Evaluation of the use of plasma rich in growth factors with immediate implant placement in periodontally compromised extraction sites: a controlled prospective study.

This study was conducted to evaluate the use of plasma rich in growth factors (PRGFs) with immediate implant placement in periodontally compromised extraction sites. Fifteen patients with chronic periodontitis were included. Each received two implants placed immediately after extraction in the anterior region of the mandible. One of the two implants was treated with PRGFs (group I), while the other was not and served as a control (group II). Implant survival, plaque index (PI), bleeding index (BI), probing pocket depth (PPD), and marginal bone loss (MBL) were evaluated for both groups. Complete soft tissue healing occurred in all patients and all implants were successfully osseointegrated over 12 months. At 12 months, results showed mean PPD values of 3.8 ± 0.3mm at the control site (group II) and 3.4 ± 0.4mm at the test site (group I); the mean MBL values were 1.1 ± 0.1mm at the control site and 0.6 ± 0.1mm at the test site. There were no statistically significant differences between the test and control groups regarding PI or BI, while there were statistical differences between the test and control groups regarding PPD and MBL throughout the follow-up period.

Seminal plasma reactive oxygen species-antioxidants relationship with varicocele grade.

This work aimed to assess seminal plasma reactive oxygen species (ROS)-antioxidants relationship with varicocele grade in infertile men with oligoasthenoteratozoospermia (OAT). The study included 89 infertile OAT men with varicocele divided into grade I (n = 22) and grade II (n = 43), grade III (n = 24) and compared with 20 healthy fertile controls. In their seminal plasma, two ROS parameters (malondialdehyde [MDA], hydrogen peroxide [H(2) O(2) ]) and four antioxidants (superoxide dismutase [SOD], catalase [Cat], glutathione peroxidase [GPx], vit.C) were estimated. There was significant increase in seminal MDA, H(2) O(2) and significant decrease in seminal SOD, Cat, GPx, vit.C in varicocele-associated OAT cases when compared with the controls. Compared with grade I cases, varicocele cases with grades II, III demonstrated significant increase in estimated seminal MDA, H(2) O(2) and significant decrease in seminal SOD, Cat, GPx, vit.C. It is concluded that seminal oxidative stress (OS) is related to increased varicocele grade in infertile OAT men associated with varicocele.

Accuracy of ultrasound diagnosis after blunt scrotal trauma (10 years experience)

Objectives:To evaluate the role of ultrasonography (US) and its accuracy; sensitivity and specificity for the diagnosis of testicular rupture after blunt scrotal trauma. Moreover; tunica albuginea breach; testicular hematoma; testis avulsion; epididymal injuries and hematocele are particularly examined. Patients and Methods: Between 1998 and 2008; 24 patients presented to Suez Canal University Hospital after blunt scrotal trauma and underwent surgical exploration. All patients had an emergency scrotal US examination with the use of a 7.5-10 MHz linear transducer. US findings were compared with the surgical findings to calculate the sensitivity and specificity of US for each type of lesion. Results: Out of 24 patients; 12 were diagnosed as having testicular rupture and tunica albuginea breach was visualized on US in 6 patients. Sensitivity and specificity of US were 92and 50for testicular rupture; 85and 75for hematocele; 80and 79for testicular hematoma; and 100 and 96 for testicular avulsion; respectively. US diagnosis of epididymal injuries was poor as it failed to detect 3 out of 5 epididymal lesions. Conclusion: US was highly sensitive in the diagnosis of testis rupture. This can provide information on the integrity of the scrotal contents that can help the physician to determine the optimal treatment

Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele.

