NORMALIZATION OF SERUM VITAMIN D IMPROVES SEMEN MOTILITY PARAMETERS IN PATIENTS WITH IDIOPATHIC MALE INFERTILITY.

CONTEXT: Idiopathic male infertility is evident in half of infertile males. Vitamin D receptors are expressed throughout male reproductive tract, including spermatozoa, promoting motility. Epidemiological studies revealed the positive association between serum vitamin D and semen quality. However, there are no clinical studies examining the differential role of vitamin D in idiopathic male infertility. OBJECTIVES: 1) To investigate the association between vitamin D deficiency and idiopathic male infertility, and 2) To determine whether vitamin D deficient males would show restoration of semen quality parameters upon supplementation with vitamin D. DESIGN: This was a year-long case-control study from November 2015 to November 2016. A therapeutic intervention cohort for 2 months was also performed. SUBJECTS AND METHODS: 117 Jordanian males were enrolled. Following a clinical evaluation by a urologist, baseline serum vitamin D and semen fluid analyses were collected. Participants were stratified into 3 groups: controls (n=30), idiopathic infertility (n=67), and secondary infertility (n=20). Idiopathic infertility patients with low vitamin D (n= 45) were supplemented with oral vitamin D, 5000 IU, once daily for two months. Thereafter, serum vitamin D and semen fluid analyses were reassessed (n= 34; 11 patients were lost to follow up). RESULTS: Vitamin D was significantly lower in patients with idiopathic infertility than in both controls and men with secondary infertility. Significant improvement of progressive and total sperm motility was observed after vitamin D treatment. Vitamin D correlated significantly with semen quality in the study population. However, no correlation was found between vitamin D and any of the semen quality parameters in the idiopathic infertility group. CONCLUSIONS: Vitamin D supplementation improves sperm motility in idiopathic male infertility patients with low vitamin D. Larger and longer clinical trials are warranted to validate the use of vitamin D in these cases.

Central mucoepidermoid carcinoma in a previously enucleated radiolucent lesion in the mandible. A case report.

Central muco epidermoid carcinomas (CMC) are rare tumours, representing about 2 to 3% of all mucoepidermoid carcinomas. Usually affecting the mandible, they appear as uni- or multilocular radiolucent lesions. We report a case of CMC in a 52-year-old Middle Eastern woman who presented with pain, limitation of jaw movement and tingling sensation of the tongue, related to a radiolucent lesion in the angle of the mandible. The lesion was first detected but not diagnosed in another hospital three years earlier. We describe the progression of the lesion over the past three years and describe the clinical, radiographic, histopathological, and surgical aspects of the case.

The trans-cervical plane (TCP): A new anatomical landmark for minimally invasive neck surgery

The currently used subdivisions of the neck are not helpful in neck surgery. In addition, the wide use of minimally invasive neck surgery has made it necessary to find reference points that make these procedures easier and safer. Here, clinical, anatomical and radiological study was undertaken to determine the relationships between the trans-cervical plane (TCP) and important neck structures. One hundred and ninety healthy volunteers were examined to determine the surface anatomy of the TCP together with 17 CT scans on the same plane and, five cadavers were dissected in an attempt to describe the anatomy of the mid-cervical region. The distance between the submental point and the sternal notch was measured, and the important anatomic features at this level were recorded. The anatomical location of the TCP was confirmed. TCP was opposite to the lower border of thyroid cartilage in 90% of the cases, and in 10% it was at the cricothyroid membrane. The average distance from the submental point to the TCP in the hyperextended neck was (6.5-11.5 cm). In spite of the wide range of variation of the distance between the submental point and sternal notch (13-23 cm), the middle of this distance is constant and often related to important anatomical structures: the junction between the upper 1/3 and lower 2/3 of the thyroid lobes, superior parathyroid, and the body of the 6th cervical vertebra. It is concluded that the trans-cervical plane is an important landmark in the neck region that enables accurate and rapid localization of the cricothyroid membrane for emergency cricothyroidotomy and the tracheal rings for percutaneous dilatational tracheostomy and provides a reference point to mark skin incisions necessary for minimally invasive neck surgery (AU)

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Magnetic resonance imaging of normal lumbar intervertebral discs.

OBJECTIVE: To study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. METHODS: A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. RESULTS: The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. CONCLUSION: The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed.

Magnetic resonance imaging of normal lumbar intervertebral discs.

OBJECTIVE: To study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. METHODS: A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. RESULTS: The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. CONCLUSION: The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed.