Chromosomal anomalies and sperm retrieval outcomes of patients with non-obstructive azoospermia: a case series.

Some preoperative factors affecting the outcome of microdissection testicular sperm extraction (micro-TESE) have been previously evaluated. However, other than Klinefelter syndrome (KS), no other chromosomal anomalies have been discussed in the context of sperm retrieval outcomes. The objective of this study was to describe chromosomal anomalies and their relationship with sperm retrieval outcomes in patients with non-obstructive azoospermia (NOA). Of the 197 NOA patients whose clinical records were retrospectively reviewed, 144 (73.1%) had normal 46,XY karyotype, 40 (20.3%) had KS (47,XXY), and 13 (6.6%) had other chromosomal anomalies (autosomal in seven cases and sex-chromosomal anomalies in six). Of the seven patients with autosomal anomalies, two had the reportedly normal variant 46,XY,inv(9)(p12;q13). Testicular volume and serum hormone levels (luteinizing hormone, follicle-stimulating hormone, and total testosterone) of the patients with chromosomal anomalies other than KS were comparable to those of the patients with normal karyotype. The sperm retrieval rate of the patients with 46,XY karyotype, KS, or other chromosomal anomalies were 27.1%, 22.5%, and 15.4%, respectively, with no statistically significant difference. However, among the samples collected from the 13 patients with chromosomal anomalies other than KS, only those from the two patients with the normal variant 46,XY,inv(9)(p12;q13) contained spermatozoa. Among our series of NOA patients, the incidence of autosomal anomalies was higher than that generally noted among neonates, which suggests that not only sex-chromosomal anomalies but also autosomal anomalies may affect the development of NOA. Furthermore, our findings suggest that sperm retrieval outcome is more unfavorable in NOA patients with chromosomal anomalies than in NOA patients with 46,XY karyotype or KS, despite the use of micro-TESE.

Effect of obesity on sperm retrieval outcome and reproductive hormone levels in Japanese azoospermic men with and without Klinefelter syndrome.

Obesity is reported to have adverse effects on semen quality and the endocrine system. In this study, we evaluated the effect of obesity on sperm retrieval outcome and reproductive hormone levels in Japanese men with non-obstructive azoospermia (NOA). This study is based on the clinical records of 217 men [172 with a 46,XY karyotype, 45 with Klinefelter syndrome (KS)] with NOA who underwent microdissection testicular sperm extraction at Nagoya City University Hospital between January 2004 and December 2014. Body mass index (BMI) and serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and total testosterone (TT) were measured in all patients. In a subset of patients, bioavailable testosterone (cBAT) also was calculated. Values were evaluated separately in patients with and without KS. Sperm retrieval rates (SRRs) in 46,XY men with a BMI <25 kg/m2 and ≥25 kg/m2 were 29.3% and 18.4%, respectively (p = 0.142), while SRRs in KS men with a BMI <25 kg/m2 and ≥25 kg/m2 were 25.0% and 35.3%, respectively (p = 0.460). TT level in men with a BMI ≥25 kg/m2 was lower than that in men with a BMI <25 kg/m2 , regardless of KS status. According to Pearson product-moment correlation coefficients, TT and cBAT levels tended to have negative correlations with BMI; however, statistical significance was observed only for TT level in 46,XY men (r = 0.340, p < 0.001). LH and FSH levels were negatively correlated with BMI in KS men (r = -0.466, p = 0.001 and r = -0.647, p < 0.001, respectively), but not in 46,XY men. These results suggest that obesity may be irrelevant to sperm retrieval outcome in patients with NOA. The negative correlations between gonadotropins and BMI in patients with KS suggest an underlying suppressive effect on gonadotropin excretion, which is distinctive in obese patients with KS.

Hot water immersion induces an acute cytokine response in cervical spinal cord injury.

