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Biomedical subjects

S S Howards

Publications and source records attributed to S S Howards.

At least 55 records · Page 3Linked to original sources
PubMed1990

Inflammatory changes in the epididymis after vasectomy in the Lewis rat.

The epididymides of Lewis rats were studied at intervals up to 7 months after vasectomy, vasectomy followed 3 months later by vasovasostomy, or sham operations. Epididymal histology was related to testicular alterations and to serum antisperm antibodies as determined with an enzyme-linked immunosorbent assay. In vasectomy and vasovasostomy groups. 13 of 33 rats had testicular alterations, which consisted mainly of pronounced depletion of germ cells. Over half of the rats with testicular alterations also had severe epididymal lesions that included interstitial changes characteristic of an inflammatory response. These consisted of aggregates of mononuclear cells, including lymphocytes, plasma cells, and macrophages. The lumina of epididymides with interstitial changes contained polymorphonuclear leukocytes and/or macrophages. All animals with altered testes had greatly decreased numbers of epididymal sperm. In many instances, the lumen of the proximal cauda epididymidis was collapsed, and columnar cells of the epididymal epithelium contained many very large lysosomes. The distal cauda epididymidis was distended with sperm and debris. None of the rats that lacked testicular alterations showed epididymal changes. Mean serum antisperm antibody levels were significantly higher for rats with epididymal interstitial changes than for animals without such epididymal alterations. Infiltrations of inflammatory cells into the epididymal interstitium and lumen are part of the constellation of changes that occurs after immunization with testicular homogenates to produce experimental allergic orchitis. The observations reported here support the hypothesis that reproductive tract alterations after vasectomy in this model have an immune basis.

Animals↗
PubMed1989

Histologic analysis of orchiopexy in a cryptorchid rabbit model.

Although there is a consensus that very early orchiopexy is advantageous, there is little experimental data to support this view. Therefore, we studied early pre-pubertal versus later pre-pubertal orchiopexy in a cryptorchid rabbit model. Male offspring were divided into four groups with six to nine rabbits in each group: 1) controls (CON); 2) shams undergoing sham operations at both three weeks and two months of life (SHAM); 3) cryptorchid on day 3 with orchiopexy at three weeks and sham operation at two months (O3W); 4) cryptorchid on day 3 with sham operation at three weeks and orchiopexy at two months (02M). All animals were sacrificed post-puberty at six months of age; the tests were fixed in situ by perfusion fixation, embedded in glycol methacrylate, and underwent morphometric analysis in a blinded fashion. The average seminiferous tubular diameter (STD) of the CON, SHAM, O3W, and O2M groups was 234, 160, 116, and 123 microns, respectively. The average testicular biopsy score count (TBSC) of the CON, SHAM, O3W and O2M groups was 9.0, 5.2, 3.5 and 3.5, respectively. There is no significant difference in STD or TBSC between the O3W and O2M cryptorchid groups, and values for both of these groups were significantly different from those of the SHAM group. In addition, a significant effect of sham operation was demonstrated. These results demonstrate no advantage of very early orchiopexy in this model, and are consistent with the clinical literature which, in general, shows reduced reproductive potential of a cryptorchid testis after orchiopexy.

Age Factors↗
PubMed1989

The influence of vasovasostomy on antisperm antibodies in rats.