The aim of this study was to assess seminal reactive oxygen species (ROS)-antioxidants relationship in fertile and infertile men with and without varicocele. One hundred and seventy six males were studied; fertile healthy volunteers (n = 45), fertile men with varicocele (n = 45), infertile oligoasthenozoospermia (OA, n = 44) without varicocele and infertile OA with varicocele (n = 42). In their seminal plasma, two ROS parameters (malondialdehyde, hydrogen peroxide) and five antioxidants (superoxide dismutase, catalase, glutathione peroxidase, vitaminE, vitaminC) were estimated. Compared with fertile healthy men, in all other studied groups, estimated seminal ROS were significantly higher and estimated antioxidants were significantly lower. Infertile men with varicocele showed the same relationship as infertile men without varicocele. Sperm concentration, total sperm motility as well as sperm normal forms were negatively correlated with seminal malondialdehyde and were positively correlated with vitaminC. It is concluded that varicocele has an oxidative stress (OS) in fertile normozoospermic bearing conditions. This may allow understanding that, within men with varicocele, there is a threshold value of OS over which male fertility may be impaired.

alpha-1,4-Glucosidase activity in infertile oligoasthenozoospermic men with and without varicocele.

This work aimed to assess seminal alpha-1,4-glucosidase activity in infertile oligoasthenozoospermic men associated with and without scrotal varicocele. Eighty men were investigated. They were divided into three groups: group 1 (n = 20), fertile normozoospermic men; group 2 (n = 30), oligoasthenozoospermia with varicocele; and group 3 (n = 30), oligoasthenozoospermia without varicocele. The patients underwent medical history, clinical examination, conventional semen analysis and estimation of seminal plasma alpha-1,4-glucosidase activity by double-beam spectrophotometer method and serum testosterone by radioimmunoassay method. There was a significant decrease in the mean seminal alpha-1,4-glucosidase activity levels in infertile men versus controls (mean +/- SD; 7.66 +/- 0.433, 2.088 +/- 0.565, 5.384 +/- 0.85 mU ml(-1) respectively). Mean serum testosterone levels demonstrated nonsignificant differences between studied groups. Seminal alpha-1,4-glucosidase activity levels demonstrated significant correlation with sperm count, sperm motility percentage and serum testosterone in oligoasthenozoospermia with varicocele group and demonstrated nonsignificant correlation in other groups. It is concluded that varicocele-induced hypoxia is the adverse effect that causes both oligoasthenozoospermia and decreased seminal alpha-1,4-glucosidase levels.

Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome.

OBJECTIVES: To compare and assess objectively the postoperative outcome parameters of both microsurgical subinguinal artery sparing and retroperitoneal high ligation techniques for varicocele in infertile men. METHODS: We performed a prospective study that included 413 consecutive patients who presented with varicocele. Of the 413 patients, 304 underwent subinguinal varicocelectomy (group 1) and 109 patients underwent high ligation varicocelectomy (group 2). Subinguinal varicocelectomies were performed under local anesthesia, with intravenous propofol sedation administered as needed. The operating microscope (x10 to x16) was used to spare the arteries and lymphatics. High ligation was performed through a retroperitoneal approach. RESULTS: All patients went home on the evening after surgery with minimal discomfort. No intraoperative complications occurred. The internal spermatic artery was identified in all microvaricocelectomy cases. No testicular atrophy occurred in either group. Five (1.6%) and seven (6.4%) hydroceles were identified at the 3-month postoperative visit in groups 1 and 2, respectively. CONCLUSIONS: Microvaricocelectomy is safe and effective and associated with a rapid recovery and minimal morbidity. However, it requires microsurgical training.

The Impact of preservation of the prostatic apex on the urodynamic characteristics in different orthotopic ileal reservoirs