PURPOSE: The dysfunctional sympathetic nervous system in individuals with cervical spinal cord injury (CSCI) impairs adrenergic responses and may, therefore, contribute to the blunted post-exercise cytokine response. The purpose of this study was to investigate an alternative way to exercise to induce an acute cytokine response by passive core temperature elevation in CSCI. METHODS: Seven male participants with a motor complete CSCI and 8 male able-bodied controls were immersed for 60 min in water set at a temperature 2 °C above the individuals' resting oesophageal temperature. Blood was collected pre, post, and every hour up to 4 h post-immersion. RESULTS: Hot water immersion resulted in an IL-6 plasma concentration mean increase of 133 ± 144 % in both groups (P = 0.001). On a group level, IL-6 plasma concentrations were 68 ± 38 % higher in CSCI (P = 0.06). In both groups, IL-8 increased by 14 ± 11 % (P = 0.02) and IL-1ra by 18 ± 17 % (P = 0.05). Catecholamine plasma concentrations were significantly reduced in CSCI (P < 0.05) and did not increase following immersion. CONCLUSIONS: Passive elevation of core temperature acutely elevates IL-6, IL-8 and IL-1ra in CSCI despite a blunted adrenergic response, which is in contrast to earlier exercise interventions in CSCI. The present study lays the foundation for future studies to explore water immersion as an alternative to exercise to induce an acute cytokine response in CSCI.

Elevation of interleukin-6 and attenuation of tumor necrosis factor-α during wheelchair half marathon in athletes with cervical spinal cord injuries.

STUDY DESIGN: Nonrandomized study. OBJECTIVES: The purpose of this study was to determine the effects of long and intensive exercise on interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in athletes with cervical spinal cord injuries (CSCI). SETTING: The 30th Oita International Wheelchair Marathon Race. METHODS: Blood samples from six athletes with CSCI and eight athletes with thoracic and lumber spinal cord injuries (SCI) participating in wheelchair half marathon race were collected before the race, immediately after the race and 2 h after the race. IL-6, TNF-α, adrenaline and blood cell counts were measured. RESULTS: Monocyte count remained stable throughout the study in the CSCI group but was significantly high at 2 h after the race in the SCI group. Plasma IL-6 concentrations were significantly elevated immediately after the race in both groups, although the levels in CSCI were significantly lower than in the SCI group. Plasma adrenaline was significantly elevated immediately after the race in the SCI group but recovered at 2 h after the race. In contrast, plasma adrenaline did not change in the CSCI group throughout the study and was significantly lower than in the SCI group. Plasma TNF-α did not change throughout the study in the SCI group compared with a significant decrease at 2 h after the race in the CSCI group. CONCLUSION: Long and intensive exercise increased IL-6 in the CSCI group despite the small muscle mass and lack of sympathetic nervous system. The post-race fall in plasma TNF-α in the CSCI group could be related to the inhibitory effect of rising IL-6 in the presence of normal monocyte count and stable adrenaline level.

Increase in interleukin-6 immediately after wheelchair basketball games in persons with spinal cord injury: preliminary report.

STUDY DESIGN: Case series. OBJECTIVES: To investigate the effects of wheelchair basketball game on plasma interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and blood cell counts in persons with spinal cord injury (SCI). SETTING: The 2009 Mei-shin League of Wheelchair Basketball Games held at Wakayama, Japan. PARTICIPANTS: Five wheelchair basketball players with SCI voluntarily participated in this study. INTERVENTIONS: Blood samples were taken approximately 1 h before the player warm-up for the game and immediately after the game. MAIN OUTCOME MEASURES: IL-6, TNF-α, CRP and blood cell count were measured. RESULTS: Plasma IL-6 level and number of monocytes were significantly increased after the game, compared with pre-game measurements (P<0.05). No changes were observed in other measurements. There was a significant relationship between increased IL-6 levels and accumulated play duration. CONCLUSION: The lack of change in TNF-α and CRP levels suggested that the exercise-induced rise in IL-6 was not related to exercise-induced inflammatory response. Furthermore, the associated increase in the number of monocytes did not correlate with exercise-induced IL-6 changes, negating monocytes as the source of IL-6.

