Leslie C. Powell

Effect of ascorbic acid supplementation on the sperm quality of smokers.

OBJECTIVE To determine the effect of ascorbic acid supplementation on the sperm quality of heavy smokers. DESIGN Microscopic examination of semen for 1 month during supplementation with placebo or ascorbic acid at dose levels of 200 or 1,000 mg/d. SETTING Department of Obstetrics and Gynecology, The University of Texas Medical Branch. PARTICIPANTS Seventy-five men (20 to 35 years old) randomly divided into one of three supplementation groups: placebo, 200 mg and 1,000 mg of ascorbic acid. MAIN OUTCOME Improvement in sperm quality as compared with presupplementation levels and between the three treatment groups. RESULTS The placebo group showed no improvement in sperm quality. The groups receiving ascorbic acid showed improvement in sperm quality with most improvement in the 1,000-mg group. Pearsons correlation showed statistically significant relationships between the weekly group means of serum and seminal plasma ascorbic acid levels and sperm qualities. CONCLUSIONS Ascorbic acid supplementation of heavy smokers in excess of 200 mg/d results in improved sperm quality.

Effects of depo-medroxyprogesterone acetate as a contraceptive agent☆☆☆

Abstract Depot medroxyprogesterone acetate (DMPA), 150 mg. every 3 months, has been used in 1,123 patients, followed through 14,000 months of use as a contraceptive. The major side effect has been a completely unpredictable bleeding pattern. Only one method-failure pregnancy occurred. There were 3 patient-failure pregnancies. One hundred twenty-seven pregnancies have occurred during administration of and after discontinuance of the drug. Conception occurred within 12 months in over 60 per cent of the patients. No deleterious effect on pregnancy outcome could be noted. One case of questionable deep thrombophlebitis occurred, but there were no cases of thromboembolic phenomena. Abnormal cervical cytology developed in 34 instances and carcinoma in situ in 11 cases. These rates are higher than in our general clinic population. This injectable progestin is a highly effective contraceptive agent, well suited for a clinic-type population requiring infrequent motivation.

COMPARISON OF SPERM VIABILITY WITH SEMINAL PLASMA METAL LEVELS

This study compares the semen levels of lead (Pb), cadmium (Cd), and aluminum (Al) in relation to live sperm in semen samples from 64 apparently healthy men. The measured levels were separated into live sperm count tertiles (<25% [18 subjects], 25–50% [26 subjects], and >50% [20 subjects]). The mean ± SD for each group was calculated, and the difference between the means of the high and low tertiles were compared by ANOVA. Significant differences were observed between the high and low live sperm groups for Pb (p < 0.01) and Al (p < 0.05), but not Cd. Spearman’s rank correlation between sperm viability and the semen plasma metal levels showed a direct relation to Mg (p < 0.05). However, there was an inverse relation to lead (p < 0.001), cadmium (p < 0.01), and aluminum (p < 0.01). There was no significant correlation between Ca and Zn. Linear regression between the live sperm counts and semen level of the three metals show that metal levels were inversely correlated with the percentage of live sperm (p < 0.001, <0.01). Apparently, the presence of these metals in the environment and in seminal plasma exerts a toxic effect on sperm.

Intense plasmapheresis in the pregnant Rh-sensitized woman

Abstract Reduction of Rh antibody titers in sensitized pregnant females has been carried out with intense plasmapheresis in 8 patients with bad Rh obstetric histories with prior fetal loss. As low titers are generally associated with less severely affected infants, this was studied as a means of lowering the titer to alleviate fetal effects of the isoimmunization process. Detailed studies of hematologic, nutritional, and biochemical changes as well as changes in the amniotic fluid have been done. Adjunctive measures of mercaptan administration, intrauterine transfusion, and plasma replacement were selectively used. Drops in Rh antibody titer have been achieved but not sustained, and cost factors limit clinical application. Depleted serum proteins rebound quickly. The safety of massive plasma removal in pregnancy has been shown and should help to stimulate its use in production of Rh-immune globulin.

