a large number of patients increased values for the following variables were found--magnesium in 43%, zinc in 45%, cobalt in 57%, manganese in 70% and plasma osmolality in 66%. It is suggested that vibration affects mineral metabolism. However, these disturbances in mineral metabolism are secondary to other pathological changes in the body.

Effect of vibrations on the organism--possibilities for development of non-specific diseases and their prognostication.

Changes in the lipid metabolism, electrolytes, trace elements, acid-base balance in experimental animals and in workers exposed to vibrations, as well in patients suffering from vibration disease were investigated. The role of vibrations as a modifier of chemically induced cancerogenesis, and in implanted tumour cells was studied under laboratory conditions. A study was carried out on the morbidity with temporal work incapacity and total morbidity according to the turnover of the investigated groups (workers and patients suffering from vibration disease) in industrial branches with exposure to vibrations. Using statistical and mathematical methods of dispersion, correlation, factor and discriminant analysis, we detected interrelations between the investigated non-specific and specific indices of vibration exposure on the one hand, and possibilities for the development and the prognostication of cardiovascular, osteo-arthritic and other diseases and pathologic states, non-specific for vibration exposure, on the other hand.

Vibrations--discriminant models and possibilities for prognosticating specific and non-specific effects on the organism.

The present study involved 290 workers from branches of industry in which they were exposed to intense vibration and 102 patients suffering from disease due to vibration. Some specific (physiological) indices for exposure to vibration, such as the sensation of vibration, cold provocation test, Doppler-ultrasound, etc., and some non-specific (biochemical) indices, such as blood lipids, electrolytes and trace elements were studied. A discriminant analysis was made and 17 discriminant models (including different numbers of physiological and biochemical indices, age, and length of service) were elaborated. These models were used to predict the presence or absence of concomitant diseases, such as hypertension, coronary heart disease and arthritic lesions in persons exposed to vibrations; the stage of the vibration disease; the occurrence of exposure to vibration or of vibration disease. It was shown that physiological (specific) and biochemical (non-specific) indices affected by the exposure to vibration were interrelated, and that their estimation by means of the discriminant analysis revealed the distinction between the states mentioned above.

Vibration effects on fatty acid composition of organ and cell membrane lipids.

The influence of middle and high frequency vibrations (50 and 150 Hz) on the fatty acid pattern of structural lipids in white rat liver, kidney, heart, aorta and muscular tissue was studied in a 3-month experiment. The study also examined the fatty acid composition of phospholipids in erythrocyte cell membranes of workers occupationally exposed to vibrations and of patients suffering from vibration disease. Statistically significant changes in the per cent distribution of fatty acids were observed, which were more evident in the liver and kidney of experimental animals, and also after high frequency (150 Hz) vibration exposure. Changes in human subjects were greater in workers exposed to hand-arm vibrations and in patients suffering from vibration disease. Routine and more precise methods are needed to assess occupational risk via determination of the lipid metabolism state in workers exposed to vibrations and in patients suffering from vibration disease.

Electrolytic exchange in organism under the conditions of vibration. Experimental studies.

The study deals with a wide spectrum of indices of the electrolytic metabolism--sodium, potassium, calcium, chlorides, magnesium, iron, copper, zinc, cobalt and manganese--in blood, organs and tissues under the conditions of experimental chronic exposure of whole-body vibration frequency of 50 and 150 Hz and velocity of 85 mm.s-1 during a three months experiment (3 h daily) Reference methods were used for the determination of the indices--atom absorption spectrophotometry (variants with flame and without flame), coulometric chlorine titrator, flame photometry, etc. The indices were examined three times (1, 2 and 3rd months). Statistic analysis of the data showed significant changes in the number and the values of the indices and their character (increase or decrease) in comparison with the control values. The indices modifications occur early (at the end of the first month) and they proceed till the end of the experiment (till the end of the 3rd month) during the exposure to both frequencies, but are strongly expressed in the case of high frequency vibrations. The disorders in electrolytic metabolism established in the experiment testify that people exposed to vibrations are likely to suffer analogical changes and develop other pathologies--diseases of cardiovascular system, of blood and haematopoietic organs, etc. as well as an increase of specific disorders in connection with vibration exposure.

Effect of orchiopexy on human testicular ultrastructure.

The effect of orchiopexy performed before puberty on the testicular ultrastructure in sexually mature infertile men have been levels, as well as an analysis of spermogram and karyotype was carried out. It was found an elevation of FSH and LH, while T levels were decreased. Disturbances in the ultrastructure of all testicular cell types-germ, Sertoli and Leydig cells are related with the smooth and rough endoplasmic reticulum and mitochondria as well. It is concluded that the application of orchiopexy in 8-10 years old cryptorchid boys have no curative effect on the descended testes.

Testicular ultrastructure in infertile men.

The review shows typical ultrastructural alterations of germ, Sertoli, and Leydig cells in infertile men. Regardless of the cause of infertility, the disruption of the spermatogenic process usually occurs in the pachytene stage of meiotic prophase and in the stages of early spermatid maturation. The disturbances affect the cytoplasm more than the nucleus, and the synaptonemal complexes have shown significant stability even in the severely injured testes. An acrosome formation is found to be open to injury in more advanced germ cells during spermatid maturation. The manner of reaction of the Sertoli cells under different pathological conditions depends on the presence and degree of maturation of the neighboring germ cells. The appearance of immature Sertoli cells is accompanied by the loss of germ cells more advanced in their differentiation. In most pathologically altered testes, mature Sertoli cells reveal a universal manner of reaction of cell organelles. Leydig cell ultrastructure fluctuates considerably, and the alterations predominantly affect the sites of steroid synthesis, in spite of disease specificity. It becomes clear that a complex estimation of a real testicular state requires the application of new techniques as well as recognition of local control mechanisms. This will provide evidence toward elucidation of male infertility.