Varicocele scintigraphy: a simplified screening method for the detection of spermatic vein reflux

Forty-three men underwent varicocele scintigraphy to exclude underlying varicocele as a possible cause of decreased semen quality. The total acquisition time for each study amounted to as little as 200 seconds. In four cases retrograde blood flow was seen in the left internal spermatic vein, with subsequent clear visualization of the pampiniform plexus. In three of four of these patients, pregnancy ensued after therapeutic intervention. Seven patients showed only increased scrotal activity locally, in the absence of retrograde blood flow. The remaining 32 patients showed a normal blood flow pattern. The existence of spermatic vein reflux in varicocele-related infertility is thought to be a major factor in proper patient selection for therapeutic ligation or embolization of the internal spermatic vein. It is suggested that this simplified scintigraphic method may be useful in the detection of retrograde blood flow in patients with varicocele, especially in small or subclinical varicocele.     

The influence of clinical and subclinical varicocele on testicular volume

OBJECTIVE: To examine the possible loss of testicular volume in infertile men with clinical and subclinical varicocele by using ultrasound (US)-derived measurements of testicular volume. DESIGN: Retrospective review of clinical and scrotal US reports. SETTING: University infertility clinic. PATIENT(S): Infertile men (n = 404) presenting for evaluation from 1992 to 1996. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Presence of clinical or subclinical varicocele, US-derived measurements of testicular volume. RESULT(S): In men with clinical left or subclinical left varicocele, left testicular volume was significantly less than right testicular volume (12.9 versus 14.1 and 13.2 versus 14.7 mL, respectively). This finding was not observed in men with bilateral clinical or bilateral subclinical varicoceles or in men without varicocele. CONCLUSION(S): Our data confirm previous reports showing that a clinical left varicocele can negatively impact on left testicular volume and for the first time show that a subclinical varicocele is also associated with decreased left testicular volume.     

Human joint performance and the roughness of articular cartilage

The Doppler technique has been used to evaluate venous reflux in the spermatic cord. Valsalva-induced reflux occurred on the left side in 83% and on the right side in 59% of 118 patients without clinical varicoceles and there was no difference in incidence between fertile and infertile men. The significance of Valsalva-induced reflux should be questioned. Greater importance should be attributed to the spontaneous venous reflux that occurred during quiet respiration in the majority of patients with varicoceles. Seven velocity waveform patterns are described and these are thought to represent increasing degrees of internal spermatic vein reflux and provide a basis on which it is possible to grade varicoceles. The Doppler grades correlated with the size of the varicocele, and with the internal spermatic vein diameter and testosterone concentrations.     

Comparison of radionuclide scrotal blood-pool index versus gonadal venography in the diagnosis of varicocele

The purpose of our study was to assess the value of a radionuclide scrotal blood-pool index (SBPI) in diagnosing and grading clinical and subclinical varicocele. METHODS: Scrotal scans were performed on 1360 infertile patients. Thirty fertile patients with a normal scrotum on palpation served as controls. The patients' red blood cells were labeled in vivo by administration of stannous ions of pyrophosphate followed by the intravenous administration of 99Tc-pertechnetate. The scans initially were inspected visually and, when bilateral varicocele was excluded, a computerized analysis of the ratio of the blood-pool activity in each hemiscrotum (SBPI) permitted accurate grading of the varicocele. A subgroup of 224 patients was selected randomly and had gonadal venography. The results of physical examination, scrotal scan, gonadal venography and semen analysis were compared. RESULTS: Normal values of SBPI (0.9-1.1) were derived from the control group. There was a 93.5% correlation between palpation and SBPI grade in diagnosing palpable varicocele. When compared to gonadal venography, subclinical varicocele was demonstrated by scrotal scan in 54.8% of infertile male patients with abnormal semen analysis, normal female partners and no other cause of infertility. Of these patients, 32.6% had, unexpectedly, Grade 2 or 3 varicocele. Right and bilateral varicocele were demonstrated three times as often by scrotal scan than by palpation. SBPI was accurate in diagnosing recurrent varicocele but there was a low correlation (61.1%) between SBPI and gonadal venography grade. There was a high correlation between SBPI grade and sperm analysis grade. CONCLUSION: SBPI grading of varicocele was validated as an accurate, quantitative and noninvasive method of grading varicocele, equivalent to the grading system by palpation in a large group of infertile patients. The main contribution of SBPI was in detecting and grading subclinical varicocele in infertile patients with no other cause of infertility. SBPI also was accurate in diagnosing but not in grading recurrent varicocele.     

