Biomedical subjects

Zvi Zukerman

Publications and source records attributed to Zvi Zukerman.

6 recordsLinked to original sources

PubMed2005

Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system.

BACKGROUND: Varicocele is a bilateral vascular disease, involving a network of collaterals and small, retroperitoneal bypasses. The right and the left testicular venous drainage systems are complex and not identical to each other. It was considered a predominantly unilateral (left-sided) disease. Its pathophysiology has not been clearly delineated and the treatments offered do not seem to be effective. The medical literature is replete with articles demonstrating inconsistent and even contradictory results which have led clinicians to dissociate varicocele from male infertility. Since male fertility is preserved with only one healthy testis, male infertility perforce represents bilateral testicular dysfunction. This poses an enigma to clinicians: How can left-sided varicocele causes bilateral testicular dysfunction? METHODS: We investigated the internal spermatic veins by venography to understand testicular damage due to varicocele. A total of 740 venographies of the internal spermatic veins (ISVs) were performed, with sclerotherapy of the ISV as treatment for varicocele. Epon-embedded testicular tissue sections were used to identify blood stagnation in the testis. RESULTS: Varicocele is predominantly a bilateral disease in 84% of cases, associated with collaterals and retroperitoneal venous bypasses in 70% in the left side and 75% in the right side. Histopathology demonstrate stagnation in the testicular microcirculation and hypoxic-ischaemic degenerative changes in all cells' types in the sperms' production site. CONCLUSION: Based on our findings (i) varicocele is a bilateral disease; (ii) the disease is expressed earlier in the left side and is more intense because the blood column is longer in the left side than the right; (iii) partial treatment to the left side only and ignoring bypasses is not adequate to correct the problem; (iv) hypoxia leading to ischaemic damage to both testes is the effect of varicocele due to hydrostatic pressures in the impaired venous drainage system, which exceeds the pressures in the testicular arterial microcirculation due to blood columns produced in the disease; (v) hydrostatic pressure does not depend on vein diameter but on blood column height, only; and (vi) thermography alone or combined with ultrasonography with special attention to the bilaterality of the disease are the best non-invasive tools for its detection.

Adult↗

PubMed2005

[Treatment of vaginismus with the Paula Garburg sphincter muscle exercises].

OBJECTIVE: To prospectively assess and compare a novel approach to the treatment of vaginismus based on Paula Garburg's sphincter muscle exercises to the traditional approach based on Masters & Johnson. PATIENTS AND METHODS: The study population included 60 consecutive patients with vaginismus who were referred to our sex therapy clinic. The patients were randomly assigned into two groups. The study group (30 patients) underwent a step-by-step program consisting of the performance of the Paula Garburg sphincter muscle exercises to achieve pelvic muscle relaxation combined with the active introduction of Young vaginal dilators of graduated size. A control group (30 patients) underwent a behavioral treatment based on Masters and Johnson's desensitization approach that was combined with the active introduction of Young vaginal dilators of graduated size. RESULTS: All patients completed the program, all with a successful outcome, as defined by the achievement of full intercourse or the introduction of a number 6 Young vaginal dilator. The mean number of treatment sessions required for successful outcome was shorter in the study as compared to the control group (4.9 +/- 1.4 vs. 7.4 +/- 3.5, respectively. P < 0.001). Furthermore, while the percentage of patients undergoing up to 5 sessions until successful outcome was significantly higher in the study as compared to the control group (p < 0.05), the percentage of patients undergoing > 10 sessions was significantly lower. CONCLUSION: Paula Garburg's sphincter muscle exercises together with the use of Young vaginal dilators is a simple, easy and very effective treatment for vaginismus. The outcome matched or even surpassed that of the traditional behavioral approaches.

Exercise↗

PubMed2004

Varicocele: a bilateral disease.

OBJECTIVE: To evaluate the prevalence of varicocele in the left and right spermatic veins in infertile men by several methods of examination. DESIGN: Prospective study. SETTING: Andrology unit of a department of obstetrics and gynecology, and interventional radiology unit of the radiology department at a tertiary care facility. PATIENT(S): Two hundred eighty-six infertile men evaluated for varicocele. INTERVENTION(S): Patients underwent evaluation for infertility. Physical examination was followed by contact thermography, Doppler sonography, and venography of both testes. MAIN OUTCOME MEASURE(S): We measured the prevalence of varicocele in the left and right spermatic veins in infertile men, and the response of semen parameters after embolization of internal spermatic vein. RESULT(S): Varicocele was detected by one of the noninvasive methods and confirmed by venography in 255 patients (89.2%): the left site in 45 (17.6%), the right side in 4 (1.5%), and bilaterally in 206 (80.8%). All patients were treated by embolization. Mean sperm concentration increased from 6.12 +/- 1.02 to 21.3 +/- 1.69 million/mL; mean sperm motility from 16.81 +/- 1.51 to 35.90 +/- 1.41%; and mean sperm morphology from 9.75 +/- 0.85 to 16.92 +/- 1.17%. Pregnancy rate was 43.5%. CONCLUSION(S): The present study finds that what was traditionally considered a predominantly unilateral anatomical abnormality apparently has a strikingly high bilateral prevalence (80.7%). This may suggest that we should consider varicocele a bilateral disease. The second finding is the high rate of varicocele detected by venography, thermography, and sonography when compared with physical examination results. Our study may have important implications for treatment, indicating that patients with clinical evidence of unilateral left varicocele should be carefully evaluated for bilateral varicocele.

