Compensatory enlargement of an accessory spleen mimicking a retroperitoneal tumor: a case report.

We report a case of an accessory spleen in close relation to the upper pole of the left kidney, mimicking a retroperitoneal tumor. A 58-year-old asymptomatic woman was admitted to our department for the management of a retroperitoneal mass, when the structure was incidentally discovered by ultrasound scan. The patient reported having a splenectomy at a young age, due to echinococcal disease. The computed tomography and magnetic resonance imaging confirmed the presence of a solid retroperitoneal tumor (5 cm in diameter) in the lateral aspect of the left kidney. To rule out the presence of a malignant tumor, surgical exploration was performed. The macroscopic examination of the specimen revealed a well-circumscribed encapsulated mass, which appeared to have the typical features of splenic tissue. Histology confirmed that the mass was actually an accessory spleen. The retroperitoneal accessory spleen is a rare clinical entity. However, it should always be considered, when investigating a retroperitoneal mass, especially in patients who have had previous splenectomy.

The effects of benzoylecgonine, oxytocin, ritodrine and atosiban on the contractility of myometrium. An experimental study.

PURPOSE: To investigate the response of pregnant and non pregnant rat myometrium to benzoylecgonine, a cocaine metabolite, and oxytocin and to investigate the efficiency of ritodrine and atosiban to overcome the effects of benzoylecgonine and oxytocin. METHODS: Isolation of rat myometrial tissue and recording of contractile activity with isotonic muscle transducer. RESULTS: Benzoylecgonine and oxytocin increase myometrial contractility, while atosiban and ritodrine induce myometrial relaxation. Atosiban was able to revoke the action of oxytocin but not the action of benzoylecgonine. Ritodrine was able to induce muscle relaxation in both oxytocin and benzoylecgonine administration. CONCLUSION: Cocaine metabolites seem to act on the myometrium through different pathways compared with oxytocin. After comparing two widely used tocolytic agents: atosiban and ritodrine, it is indicated that only ritodrine, a beta2 adrenergic receptor agonist, can inhibit the action of cocaine metabolites. This finding indicates that the actions of cocaine on adrenergic mechanisms are responsible to a large part for its effects on myometrium contractility. The use of beta2 adrenergic receptor agonists seems to be preferable for the treatment of myometrial contractions induced by cocaine consumption.

Prevalence of ejaculatory disorders in urban men: results of a random-sample survey.

We aimed to determine the prevalence of early ejaculation disorders (EED) and to calculate the prevalence of lifelong premature ejaculation (PE) in Greek urban men. Associations with physiological and psychological conditions, treatment-seeking and treatment efficacy were defined. We surveyed 522 urban men aged 16-62 individually using an open, one-on-one questionnaire. A total of 305 (58.43%) participants reported EED. The prevalence of lifelong PE, according to the International Society for Sexual Medicine criteria, was calculated as 17.7%. Among sufferers of EED, unrelated stress was the most frequent comorbidity (42.6%) and, along with erectile dysfunction and lower urinary tract symptoms, occurred more frequently than in normal participants (P < 0.05). Half (50.3%) of the sufferers believed that their problem was psychological, while 69.5% never sought help. Most (69.2%) of those who did seek help sought it anonymously through the internet. Behavioural treatment was preferred to medical treatment. Few (13.8%) men were satisfied with their treatment. In conclusion, although the observed PE prevalence agrees with the previous findings, more patients suffer negative personal and relationship consequences and may also require treatment. Most men do not seek medical assistance, and from those who do, most are not satisfied with the results of treatment.

Serum pattern of circulating soluble receptor of leptin throughout the menstrual cycle.

AIM: The aim of the study was to investigate the pattern of circulating soluble receptor of leptin (sLeptinR) during the menstrual cycle and the association of sLeptinR to leptin, sex hormones and gonadotropins. METHODS: Fasting blood samples were collected on alternate days throughout a full cycle from fifteen healthy volunteers. Immunoenzymatic assays were employed to record the relevant levels. RESULTS: sLeptinR concentrations throughout the cycle were found to vary negligibly. No significant correlations between sLeptinR and leptin, gonadotropins or progesterone, were established. During the follicular phase, subjects presenting with higher estradiol levels tended to have higher sLeptinR concentrations. CONCLUSION: The little variation of sLeptinR concentrations during the menstrual cycle indicates that the rise of leptin during the luteal phase implies an increase of its bioactivity.

Bilateral abdominal cryptorchidism with large left testicular seminoma and failed right urogenital union.