Plasma IL-6 levels during arm exercise in persons with spinal cord injury.

STUDY DESIGN: Non-randomized study. OBJECTIVES: Previous studies indicated that at least 2-h leg exercise at more than 60% maximum oxygen consumption (VO(2)max) increased plasma interleukin (IL)-6 in able-bodied (AB) subjects. The purpose of the present study was to compare IL-6 response to arm exercise in AB subjects and persons with spinal cord injury (SCI). SETTING: Wakayama Medical University in Japan. METHODS: Six subjects with SCI between T6 and T10 and seven AB subjects performed 2-h arm crank ergometer exercise at 60%VO(2)max. Plasma catecholamines, IL-6, tumor necrosis factor (TNF)-α and high-sensitivity C-reactive protein (hsCRP) were measured before exercise, 60-min exercise, immediately and 2 h after the completion of exercise. RESULTS: Arm exercise increased myoglobin and plasma IL-6 levels in SCI and AB (P<0.01), but there were no differences in them between the two groups throughout the study. Plasma levels creatine kinase, lactate dehydrogenase, TNF-α and hsCRP did not change throughout the study in both groups. CONCLUSION: These findings suggest neither significant muscle damage nor inflammatory response during exercise. The increase in plasma IL-6 in SCI was not unexpected, confirming that moderate intensity and relatively long-arm exercise is safe and beneficial for SCI subjects with regard to IL-6 excretion, as in AB subjects.

Preoperative diagnosis of malignant transformation in mature cystic teratoma of the ovary.

OBJECTIVE: Malignant transformation of mature cystic teratomas (MCT) of the ovary is extremely rare. There are no established criteria of diagnosis before surgery for carcinoma arising from MCT of the ovary. Thus, we analyzed retrospectively tumor size and preoperative values of tumor markers in patients with MCT and investigated the possibility of preoperative diagnosis. METHODS: This was a retrospective case series of 278 patients with MCT of the ovary. Data were obtained from hospital charts and the pathology registry. Average tumor size (greatest diameter) was determined by the preoperative findings of both MRI and ultrasound examination. RESULTS: Malignant transformation was seen in five patients (11%) among those whose tumor was > or = 10 cm in diameter, four patients (23%) among those whose pretreatment serum SCC level was > or = 2.0 ng/ml, two patients (13%) among those over 60 years of age and five patients (2%) with a tumor on one side. Mean tumor size and serum SCC level were significantly higher than those of benign MCT. CONCLUSIONS: We conclude that patients over 60 years old who have unilateral MCT with SCC value of < or = 2.0 ng/ml and > or = 10 cm tumors may be a high-risk group for malignant transformation.

Eimeria stiedai merozoite 49-kDa soluble antigen induces protection against infection.

A soluble antigen isolated from Eimeria stiedai merozoites with a molecular mass of 49 kDa was detected in the bile of infected rabbits. Rabbits immunized with the antigen shed a lower number of oocysts than did nonimmunized rabbits postchallenge (p.c.). The immunized rabbits showed a marked and transient increase of alanine-aminotransferase (ALT) activity on day 8 p.c. The blood indocyanine green (ICG) clearance and r-glutamyltransferase (GGT) activity showed no change throughout the experiment However, nonimmunized rabbits showed a gradual increase of ALT and GGT in the plasma and a delay of ICG p.c. Many merozoites were observed in the biliary ducts of the nonimmunized rabbits on day 8 p.c. using standard histology. In contrast, in the immunized rabbits, many inflammatory cells were observed around the biliary ducts, but there were few parasites in the tissue. These results suggest that the 49-kDa soluble protein antigen detected in the bile of the infected rabbits was a merozoite-specific antigen, and the immune reaction to the antigen may induce protective effects against the infection.

Relationship between liver disorders and protection against Eimeria stiedai infection in rabbits immunized with soluble antigens from the bile of infected rabbits.

