RESUMEN
PURPOSE: To describe a potential association between male infertility and valproate (VPA) exposure. VPA has been implicated in the development of polycystic ovarian disease and subsequent menstrual and infertility problems in women with epilepsy. Infertility has been well described in population-based studies of persons with epilepsy. The low marital rates for men with epilepsy have previously been thought to play a major contributing role. METHODS: We report a case of a 32-year-old man whose wife and he were able to bear a child before the development of his epilepsy. With VPA monotherapy, the family were unable to conceive despite 4 years of unprotected intercourse. An infertility evaluation of the man revealed a very low sperm count of < 50,000/ml, no motile sperm, < 10% viability, and 100% with abnormal structure. Follicle-stimulating hormone, luteinizing hormone, and testosterone levels were normal. RESULTS: Felbamate (FBM) was initiated and VPA discontinued for improved seizure control. Within 4 months, the couple conceived their second child. A seminal analysis revealed a sperm count of > 16 million, 50% motility, 78% viability, and 72% with abnormal structure. CONCLUSIONS: One must be cautious in extrapolating from a case report, but these findings strongly suggest a direct effect of VPA on spermatic structure and function.
Asunto(s)
Anticonvulsivantes/efectos adversos , Epilepsia/tratamiento farmacológico , Infertilidad Masculina/inducido químicamente , Ácido Valproico/efectos adversos , Adulto , Anticonvulsivantes/uso terapéutico , Quimioterapia Combinada , Felbamato , Femenino , Humanos , Infertilidad Masculina/prevención & control , Masculino , Fenilcarbamatos , Glicoles de Propileno/uso terapéutico , Recuento de Espermatozoides/efectos de los fármacos , Ácido Valproico/uso terapéuticoRESUMEN
A 43-year-old man with presumed renal cell carcinoma who was found to have an asymptomatic hot spot in his right zygoma on a bone scan during a metastatic evaluation. At the time of nephrectomy, an excisional biopsy of the lateral orbital wall was performed to rule out solitary metastasis of his renal cell carcinoma. The lateral wall was reconstructed with a rib autograft and multiple rigid fixation. Histopathologic examination of the specimen showed a fibrous matrix with large, dilated, sinusoidal, vascular channels typical of an aneurysmal bone cyst. In the absence of metastasis, the five-year survival rate is approximately 90% with nephrectomy alone.
Asunto(s)
Quistes Óseos Aneurismáticos/complicaciones , Carcinoma de Células Renales/complicaciones , Neoplasias Renales/complicaciones , Enfermedades Orbitales/complicaciones , Adulto , Quistes Óseos Aneurismáticos/diagnóstico , Carcinoma de Células Renales/cirugía , Humanos , Neoplasias Renales/cirugía , Masculino , Nefrectomía , Enfermedades Orbitales/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Described herein are renal transplant techniques which have been successfully applied to general urology patients. These include surface and core cooling of the kidney, autotransplantation, renal vein translocation, the use of a transcutaneous stent for upper urinary tract repairs, and an unstented, parallel incision, extravesical ureteroneocystostomy.
Asunto(s)
Hipotermia Inducida , Trasplante de Riñón , Enfermedades Urológicas/cirugía , Adulto , Carcinoma de Células Renales/cirugía , Carcinoma de Células Transicionales/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Arteria Renal/cirugía , Venas Renales/cirugía , Trasplante Autólogo , Neoplasias Ureterales/cirugía , Derivación Urinaria/métodosRESUMEN
Acute placement of a suprapubic bladder tube followed months later by open urethroplasty has been the traditional manner for managing traumatic disruption of the proximal urethra. The latter procedure has generally been performed via the transpubic or perineal approach. These procedures have been complicated by excessive blood loss, impotence, incontinence, strictures, and extended hospitalizations. Since 1979, 12 patients with obliterated urethras (ten membranous, two bulbous) have been treated by direct vision urethrotomy using a second cystoscope or sound passed through the previously placed suprapubic tract as a guide. Mean blood loss, hospital stay, and followup were 70 ml, 6 days, and 22 months, respectively. Six patients required at least one additional internal urethrotomy. With the exception of one patient who still requires intermittent self-catheterization, all have stable strictures. Ten are continent (one was incontinent secondary to previous radical prostatectomy before urethrotomy and one became incontinent after a TURP performed 3 years after urethrotomy). Five are potent and none lost potency as a result of urethrotomy. Flow rates range from 15-25 ml/second in the continent patients. This is a reasonable first procedure for restoring continuity of traumatically obliterated membranous and bulbous urethras.