A comparative study of intravenous anaesthesia with thiopental versus althesin in outpatient dental practice

Selective retrograde catheterisation of the left internal spermatic vein at its orifice in the renal vein was carried out in 25 patients suspected of varicocele. When contrast medium is injected, the patients with varicocele, standing in the erect position, present a retrograde filling of the varicose spermatic vein, in contrast to the absence of such reflux in normal men. The venography is indicated for diagnostic and therapeutic purposes and it is the only available, non-surgical technique to prove the existence of a disturbed venous flow in the testicular region.     

Traumatic brain injury care path

INTRODUCTION: We report the results of our experience with venography in patients with postoperative recurrent varicocele. The study was carried out to detect the causes of this condition. MATERIAL AND METHODS: Forty-four patients with postoperative recurrent varicocele, examined in our department from June, 1993, to June, 1996, were submitted to selective spermatic venography after clinical examination and color Doppler sonography. Thirty-six patients had been treated with high surgical ligation of the spermatic vein and 8 with inguinal ligation. Thirty-two patients were treated percutaneously, after diagnostic angiography, with coils and/or sclerotizing agents. RESULTS: In our study, the persistence of patent collateral veins, missed at surgical ligation, was the main cause of recurrence (68%): this was due either to a double or triple spermatic vein, mostly in the pelvic tract (50%), venous bridges crossing the surgical ligation (11%), or to retroperitoneal anastomoses (7%). A smaller group of patients showed ineffective ligation of the vein (27%); in the remaining 5% of cases incompetence of the extrafunicular plexus was detected. DISCUSSION AND CONCLUSIONS: Our experience, supported by a literature review, demonstrates that the anatomic variants, not detected preoperatively because phlebography had not been performed, were the most frequent causes of recurrence. Spermatic venography is the most accurate imaging modality for vascular mapping in postoperative recurrences; it often allows to treat the patients simultaneously by a percutaneous approach.     

"Tower vertebra": a new observation in sickle cell disease

PURPOSE: We studied the frequency of testicular microlithiasis (TM) in a select group of otherwise healthy infertile men with abnormal semen. METHODS: We reviewed scrotal sonography records of 180 consecutive patients with abnormal semen who were referred for evaluation of male infertility. The pampiniform plexus was evaluated for possible varicocele, and the testes were examined for the presence or absence of intratesticular calcifications and/or masses. Five patients with more than 5 echogenic foci per transducer field in either testis were identified. The medical records and sonograms of this subgroup of patients were analyzed. RESULTS: Of the 180 patients, 5 (2.8%) had TM. Three patients with TM had concomitant small varicoceles; 2 others had a history of testicular maldescent. Two patients eventually became fertile. CONCLUSIONS: Our results indicate a higher than expected frequency of TM in otherwise healthy infertile men. We speculate that the magnitude of hypospermatogenesis in patients with TM is variable and may relate to both the degree of testicular dysgenesis and the presence or absence of concomitant scrotal pathology (eg, scrotal varicocele and cryptorchidism).     

