Akira Iwasaki

TRANSARTERIAL EMBOLIZATION AND ABLATION OF RENAL ARTERIOVENOUS MALFORMATIONS: EFFICACY AND DAMAGES IN 30 PATIENTS WITH LONG-TERM FOLLOWUP

PURPOSE We evaluate the long-term efficacy and side effects of transarterial embolization and ablation for renal arteriovenous malformations. MATERIALS AND METHODS A total of 30 patients with cirsoid arteriovenous malformations causing massive hematuria underwent 34 procedures of embolization or ablation. We confirmed the ratios of occluded arteriovenous malformation areas on angiograms and those of infarcted areas on computerized tomography. All patients were followed for 4.1 to 15.0 years (mean 8.0 +/- 2.8) after the initial procedures. RESULTS Hematuria ceased in all patients after the initial procedures, including partial embolization or ablation of the arteriovenous malformations in 8. Massive hematuria recurred in 4 patients, who had undergone absorbable gelatin sponge (2), embolization, combined alcohol and subselective absorbable gelatin sponge embolization (1) and polyvinyl alcohol particles embolization (1). In these 4 cases total ablation of the arteriovenous malformations with alcohol was successful. In 29 patients, including aforementioned 4, no hematuria recurred after 5 years following total or partial ablation with alcohol. Large nontarget embolization with reflux of subselectively infused absorbable gelatin sponge caused a nonfunctioning kidney in 1 patient. The remaining 33 procedures caused 6.3 to 48.0% (mean 15.7 +/- 6.9%) areas of renal infarction. Polyvinyl alcohol embolization caused pulmonary embolism and renin dependent hypertension. CONCLUSIONS Partial or total transarterial ablation of arteriovenous malformations with alcohol proved effective for long-term cessation of hematuria. However, this procedure as well as transarterial embolization has the potential risk of nontarget infarction.

Effect of reactive oxygen species in semen on the pregnancy of infertile couples.

Objective:  We intended retrospectively to investigate whether reactive oxygen species (ROS) levels, detected in whole semen, were correlated with the actual pregnancy rate.

Successful pregnancy with sperm retrieved from the bladder after the introduction of a low-electrolyte solution for retrograde ejaculation.

OBJECTIVE To determine the safety and efficacy of the introduction of a low-electrolyte solution into the bladder before masturbation for sperm recovery in patients with retrograde ejaculation. DESIGN Two case reports. SETTING Assisted reproduction practice at a university hospital. PATIENT(S) Two men with retrograde ejaculation. INTERVENTION(S) A 0.32-mol/L glucose solution or Hams modified F-10 medium (GIBCO, Grand Island, NY) with 10% serum was introduced into the urinary bladder before masturbation. The retrieved sperm were used for IUI. MAIN OUTCOME MEASURE(S) The motility of retrieved sperm, achievement of pregnancy, and outcome of pregnancy. RESULT(S) In patient 1, the motility rate of sperm retrieved from the bladder after the introduction of Hams modified F-10 medium was higher than that after the introduction of a glucose solution. The patients wife did not become pregnant during 10 IUI cycles after treatment with Hams modified F-10 medium. However, she became pregnant during the first IUI cycle after treatment with a glucose solution and was delivered of healthy twin infants. The wife of patient 2 also became pregnant during the first IUI cycle after treatment with a glucose solution and was delivered of a healthy female infant. CONCLUSION(S) The introduction of a glucose solution appears to be a safe and simple method for sperm recovery in patients with retrograde ejaculation.

A new method of the electrolyte-free long-term preservation of human sperm at 4°C

Objectives To develop a new method for the long-term preservation of human sperm. Setting Andrology laboratory of our hospital. Patients Thirty-one normal and 19 asthenozoospermie semen samples obtained from patients attending our infertility clinic. The average sperm motility was 70.2% and 36.0% in the normal and asthenozoospermie groups, respectively. Interventions Ejaculated sperm were centrifuged and washed using the electrolyte-free Percoll gradient and then were preserved at 4°C. Main Outcome Measures The motility of the preserved sperm was analyzed using computer-assisted semen analyzer after the addition of Hams modified F-10 (GIBCO, Grand Island, NY). Results In the normal group, motility rate after the addition of Hams F-10 for 1, 2, and 4 weeks of preservation was 65.4%, 40.4%, and 5.5%, respectively. In the asthenozoospermie group, motility rate after 1 and 2 weeks of preservation was 31.3% and 18.1%, respectively. Preservation solutions containing sodium or potassium decreased motility after preservation. Restoration of preserved sperm was not achieved by incubation alone; however, reinitiation was induced by incubation together with Hams F-10. Conclusions Human sperm in the electrolyte-free solution survived for a long period of time at 4°C and reinitiation of sperm motility after preservation required the addition of Hams F-10.

