Morphologic predictors of in hospital mortality in acute type III aortic dissection. / Morfologicheskie prediktory gospital'noi smertnosti u bol'nykh s ostrym rassloeniem aorty III tipa.

INTRODUCTION: In-hospital mortality of acute aortic type III dissection ranged about 12%. Complicated dissections represent about 18% of all cases, and require open surgery or TEVAR. More morphological predictors of in hospital mortality are needed to differentiate patients who should be selected for immediate, surgical or endovascular intervention. METHODS: From January 2009 to December 2014, 74 patients with acute aortic type III dissection were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade Serbia and retrospectively analyzed. Every MSCT was observed in regard to morphologic characteristics of dissection. RESULTS: By analyzing morphologic parameters in patients between survival and non-survival group only localization of intimal tear showed statistical significance (p=0,020). The size of the intimal tear didn't reach statistical significance with the tendency of doing so in a larger sample of patients (p=0,063) with the cut-off value of 9.55mm. The shape of the true lumen was on the border of statistical significance (p=0,053). CONCLUSION: Inner curvature intimal tear localization, huge intimal tear as well as elliptic shape of the true lumen together should raise awareness to a subgroup at risk for in hospital mortality. More liberal endovascular treatment in this subgroup of patients is advocated.

Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS).

The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

A correlation between selenium and carnitine levels with hypo-osmotic swelling test for sperm membrane in low-grade varicocele patients.

OBJECTIVE: The hypo-osmotic swelling (HOS) test predicts membrane integrity by determining the ability of the sperm membrane to maintain equilibrium between the sperm cell and its environment. The aim of our study was to determine the correlation between selenium and carnitine levels in the seminal fluid with HOS test for sperm membrane in low-grade varicocele patients. PATIENTS AND METHODS: Study numbered 64 examinees who suffered from low-grade varicocele and were divided into two groups, according to fertility potential and HOS test outcome. The study also included a control group of 64 healthy subjects, with no varicocele. RESULTS: From the Shapiro-Wilk's test, it is clear that carnitine distribution differs significantly from normal (0.938, p = 0.03). In distribution of selenium, Kolmogorov-Smirnov test clearly shows statistically significant deviation from the normal curve (z = 0.225, p < 0.000), likewise Shapiro-Wilk's statistic (0.787, p < 0.000). According to the results, the second group had significantly higher levels of carnitine and selenium than the first group of examinees (p < 0.05); therefore, when we compared epididymal markers with HOS tests outcomes, we found significant differences between the two groups. There were no significant differences between second group and healthy subjects (p > 0.05). CONCLUSIONS: HOS test outcome in varicocele patients is directly proportional to the carnitine and selenium levels, which could play a major role in both determining fertility parameters and in the treatment of its impairment. This result is important for sub-clinical varicocele in infertile patients with normal semen analysis, since there is no evidence of benefit from any treatment so far.

O blood group as an indicator for abdominal aortic aneurysm.

OBJECTIVE: An aortic aneurysm is a general term for an enlargement (dilation) of the aorta to greater than 1.5 times normal size. Abdominal aortic aneurysm (AAA) primarily affects the population older than 50 years, with a prevalence of approximately 5%. There are a few theories about AAA etiology. Interest in the relationship between blood type and vascular disease has been established. The aim of our study is to evaluate distribution of blood-groups among the patients with abdominal aortic aneurysm (AAA) as well as to identify any kind of relationship between blood type and AAA. MATERIALS AND METHODS: The design of our research is combination of retrospective and prospective case-control study in a sample of population of Montenegro. Statistical analysis was performed in SPPS v 20.0, using the chi-square test for independent samples, with the probability level at p < 0.05 as significant, and p < 0.01 as highly significant. RESULTS: O blood group was the most frequent among the examination group (53.11%), and A blood group was the most frequent among group without AAA (43.22%). Presence of AAA in individuals with O blood type was 1.46 higher than for the other blood types. CONCLUSIONS: This finding leads us to suspect that O blood type can be indicator for AAA.

Thyroid dysfunction and thyroid autoimmunity in euthyroid women in achieving fertility.