Descriptive epidemiology of thyroid cancer in greater Bombay

Idiopathic varicocele can compromise the spermatogenetic function of the testicle and associate with alterations of the semen quality. The treatment of varicocele stops the progress of testicular damage and improves spermatogenesis and semen parameters. These are the main alternatives to the traditional surgical treatment of varicocele retrograde percutaneous occlusion of the internal spermatic vein using sclerosing agents and embolizing devices (either separately or in combination), microsurgical ligation via inguinal or sub-inguinal approach, laparoscopic ligation and, more recently, antegrade scrotal sclerotherapy. None of these techniques can be considered the "gold standard" therapy. Literature does not point out any significant difference between them, either considering the absence of reflux percentage, or the improvement of semen quality, or the pregnance rate. Therefore cost comparison may be a valid criterion in the choice of treatment for varicocele correction. The total cost of the surgical retroperitoneal unilateral ligation of the internal spermatic vein is 968,805 Lire, while for the bilateral ligation it is 1,118,285 Lire. The costs of sclerotherapy and percutaneous embolization are respectively of 698,750 Lire and 1,708,950 Lire. The combination of the two techniques amounts to 1,918,230 Lire. Laparoscopic bilateral ligation costs 2,437,935 Lire. Antegrade scrotal sclerotherapy costs 191,035 Lire if unilateral, 216,580 Lire if bilateral. After considering these data we can say that antegrade scrotal sclerotherapy is the first choice economically in the treatment of both unilateral and bilateral varicocele.     

The venous anatomy of experimental left varicocele: comparison with naturally occurring left varicocele in the human

OBJECTIVE: To determine the effect of experimental left varicocele on the anatomy of the veins serving the rat testis and to compare that anatomy to known patterns of vascular drainage from the human testis with and without varicocele. DESIGN: Vascular maps were made of the effluent vessels from the rat testis in control animals and those with a 30-day experimental left varicocele. Consensus maps were arrived at and these were compared to published reports of the pertinent venous anatomy in humans with and without varicocele. SETTING: Research laboratory. RESULTS: The major route of blood leaving the rat testis was confirmed to be the spermatic vein, but nine common collaterals were also found to exist. Four of these collaterals became more pronounced with experimental varicocele as did several dilated perineal veins. These latter vessels all led to the iliac vein. The vasculature of the rat experimental varicocele model shares some important anatomical features with human varicocele anatomy. CONCLUSIONS: Varicocele in humans and in the rat model causes a redistribution of blood flow from a route primarily out the spermatic vein to routes leading to the iliac vein. The redistribution is similar but not identical.     

Antibiotic phenol nor-triterpenes from Maytenus canariensis

OBJECTIVE: To calculate and compare the costs of the treatment of varicocele by antegrade scrotal sclerotherapy with other modalities. PATIENTS AND METHODS: A total of 2305 operations using antegrade scrotal sclerotherapy to treat varicocele in childhood and adolescence were analysed for cost factors and compared with different surgical treatment methods for varicocele. RESULTS: Calculation of the pre-, intra- and post-operative costs showed that antegrade scrotal sclerotherapy was the most economically effective of all forms of surgical management for varicocele. CONCLUSIONS: Because antegrade scrotal sclerotherapy is a cost-effective treatment for varicocele, the indications for treatment may be widened to include more men with potential infertility, and thus avoid the need for expensive methods of artificial fertilization.     

Our experience in the percutaneous treatment of varicocele

For its high incidence among young men and its affecting male fertility, varicocele requires an accurate screening, as well as an early and definitive treatment. The Authors report their experience in the treatment of varicocele with sclerotherapy: 24 patients underwent sclerotherapy of the left internal spermatic vein with a success rate of 91%. Complications never required hospitalization or surgery. Percutaneous therapy represents thus the treatment of choice in case of varicocele: compared with surgery, it offers similar clinical results and a lower recurrence rate, and it can be performed on an outpatient basis. Surgery should be performed only when anatomic variants make percutaneous treatment not feasible.     

Clinical usefulness of transrectal sonography and transperineal color Doppler flow imaging in the diagnosis of intrapelvic venous congestion syndrome

