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PubMed1992

Mycobacterium bovis vertebral osteomyelitis and psoas abscess after intravesical BCG therapy for bladder carcinoma.

Systemic complications of intravesicular BCG for bladder carcinoma are uncommon, and include fever, pneumonia, hepatitis, arthralgias, or skin rash. Local complications of BCG therapy for bladder cancer include cystitis, prostatitis, epididymo-orchitis, granulomatous lymphadenitis, or ureteral obstruction. We believe this is the first case of Mycobacterium bovis vertebral osteomyelitis and psoas abscess complicating intravesicular BCG therapy for bladder carcinoma.

Administration, Intravesical↗
PubMed1989

Guinea pig testicular proacrosin-acrosin system: preliminary immunological characterization.

In this study, immunochemical techniques were employed to examine the guinea pig (GP) testicular proacrosin-acrosin system. Monospecific polyclonal antibodies to the highly stable enzymatically active 34,000 molecular weight form of GP testicular acrosin were generated. Western blot analysis of acid extracts prepared from snap-frozen freshly excised GP testes revealed two major immunoreactive bands with mol. wts of approximately 62,000 and 48,000 and one minor band with an approximate mol. wt of 54-56,000. The 62,000 mol. wt molecule identified is in close agreement with the previously reported mol. wt for purified GP testicular proacrosin. Western blot analysis of different species of testicular acid extracts demonstrated the evolutionary relatedness of the proacrosin-acrosin systems since immunoreactivity was observed primarily with acid extracts from rodent species (rat, mouse and hamster) and not with extracts from evolutionarily less-related species (goat, ram and bovine). The majority of the cross-reactivity observed was characterized by immunoreactivity with the 62,000 and 48,000 mol wt molecules. The only species which exhibited cross-reactivity with the 54-56,000 mol. wt protein was rat. In addition, the iso-immunogenic and aspermatogenic properties of the 34,000 mol. wt form of GP testicular acrosin were examined. One out of five Hartley and one out of seven Strain 2 female GPs immunized and boosted with a total of 200 micrograms of purified protein exhibited increased levels of circulating anti-acrosin iso-antibodies. The antigenic specificity of the iso-antibodies observed in the two animals was verified by Western blot analysis. All other female animals, including two strain 13 GPs, exhibited very low or undetectable levels of such antibodies following immunization. One out of three male Hartley GPs immunized with 50 micrograms of the purified protein exhibited typical lesions of experimental allergic orchitis while none of a group of three animals developed lesions at a 5 micrograms dose. Taken together, these results suggest that the 34,000 mol. wt form of GP testicular acrosin is neither a highly potent iso-immunogen nor aspermatogenic autoantigen.

Acrosin↗
PubMed1992

Ontogeny of immunosuppressive activity, MHC antigens and leukocytes in the rat testis.

The levels of immunosuppressive activity and the presence of MHC antigens and leukocytes were studied in the immature and the sexually mature rat testis. The immunosuppressive activities were measured from high-molecular weight (greater than 5 kDa) fractions of testis extracts using the protectin bioassay. The presence of MHC antigens and leucocytes was studied using the indirect immunoperoxidase method. In the immature rats, clusters of class I MHC antigen positive cells and a few cells expressing class II MHC antigen were present in the testicular interstitium. In the sexually mature rats, all the cells were MHC I+, and MHC II+ cells were numerous in the testicular interstitium. The seminiferous epithelium was MHC-negative in both the immature and the sexually mature testis. W3/25+ leukocytes were present in the interstitium and the tubular wall in both the immature and the sexually mature rat testis, but not in the seminiferous epithelium at any age. At 20-30 days of age, the testicular extracts were neutral or slightly stimulated 3H-TdR incorporation into peripheral blood lymphocytes, but at 44-60 days of age they inhibited lymphocyte proliferation significantly. In gel filtration, a peak of immunosuppressive activity was observed at approximately 400 kDa (protectin A) in both 20- and 60-days-old rat testes. A smaller peak was present at approximately 200 kDa in both age groups. This study shows that the testicular immunoregulatory microenvironment is different in the immature and the sexually mature rats. This may be important in such age-dependent human diseases as mumps orchitis and the testicular relapses of acute lymphoblastic leukemia.

