Biomedical subjects
Publications and source records attributed to W J Hellstrom.
A case of successful treatment of glans hyperemia following a modified VIRAG II deep penile vein revascularization is reported. Potency was preserved using an open surgical technique to ligate an arterialized communicating venous segment.
The use of vasoactive intestinal peptide (VIP), sodium nitroprusside (SNP), and the reference combination of papaverine, prostaglandin E1, and phentolamine was studied in 22 adult cats. The maximal erectile response (intracavernous pressure, penile length, and rigidity) was produced by intracavernous injection of a combination of 1.65 mg papaverine, 0.5 micrograms PGE1, and 25 micrograms phentolamine. This combination was considered as "control" in order to compare the effect of other agents. VIP and SNP increased the intracavernous pressure and caused erection in a dose-dependent manner with a maximal response obtained with 5 micrograms VIP or 10 micrograms SNP. The duration of peak erection and the total duration of drug effect were significantly shorter with VIP and SNP than with the reference combination (P < 0.01). Epinephrine (30 micrograms) reversed the effects of SNP and significantly shortened the duration of peak action and total effect (P < 0.05). This study supports the use of an in vivo feline model for the evaluation of vasoactive agents and demonstrates that the intracavernous injection of either VIP or SNP can induce penile erection in the adult cat.
The ethyl acetate fraction of Mollugo pentaphylla, a tropical herb, contains an antifungal saponin (mollugogenol-A). We report here the spermicidal effects of this saponin. Washed sperm (> 100 x 10(6) with > 50% motility) from normal volunteers were incubated with varying concentrations (0-300 micrograms/ml) of mollugogenol-A at 30 degrees C. Sperm motility, velocity and viability were assessed at 0, 30, 60 minutes both manually and by using computer assisted semen analysis (CASA). Samples collected at 0 and 60 minutes were evaluated for membrane lipid peroxidation, superoxide dismutase (SOD) activity and transmission electron microscopy. A dose- and time-dependent effect of this saponin on sperm motion and viability was observed. The maximal spermicidal effect (4-5 fold decrease in motility and viability) was observed with 300 micrograms/ml dose of saponin. A three-fold increase in sperm membrane lipid peroxidation with corresponding inhibition of SOD activity were observed after 60 minutes incubation with this spermicidal agent. Transmission electron microscopy of saponin-treated samples revealed significant damage to the sperm membrane in both head and tail regions, and the acrosomal membranes were notably swollen and disrupted. These results indicate that this natural saponin has a potential spermicidal effect besides its known antifungal activity. The likely mechanism of its action involves sperm membrane damage by increased lipid peroxidation.
OBJECTIVE: To explore whether the addition of platelet-activating factor (PAF) or pentoxifylline before cryopreservation improves the recovery of motile viable sperm and what role cyclic adenosine monophosphate (cAMP) plays in this recovery. DESIGN: Washed sperm was cryopreserved in the absence of and in the presence of PAF and pentoxifylline. After 2 weeks these samples were quick-thawed and evaluated before and after washing for sperm motility and other motion characteristics. Sperm viability and cAMP concentration were determined to compare the effects of these cryoprotectants. RESULTS: When sperm samples were cryopreserved in the presence of PAF or pentoxifylline, an improvement in the recovery of motile sperm in unwashed and washed post-thaw samples was observed. There were 38% more motile sperm recovered with PAF and 15% more with pentoxifylline when compared with untreated samples. In comparison with the unwashed samples, sperm motility in post-thaw samples was lowered by the washing procedure. When PAF was used as a cryoprotectant, a significant improvement in the linearity and straight line velocity of the post-thaw sperm was observed. When pentoxifylline was used as a cryoprotectant, lateral head displacement was significantly improved in the post-thaw samples than in the control group. Both PAF-and pentoxifylline-treated samples contained a greater number of viable sperm than the control. The cAMP concentrations in post-thaw samples were 12-fold higher in pentoxifylline-treated samples and 4-fold higher in PAF-treated samples when compared with the untreated control. A 4-fold decrease in cAMP concentration was observed in post-thaw control samples compared with fresh-washed sperm. CONCLUSIONS: The results of this study suggest that both PAF and pentoxifylline are useful cryoprotectants for the increased recovery of motile, viable sperm. Although increased recovery of motile sperm in pentoxifylline-treated samples is related to higher cAMP levels, the cryoprotective effect of PAF does not appear to be due to increased cAMP.