Serum antisperm antibodies were studied in Sprague-Dawley rats after vasectomy and vasovasostomy. Animals received a bilateral vasectomy, a vasectomy followed 3 mo later by vasovasostomy, or sham operations. Blood samples were obtained at 1, 3, 4, and 7 mo, and antisperm antibodies were assayed by an enzyme-linked immunosorbent assay. After vasectomy reversal was performed at 3 mo, antisperm antibodies were significantly higher in rats in the vasovasostomy group at 4 mo than in animals that had a persisting vasectomy or sham operations. At 7 mo, the antisperm antibody level for the vasovasostomy group was approximately double that for the vasectomized rats. Spermatic granulomas occurred in 76% of rats after vasovasostomy. Antisperm antibody levels were higher in vasovasostomized animals with granulomas than in those lacking granulomas. The results suggest that vasovasostomy may stimulate an antibody response to sperm rather than lead to a reduced response, as was anticipated upon removal of the obstruction. Spermatic granulomas may serve as sires for continued antigenic challenge. The observed increase in antisperm antibodies after vasovasostomy in Sprague-Dawley rats may be related to their relatively low immunologic responsiveness to vasectomy, with vasovasostomy serving as a second major immunologic challenge, aided by the formation of an additional granuloma. In the more responsive Lewis strain, we previously observed a rise in antisperm antibodies after the initial vasectomy, with no further increase after vasovasostomy.

Animals↗
PubMed1988

Transdermal testosterone treatment of hypogonadal men.

Hypogonadism, either primary or secondary, results in diminished libido and/or impotence. Conventional treatment consists of periodic intramuscular injections (usually bimonthly) of a depot testosterone preparation or daily oral ingestion of methyl testosterone. These conventional treatments may be associated with side effects, such as gynecomastia, liver function abnormalities and edema. A new method of administering testosterone is by daily application of a transdermal therapeutic system. We studied the efficacy and safety of the transdermal therapeutic system in 4 hypogonadal men. Three patients were treated for 12 weeks and 1 for 7 weeks, and they were evaluated weekly. Of 4 patients 3 had improvement in erectile and/or sexual function. Mean plasma testosterone levels increased significantly compared to pre-treatment values during 7 of 12 treatment weeks. There were no adverse effects of the transdermal therapeutic system as indicated by serial physical examinations, daily reports, blood chemistry studies, liver function tests, urinalysis and hematological profiles. This preliminary report of transdermal testosterone delivery indicates that it may provide an effective alternative method of gonadal steroid replacement.

Administration, Cutaneous↗
PubMed1988

Testicular alterations are linked to the presence of elevated antisperm antibodies in Sprague-Dawley rats after vasectomy and vasovasostomy.

The relationship between alterations in testicular histology and antisperm antibodies was studied after vasectomy and vasovasostomy in Sprague-Dawley rats, which are immunologically relatively non-responsive to vasectomy. Testes were prepared for histologic study at intervals up to seven months after vasectomy, vasectomy followed three months later by vasovasostomy, or sham operations. Antisperm antibodies were assessed with an ELISA. Testicular alterations, which were observed in a minority of animals after vasovasostomy, consisted mainly of depletion of germ cells. Mean serum antisperm antibody levels were greater for animals with altered testes than for rats with normal testicular histology. In addition, the proportion of rats that showed a positive antisperm antibody response was greater among animals with testicular changes than among those with unaltered testes. When the present results on Sprague-Dawley rats were compared with previous findings on the highly responsive Lewis strain, it was evident that the incidence of testicular changes and the proportion of positive antibody responders were greater in the Lewis strain. However, elevated antisperm antibodies and testicular alterations appeared to be more tightly linked in the less responsive Sprague-Dawley rats.

Animals↗
PubMed1988

Multicystic dysplastic kidneys and diagnostic confusion on renal scan.

The combination of ultrasound and renal scan usually provides a reliable means of differentiating congenital ureteropelvic junction obstruction with hydronephrosis from multicystic dysplasia in the newborn with an abdominal mass. Rarely, a multicystic kidney will show definite function on a renal scan. We describe 2 newborns who were thought to have hydronephrosis based on a renal scan but who had typical multicystic dysplastic kidneys at operation.

Diagnosis, Differential↗
PubMed1988

Effects of granuloma formation at site of vasovasostomy.

Spermatic granulomas forming after vasectomy reversal have been thought to mechanically compromise the anastomosis. We have studied the physiologic effects of vasectomy and vasovasostomy in rats. Following delayed microsurgical vasovasostomy, fluid flow through the anastomosis and cauda epididymidal hydrostatic pressure are not significantly different in tracts that form, or do not form, sperm granulomas at the anastomosis. Given a properly performed microsurgical vasectomy reversal, a sperm granuloma arising from a small leak does not appear to mechanically compromise the anastomosis in the rat. Fertility after vasovasostomy is not significantly reduced in rats with granulomas.

