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Biomedical subjects

G J Matthews

Publications and source records attributed to G J Matthews.

At least 19 recordsLinked to original sources
PubMed1998

Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia.

OBJECTIVE: To characterize treatment outcome after varicocele repair in men with azoospermia and severe oligoasthenospermia. DESIGN: Prospective nonrandomized study. SETTING: University-based medical center. PATIENT(S): Seventy-eight men with a palpable varicocele and absolute azoospermia (n = 22) or severe oligoasthenospermia (n = 56). INTERVENTION(S): Microsurgical varicocelectomy. MAIN OUTCOME MEASURE(S): Sperm count and pregnancy rate. RESULT(S): Twelve (55%) of the 22 men with azoospermia and 35 (69%) of the 51 men with zero motile sperm before surgery had motile sperm observed in their ejaculate after varicocele repair. The total number of motile sperm per ejaculate increased from 0.08 +/- 0.02 x 10(6) before varicocelectomy to 7.2 +/- 2.3 x 10(6) afterward. Twenty-four men (31%) contributed to pregnancies leading to live births (15 unassisted [19%]), including 3 men with azoospermia preoperatively. CONCLUSION(S): Varicocele repair resulted in the induction or enhancement of spermatogenesis for most men with azoospermia or severe oligoasthenospermia. Unassisted pregnancies after varicocele repair in men with profound abnormalities of spermatogenesis are possible. Varicocele repair should be considered for all men with azoospermia and severe oligoasthenospermia.

Female↗
PubMed1998

Microsurgical vasovasostomy: the microdot technique of precision suture placement.

PURPOSE: A technique of vasovasostomy that facilitates precision suture placement is presented. MATERIALS AND METHODS: The technique involves mapping of the planned suture exit points with "microdots" placed on the cut ends of the vas deferens with a microtip marking pen. Microdots are placed at 12, 3, 6 and 9 o'clock positions. Four additional dots are placed between each of the previous 4 dots. Exactly 8 mucosal sutures (double armed 10-zero monofilament sutures) are used for each anastomosis. The anastomosis is completed with 8 muscularis sutures (9-zero monofilament) and 6 to 8 sutures (6-zero monofilament) approximating the vasal sheath. RESULTS: In a series of 194 consecutive vasovasostomy procedures using this technique a patency rate of 99.5% was achieved. Pregnancy rates of 54% (crude) and 64% (excluding female factor infertility) were observed for the first 100 subjects of this cohort. CONCLUSIONS: The microdot technique ensures precision suture placement and facilitates the anastomosis of lumens of discrepant diameters by exact mapping of each planned suture. The microdot method separates the planning from the placement. Patency rates using the microdot technique approach 100%.

Anastomosis, Surgical↗
PubMed1997

Predictive accuracy of transrectal ultrasound-guided prostate biopsy: correlations to matched prostatectomy specimens.

OBJECTIVES: To characterize observed differences in Gleason score between prostate biopsy and corresponding radical retropubic prostatectomy (RRP) specimens. METHODS: One hundred consecutive clinically localized prostate cancers diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and treated with RRP were reviewed. All specimens were evaluated in blinded review by a single expert uropathologist and contrasted with the initial histologic analysis, performed by multiple pathologists. RESULTS: Mean Gleason score of TRUS-Bx specimens for blinded review and at initial evaluation were 6.6 +/- 0.1 and 6.0 +/- 0.1 (P < 0.001). Corresponding RRP values were 6.8 +/- 0.1 and 6.5 +/- 0.1 (P < 0.03). Differences in Gleason score between TRUS-Bx and RRP at initial evaluation were significant (P < 0.02), but not in blinded review (P = NS). In blinded review, TRUS-Bx correctly predicted RRP histology for 88% of men with lesions scored as Gleason 5 to 7 and 41% of men with well-(Gleason score of 2 to 4) or poorly differentiated (Gleason score of 8 to 10) lesions (P < 0.01). CONCLUSIONS: TRUS-Bx does not accurately reflect RRP histology when predicting well- or poorly differentiated lesions. Prostate cancer treatment algorithms should not be predicated upon biopsy histology alone. Histologic interpretation is more accurate and precise when performed by a single experienced uropathologist.