BACKGROUND: The present study was designed to reveal the possible use of transrectal sonography (TRS) and transperineal color Doppler flow imaging in predicting intrapelvic venous congestion syndrome (IVCS), as evaluated by three dimensional magnetic resonance venography (3D-MRV). METHODS: Thirty-one patients with prostatodynia and eleven control men were enrolled in this study. The diagnosis of IVCS was made based on the findings by 3D-MRV, such as the dilation of the prostatic capsular vein, the dilation of the pudendal plexus, the interruption of the internal pudendal vein and the dilation of the plexus behind the bladder. The prostatic capsular vein was observed ultrasonically as "sonolucent zone (SZ)", and the maximum width of SZ was measured on sonograms. Transperineal color Doppler flow imaging was used to detect blood flow images of the prostatic capsular vein. The maximum velocity of it was also measured on sound spectrogram. RESULTS: IVCS was confirmed in 29 cases (IVCS group) and the other 13 cases were regarded as non-IVCS group. IVCS was recognized much more frequently in patients with prostatodynia than in controls (87% vs 18%, p < 0.0001). The maximum width of SZ was 2.4 mm (mean) in non-IVCS group, compared to 4.4 mm in IVCS group (p < 0.0001). The cutoff value of 3.0 mm for the maximum width of SZ showed as high as 86% of sensitivity for the detection of IVCS. The maximum velocity of retrograde venous flow during Valsalva's maneuver in IVCS group (mean 14.4 cm/s) was faster than non-IVCS group (mean 7.1 cm/s, p < 0.05). The cutoff value of 10 cm/s for the maximum retrograde venous flow velocity showed as high as 69% of sensitivity for the detection of IVCS. CONCLUSIONS: Both TRS and transperineal color Doppler flow imaging were usefull as a predictor for IVCS.     

Preoperative imaging of varicose veins of the lower extremities. Classical pattern of insufficiency and its clinical use

Venous varicose are one of the most common diseases in industrial countries today. New surgical strategies, tailored to a patient's specific pattern of venous incompetence require more detailed preoperative imaging. METHODS: In this review of current literature we analyzed the value of ascending venography, color coded duplex sonography and descending venography for preoperative planning of varicose surgery. On the other hand, we describe variant anatomy of the superficial venous system like the different levels of escape points and perforating veins. RESULTS: Ascending venography and color coded duplex sonography are both excellent modalities for detection of reflux in the saphenofemoral and saphenopopliteal junction. The results of current literature indicate, that ascending venography is superior to color coded duplex sonography in the detection of incompetent perforators. CONCLUSIONS: Ascending venography and color coded duplex sonography provide improved information, that may be crucial for surgical planning. The high heterogeneity and broad distribution of valvular incompetence confirms the importance of detailed preoperative imaging.     

Ophthalmic findings with partial trisomy (duplication) of the long arm of chromosome 7

BACKGROUND: The sensitivity of diagnostic imaging of processes in the parotid gland has been increased by improved spatial resolution, yet specificity remains unchanged. The purpose of this study was to determine whether the low-flow color duplex technique alters the specificity of B-mode ultrasonography. PATIENTS AND METHODS: Forty-one patients with tumors of the parotid gland were examined by color duplex echography as well as histologically. Twenty-eight of the 41 patients had benign tumors and 13 had malignant disease. In 17 of 41 patients, color duplex ultrasonography failed to detect any vascularization within the tumor. Histopathological examination showed that 3 of these 17 tumors were malignant and 14 of 17 were benign. Intranodal vascularization was detected in 24 cases. Ten of these patients were found to have malignant tumors of the parotid gland; 14 had benign parotid tumors. RESULTS: Our present findings show that marked intratumoral vascularization especially appears in malignant tumors. In contrast to lymph nodes, the location and texture of intranodal blood vessels do not provide information about the nature of the neoplasm. CONCLUSIONS: Low flow duplex ultrasonography does not increase the specificity of preoperative examination in tumors of the parotid gland.     

Acquired gastric outlet obstruction during infancy and childhood: a report of five unusual cases

We present a patient with iliac vein stenosis and thrombosis, which occurred 2 weeks after renal transplantation and were secondary to a perivascular hematic collection. The vein stenosis was identified by color Doppler ultrasonography and venography. Computed tomography demonstrated a perivascular collection. One week later, control venography identified iliac vein thrombosis. The patient underwent pharmacological thrombolysis with local infusion of urokinase for 4 hr, percutaneous transluminal angioplasty, and percutaneous installation of a metallic stent (Wallstent), with immediate favorable results. The patient remains in stable condition at 2 years after the procedure.     

