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PubMed2006

Supra-ampullar cystectomy and ileal neobladder.

OBJECTIVE: This article describes both the open and laparoscopic operative techniques of supra-ampullar cystectomy (SAC). METHODS: Both open (photographs and drawings) and laparoscopic (attached DVD) SAC are explained step by step. RESULTS: Between May 1984 and December 2005, 31 patients with bladder tumour underwent SAC with ileal orthotopic neobladder (2 Camey I, 26 Camey II, and 3 Y). Three patients underwent laparoscopy. Preoperatively, 26 patients had superficial high-risk transitional cell carcinoma (TCC). Median follow-up was 95.0 mo (range: 5-260 mo). The 10-yr cause-specific survival rate was 76.7%. Two patients had local recurrence. Potency was preserved in 28 patients (90.3%); 15 patients (48.3%) also maintained antegrade ejaculation, allowing procreation in 3 cases. In one patient the Camey I neobladder was converted into an ileal conduit (high postvoid residual, recurrent pyelonephritis). None of the remaining patients had daytime incontinence, eight had nightime urinary incontinence, and six performed intermittent self-catheterisation. CONCLUSION: SAC with detubularised ileal orthotopic neobladder allows preservation of sexual function and maintenance of urinary continence in most patients, without compromising oncologic outcome. The key element is the very strict and careful preoperative selection of the patients.

Adult↗
PubMed2002

Interviewing young men about sex and procreation: methodological issues.

Because clear instructions for interviewing men about their developing procreative identities do not exist, the authors discuss a variety of methodological issues that surfaced during in-depth interviews with young men about relationships, sex, contraception, pregnancy, and fatherhood. The authors interviewed a diverse sample of 50 single male participants, ages 16 to 30, who had dated at least one woman in the past 3 years (or had been married). The purpose of the reflexive analysis was to sensitize researchers, social service providers, and the authors to the challenges of conducting qualitative interviews with young men. The authors present indices for assessing interview success.

Adolescent↗
PubMed2005

[Female infertility: the tubal factor].

The introduction of medically assisted procreation techniques in the late '70s was an important turning-point for women with tubal infertility and still today the tubal factor, together with the male factor, is the main indication for medically assisted procreation. The outcomes of these in vitro fertilization (IVF) treatments is not significantly different from those of other indications with the exception of women suffering from hydrosalpinx. There is a detrimental effect of hydrosalpinx on the pregnancy rates in women who underwent a IVF cycle and a higher miscarriage rate. It is not yet known which is the mechanism influencing negatively the embryo implantation. However, there is agreement for the surgical removal of the salpinx improving the outcome in assisted reproductive technology (ART), whereas surgical distal tubal repair is the treatment of choice only for patients with preserved tubal mucosa.

Embryo Transfer↗
PubMed1998

[The consultation with the candidate couple for intracytoplasmic sperm injection (ICSI) using microsurgical epididymal sperm aspiration (MESA) or testicular sperm aspiration (TESA). The experience of the MATRIS (Medici Associati per la Terapia e la Ricerca dell'Infertilità e Sterilità) center of Milan].

The authors examine the relationship between doctor and patient during the consultation for the therapeutic decision for those couples who have to undergo a medical procreation, especially the ICSI by MESA and TESA. The couple's psycho-emotional involvement and the medical terminology hinder the real possibility of communication between doctor and patient. The data relating to a study of 80 couples done by the authors are presented. They show the need to improve the quality of communication between doctor and patient during the consultation. For this purpose, on the basis of the research conducted, modification of the language used and the support of audio-visual media are suggested during the consultation in order to reduce the percentage of the couple's doubts and uncertainties.

Adult↗
PubMed1984

Improved prognosis in CF patients with normal fat absorption.

CF patients with normal fat absorption, as a group, have lower mean sweat chloride levels, maintain better pulmonary function and weight for their age, and appear to survive longer than CF patients with steatorrhea. The prognostic advantage for CF males in general is not seen in the pulmonary function data for patients with normal fat absorption, but may be reflected in the smaller number of females in this group. Males in both groups are clearly better at maintaining good weight than are females. Whether this means that nutritional intervention can improve pulmonary course or that other factors (genetic, endocrinological, environmental) dictate nutritional and pulmonary state, as well as sex differences, remains to be shown. Non-steatorrheic patients are far less likely than steatorrheic patients to have Pseudomonas infecting their lungs. This is a significant prognostic advantage since the progressive lung disease and eventual mortality of most CF patients can be charted by their acquisition of P. aeruginosa and the increasing frequency of exacerbation and attempts to eradicate this organism. CF has been called a lethal genetic disease because affected homozygotes did not generally survive to procreate. However, increasing numbers of young women with CF are surviving to an age where pregnancy and child-rearing are options for them. The majority of patients who reach this stage with sufficiently good health to embark on a pregnancy are patients with normal fat absorption. They also appear to be more likely to remain well throughout pregnancy and as young mothers. There is no doubt that CF patients with normal fat absorption have a better prognosis than those with typical CF malabsorption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Our experience with treatment of varicocele in a day-surgery protocol].

