Biomedical subjects
S J Silber
Publications and source records attributed to S J Silber.
Microscopic vasovasostomy and spermatogenesis.
Initial clinical experience with a new microscopic 2-layer anastomosis for vasovasostomy shows that normal patency can be achieved almost every time. Histologic and electron microscopic studies on initial specimens and subsequent ejaculates indicate that stricture is a common cause of failure with conventional vasovasostomy techniques, obstruction of the vas deferens inhibits spermatogenesis and relief of obstruction allows return of spermatogenesis in the vast majority of cases.
Microsurgery in pediatric urology.
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Perfect anatomical reconstruction of vas deferens with a new microscopic surgical technique.
Early results with a new, two-layer microscopic technique for anastomosis of the vas deferens, using an operating microscope and ultrafine suture, reveal that patency of the vas deferens can be achieved in virtually every case. Normal sperm counts can be achieved in up to 95% of patients. Failure with conventional techniques is usually due to continuing partial obstruction. A poor sperm count after this technique is most likely due to an inherent inability of the patient to produce normal sperm, a likely sequela of chronic obstruction. Thus, while success is also good 10 years after vasectomy, it is not as predictable. Previous failure with a conventional operation does not limit success with a reoperation using the microscopic two-layer tehcnique. Operations on 200 patients since this original study are confirming these early results.
Microscopic vasectomy reversal.
More than 300 patients undergoing microscopic vasovasostomy have been carefully studied in an effort to determine the factors which affect the recovery of fertility after an accurate microscopic reanastomosis. The over-all pregnancy rate in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of seminal fluid in the vas deferens on the testicular side of the obstruction at the time of vasovasostomy. The three most important factors influencing return of fertility after vasovasostomy are (1) a meticulous microscopic technique for reconnection, (2) the duration of time the vas deferens has been obstructed, and (3) the presence of absence of a sperm granuloma at the site of the vasectomy, venting the long-term pressure buildup which otherwise would occur. The presence of a sperm granuloma at the vasectomy site generally ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy and the recovery of a good sperm count postoperatively. If all three of these factors are favorable, vasectomy should be reversible for most patients.
Growth of baby kidneys transplanted into adults.
To determine whether the growth of a kidney is affected by the age of the host or is independently programmed, baby rat kidneys were isologously transplanted into adult rats that underwent unilateral or bilateral nephrectomies. The growth of these transplanted baby kidneys was compared to the growth of baby kidneys that were left intact in the growing baby rat. After allowing for compensatory hypertrophy, the kidneys, whether in babies or adults, were found to grow at the same rate and to the same ultimate size. Renal size could be predictably related to renal age, but not to the age of the host.
Treatment of hemorrhage from renal trauma by angiographic injection of clot.
Experimental results in rats and modest clinical experience now indicate that persistent or massive hemorrhage from renal trauma can be treated by injection of clot(under angiographic control) into the bleeding vessels. There is minimal loss of renal tissue and an operation is avoided.
Successful autotransplantation of an intra-abdominal testis to the scrotum by microvascular technique.
An intra-abdominal testis in a child with prune belly syndrome was successfully transplanted to the scrotum by a microvascular technique. Immediate results were good with no palpable atrophy of the testis. Long-term results (fertility) will not be known for many years. The technique of microvascular anastomosis and its application to orchiopexy are described.
Graft-versus-host reactivity and renal allograft survival in rats given allogeneic spleen cells or spleen allografts.
Selective recruitment of antigen-sensitive cells (ASC) into the spleen as a method of inducing specific suppression was attempted by intravenous injection of either DA or Lewis spleen cells 24 hr before a (DA X Lewis)F1 renal allograft into a Lewis or DA recipient, either with or without a splenectomy. This led to suppression of rejection in the DA recipient and delayed rejection in the Lewis recipient. Splenectomy produced a minimal augmentation effect. Assay of graft-versus-host (GVH) reactions in (DA X Lewis)F1 rats by a popliteal node assay showed that injection of allogeneic DA or Lewis spleen cells 48 hr before the assay significantly reduced the reaction produced by node lymphocytes but not spleen lymphocytes, suggesting a loss of ASC from the lymph nodes. Lewis spleen allografts did not produce such a significant reduction in the GVH reactivity of DA node lymphocytes as intravenous Lewis cells, whereas DA spleen allografts led to an increased GVH reactivity of Lewis node lymphocytes. From these studies, it is not possible to attribute the suppression produced by the intravenous injection of allogeneic cells to selective recruitment of antigen-sensitive cells to the spleen.
Microscopic technique for reversal of vasectomy.
This microscopic technique for reversal of a vasectomy requires intensive training on small animals in the laboratory before it can be attempted on humans. It has assured sperm in the ejaculate of all patients who have sperm in the proximal portion of the vas at the time of vasovasostomy, good sperm count and motility three to five months later in 90 per cent of them and early pregnancy of the spouse in 50 per cent. Longer follow-up periods will be necessary to estimate how high the eventual success rate will be, but it appears at this juncture that this approach is preferable to nonmicroscopic splinting techniques.
Treatment of massive hemorrhage after renal biopsy with angiographic injection of clot.
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Microsurgery in clinical urology.
Microsurgery is not a new tool to the urologist. Transurethral resection is probably the most challenging type of microsurgery, and we do it daily. The manipulations of microvascular dissections and anastomoses may be more intricate, but the basic concept of performing delicate procedures while looking down a tube is "old hat" to us. The new techniques discussed here may extend the range of operative solutions to difficult clinical problems in urology perhaps as transurethral resection did in the thirties and forties.
Regression of Metastases after Nephrectomy for Renal Cell Carcinoma.
A case of an extensive renal cell carcinoma with temporary regression of pulmonary metastases is reported. The literature of similar reported cases is brefly reviewed.
Transplantation of rat kidneys with acute tubular necrosis into salt-loaded and normal recipients.
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Proceedings: treatment of renal trauma by angiographic injection of autologous clot.
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Growth of baby kidneys transplanted into adults.
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Renal transplantation between adults and children. Differences in renal growth.
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Extra renal function in patients with duplication anomaly: obligatory and compensatory renal growth.
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