Age Factors↗
PubMed1987

Cultivation of Besnoitia besnoiti and evaluation of susceptibility of laboratory animals to cultured parasites.

Cultivation of Besnoitia besnoiti on five mammalian cell types showed that Vero (green monkey kidney), L929 (mouse fibroblasts) and BEK (bovine embryo kidney) cells were highly susceptible and were almost destroyed after 5 days of incubation, while MDBK (Madin-Darby bovine kidney) and BL (Theileria annulata-infected bovine lymphoid) cells were less affected. Intraperitoneal infection with culture-derived endozoites was fatal for gerbils (Meriones tristrami) and sand rats (Psammomys obesus). Rabbits showed fever, conjunctivitis and orchitis, but survived the infection. Mice, rats, guinea pigs, hamsters and Microtus guentheri did not show signs of illness, but developed specific antibodies to B. besnoiti. B. besnoiti subcultivated for 2 years in BL cells remained virulent for gerbils.

Animals↗
PubMed1990

Besnoitiosis of the reproductive tract of a Blue Duiker (Cephalophus monticola).

A mature male Blue Duiker that had been born in the United States was submitted for necropsy examination following a brief illness. On histologic examination of the reproductive tract several Besnoitia cysts were found in the epididymis, prostate and bulbourethral gland. The lack of an inflammatory response or any negative effect on fertility, based on histologic evaluation and breeding history, is in contrast with the severe orchitis, epididymitis and infertility of besnoitiosis in cattle. This is the first report of an autochthonous infection of Besnoitia in the United States as well as the first report of besnoitiosis in a Blue Duiker.

Animals↗
PubMed2004

The spectrum of colovesical fistula and diagnostic paradigm.

BACKGROUND: Our experience with colovesical fistula (CVF) over a 12-year period was reviewed to clarify its clinical presentation and diagnostic confirmation. METHODS: Twelve patients with CVF were identified. Presenting symptoms, etiologic factors, diagnostic investigations, and subsequent treatment were reviewed. RESULTS: Underlying etiologies were diverticular disease (75%), colon cancer (16%), and bladder cancer (8%). Pneumaturia (77%) was the most common presentation, followed by urinary tract infections, dysuria and frequency (45%), fecaluria (36%), hematuria (22%), and orchitis (10%). The ability of various preoperative investigations to identify a CVF were: computed tomography (CT) (90%), barium enema (BE) (20%), and cystography (11%), whereas cystoscopy, intravenous pyelogram (IVP), and colonoscopy were nondiagnostic. All patients underwent single- or multiple-staged repair of the fistula. CONCLUSIONS: In patients with a suspected CVF, we recommend CT followed by a colonoscopy as a first-line investigation to rule out malignancy as a cause of CVF. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management.

Aged↗
PubMed2003

[35-year measles, mumps, rubella vaccination assessment in France].

