ICSI outcomes in obstructive azoospermia: influence of the origin of surgically retrieved spermatozoa and the cause of obstruction.

BACKGROUND: Spermatozoa can be retrieved from the testis and epididymis of men with obstructive azoospermia (OA) and used for ICSI. However, it is unknown whether the outcome of ICSI depends on the cause of obstruction or the origin of surgically retrieved spermatozoa. METHODS: A cohort of 171 men with OA and normal spermatogenesis were included in this retrospective study. They were divided into three groups according to the site and origin of obstruction: 83 men had congenital bilateral absence of vas deferens; 55 and 33 had acquired epididymal and deferent duct obstructions, respectively. The outcome of 368 ICSI cycles was determined and compared according to the origin of spermatozoa: epididymal (n = 253) or testicular (n = 115). RESULTS: Fertilization and clinical pregnancy rates did not differ between spermatozoa of different origin (58.9% versus 51.9% and 22.1% versus 24.3% with epididymal and testicular spermatozoa, respectively). However, the miscarriage rate was significantly higher for testicular spermatozoa (35.7% versus. 12.5% P < 0.05, chi2 test). Findings were similar whatever the aetiology of the OA. CONCLUSION: This study suggests that the use of testicular spermatozoa, even those generated during normal spermatogenesis, alters embryonic development and that epididymal spermatozoa should be preferentially used, irrespective of the aetiology of OA.

[Ultrasonography of dorsal elastofibroma. Apropos of 6 cases]. / Aspect échographique de l'élastofibrome dorsal. A propos de 6 cas.

Elastofibroma dorsi is a benign soft-tissue tumor. Its sub- and pre-scapular location and its appearance on CT and MRI generally lead to the diagnosis. We have analyzed with sonography 6 elastofibromas in 4 patients; the diagnosis was confirmed with CT scan or MRI. Some sonography imaging features supported the diagnosis of elastofibroma dorsi. In all the cases, (1) the tumor occurred typically in a sub- and pre-scapular location, and (2) showed a streaky echostructure (3). A similar symptomatic or asymptomatic mass in the opposite subscapular location is highly suggestive.

Ganglion cysts of the knee: articular communication revealed by delayed radiography and CT after arthrography.

OBJECTIVE: The diagnosis of ganglion cysts of articular origin may sometimes be uncertain when communication with the joint is not evident. Because we have observed that opacification of ganglion cysts revealed by arthrography can be significantly delayed, the purpose of this study was to determine retrospectively in 20 cases the time delay needed to show with arthrography a communication between the articular cavity and ganglion cysts of the knee. CONCLUSION: Arthrographic evidence of a communication between the articular cavity of the knee and communicating ganglion cysts requires delayed radiography performed at least 1 hr after intraarticular injection of contrast material. The best results are obtained with additional CT performed 1-2 hr after injection.

Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging.

OBJECTIVE: The purpose of this study was to determine the MR imaging features that enable differentiation between early irreversible osteonecrosis and transient lesions in nontraumatic lesions of the femoral condyle having the "bone marrow edema" pattern on MR imaging. MATERIALS AND METHODS: We reviewed 23 nontraumatic painful lesions of the femoral condyle in 23 patients (12 men and 11 women; mean age, 62 years). All patients had undergone radiography of the knee with findings that were normal or inconclusive. Also, all patients underwent MR imaging that revealed the bone marrow edema pattern in a condyle. Lesions observed after trauma, surgery, or glucocorticoid medication, or with epiphyseal collapse or degenerative joint disease on initial plain radiographs, were excluded from this study. Of the 23 lesions, 14 showed complete resolution (and were designated as transient epiphyseal lesions). The remaining nine lesions were irreversible and, on follow-up radiographic and MR imaging studies, evolved to collapsed osteonecrosis (and were designated as early osteonecrosis). The presence and size of the subchondral features observed by two radiologists on initial MR studies were compared for both irreversible and transient epiphyseal lesions. RESULTS: Initial MR imaging characteristics indicative of an early irreversible osteonecrosis included a subchondral area of low signal intensity on T2-weighted images with a thickness of more than 4 mm (sensitivity, 100% and 100%; specificity, 82% and 74% for the two observers) or a length of more than 14 mm (sensitivity, 89% and 88%; specificity, 93% and 87% for the two observers), focal epiphyseal contour depressions, and lines of low signal intensity located deep in the affected condyle. The extent of edema was similar for both transient epiphyseal lesions and early osteonecrosis. CONCLUSION: Careful assessment of MR imaging changes occurring in the subchondral area can enable confident differentiation between transient epiphyseal lesions and early irreversible osteonecrosis of the femoral condyle.

[Radiologic aspects of the loosening of cemented hip prostheses: mechanical, septic or granulomatous etiology?]. / Aspect radiologique des descellements de protheses de hanches cimentees: étiologie mécanique, septique ou granulomateuse?

Radiologic diagnosis of hip prosthesis loosening is based on the evaluation of each component (prosthesis, cement, bone) and of their interfaces. Both the prosthesis and the cement may deteriorate and the prosthesis/cement interface or cement/bone interface may become abnormal in prosthesis loosening of any etiology. In contrast, the aspect of the bone changes (erosion, periostitis) and their distribution vary according to the condition etiology. It appears from a retrospective study of 50 cases of chronic hip prosthesis loosening that the most specific signs for infection are unsharp bone resorption and acute-like or multifocal periostitis. In granulomatous loosening, bone resorption is sharp (as in mechanical loosening), but its distribution is not conform to the prosthesis shape (as in septic loosening), and periosteal changes are not observed.

MR imaging of the acetabular labrum: variations in 200 asymptomatic hips.

OBJECTIVE: The purpose of this study was to describe the MR appearance of the acetabular labrum in asymptomatic subjects and correlate the MR appearance with age and sex. MATERIALS AND METHODS: We evaluated high-resolution T1-weighted spin-echo coronal MR images of one hip in each of 200 asymptomatic individuals (84 men, 116 women; mean age, 44 years old; range, 15-82 years old). The labral shapes (triangular, round, flat, or absent), the intralabral signal intensity changes, and the possible extension of the intralabral signal intensity changes to the labral surface were assessed on two sections for each subject and correlated with age and sex. RESULTS: Triangle was the dominant shape seen on MR imaging (66%). However, its frequency decreased significantly with age. Absence of labrum was the second most frequent pattern (14%) and increased significantly with age. Round and flat labra were found in 11% and 9% of subjects, respectively, with no significant age correlation. The frequency of homogeneous labra with low signal intensity decreased with age. Intralabral areas of high signal intensity communicating with the free surface increased with age. CONCLUSION: The large variability of the MR appearance of the labrum in asymptomatic hips must be considered when interpreting MR examinations of patients in whom labral lesions are suspected.