Birmingham hip resurfacing at a mean of ten years: results from an independent centre.

We report the findings of an independent review of 230 consecutive Birmingham hip resurfacings (BHRs) in 213 patients (230 hips) at a mean follow-up of 10.4 years (9.6 to 11.7). A total of 11 hips underwent revision; six patients (six hips) died from unrelated causes; and 13 patients (16 hips) were lost to follow-up. The survival rate for the whole cohort was 94.5% (95% confidence interval (CI) 90.1 to 96.9). The survival rate in women was 89.1% (95% CI 79.2 to 94.4) and in men was 97.5% (95% CI 92.4 to 99.2). Women were 1.4 times more likely to suffer failure than men. For each millimetre increase in component size there was a 19% lower chance of a failure. The mean Oxford hip score was 45.0 (median 47.0, 28 to 48); mean University of California, Los Angeles activity score was 7.4 (median 8.0, 3 to 9); mean patient satisfaction score was 1.4 (median 1.0, 0 to 9). A total of eight hips had lysis in the femoral neck and two hips had acetabular lysis. One hip had progressive radiological changes around the peg of the femoral component. There was no evidence of progressive neck narrowing between five and ten years. Our results confirm that BHR provides good functional outcome and durability for men, at a mean follow-up of ten years. We are now reluctant to undertake hip resurfacing in women with this implant.

Tension hemothorax following abdominal surgery - a rare presentation of congenital diaphragmatic defect.

BACKGROUND: Small congenital diaphragmatic defects are usually occult, but can present as a problem in patients with increased abdominal fluid as unilateral massive hydrothorax. We present a unique case presentation of a small congenital diaphragmatic defect. CASE REPORT: A 79 female immediately postoperatively developed a hydrothorax following low anterior resection for rectal cancer. The hydrothorax turned out to be due to an intrabdominal bleed in a patient with a previously undiagnosed congenital diaphragmatic hernia. The respiratory ball value mechanism worked as a pump to move blood from the abdomen to the chest and caused a tension hemothorax. RESULTS: Surgeons should be aware that a post operative hydrothorax could be associated with an intrabdominal complication of recent surgery. CONCLUSIONS: A small occult congenital diaphragmatic defect and associated ball value mechanism may provide an unexpected but clinically significant communication between the abdominal and thoracic cavities.

Relationships among scrotal and testicular characteristics, sperm production, and seminal quality in 129 beef bulls.

Standard breeding soundness examinations plus measurement of scrotal surface temperature (SST), internal/scrotal testicular temperatures, testicular ultrasonographic echotexture, daily sperm production, and epididymal sperm reserves were conducted on 129, 16-month-old crossbred beef bulls. There were significant positive linear correlations between SST and internal scrotal/testicular temperatures, a positive linear regression (P < 0.06) of bottom SST with the incidence of secondary sperm defects, but a negative linear regression (P < 0.01) with the incidence of primary sperm defects. Testicular echotexture had a positive linear regression with daily sperm production (P < 0.002) and testicular tone had a negative linear regression (P < 0.008) with epididymal sperm reserves. Scrotal circumference had a positive linear regression (P < 0.04) with the percentage of progressively motile sperm, a negative linear regression (P < 0.1) with the incidence of primary sperm defects, and a positive linear regression (P < 0.0001) with epididymal sperm reserves. In addition to seminal quality and scrotal circumference, testicular ultrasonographic echotexture has considerable promise for augmenting breeding soundness examinations of bulls.

Effects of GnRH treatment on scrotal surface temperatures in bulls.

Two experiments were conducted to characterize scrotal surface temperature (SST) in bulls treated with gonadotropin releasing hormone (GnRH). In Experiment 1, Angus bulls (n = 10, 18 mo, 597 kg) were given GnRH (400 ng/kg) or saline, IV. Bottom SST increased approximately 1.7 degrees C (P < 0.005) over time (0 to 90 min) at an ambient temperature of 5 degrees C. However, there was no significant effect of GnRH treatment and temperature increases were attributed to stress. When the experiment was repeated at an ambient temperature of 25 degrees C, SST was elevated prior to treatment, with no subsequent significant increase. Experiment 2 was conducted with Charolais bulls (n = 6, 12-14 mo, 517 kg) with an emphasis on minimizing stress. Bottom SST increased approximately 2 degrees C (P < 0.05) between 0 and 45 min after GnRH treatment, supporting the hypothesis that GnRH treatment increases SST in bulls. In conclusion, it was apparent that stress, high ambient temperatures, and GnRH treatment can all increase SST in bulls.

