Biomedical subjects
Publications and source records attributed to A T Cockett.
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.
A case of polypoid granulomatous and sclerosing endophlebitis of the spermatic cord due to Schistosoma hematobium is described. The lesion was not due to deposition of ova and is believed to have resulted from death of an incarcerated worm mass upstream. As such, the case represents a hitherto unknown form of schistosomal funiculitis. Vascular changes in schistosomiasis are reviewed and a clinicopathologic classification of schistosomal funiculitis is proposed.
In the course of computed tomographic (CT) evaluations involving 200 patients with suspected pelvic disease we have found that scan quality is often suboptimal. A preliminary report employing a low density bladder opacification method is presented whereby an indwelling catheter is inserted to control bladder volume and facilitate the instillation of low density iodinated contrast agent (0.6% Renografin-60). The patient remains supine throughout the twenty-five-minute procedure. Observations during the CT staging and follow-up of a controlled group of 8 patients undergoing immunotherapy and/or radiation therapy for bladder carcinoma indicate that this is a simple, safe, and effective staging procedure. We have obtained reliable clinical-radiologic-pathologic corrlation as a result of careful surgical staging and biopsy, followed by open surgery and full pathologic examination. It is hoped that this information will help initiate other similar studies to determine the diagnostic accuracy of this method and thus its use in pretherapeutic evaluation of the bladder lesion and its subsequent response to treatment.
A left vein varicocele was created in male dogs by partially obstructing the left renal vein medial to the entrance of the left internal spermatic vein. Eight dogs had semen parameters determined preoperatively (2 times/week for five weeks) and postoperatively (2 times/week for twelve weeks). Semen quality was altered by the experimental varicocele. A significant decrease in sperm count, motility, per cent viable, and per cent oval sperm were noted. Semen volume was not affected. The possible chemical influence of serotonin is mentioned. Testosterone levels were unchanged by the varicocele. Histologic findings in the left and right testicles are mentioned before and after creation of the varicocele.
Our results indicate that the physical presence of a varicicele is not always associated with an alteration in sperm cell concentration and that a reduction of semen characteristics is more likely in men with reduced sperm counts. Our study also indicates that a higher pregnancy rate after varicocele ligation occurred in wives of patients in the lower sperm count groups. Other forms of therapy also were found to be associated with pregnancy in wives of men with varicoceles. The post-surgical pregnancy rate was 25 per cent compared to 12 per cent in the non-surgical group.
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.
Determinations of sperm morphology and viability are useful techniques for assessment of semen quality. In this report eosin-nigrosin is compared with hematoxylin-eosin for effectiveness in characterizing spermatozoa. The results indicate that eosin-nigrosin and hematoxylineosin give comparable results in differentiating spermatozoa. In addition, eosin-nigrosin allows the determination of the per cent of viable cells in each morphologic category. The eosin-nigrosin staining technique is a simple, rapid method which may give additional information in the assessment of male infertility.
An eighty-eight-year-old Puerto Rican presented with painless enlargment of one testicle which proved histologically to be due to Schistosoma mansoni. Intratesticular ovum deposits were not associated with inflammation, granulomas, or infarction, but marked sclerosing periorchitis was present. The case illustrates a very rare form of presentation of schistosomiasis which should be considered in the differential diagnosis of unilateral testicular enlargement in patients from an endemic area, despite the fact that orchiectomy will usually be necessary to establish a definitive histopathologic diagnosis.
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.
The individual effects of chlorothiazide, furosemide, and mannitol on renin activity in renal lymph have been studied in dogs. Elevation of renin activity in lymph is noted following infusion with either chlorothiazide or furosemide, while a reduction of renin activity in renal lymph is noted after mannitol infusion. The importance of elevated sodium levels in the proximal end of the distal tubule and its effects on renin release in kidney interstitium is stressed. More work is advocated to elucidate fully the role of renin when released intrarenally.