AIM: The setting-up and the follow-up of a vaccination programme require important human and economical investments. Our study objective consists of the clinical benefit evaluation given by measles, mumps and rubella (MMR) vaccination since monovalent and combined vaccines availability (35 years for measles, 30 years for rubella and 20 years for mumps). METHOD: Vaccination impact has been evaluated from the modelisation for each disease under the shape of a decision tree relying on epidemiological data and on efficacy data of the vaccines. We have compared the results in terms of complications, sequaela, deaths in the vaccinated population (vaccination period) with the results that we would obtain if this same population had not been vaccinated (non vaccination period). The general model was applied to each of the three diseases excluding congenital rubella syndrome. They have been modelised according to the occurrence, or not, of a complication leading to an evolution towards either recovery or sequaela or death. The estimation of the number of avoided congenital rubella syndromes has been made from the number of protected women by vaccination and incidence figures of congenital rubella syndromes reported in the population considered before and after vaccination. RESULTS: In France over the period of time considered, almost 2 million meningitis, 60 000 encephalitis, 170 subacute sclerosis panencephalitis and more than 5600 neurological sequaela including more than 600 deafness cases have been avoided as a result of the MMR vaccination programme. Moreover, 590 000 pneumonia, more than one million of acute otitis media and 300 000 orchitis, 3000 rubella infection cases occurring during pregnancy have also been avoided. Overall, more than 12 000 deaths that have been avoided as a result of the MMR vaccination. CONCLUSIONS: In France, MMR vaccination programme leads to a huge benefit in terms of public health, which emphasises the true value of vaccination in the daily medical practice.

Adult↗
PubMed2006

Long-term followup of patients after redo bladder neck reconstruction for bladder exstrophy complex.

PURPOSE: The aim of this study was to determine whether redo bladder neck reconstruction is effective in achieving continence after a failed bladder neck reconstruction procedure. MATERIALS AND METHODS: We retrospectively reviewed the hospital records of patients with bladder exstrophy who had undergone redo bladder neck reconstruction. There were 30 patients in the study, including 20 boys and 10 girls. Mean patient age at redo bladder neck reconstruction was 9.3 years (range 3.2 to 15.5). The patients were divided into 3 groups on the basis of the preoperative pattern of incontinence--incomplete wetters, complete wetters and those on continuous suprapubic drainage. Of the patients 15 already had undergone bladder augmentation, 12 had undergone a Mitrofanoff procedure and 12 had been treated with bulking agents injected in the bladder neck in an attempt to achieve continence. Four patients had undergone more than 1 bladder neck procedure. The patients were investigated with a combination of noninvasive urodynamics, cystoscopy, cystogram and ultrasound. All patients underwent Mitchell's modification of Young-Dees-Leadbetter bladder neck reconstruction. Additional procedures performed included augmentation cystoplasty and Mitrofanoff formation. RESULTS: Mean followup was 6.9 years (range 1.2 to 15.5). Postoperatively 28 patients were using clean intermittent catheterization to empty the bladder (5 per urethra, 23 via Mitrofanoff). Two patients remained on continuous suprapubic catheter drainage. A total of 18 patients (60%) were dry postoperatively (80% of girls and 50% of boys). Among dry patients only 3 were performing clean intermittent catheterization per urethra and 15 via a Mitrofanoff channel. No patient was able to void per urethra without the need for clean intermittent catheterization. The 2 patients on continuous suprapubic catheter drainage continued to remain so. At night only 50% of the patients were dry (5 on free drainage, 4 on clean intermittent catheterization, 6 not on any drainage). Those patients who did not respond satisfactorily to redo bladder neck reconstruction underwent subsequent additional procedures, which included injection of bulking agents (3 patients), insertion of an artificial urinary sphincter (1), Mitrofanoff formation (2) and bladder augmentation plus Mitrofanoff channel (1). Postoperative complications included difficulty with clean intermittent catheterization (8 patients), perivesical leak (1), recurrent epididymo-orchitis (1), upper urinary tract dilatation (2) and incisional hernia (1). Bladder neck closure was being considered in 5 patients. CONCLUSIONS: In our experience redo bladder neck reconstruction cannot achieve continence with volitional voiding per urethra. Although redo bladder neck reconstruction can render a significant number of patients dry, it is only effective if performed in conjunction with augmentation. Failure of the initial bladder neck reconstruction may be a reflection of a bladder that is of inadequate capacity and/or compliance. Therefore, bladder augmentation should be considered in all patients requiring redo bladder neck reconstruction. Bladder neck closure may be a better alternative to redo bladder neck reconstruction.