In the last few years the increasing interest for non-invasive operating techniques has allowed to reevaluate the sublinguinal varicocelectomy surgical technique for idiopathic varicocele surgical treatment. During the years 1998-2001, 29 patients have been operated on sub-inguinal varicocelectomy (14 patients were suffering from idiopathic varicocele of third grade, 11 of second grade, 3 of first grade, and 1 subclinical). Out of the 29 patients, only 10 were unable to procreate. All patients were operated under local anesthesia and discharged the same day (day-surgery). Owing to Authors' experience, the sublinguinal varicocelectomy by optical magnifying devices represents the "gold standard" in the idiopathic varicocele treatment because it allows to minimize relapsing rates, to limit post-operation complications, to improve the reproductive faculty of seminal fluid both qualitatively and quantitatively, to cut patient's operating costs significantly, to keep the operation time within acceptable limits, and to be easily learned and carried out.

Adult↗
PubMed1985

Contracts to bear children.

In the surrogate mother procreation can be divorced both from sex as well as any anticipation of child rearing. Often the risks of surrogate motherhood are presented in terms of alternative family structures and economic exploitation of women. Such possibilities must invite critical reflection in order for there to be legal reform. Of paramount importance is the child's best interest and until the full psychological is the child's best interest and until the full psychological ramifications for the child, adoptive parents and natural mother are determined then the law's role must be ambivalent. In this impasse the minority view of the Warnock Report has much to commend itself.

Advisory Committees↗
PubMed1979

[Artificial marital (homologous) insemination of women with sterility and retroflexion of uterus (author's transl)].

Successful use of artificial marital (homologous) insemination is described in this paper by examples of eight sterility patients (women aged 31 on average) with mobile retroflexion of uterus and procreative husbands. After an average period of 4.7 years had elapsed with desires for children unaccomplished in spite of special treatment, the above approach led to positive success in al cases. Five women turned pregnant in the first insemination cycle, one in the second, and two in the third. There were five spontaneous births of six intact infants, while two patients still are pregnant. Laparotomy was necessary in one case for ectopic gravidity. The authors are inclined to conclude from their own experience that homologous insemination may be used as one of the therapies applicable to childlessness, if no causative factors are detectable in addition to mobile retorflexion of uterus.

Adult↗
PubMed1992

The right to procreate: intellectual disability and the law.

The common law recognizes the right of every woman to bear a child and will not contravene that right unless there are compelling reasons for doing so. The issue of the right of intellectually disabled girls, below the age of 18 years, to ultimately bear a child has now been removed to the courts. Following a recent High Court decision, surgery resulting in the sterilisation of intellectually disabled minors cannot be performed without the sanction of the Family Court. Intellectually disabled women differ in that they are legally adults once they reach the age of majority with presumed full adult rights to consent to medical treatment. Other legal mechanisms are require when they lack this capacity. This article discusses the High Court case and others that have been heard in Australia recently.

Adolescent↗
PubMed1993

[Sexual behavior in the elderly].

With the improvement of quality life in the elderly of technologically developed countries, sexuality has become an important aspect of aging. In the elderly there is a progressive decline of organic functions; the decrease of sexual and procreating activity is linked with the impaired male hormonal production. The four stages of sexual function are modified: 1. delayed erection; 2. plateau prolongation; 3. orgasm modifications; 4. fast penis detumescence. In addition to organic impairment, aesthetic, social, environmental and psychological factors can restrict sexual activity, as well as past sexual experiences and co-morbidity. There are specific aspects concerning sexuality in the elderly, such as the increased chances of public relations and emotional involvement, the more intense psychic activity and the stronger process of removal and sublimation of impulses. In conclusion the best way to deal with sexuality in the elderly is the multidimensional assessment.

Aged↗
PubMedDate not supplied

Poverty and procreation among women. An anthropologic study with implications for health care providers.