Comparison of models for genetic evaluation of scrotal circumference in crossbred bulls.

The aim of this study was to evaluate the effect of including concomitant body weight and(or) a random dam effect in genetic evaluation models on variance component estimates and standard error of prediction for scrotal circumference (SC) at 6, 8, 10, and 12 mo. Variance components and average standard errors of prediction were compared under models differing in either the number of related traits (M11 [SC], M12 [SC and BW]) or an uncorrelated random dam effect (M21 [SC], M22 [SC and BW]) using records on 1,547 bull calves. In a single-trait model (M11), estimates of direct heritabilities (h2a) for SC were .45, .49, .57, and .66 at 6, 8, 10, and 12 mo, respectively. In a two-trait model (M12), h2a were similar to those in M11 model. In M21, h2a for SC were .37, .42, .54, and .65, whereas the proportions of phenotypic variance due to dams (d2) were .12, .11, .04, and .02 at 6, 8, 10, and 12 mo, respectively. Similarly, in M22, h2a for SC were .36, .44, .56, and .65 and d2 were .13, .10, .02, and .02. Standard errors of prediction for SC EBV from M22 were reduced by 2.86, 1.21, 3.02, and 1.99% relative to M21 and by 6.45, 2.70, 2.72, and 1.21% relative to M11 at 6, 8, 10, and 12 mo, respectively. Standard errors of prediction for SC EBV from M12 were reduced by .06, .73, 1.56, and .87% relative to M11 at 6, 8, 10, and 12 mo, respectively. The importance of the dam effect decreased with age for both SC and BW. These results demonstrate that a two-trait (SC and BW) animal model would result in more accurate evaluations of yearling SC EBV in beef cattle than a single-trait model.

Effects of ambient temperature and scrotal fleece cover on scrotal and testicular temperatures in rams.

The objective was to determine scrotal and testicular temperatures in rams and how they are affected by ambient temperature (10 degrees C vs 25 degrees C) and scrotal fleece (densely fleeced vs shaved). Scrotal surface temperatures (SST) of the caudal aspect of the shaved hemi-scrotum at 10 degrees C vs 25 degrees C were (mean, degrees C) 28.9 and 30.5 (P < 0.03), 28.2 and 29.6 (P < 0.04), and 26.1 and 27.6 (P < 0.06) at the top, middle and bottom of the testis, respectively. Scrotal subcutaneous temperatures (SQT) on the fleeced vs shaved side were 33.5 and 32.0 (P < 0.02), 32.2 and 31.1 (P < 0.06), and 31.7 and 30.8 (P < 0.09) at the top, middle, and bottom at 10 degrees C; they were 33.9 and 32.1 (P < 0.02), 33.1 and 31.9 (P < 0.05), and 32.5 and 32.0 (P < 0.15) at 25 degrees C. Intratesticular temperatures (ITT; measured only at 25 degrees C) on the fleeced vs shaved side were 35.3 and 35.0 (P < 0.5), 35.5 and 35.2 (P < 0.4), and 35.4 and 35.0 (P < 0.3) at the top, middle, and bottom. Temperature gradients (difference from top to bottom) were greatest for SST (2.8 degrees C), moderate for SQT (1.8 to 0.1 degrees C), and not significant for ITT (-0.1 and 0.1 degrees C). The SST was approximately 1.5 degrees C warmer at all 3 locations at 25 degrees C vs 10 degrees C. Increased ambient temperature affected SQT more at the bottom than at the top. Conversely, the difference in SQT between the fleeced and shaved sides was greatest at the top. The difference in ITT (0.3 degrees C warmer on the fleeced vs the shaved side at all locations) was not significant. Therefore, the magnitude of temperature increase associated with ambient temperature or scrotal fleece was affected by both depth and vertical location.