Adolescent↗
PubMed2006

Patient-reported outcomes after inguinal herniorrhaphy.

BACKGROUND: Patient-reported outcomes (PRO) reflect the functional outcomes of inguinal herniorrhaphy. We studied the effect of hernia recurrence and complications on PRO for participants in the Veterans Affairs trial of Open or Laparoscopic Repair of Inguinal Hernia. METHODS: Analyzed PRO included (1) the Medical Outcomes Study Short Form 36, version 2, (2) the Surgical Pain Scale, (3) the Activities Assessment Scale, and (4) patient satisfaction. Recurrences and complications were recorded at follow-up visits. Complications were categorized by (1) hematoma/seroma, (2) orchitis, (3) neuralgia, and (4) other. Univariate and multivariable regression analyses identified variables significantly associated with postoperative PRO. RESULTS: Of the 1603 patients with PRO data, 105 had a recurrence and 342 had a complication at 2 years. Multivariable analyses showed neuralgia (P < .0005) adversely affected all PRO, and recurrence (P < .05) affected patient-reported pain, activity, and satisfaction, but not the score for the Medical Outcomes Study Short Form 3. Patients with a recurrence after open repair had more pain than those with a recurrence after laparoscopic repair (P = .0001). Patients with other complications after laparoscopic repair reported more pain and less activity than those with other complications after open repair (P = .003 and P = .009, respectively). CONCLUSIONS: The effectiveness of inguinal herniorrhaphy should be measured by the rate of recurrence and neuralgia. Postoperative neuralgias have a deleterious effect on all patient-reported outcomes.

Activities of Daily Living↗
PubMed2004

Epididymitis after prostate brachytherapy.

OBJECTIVES: To analyze the incidence, time-course, and potential predisposing factors for what was clinically diagnosed as postimplant epididymitis. METHODS: Of 517 patients randomized and treated on two treatment protocols, with a planned total accrual of 1200, 5 patients were identified who developed clinically diagnosed epididymitis after iodine-125 or pallidium-103 prostate brachytherapy. Implants were performed by standard techniques, using a modified peripheral loading pattern. Perioperative antibiotics (cefazolin and ciprofloxacin) were given to 258 patients, according to physician preference. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological Association (AUA) and Radiation Therapy Oncology Group criteria at 1, 3, 6, 12, and 24 months. Patients who did not respond to the mailed questionnaires were interviewed by telephone. Although the patients were not queried specifically regarding epididymitis, its occurrence was noted when discovered in the course of follow-up examinations. RESULTS: Postimplant epididymitis occurred in 5 (1%) of 517 consecutive brachytherapy patients. None of the 5 patients had had a prior history of orchitis, epididymitis, vasectomy, or preimplant catheterization. The symptoms of epididymitis first appeared at 4, 7, 10, 150, and 300 days after implantation. Patients with epididymitis had prostate volumes, preimplant AUA scores, and ages typical of other implant patients. No association was apparent between postimplant epididymitis and the degree of implant-related prostate swelling or the number of seeds implanted. Only the preimplant AUA score predicted for epididymitis, but 2 of the 5 patients had low scores. Only 1 (0.4%) of the 258 patients who received perioperative antibiotics developed epididymitis, and 4 (1.5%) of the 259 patients with prophylactic antibiotics developed epididymitis. CONCLUSIONS: Epididymitis is an uncommon postimplant complication occurring in 1% of a large patient cohort. That epididymitis patients had greater preimplant AUA scores is consistent with a retrograde infection route, at least in some cases.

Adenocarcinoma↗
PubMed2005

Testicular torsion in a 68-year-old man.

Testicular torsion is a rare, yet often underrecognized, cause of scrotal pain in adult men. Few reports have commented on testicular torsion in the geriatric population. We report a case of a 68-year-old man initially diagnosed with epididymo-orchitis, who, on surgical exploration, was found to have intravaginal testicular torsion. The diagnosis in this patient population is often delayed, leading to poor salvage rates. The use of color Doppler ultrasonography should be strongly considered if the history and physical examination is suggestive of testicular torsion, regardless of patient age.

