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Eric J H Meuleman

Publications and source records attributed to Eric J H Meuleman.

10 recordsLinked to original sources
PubMed2006

Testicular adrenal rest tumors in adult males with congenital adrenal hyperplasia: evaluation of pituitary-gonadal function before and after successful testis-sparing surgery in eight patients.

CONTEXT: In male patients with congenital adrenal hyperplasia (CAH), testicular adrenal rest tumors (TART) are frequently present. These tumors can interfere with testicular function. Intensifying glucocorticoid therapy does not always lead to tumor regression and improvement of testicular function. Recently, testis-sparing surgery was introduced for treatment of TART. OBJECTIVE: The aim of this study was to evaluate tumor volume, symptoms, and pituitary-gonadal function in male patients with CAH caused by 21-hydroxylase deficiency and bilateral TART before and after testis-sparing surgery. SETTING: This study was conducted at Radboud University Nijmegen Medical Centre in The Netherlands. PATIENTS: Eight adult male CAH patients with bilateral TART and infertility were included. INTERVENTIONS: Evaluation of testicular magnetic resonance imaging, symptoms, fasting serum concentrations of ACTH, LH, FSH, inhibin B, 17-OH progesterone, androstenedione, testosterone, and estrone, and semen analysis (six of eight patients) was performed before and 6 and 22 months after testis-sparing surgery. MAIN OUTCOME MEASURES: The main outcome measures were absence of residual tumor and improvement of symptoms and pituitary-gonadal function. RESULTS: Residual tumors were not found on any of the patients' magnetic resonance imaging after surgery. Two patients reported testicular pain and discomfort that disappeared after surgery. Parameters of pituitary-gonadal function did not improve after surgery: semen analysis showed azoospermia (five patients) or oligospermia (one patient) without improvement, and all patients had persistently low inhibin B concentrations. CONCLUSION: Testis-sparing surgery did not improve pituitary-gonadal function despite successful removal of the tumors. Further studies are needed to investigate whether surgery at an earlier stage in the natural history of TART can prevent permanent testicular damage.

17-alpha-Hydroxyprogesterone↗
PubMed2005

Corpus cavernosum electromyography during morning naps in healthy volunteers: further evidence that corpus cavernosum potentials reflect sympathetically mediated activity.

PURPOSE: We assessed the practicability of corpus cavernosum (CC) electromyography (EMG) in volunteers during morning naps in the laboratory and further validated this method. MATERIALS AND METHODS: A total of 11 healthy volunteers with a mean age of 23.8 years (range 19 to 31) were included. CC-EMG was started between 6:30 a.m. and 7 a.m. Two surface electrodes were placed at the base of the penis bilaterally and a reference electrode was placed on 1 kneecap. A strain gauge or Barlow gauge (Behavioral Technology, Salt Lake City, Utah) was used to monitor changes in penile circumference. Subjects were asked to sleep. Recording duration was 2 to 3 hours. Two recordings were performed per subject. RESULTS: Full erection was observed on 17 of the 22 recordings (77%), partial erection was noted on 3 (14%) and no tumescence was observed on the other 2 (9%). CC potentials consistently disappeared during tumescence and erection, while continuous CC potential oscillations reappeared during detumescence. During flaccidity bursts of CC potentials and electrical silence were recorded. Penile shrinkage was observed to accompany CC potentials but not to accompany electrical silence. CONCLUSIONS: CC-EMG during morning naps is a practical and valid method for investigating CC electrophysiology. CC-EMG signal patterns during tumescence, detumescence and flaccidity fit the existing theory that CC potentials reflect cavernous smooth muscle sympathetically mediated activity.

Adult↗
PubMed2003

Fertility in men with testicular germ cell tumors.

OBJECTIVE: To assess the prevalence of fertility or infertility in men before and after treatment for unilateral testicular cancer. The results were compared with the lifetime prevalence of infertility in the general population (20%-28%). DESIGN: Survey. SETTINGS: University referral center for testicular cancer. PATIENT(S): Two hundred twenty-six patients treated for testicular cancer. INTERVENTION(S): Questionnaire on fertility and fertility-related factors before and after treatment of disease. MAIN OUTCOME MEASURE(S): Prevalence of fertility before and after treatment for testicular cancer. RESULT(S): Before the cancer was diagnosed, 79 (66%) of 120 couples who attempted to conceive succeeded within 1 year. After treatment, 38 (43%) of 88 couples conceived within 1 year. Seven couples used cryopreserved sperm to conceive a child after treatment. The different treatment modalities did not significantly influence the outcome of patients' wish for children. Congenital malformations were recorded in approximately 4% of the children born before or after treatment. CONCLUSION(S): Although the majority of the patients with testicular cancer have a fulfilled wish with regard to children, it seems to be more difficult to father a child after treatment compared with the case in the general population. Because it is not possible to predict which patient will have fertility problems after treatment, cryopreservation should be offered to every testicular cancer patient. An increased risk for congenital malformations was not observed.

Adult↗
PubMed2003

Investigations in erectile dysfunction.