Seminal plasma trace metal levels in industrial workers.

This study compares the seminal plasma trace metal levels of hospital workers with groups of industrial workers in a petroleum refinery, smelter, and chemical plant. The metals measured were the essential metals (copper, zinc, nickel, cobalt, and manganese) and the toxic metals (lead, cadmium, and aluminum). The group mean±SE metal level for each group (50 subjects per group) was calculated, and the statistical significance of the group mean differences of the industrial groups with the hospital group (control) was determined by the Student’s t-test.The differences observed in the smelter group were increased copper and zinc (p≤0.001) and decreased nickel, cobalt, and manganese (p≤0.001,≤0.01). The refinery group differences were increased copper, zinc, and nickel (p≤0.001) but decreased cobalt and manganese (p≤0.001). The chemical group differences were increased zinc (p≤0.001) and decreased cobalt (p≤0.001). The seminal plasma levels of the toxic metals lead and aluminum were increased in each of the industrial groups (p≤0.001). Concurrent differences were (1) decreased accumulation of nickel, cobalt, and manganese in the smelter group, (2) decreased cobalt and managanese in the refinery group, and (3) only decreased cobalt in the chemical group.

The ultrastructural response of human endometrium to medroxyprogesterone acetate.

Medroxyprogesterone acetate is a steroid compound similar to progesterone in structure and function. Thirty women were given 150 mg. of medroxyprogesterone intramuscularly, and samples of the endometrium were examined by light and electron microscopy. The initial response of normal human endometrium was maturation and then inhibition. By 50 days after injection, the atrophic changes began to reverse, and by Day 90, after injection the tissue resembled normal proliferative endometrium. A previously undescribed nuclear inclusion body is present; however, its significance is unclear at this time. On the basis of ultrastructural changes, medroxyprogesterone appeared not to exert a significant influence on the endometrium past 90 days at this dosage.

A short-term, intensive workshop approach for the treatment of human sexual inadequacy

A rapid treatment approach to common sexual dysfunctions has been used in treating 59 couples, including 74 symptomatic individuals. Using a multidisciplinary team approach in an intensive 2 1/2 day workshop format, symptom improvement has been obtained in 86.5% of the dysfunctional individuals, with complete symptom reversal in 63.5%. The intensive workshop format has resulted in a saving of both patient and professional time and is seen as a viable and successful alternative to more time-consuming approaches of treating various sexual dysfunctions.

Rapid treatment approach to human sexual inadequacy.

Abstract Use of a multidisciplinary therapy team in a rapid treatment approach to problems in sexual inadequacy has been used in the treatment of 16 couples with common sexual problems. Dual sex interviews are done on each couple, followed by a sexological examination. Then a 2½ day intense workshop is used to give group instructions in couple communication, sexual anatomy and physiology, sensate focus training, and coital instruction with individual practice sessions. Explicit audiovisual material is used. Results have been good, with symptom reversal in 14 couples and improvement in the other two. Total treatment time has required only 34 hours of physician time.

Retropubic urethrocystopexy: Vaginal approach

A modification of the classic Marshall-Marchetti-Krantz (MMK) operation which includes suspending the urethrovesical junction to the pubis by the vaginal approach is presented. This offers the advantages of a shorter operating time, the lack of an abdominal incision, and the concomitant repair of other pelvic anatomic defects through the vagina, with a cure rate at least equal to, if not better than, that associated with the abdominal route. The study group of 25 patients had less morbidity, a 1-day decrease in hospital stay, and 1 1/2 fewer days of catheter drainage compared to a matched control group of MMK operations done abdominally in this preliminary report. A 96% cure and improvement rate of the symptoms of stress incontinence was shown at the 6-week postoperative visit. This compares to a 92% rate in the control series of abdominal MMKs. The permanency of the procedure will have to be evaluated critically as more cases are added and sufficient time elapses to see if these good initial results hold up.