Aged↗
PubMed2006

Simple differentiation method of mumps Hoshino vaccine strain from wild strains by reverse transcription loop-mediated isothermal amplification (RT-LAMP).

Mumps virus is still circulating and annual mumps outbreaks occur with fluctuating magnitudes in Japan. Aseptic meningitis has been reported after vaccination and it would be of importance to determine whether this was related to the vaccination. The objective of this study was to develop a sensitive, specific and rapid diagnostic method for the differentiation of the Hoshino vaccine strain from circulating wild types. We developed a reverse transcription loop-mediated isothermal amplification (RT-LAMP) method of the hemagglutinin neuraminidase (HN) region for the detection of mumps virus genome from clinical samples. The typical ladder pattern disappeared after the LAMP products of the Hoshino vaccine strain were digested with ScaI, but those of wild types were not cut by ScaI. We obtained 19 cerebro spinal fluids (CSF) from the patients with aseptic meningitis and 17 salivary swab samples from the patients with acute parotitis after mumps vaccination, in which one case was complicated with orchitis. Mumps virus genome was detected in 18 CSF samples and in all NPS by RT-LAMP. The Hoshino vaccine strain was identified in 16 out of 18 CSF RT-LAMP positives and in 11 out of 17 NPS samples and the remaining samples were identified as wild types. RT-LAMP followed by ScaI digestion is a sensitive, simple and rapid differential method and useful for laboratory surveillance for vaccine-adverse events.

Base Sequence↗
PubMed2006

Severe outbreak of disease in the southern chamois (Rupicapra pyrenaica) associated with border disease virus infection.

An outbreak of a previously unreported disease affecting southern chamois (Rupicapra pyrenaica) in the central Pyrenees (NE Spain) was recorded in 2001 and 2002. There was a marked temporal distribution, most animals being found between February and June. After the outbreak, the population was found to have decreased by about 42%, most probably due to the disease. We examined 20 affected chamois. Clinical manifestations included depression, weakness and movement difficulties in all cases. Three chamois presented abnormal behaviour, with absence of flight reaction, and 16 showed different degrees of alopecia with skin hyperpigmentation. At necropsy cachexia was observed in all animals, four chamois had abscesses in different parts of the body, four had pneumonia, one had an extensive subcutaneous infection on the head and neck and one had severe orchitis. Microscopic lesions were found in the brain, mainly edema, gliosis, espongiosis, cariorrexis and neuronal multifocal necrosis. A perivascular mononuclear inflammatory infiltrate was present in three of them. Skin lesions included marked follicular atrophy, mild to moderate epidermal hyperplasia with orthokeratotic hyperkeratosis and follicular hyperkeratosis, and hypermelanosis. In 13 chamois there were haemosiderin deposits in the spleen, and in three individuals kidney "cloissone" was observed. Intraeritrocitic parasites were detected either by direct observation or PCR in 8 of 17 chamois. A pestivirus was isolated and detected by RT-PCR from 12 of 13 affected chamois and antigenic characterized as border disease virus by monoclonal antibodies. This is the first time a border disease virus has been associated with an outbreak of a high-mortality disease in a wild species.

Animals↗
PubMed2003

Testicular sparganosis in a child from Uruguay.

A patient 9 years old had a painless tumor in the left testicle. The left testicle measured about 5 cm long and about 3 cm wide and was stony hard in part. From an echographic image, the patient was diagnosed to have a hematoma in the left testicle. The left testicle was surgically removed. From histological observations, burrows were surrounded by numerous eosinophils in the testicle, epididymis and tunica vaginalis. Cross sections of spargana were in the burrows. Severe granulomatous orchitis and epididymitis were around the burrows. This case was the second one of human sparganosis in Uruguay.