Animals↗
PubMed1987

The influence of vasovasostomy on testicular alterations after vasectomy in Lewis rats.

The occurrence of alterations in testicular weight and morphology after vasectomy and vasectomy reversal by vasovasostomy was studied in Lewis rats. Animals were studied 3, 4, and 7 months after bilateral vasectomy or a vasectomy followed 3 months later by vasovasostomy. Other rats served as sham-operated controls. The weights of the testes in vasectomy and vasovasostomy animals fell into two groups-small testes weighing less than 0.88 g and normal-sized testes of 1.2 g or more. When the extent of testicular alterations was estimated in sections for light microscopy by use of a semiquantitative testicular biopsy score count (TBSC), the morphology of the testes corresponded closely to the testis weight (r = .94), small testes having correspondingly low TBSC scores. In severely altered small testes, the seminiferous tubules were narrower than in sham-operated rats, and numbers of germ cells were greatly depleted. Many tubules contained only Sertoli cells and spermatogonia, although spermatocytes were present in a minority of tubules. A few seminiferous tubules contained multinucleate spermatids. Electron microscopy of severely altered tubules revealed closely apposed processes of Sertoli cells, which contained filaments, microtubules, and endoplasmic reticulum. In contrast, testes with normal weight in vasectomy and vasovasostomy groups resembled those of the sham-operated animals. Comparison of distributions of testicular biopsy score counts demonstrated differences between vasectomy and vasovasostomy groups as time after operation increased. At the 3-4-month intervals, approximately one-third of the testes were severely altered in both vasectomy and vasovasostomy groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Initial experience with extracorporeal shock wave lithotripsy in children.

The clinical experience is presented of 4 United States centers at which extracorporeal shock wave lithotripsy was used for the treatment of renal calculi in 38 children 12 months to 16 years old. Patient characteristics, treatment specifics and followup data are detailed. Complete fragmentation of calculi was obtained in 97 per cent of those treated, with a 5 per cent complication rate. This experience demonstrates that with proper safeguards, extracorporeal shock wave lithotripsy can be performed safely and effectively in the pediatric population.

Adolescent↗
PubMed1987

Inhibition of testicular testosterone biosynthesis following experimental varicocele in rats.

In an attempt to determine whether defective testicular testosterone (T) biosynthesis may be associated with a varicocele, an experimental study was performed in adult rats whereby a unilateral left varicocele was surgically created. At 2, 4, 8, and 12 wk following the creation of the varicocele, intratesticular T as well as the activities of three (17 alpha-hydroxylase, 17,20-desmolase, and 17 beta-hydroxysteroid dehydrogenase) of the five enzymes in the delta 4 pathway of testicular T biosynthesis were measured. Intratesticular T (ng/g testis +/- SEM) in the left testis decreased significantly from 121 +/- 21 in the control group to 59 +/- 8 in the two-wk varicocele group (p less than 0.01), and remained significantly suppressed throughout the experimental period. The T concentrations in the right testis paralleled those in the left in both the control and varicocele animals. At 2 wk following the creation of the varicocele, the activity (nmol/min/testis +/- SEM) of the 17,20-desmolase enzyme decreased significantly, from 115 +/- 8 in the left testis of control rats to 87 +/- 6 in the left testis of the varicocele animals (p less than 0.025), and remained low throughout the 12 weeks of the study. The activity of the 17 alpha-hydroxylase enzyme was significantly decreased at the 8th and 12th weeks of the study, while the 17 beta-hydroxysteroid dehydrogenase activity did not show any significant change during the study period. The enzyme activities in the right testis paralleled those in the left testis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

The relation between antisperm antibodies and testicular alterations after vasectomy and vasovasostomy in Lewis rats.