Soluble antigens exist in the bile of rabbits infected with Eimeria stiedai (E. stiedai) in the acute phase, and rabbits immunized with the antigens show resistance against the infection. In this study, the liver function of rabbits immunized either with the soluble antigens or PBS were examined following the parasite challenge. Rabbits immunized with PBS shed a number of oocysts and showed an increase in r-glutamyltransferase (GGT) activity and a decrease in blood Indocyanine green (ICG) clearance. However, rabbits immunized with the soluble antigens shed a lower number of oocysts and showed a transient increase of alanine-aminotransferase (ALT) activity on Day 8 post-challenge (p.c.). The blood Indocyanine green clearance of the rabbits showed no change throughout the experiment. By histopathological observation of the liver, a number of merozoites were found in the biliary ducts on Day 8 post-challenge in the non-immunized rabbits. In contrast, a number of lymphocytes and neutrophilic leukocytes assembled around the biliary ducts of the immunized rabbits, but few parasites were found there on Day 8 post-challenge. These results suggest that the soluble antigens stimulate local immune reactions, for example around the biliary ducts, resulting in elimination of the parasite's development.

Clinical features and management of hepatic portal venous gas: four case reports and cumulative review of the literature.

HYPOTHESIS: Hepatic portal venous gas (HPVG) has been considered a rare entity associated with a grave prognosis. Since 1978, when Liebman et al reviewed 64 cases of HPVG and reported a mortality of 75%, the number of reported cases has been increasing. DESIGN: Case series. PATIENTS AND METHODS: We reviewed the literature on 182 cases of HPVG in adults, including 4 of our patients, (transplantation and abdominal trauma cases were excluded) and analyzed the cause, pathogenesis, and clinical features. RESULTS: In this series, the underlying clinical events associated with HPVG were bowel necrosis (43%), digestive tract dilatation (12%), intraperitoneal abscess (11%), ulcerative colitis (4%), gastric ulcer (4%), Crohn disease (4%), complications of endoscopic procedures (4%), intraperitoneal tumor (3%), and other (15%). The overall mortality was 39% but varied depending on the underlying disease. CONCLUSIONS: Hepatic portal venous gas is a lethal or curable entity caused by various diseases. The underlying disease associated with HPVG determines the clinical features and prognosis of the patients. The treatment of patients with HPVG should be directed to the underlying disease.

Involvement of calpain for apoptosis in dysfunction of the unaffected testis in rats with experimental testicular torsion.

PROBLEM: The dynamics of calpain and involvement of apoptosis in sperm formation disorder of the unaffected testis in rats with experimental testicular torsion were investigated. METHODS OF STUDY: Using 6-week-old Wistar rats, an experimental unilateral testicular torsion model was prepared. The bilateral testes were excised 1, 3, 5, 7, 14, 35, and 70 days after the left testis was twisted, and the unaffected testes were subjected to immunohistological staining, sodium dodecyl sulfate polyacrilamide gel electrophoresis and Western blotting using anti-calpain antibodies. Apoptosis was detected by the TdT-mediated dUTP biotin nick end-labeling (TUNEL) method. RESULTS: By immunohistological staining, positive immunostaining by anti-pro mu-calpain antibody was observed in the spermatocyte nucleus, but not with anti-pro m-calpain antibody. The staining was increased until 7 days after testicular torsion, then decreased with progression of sperm formation disorder. By Western blotting, the intensity of staining with anti-pro mu-calpain antibody was increased until 7 days after torsion of the testis. Apoptosis expression in the unaffected testis was significantly inhibited by addition of a calpain inhibitor. CONCLUSIONS: It was suggested that mu-calpain may be involved in apoptosis expression in sperm formation disorder of the unaffected testis in unilateral testicular torsion.

Venous blood flow measurement by determination of change in venous hemoglobin saturation.