Animals↗
PubMed2004

Collapse and restoration of MHC class-I-dependent immune privilege: exploiting the human hair follicle as a model.

The collapse of major histocompatibility complex (MHC) class-I-dependent immune privilege can lead to autoimmune disease or fetal rejection. Pragmatic and instructive models are needed to clarify the as yet obscure controls of MHC class I down-regulation in situ, to dissect the principles of immune privilege generation, maintenance, and collapse as well as to develop more effective strategies for immune privilege restoration. Here, we propose that human scalp hair follicles, which are abundantly available and easily studied, are ideally suited for this purpose: interferon-gamma induces ectopic MHC class I expression in the constitutively MHC class-I-negative hair matrix epithelium of organ-cultured anagen hair bulbs, likely via interferon regulatory factor-1, along with up-regulation of the MHC class I pathway molecules beta(2)microglobulin and transporter associated with antigen processing (TAP-2). In the first report to identify natural immunomodulators capable of down-regulating MHC class I expression in situ in a normal, neuroectoderm-derived human tissue, we show that ectopic MHC class I expression in human anagen hair bulbs can be normalized by treatment with alpha-MSH, IGF-1, or TGF-beta1, all of which are locally generated, as well as by FK506. These agents are promising candidates for immune privilege restoration and for suppressing MHC class I expression where this is clinically desired (eg, in alopecia areata, multiple sclerosis, autoimmune uveitis, mumps orchitis, and fetal or allograft rejection).

Down-Regulation↗
PubMedDate not supplied

An outbreak of cameline filariasis in the Sudan.

Sheathed microfilariae (mean length 278 +/- 10 microns SEM; mean width 7.2 +/- 0.8 microns) were detected in the blood of 7/14 housed camels (Camelus dromedarius). Microfilaraemic camels of either sex were inappetent, lethargic, reluctant to move and exhibited weakness in the hind limbs; some remained in sternal recumbency. Cardiac disorders, orchitis and skin nodules were conspicuously absent. The microfilariae showed a biphasic pattern in the blood that peaked at 20:00 and plateaued between 04:00 and 06:00. Adult filarial worms were recovered from the mesenteric and femoral arteries. Marked clinical improvement within 1-2 weeks was seen in three camels treated at 10:00 with a single subcutaneous injection of 0.2 mg/kg of ivermectin. These camels became amicrofilaraemic 2-5 days after treatment and remained so for the length of the observation period (133 days). Treatment of two camels at the time of high microfilaraemia (06:30) resulted in adverse reaction and death.

Animals↗
PubMed1984

Radionuclide evaluation of acute scrotal disease.

Technetium-99m sodium pertechnetate scintigraphy is an established method for evaluating organ perfusion and can be applied to the investigation of suspected testicular ischaemia due to acute torsion. One hundred and six consecutive scrotal investigations have been analysed qualitatively and quantitatively using a computer-based comparison of the perfusion slopes over each testis. Decreased vascularity on the symptomatic side only occurs in torsion and quantitative analysis is needed to detect it reliably. Increased vascularity on the symptomatic side can usually be detected qualitatively and occurs in orchitis, tumours, trauma and resolved torsion. Distinction between the causes of increased vascularity is aided by the clinical data. A halo of increased activity surrounding a relatively cold centre was seen in chronic torsion, some tumours and hydrocoeles. The test is both sensitive and specific for acute torsion but its usefulness is limited if it is not available at all hours. The test is useful, also, in confirming a diagnosis that does not require emergency operation and in identifying chronic torsion which is an indication for contralateral orchidopexy.

Acute Disease↗
PubMed2000

Safety and effectiveness of vasectomy.

OBJECTIVE: To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy. DESIGN: A systematic MEDLINE review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998. MAIN OUTCOME MEASURE(S): Early failure rates are <1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%-6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers. CONCLUSION(S): Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.

Adolescent↗