In this study, 8 patients were diagnosed as having ejaculatory duct obstruction. The complaints included infertility, painful ejaculation, hematospermia, and perineal and/or testicular pain. Preoperative diagnostics included transrectal ultrasonic scanning and magnetic resonance imaging. A body coil and an endorectal coil using fast spin-echo techniques were used. The diagnosis of ejaculatory duct obstruction in each patient was confirmed by vasography with a combined iodinated contrast medium and methylene blue solution for radiological and direct visualization. A resectoscope was used for careful unroofing of the involved ejaculatory duct orifice. Patency was confirmed radiographically and by direct vision. In terms of presenting complaints, 7 of 8 patients improved symptomatically and/or objectively. Ejaculatory duct obstruction, a more prevalent condition than is currently appreciated, should be thoroughly investigated and actively treated in cases of infertility or complaints referable to ejaculatory dysfunction. Magnetic resonance imaging using an endorectal coil is a valuable adjunct in the diagnosis and therapy of this disorder.
The evaluation of vasculogenic impotence by color flow Doppler ultrasound after injection of intracavernous vasoactive agents allows for simultaneous visualization in real time of arterial and venous blood flow. Normal arterial blood flow parameters after prostaglandin E1 injection have yet to be standardized. Our study was initiated to evaluate blood flow parameters in a normal control population after prostaglandin E1 and visual stimulation. A total of 20 healthy male volunteers 45 to 60 years old with histories of normal sexual function was selected. All volunteers were given intracavernous injections of 10 micrograms prostaglandin E1 and received concurrent visual stimulation by means of an erotic video. All patients developed rigid erections with no complications. Using color flow Doppler ultrasound measurements were done before and after prostaglandin E1 injection of right and left superficial and deep cavernous artery diameters, peak blood flow velocities and blood flow volumes. Results (mean plus or minus standard error) showed a significant increase in diameters after prostaglandin E1 in the superficial (20% increase) and deep (70% increase) penile arteries. Blood flow volume increased 3-fold for the superficial penile arteries (from 7.3 +/- 1.4 to 20 +/- 3.5 cc per minute) and 4-fold for the deep cavernous arteries (from 3.8 +/- 1 to 12.5 +/- 1.8 cc per minute). Peak blood flow velocity increased 2-fold (from 22 +/- 3 to 46 +/- 7 cm. per second) for the superficial arteries and 3-fold (from 12.5 +/- 2 to 37 +/- 5 cm. per second) for the deep cavernous arteries. These data suggest control values for normal erectile function in middle-aged men as a 70% increase in deep cavernous artery diameter, a systolic peak blood flow velocity greater than 30 cm. per second and more than 10 cc per minute of blood flow volume. With these standards the clinician may assess, design and follow treatment strategies for vasculogenic impotence.
Extracorporeal shock wave lithotripsy (SWL) is becoming popular in the management of lower ureteral calculi; however, the quantity of data on its potential gonadotoxic effects are limited. Eight nonhuman primates had baseline measurements of testicular volume, semen analysis, serum testosterone and FSH assays, and DNA flow cytometric analysis of testicular aspirates. The anesthetized primates were lowered into a Dornier XL-1 lithotripter and at a 20 kV power setting had various numbers of shocks (0, 500, 1500) directed at each testis. Sequential studies were done at 6-week intervals for 9 months. The control group showed no significant change in any measure. Semen analysis, testosterone, and FSH results were variable and without statistically significant differences. There were changes in the DNA histograms, with the tetraploid (4N) group of cells being the most sensitive. All changes caused by SWL application returned to baseline by 9 months. Data from this primate study document no apparent long-term male gonadotoxicity from SWL, but the authors suggest measures to protect the testis during clinical use.