Objective This study was carried out to evaluate the urodynamic characteristics of the Camey II; Kock's and W-configured ileal reservoirs utilized for orthotopic urinary diversion. Patients and Methods Between January 2000 and 2002; 42 male patients prospectively underwent radical cystoprostatectomy for bladder cancer followed by orthotopic urinary diversion at the urology department of Cairo University hospitals. All cases were evaluated clinically; bacteriologically; radiologically and urodynamically including uroflowmetry; medium-fill and voiding enterocystometry and urethral pressure profilometry; which was done in the early and late postoperative period (at 3-6 months and 6-18 months). Patients were divided into four groups: Group I: 11 cases with preservation of the prostatic apex and creation of a W-neobladder. Group II: 11 cases without prostatic apex preservation and creation of a W-shaped ileal pouch. Group III: 12 cases without prostatic apex preservation and creation of a Camey II pouch. Group IV: 8 cases without prostatic apex preservation and creation of a Kock's pouch. Results The patients of Group I had a larger mean neobladder capacity (699 ml) and volume at which the first contraction occurred (315 ml) and a larger amount of residual urine (224 ml) as compared to Group II (511.1; 285 and 77.5 ml; respectively); Group III (375; 200 and 55 ml; respectively) and Group IV (563; 266 and 600 ml; respectively). Also Group I with a preserved prostatic apex had a higher mean intraluminal opening pressure (55 cm H2O) and a higher pressure at maximum flow (62.36 cm H20) as compared to the patients with complete prostatic resection. Conclusion We conclude that the patients with a preserved prostatic apex (Group I) had a statistically significant higher mean residual urine in the early and late postoperative period and a significantly higher mean maximum cystometric capacity in the late postoperative period as compared to those recorded in patients with complete prostatic resection (Groups II; III; IV). A higher incidence of upper tract deterioration was detected in Group I (35) vs. 4.6; 27.8and 12.5in Groups II; III and IV; respectively

Complications of orthortopic ileal reservoirs

Objectives To evaluate the early and late postoperative complications; upper urinary tract morphology and function and metabolic alterations which may occur after ileal continent orthotopic urinary diversion. Patients and Methods Between July 1999 and January 2001; 42 male patients were subjected to radical cystoprostatectomy for bladder cancer and orthotopic urinary diversion at the urology departments of Cairo University and Suez Canal University Hospitals. All cases were evaluated clinically; bacteriologically; urodynamically and radiologically during the early and late postoperative periods (at 3 - 6 months and 6 - 18 months; respectively). The patients were divided into three groups: in Group I (22 cases) a W neobladder was fashioned with the uretero-ileal anastomosis done by creating extramural serosally lined tunnels. In Group II (12 cases) a Camey II pouch was done with ureteroileal anastomosis by direct end-to-end anastomosis in four and by Le Duc technique in eight pouches. In Group III (8 cases) a Kock's pouch was done with the ureters being directly implanted in the afferent loop above the constructed intussusception ileal nipple valve. In all types of reservoirs we used 45 cm of the ileum. Preoperatively all but four ureters were normal. These four ureters were dilated and uretero-ileal anastomosis was done by extramural serosally lined tunnels. Results In the early follow-up period total diurnal continence was achieved in 72; 75and 75of the patients of Groups I; II and III; respectively; versus 91; 83and 88in the late postoperative period. Nocturnal continence was achieved in 64; 67and 63during the early postoperative period compared to 73; 75and 75in the postoperative period for the three groups; respectively. In the early postoperative period complications occurred in 33of the patients including ureteroileal leakage (9.5); a prolonged pouchourethral anastomotic leakage (11.9); wound dehiscence (4.7); deep venous thrombosis (2.3); bronchopneumonia (2.3) and a prolonged ileus (2.3). Late complications occurred in 26.2of the patients including urethral recurrence; pelvic recurrence and urethroileal anastomotic stricture in 4.8; 14.2; 4.8; respectively and urethral stricture at the bulbomembranous junction in 2.4. A higher incidence of renal deterioration was detected in cases where the ureters were implanted directly (60) or in cases where the ureters were implanted by Le Duc technique (30). Deterioration was noted in 12.5of the cases where the ureters were implanted in an intussusception nipple valve and in 4.5of the renal units where the ureters were implanted in an extramural serosally lined tunnel. At 9 months postoperatively metabolic acidosis occurred in one patient with a Camey II neobladder. Conclusion A number of early and late postoperative complications were encountered after orthotopic neobladder. Metabolic complications were found in the form of metabolic acidosis in one patient. The lowest incidence of renal deterioration was reported in cases with extramural serosally lined ureteroileal anastomosis

Automatic analysis and classification of surface electromyography.