The relationship between antisperm antibodies as determined by enzyme-linked immunosorbent assay (ELISA) and the occurrence of alterations in testicular weight and histology was studied following vasectomy in Lewis rats. The effects of vasovasostomy on antisperm antibody levels were also examined. At 1, 3, and 4 months after vasectomy, the mean absorbance values in an ELISA for sera from animals with altered testes was significantly greater than that from animals lacking testicular alterations. However, animals showing positive antisperm antibody responses were represented both in the group with testicular alterations and among those that lacked testicular damage. Levels of antisperm antibody in both vasectomy and vasovasostomy groups significantly exceeded that for sham-operated animals, but the level of antisperm antibodies in vasovasostomized animals with positive responses was similar to vasectomized animals one and four months after reanastomosis. It is suggested that persistence of antisperm antibodies or testicular alterations, or both, may play roles in limiting the restoration of fertility after vasovasostomy.

Animals↗
PubMed1987

Varicocele.

Approximately one third of infertile men present with varicocele, while the incidence among males in the general public is approximately 15 per cent. The etiology may be a longer left spermatic vein with its right-angle insertion into the left renal vein and/or absence of valves, which causes a higher hydrostatic pressure in the left spermatic vein causing dilatation. The nutcracker phenomenon is also a possible etiology. Much of the pathophysiology is still unknown, but increased blood flow causing an elevated intratesticular temperature may be of significance. Though there are many recent reports on the importance of a subclinical varicocele, we are not convinced of its significance. The best method for diagnosis remains a good clinical examination. The incidence of adolescents with varicocele is about the same as men with varicocele (approximately 15 per cent). Adolescents with varicocele should be treated if the testicular mass is decreased or if they are symptomatic. Surgical ligation is still the preferred method of treatment. Percutaneous treatment of varicoceles has an approximately 11 per cent incidence of minor complications and an occlusion rate of 73 per cent with a recurrence rate of 5 per cent. We reserve percutaneous treatment for recurrent varicoceles after surgical ligation, but primary percutaneous therapy is a reasonable approach.

Adolescent↗
PubMed1987

Vasovasostomy.

The popularity of vasovasostomy in recent years can be attributed to improvements in operative techniques, instruments, optics, and most importantly, results. This article addresses the evolution of vasovasostomy, a method of training, the equipment necessary to perform the procedure, and various operative techniques, both macroscopic and microscopic. A brief comparison of postoperative results is included.

Animals↗
PubMed1987

Outpatient pediatric urologic procedures.

Outpatient pediatric urologic surgery is not a new concept. However, it has recently become extremely popular. The general experience nationwide and particularly the experience at Children's Hospital of Philadelphia and the University of Virginia Hospital indicate that outpatient surgery can be very safe and satisfactory for patients. The outpatient approach requires close cooperation among anesthesiologists, surgeons, and outpatient personnel. Excellent communication with the patient and family is essential. This includes extensive educational printed material and 24-hour availability by telephone. Once the infrastructure is in place, outpatient pediatric urologic surgery results in efficient use of facilities and a more pleasant surgical experience for the patient. The psychological, social, and economic benefits of outpatient surgery make it imperative that a large percentage of pediatric procedures be done on an ambulatory basis. We do not, however, intend to suggest that all minor procedures can be done on an outpatient basis, as certain special situations will mandate hospitalization.

Ambulatory Surgical Procedures↗
PubMed1986

An enzyme-linked immunosorbent assay for measuring antisperm autoantibodies following vasectomy in Lewis rats.

