S. Mantalenakis

Cigarette smoking and urinary incontinence in women—a new calculative method of estimating the exposure to smoke

The aim of the study was to investigate the relation between cigarette smoking and urinary incontinence. A group of 80 women with incontinence (Group A) were tested urodynamically and compared with a group of 80 continent women (Group B). Patients were divided into smokers (S) and non-smokers (NS) with the incontinent ones classified as suffering from stress (SI) or motor in-continent (UI). The assessment of the smoking behavior of each individual focused upon the tar and nicotine content of each cigarette. The overall exposure to smoke was assessed as follows: tar/nicotine content in mg per cigarette x consumed cigarettes per day x duration of smoking intervals in years. According to the obtained data smokers were divided into current smokers (cs) and stop/start smokers (sss), whereas the current smokers were subdivided into heavy current smokers (hcs) and light current smokers (lcs). Significantly, more S were observed in Group A compared with Group B (48/80 vs. 11/32, P < 0.0005), whereas significantly more SI was found in NS compared with S (21/32 vs. 19/48, P < 0.0025). Particularly hcs developed more frequently UI than SI, although this difference had no statistical significance. According to our data smoking women are more likely to develop incontinence, especially motor incontinence, than non-smokers. Heavy smokers seem to tend more to UI.

Therapeutic approach of immotile cilia syndrome by intracytoplasmic sperm injection: a case report

OBJECTIVE To present a case of immotile cilia syndrome, a very rare cause of male infertility and to evaluate the role of the recently suggested treatment by intracytoplasmic sperm injection (ICSI). DESIGN Case report. SETTING Tertiary-care academic hospital. PATIENT(S) One man with immotile cilia syndrome, showing no motile spermatozoa despite normal morphology and viability. INTERVENTION(S) The patients partner underwent two cycles with IVF of the oocytes achieved by ICSI. MAIN OUTCOME MEASURE(S) Evaluation of ICSI procedure in cases of immotile cilia syndrome. RESULT(S) Thirty-three percent of the oocytes were fertilized and subsequently divided enabling ET in both cycles. CONCLUSION(S) Intracytoplasmic sperm injection seems to represent a promising approach to the problem of infertility in men with immotile cilia syndrome.

Cytokines in the human ovary : Presence in follicular fluid and correlation with leukotriene B4

Purpose: This study was undertaken to correlate the follicular levels of interleukin (IL)-1α, IL-2, tumor necrosis factor-α (TNF-α), and leukotriene (LT) B4 with oocyte maturity, fertilization, and achievement of pregnancy.Methods: The material was obtained from 22 women undergoing IVF, 8 of whom became pregnant and 14 of whom did not.Results: All of the studied cytokines and LT B4 were found in follicular fluids, but there were no significant differences according to oocyte maturity, fertilization, embryo quality, and achievement of pregnancy. On the other hand, a significant positive correlation was found between IL-1α and TNF-α, IL-1α, and LT B4 as well as between TNF-α and LT B4 in follicular fluids with subsequently fertilized oocytes.Conclusions: It seems that IL-1α, TNF-α and LT B4 may take part in the process of follicle wall degradation, and their follicular correlations may suggest more optimal follicular and oocyte development and maturation.

EFFECT OF PENTOXIFYLLINE ON HUMAN SPERM MOTILITY AND FERTILIZING CAPACITY

The effect of pentoxifylline (PF) treatment on human sperm motility and fertilizing capacity was assessed in 43 couples undergoing IVF/ET, as well as in 84 couples treated with AIH/IUI. Sperm motility increased following PF treatment in asthenospermic samples (n = 12) from 39.2 +/- 1.5 to 45.5% +/- 2% (p = .05), in oligoasthenospermic (n = 40) from 38.1 +/- 1.6 to 43.6 +/- 1.7% (p = .001), and in total (n = 127) from 50 +/- 1 to 52.5 +/- 1% (p < .001). In addition, PF incubation of sperm samples resulted in higher sperm motility values compared to swim-up in all categories of sperm samples. Furthermore, progressive motility increased in all sperm groups following PF treatment (astheno-spermic: +16.7%; oligoasthenospermic: +14%, p < .001; oligozoospermic: +23.5%, p < .001; normozoospermic: +15.3%, p < .05; total +19.2%, p < .001). Sperm preparation with PF resulted in higher fertilization rates in all categories of sperm samples compared to swim-up (total: 46.6 vs. 29.1%, respectively; p < .05). Moreover, PF treatment of human sperm resulted in 9 viable pregnancies (IVF/ET: 5, AIH/IUI: 4) and one biochemical (IVF/ET). PF improving sperm motility and fertilizing capacity appears to be a promising motility stimulant.

Acute renal failure in pregnancy

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclampsia/eclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (< 3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most effective measures remain the careful prevention and the aggressive management of the obstetric complications.