OBJECTIVE: Thyroid disease is the second most common endocrine condition in women of childbearing age. Thyroid hormones are involved in control of menstrual cycle and in achieving fertility affecting the actions of follicle-stimulating hormone and luteinizing hormone on steroid biosynthesis by specific triiodothyronine sites on oocytes; therefore, affect all aspects of reproduction. It remains controversial if pregnant women should be screened for thyroid dysfunction. Purpose of this review was to examine recent studies on the assessment of thyroid dysfunction in pregnancy, its treatment and newly perspective of thyroid autoimmunity in pregnant euthyroid women in achieving fertility. METHODS: An electronic search was conducted using the internet medical databases: Medline/PubMed, EMBASE, EBSCO, and the Cochrane library. RESULTS: Thyroid gland faces great challenge in pregnancy when many hormonal changes occur. Precondition for normal follicular development and ovulation is pulsate gonadothropin realizing hormone secretion. Thyroid dysfunction in pregnancy is classified as forms of hypothyroidism (positivity of thyroid autoantibody, isolated hypothyroidism, and subclinical or overt hypothyroidism), hyperthyroidism, and autoimmune disease, but also thyroid nodules and cancer, iodine insufficiency and postpartum thyroiditis. These conditions can cause adverse effects on mother and fetus including pregnancy loss, gestational hypertension, or pre-eclampsia, pre-term delivery, low birth weight, placental abruption and postpartum hemorrhage. There is an evidence that thyroid autoimmunity, in thyroid dysfunction adversely affects conception and pregnancy outcomes, but it is unclear what impact has isolated eumetabolic thyroid autoimmunity in achieving fertility, especially in women undergoing in vitro fertilization. Treatment of euthyroid pregnant women with positive thyroid peroxides antibodies is still controverse, but not few studies show that levothyroxine substitution is able to lower the chance of miscarriage and premature delivery. CONCLUSIONS: Further randomized trials are needed to expand our knowledge of physiologic changes in thyroid function during the pregnancy and to reveal mechanisms by which thyroid autoimmunity in euthyroid women affect fertility, especially the success of assisted reproductive technology in achieving the same and validity of levothyroxine administration in thyroid autoimmunity positive women.

Advantages of microsurgical varicocelectomy over conventional techniques.

OBJECTIVE: Varicocelectomy is the only effective method of treating varicocele. Nowdays, many techniques for varicocelectomy include retroperitoneal, inguinal, and subinguinal varicocele repairs with or without magnification and laparoscopic repair. The advantages of the microsurgical approach to varicocele repairs are reliable identification and preservation of the vascular structures. Thus, our aim is to compare the efficiency of microsurgery over conventional techniques of varicocele repairs. PATIENTS AND METHODS: We have evaluated 105 man divided into three groups of 35 patients surgically treated with open varicocelectomy in the first group, microsurgical varicocelectomy in the second, and laparoscopic varicocelectomy in the third group. Sperm test improvement and complications were then compared. RESULTS: The testicular volume shows a significant increase after all three types of surgery, the highest one being after the laparascopic varicocelectomy (14.47 ± 6.76 vs. 21.8 ± 7.52), whereas the lowest increase was recorded in open varicocelectomy (14.90 ± 6.26 vs. 17.46 ± 5.89). Regarding motility of spermatozoids, the highest postoperative increase of values is after microsurgical varicocelectomy (4.30 ± 2.19 vs. 15.88 ± 3.13). CONCLUSIONS: Our study shows the lowest degree of postoperative complications among patients treated with microsurgical varicocelectomy, and the most frequent complications in those treated by open varicocelectomy. Sperm test outcomes after microsurgical varicocelectomy was better than those after other conventional techniques: significantly higher improvement of sperm quality, shoter postsurgical clinical treatment, and the lowest rate of postsurgical complications.

Chronic Mesobuthus gibbosus scorpionism related to the sting in vein.

BACKGROUND: A small amount of data is already presented in the relevant literature related to the medical facts of scorpionism caused by Yellow scorpion (Mesobuthus gibbosus: M. gibbosus). Undoubtedly, it is considered as dangerous to human health. This paper presents an unusual case of scorpionism after the sting in vein. CASE REPORT: A 25 year old male was bitten by M. gibbosus. He experienced extremely severe intermittent pain in the right feet, followed by pulsating and glowing sensations, cold sweat and paleness. 15 minutes after the sting, the pain started to spread through the medial side of the leg, up to the inguinal region. Patient became excited, and experienced occasional spasms of leg muscles. A month after, the bitten vein of dorsal arch of the foot and v. sephena magna became non-uniformly tortuously spread through the entire length. On physical examination four years after the sting, the enlargement of the veins still exists, periodical tingling, and occasional muscle twitches during the night. CONCLUSIONS: M. gibbosus is endemic in Mediterranean area and represents a real hazard for local inhabitants and tourists. The medical treatment of this type of scorpionism is exclusively symptomatic.

Prospective follow up of fertility after adolescent laparoscopic varicocelectomy.