Biopsy↗
PubMed1997

Microsurgical reconstruction following failed vasectomy reversal.

PURPOSE: We characterized microsurgical reconstruction treatment outcomes following a failed vasectomy reversal. MATERIALS AND METHODS: We evaluated 64 repeat vasectomy reversals (52 first and 12 second repeat procedures) performed on 57 men. RESULTS: Of men with absolute azoospermia (initial or complete procedure failures) following vasovasostomy 74% required 1 or more vasoepididymostomies, compared to 24% of men with initially patent vasovasostomies (late failures) (p < 0.001). Crude patency and pregnancy rates were 67 and 30%, respectively, for the entire cohort, 93 and 43%, respectively, for men undergoing vasovasostomy on at least 1 side, and 47 and 15%, respectively, for those undergoing vasoepididymostomy only. Stenosis rates for repeat vasovasostomy and vasoepididymostomy were 27 and 18%, respectively. CONCLUSIONS: Complete failure of vasectomy reversal usually is due to unrecognized epididymal obstruction. Late failure following initial patency suggests a compromised anastomosis. Repeat vasectomy reversals result in patency and pregnancy rates somewhat lower than previously reported for unselected vasovasostomy and vasoepididymostomy. Because stenosis rates are greater following reoperation, intraoperative and postoperative sperm cryopreservation is recommended.

Female↗
PubMed1996

A simplified method of epididymal sperm aspiration.

We present a simple technique of epididymal sperm aspiration that uses inexpensive and readily available materials. Men undergoing epididymal reconstruction with vasoepididymostomy or autogenous sperm reservoir had sperm aspiration for cryopreservation. Mean total and total motile sperm per aspirate recovered from 25 men have been 25.1 +/- 4.8 x 10(6) and 4.0 +/- 1.4 x 10(6), respectively. Two ongoing pregnancies have been achieved with intracytoplasmic sperm injection using thawed epididymal sperm. Sperm aspiration and cryopreservation maximize a couple's fertility potential with a single procedure and provide a viable fertility alternative to a second surgical procedure in the event of a primary reconstructive failure.

Epididymis↗
PubMed1996

Ventriculoperitoneal shunt infection after augmentation cystoplasty.

PURPOSE: We characterized the occurrence of ventriculoperitoneal shunt infections after augmentation cystoplasty. MATERIALS AND METHODS: We reviewed the records of 20 myelodysplastic children with ventriculoperitoneal shunts followed for a minimum of 12 months after augmentation. RESULTS: In 4 children (20%) a ventriculoperitoneal shunt infection developed. The single gram-positive infection occurred early (less than 30 days). The 3 gram-negative infections were delayed presentations (greater than 30 days). Organisms in 2 of the 3 gram-negative infections had been noted in a preoperative urine culture. CONCLUSIONS: Ventriculoperitoneal shunt infection after bladder augmentation is common. Delayed presentation of shunt infections may indicate gram-negative infection. Sterilization of the urinary tract is indicated before augmentation.

Adolescent↗
PubMed1996

In vitro fertilization improves pregnancy rates for sperm obtained by rectal probe ejaculation.

PURPOSE: We evaluated semen quality and pregnancy rates achieved with sperm obtained by rectal probe ejaculation. MATERIALS AND METHODS: A series of 183 rectal probe ejaculation procedures performed by 1 of us (J. F. E.) on 40 anejaculatory men was reviewed. RESULTS: Motile sperm were recovered from 95% of men undergoing rectal probe ejaculation. Live births were recorded for 15 of 33 couples (45%) via intrauterine insemination (10) or in vitro fertilization (5). Three of the latter 5 pregnancies were achieved with intracytoplasmic sperm injection. CONCLUSIONS: Motile sperm are obtained from most men undergoing rectal probe ejaculation and pregnancy rates obtained with these sperm are improved by in vitro fertilization.

Ejaculation↗
PubMed1995

PSA-detected prostate cancer: contrasts with palpable disease.