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The effect of increasing concentrations of amylase on the percentage of active spermatozoa, the quality of their motility and the percentage of viable cells was studied in semen samples in vitro. The amount of amylase needed to liquefy viscous semen samples in vitro also was determined. The percentage of active spermatozoa and viable cells, and the quality of sperm motility were altered in relationship to the amylase levels. Significant decreases in these parameters compared to control values were seen at the higher concentrations of amylase. The lowest level of amylase did not alter these parameters significantly and was sufficient to liquefy 80 per cent of the viscous semen samples. Amylase appears to be effective at low concentrations for use in liquefying viscous semen samples, thus making them easier to analyze during routine semen examination. The level of amylase used and the interval between addition and analysis must be controlled carefully.
Urologic complications related to renal transplantation may be difficult to treat and can be serious threats to life or to function of the transplanted kidney. Successful experience with omentrum for non-transplant and transplant-related reconstructive procedures recommends its further use. Herein are reported 4 patients in whom pedicled flaps of omentum were used to treat transplant-related urologic problems.
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A small number of investigators, including our team, has been responsible during the past two decades for many studies focusing on the kidney lymphatics. Interesting new information and concepts have been published, but unfortunately some of these data are scattered in obscure journals. The major purpose of this, and three subsequent reviews, is to present these new concepts in a more organized fashion. The reviews will also allow our group an opportunity to emphasize physiologic principles which have been ignored in the past. In a future review we will emphasize the role of the immunoblast, found only in kidney lymph and responsible for rejecting the renal allograft. Azathioprine (Imuran), if given early and in adequate dosage, will reduce the role of these transformed lymphocytes. Still another review article will emphasize the importance of renal tissue concentrations of antibacteria in eradicating acute pyelonephritis. Blood and urine levels of antibiotics are also important in eradicating pyelonephritis. Since renal lymph represents interstitial fluid, the concentration of appropriate bacteria-sensitive antibacterials is probably more important. We have now evaluated fourteen antibacterials individually in the mongrel dog, comparing plasma, urine, and renal lymph levels during similar time intervals. Finally, we will review the role of diuretics in altering the interstitial gradient of various solutes. Osmotic diuretics of more potent diuretics which affect renal tubular reabsorption manifest their action by different means when renal lymph fluid is evaluated.
Urinary sediments with significant pyuria were supravitally stained to assess the inflammatory state. Clinic patients showed a significant correlation between acute urinary infection, inflammation, and the predominance of live polymorphonuclear leukocytes. Post-transurethral prostatic resection patients demonstrated to show a predominance of live polymorphonuclear leukocytes, which may be clinically usefull in a more careful selection before relying fully on bacteriologic cultures.
Plasma follicle stimulating hormone, testosterone and urine 5-hydroxyindole acetic acid levels were measured in 300 patients seen at an andrology clinic. Testicular biopsies were obtained from many of the severely oligospermic or azoospermic patients. Plasma follicle stimulating hormone concentrations were related inversely to sperm cell concentration, while plasma testosterone concentrations were depressed as the sperm count decreased to 5 times 10(6) per ml. The urine levels of 5-hydroxyindole acetic acid followed the same pattern as follicle stimulating hormone and were elevated in the group of individuals with sperm counts less than 10 times 10(6) per ml. Elevations in 5-hydroxyindole acetic acid often were associated with abnormalities in the testicular biopsy. Only 30 per cent of the patients who had elevated 5-hydroxyindole acetic acid also had elevated follicle stimulating hormone or depressed testosterone levels. The factors responsible for the elevation in 5-hydroxyindole acetic acid levels as the sperm count declines remain unclear.
Supravital staining of human spermatozoa is a useful technique to assess semen quality. We compared 3 concentrations of eosin (1, 2.5 and 5 per cent) for their effectiveness to differentiate viable and non-viable spermatozoa. The percentage of viable cells determined by each concentration was compared as well as the percentage of cells estimated to be active. The results indicate that the percentage of spermatozoa determined to be viable with the supravital stains can be altered by changing the percentage of eosin in the stains. Use of 1 per cent eosin gave values that were significantly higher than the percentage of cells determined to be viable with 5 per cent eosin and the percentage of cells estimated to be active. Better quality slides were produced with 5 per cent eosin, which provided values that correlated favorably with motility estimations.