D.R Nelson

Laparoscopic radical nephrectomy in 100 patients

The objective of the current study was to report a single‐surgeon, single‐center experience with 100 consecutive laparoscopic radical nephrectomies with intact specimen extraction, with the aim of evaluating the oncologic adequacy of the laparoscopic dissection from a technical standpoint and various parameters including the learning curve.

PATIENT CHARACTERISTICS ASSOCIATED WITH VASECTOMY REVERSAL

PURPOSE More than 30 million couples throughout the world are using vasectomy as a method of birth control. It is estimated that up to 6% of men who undergo voluntary sterilization will eventually request reversal, despite the high cost and relatively low success rate of the procedure. We identified characteristics that predict which vasectomy patients may request reversal. We also examined the cost and effectiveness of pre-vasectomy sperm cryopreservation followed by intrauterine insemination as an alternative method of achieving pregnancy. MATERIALS AND METHODS We reviewed medical charts of 365 patients who underwent vasectomy and 290 who underwent vasectomy reversal between 1990 and 1997. Data were collected on patient age at the time of vasectomy, religion, occupation, wife employment status, number of marriages, number of children, reason for reversal, and number of years between vasectomy and reversal. Based on previously reported values, pregnancy rates and cost per successful pregnancy were estimated for vasectomy reversal surgery, and compared with a calculated cost per pregnancy for sperm cryopreservation and intrauterine insemination. RESULTS Patient factors significantly associated with increased vasectomy reversal included younger age at time of vasectomy (p < 0.001) and a wife who worked outside the home (p < 0.001). Vasectomy reversal occurred 12.5 times more often (95% confidence interval [CI] 7.6 to 20.7) in men who underwent vasectomy in their 20s than in men who were older. Men whose wives were not employed requested reversal 0.48 times as often (95% CI 0.33 to 0.71) as those whose wives worked. Men who were younger at vasectomy tended to wait longer before reversal (median 10 years) than other patients (p < 0.001). At 10 years our calculated pregnancy rates and cost per pregnancy were 44% and

Semen Quality Score Is a Novel Measure of Sperm Quality in Infertile Men

12,727 for vasectomy reversal, and 41% and

Assessment of laboratory variability in the measurement of total non-enzymatic antioxidant capacity of semen using an enhanced chemiluminescence assay.

9,512 for intrauterine insemination with banked sperm (3 attempts). CONCLUSIONS Patients who requested vasectomy reversal most often chose voluntary sterilization at a younger age. We believe that younger men should be given better pre-vasectomy counseling. However, the success rate and cost-effectiveness of sperm cryopreservation before vasectomy, with subsequent intrauterine insemination, may make this nonsurgical alternative desirable for younger couples who choose vasectomy even when properly informed about reversal rates.

Prediction of endometriosis with serum and peritoneal fluid markers: a prospective controlled trial

nous Pb21 (0–5180 mg/L). Materials and Methods: Cd21 in BP and SP was assayed by graphite furnace atomic absorption spectroscopy. WHO (1992) semen parameters were recorded for fresh semen. Motile sperm populations were obtained from frozen/thawed semen by Percoll density gradient centrifugation and were examined for surface expression of mannose (Man) receptors (MR) and non-nuclear progesterone (P) receptors (NNPR), spontaneous and agonist (free Man and P)-stimulated acrosome reactions (AR). Results were compared using SC and repeated measures analysis of variance (RMANOVA) models. Results: BP and SP Cd21 levels were more tightly clustered than Pb21 (range, 0.081 mg/L to 0.161 mg/L). Pb21 and Cd21 in BP and SP were positively correlated (SC, respectively, n511, r50.7, P,0.01 and n513, r50.7, P,0.007). SP Pb21 levels and sperm count, motility, percentage normal morphology and NNPR were not related. In contrast, significant inverse relationships existed between SP Pb21 levels and MR (SC, n512, r520.5, P,0.007), Man AR (SC, n515, r520.5, P,0.04) and P AR (SC, n526, r520.4, P,0.03). SP Pb21 and spontaneous AR were positively correlated (SC, n516, r50.6, P,0.01). SP Pb21 levels and f showed a strong inverse relationship (SC, n524, r520.6, P,0.02). In vitro exposure of fertile donor sperm to exogenous Pb21 resulted in a dosedependent decrease in MR (RMANOVA, P,0.01), Man AR (RMANOVA, P,0.0008) and a dose-dependent increase in spontaneous AR (RMANOVA, P,0.0007). Conclusions: SP Pb21 in subjects studied are representative of the general population. Within the AI group, selected for normal WHO semen parameters, donors with high SP Pb21 had significantly lower fertility. The correlation between Cd21 and Pb21 suggests other metal toxicants may play a role. But in vitro modeling shows Pb21 alone is sufficient to induce the same characteristics (increased spontaneous AR, decreased MR, decreased agonist-induced AR) in fertile sperm as seen in vivo in subjects with high SP Pb21. We suggest that potential donors be screened for Pb21 levels and sperm biomarker expression prior to acceptance into an AI program. These methods may also prove useful in directing ART patients to conventional IVF or to ICSI. (Support: NIH Grant No. ES 06100 to S.B.)

Laparoscopic radical nephrectomy in 100 patients: A single center experience from the United States

MEASUREMENT OF TOTAL NON-ENZYMATIC ANTIOXIDANT CAPACITY OF SEMEN USING AN ENHANCED CHEMILUMINESCENCE ASSAY Ramadan A. Saleh, Hiroshi Kobayashi, Pavithra Ranganathan, Rakesh K. Sharma, David R. Nelson, Ashok Agarwal, The Cleveland Clinic Foundation Objective: It has been established that non-enzymatic antioxidants in seminal plasma are as important as enzymatic antioxidants in protecting the sperm against oxidative stress-induced damage. Accurate and reliable assessment of total non-enzymatic antioxidant capacity (TAC) of seminal plasma is essential for both research and clinical purposes. The objectives of this study were to assess the inter-donor (different donor samples measured in the same day), intra-assay (running the same sample in duplicate or triplicate), inter-assay (same sample measured on different days by the same observer), and inter-observer (multiple observers on the same day with the same sample) variability using an enhanced chemiluminescence assay.