We report here the establishment and characterization of a corpus cavernosum cell line (DS-1) from human penile tissue. This is the first cell line of its type derived from cavernosum tissue. DS-1 cells have become immortalized in culture, and show growth in monolayers. These cells have a doubling time of about 45 h in in vitro culture. Cytogenetic analysis by G-banding demonstrated a diploid karyotype with a model chromosome number of 46. The chromosome constitution of DS-1 cells was found to be male (XY), in 28/30 cells scored. Two of the 30 cells showed an extra structurally rearranged "marker" chromosome, that appeared to be a derivative of chromosome 18 with excessive chromosome on the short arm. Ploidy analysis revealed that the majority of DS-1 cells had a DNA index of one. About 35% cells were found to be in G-1 phase and 52% cells in S phase. Light and electron microscopy of DS-1 cells and original penile tissue showed typical characteristics of this tissue. Immunocytochemistry studies using antibodies to smooth muscle actin, desmin, vimentin and cytokeratin (LP34, CAM5.2) showed that the DS-1 cell line had predominantly smooth muscle cells, as these cells were positive for smooth muscle actin, desmin and vimentin.
Histological examination of the radical nephrectomy and renal biopsy specimens in a 49-year-old woman revealed bilateral renal malacoplakia. The literature reports bilateral renal malacoplakia to be uniformly fatal. The preoperative diagnosis is based upon patient presentation and imaging studies. Insights into the bacterial etiology of this systemic disease are presented.
A comparison of the delivery of several antibiotics (vancomycin, gentamicin and aztreonam) to the tissue site of prosthesis implantation was studied using cavernous tissue levels for each antibiotic. A total of 32 patients underwent penile prosthesis implantation. Intravenous antibiotics were administered 1 to 2 hours preoperatively, with vancomycin and aztreonam given to patients at the Tulane University Medical Center, and vancomycin and gentamicin given to patients at the New Orleans Veterans Administration Hospital. At operation the urine, serum and cavernous tissue were concurrently sampled and later analyzed for antibiotic concentration. The mean cavernous tissue level for vancomycin was 55.5 +/- 5.5 ng./mg. (standard deviation) for 20 patients, while the mean cavernous tissue levels for aztreonam and gentamicin were 8.9 +/- 2.1 ng./mg. for 10 patients and 4.7 +/- 1.2 ng./mg. for 12 patients, respectively. When the delivery of antibiotic to cavernous tissue was compared (quantitated as ng. antibiotic per mg. tissue per mg. drug administered), a statistically significant value (p less than 0.01) was observed with vancomycin (0.11 ng./mg./mg.) greater than gentamicin (0.06 ng./mg./mg.) or aztreonam (0.01 ng./mg./mg.), and with no significant difference observed between aztreonam or gentamicin. These findings suggest that cavernous tissue levels may be used as a method to determine optimal antibiotic prophylaxis against penile prosthesis infection.
The U.S. Food and Drug Administration (FDA) lists vacuum constriction devices (VCD) as safe, nonsurgical therapy for erectile dysfunction. Our study compared the responses of 30 male (10 novice and 20 regular) VCD users of seven commercially available systems (Mentor Response, Mentor-Touch, Mentor-Piston, Dacomed Catalyst, Mission VED, Osbon ErecAid, and Pos-T-Vac). Variables evaluated included simplicity of instruction, ease of use, cost, instructional value of videotape, company follow-up, presence of a pressure-limitation gauge, and length of warranty. The results from our study show (1) 100 percent reported an additional cost to be of minor importance in determining choice of device, (2) 80 percent of novice and 95 percent of regular users stated the instructional videotape was essential, (3) 95 percent of the participants desired a twenty-four-hour hot-line, (4) 40 percent of novice users but only 25 percent of regular users wanted personalized company follow-up, (5) 100 percent of novice users preferred single-handed devices, while regulars showed no preference. (6) Regular users scored Mentor Response, Osbon ErecAid, and Mentor-Piston highest regarding ease of use. While the vacuum constriction devices are conceptually similar, there are subtle operational distinctions between the different brands. The clinical urologist should be aware of these nuances.
