Ibrahim Bani-Hani

Fournier's gangrene: changing face of the disease.

PURPOSE: Our experience with ten cases of Fourniers gangrene prompted us to review the related literature to highlight the current status of the disease. METHODS: Data from ten patients with the diagnosis of Fourniers gangrene treated at our center from January 1997 until December 1998 were analyzed. These patients were treated by aggressive resuscitation, triple antibiotics, and urgent surgery. The English-language medical literature for the past 30 years was reviewed. RESULTS: The epidemiologic features of our patients were similar to those reported in other recent studies. Mortality rate was 20 percent. Currently, the disease affects both genders and a wide range of ages, has a more insidious onset than in the past, and is not idiopathic. Associated systemic disorders (diabetes, alcoholism, and immunosuppression) are common. Perianal infection is the commonest cause and is associated with more moribund features. CONCLUSION: The epidemiology of Fourniers gangrene is changing from its original description. Population aging worldwide—as a result of improving health care—and therefore the increasing prevalence of associated medical disorders may explain these changes. These factors may also explain the consistently high mortality rate during more recent years, masking any survival benefits from improved medical care. Better understanding of the pathophysiology has reduced the ratio of idiopathic cases to a minimum.

Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia.

Background We compared the efficacy of microdissection testicular sperm extraction (microdissection TESE) and conventional TESE in patients with non-obstructive azoospermia (NOA) and related the positive sperm recovery to certain variables: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, testicular volume and histology. Methods Sperm retrieval rates (SRR) in patients with NOA who underwent microdissection TESE (n = 65) or conventional TESE (n = 68) were compared and related to the different variables. Results SRR by microdissection TESE (56.9%) was significantly higher than conventional TESE (38.2%). There was a positive relation between the SRR and increased testicular volume or decreased FSH levels. No effect of Testosterone or Prolactin levels on SRR by using either technique was observed. Sperm were recovered from those with hypospermatogenesis in 84% and 92.9% by conventional and microdissection TESE, respectively (P = 0.3). In cases of maturation arrest the SRR was 27.3% and 36.4%, respectively (P = 0.6). In cases of Sertoli-cell-only syndrome (SCOS) the SRR was 6.2% and 26.9%, respectively (P = 0.03). No major operative complications occurred in any patient in either group, and no patient required post-operative hormone replacement to treat hypogonadism. Conclusions Microdissection TESE significantly had twice better probability of success of SRR when compared to conventional TESE. No secure pre-operative prognostic elements of sperm recovery exist for NOA patients. Microdissection TESE appears to be recommendable in cases of atrophied testicles, high FSH concentration, or when SCOS with high FSH concentration can be predicted. Keywords Microdissection TESE; Sperm retrieval; Non-obstructive azoospermia; Histopathology; FSH concentration; Orchidometry

Osteosarcoma of the urinary bladder occurring simultaneously with prostate and bowel carcinomas: report of a case and review of the literature.

Osteosarcoma is a very rare tumor of the urinary bladder, with only 28 well-documented cases reported in the literature to date. The tumors have characteristically been large and polypoid and most commonly have been located in the trigone. An abdominal mass has occasionally been palpated, and rectal examination has frequently revealed a mass in the region of the bladder. The prognosis for this tumor is very poor. In this report, a 75-year-old man with hematuria was found to have a primary osteosarcoma of the urinary bladder with superficial invasion. Radical cystoprostatectomy and ileal conduit urinary diversion were performed. During surgery, a synchronous mucinous adenocarcinoma of the ascending colon was found, and a right hemicolectomy was performed. Prostatic adenocarcinoma was discovered from the histology. The patient died 7 months after surgery with systemic spread of the osteosarcoma. Osteosarcoma of the bladder should be distinguished from other bladder tumors that may be associated with bone formation, such as carcinosarcomas and transitional cell carcinomas with osseous metaplasia of their stroma, both of which have a better prognosis than osteosarcoma.

Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

PURPOSE Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. MATERIALS AND METHODS From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. RESULTS Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p=0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of <8 and PSA≤20 ng/mL, the bone isotope scans were negative. In univariate analysis, PSA (>20 ng/mL) and Gleason score (>7) were independently predictive of positive bone scan, while clinical stage was not. CONCLUSION Staging bone scans can be omitted in patients with a PSA level of ≤20 ng/mL, and Gleason score<8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.

Does the duration of infertility affect semen parameters and pregnancy rate after varicocelectomy? A retrospective study

OBJECTIVES The most common indication for treatment of varicocele is still male subfertility. The aim of this study was to explore the effect of infertility duration on semen parameters and spontaneous pregnancy rate after varicocelectomy. MATERIALS AND METHODS The medical records of 183 infertile patients with clinical varicocele were retrospectively reviewed. The patients were divided into three groups according to the duration of infertility (group I, 1-3 years, group II, 3-6 years and group III, > 6 years). Total sperm motility counts (TMCs) before and after varicocelectomy and spontaneous pregnancy rate among these groups were statistically compared. RESULTS The greatest changes, regarding preoperative and postoperative TMCs and spontaneous pregnancy rate were noticed between group I and III. Preoperative TMCs in group I and III was 15.2 ± 1.2, 7.8 ± 1.4, respectively (p < 0.05). Postoperative TMCs in group I and III was 33.7 ± 2.5, 25.2 ± 1.9, respectively (p < 0.05). An overall spontaneous pregnancy rate of 34.4% was achieved after inguinal varicocelectomy. The greatest spontaneous pregnancy rate was achieved in Group I (37.3%), and the lowest pregnancy rate in Group III (26.3%) (P < 0.05). CONCLUSIONS Surgical varicocelectomy improves the total sperm motility counts especially in patients who have a TMCS more than 5 million and improves the spontaneous pregnancy rates. The improvement in the spontaneous pregnancy rates after varicocelectomy correlates negatively with the duration of infertility. Therefore, duration of infertility should be considered in treating a patient with a varicocele as a cause of infertility.