The clinical and pathologic characteristics of 100 consecutive men with clinically localized prostate cancer and staged by radical prostatectomy were reviewed. Men with impalpable prostate-specific antigen (PSA) detected cancers (T1c) were contrasted against men with palpable disease (TB). Lesions were clinically staged as T1c in 53 men and TB in 47 men. Mean serum PSA for men with T1c cancers was 11.8 +/- 0.7 ng/dL (normal: 0 > 4) and 14.1 +/- 1.7 ng/dL for men with TB disease. Histologic evaluation revealed a mean Gleason's sum of 6.4 +/- 0.2 (scale: 2 > 10) for T1c lesions and 6.6 +/- 0.2 for men with TB cancers (P = NS). DNA content was diploid in 67% of T1c cancers and 62% of TB lesions (P = NS). An overall 43% clinical staging error was observed. Extraprostatic extension was demonstrated in 36% of T1c cancers and 51% TB lesions (P = NS). PSA-detected cancers were indistinguishable from palpable lesions by all measures evaluated. Prostate cancers detected in asymptomatic men by an elevated PSA should be considered biologically significant lesions.

Aged↗
PubMed1995

Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations.

PURPOSE: We evaluate the temporal parameters of patency following vasoepididymostomy and vasovasostomy. MATERIALS AND METHODS: A series of consecutive and concurrent vasoepididymostomies (100) and vasovasostomies (100) performed by a single surgeon (M. G.) was reviewed. RESULTS: Patency rates following vasoepididymostomy and vasovasostomy were 65% and 99%, respectively (p < 0.001). Motile sperm were observed at a mean of 5.8 +/- 0.8 months (standard error) following vasoepididymostomy and 2.1 +/- 0.2 months following vasovasostomy (p < 0.01). Late failure rates were 21% for vasoepididymostomy and 12% for vasovasostomy. Pregnancy rates following vasoepididymostomy and vasovasostomy were 21% and 52%, respectively. CONCLUSIONS: Patency is rapid following vasovasostomy but requires 12 or more months following vasoepididymostomy. Intervention for azoospermia is appropriate 6 months after vasovasostomy and 1 year after vasoepididymostomy. Intraoperative cryopreservation of sperm in men undergoing vasoepididymostomy and postoperatively in all men with motile sperm will maximize fertility options.

Anastomosis, Surgical↗
PubMed1995

Xanthogranulomatous pyelonephritis in pediatric patients.

We observed xanthogranulomatous pyelonephritis in 5 of 27 nephrectomies (18.5%) performed for end stage pyelonephritis. Two patients were 5 months old or younger, of normal birth weight and the products of uncomplicated full-term pregnancies. In all cases clinical histories and findings were consistent with xanthogranulomatous pyelonephritis yet this diagnosis was suspected prospectively in only 1 case. Our observations, supported by recent literature, suggest that xanthogranulomatous pyelonephritis may occur more commonly than previously reported. In addition, the clinical and pathological expression of this process in the pediatric population appears to be no different from that in adults. The true incidence and presumed chronicity of this process need to be reevaluated in light of recent data.

Adolescent↗
PubMed1995

Volume expansion enhances the recovery of renal function and prolongs the diuresis and natriuresis after release of bilateral ureteral obstruction: a possible role for atrial natriuretic peptide.