In this article, select findings from a 5-year ethnographic study of homeless, pregnant women in Southern California pin-pointed the contextual constraints, along with individual factors, that framed the women's reproductive options and actions. The women had very little choice in the timing, the place, the partner, and the circumstances surrounding conception. Factors contributing to their becoming pregnant were the woman's victimization, economic survival, lack of access to contraceptives, uncertain fertility, desire for intimacy, and hope for the future. Findings suggest that even if the women were able to establish reproductive goals and had the wherewithal to acquire and effectively use contraceptives, situational constraints (homelessness, pregnancy, poverty, contraception, fertility patterns) might still prevent their success.

Adolescent↗
PubMedDate not supplied

Male procreative superiority index (MPSI): the missing coefficient in African anthropogenetics.

The adult man in Africa, unlike the average European man, can have a biological fitness exceeding that of this wife. Sociocultural factors allow, and indeed encourage, this state of affairs, which may have far-reaching genetic consequences. The male procreative superiority index (MPSI) of any man is easily worked out by dividing the total number of a man's children by the average number of children born to each wife. The country-wide mean MPSI for 3095 fathers contacted throughout Ghana was 2 . 03, indicating that the Ghanaian father on the average has twice as many children as the mother. The genetic consequences of this phenomenon are discussed, bringing out effects on such diverse genes as those for abnormal haemoglobins, twins, and extra digits. African anthropogenetics needs rethinking more on factual lines than on theoretical evolutionary concepts.

Anthropology, Cultural↗
PubMed1984

[Diabetic neuropathy. III: Autonomic neuropathy. Genito-urinary system].

When considering urogenital complaints occurring during diabetic autonomous neurotherapy , three clinical situations are important due to their frequency and the clinical situation, the considerable effect they have on quality of life. In addition they may also be responsible for severe complications as in the case of diabetic cystopathy . This syndrome is the cause of considerable subjective disturbances even though it may be diagnosed instrumentally in its early, completely asymptomatic stage. The complaint evolves inevitably towards bladder denervation, chronic urinary retention and more or less severe septic complications. Retrograde ejaculation may lead to the loss of procreative ability as in the case of neurogenic impotence in diabetics. These three autonomous neuropathic situations occur quite frequently, especially in older subjects who have suffered from diabetes for more than ten years. Often the three syndromes are interconnected or linked to autonomous or peripheric neuropathic complaints affecting other areas. The few therapeutic measures practised have not proved very conclusive. Only a diligent examination of signs and symptoms with the aim of early diagnosis and the maintenance of good glycometabolic balance are considered to be at all effective as preventive measures.

Adult↗
PubMed1983

[Genetic counseling and prenatal diagnosis in families with neural tube defects].

An analysis of 141 families with children with neural-tube defects was performed. The families were consulted in the Department of Genetics, the Institute of Mother and in Child the period between 17.01.1978 and 29.02.1980. The family histories were obtained from the parents. The diagnosis was established on the basis of autopsy data and/or medical records. In cases of multiple congenital malformations coexisting with a neural-tube defect the precise diagnosis of the syndrome was established after a thorough search of the medical literature. Analysis of the material, showed that in 10 families (6,5%) neural-tube defect was associated with other malformations. There were 5 cases of sporadic syndromes (cloacal extrophy-2, aberrant tissue bands-2, sacrococageal teratoma-1), 3 families with Meckel's syndrome and 2 cases in which the nature of the syndrome was not determined. In 131 families the neural-tube defect was isolated and multifactorial inheritance was assumed (table VII). 113 families were given information about the cause of malformation, risk of recurrence, possibility of prenatal diagnosis and indications for amniocentesis (estimation of alpha-foetoprotein in amniotic fluid). After receiving genetic counseling and being fully informed about prenatal diagnosis the parents were asked about their procreative plans and their attitude to amniocentesis. Out of these families 74,3% planned next pregnancy (table IX), 57,6% wanted to have prenatal diagnosis (table VI). 131 family histories (probands with isolated neural-tube defect) were reviewed to determine recurrence risk for relatives. The recurrence risk for sibs was found to be: 4,9% (table III) and was higher than the expected risk (3,4%) from the population incidence of neural-tube defects in Poland (1, 15/1000 births including stillbirths). The recurrence risk for second and third degree relatives was found to be 0,1% (table IV) and 0,3% (table V) respectively.

Adolescent↗
PubMedDate not supplied

25 years of HNPCC.

