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Epididymectomy for post-vasectomy pain: histological review.

Fifteen epididymectomies were performed on 10 patients with post-vasectomy pain and 12 specimens were available for histopathological review. The findings were compared with those in 2 groups in which epididymectomy was performed for chronic epididymo-orchitis and epididymal cysts. The results showed that 50% of the post-vasectomy group were cured by simple epididymectomy. Pathological findings revealed features of long-standing obstruction and interstitial and perineural fibrosis which may have accounted for the pain. It is important to recognise this late complication of vasectomy and, if surgery is to be performed, to include all of the distal vas and previous vasectomy site in the excision.

Adult↗

Tc-99m polyclonal human immunoglobulin scintigraphy in brucellosis.

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.

Abscess↗

In vitro cell-mediated and complement-mediated cytotoxicity to murine testicular cells.

Male BALB/c mice at 8 to 14 weeks of age were divided into three groups: group 1 was immunized with an emulsion of testicular cells (TCs) (10(7)/mouse), complete Freund's adjuvant (CFA), and extract of Bordetella pertussis (BP); group 2 was given CFA and BP injections; and group 3 was given sterile saline injections. Suspensions of TCs and spleen cells (SCs) from each mouse were prepared 4 weeks after the first immunization for a cytotoxic T lymphocyte (CTL) assay. For the antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent complement-mediated cytotoxicity (ACC) assays, TCs and SCs were prepared from normal male and female mice, respectively. Targets were labeled with Na251 Cr0(4). The interactions of targets (TCs) and effectors (SCs) were conducted at 32.5 degrees C (for CTL, ADCC, and ACC assays) or 37 degrees C (for ACC assay). In the CTL assay, SCs from group 1 and group 2 caused significantly more killing than those from group 3. Specific cytotoxicity in the ADCC assay was only detected in the serum (maximum specific lysis 47.65%) of one mouse. No other cytotoxicity was detectable in 61 serum samples from group 1 (n = 25), group 2 (n = 17), and group 3 (n = 19). In the ACC assay, no significant specific cytolysis was found at different incubation temperatures (32.5 and 37.0 degrees C) in 44 serum samples from the three groups. These results suggest that CTLs are important in the pathogenesis of experimental allergic orchitis (EAO). Adjuvant alone, probably because of breakdown of the blood-testis barrier, causes significant T lymphocyte cytotoxicity to TCs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvants, Immunologic↗

Immunization of male but not female mice with the sperm-specific isozyme of lactate dehydrogenase (LDH-C4) impairs fertilization in vivo.

The goals of this study were to determine the site at which fertility is impaired in mice immunized with LDH-C4 and to determine whether immunization of both males and females would have a greater antifertility effect than immunization of one sex alone. Mice were immunized with LDH-C4 in two systemic doses in Freund's adjuvants and two gastric doses in bicarbonate buffer. The presence of anti-LDH-C4 antibodies in uterine fluid was confirmed. Male and female mice were assigned to four blocks in which either the males, the females, both, or neither were immunized. Oviducts were viewed directly 1 h after mating for the presence of sperm. No significant effect of immunization on sperm transport to the oviduct could be demonstrated. Fertilization was evaluated 4 h after mating. It was found that immunization of males, but not females, impaired fertilization (19.6% versus 50.8% of the oocytes penetrated in 17 and 19 females, respectively). Orchitis was found histologically in 43.8% of the immunized males and 10% of the control males.

Animals↗

Increased IL-18 levels in seminal plasma of infertile men with genital tract infections.