This is a case report of a 32-year-old male with bilateral intra-abdominal cryptorchidism. A large seminoma had developed on the left testis with paraaortic lymph nodes metastasis. The tumour was excised easily. The right testis was found just inside the deep inguinal ring, without the vas deferens in the spermatic cord. The patient requested orchidopexy despite the well-explained risk of cancer development. Therefore, a second right groin incision was performed. In the right inguinal canal, there was a normal-looking vas deferens that ended in an atrophic nubbin of fibrous tissue without an epididymis. This is the sixth case in the literature of failed urogenital union resulting in complete separation of testis and vas deferens. The patient underwent orchidopexy and had four cycles of chemotherapy, which led to complete remission of the metastasis. This case highlights the fact that an impalpable undescended testis and finding of blind-end vas deferentia are not enough to establish the diagnosis of vanished testis. The decision to undergo orchiectomy in cases of bilateral cryptorchidism after puberty is also discussed. In our opinion, the choice should be made by the patient after a discussion of the risk for cancer development in the salvaged testis.

Are vascular disorders a common cause of erectile dysfunction in non hypogonadal, non neuropsychiatric patients?

OBJECTIVES: Pharmacological Color Duplex Ultrasonography (PCDU) is a technique used as an advanced investigation of erectile dysfunction (ED) causes. Aim of the study was to determine, if frequency of vascular disorders in ED patients justifies routine use of PCDU. MATERIALS AND METHODS: Seventy six patients aged 25-69 years with moderate to severe ED, free neuropsychiatric history and normal hormones were included in the study. The investigation consisted of basic ED work up and penile PCDU. Erection vascular parameters were determined. RESULTS: In the younger group (≤45 years), 12% of patients demonstrated mild arterial insufficiency and none venous leakage, with only two patients not achieving hard erection. In the older group, 19.6% of patients demonstrated mild to moderate arterial insufficiency and 5.9% severe. Venous leakage was detected in 7.84%. Most patients (74.6%) achieved normal erection and 66.7% had normal PCDU parameters. CONCLUSIONS: Vascular disorders were not found the primary cause of ED, especially among younger patients. PCDU is an advanced ED investigation, which should be applied only in vascular high risk cases.

Preputial graft in penile curvature correction: preliminary results.

Our purpose is to assess efficacy and complications of preputial skin graft for treatment of penile curvatures by grafting corporoplasty. Five congenital curvature and 14 Peyronie's disease patients were treated by grafting corporoplasty using preputial skin. Patients were evaluated by medical history and International Index of Erectile Function-5 (IIEF-5) questionnaire. After injection-induced erection, patients were evaluated by penile length measurement and color Duplex. Patients were re-evaluated 1 month later and advised to start intercourse. Patients were also evaluated during the 3rd and 12th months postoperatively, as per the original protocol. By the end of the follow-up period, 75% of patients were satisfied with straightened penises, without dilatation of the graft (ballooning) or venous leakage. Patients also exhibited a mean increase of two units in IIEF-5 score. Penile straightening and satisfaction rate were lower in the remaining 25% of patients, but no complaints of worsening erection or bulging of the graft area were reported. Preputial graft is an inexpensive procedure involving a tissue familiar to the urologist. The results of grafting corporoplasty are promising, without significant complications.

IGF-I and epidermal growth factor levels in follicular fluid of women undergoing controlled ovarian hyperstimulation using the multidose GnRH-antagonist protocol or the long GnRH-agonist protocol.

The intrafollicular levels of IGF-I and epidermal growth factor (EGF) were studied in women undergoing controlled ovarian hyperstimulation using the multidose GnRH-antagonist protocol or the long agonist protocol, in an attempt to elucidate whether GnRH-antagonists affect the levels of the two growth factors. The follicular fluid concentration of IGF-I, EGF, estradiol and progesterone were detected in 68 women undergoing ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI) cycles. There were no differences in intrafollicular concentrations of EGF and IGF-I in the two studied groups. Additionally, we found no correlation between the intrafollicular levels of IGF-I or EGF and the ICSI outcome. The intrafollicular levels of IGF-I were positively correlated with those of progesterone. In conclusion, the intrafollicular levels of IGF-I and EGF do not seem to be influenced by the stimulation protocol. The intrafollicular levels of both growth factors can not serve as prognostic markers for the ICSI outcome.

The role of basic-fibroblast growth factor (b-FGF) in cyclosporine-induced nephrotoxicity.

BACKGROUND: The effect of the b-fibroblast growth factor (b-FGF) on cyclosporine A (CsA)-induced nephrotoxicity in the rat kidney was investigated. MATERIALS AND METHODS: The rats were divided into six groups: A (control), B (b-FGF-treated), C, D: (CsA-treated and sacrificed on days 14 or 21), E, F (Cs A- and b-FGF- treated and sacrificed on days 14 or 21). The antibody mouse anti-rat CD31 was used to evaluate the kidney vessels present in histological preparations. RESULTS: The kidney vessels in group B were increased in comparison with the control group (p<0.05). Reduction of kidney vessels in groups C and D (p<0.05) in comparison with the controls was observed, while in groups E and F they were increased when compared to group C (p<0.05) and D (p<0.05), respectively. CONCLUSION: The angiogenic role of b-FGF was confirmed in normal rats and a possible "protective" role of b-FGF was shown in rat kidney with CsA-induced nephrotoxicity.