Plasma atrial natriuretic peptide (ANP) levels are elevated in patients with bilateral ureteral obstruction (BUO). To further evaluate the role of ANP in postobstructive diuresis, natriuresis and recovery of renal function, 3 groups of dogs were studied: Group 1, 6 dogs that underwent 48 hours of unilateral ureteral obstruction (UUO); Group 2, 6 dogs that underwent 48 hours of BUO; and Group 3, 6 dogs volume replete with normal saline during 48 hours of BUO. All 3 groups underwent hourly hemodynamic and clearance studies for 15 hours after the release of obstruction. Group 1 experienced no increase in either urine output or sodium excretion from the ipsilateral or contralateral kidney after release of obstruction. Groups 2 and 3 both experienced an initial diuresis and natriuresis after BUO (p < 0.01). However, in Group 2 diuresis and natriuresis after BUO ceased at 5 and 2 hours, respectively, while in Group 3 both persisted for 10 and 9 hours, respectively. Before obstruction the GFR was similar in all three groups. In Group 1 the GFR decreased significantly in the ipsilateral kidney (34.5 +/- 1.4 to 14.48 +/- 1.5 ml. per minute, (p < 0.01)) and increased significantly in the contralateral kidney (32.4 +/- 2.8 to 44.4 +/- 2.0 ml. per minute, (p < 0.05)) and remained so throughout the postobstruction period. The GFR in Groups 2 and 3 decreased to a similar level 1 hour after release (13.3 +/- 1.7 and 17.5 +/- 3.4 ml. per minute, respectively); however, Group 2 remained decreased during the period after release while group 3 increased to 23.4 +/- 3.4 ml. per minute (p < 0.01) at 11 hours after release of obstruction. In Group 2 the control plasma ANP level was 17.9 +/- 3.7 pg./ml. and was not altered by BUO, whereas ANP increased significantly after 48 hour BUO in Group 3, from 30.6 +/- 6.7 to 63.7 +/- 11.7 pg./ml. (p < 0.01). Before and after 48 hours of BUO, the pulmonary capillary wedge pressure was 5.0 +/- 2.0 mm. Hg and 7.0 +/- 1.0 mm. Hg (NS) in Group 2, while it increased from 7.18 +/- 1.5 mm. Hg to 11.6 +/- 1.9 mm. Hg (p < 0.01) in Group 3. We conclude that volume expansion during BUO enhances postobstructive diuresis and natriuresis and allows a greater recovery of GFR after release of the obstruction. This effect may be mediated through elevated plasma levels of ANP as measured in this study.

Animals↗
PubMed1995

Microsurgical autogenous sperm reservoir with simultaneous epididymal sperm aspiration: a novel approach for the man with surgically unreconstructable obstruction.

The purpose of this article is to present a technique for microsurgical marsupialization of an epididymal tubule to the tunica vaginalis to create an autogenous sperm reservoir (ASR) with simultaneous epididymal aspiration. This procedure is offered to men with bilateral congenital absence of the vas deferens (CAV) or otherwise surgically unreconstructable reproductive tracts. Sperm (mean +/- standard error of the mean, 33 +/- 13 x 10(6)) have been percutaneously recovered by fine needle aspiration of an ASR in 47% (7/15) of men. Motile sperm have been recovered as long as 2 years following surgery. Simultaneous epididymal aspiration at the time of marsupialization has yielded a mean of 20.2 +/- 6.9 x 10(6) total sperm per aspirate. Thawed sperm, recovered and cryopreserved at the time of ASR surgery, has been successfully employed for two couples in pregnancies achieved with in vitro fertilization. The microsurgical ASR is a viable alternative in the treatment of men with CAV or otherwise unreconstructable reproductive tracts. Simultaneous epididymal sperm aspiration maximizes a couples fertility options with a single surgical procedure.

Cryopreservation↗
PubMed1992

Clusterin production in the obstructed rabbit kidney: correlations with loss of renal function.

Clusterin, a protein associated with cell death, has been suggested as a marker of renal injury. Correlation of clusterin gene expression with changes in renal function and quantitative measurement of clusterin protein levels after ureteral obstruction have not been previously reported. With unilateral ureteral obstruction in rabbits as the experimental model, the time course of alterations in renal function, clusterin mRNA accumulation, and concentrations of clusterin protein in serum, urine, and renal tissue were investigated. RBF, GFR, and renal concentrating ability (percent sodium reabsorption and urine osmolarity) all decreased (P < 0.05) in the obstructed kidney from control values within 1 day of ureteral obstruction. Clusterin mRNA levels started to rise in the ipsilateral kidney within 12 h of ureteral obstruction and increased up to 10-fold above control levels after 3 days of obstruction. Hybridization histochemistry showed that clusterin mRNA was initially detectable in collecting ducts and distal tubules within 12 h of ureteral obstruction. After 7 days of obstruction, increased accumulation of clusterin mRNA was also detectable in proximal tubular epithelial cells. Clusterin gene expression remained elevated in collecting ducts after 60 days of obstruction. Clusterin expression in the contralateral kidney was increased twofold over control values after 12 h of obstruction. No increase in clusterin mRNA accumulation was detectable after 24 h in the contralateral kidney. Total clusterin protein in the obstructed kidney increased from 0.59 +/- 0.66 (mean +/- 1 SD) to 2.5 +/- 1.3 micrograms after 7 days of ureteral obstruction (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