PROBLEM: Interleukin (IL)-18 is a novel cytokine, previously known as interferon (IFN)-gamma inducing factor. We evaluated the levels of IL-18 and IFN-gamma in seminal plasma (SP) of fertile and infertile men. METHOD OF STUDY: Semen samples were obtained by masturbation from 80 men, and were examined for the levels of IL-18 and IFN-gamma by enzyme-linked immunosorbent assay. Seven groups were included: (i) fertile men (n = 18), (i) infertile men with genital tract infections (n = 17), (iii) with varicocele (n = 15), (iv) with Klinefelter syndrome (n = 6), (v) with cryptorchidism (n = 7), (vi) with mumps orchitis (n = 7), and (vii) with idiopathic testicular lesions (n = 10). RESULTS: Mean levels of IL-18 were higher in SP from infertile men with genital tract infections compared with SP from other groups except Klinefelter syndrome (P < 0.05). However, no significant differences could be detected for IFN-gamma. A significant positive correlations was found between IL-18 and IFN-gamma in total patient population (P < 0.001). Moreover, a negative correlation was observed between IL-18 and sperm concentrations, and motility (P < 0.01 and < 0.03, respectively). Furthermore, there was a positive and statistically significant association between IL-18 and IFN-gamma levels in SP of infertile men with genital tract infections (P < 0.0001). However, there was no relationship between IL-18 and IFN-gamma, and semen parameters in the same group. CONCLUSION: SP IL-18 levels were increased in men with urogenital infections. Thus, the elevated expression of IL-18 in SP may be used as a diagnostic marker in the male genital tract infections.

Adolescent↗

Loss of Treponema pallidum during incubation in Nelson's survival medium with or without serum added.

Treponema pallidum organisms suspended in equal parts of Nelson's survival medium alone and with addition of various sera were counted in 5 microliters samples before and after 18 hours' anaerobic incubation at 35 degrees C. Samples in which the treponemes were not Poisson-distributed were excluded from the study. A loss of greater than 30% occurred in 230 out of 391 samples. The disappearance of treponemes did not seem to be caused by treponemal agglutination during incubation. There was no adherence of treponemes to the formed elements remaining in the suspension. The loss was not dependent on the concentration of syphilitic serum, nor was it influenced by the presence of immobilizing antibody in the serum. Lack of rigorous anaerobiosis during the manipulations did not influence the treponemal loss. The loss was independent of the density of the treponemal suspensions which did not contain unheated guinea-pig serum (GPS). The relative frequency of the loss exceeding 30% was highest in suspensions containing unheated GPS. However, the extent of loss in individual samples was haphazardly distributed among suspensions of all the compositions examined. The loss of treponemes seems to depend on at least two factors: a) a factor which is eluted together with the treponemes from the syphilitic orchitis and b) the presence of active guinea-pig complement. It is conjectured that the complement is non-immunologically activated and acts through the alternative pathway.

Agglutination↗

Testicular fine needle aspiration cytology as a diagnostic tool in dog infertility.

The results of testicular aspirate cytology taken from clinical patients with a history of infertility were compared with the clinical and histological findings. Azoospermia was the most common and the most rewarding indication for the examination. Samples were also taken from cases with suspected testicular tumours, orchitis, epididymitis, severe oligo- and teratozoospermia, lack of libido and unilateral testicular atrophy. Histological and cytological findings were found to correlate well. Identification of cell types from normal germinal epithelium was relatively easy. No immediate adverse effects of aspiration were noted. Five normospermic dogs were monitored for two to six months after aspiration, and there were no marked deleterious effects on testicular consistency, testicular histology or semen characteristics. Testicular cytology obtained by fine needle aspiration may, at least to some extent, be used to assist clinical diagnosis, especially in azoospermic dogs and dogs with palpable changes of testicular tissue.

Animals↗

Meningoencephalitis and other conditions associated with Histophilus ovis infection in sheep.

Histophilus ovis was isolated from 29 sheep in 20 flocks and 2 artificial insemination (AI) centres in southern New South Wales from 1984 to 1990. The clinical and pathological findings were consistent with previous reports and included polyarthritis (7 flocks), epididymo-orchitis (5), meningoencephalitis (3), pneumonia (3), septicaemia (2), mastitis (1) and metritis (1). Six sheep had meningoencephalitis, a syndrome not previously associated with H ovis infection in sheep, which was similar pathologically to thromboembolic meningoencephalitis in cattle, caused by the related organism, Haemophilus somnus. H ovis was isolated from the semen of 12-month-old rams in a flock that had polyarthritis due to H ovis, in 4-month-old ram lambs and from the uterus of a ewe in a flock that had sporadic cases of H ovis septicaemia.

