Rapid method for determination of isocenter of radiation gantry and alignment of laser beams for stereotactic radiosurgery.

A simple technique has been designed which identifies the gantry isocenter and aligns the laser beams to the isocenter of the gantry within 3-5 min with an error of less than 0.75 mm, depending upon the accuracy of gantry rotation.

A daily radiation therapy record form.

This communication reviews one institution's experience in developing a reliable and accurate radiation therapy record form. The design of a daily record is highly subjective. With the subjectivity of this process in mind, the purpose of this presentation is to describe the advantages of our form and to acquaint the reader with the literature useful in preparing a therapy record that fulfills their facility's requirements.

Hemangiomatosis of the pleura with hemorrhage and disseminated intravascular coagulation.

Hemangiomatosis involving the pleura is a rare cause of bloody pleural effusion in the neonate. When congestive heart failure and consumption coagulopathy are associated, the prognosis is particularly grave. Corticosteroids and radiation therapy have been reported to shrink hemangiomas. We present such a case in a 2.5-mo-old whose condition did not appear to respond to prednisone or radiation therapy but resolved quickly when cyclophosphamide was given. In this case cyclophosphamide appeared to be life saving.

Quantitative analysis of the effects of caffeine on sperm motility and cyclic adenosine 3',5'-monophosphate (AMP) phosphodiesterase.

Caffeine in high concentrations (2 to 6 mM) has been shown to increase sperm motility and metabolism when added to semen. High concentrations of caffeine have also been demonstrated to inhibit cyclic adenosine 3',5'-monophosphate (AMP) phosphodiesterase isolated from sperm. Since cyclic AMP is known to increase sperm motility, some investigators have attributed the stimulatory effect of caffeine on sperm motility to the inhibition of phosphodiesterase. The authors used semen from healthy donors to quantitate the effects of caffeine on sperm motility by turbidimetric analysis and to analyze kinetically the effect of caffeine on phosphodiesterase isolated from sperm preparations. Caffeine (0.012 to 2.0 mM) produced a dose-dependent increase in sperm motility. The ED50 for motility stimulation was 300 microM of caffeine; a significant increase in motility was observed with 60 microM; and maximal stimulation (a threefold increase) occurred with 1 mM. The phosphodiesterase activity of sperm homogenates displayed linear kinetics with a Vmax of 0.5 nmoles/mg of protein per minute and a Km of 125 microM. Caffeine (0.1 to 40 mM) produced a dose-dependent inhibition of sperm phosphodiesterase. Kinetically, caffeine was a mixed inhibitor of sperm phosphodiesterase, displaying a Ki of 1.2 mM. These results suggest that caffeine may stimulate sperm motility by a mechanism other than phosphodiesterase inhibition.

ATP concentration of human spermatozoa: lack of correlation with sperm motility.

The primary source of energy for sperm motility is intracellular adenosine 5'-triphosphate. We studied the relationship between the concentration of ATP and sperm motility in normal semen donors and in a series of male infertility patients. The ATP concentration was determined by the firefly luciferin-luciferase assay, and sperm motility was quantitated by the turbidimetric method. Although the patient population demonstrated a significantly lower sperm motility than the donor population, we found no significant difference between the two groups in the intracellular concentration of ATP. Thus, the data indicate that the poor sperm motility observed in some of the patients' specimens was not associated with abnormally low levels of ATP. In separate experiments the intracellular concentration of ATP decreased gradually with time at approximately the same rate at which sperm motility declined. Both factors had decreased by 50% approximately 3 hours after collection.

The falsely positive gonadal venogram: presence of a pampiniform plexus without a gonad.

Two men with 3 non-palpable testes underwent gonadal venography, which in each instance demonstrated a typical pampiniform plexus. No gonadal tissue was found surgically or pathologically. The clinical significance of these findings is discussed.

Clinical use of the turbidimetric analysis of sperm motility: comparison with visual techniques.

Semen characteristics of men with apparent fertility problems are analyzed primarily by routine visual techniques. Although these techniques provide quantitative information regarding the sperm count, they give only qualitative information about sperm motility. We compared visual microscopic ratings of sperm motility (based on an arbitrary scale of 0 to 4 in half-unit steps) with turbidimetric spectrophotometric analyses for 100 patients from our male fertility clinic. In the turbidimetric method, semen is layered on the bottom of the cuvette filled with Lopata's medium, and motility is quantitated as the rate of change in optical density as the sperm swim upward into the light path. The visual sperm motility rating did not correlate with the turbidimetric rating. Whereas most of the patients had visual ratings of 2.5 to 3.0 (indicating normal motility), the majority had turbidimetric motility factors that were well below the average motility factor for a control group. On the basis of these studies we believe that the turbidimetric analysis of sperm motility is a much more accurate measure of sperm motility than is visual microscopic analysis. Its major advantages are that (1) it provides a quantitative measure of sperm motility; (2) it does not rely on arbitrary rating by an individual; and (3) the sperm must perform work in order to be measured (i.e., leave the semen and swim upward into the light path).