PURPOSE OF REVIEW: This is an update of recent developments in the investigation of erectile dysfunction in the period since March 2002. RECENT FINDINGS: Three developments in the field of medical sexology redirected the approach towards the investigation of erectile dysfunction. First, the emergence of oral pharmacological therapy; second, the notion that sexual relationship issues have an important impact on the successful outcome of pharmacological therapy; and finally, the concept that erectile dysfunction is often a sequel or even a sentinel of cardiovascular disease. Consequently, the current evaluation of men with erectile dysfunction may be divided into two steps: a basic diagnostic evaluation for the majority of men, and specific diagnostic procedures for a small minority. The basic evaluation is aimed at the identification of the underlying pathological condition and erectile dysfunction-associated risk factors. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical and psychological conditions that manifest with erectile dysfunction. The basic evaluation consists of a comprehensive medical, sexual and psychosocial history and a physical examination. Patients who have failed first-line treatment or complicated cases qualify for specific diagnostic procedures, traditionally performed by urologists. SUMMARY: Current research into the investigation of erectile dysfunction emphasizes the notion that erectile dysfunction is often a result of an interplay between medical and psychosexual conditions. Recognition of the underlying conditions and an estimation of their relative contribution to the patient's and his partner's sexual problem are key issues in the current evaluation of the man with erectile dysfunction.

Erectile Dysfunction↗
PubMed2003

Review of tadalafil in the treatment of erectile dysfunction.

Approximately 150 million men worldwide experience erectile dysfunction (ED) whereby they are unable to achieve and maintain an erection adequate for satisfactory sexual performance. ED has a considerable impact on quality of life. Tadalafil (Cialis( trade mark ), Eli Lilly & Co./ICOS) is a novel effective and safe phosphodiesterase type 5 inhibitor, a secondary messenger for the smooth muscle relaxing effects of nitric oxide, which plays a central role in the vasodilation of erectile tissues. It has a longer half-life than sildenafil. As head-to-head comparative trials are lacking, it is not clear what tadalafil offers over sildenafil. In terms of marketing, much is made of the 'spontaneity' achievable because of the (relatively) longer half-life of tadalafil.

Aged↗
PubMedDate not supplied

Underestimation of subfertility among relatives when using a family history: taboo bias.

Family history is widely used in clinical practice and research in order to study genetic aspects of disorders in general, and is recommended as a tool in the assessment of male subfertility. Unfortunately, little is known about the validity of this tool. In this survey, we sent questionnaires to 474 randomly selected men aged 25-40 years in order to collect data on subfertility among them and their relatives. A nonresponder study was also conducted in order to evaluate selection bias. A personal interview was also performed with some respondents in order to gauge how well the data corresponded with questionnaires that were returned. Two hundred forty-three men (51.3%) completed the questionnaire. The responders reported a significantly lower prevalence of subfertility among their relatives than among themselves. Among brothers, the reported prevalence was about 5 times lower (ie, 3.6%) than among responders (15.3%). The nonresponder study and personal interviews showed that these differences were not caused by a selective response to the survey or by the use of a questionnaire instead of a personal interview. We conclude that subfertility among relatives is severely underestimated through the use of family history, probably because of the taboo of discussing subfertility. Knowledge of subfertility may spread selectively within families, causing substantial misclassification. Therefore, researchers and clinicians should be aware that an inquiry of family history is likely to lead to underestimation of subfertility among relatives.

Adult↗
PubMedDate not supplied

Evaluation of ICSI-selected epididymal sperm samples of obstructive azoospermic males by the CKIA system.

The objective of this study was to evaluate nuclear normality in intracytoplasmic sperm injection (ICSI)-selected epididymal sperm from obstructive azoospermic (OA) patients. We evaluated whether the selection criteria used in routine ICSI (morphology and motility at a magnification of 400x) is adequate for selecting "normal" sperm from epididymal samples. Surgically retrieved spermatozoa from the caput epididymis of 15 OA patients and ejaculated sperm samples from 9 normospermic donors were evaluated with a DNA-specific stain (Feulgen) and in combination with the computerized karyometric image analysis (CKIA) system. Original (unselected) samples and ICSI-selected sperm were compared in donor and patient samples. In the original fraction, a larger variation in almost all measured parameters was found in epididymal sperm than in ejaculated sperm. After sperm selection, the morphometry was comparable between epididymal and ejaculated sperm. However, for those parameters related to the DNA stainability and chromatin texture (nuclear condensation), significant differences between patients and donors were observed. This result suggests that the size and form of the sperm do not necessarily hold similar internal structures. Thus, the frequency of "normal" sperm significantly increased after ICSI selection, but the improvement was more marked in donor than in OA patients' samples. In conclusion, at least a twofold increase in the number of normal spermatozoa was achieved after ICSI selection. The heterogeneity in the stainability and chromatin condensation of epididymal samples from OA patients indicates that some of the selected spermatozoa have a hypocondensed or hypercondensed chromatin. Even in the best of donor cases, no more than 55% of the selected sperm scored normal with CKIA, indicating that the present routine ICSI selection criteria are not sufficient for selecting normal condensed nuclei.

Ejaculation↗
PubMedDate not supplied

Phenotypic characteristics of male subfertility and its familial occurrence.

Genetic factors can attribute to male subfertility. A case-control study was carried out to investigate familial occurrence of male subfertility and the phenotypic characteristics of familial male subfertility. The medical data and family histories of 253 severely subfertile men who were candidates for intracytoplasmic sperm injection were compared to the data from 243 randomly selected men. The prevalence of male fertility problems among brothers and maternal uncles of subfertile men was significantly higher than among controls (brothers 10.4% vs 0.5% and maternal uncles 1.7% vs 0.2%). The phenotypes of subfertile men with a positive family history more often showed normal levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) compared to the phenotypes of subfertile men with a negative family history. In addition, subfertile men with a positive family history had a lower percentage of motile sperm. Genetic aberrations, including a chromosomal abnormality or a microdeletion of the Y chromosome, were present in 13.8% of the severely subfertile men. Male subfertility appears to have a familial occurrence, especially among brothers and maternal uncles. Furthermore, examination of the data suggests that subfertile men with a familial occurrence of male subfertility more often have normal levels of FSH and LH and a lower percentage of motile sperm.

Adult↗