Animals↗

Regulation of immune functions by sperm-specific LDH and its differences with somatic isozyme in primary and secondary lymphocyte cultures.

PROBLEM: Sperm-specific lactate dehydrogenase-C4 (LDH-C4) is an autoantigen that produces experimentally induced autoimmune orchitis in testes. In the present study, immunological functions of B and T cells have been examined and compared after immunization with sperm-specific LDH and the LDH from somatic cells. METHODS: Three sets of experiments were performed. In the first set, effects of Balb/C LDH isozymes at 10(-3) - 1 L microg/well were investigated: (i) by mixed lymphocyte cultures (MLC) using C-57 B1/6 female cells as responders and AKR lymphocytes (irradiated) as stimulators, (ii) for regulatory T cell activity in MLC co-cultured along with Con-A-induced AKR lymphoblasts and (iii) for modulation of lymphocyte activation by PHA in vitro. In the second set of experiments, female mice (C-57 B1/6) were distributed in six groups for various treatments: i) saline (as vehicle), ii) adjuvant, iii) LDH-B4 (20 x 3 microg), iv) LDH-B4 (40 x 3 microg), v) LDH-C4 (20 x 3 microg), and v) LDH-C4 (40 x 3 microg). Mice were hyperimmunized with -B4 or -C4 (Balb/c) with a primary dose of 20 or 40 microg of protein per mouse, emulsified in Freund's complete adjuvant (FCA) and two identical doses in Freund's incomplete adjuvant (s.c.) within 22 days. Saline (group i) or adjuvant treated dams (group ii) served as controls. One week after the second booster, sera were tested for IgG response and lymphocytes harvested for polyclonal activation in vitro using LPS and Con-A as mitogens. In the third set of experiments, female Balb/c mice were divided into six groups as in the second experiment and immunized with a single primary dose of isogenic LDH-B4 or LDH-C4 at 20 or 40 microg of protein in FCA. On day 5, after sensitization with LDH, lymphocytes were evaluated for mitogenesis and for IgM production in vitro using LPS and Con-A as mitogens. RESULTS: i) Primary MLC(s) were non-specifically suppressed in the presence of 10(-3)- 1 L x microg allogenic LDH-C4 or -B4, although LDH-C4 tended to abolish MLC completely. But MLC co-cultured with blast cells was suppressed by LDH-C4 alone, indicating that sperm LDH suppresses induced formation of regulatory T cells. ii) FCA primed lymphocytes in situ were significantly inhibited for Con-A stimulation in vitro. Since LPS stimulation remained unaffected, it appeared that FCA is immunosuppressive for T cell proliferation alone. iii) Cells primed with LDH increased mitogenic activity of LPS several fold, although LDH-C4 was less effective than LDH-B4 in sensitization of B lymphocytes. iv) However, effect of Con-A in mitogenesis was dose-dependent, viz. cells primed at 20 x 3 microg of each isozyme overcame the immunosuppressive nature of FCA by bringing back the SI ( x 25) equivalent to saline primed cells, while pre-treatment of cells with 40 x 3 microg LDH-C4 abolished SI completely, indicating that -C4 primed cells were immunologically suppressed for Con-A stimulation. Such a response was markedly visible when allogenic LDH-C4 was used for hyperimmunization; lymphocytes challenged with somatic LDH under similar conditions did not react. Loss of T cell functions by LDH-C4 was confirmed in the presence of PHA in primary cultures. v) For antibody responses, although sperm LDH was highly reactive and dose-dependent, somatic LDH was also immunogenic for IgG production in serum to a lesser degree. Besides, IgM antibody was also discernible by two isozymes in LPS-induced cultures. Significantly, -C4 primed cells at the higher dose, in comparison with the lower dose, were less responsive for IgM production. CONCLUSIONS: It is concluded that LDH(s) from sperm and somatic cells share functionally related antigenic epitopes that can generate/modify immune responses in vivo and in vitro with qualitative differences. However, immunosuppressive determinant of LDH-C4 is cell specific and dose selective.