Research on the genetic, molecular genetic, clinical features, and natural history of HNPCC has shown tremendous progress and evolution during the past 25 years. Specifically, HNPCC's autosomal dominant mode of genetic transmission has now been documented through linkage studies of the gene at 2p (MSH2) and at 3p (MLH1) with the cloning of these genes. Also, the tumor spectrum has increased, which now, in addition to carcinoma of the colon, endometrium, stomach, and ovary, includes transitional cell carcinoma of the ureter and renal pelvis, and adenocarcinomas of the small bowel and pancreas. Surveillance and management protocols for patients at high risk should include full colonoscopy since 70% of the colon cancers occur in the proximal colon. Because of the marked excess of synchronous and metachronous colorectal cancers (CRC), no less than a subtotal colectomy should be performed at the time of initial CRC. Women, in addition to colonoscopy, require endometrial aspiration biopsy. Should they develop CRC and if their procreation is completed, we recommend that they consider prophylactic hysterectomy and bilateral salpingo oophorectomy at the time of their subtotal colectomy. Now that the deleterious genes at 2p and 3p have been identified, we are offering candidates, in whom the MSH2 or MLH1 mutation has been verified, an option of prophylactic subtotal colectomy as opposed to annual life time colonoscopy. With the development of the International Hereditary Nonpolyposis Colorectal Cancer Collaborative Group, knowledge can be disseminated worldwide about the public health importance of HNPCC and the need to implement highly targeted surveillance and management strategies in all clinical practice settings.

Colorectal Neoplasms, Hereditary Nonpolyposis↗
PubMed2001

Why genetic testing for genes for criminality is morally required.

This paper argues for a Principle of Procreative Beneficence, that couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others. If there are a number of different variants of a given gene, then we have most reason to select embryos which have those variants which are associated with the best lives, that is, those lives with the highest levels of well-being. It is possible that in the future some genes are identified which make it more likely that a person will engage in criminal behaviour. If that criminal behaviour makes that person's life go worse (as it plausibly would), and if those genes do not have other good effects in terms of promoting well-being, then we have a strong reason to encourage couples to test their embryos with the most favourable genetic profile. This paper was derived from a talk given as a part of the Decamp Seminar Series at the Princeton University Center for Human Values, October 4, 2000.

Beneficence↗
PubMed1987

Abnormal seasonality of schizophrenic births. A specific finding?

The unusual finding of an abnormal seasonal distribution of schizophrenic births, showing an excess of 10% in the winter or spring months and an equal deficit in the summer or autumn months, cannot be explained by artefacts. It has not yet been established whether the finding is specific to schizophrenia. We observed an excess of schizophrenic births of some 10% in March to May, significant at the 5% level, and a deficit of approximately the same size in June to August on the birth data of first-admission patients with the clinical diagnosis of schizophrenia. The data, obtained from the Mannheim Psychiatric Case Register, were compared with those of the Mannheim population and a control group matched by birth year and sex. The total population of mentally retarded children aged 7 to 16 years from the Mannheim population showed an excess of some 20% in April to June and an equal deficit in the last two quarters of the year, compared with the Mannheim population of the same birth years. The finding was not significant, but allowance must be made for the low case number of 415. We also compared 3409 first-admission patients with depressive syndromes (ICD 296 and 300.4) and 5615 first-admission patients with the diagnosis of "neurosis and personality disorders" (ICD 300-302, except 300.4, and 305-309) from the Mannheim Case Register with a control population and a parallel control group. Depressed males showed an excess of births in March to May, which was significant at the 1% level; the birth peak for females was smaller and not significant. The same findings were obtained for the category of neurosis and personality disorders, i.e. an excess of about 10% in March to May for males, significant at the 1% level, and a non-significant excess for females. Our findings are awaiting replication. Causal explanations will be discussed with great reservation. The procreational hypothesis, assuming those factors that lead to an equidirectional seasonal pattern of births with a slight deviation from the average of a year in the general population, to be reinforced in the disease categories mentioned, is regarded as the most simple and plausible explanation. It is based on the assumption that some of the parents of individuals suffering from schizophrenia, mental retardation or probably also some other mental disorders running from generation to generation, have a higher threshold in partner-seeking behaviour, which is overcome more easily in the summer months with the consequence of increased pregnancies.

Adolescent↗
PubMed1993

Comparative prospective study of the psychological development of children born by in vitro fertilization and their mothers.

A comparative prospective survey of psychomotor development and mother-infant bonding was conducted on 33 children born after in vitro fertilization and two control groups composed of: a group of children born to infertile women who underwent ovulation induction treatment but with no medically assisted procreation; and a group of children born by natural procreation, with no medical intervention. No major disorders were observed. In the postpartum, the minor mother-infant relational problems seemed to be more frequent in the in vitro fertilization and infertility groups but with no statistical differences. At 9 months, the factors related to sleep disturbances in the child and maternal depressive syndromes seemed to be more frequent in the in vitro fertilization and infertility groups than in the controls. At 18 months these minor disturbances decreased and there were fewer differences across the three groups. This trend was confirmed at 3 years.

Case-Control Studies↗