An indirect enzyme-linked immunosorbent assay (ELISA) was devised to measure antisperm auto-antibodies in the Lewis rat following vasectomy. The assay system was validated by employing prevasectomy sera and postvasectomy antisera, previously demonstrated to contain antisperm antibodies by indirect immunofluorescence. A standardized ELISA protocol was developed employing 10(5) sperm per microtiter plate well and sucrose-polyvinylpyrrolidone as a postcoat stabilizer solution. The ELISA was shown to yield significant detectable antibody at dilutions of 1/512 or greater in the most reactive sera. A standard for scoring positive titers was adopted: 1.96 standard deviations above the mean of the preimmune value. Using the criterion, 88% of 7-week postvasectomy samples could be discriminated from preimmune samples at a 1:16 dilution, which was adopted for subsequent assays. The ELISA demonstrated 73% and 91% reproducibility for an intraassay analysis of single prevasectomy and postvasectomy serum samples (7 weeks postvasectomy) tested in 160 determinations on a standard sperm pool. When this single antigen pool was employed in 35 determinations at 0, 1, and 4 weeks in an interassay study, 56% and 70% reproducibility was found for pre- and postvasectomy sera respectively. A correlation (r = 0.75) was made between a single absorbance value and the endpoint titer of the same sera, which indicated that single absorbance values could be used to predict serum titer and single dilutions could be used for general screening of a large number of samples. The ELISA described provides a rapid, sensitive, and reliable method that discriminated between samples taken before and after vasectomy.

Animals↗
PubMed1985

Effects of varicocele after unilateral orchiectomy and sympathectomy.

An experimental varicocele was created in the adult rat by partial ligation of the left renal vein. There was a significant bilateral elevation of both testicular blood flow and temperature in the varicocele animals (p less than 0.01). Mean testicular blood flow for control and varicocele animals was 29.6 +/- 1.0 and 39.8 +/- 2.0 ml./min./100 gm. tissue, while mean testicular temperature was 34.4 +/- 0.1 and 35.3 +/- 0.2C, respectively. A left orchiectomy was combined with a left varicocele to determine if the left testis is essential for the right testicular response to a varicocele. Elevation of right testicular blood flow was not altered by left orchiectomy (p less than 0.05); however, right testicular temperature was no longer significantly increased. Mean right testicular blood flow and temperature for this group was 39.0 +/- 1.5 ml./min./100 gm. tissue and 34.2 +/- 0.15C, respectively. A left sympathectomy was combined with a left varicocele to ascertain if the right testicular response to the left varicocele was mediated through a neural pathway. A significant bilateral increase in testicular blood flow was noted with a left sympathectomy alone, and thereby masked the ability to evaluate the right testicular response to the simultaneous left sympathectomy and varicocele. Elevation of right testicular blood flow in response to the left varicocele is independent of the presence of a left testis and any immune response it may stimulate. The role of the sympathetic nervous system as a mediator of the bilateral varicocele effect remains undetermined.

Animals↗
PubMed1985

Human antisperm monoclonal antibodies constructed postvasectomy.

Sperm and spermatogenic cell antigens, escaping the blood-testis/blood-epididymal barrier, elicit an autoimmune response in patients following vasectomy. In this study, antisperm antibody-positive sera and peripheral blood lymphocytes were obtained 6-9 mo following vasectomy. Serum antisperm antibody levels were assessed by enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence. Lymphocyte-myeloma hybridomas were constructed by fusing peripheral blood lymphocytes, harvested from antisperm antibody-positive sera, with a hypoxanthine guanine-phosphoribosyltransferase (HGPRT)-negative mouse myeloma line. Immunoglobulin-secreting colonies surviving drug selection were detected by ELISA and screened for antisperm activity. Antisperm antibody-producing cultures were cloned and expanded for bulk antibody production both in culture and as ascites in athymic nude mice. Eight mouse-human fusions yielded 205 hybridomas secreting human monoclonal antibody, of which 11 demonstrated antisperm reactivity by ELISA. Two of these hybridomas are described in detail: HAS-1, which secretes human immunoglobulin M (IgM, kappa)-recognizing epitopes located on the sperm midpiece, and HAS-2 (IgM, lambda), which secretes monoclonal antibody-recognizing epitopes located on the entire sperm tail. The results indicate successful capture of human antisperm autoantibody from the postvasectomy autoimmune state using somatic cell hybridization techniques.

Animals↗