We used a retrospective case-control study design to compare sperm morphology in 50 varicocele patients and 50 patients with idiopathic infertility. Cases and controls were matched for the percentage of motile sperm and total sperm number per ejaculate. Varicocele patients had significantly more tapered sperm (36% +/- 3% versus 15% +/- 2%) and significantly fewer oval sperm (41% +/- 3% versus 47% +/- 2%). There was no significant difference between cases and controls in any other morphological type.
Platelet-activating factor is a naturally occurring molecule that does not appear to cause the detrimental effects to sperm as have been reported for other synthetic stimulatory agents. Incubation of freeze-thawed sperm with low motility with PAF at concentrations greater than or equal to 1.0 microM significantly improved a number of motion parameters (% motility, VSL and LIN). Optimal incubation conditions for PAF were defined at 1 hour and at 25 degrees C. The success of assisted reproductive techniques employing cryopreserved sperm with poor motility may be enhanced by stimulation protocols employing PAF.
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We compared DNA flow cytometry to morphologic evaluation of routine testicular biopsies as methods of monitoring spermatogenesis. The study group consisted of 14 azoospermic men and 5 others who underwent testicular surgery unassociated with fertility problems. The findings for both studies were divided into three groups: normal, moderately abnormal, and markedly abnormal. Correlations between the findings from routine biopsy and flow cytometry were good. Of 9 patients having normal testicular morphology, 7 had normal ploidy classes by DNA flow cytometry while 2 had moderately abnormal histograms. Of 5 cases with moderately abnormal morphology, 1 had normal, 1 had moderately abnormal, and 3 had markedly abnormal ploidy distributions. In 5 cases described as Sertoli cell only, all DNA histograms were markedly abnormal, consisting almost exclusively of diploid cells. DNA flow cytometry of testicular biopsies and aspirates has been demonstrated to be a rapid, reproducible, and objective approach in evaluating the infertile male and is a promising method to investigate spermatogenesis in an outpatient clinic in lieu of formal testis biopsy.
Microsurgery, especially on an outpatient basis, is a growing part of urologic practice. A commercial table that matches the exacting requirements of urologic microsurgeons does not exist. We have developed a simple and inexpensive design that can be fabricated easily by a hospital workshop. Notable features include removable arm rests, table indentations, and an x-ray carriage assembly. The table is easy to maintain, transport, and store. Comfort and easy access to the operative field improve the surgeon's performance and ultimately translate into better operative results.
Deoxyribonucleic acid flow cytometry on testicular tissue is an established method to evaluate spermatogenesis. Needle aspiration is less invasive and permits sequential sampling as compared with open testis biopsy. Using seven primates, we examined the needle aspiration technique. There was no significant difference among locations aspirated; the Westcott needle (Bard Urological, Covington, GA) provided the most rapid analysis, and both the Biopty gun (Bard Urological) and Westcott needle were easy to use. Baseline means +/- SD for ploidy distributions were 1N: 65.73% +/- 7.1; 2N: 18.95% +/- 5.5; 4N: 11.4% +/- 2, Experimental data generated from primate models using testis aspiration and flow cytometry may elucidate human infertile conditions.
We compared two testing protocols designed to detect immunoglobulin (Ig) G antibodies on sperm surfaces: (1) SpermMar (Ortho, Raritan, NJ) and (2) Immunobead Testing (Biorad, Richmond, CA). The standard SpermMar (SPMAR) protocol (direct test of unwashed semen) was performed with 47 ejaculates and found to be more sensitive than Immunobead Testing (IBT) on washed sperm, detecting five samples with greater than or equal to 30% bead binding, all of which by IBT had less than 20% bead binding. In contrast, when SPMAR was performed on washed sperm or with an indirect antibody transfer from serum or seminal plasma, SPMAR results gave mostly low values for bead binding in comparison with IBT. Our data suggest that SPMAR be used only in direct assays employing unwashed ejaculates, that it can be easily incorporated into routine semen analysis as a screening test, and that positive results should be confirmed by IBT (IgG and IgA).