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Biomedical subjects

Marc Goldstein

Publications and source records attributed to Marc Goldstein.

44 records · Page 3Linked to original sources
PubMed2002

The diagnosis and treatment of the azoospermic patient in the age of intracytoplasmic sperm injection.

Microsurgical reconstruction remains the treatment of choice for men with reconstructable obstructive azoospermia. Sperm retrieval techniques performed with ICSI are highly effective for men in whom reconstruction is not feasible. In men with nonobstructive azoospermia, the optimization of spermatogenesis with hormonal therapy and, when appropriate, microsurgical varicocelectomy can result in the appearance of adequate sperm in the ejaculate for ICSI. In men with persistent nonobstructive azoospermia, TESE with ICSI has provided encouraging results. Caution must be used when this ART is applied in couples in whom genetic aberrations are detected given certain inheritance of these anomalies, as the genetic consequences of this procedure have not been thoroughly elucidated. Just as the possibility of ICSI was thought to be inconceivable several decades ago, the advent of future sentinel discoveries will present the possibility for realization of achievements that now seem incredulous.

Humans↗
PubMed2002

Topical perioperative antibiotic prophylaxis for minor clean inguinal surgery.

BACKGROUND: In minor clean procedures, such as inguinal hernia repair and varicocelectomy, the efficacy of systemic perioperative antibiotic prophylaxis is not well established. To determine the efficacy of topical antibiotic prophylaxis alone in preventing postoperative wound infection in a minor urologic clean procedure, we retrospectively reviewed the medical records of 1,654 patients who had undergone microsurgical varicocelectomy. STUDY DESIGN: From September 1985 until December 2000, 1,654 men underwent 2,554 microsurgical varicocelectomies (900 bilateral) by a single surgeon (MG). The skin was shaved and then prepped with standard Betadine gel (Purdue Frederick) that was wiped away with 70% ethanol. No systemic antibiotics were used. The wound was irrigated with 1% neomycin at the moment the incision was made, and then every few minutes until the completion of the procedure, which averaged 45 minutes per side. No postoperative antibiotics were used. RESULTS: No wound infections occurred. No patient developed an adverse reaction to topical application of neomycin. One can conclude that the infection rate in this study is no higher than 0.2% with 95% confidence. CONCLUSIONS: Our review of a large series of consecutive clean urologic procedures indicates that by combining a skin preparation of Betadine gel and 70% ethanol with perioperative topical neomycin irrigation at the moment of skin incision, the risk of postoperative wound infection when performing microsurgical varicocelectomy can be effectively reduced to less than 0.2%.

Administration, Topical↗
PubMed2002

Medical backgrounder on varicocele.

Varicocele is an extremely common entity, present in 15% of the male population. Varicoceles are found in approximately 35% of men with primary infertility but 75%-81% of men with secondary infertility. Mounting evidence clearly demonstrates that varicocele causes progressive duration-dependent injury to the testis. Larger varicoceles appear to cause more damage than small varicoceles and, conversely, repair of large varicoceles results in greater improvement of semen quality. Varicocelectomy can halt the progressive duration-dependent decline in semen quality found in men with varicoceles. The earlier the age at which varicocele is repaired, the more likely is recovery of spermatogenic function. Varicocelectomy can also improve Leydig cell function resulting in increased testosterone levels. The most common complications after varicocelectomy are hydrocele formation, testicular artery injury and varicocele persistence or recurrence. The incidence of these complications can be reduced by employing microsurgical techniques, with inguinal or subinguinal operations, and exposure of the external spermatic and scrotal veins. Employment of these advanced techniques of varicocelectomy provide a safe, effective approach to elimination of varicocele, preservation of testicular function and, in a substantial number of men, an increase in semen quality and likelihood of pregnancy.

Animals↗
PubMed2002

Skeletal identification using the frontal sinus region: a retrospective study of 39 cases.