Staging pelvic lymphadenectomy for carcinoma of the prostate review of 91 cases.

Bilateral pelvic lymphadenectomy was done in 91 consecutive patients for the staging of carcinoma of the prostate. Of the 91 patients 47 additionally received placement of radioactive gold grains or iodine seeds into the prostate. The incidence of positive nodes was 53 per cent in patients with clinical stage A2 disease, 17 per cent in stage B1, 29 per cent in stage B2 and 56 per cent in stage C disease. Pedal lymphangiography was shown not to be a useful staging procedure. Excellent correlation exists between histologic grade and pathologic stage. The surgical technique and low complication rate are discussed.

Omental transposition as an aid in genitourinary reconstructive procedures.

Mobilization of an intact omental pedicle graft for supportive use has been carried out in a variety of genitourinary reconstructive procedures. Mobilzation is accomplished by detachment of the omentum from the transverse colon and by separation from the greater curvature of the stomach. The right gastroepiploic artery is generally preserved as the blood supply to the omental pedicle. Further pedicle lengthening can be achieved as necessary by selective division of the omentum, based on the arterial anatomy. The rich vascular and lymphatic supply of the omentum and its attendant potential to contribute to healing, even in the presence of infection, while maintaining its suppleness and allowing epithelization to occur over its surface, makes the omental pedicle graft an extremely useful adjunct in the following difficult situations: complicated vesicovaginal, prostatorectal, and rectovaginal fistulas; reconstruction of the bladder neck and bulbo-membranous urethral areas; extensive injury to the bladder; and a variety of renal and ureteral reconstructive procedures.

A quantitative method for determining the effects of drugs on spermatozoal motility.

The purpose of this study was to demonstrate whether the turbidimetric method of measuring sperm motility could be used to quantitate the effects of drugs. Human ejaculate was layered on the bottom of a cuvette containing Lopata's medium, and sperm motility was measured spectrophotometrically. The slope of the initial increase in absorbance (OD) is directly proportional to the rate at which the fastest fraction of sperm enters the light path and provides a highly reproducible measure of sperm motility. The effects of caffeine and imipramine on sperm motility were studied. The test drug was added to the buffer before the semen was introduced so that the assay would measure the immediate effect of the drug on the sperm. Caffeine produced a dose-dependent increase in sperm motility, and imipramine produced a dose-dependent decrease. We conclude from these studies that the turbidimetric assay is capable of providing a rapid, reproducible, quantitative analysis of the effects of drugs on sperm motility.

PIP: The purpose of this study was to demonstrate whether the turbidimetric method of measuring sperm motility could be used to quantitate the effects of drugs. Caffeine and imipramine on sperm motility were investigated. Human ejaculate was layered on the bottom of a curette containing Lopata's medium, and sperm motility was measured spectrophotometrically. The slope of the initial increase in absorbance is directly proportional to the rate at which the fastest fraction of sperm enters the light path and provides a highly reproducible measure of sperm motility. The test drug was added to the buffer before the semen was introduced in order that the assay would measure the immediate effect of the drug on the sperm. Caffeine produced a dose-dependent increase in sperm motility, and imipramine produced a dose-dependent decrease. It is concluded from these studies that the turbidimetric assay is capable of providing a rapid, reproducible, quantitative analysis of the effects of drugs on sperm motility.

Repair of vesicovaginal fistula by a suprapubic transvesical approach.

Thirty-four vesicovaginal fistulas of various causes were repaired using a suprapubic, transvesical approach modified after the original technique of O'Connor. Only four failures resulted. Two of the failures were attributed to residual or recurrent carcinoma and two to poor tissue healing resulting from an inadequate delay between the initial surgical procedure and an attempt at reconstructive surgery. Surgical complications included three wound infections and one instance of severe gastrointestinal bleeding. Technical considerations thought to be important include excision of all diseased tissue in the bladder and vagina; complete separation of the bladder from the vagina with a margin of healthy tissue in all directions; careful, watertight closure of both bladder and vagina without tension; interposition of peritoneum or omentum between the closed bladder and vagina, and initial postoperative maintenance of an uninfected and dry suture line.