OBJECTIVE: To evaluate a method of measuring venous blood flow in vitro by using the Fick principle and change in saturation of venous blood and to apply the method to the clinical measurement of hepatic blood flow. DESIGN: Experimental study using an in vitro model and clinical study for critically ill patients. SETTING: Department of Anesthesiology and Intensive Care Medicine in Osaka City University Medical School. MODEL: Human blood deoxygenated by bubbling of nitrogen was circulated in a closed circuit at 10-120 mL/min by a roller pump. A fiber optic sensor was attached to the circuit for continuous monitoring of hemoglobin saturation. PATIENTS: Eight critically ill patients, aged 54.3 +/- 15.1 yrs, were studied. INTERVENTIONS: Hemoglobin saturation was changed in the in vitro study by the injection of 0.2 mL of oxygenated blood. Signals from the optical fiber were analogue-digital converted and recorded in a computer. In the clinical study, an oximetry catheter was inserted into the inferior vena cava (IVC) via the femoral vein. Arterial blood (10 mL) was drawn from the radial artery, and injected into the IVC. The changes in oxygen saturation in the venous blood were recorded. MEASUREMENTS AND MAIN RESULTS: Blood flow was calculated using the Fick principle, assuming that all the injected blood passes through the sensor. In vitro estimation of blood flow was well correlated with the actual flow (r2 = .94). IVC blood flow was measured above and below the merging point of the hepatic vein. The difference of the two values was assumed to represent hepatic blood flow. IVC blood flow was calculated by the same method as for the in vitro study. The blood flows in the IVC above and below the anastomosis with the hepatic vein were 2.82 +/-0.56 (SD) Umin and 1.96 +/- 0.61 (SD) L/min. Average estimated hepatic blood flow was 0.86 L/min (range, 0.34-1.75 Umin). CONCLUSION: We examined the accuracy and reliability of this new method in the present in vitro study. This method may be clinically useful for measuring hepatic blood flow.

[Emphysematous pyelonephritis complicated with diabetes mellitus: a case report].

A 46-year-old woman with diabetes mellitus was admitted to our hospital due to lower right abdominal pain. Urinalysis did not show marked pyuria. Abdominal computed tomography showed an abnormal gas shadow in the right renal parenchyma. A diagnosis was made of right emphysematous pyelonephritis. Despite aggressive supportive therapy, the patient's condition worsened. Therefore, right nephrectomy was performed. The next day her general condition was markedly improved. We reviewed 122 cases of emphysematous pyelonephritis including our case in the Japanese literature, and discussed its etiology, symptomatology, choice of treatment and prognosis.

[Composite pheochromocytoma with ganglioneuroma in the adrenal gland: a case report].

A 67-year-old male demonstrated a right adrenal tumor at another hospital, and consulted our hospital for surgical treatment. Abdominal computed tomography revealed a 13 x 12 cm mass in the right adrenal region. Serum and urinary adrenaline levels were high, and the catecholamine levels in the blood sample of the selective adrenal vein were also high. The tumor was 1,325 g in weight and 13 x 9 x 18 cm in diameter. Pathological diagnosis was a mixed neuroendocrine-neural tumor. It was composed of pheochromocytoma and ganglioneuroma. This combination in the adrenal gland is rare. We reviewed 3 previously reported cases of composite pheochromocytoma with gangloineuroma in the adrenal gland in the Japanese literature, and this is considered to be the fourth case.

[A case of successful hypospadias repair without infection using recombinant human granulocyte-colony stimulating factor (rhG-CSF) for idiopathic neutropenia].

A boy aged 1 year 8 months, who was referred to our hospital because of hypospadias, was followed for 17 months under a diagnosis of idiopathic neutropenia. He was given recombinant human granulocyte colony-stimulating factor (rhG-CSF) at a dosage of 37.5 micrograms/day for 2 days preoperatively. His absolute neutrophil count in peripheral blood increased to more than 500/microliter, and hypospadias repair (free graft method) was performed. RhG-CSF was administered on the first, sixth, and eleventh days after the operation, and the postoperative course was uneventful. During pediatric surgery in patients with neutropenia, appropriate administration of rhG-CSF may be useful for preventing infection.