Father-to-son sperm donation. A report of three cases.

Sperm donation is a common practice in assisted reproduction. In cases of azoospermia and negative results of testicular sperm extraction, it appears as the only solution. Sperm donation entails a complete genetic dissociation between husband and offspring, which brings psychological stress for the couple arising from ethical and existential dilemmas. Faced with such dilemmas, some couples prefer father-to-son donation as an alternative solution. Here, three cases of non-obstructive azoospermia are presented where intracytoplasmic sperm injection was performed with father-to-son sperm donation.

Outcome of anticipated ICSI cycles using intentionally frozen-thawed testicular spermatozoa according to the spouse's response to ovarian stimulation.

PURPOSE: To investigate the outcome of ICSI cycles, using frozen-thawed testicular spermatozoa from patients suffering from non-obstructive azoospermia, in relation to the spouse's response to ovarian stimulation. METHODS: A retrospective study with two groups of couples where males suffered from non-obstructive azoospermia. In group 1 (n = 14), the female partners responded poorly to ovarian stimulation (< or = 4 oocytes retrieved). In group 2 (n=14), the female partners responded well (> or = 10 oocytes retrieved). Both groups underwent 14 cycles of ICSI using frozen-thawed spermatozoa obtained by TESE. RESULTS: The total amount of gonadotropin, the duration of stimulation, the peak estradiol concentrations and the number of oocytes were significantly different between the two groups. Despite the satisfactory fertilisation rates, the outcome in poor responders was disappointing due to a low number of oocytes. There was only one pregnancy in the poor responder group whereas there were four in the group that responded well. The pregnancy rates per oocyte collection were 7.14% in group 1 versus 28.57% in group 2. The implantation rates were 60.60% versus 55.33%, respectively. CONCLUSION: It is possible to achieve satisfactory fertilisation rates using frozen-thawed, surgically-retrieved testicular spermatozoa, but the poor ovarian response to stimulation induction is the limiting factor in reaching implantation and pregnancy. It is preferable that poorly stimulated cycles be canceled, in the hope of a better subsequent response.

Comparison of poor responders with good responders using intentionally frozen-thawed epididymal spermatozoa in subsequent ICSI cycles.

PURPOSE: To compare the outcome of intracytoplasmic sperm injection (ICSI) cycles performed with frozen-thawed epididymal spermatozoa between patients who respond poorly and patients who respond well to ovarian stimulation. METHODS: 17 patients suffering from obstructive azoospermia underwent microsurgical retrieval of epididymal spermatozoa (MESA) and the spermatozoa were frozen. The frozen-thawed spermatozoa were used in subsequent ICSI cycles. In six patients, the female partners responded poorly to ovarian stimulation. They accomplished nine ICSI cycles. In 11 patients, the female partners responded well to ovarian stimulation and they accomplished 16 cycles. RESULTS: Poor responders were older than those who reponded well. The mean number of metaphase II oocytes collected was lower in the poor responder group. In the poor responders, two couples failed to fertilise the oocytes in two ICSI cycles. In the good responders, one couple failed to fertilise the oocytes in an ICSI cycle. There were no significant differences in fertilization rates between the two groups. The estradiol concentrations on the day of hCG administration were significantly higher in the good responders. There was no pregnancy in the poor responder group, while three patients who responded well conceived. Eight good responders had 34 supernumerary 2PN oocytes which were cryopreserved. CONCLUSION: Frozen-thawed epididymal spermatozoa from men with obstructive azoospermia are potent to achieve satisfactory fertilization rates. Poor ovarian response to stimulation induction appears to be the main limiting factor in reaching the stage of embryo transfer. It is preferable in older women to cancel cycles with poor response in the hope that a better response might be obtained in a subsequent cycle. Thus, the frozen-thawed epididymal sperm can be preserved and the most stressful and expensive phase of IVF-ICSI treatment can be avoided.

Endometrial fluid accumulation during controlled ovarian stimulation for ICSI treatment. A report of three cases.

The occurrence of endometrial fluid accumulation was examined in patients undergoing ovarian stimulation in a program of intracytoplasmic sperm injection (ICSI), by vaginal ultrasound. Endometrial fluid accumulation was recorded in three cycles out of 124. In one case, the fluid was absorbed before embryo transfer (ET), but in the other cases it was present in ET. In these three cases, the endometrium had been evaluated as normal before ovarian stimulation. Fluid accumulation in the endometrial cavity possibly affects the implantation process negatively. Therefore, alternative options should be considered as cancellation of the embryo transfer and cryopreservation of embryos to be available in a subsequent mild stimulated cycle.