Animals↗

Torsion of the testis and its appendages.

In a survey of 101 cases with an index diagnosis of torsion of the testis or its appendage, there were 86 instances of torsion of the testis and 14 of torsion of the hydatid of Morgagni. In 38 of the patients with testicular torsion there were one or more "warning" attacks of pain and swelling, due to torsion which became spontaneously untwisted. In 19 cases operative fixation was performed because of this warning history, and all the testes were preserved. In the other 19 the testes were not explored until the patient came in with a severe "classical" episode of torsion: seven of these testicles were lost from gangrene or delayed atrophy.In 31 cases torsion resulted in failure to save the testis. Of these, 20 were misdiagnosed and treated initially as epididymo-orchitis, despite there being no evidence of a urinary tract infection. There is no excuse for not exploring any actuely inflammed testicle which is unaccompanied by definite evidence of urinary or urethral infection.

Adolescent↗

Infected infarcts of the testis: a study of 18 cases preceded by pyogenic epididymoorchitis.

Eighteen cases of infected infarcts of the testis are presented, and evidence is put forward that these result from venous occlusions in the epididymis and cord. The venous lesions probably result from thrombosis during the course of an attack of epididymoorchitis. Granulomatous orchitis was present in some part of half of the orchidectomy specimens, and the clinical histories, bacteriological findings, and histological data all suggest that this form of inflammation results from pyogenic infection of the testicle. What the factor is which determines whether the inflammation is granulomatous or not is unknown.

Adult↗

Effect of spectinomycin on T. pallidum in incubating experimental syphilis.

Animal experiments were performed to determine if a single-dose treatment for acute gonorrhoea with 2 g. spectinomycin could cure a simultaneously acquired syphilis at a very early stage of incubation. 300 treponemes (Nichols stain T. pallidum) were inoculated intratesticularly and 3 days later spectinomycin was administered in a dose which produced spectinomycin serum levels similar to those in patients who had received a single oral dose of 2 g. This dosage of spectinomycin did not prevent the development of syphilitic orchitis or reactivity to the FTA-ABS test, but it prolonged the subclinical incubation period.

Animals↗

Acute scrotal disorders: prospective comparison of color Doppler US and testicular scintigraphy.

Color Doppler ultrasonography (US) and testicular scintigraphy were used prospectively to evaluate 28 patients with acute scrotal pain. The results of these imaging studies were correlated with final diagnoses established by means of surgery or clinical follow-up. In all patients, testicular torsion was considered to be a possible diagnosis based on findings from the initial clinical evaluation. Findings from surgery confirmed testicular torsion in seven patients. All cases were correctly diagnosed with color Doppler US. Scintigraphy enabled correct diagnosis of six, but findings were false-negative in one patient with 180 degrees torsion. One patient had a surgically confirmed scrotal abscess that was correctly diagnosed with both color Doppler US and scintigraphy. Findings from clinical follow-up in the remaining 20 patients were consistent with epididymitis, orchitis, or torsion of an appendix testis. There were no false-positive diagnoses of testicular torsion by means of either color Doppler US or scintigraphy in any of these 20 patients. Color Doppler US is at least as accurate as testicular scintigraphy and can function as an effective means of evaluating patients with suspected testicular torsion.

Acute Disease↗

Scrotal inflammatory disease: color Doppler US findings.

A study of 45 patients with 51 cases of hemiscrotal inflammatory disease was done to determine the color Doppler ultrasonographic appearance of scrotal inflammatory disorders. The diagnosis was ultimately established by means of appropriate response to antibiotic treatment (47 cases) or surgery (four cases). In all cases, there was evidence of hyperemia: an increased number and concentration of detectable vessels in the affected portion of the scrotum. In 17 cases, the gray scale images were normal, and the only evidence of inflammation was the presence of hypervascularity. Abnormally decreased epididymal vascular resistance was detected in 14 cases of epididymitis; abnormally decreased testicular vascular resistance was detected in six cases of orchitis. Spontaneous venous flow was present in 18 patients. The authors conclude that color Doppler can demonstrate the hyperemic response to scrotal inflammatory disease and that, in the proper clinical setting, it can supplement the gray scale findings and increase diagnostic confidence.

