Varicoceles: postoperative prevalence--a prospective study with color Doppler US.

To define the ultrasound (US) prevalence of varicoceles after surgical repair, 28 postoperative patients underwent color Doppler US. A group of 26 control subjects also underwent color Doppler US to establish the prevalence of varicoceles in the healthy population. Eighteen of 28 (64%) patients who underwent color Doppler US scanning 16.4 months, on average, after varicocele repair had evidence of a varicocele, a number similar to that reported in other series for infertile men before surgery. Dominant veins in the postoperative patients were larger (P < .01) than those in the control subjects. Postoperative improvements in sperm parameters and conception rate in our subjects were 58% and 43%, respectively, consistent with findings reported in the literature. The prevalence of varicoceles detected at color Doppler US in our healthy population was 42% (11 of 26). Physical examination after surgery failed to show a varicocele in 20 of 22 (91%) patients examined. The discrepancy between sperm parameters and the results of color Doppler US and physical examination raises questions about the utility of US as a means of evaluation in the postvaricocelectomy patient.

Evaluation of sapphire tip Nd:YAG laser fibers in partial nephrectomy.

Sapphire tips for Nd:YAG lasers fibers have been introduced recently. The increased energy density improves the cutting effect while, reportedly, preserving the hemostatic properties of Nd:YAG laser energy. The capacity of sapphire tip laser fibers to facilitate partial nephrectomy was tested in mongrel dogs. No advantage for this technique was demonstrated compared to standard methods of partial nephrectomy.

Renal evaluation after CUSA plus Nd:YAG laser for partial nephrectomy.

A technique for partial nephrectomy using a combination of an Ultrasonic Surgical Aspirator and a neodymium:YAG laser provided better hemostasis and decreased total operative time compared to standard methods. Delayed hemorrhage was not seen, and thermal damage to the remaining renal parenchyma was minimal.

Combination of CUSA and neodymium:YAG laser for canine partial nephrectomy.

A Cavitron Ultrasonic Surgical Aspirator (CUSA) was used to isolate and skeletonize parenchymal renal vessels during 20 partial nephrectomies performed on 10 dogs. After isolation of the renal vessels, hemostasis was obtained by direct application of neodymium:YAG laser energy. Blood loss and total operative time were reduced compared to a control series of partial nephrectomies performed with a scalpel. The combination of Cavitron Ultrasonic Surgical Aspirator plus a Nd:YAG laser appears to offer advantages compared to either modality used alone or to standard techniques for partial nephrectomy.

Intraperitoneal insulin administration produces a positive portal-systemic blood insulin gradient in unanesthetized, unrestrained swine.

The present study was performed to evaluate the porto-systemic insulin gradient in response to (1) glucose feeding (2) intramuscular insulin administration, and (3) peritoneal insulin administration in unanesthetized swine. The experiment was designed to verify the hypothesis that intraperitoneal insulin administered might lead to a more physiologic portal vein insulin concentration than systemic administration of a similar insulin dose. Studies were performed in 4 domestic swine with chronic, indwelling catheters in the inferior vena cava and portal vein. Unpaired studied of the absolute portal venous and systemic venous insulin concentrations were performed in response to glucose prn(n = 4), 1 unit regular insulin/kg i.m.(n = 4), and 1 unit regular insulin/kg i.p.(n = 5). Timed blood samples were obtained and serum insulin concentrations determined by RIA. Portal and caval serum insulin concentrations following intramuscular insulin injection showed no significant difference. A significant portal vein insulin excess (p less than 0.001) was demonstrated following both feeding and intraperitoneal insulin.