Functional Laterality↗

PubMed2004

Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities.

PURPOSE: We evaluated the sensitivity of 3 noninvasive methods for detecting left and right varicoceles. MATERIALS AND METHODS: Three noninvasive methods for the detection of varicocele in the left and right internal spermatic veins were evaluated in 214 infertile men, namely, physical examination, scrotal contact thermography and ultrasound Doppler. Venography was used as the reference diagnosis. RESULTS: Varicocele was detected in 195 patients (91.1%), on the left side in 37 (19%), on the right side in 3 (1.5%) and bilaterally in 155 (79.5%). Scrotal contact thermography using varicoscreen proved to be the most accurate method. Sensitivity, specificity, accuracy and positive predictive value were 98.9%, 66.6%, 98.5% and 100%, respectively, for left varicocele, and 95.6%, 91.6%, 94.9% and 98%, respectively, for right varicocele. Doppler sonography was associated with the highest number of false-positive results. Accuracy in evaluating retrograde flow was lowest for both sides for physical examination and highest for the combination of Doppler sonography and contact thermography, with a sensitivity, specificity, accuracy and positive predictive value of 100%, 33.3%, 99.0% and 98.9%, respectively, for the left side, and 97.4%, 58.3%, 90.3% and 91.1%, respectively, for the right side. In 165 (85%) of the 195 patients who underwent internal spermatic vein embolization sperm parameters were improved. CONCLUSIONS: The present study yielded 2 major findings. Thermography is more sensitive and accurate for the detection of varicocele than Doppler ultrasound and physical examination, and it can be used for screening as a single modality in infertile men. Doppler ultrasound and thermography are complementary and their combined use yields the highest sensitivity and accuracy.

Adult↗

PubMed2003

Does preejaculatory penile secretion originating from Cowper's gland contain sperm?

PURPOSE: To determine if spermatozoa are present in the preejaculatory penile secretion, originating from Cowper's gland. METHODS DESIGN: Prospective clinical and laboratory study. SETTING: Andrology and Sex Counseling Unit, Department of Obstetrics and Gynecology, Academic Teaching Hospital. PATIENTS: Five patients referred for premature ejaculation, three for excessive fluid secreted during foreplay and four normal healthy volunteers. INTERVENTION: Glass slide smears of preejaculatory Cowper's gland secretion obtained during foreplay from at least two different occasions, and semen samples after masturbation. MAIN OUTCOME MEASURES: Microscopic examination of air-dried smears, and routine semen analyses. RESULTS: None of the preejaculatory samples contained sperm. All the patients had sperm in routine sperm analyses. CONCLUSIONS: Preejaculatory fluid secreted at the tip of the urethra from Cowper's gland during sexual stimulation did not contain sperm and therefore cannot be responsible for pregnancies during coitus interruptus.

Adult↗

PubMed2002

Preliminary studies on apoptosis in human fetal ovaries.

OBJECTIVE: To evaluate if apoptosis occurs in human germ cells between 19 and 33 gestational weeks (GW). DESIGN: Human fetal ovaries were obtained from aborted fetuses aged 19-33 GW. SETTING: Rabin Medical Center, a major tertiary care and referral center. PATIENT(S): Twenty-seven women undergoing pregnancy termination. The abortions were mostly because of fetal anatomical or chromosomal abnormalities. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Microscopy studies, terminal deoxynucleotidyl transferase (TdT) assay (TUNEL), and immunocytochemistry for B-cell lymphoma/leukemia-2 (bcl-2). RESULT(S): TUNEL assay revealed a slight increase in apoptotic oocytes in fetuses from 23 GW, with a peak at 27 GW. Overexpression of bcl-2 was detected in all ovarian components, regardless of fetal age. CONCLUSION(S): There seems to be a slight increase in apoptosis in oocytes from 23 GW with a peak at 27 GW. However, it is very unlikely that these low apoptotic rates could be the cause of the extensive germ cell loss throughout human pregnancy. The overexpression of bcl-2 possibly suggests either that this gene is necessary to overcome extensive apoptotic activity or that it is responsible for the low apoptosis rates. However, these results should be considered with caution, since the ovaries were mostly from abnormal fetuses after feticide.

Apoptosis↗