The importance of identification using the frontal sinus has been previously demonstrated in case reports. In this study, 39 cases of identification using frontal sinus comparison from the Ontario Chief Coroner's Office were reviewed and differences between antemortem and postmortem radiographs examined. All cases involved decedents older than twenty years. Three cases were rejected due to poor antemortem and postmortem film quality. One subject had no frontal sinus. Thirty-five cases provided conclusive postmortem to antemortem pattern matches. Sixteen cases also yielded metric (quantitative) matches. Duration between antemortem and postmortem radiographic examinations, age, gender, and cause of death did not affect the ability to obtain a match. This is the largest study undertaken on actual cases and demonstrates the validity of frontal sinus pattern matching for forensic identification.

Adult↗
PubMed2002

Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats.

PURPOSE: Vasoepididymostomy is a technically challenging and complex microsurgical procedure. Recently a new triangulation end-to-side microsurgical technique was reported that allows intussusception of the epididymal tubule into the vasal lumen, resulting in a higher clinical patency rate of 92% with shorter operative time in preliminary clinical studies. We performed a prospective controlled randomized study comparing the patency rate, postoperative sperm granuloma rate and operating time of conventional and intussusception end-to-side vasoepididymostomy in previously vasectomized rats. MATERIALS AND METHODS: We randomized 42, 6-week-old male Wistar rats into 4 groups, including 6 into the sham operation, and 12 each into the control, conventional end-to-side and intussusception end-to-side vasoepididymostomy groups. Bilateral 2-clip vasectomy was performed in all animals except those in the sham operation group. Bilateral intussusception or conventional end-to-side vasoepididymostomy was performed in the assigned animals 2 weeks after vasectomy. Animals in the control group underwent vasectomy only. In the sham operation group the testes were mobilized out of the scrotum and then returned. Rats were sacrificed at 8, 12, 16 and 24 weeks, respectively. The anastomosis and vasectomy sites were inspected for sperm granuloma. To assess patency the abdominal end of the vas was transected and intraluminal fluid was examined microscopically at 400x magnification for the presence of motile sperm. Patency was further confirmed by performing retrograde indigo carmine vasography through the anastomoses. RESULTS: In the intussusception and conventional groups the patency rate was 91.7% and 54.2% (p = 0.004), the sperm granuloma rate was 20.8% and 58.4% (p = 0.035), and average operative time was 65.8 and 67.7 minutes (p = 0.197), respectively. CONCLUSIONS: Intussusception end-to-side vasoepididymostomy is superior to conventional end-to-side vasoepididymostomy with respect to the patency and postoperative sperm granuloma rates. Further investigations are required to confirm such findings clinically in humans.

Anastomosis, Surgical↗
PubMedDate not supplied

Rapid disappearance of spermatozoa after vasal occlusion in the dog.

The reproductive system of the male dog is unusual in that the seminal vesicles and bulbourethral glands are absent. Therefore, we chose the dog as a model to evaluate the effect of seminal vesicles on clearance of spermatozoa from the male reproductive tract after vasal occlusion. Thirty adult male beagle dogs with ejaculates containing at least 500 x 10(6) sperm with greater than 90% motility were used for this study. The dogs' vasa were occluded percutaneously using a Vasocclude clip-applying device through a small scrotal puncture site. Dogs were ejaculated and semen analysis was performed before and after vas occlusion. The first 24 dogs were completely azoospermic 1 week following vas occlusion. In order to explain these unanticipated results, an additional 6 dogs were evaluated to determine the specific time course of sperm disappearance from the ejaculate at 1, 3, 5, and 7 days after vas occlusion. The results revealed that spermatozoa were almost completely absent within 1 day after vas occlusion (99.9% reduction, X = 1.0 + 1.1 x 10(6) sperm per milliliter at 1 day, P <.0005 vs prevas occlusion). The rapid elimination of spermatozoa after vas occlusion indicates that sperm transit rapidly through the vas deferens in dogs. Therefore, the delayed clearance of spermatozoa from the ejaculate in humans may be due to sperm storage in the seminal vesicles.

Animals↗