Minimally invasive cardiac surgery: current status and perspective

This study investigated the features of calf deep vein thrombosis (DVT) as a pulmonary embolic source. Fifty-eight lower limbs in 29 patients who were suspected of having DVT distal to the popliteal vein were screened by ultrasonography. Then, ascending venography was performed to confirm the diagnosis. Pulmonary embolism (PE) was diagnosed in suspected patients by use of pulmonary perfusion scanning or pulmonary angiography. Venography revealed calf DVT in 33 limbs in 28 patients. Of 28 patients, six had symptomatic PE. Thrombosis was found in the muscle veins in 18 limbs, the trunk veins in 11, and both veins in four. Isolated single vein thrombosis was found in the soleal vein in 14 limbs (42%), the posterior tibial vein in eight, the peroneal vein in two, and the gastrocnemius vein in two. The overall percentage of soleal vein thrombi was 61%. All six patients with symptomatic PE had isolated soleal vein thromboses. Calf DVT was a pulmonary embolic source when isolated thrombosis of the large soleal vein was more than 7 mm in diameter. Soleal veins were the most frequent and important location of calf DVT, suggesting that these were an occasional embolic source of critical PE.     

Interaction between triiodothyronine and ovarian steroid hormones on the regulation of the release of thyrotropin and thyrotropin-releasing hormone in vitro

Laparoscopic access to the retroperitoneum without abdominal insufflation has recently been made possible by devices designed to create a dilated laparoscopic cavity maintained by a fixed retraction system. This technique was applied in 10 patients undergoing laparoscopic ligation of the internal spermatic vein via extraperitoneal and intraperitoneal approaches. Gasless laparoscopic varicocelectomy was completed in 7 of 8 men by the extraperitoneal route and in neither of the 2 men approached intraperitoneally. The mean operative time was 170+/-55 min and postoperative pain exceeded the norm for standard insufflative laparoscopic varicocelectomy. Whereas certain theoretical advantages are offered by the gasless extraperitoneal approach to varicocele ligation, exposure through the gasless technique is currently suboptimal. Further development of "retraction" technology is required, prior to its routine application for varicocele ligation.     

Doppler color echography in the diagnosis of impotence

This study reports the experience achieved with duplex and color Doppler ultrasonography in 120 impotent patients. The following morphodynamic parameters of the cavernosal arteries were studies before and after intracorporal injection of a mixture of vasoactive drugs: arterial diameter, wall pulsatility, morphology of the spectral waveform, peak systolic velocity, end diastolic velocity and flow volume. The veno-occlusive mechanism of the corpora cavernosa was studied directly by determination of flow along the deep dorsal vein of the penis and indirectly by serial evaluation of the diastolic flow of the cavernous arteries.     

Comparison of immunofiltration assay of plasma D-dimer with diagnostic imaging in deep vein thrombosis

This prospective study was designed to assess the diagnostic sensitivity, specificity and negative predictive value of the NycoCard D-dimer plasma immunofiltration assay in patients with suspected deep vein thrombosis (DVT) confirmed by ultrasonography/venography. 84 medical patients were recruited: 43 patients (51%) had proven venous thrombosis, 33 by venography and 10 by ultrasonography. The sensitivity of NycoCard D-dimer in patients with DVT was 95.3%, the specificity was 22.0% and the negative predictive value was 81.8%. An algorithm including the NycoCard D-dimer test for the acute management of DVT is proposed. This would enable low-risk patients to be discharged early from hospital, without imaging or anticoagulant therapy.     

Mitochondrial respiration and the state of adenine nucleotide phosphorylation in rat liver following multiple administration of 3-methylcholanthrene and phenobarbital]

Five infertile males, ages 25 to 35, with oligospermia and varicocele had following gonadotropin-releasing hormone (LRF) infusion a rise of serum follicle-stimulating hormone, luteinizing hormone, and testosterone levels which was not different from that of normal fertile males. The response of these hormones to LRF infusion was unaltered by spermatic vein ligation, but a significant elevation of the sperm count occurred. Thus, improvement in sperm count following spermatic vein ligation is not mediated via changes in peripheral gonadotropin or testosterone concentrations.