Morphologic, endocrine and thermographic measurements of testicles in comparison with semen characteristics in mature Holstein-Friesian breeding bulls.

Twenty Holstein-Friesian breeding bulls (62-79 months of age) were examined 3 times, at 30-day intervals. Scrotal thermograms for assessment of scrotal surface temperature (SST) and blood samples for plasma testosterone concentrations were taken just before and then 45 and 90 min, respectively, after treatment with GnRH (50 micrograms, Gonavet, i.m. per bull). Following GnRH treatment, there generally were significant increases in mean values of both top SST (range, -0.1 to 1.4 degrees C) and bottom SST (range, 0.3 to 1.8 degrees C). Scrotal circumference was highly repeatable but SST and video-measurements of scrotal dimensions were less repeatable, because apparently they were affected by ambient temperature. Plasma testosterone concentrations before GnRH treatment were more repeatable than those after GnRH treatment. Correlations between examinations of 0.67 to 0.81 and -0.14 to 0.47, respectively, but the converse was true for SST measurements. Semen was collected with an artificial vagina 3 times per week for 12 weeks starting 2 weeks before the first examination. The total number of spermatozoa per ejaculate was highly repeatable and the percentage of motile and live spermatozoa were relatively consistent. Separate regressions for each variable and for each examination were conducted for these 3 semen characteristics as dependent variables. For the number of spermatozoa per ejaculate and for the percentage of motile spermatozoa, significant independent variables were plasma testosterone concentrations and difference between top and bottom SST, respectively. The slopes of these equations were nearly all negative and the R2 was from 0.15 to 0.42. For prediction of the percentage of live spermatozoa, both SST gradient and plasma testosterone concentrations were significant independent variables. For these regressions, the slopes were negative and the regression coefficients were generally lower than for the other 2 dependent variables (range, 0.16 to 0.25). Treatment with GnRH and assessment of SST and plasma testosterone concentrations have some correlation with the semen production in the mature bull.

Endocrine and thermal responses to GnRH treatment and prediction of sperm output and viability in holstein-Friesian breeding bulls.

A study was conducted to determine changes in serum LH and testosterone concentrations and in scrotal surface temperature (SST; measured with infrared thermography) following GnRH treatment and to predict the number of spermatozoa collected and the proportion that were viable. Holstein-Friesian breeding bulls (n = 22, average age, 24.3 m.o.; range, 15 to 41 m.o.) were examined twice 30 d apart. Concurrently, semen was collected twice weekly with an artificial vagina. Treatment with GnRH (100 micrograms, i.m.) increased (P < 0.0001) serum LH and testosterone concentrations and increased (P < 0.0001) SST (range 0.6 to 1.1 degrees C; P < 0.05) at the top and bottom of the scrotum. In regression models to predict the total number of spermatozoa, significant independent variables included ultrasonic echotexture of the testes (negative slope), scrotal width (positive slope) and SST at the bottom of the scrotum 45 min after GnRH treatment (positive slope). In regression models to predict the percentage of live spermatozoa, ultrasonic echotexture was a significant independent variable (negative slope). Measurement of testicular ultrasonic echotexture and SST after GnRH treatment augmented measurement of testicular size for predicting the number and percentage of live spermatozoa.

Scrotal/testicular thermoregulation and the effects of increased testicular temperature in the bull.

Scrotal/testicular thermoregulation is a complex process controlled by numerous local mechanisms that attempt to maintain the testes at conditions ideal for spermatogenesis. This article provides a background of the anatomy and physiology of the bovine scrotum and its contents with emphasis on thermoregulation. Experiments are cited that demonstrate scrotal/testicular thermoregulation mechanisms and the effect that changes in ambient temperature have on internal testicular temperature and subsequent seminal quality.

Effects of dietary energy on scrotal surface temperature, seminal quality, and sperm production in young beef bulls.

