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Sirolimus is used as a powerful immunosuppressant drug in patients after organ transplantation. It was shown to block spermatogenesis by interrupting the stem cell factor/c-kit system. Oligozoospermia was shown in single patients. In addition, a decrease of testosterone and an increase of gonadotropin levels were observed. We report on a young patient who showed azoospermia during the treatment with sirolimus after renal transplantation. After changing the immunosuppression to tacrolimus, spermatogenesis of the patient recovered. Five months after cessation of the treatment with sirolimus, a sperm concentration of 8 x 10(6) ml(-1) was found. Depression of spermatogenesis is an important side effect in younger men who aspire paternity, so that waiving of sirolimus is advisable in these patients.

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Leucocytospermia is considered to be a sign of male accessory gland inflammation. The leucocytes in semen are mainly polymorphonuclear neutrophilic granulocytes. Leucocytospermia is not associated with the presence of bacteria and antibiotic treatment does not significantly lower the extent of leucocytospermia. A higher frequency of elevated herpes simplex antibodies titres were found in men with leucocytospermia. The concentration of inflammatory cytokines, interleukin-6 and -8, is closely correlated with the number of leucocytes. Their determination does not provide additional information. Reactive oxygen species (ROS) are generated at least in part by seminal leucocytes in response to stimulating factors. Purified leucocytes produce high levels of ROS. The determination of ROS appears to represent a parameter of functional activity of leucocytes. The role of chlamydiae in male accessory gland infection is unclear. Their determination in semen by DNA amplification and by immunological tests does not provide reliable results.

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The manual of the World Health Organization defines leucocytospermia as the presence of >1 x 10(6) white blood cells per ml semen. Most authors consider leucocytospermia to be a consequence of inflammation due to bacterial infection. However, the efficacy of antibiotic therapy was not unequivocally demonstrated until now. We started a prospective, randomized, controlled study in 36 patients, who consulted our department for infertility with leucocytospermia. None of the patients reported any symptoms of genital infection. The patients were assigned randomly to two groups: group 1 received 250 mg levofloxacin once a day over 10 days, patients of group 2 received no therapy. Semen analysis was repeated 2 weeks later. After administration of levofloxacin, a mean decrease of leucocyte count of 45.8 +/- 72.2% compared with a decrease of only 3 +/- 109.2% in the untreated group was observed. However, this difference is not statistically significant. There were no significant differences between the two groups with respect to leucocyte count, sperm count and sperm cell after treatment. We conclude from our study that antibiotic therapy does not provide benefit for treatment of asymptomatic leucocytospermia.

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The presence of interleukins (IL) and other cytokines in seminal plasma was demonstrated in the literature. In particular, the levels of IL-6 were found to be related to male accessory gland inflammation. The close correlation to leucocyte count indicates a production of interleukins from the leucocytes and by the prostate gland. No relation of IL-6 levels to spermatogenic activity was quoted in the literature. We measured IL-6 and IL-8 in 454 men and compared the values with seminal parameters. The mean values of IL-6 30.7 +/- 101.2 pg ml-1 and IL-8 2023 +/- 1721 pg ml-1. The correlation analysis revealed a significant correlation of IL-6 and/or IL-8 to age, total fructose, immunoglobulin G (IgG) concentration and leucocyte count. The significant correlation of IL-6 and fructose levels indicates that also the seminal vesicles take part in the production of seminal IL-6. No correlation of the two interleukins measured to sperm parameters occurred. The calculation of a single harmonic trend revealed a significant trend over the year of the levels of IL-6 with a maximum in December and a peak-to-trough variation of 33% of the mean. It may be the consequence of a higher frequency of seminal tract inflammations in autumn and winter.

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OBJECTIVE: To evaluate the influence of antisperm antibodies on the acrosome reaction (AR). DESIGN: Clinical study. SETTING: University of Marburg, Department of Andrology, Clinical Training Center of the European Academy of Andrology. PATIENT(S): Spermatozoa from a pool of healthy donors were incubated with 30 seminal plasma samples from infertile men containing antisperm antibodies; they were compared to a control group of 10 samples without antisperm antibodies and five samples with buffer only. INTERVENTION(S): The spontaneous acrosome reaction (SAR) and the induced acrosome reaction (IAR) by calcium ionophore A23187 were observed and determined by means of a flow cytometer. Flow cytometric double-staining estimates of acrosomal integrity were determined by using a monoclonal antibody (TUS 19), marked with a secondary fluorescein isothiocyanate-labeled antibody. Cell viability was determined by counterstaining with propidium iodide (PI). MAIN OUTCOME MEASURE(S): Number of acrosome reacted spermatozoa. RESULT(S): The spermatozoa treated with antisperm antibodies showed significantly higher SAR and IAR responses than the control group. CONCLUSION(S): Some of the antisperm antibodies from individual patients are able to enhance the acrosome reaction in donor sperm, but none of them appeared to inhibit acrosome reaction.

