Biomedical subjects
Publications and source records attributed to A A Caldamone.
Artifactual urethral obstruction at the suspensory ligament of the penis may be produced if the penis is left in its normally dependent position during a urethrogram. We present 2 such cases to re-emphasize this phenomenon so that caution is taken in interpreting distal bulbous urethral strictures.
In adult patients with Leydig cell tumor of the testis, endocrinologic signs occur in 30 per cent of the cases and often precede the onset of a palpable testicular mass. Gynecomastia is the most common endocrinologic manifestation and probably is due to increased estrogen secretion by the Leydig cells. In the patient with adrenogenital syndrome and testicular enlargement it is difficult to distinguish Leydig cell tumor from adrenal rest hypertrophy. Four patients with Leydig cell tumor and endocrinologic manifestations are discussed; three are adults who presented with gynecomastia and the fourth is a patient with congenital adrenogenital syndrome. In the adult patient inguinal orchiectomy is the treatment of choice, while in the patient with adrenogenital syndrome initial management by high-dose steroid suppression should be attempted prior to testicular exploration.
More and more renal artery aneurysms are being diagnosed, especially after the introduction of selective arteriography for the evaluation of renovascular hypertension. However, renal artery aneurysm still remains a rare entity. The pathogenesis of renal artery aneurysm is identical to the pathogenesis of arterial aneurysm in other arteries. Symptoms of aneurysm of the renal artery are dependent on a variety of factors, the most important of which are the size of the aneurysm, its location, and whether or not rupture has occurred. The indication for operation on renal artery aneurysm is rupture or threat of rupture. Herein we present a review of the literature and a report of 2 cases which exemplify the capabilities of the surgeon in dealing with such cases.
Low seminal plasma zinc is an indication of prostatic secretory dysfunction. We have identified a group of patients referred for infertility evaluation who demonstrated low seminal plasma zinc and decreased sperm motility, in the absence of infection. Treatment of these patients with oral zinc sulfate results in improved sperm motility.
The predominant electrolyte imbalance associated with enterourinary fistulas is hyperchloremic acidosis. The mechanism is the absorption of urinary electrolytes across the colonic mucosa. One of the genitourinary associated anomalies of a high imperforate anus is a rectourinary fistula. There have been 5 cases of hyperchloremic acidosis as a complication of an imperforate anus with a rectourinary fistula reported in the literature to date. An additional case is presented with a clinical analysis of the previously reported cases. The important factors in the development of hyperchloremic acidosis in patients with an imperforate anus are 1) the presence of a rectourinary fistula, 2) an initial diverting colostomy permitting a long segment of colonic mucosa for the absorption of urinary electrolytes, 3) distal urinary tract obstruction allowing significant volumes of urine to flow into the colonic segment and 4) the presence of urinary tract infection contributing to the urinary obstruction. Management should consist of vigorous electrolyte therapy, decreasing the retrograde flow of urine into the colon by temporary catheterization and early repair of the fistulous tract.
A number of reports have shown that serotonin has a detrimental effect on spermatogenesis and androgen synthesis. Serotonin has 2 mechanisms of action on the testicle: 1) vasoconstrictive changes and 2) direct alterations of testicular metabolism and endocrine activity. The data in animals with the experimental varicocele clearly mimic the human situation. All of the seminal parameters except volume are decreased after creating the varicocele. In many infertile patients with a varicocele serotonin may be the inciting factor that results in subfertile semen parameters. This is corroborated by the presence of elevated serotonin levels in spermatic vein plasma of certain patients with a varicocele. More data comparing the relationship between spermatic vein and peripheral blood serotonin levels in patients with and without a varicocele are needed. This investigation also is being pursued in patients undergoing inguinal operations for lesions other than a varicocele.
There is a vast amount of evidence linking the presence of genitourinary infection with infertility. Infection in either partner can result in specific effects on sperm function, accessory sexual gland dysfunction, and the induction of immunologic responses in either partner. Careful investigation for infection should be undertaken in every couple with the complaint of infertility. Treatment needs to be individualized in each instance.
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