The role of potassium ion and extracellular alkalization in reinitiation of human spermatozoa preserved in electrolyte-free solution at 4°C

OBJECTIVE To elucidate reinitiation factors in human spermatozoa preserved in the electrolyte-free solution at 4 degrees C. SETTING Andrology laboratory of our hospital. PATIENTS Semen samples were obtained from patients attending our infertility clinic. INTERVENTIONS Ejaculated sperm were centrifuged and washed using the electrolyte-free Percoll gradient and then were preserved for 1 week at 4 degrees C. MAIN OUTCOME MEASURES The motility of preserved sperm was incubated and analyzed after the addition of electrolyte solutions. RESULTS The motility rate was 9.6% when the preserved sperm were incubated directly. The motility increased to 35.1% after alkalization (pH 7.8) and further increased to 40.7% when 0.1 mM KCl was added. The motility decreased to 1.4% in a weak acidic solution (pH 6.8), however, the addition of a > or = 10 mM concentration of NaCl or > or = 0.1 mM concentration of KCl increased in motility. The motility rate in 40 mM NaCl and 40 mM KCl (pH 6.8) was 19.8% and 31.5%, respectively. The restoration of motility by NaCl was inhibited by 1 mM amiloride. The motility also rose to 54.1% and 32.3% in 0.04% NH3 and 80 mM NH4Cl solution, respectively. CONCLUSIONS The reinitiation of preserved spermatozoa was induced by potassium ion and extracellular alkalization.

Viability and function of human sperm in electrolyte-free cold preservation

OBJECTIVE To assess the viability and function of human sperm in electrolyte-free cold preservation. DESIGN Prospective comparative study. SETTING Andrology laboratory of our hospital. PATIENT(S) Ten semen samples obtained from patients attending our infertility clinic. INTERVENTION(S) Ejaculated sperm were washed using the electrolyte-free Percoll gradient and were then preserved in 0.33 M glucose solution, 0.16 M NaCl solution, 0.16 M KCl solution at 4 degrees C for 4 weeks. As a control, TEST (TES and Tris) yolk buffer (TYB) was added to the ejaculated semen and preserved at 4 degrees C. MAIN OUTCOME MEASURE(S) Sperm tail morphology, motility, viability (eosin-Y stain), and the concentration of adenosine triphosphate (ATP) were analyzed. RESULT(S) The number of sperm with normal tail form and the motility of sperm preserved in glucose solution (electrolyte-free cold preservation) were significantly (P < 0.01) higher for 4 weeks than those of sperm preserved in the other three media. The sperm viability in glucose solution was 75.5%, 65.4%, and 51.3%, after 1, 2, and 4 weeks, respectively. The ATP concentration after 1, 2, and 4 weeks remained 64.2%, 53.0%, and 4.3% of the prestorage value, respectively, in the sperm stored in glucose solution. CONCLUSION(S) The morphology, motility, viability, and ATP concentration of sperm in electrolyte-free cold preservation were substantially better than those in NaCl solution, KCl solution, or TYB for 2 weeks.

Idiopathic ureteroduodenal fistula.

AbstractA case of ureteroduodenal fistula corrected by fistulectomy is described. The possible causes of its formation are discussed and the likelihood of a primary duodenal origin is postulated.

Contemporary outcomes of seminal tract re-anastomoses for obstructive azoospermia: a nationwide Japanese survey.

To evaluate current outcomes of seminal tract re‐anastomoses in Japan, and to compare them with historical data.

Effects of extracellular ions on the reactivation of human spermatozoa preserved in electrolyte-free solution

It has previously been reported that human spermatozoa preserved in an electrolyte‐free solution can survive for several weeks at 4 °C. However, the motility of spermatozoa after preservation cannot be restored when incubated at 37 °C, unless reactivated by extracellular alkalisation. Under weak acidic conditions, the reactivation is induced by ≥10 mmol l–1 Na+ and inhibited by a Na+‐H+ antiporter inhibitor. The addition of ≥0.1 mmol l–1 K+ also induces the reactivation. In the present study, the reactivation was induced by ≥0.1 mmol l–1 Rb+ or ≥1 mmol l–1 Cs+ at an acidic pH. The maximum motility rate with K+, Rb+ or Cs+ was obtained at 10–20 mmol l–1 and inhibited by 10−5–10−2 mol l−1 ouabain in a dose‐dependent manner, while ouabain had no effect on the Na+‐induced reactivation. The addition of K+ further increased sperm motility reactivated by Na+, which was also inhibited by ouabain. The addition of Ca2+ did not induce the reactivation or increase sperm motility reactivated by Na+ or K+. It was concluded that activation of the ouabain‐sensitive Na+‐K+‐ATPase and Na+‐H+ exchange mechanism has an important role in sperm motility.

Continuous Intercostal Nerve Block for Pain Relief After Lumbar Incision

To relieve postoperative pain along a lumbar incision in 9 patients the intercostal nerves were blocked with catheters for continuous epidural anesthesia. The catheters were inserted near the intercostal nerves, above and beneath the incision, just before the wound was closed and 0.25% bupivacaine hydrochloride solution was infused periodically through the catheters. With this technique 5 of 9 patients had a satisfactory analgesic effect and could breathe deeply or cough without pain. The other 4 patients did not have satisfactory results and this was believed to be owing to inadequate insertion of the catheters. None of the patients had any complications. The technique is simple and can produce an analgesic effect repeatedly without causing pain for the patient.