The objective of this study was to determine the effect of dietary energy, breed (British vs Continental x British crosses), and their interactions on scrotal surface temperature (SST), seminal quality, and sperm production in bulls. This experiment, replicated over 2 yr, included 72 Angus, Angus x Simmental, or Hereford x Simmental bulls fed either a moderate- (100% forage) or high-energy (80% grain, 20% forage) diet for 168 d after weaning. At the end of the feeding period, SST was determined by infrared thermography, seminal samples (two ejaculates) were collected by electroejaculation, and reproductive tracts were collected at slaughter. Bulls fed the high-energy diet were heavier (P < .0001; diet x time interaction), had thicker backfat (P < .05; diet x line x time interaction), and had a larger scrotal circumference (P < .05). Testicular tone decreased over time (P < .0001) with a diet x time interaction (P < .05). There was no significant effect of diet on top, bottom, or average SST. However, bulls fed the moderate-energy diet had a larger (P < .02) SST gradient (3.9 vs. 3.4 degrees C). Bulls fed the moderate-energy diet had more (P < .01) morphologically normal spermatozoa (68.8 +/- 2.1 vs 62.5 +/- 2.5%) and a higher proportion (P < .006) of progressively motile spermatozoa (53.4 +/- 2.1 vs 44.5 +/- 2.4%). No effects (P > .05) of dietary energy on epididymal sperm reserves or daily sperm production were detected. Increased dietary energy may affect scrotal or testicular thermoregulation by reducing the amount of heat that can be radiated from the scrotal neck, thereby increasing the temperature of the testes and scrotum.

Relationship between scrotal infrared temperature patterns and natural-mating fertility in beef bulls.

The infrared temperature pattern (IRT) of the scrotal surface was recorded for 73 yearling beef bulls and a color video thermogram of the pattern of each bull was recorded. The average scortal surface temperature, temperature at the top and bottom of the scrotum, scortal temperature gradient, and thermal class (normal, questionable, or abnormal scortal surface thermal pattern) were recorded for each thermogram. Thirty-seven bulls had a normal temperature pattern (51%), 20 had a questionable pattern (27%), and 16 had an abnormal temperature pattern (22%). Bulls exhibiting abnormal scrotal temperature patterns had lower (P < .05) percentages of sperm exhibiting normal head and tail morphology and had a higher (P < .01) percentage of sperm with proximal droplets than did bulls with normal or questionable thermogram patterns. Thirty bulls with acceptable testis size and semen quality and representing the three thermal classes were each exposed single-sire to approximately 18 heifers during a 45-d pasture breeding period. Pregnancy rate was lower (P < .01) for bulls with abnormal scrotal temperature patterns (68 +/- 4%, n = 8) than for bulls with normal (83 +/- 4%, n = 13) and questionable temperature patterns (85 +/- 4%, n = 9), and pregnancy rate was related significantly to all four major characteristics (surface, top, and bottom temperatures and temperature gradient) of scortal thermograms. Data indicated that bulls with abnormal scortal temperature patterns exhibited a reduced ability to maintain an effective thermal gradient from top to bottom of the testes and that bulls with abnormal scrotal temperature patterns achieved reduced pregnancy rates when used for natural mating.

Contribution of the scrotum, testes, and testicular artery to scrotal/testicular thermoregulation in bulls at two ambient temperatures.