Transfusion-dependent homozygous β-thalassaemia major: successful pregnancy in five cases

beta-Thalassaemia major is a severe, transfusion-dependent anaemia that also causes infertility due to iron deposition to endocrine organs. Very few pregnancies have been reported among such patients. In this report we describe the evolution and successful outcome of pregnancy in 5 Greek women with beta-thalassaemia major. There were four full-term and one preterm deliveries of two normal and three small for the date neonates. Cardiovascular changes related to gestation may aggravate the underlying multiorgan damage of the pregnant mother and predispose to poor fetal growth and development. All five patients followed a strict transfusion regimen in order to maintain the haemoglobin level above 10 g/dl. The inadvertent administration of desferrioxamine in one patient until the 8th gestational week did not seem to have any serious effects on the development and well-being of the fetus. Although pregnancy is not contraindicated in beta-thalassaemia major, intensive individualized care is required if it is to be safe for the mother, and have a reasonably good chance of producing a healthy child.

Outcome of pregnancy in women with glomerular diseases.

Over the last 16 years the evolution of 24 pregnancies in 17 women with biopsy-proven glomerular disease was analyzed. The underlying renal histology was IgA nephropathy in 8 cases, lupus nephritis in 7, mesangiocapillary glomerulonephritis type I in 1, and focal segmental glomerulosclerosis in 1. All but 2 had normal renal function before conception and 3 were hypertensive. Fetal survival rate was 75%. There were 6 preterm deliveries (33.3%), 3 newborns small for gestational age (17%), 1 stillbirth, and 5 therapeutic abortions. The perinatal mortality was 5.5%. De novo hypertension occurred in 8 pregnancies (33.3%). In 11 pregnancies (46%) increased proteinuria was diagnosed and in 6 (25%) a decline in maternal renal function was recorded. Permanent impairment of renal function was seen in 2 women with renal insufficiency before conception. Maternal hypertension and renal function impairment were associated more frequently with obstetric complications. In conclusion, pregnancy is safe for normotensive mothers with glomerular diseases and normal renal function. Hypertension and impaired renal function at conception seem to carry increased risk for mothers and fetuses. Low-dose immunosuppressive treatment during pregnancy is not harmful for the fetus.

Azoospermia: Clinical, Hormonal, and Biochemical Investigation

The aim of this study was to evaluate the clinical, hormonal and biochemical characteristics of infertile men with azoospermia. A total of 187 azoospermic out of 2610 infertile men (7.2%) were studied. Mean testicular volume and basal plasma levels of FSH were the most useful parameters concerning the evaluation of azoospermia. Basal plasma levels of LH and T were useful only in azoospermic men with hypogonadism, whereas plasma PRL levels, semen volume, and seminal plasma fructose levels were not found to be of common use except in selected cases.

Effect of Follicular Fluid on the Kinetics of Human Sperm Acrosome Reaction in Vitro

The purpose of the present study was to evaluate the kinetics of human sperm acrosome reaction in vitro using the triple stain technique. Acrosome reaction was studied in sperm samples from 16 fertile men 2, 6, and 9 h after ejaculation, following incubation in culture medium (CM; Hams F-10), with a mixture of CM and follicular fluid (FF), or with FF only. Incubation of sperm samples without the influence of any medium served as control. The highest proportion of living acrosome-reacted sperm after a 2-h incubation period occurred in samples incubated with FF (18%), followed by samples incubated with the mixture (15.2%), and then with CM (11.8%). The proportion of living sperm that had undergone the acrosome reaction in the control group was significantly lower (5.7%, p < 0.05). After 6 h of incubation, live acrosome-reacted sperm in FF had increased to 39%, in the mixture to 35.5%, and in CM to 30.5%, whereas in the control group the increase was only 6.3% (p < 0.05). After 9 h of incubation, the percentage of living reacted sperm showed a decline compared with the percentage at 6 h. This decline was greater in samples incubated with FF (from 39 to 19.8%) than in samples incubated with the mixture (from 35.5 to 23.6%). Samples incubated in CM only showed a small decrease from 30.5 to 28.4%, while in the control group this percentage decreased from 6.3 to 2.3%. In conclusion, incubation of sperm in suitable media favorably influences the acrosome reaction, inducing an increase in the percentage of live acrosome-reacted sperm.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of two gonadotropin-releasing hormone (GnRH) analogues (leuprolide and buserelin) in short and long protocols for assisted reproduction techniques.

PurposeThe administration of two GnRH analogues (buserelin and leuprolide acetate) in long and short protocols was evaluated prospectively. In the long protocol, the analogues were given from day 1 of the cycle for at least 14 days and then hMG administration was started, while in the short protocol the analogues were initiated from cycle day 1, adding hMG from day 3. The patients were divided into four groups according to the protocol used: Group I, buserelin-long; Group II, buserelin-short; Group III, leuprolide-long; and Group IV, leuprolide-short. Serum E2levels on the day of hCG injection and the number of follicles observed, oocytes retrieved, and embryos obtained, as well as implantation rates, were significantly higher (P<0.001) in the long protocols than in the short ones.ResultsPregnancy rates were similar in all groups, although a trend for better results was observed in buserelin-long compared to buserelin-short. There were no differences in the results achieved with buserelin or leuprolide.ConclusionThe administration of GnRH analogues (buserelin and leuprolide acetate) in long protocols induced a more intense ovarian response and was associated with significantly higher implantation rates and also a trend for higher pregnancy rates, although this difference was not statistically significant.