In this paper, parametric modeling of surface electromyography (EMG) algorithms that facilitates automatic SEMG feature extraction and artificial neural networks (ANN) are combined for providing an integrated system for the automatic analysis and diagnosis of myopathic disorders. Three paradigms of ANN were investigated: the multilayer backpropagation algorithm, the self-organizing feature map algorithm and a probabilistic neural network model. The performance of the three classifiers was compared with that of the old Fisher linear discriminant (FLD) classifiers. The results have shown that the three ANN models give higher performance. The percentage of correct classification reaches 90%. Poorer diagnostic performance was obtained from the FLD classifier. The system presented here indicates that surface EMG, when properly processed, can be used to provide the physician with a diagnostic assist device.

Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele.

Several theories have been advanced to explain the mechanisms by which varicocele impairs male fertility. These theories include scrotal hyperthermia, retrograde flow of adrenal or renal metabolites, Leydig cell dysfunction and hypoxia. Varicocele is reported to be associated with elevated reactive oxygen species (ROS) production in spermatozoa and diminished seminal plasma antioxidant activity. The aim of this study was to investigate whether surgical correction of varicocele might reduce ROS or increase the antioxidant capacity of seminal plasma from infertile patients with varicocele. The study group consisted of 68 infertile males, selected from patients scheduled for varicocelectomy at Cairo University Hospital during the year 1999. Seminal plasma levels of two ROS [malondialdehyde (MDA), hydrogen peroxide (H2O2)] and one ROS radical [nitric oxide (NO)] were estimated as well as six antioxidants [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), vitamin C (Vit C), vitamin E (Vit E), albumin) on the day prior to varicocelectomy. For comparison, the same parameters were measured again 3 and 6 months post-operatively. A statistically significant reduction in the 3 month post-operative levels of MDA, H2O2 and NO was observed when compared with the pre-operative values. A further significant reduction took place during the following 3 months. Four of the six antioxidants tested (SOD, CAT, GPx, and Vit C) showed a significant increase in seminal levels when comparing 3-month post-operative with pre-operative values. A further significant increase of the four antioxidant levels took place during the following 3 months. No significant change in the level of seminal plasma albumen took place during the first 3 months after varicocelectomy, however, a significant increase was noted during the next 3 months. In contrast to other antioxidants, seminal plasma levels of Vit E showed a significant decrease when comparing 3-month post-operative with pre-operative values. A further significant decrease took place during the following 3 months. It is concluded that varicocelectomy reduces ROS levels and increases antioxidant activity of seminal plasma from infertile men with varicocele.

Removal of intrauterine devices with missing tails during early pregnancy.

During a 70-month period, CO2 hysteroscopy was carried out on 52 pregnant women wearing IUDs with retracted tails. Ultrasonography was done prior to hysteroscopy to determine the size of the gestational sac and the site of the device. Successful removal of the device occurred in 46 cases. The technique, the findings of the study, and the limitations of the procedure are described.

PIP: IUDs were successfully removed from 46 of 52 pregnant women bearing IUDs with retracted tails, from December 1985 to November 1991, at the Department of Gynecology and Obstetrics, Benha University Hospital, Egypt. The presence and location of the IUD was confirmed with ultrasonography, excluding 3 patients who did not have retracted IUD tails, and 8 who were 12 weeks' gestation. After paracervical block or short-acting IV anesthesia, the 7 mm Storz hysteroscope was introduced, using cervical dilatation only if needed. CO2 gas, up to 200 ml, was injected into the internal os with a Hysteroflator (Wiest, Berlin). The IUD was carefully removed with a grasping forceps. The women received the antiprostaglandin endomethasin (sic) by suppository the night before, and after the procedure. Patients were observed for 5 days, and ultrasound was repeated 2 weeks later to confirm fetal viability. There were 6 failures to remove an IUD, 2 involving disturbance of the gestational sac, and 2 where the IUD lay beneath the sac. 2 spontaneous abortions resulted in the series. 24 Lippes Loops, 12 Copper Ts, 8 Copper 7s, and 6 Nova T devices were removed. It is recommended that the operator gain experience on women having their pregnancy terminated before attempting to remove an IUD from a pregnant woman wishing to continue her pregnancy.