The objective of this study was to determine the contribution of the scrotum, testes, and the testicular artery to scrotal/testicular thermoregulation in bulls at two ambient temperatures. Crossbred beef bulls, 1.5 years of age, were placed in controlled environment chambers at ambient temperatures of 15 degrees C (n = 5) or 25 degrees C (n = 6). The distal lateral aspects and entire ventral part of the scrotum was incised under caudal epidural anaesthesia (xylazine, 0.07 mg kg-1. Both testes were withdrawn from the scrotum and then replaced and maintained by clamping the scrotal incisions with towel clamps. One testis was randomly chosen to be the exposed testis and was withdrawn prior to temperature measurements. Surface and internal temperature were measured with infrared thermography and needle thermocouples, respectively. Temperature gradients (degree C; difference in temperature from top to bottom at 15 and at 25 degrees C) were: scrotal surface (with testis), 1.5 and 1.3; scrotal surface (without testis), 2.1 and 1.6; surface of exposed testis, -0.6 and 0.0; sub-tunic of exposed testis, -2.2 and -0.6; intratesticular (covered testis), 0.0 and 0.4; and intratesticular (exposed testis), -1.3 and 0.4. The scrotum markedly affects testicular temperature but the testes have limited influence on scrotal surface temperature. The bovine scrotum and testes have opposing temperature gradients that complement one another, resulting in a relatively uniform intratesticular temperature. These temperature gradients are attributed in part to the testicular artery, which goes from the top of the testis to the bottom, divides into several branches and ramifies dorsally and laterally before entering the testicular parenchyma. Intra-arterial temperatures (measured with needle thermocouples) were lower (P < 0.05) where the artery entered the testis than at both the bottom and top of the testis for both the covered (31.7, 33.4 and 34.3 degrees C) and exposed testis (29.6, 32.0 and 32.5 degrees C) at an ambient temperature of 15 degrees C. Temperature differences were similar, but less pronounced, at 25 degrees C (covered testis, 34.8, 36.3 and 36.5 degrees C; exposed testis, 32.4, 33.5, 33.9 degrees C). Results supported the hypothesis that blood within the testicular artery has a similar temperature at the top of the testis (just ventral to the testicular vascular cone) compared with the bottom, but subsequently cools before entering the testicular parenchyma.

Ejaculation increases scrotal surface temperature in bulls with intact epididymides.

The objective of the study was to determine the effects of ejaculation on scrotal surface temperature (SST) measured with infrared thermography in bulls. In 18 Holstein bulls (18 mo old), sexual stimulation and spontaneous ejaculation (into an artificial vagina) increased SST at the bottom of the scrotum (0.9 degrees C; P < 0.0001). In 11 Angus bulls (1 yr old) electroejaculation increased both bottom and average SST (1.7 degrees C; P < 0.005 and 0.9 degrees C, P < 0.05), while in 12 Simmental cross bulls (2 yr old) electroejaculation significantly increased top, bottom and average SST (1.0, 1.2 and 1.1 degrees C, respectively). However, there was no significant increase in SST following electroejaculation in 15 Simmental cross bulls (2 yr old) with caudal epididectomies. The increase in SST was attributed to a localized increase in SST over the cauda epididymides, perhaps due to heat produced by contraction of the cauda epididymides during ejaculation. The results support the hypothesis that spontaneous ejaculation or electroejaculation increases SST and that this response is mediated by the cauda epididymides. Infrared thermography of the scrotum for evaluation of scrotal/testicular thermorégulation for clinical or research purposes should be performed before semen collection since thermography conducted soon after ejaculation may be misleading.

Contribution of the scrotum and testes to scrotal and testicular thermoregulation in bulls and rams.

A novel model was used to determine the role of the scrotum and testes in scrotal/testicular thermoregulation in bulls and rams. Eleven yearling bulls and 12 yearling rams were used at an ambient temperature of 15 degrees C. The distal lateral aspects and entire ventral part of the scrotum were incised under caudal epidural analgesia (xylazine, 0.07 mg ml-1). Both testes were withdrawn from the scrotum, the vaginal tunic was removed and one testis was replaced in the scrotum. Surface and internal temperatures were measured with infrared thermography and needle thermocouples, respectively. Temperature gradients (difference in temperature from top to bottom; degree C) for bulls and rams, respectively, were: scrotal surface (with replaced testis) 2.1 and 3.5; scrotal surface (without testis) 2.5 and 3.6; scrotal subcutaneous (with replaced testis) 1.0 and 0.7; testicular subtunic (without scrotum) -0.7 and -0.3; deep intratesticular (with scrotum) -0.2 and -0.6; and deep intratesticular (without scrotum) -0.5 and -0.5. Results supported the hypotheses that the scrotum has a positive temperature gradient (warmer at the top than the bottom) and that the testis has a negative temperature gradient (warmer at the bottom than the top). These opposing gradients apparently complement one another, resulting in a relatively uniform intratesticular temperature, below body core temperature, that is essential for normal sperm production. The scrotum substantially increased intratesticular temperature, but scrotal surface temperature was not significantly affected by the presence of a testis.

Insulating the scrotal neck affects semen quality and scrotal/testicular temperatures in the bull.