Abscess↗

Ageing changes in the human testis: a light-microscopic study.

A histologic study of ageing testes, removed surgically from 'healthy' men aged 52-100 years, is presented. The age-related changes noted were: tubular sclerosis, Leydig cell hyperplasia, focal mononuclear orchitis, capsular smooth muscle hyperplasia, and dilatation of the rete testis. Great individual variations were seen but the testes, removed from patients with prostatic carcinoma, showed less severe ageing changes than those removed from patients during herniorrhaphy. The aetiology and pathogenesis of these changes are briefly discussed. A plea is made for more systematic studies of the ageing human testis, combining light microscopy with more sophisticated techniques, such as electron microscopy, histochemistry and cytochemistry.

Aged↗

Ceftriaxone given repeatedly cures manifest syphilis in the rabbit.

Repeated intramuscular injection of ceftriaxone to rabbits with manifest syphilitic orchitis leads to clinical cure as does penicillin, given the serum levels reached are similar to the ones obtained clinically in man. Totally different to untreated controls the Treponema pallidum hemagglutination (TPHA) titers remain relatively low and later even tend to decrease further. Thus, it seems justified to start clinical trials on the definite role of ceftriaxone in the treatment of clinical syphilis.

Animals↗

Acute scrotum in Nigeria: an 18-year review.

One hundred and seventy-eight patients presenting with an acute scrotum during a period of 18 years (1978-1997) were reviewed retrospectively. Fifty per cent had testicular torsion, with a mean age of 23 years (range 3 weeks-55 years). Torsion was significantly more common in the cold harmattan season (October-early March). The salvage rate of torted testes was 52%. Inguinoscrotal hernia was the cause of testicular infarction in 10% and is an important contributor to male infertility. Twelve per cent of cases of suspected torsion were found to have epididymo-orchitis, at exploration. Twenty-three (13%) patients presented with scrotal gangrene (Fournier's gangrene) which did not result in testicular loss. There was significant morbidity following intervention by non-doctors, and misdiagnosis from unsuspecting physicians. The acute scrotum affecting young patients is a significant cause of male infertility and morbidity in Zaria. Early recognition, prompt treatment and re-education of those who may provide the first line care for such patients will reduce the morbidity and pathologic consequences following neglect.

Acute Disease↗

Pathogenesis of Trypanosoma brucei infection in deer mice (Peromyscus maniculatus). Light and electron microscopic study of testicular lesions.

The results of light and electron microscopic studies demonstrated that Trypanosoma brucei infection produced marked testicular degeneration in deer mice (Peromyscus maniculatus) with highly significant (p less than 0.001) decreases in testicular weight, seminiferous tubular diameter, and epithelial thickness. Lesions in seminiferous tubules consisted of necrosis of spermatids, spermatocytes, and sometimes the spermatogonia. Sertoli's cells had marked vacuolation and accumulation of phagocytic material. Orchitis was present in most infected mice, particularly those with severe seminiferous tubular degeneration. There was marked folding of the basal laminae of the seminiferous tubule and myoid layer, and a consistent increase in the layers of the basal laminae of the seminiferous tubule. Trypanosomes were present in the intertubular tissues of seminiferous tubules, and they occasionally crossed the myoid layer but never the basal lamina of seminiferous tubules. Inflammatory and other cells in the interstitium consisted of lymphocytes (35.2%), Leydig's cells (25.1%), macrophages (18.1%), plasma cells (12.3%), neutrophils (5.6%), eosinophils (3.2%), and mast cells (0.5%). Inflammatory cells including lymphocytes (51.6%), macrophages (43.9%), plasma cells (3.0%), and eosinophils (1.5%) occasionally breached the myoid layer and occupied the space between it and the basal lamina of the seminiferous tubule. Leydig's cells usually existed in clusters, had decreased mitochondrial size and secretory granules, and folding of the nuclear membrane.

Animals↗