BACKGROUND: Varicocele associated with infertility has been recognized for years. Referential literature provides few papers, even meta-analyses which did not confirm the success of surgery related to the increasing of the semen quality. AIM: The purpose of the presented paper is referred in arising the quantum of knowledge related to usefulness of surgery in varicocele treatment. PATIENTS AND METHODS: The varococele incidence was established in premature age (7-18) in population of 969 boys. In those who suffered from varicocele, we estimated their semen analysis parameters before and three months after the surgery, and followed up the pregnancy rate in surgically treated subjects many years after the treatment. RESULTS: A prevalence of 9.7% in premature age, significantly raising in the group aged 15-18 was showed. After the laparoscopic varicocelectomy, all of the semen parameters (left testicular volume, pH, sperm count, abnormal forms and viability) were improved, since the semen volume and the progressive motility not significantly. Since we observed adolescent varicocele, some of the semen parameters initialy have not been out of reference limits. Following the surgically treated subjects for next 12-17 years, the pregnancy rate is at least 75%, since not all of them have been married yet. CONCLUSIONS: We recorded improvement of two out of three parameters of fertility after the operation in a group of 23 surgically treated patients. This fact encourages those who advocate surgical treatment of varicocele in adolescents, since the early therapy would prevent fertility disorders.

Semen analysis before and after antibiotic treatment of asymptomatic Chlamydia- and Ureaplasma-related pyospermia.

Pyospermia is the abnormally high concentration of white blood cells in human ejaculate, as caused by a bacterial infection. This study addresses the evaluation of the use of an antibiotic treatment in infertile patients who show asymptomatic pyospermia through the monitoring of semen analysis parameters. The study was carried out on 60 infertile patients who were diagnosed with asymptomatic genital infections, focused on pyospermia caused by Chlamydia trachomatis and Ureaplasma urealyticum. The volume of the ejaculate, pH, sperm concentration and progressive motility, as well as the viability of the spermatozoa and their morphology, were all observed before therapy, 10 and 30 days after. Patients were treated with antibiotics in accordance with the recommendations given by the European Urology Association. The results showed a clear effect of antibiotic therapy on the volume and pH of the seminal fluid; moreover, only 30 days after completion of the therapy sperm concentration itself significantly increased, and progressive motility greatly improved, albeit slowly. However, it must be noted that the antibiotic therapy had no significant effect on the viability of the spermatozoa within 30 days of beginning the treatment.

Arthropods and their products as aphrodisiacs--review of literature.

After a short review of impotence, the definitions of erectants and aphrodisiacs are presented. The Authors propose division of arthropods according to the places of effect. The description of particular arthropods with their pictures and nomenclature, is followed by certain or probable mechanisms of achieving the aphrodisiac and sometimes toxic effect, that were available in the literature since 1929 till nowadays. We mention the most usual locations, mainly in Asia, where they are found and consumed, but also, we describe the manner of preparing and intake. The review includes the following arthropods: lobster, Arizona bark scorpion, deathstalker, banana spider, Mediterranean black widow, Burmeister's triatoma, giant water bug, diving-beetle, Korean bug, diaclina, flannel moth, Spanish fly, migratory locust, red wood ant and honeybee.

Tolerability and toxicity of lipidosterolic extract of American dwarf palm Serenoa repens in Wistar rats: well-known extract, new insight.

BACKGROUND AND OBJECTIVES: Serenoa repens extracts (SrE) have been used for centuries in the treatment of benign prostatic hyperplasia (BPH). According to recommendations that each product should be examined separately, including its tolerability and toxicity, we conducted this study in order to broaden the current cognition about tolerability and toxicity of SrE, in particular of German brand ProstamolunoR. MATERIALS AND METHODS: Twenty-four adult male Wistar rats were randomly distributed into 4 groups of 6 animals. The first control group (O) received water (1 ml/kgBW) and second control group (OO) received olive oil (1 ml/kgb.w.) every day for 30 days. The third and fourth group of rats (SR5 and SR10) were treated with SrE (150 and 300 mg/kgb.w. daily) dissolved in olive oil. Tolerability and toxicity of SrE were estimated on the basis of daily monitoring of behavior, body weight gain (BWG), relative weight of liver, left kidney, prostate and left testis, and values of general biochemical parameters. Total liver proteins (TLP) and glutathione content in hepatocyte suspension were also determined. RESULTS: BWG was significantly unchanged in SR5 and SR10 compared to both controls in all intervals of measurement and at the end of treatment (p > 0.05). LW/BW ratio was significantly higher in SR10 compared with O (p < 0.01). Creatinine and potassium were significantly higher in SR5 compared to O (p < 0.05), but in SR10 were significantly higher compared to both control groups (p < 0.01). TLP content was significantly higher in SR5 compared to OO (p < 0.01). The content of glutathione in homogeneous suspension of hepatocytes didn't alter significantly. CONCLUSIONS: Obtained results have expanded the current state of knowledge about the tolerability and toxicity of SrE, in particular of Prostamol-unoR. For the adoption of a more precise conclusion about its tolerability and toxicity, it should be excluded possible limiting factors that we identified in this study.