Nine Simmental X Angus bulls (2-yr of age) were used in 2 experiments. In Experiment 1, the scrotal neck was insulated (from Day 1 to Day 8) in 5 bulls, and semen was collected from all 9 bulls by electroejaculation approximately every 3 d until Day 35. Bulls with insulated scrotal necks had lower percentages of normal spermatozoa (P < 0.08) and higher percentages of spermatozoa with head defects (P < 0.06) or droplets (P < 0.08) than the untreated bulls. There was a time-by-treatment interaction (P < 0.04) for midpiece defects; the incidence was higher (P < 0.05) in the insulated than noninsulated bulls from Day 5 to Day 32. Spermatozoa within the epididymis or at the acrosome phase during insulation appeared to be the most affected. Compared with the noninsulated bulls, the insulated bulls had twice as many (P < 0.02) spermatozoa with midpiece defects and 4 times as many (not significant) with droplets on Day 5, fewer (P < 0.04) normal spermatozoa and 3 times as many with midpiece defects (P < 0.05) and with droplets (not significant) on Day 8, fewer (P < 0.02) normal spermatozoa on Days 15 and 18, and more sperm cells (P < 0.05) with head defects on Days 18 and 21. In Experiment 2, scrotal subcutaneous temperature (SQT; degrees C, mean +/- SE) prior to and after the scrotal neck had been insulated for 48 h in all 9 bulls was 30.4 +/- 0.7 and 32.4 +/- 0.6 (P < 0.01) at the top, 30.3 +/- 0.7 and 31.8 +/- 0.6 (P < 0.03) at the middle, and 30.2 +/- 0.8 and 30.7 +/- 0.6 (P < 0.05) at the bottom of the scrotum. Concurrently, there was an increase (0.9 degrees C) in intratesticular temperature (ITT) at the top (P < 0.07), middle (P < 0.04), and bottom (P < 0.04) of the testes. Scrotal surface temperature (SST) prior to and after the scrotal neck had been insulated for 24 h was 29.2 +/- 0.7 and 28.2 +/- 0.4 (P < 0.05) at the top of the scrotum and 24.7 +/- 0.6 and 25.3 +/- 0.7 (not significant) at the bottom, resulting in SST gradients of 4.6 +/- 0.6 and 2.9 +/- 0.5, respectively (P < 0.05). However, after the scrotal neck had been insulated for 48 h, none of the SST end points were significantly different from those prior to insulation. It appears that compensatory thermoregulatory mechanisms restored SST but were not able to restore SQT and ITT. Insulation of the scrotal neck affected SST, SQT, ITT and semen quality, emphasizing the importance of the scrotal neck in scrotal/testicular thermoregulation.

Seminal quality and sperm production in beef bulls with chronic dietary vitamin A deficiency and subsequent re-alimentation.

Sixteen Hereford bulls (16 mo of age, 462 kg average body weight) were used in each of 2 yr to evaluate the effects of hypovitaminosis A on seminal quality and sperm production. Bulls were fed a high-concentrate diet with (+VIT) or without (-VIT) supplemental Vitamin A until the apparent onset of hypovitaminosis A (28 and 32 wk in Year 1 and 2, respectively). Half of the bulls on each treatment were then slaughtered and those remaining were re-alimented with Vitamin A. Plasma retinol concentration in -VIT bulls reached a nadir at approximately 25 wk. In Year 1, the proportion of progressively motile spermatozoa was lower in -VIT bulls after 17 wk but returned to that of the +VIT group after re-alimentation. The proportion of spermatozoa with primary morphological defects appeared to be greater in -VIT bulls compared to +VIT bulls by 26 and 24 wk in Year 1 and 2, respectively. The incidence of these defects declined in -VIT bulls upon re-alimentation, and approached the incidence observed in +VIT bulls by 8 to 12 wk of re-alimentation. Hypovitaminosis A decreased paired testes weight, daily sperm production, and epididymal sperm reserves but did not affect daily gain. Prolonged dietary Vitamin A deficiency impaired semen quality and sperm production in the absence of other clinical symptoms. However, under practical feeding conditions, diets that result in long-term, marginal Vitamin A deficiency or a relatively short-term absence of Vitamin A intake probably would have minimal effects on spermatogenesis.