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The clinical usefulness of detection of TSH receptor antibodies (TRAK-assay, Henning) in differential diagnosis of thyroid disorders and in follow up of treatment of Graves' disease was evaluated and compared to thyroperoxidase antibodies estimation (DYNOtest antiTPO Henning). 313 patients with various thyroid diseases and 50 persons from control group were examined. Thyroperoxidase antibody (TPO-Ab) titers were frequently elevated in Graves' disease before treatment (88.6%, median 3361 U/ml) and in Hashimoto thyroiditis (100%, median 6055 U/ml). Median TPO-Ab was in normal range in other thyroid disorders and in control group (toxic nodular goiter: 58.5 U/ml, neutral nodular goiter: 46.0 U/ml, thyroid cancer after thyroidectomy: 58.8 U/ml, control group: 0 U/ml). TSH-receptor antibodies (TRAb) were detected in 94.1% in patients with Graves' disease (median 52 U/l) and only in 12.5% with Hashimoto disease (median 4.1 U/l), in 25% with toxic nodular goiter (median 4.1 U/l), in 10.9% with neutral nodular goiter (median 4.6 U/l) in 17.4% with thyroid cancer (median 1.6 U/l) and in 4.8% in control group (median 1.7 U/l). The TPO-Ab titers did not decrease significantly during thyrostatic treatment of Graves' disease. Patients in clinical remission after treatment exhibited TPO-Ab in 76.9% (median 615.5 U/ml). In contrast, the TRAb titers failed in patients treated with thyrostatics longer then six months (64%, median 16 U/l). After treatment 86.7% of them had normal values (median 1.0 U/l). The increase of TPO-Ab persisted in patients investigated two years after subtotal thyroidectomy (92.3%, median 750 U/ml). Only in patients operated before 10 years the titers declinedsignificantly (32%, median 43.4 U/ml). The TRAb titers fell significantly after thyroidectomy (two years: 62.5%, median 10.7% U/l, 10 years: 36.4%, median 4.2 U/l). Estimation of TRAb is a powerful tool for differential diagnosis of Graves' disease and enables better monitoring of the applied treatment than estimation of TPO-Ab.

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UNLABELLED: The present study aimed assess the relationship between erythropoietin (EPO) and parathormone (PTH) secretion in patients with primary hyperparathyroidism (PHP). Seventeen patients with PHP and 24 patients with uncomplicated cholelithiasis were examined before and during 14 days after surgical treatment. In PHP patients plasma EPO levels were significantly higher than in patients with cholelithiasis (31.5 + 4.3 vs 14.1 + 0.9 mU/ml, p < 0.01). After cholecystectomy transient increase of plasma EPO level was noticed postoperatively during the first 6 days. Such an increase of plasma EPO was absent in PHP patients after removal of the cause of primary hyperparathyroidism. Only in PHP patients a significant negative correlation was found preoperatively between plasma EPO level and Hct value or creatinine clearance respectively. CONCLUSIONS: 1. Patients with PHP are characterized by significantly elevated plasma EPO levels which are related to the degree of anaemia and decrease of GFR. 2. In patients with PHP presence of significant relationship between EPO and PTH secretion could not be proven.

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Textural segmentation plays an important role in the figure-ground discrimination process. Evidence from neuroscience and psychophysics suggests that the segregation of texture patterns composed of oriented line segments is strongly influenced by the orientation contrast between the patterns (Nothdurft, Vision Res. 31, 1073-1078, 1991). In contrast to models available in the literature, this paper presents a neural network architecture for textural segmentation that can adaptively delimit the boundaries of uniformly textured regions. Cells with adaptive receptive fields encode uniformly textured regions by diffusively interpolating the estimates of feature orientations across the image. Orientation contrast boundaries are detected at gradients across the interpolated regions to produce the final segmentation. Consistent with neurophysiological data from simple and complex cells sensitive to static and moving textural patterns (Hammond and MacKay, Exp. Brain Res. 30, 275-296, 1977), the present model suggests that preattentive textural segregation can be performed by early visual processes localized to areas V1, V2, and perhaps V3 or V5. The computational results further support the idea that textural segmentation should not be thought of as a 'static' process, but as a system that employs cells with context-dependent response characteristics (Gilbert and Wiesel, Vision Res. 30, 1689-1701, 1990), here modeled as adaptive receptive fields.

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The thyroid hormone level was studied in the perioperative period in patients with various types of goitre. The clinical material comprised 85 patients treated surgically for nodular neutral goitre, nodular hyperactive goitre, Graves-Basedow disease, and cholecystolithiasis. The determination of total and free thyroid hormone blood serum levels was carried out in three periods of time, that is 4-5 days before operation, immediately after operation, and on the fifth day after operation. The obtained results led us to reaching the following conclusions: 1. Achieving of clinical euthyroid state in patients with Graves-Basedow disease during preoperative preparation with thyrostatic drugs was connected with the decrease of total and free thyroid hormone levels below the lower range of normal values which persisted immediately after, and on the 4th-5th day after operation. 2. During operation no significant increase was found of serum thyroid hormone levels. 3. On the 4th-5th day after operation, especially in patients with nodular neutral goitre and cholecystolithiasis a tendency was observed for a drop of triiodothyronine level, especially of its free fraction level.

