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Biomedical subjects

J W Marsman

Publications and source records attributed to J W Marsman.

At least 19 recordsLinked to original sources
PubMed1995

Clinical and subclinical varicocele: a useful distinction?

OBJECTIVE: The purpose of the study was to establish whether it is useful to make a distinction between clinical and subclinical varicoceles with a view to deciding for treatment or not. Therefore, we compared our results of treatment of clinical vs. subclinical varicoceles. STUDY DESIGN: The changes of semen parameters and the occurrence of pregnancies in 40 infertile men treated for clinical varicocele were compared with those in 46 infertile men treated for subclinical varicocele. The significance of individual semen changes was analysed by paired t-test in both groups and the results of both groups were compared by analysis of covariance. The pregnancy rates were calculated and the life table curves of pregnancy of both groups were compared. RESULTS: There were statistically significant increments in sperm density, motility and morphology both after treatment of clinical and subclinical varicoceles, and these increments did not differ significantly between both groups. The cumulative pregnancy rates after a mean follow-up period of 6.6 years amounted to 42.5% for clinical varicoceles and to 39.1% for subclinical varicoceles and the life table curves of pregnancy ran a rather similar course in both groups. CONCLUSION: We conclude that there is no reason to emphasize the palpatory findings in infertile men with varicocele.

Adult↗
PubMed1995

Risk of small field of view in lumbar spine computed tomography for assumed lumbar disc herniation: beware contained ruptured aortic aneurysm.

Among several other atypical clinical presentations, back and leg pain may ensue from a contained ruptured abdominal aortic aneurysm. The present case concerns a patient whose back and leg pain were primarily thought to be orthopaedic or neurologic in origin. Computed tomography with small field of view, performed for the detection of a possible lumbar disc herniation, only partially showed a paraspinal soft tissue mass. Subsequently, recognition of this mass as a contained ruptured aortic aneurysm was delayed. The literature is reviewed concerning comparable cases and it is concluded that computed tomograms performed for possible lumbar disc herniation should also be screened for paraspinal disease and consequently, the applied field of view should be large enough to include at least the paraspinal psoas regions.

Aged↗
PubMed1995

The aberrantly fed varicocele: frequency, venographic appearance, and results of transcatheter embolization.

OBJECTIVE: Retrograde flow in the internal spermatic vein, which is characteristic of varicocele, can occur despite competent valves because of the presence of bypassing anastomoses. The resulting condition has been called aberrantly fed varicocele. The purpose of this study was to determine the frequency of aberrantly fed varicocele, to analyze its various venographic appearances, and to review the results of attempted embolotherapy. SUBJECTS AND METHODS: We performed left-sided (n = 213) and/or right-sided (n = 121) spermatic venography in 213 patients who were examined for infertility (n = 179), for physical complaints of their varicocele (n = 17), or for varicocele impeding testicular growth (n = 17). The resulting 334 venograms were subdivided as negative or positive for varicocele, and positive venograms were further classified as showing normally or aberrantly fed varicoceles. The aberrantly fed varicoceles were classified according to the sites of the bypassed competent valves and the levels at which the bypassing anastomoses joined the internal spermatic veins. The technical success rate of 192 attempted embolizations of normally and aberrantly fed varicoceles was determined. RESULTS: Of the left-sided spermatic venograms, 42 (20%) were negative and 171 (80%) were positive for varicoceles, which in turn consisted of 125 normally and 30 (19%) aberrantly fed varicoceles (16 could not be classified). On the right side, 78 (64%) venograms were negative and 43 (36%) were positive for varicoceles, consisting of 34 normally and seven (17%) aberrantly fed varicoceles (two were not classified). Venographic classification showed that about half of the cases were in patients with competent orificial valves, which were bypassed by anastomoses joining the internal spermatic veins in their cranial lumbar subsegments. Competent valves lower down were seen only on the left side, and anastomoses joining the internal spermatic veins in their cranial pelvic subsegments occurred relatively more frequently on the right side. Coil embolization was attempted in 118 left-sided and 32 right-sided normally fed varicoceles and in 30 left-sided and seven right-sided aberrantly fed varicoceles. The technical success rate was 97% for left- and right-sided normally fed varicoceles and 73% for left-sided and 57% for right-sided aberrantly fed varicoceles. CONCLUSION: Aberrantly fed varicoceles are found in 17-19% of patients examined with spermatic venography. Coil embolization of aberrantly fed varicoceles is usually successful, but not as reliably as with normally fed varicoceles.

Adolescent↗
PubMed1994

The subclinical varicocele debate.

The debate concerning the indications to treat subclinical varicocele has been on-going for 15 years. In order to understand this debate we have thoroughly reviewed the literature concerning the arguments for and against its treatment. Arguments posed by 59 investigators who considered the possibility of diagnosing subclinical varicocele were analysed. In 26 of these no definite statements were made concerning the value of treatment, in 29 there were positive statements and in only four were there negative statements. The arguments in favour of treatment were mainly based on positive results from patients and on the assumed lack of correlation between the size of varicocele and the degree of infertility. Although the majority of statements were positive, definite conclusions could not be drawn since data from a randomized prospective trial were not available. Consequently it is concluded that the subclinical varicocele debate can only be resolved by performing a randomized trial with treated and untreated groups of patients. Patients undergoing treatment for subclinical varicocele should be made aware that such treatment might not improve their fertility.

Humans↗