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In 1819 patients with active or non active respectively nephrolithiasis the following parameters were assessed: plasma level of calcium, phosphate, and uric acid and urinary excretion of calcium, phosphate, oxalate, uric acid and creatinine. These parameters were estimated after 5 days of diet containing 400 mg of calcium, 800 mg of phosphate, 100 mg of purines and 40 g of proteins. In 3/4 of all examined patients at least one lithogenic factor was present. More than 40% of patients showed presence of hypercalciuria. Among these patients in 68% renal in 17% absorptive and in 15% undefined hypercalciuria was diagnosed. Patients with active nephrolithiasis showed a similar frequency of hypercalciuria but more profound abnormalities of Ca P metabolism than patients with non active renal stone disease.

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Among 1819 patients with renal stone disease 44 cases with primary hyperparathyroidism (p.h.p.) were diagnosed. In all cases the diagnosis of php was confirmed by histomorphological examination. In 34 patients with php solitary adenoma was found, in 5 patients an adenoma with concomitant hyperplasia of the parathyroid glands, in 2 patients hyperplasia and in 3 patients carcinoma of the parathyroid glands. Hypercalcemia was found in 86% of patients, while elevated plasma levels of PTH in 90% of patients with php. Not in all patients PTH secretion was entirely autonomous. No significant correlation was found between plasma levels of PTH and kind of pathology of the parathyroid glands as well as clinical feature of php respectively.

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The evaluation of the migration inhibition test with thyroid membrane antigen was carried out in 20 patients with Graves' disease, 13 patients with neutral nodular goiter and 13 healthy subjects. A significant inhibition of migration by thyroid antigen as compared to the control group was demonstrated only in the patients with Graves' disease (the value of the migration index was 0.57 +/- 0.07). The respective value was 0.79 +/- 0.16 in patients with nodular goiter and 0.85 +/- 0.11 in healthy subjects. The results obtained indicate the practical value of the migration inhibition test in diagnosing the thyroid diseases having an autoimmune background.

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In five patients having extensive abdominal hernias, after performing the plastic operation - the abdominal wall was strengthed by seving on the DALLOP type muscles fascias prosthesis. The postoperative course was uncomplicated, and the remote result satisfactory. No recurrent hernia has been observed.

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We studied lateral interactions between horizontal cells in the tiger salamander retina in order to determine the underlying mode of synaptic transmission. Pairs of cells, visually identified by inspection of the in vitro retinal slices, were impaled with two separate electrodes and the transmission between them was examined by injecting current into one cell while recording the resulting voltage response from the other soma. It was found that coupling between horizontal cells remained intact and even increased somewhat during the light response and in the presence of cobalt or acetylcholine. It was also observed that a fluorescent dye injected into one cell would often migrate and stain neighbouring horizontal cells. These results suggest that synaptic transmission between horizontal cell bodies is mediated mainly by electrotonic conduction. The increase in apparent coupling observed under certain experimental conditions can be explained by the increase in input resistance of each horizontal cell.

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1. The reversal potential of the surround response in cones was measured by inactivating the outer segment, polarizing the cone to different potential levels with extrinsic current, and flashing a full-field stimulus. This elicited a 3- to 4-mV depolarizing response at the normal -40-mV dark level. Its reversal potential was typically near -60 mV. 2. Cones were also polarized by a steady center light while flashing an annulus. The annular response was suppressed when the cone was polarized to near -60 mV. No reversal was measured, presumably because the maximum center light response could not exceed -60 mV. 3. Items 1 and 2 provide a method for measuring surround responses in cells post-synaptic to the cones in the absence of the surround response in the cones themselves; cone surround responses are suppressed although some horizontal cell surround responses are enhanced (item 6) at high center intensities that polarize the cones to near -60 mV. 4. Bipolar cells of both types (depolarizing and hyperpolarizing) generate a surround response that opposes the center response. In both bipolar cell types, the surround response is completely suppressed near center intensities that suppress the surround response in the cones. 5. Narrow-field horizontal cells behave like cones and bipolar cells; the depolarizing surround response is suppressed at high center intensities bright enough to suppress the cone surround response. At higher center intensities the surround response becomes hyperpolarizing, presumably due to direct coupling to peripheral horizontal cells. 6. Broad-field horizontal cells always hyperpolarize in response to surround illumination. The hyperpolarizing surround response is augmented at high center intensities, presumably because the depolarizing component, initiated in the cones, is suppressed, while the direct coupling to peripheral horizontal cells remains intact.

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