1.  Title: ER, PR and Ki-67 expression status in granulomatous and chronic non-specific endometritis. Author: Mishra K; Wadhwa N; Guleria K; Agarwal S Source: Journal of Obstetrics and Gynaecology Research. 2008 Jun;34(3):371-378. Abstract: Aim: To study the changes in the histological pattern, distribution and intensity of sex steroid receptors (estrogen and progesterone) and cell proliferation by Ki-67 expression by semi-quantitative scores in granulomatous and chronic non-specific endometritis in the premenstrual phase. Methods: A retrospective study was conducted on 20 cases of granulomatous endometritis, 10 of chronic non-specific endometritis and 30 age matched (+or- 2 years) controls with no endometrial lesions. Morphological changes were noted on histological examination and semi-quantitative scoring of Estrogen Receptor (ER), Progesterone Receptor (PR) and Ki-67 expression was done by immunohistochemistry. Results: There was significantly higher ER, PR and Ki-67 expression in endometrial glandular and stromal cells in inflamed endometria as compared with the controls (all P-values < 0.02) regardless of the character of the inflammation. The cases with morphology not conforming to the secretory phase at which biopsy was takenhad significantly higher ER, PR and Ki-67 expression in both endometrial and stromal cells indicating a lag in the endometrial maturation (all P-values < 0.02). Interestingly, all parameters except PR expression in glandular cells had a significantly higher expression even in cases with secretory morphology indicating disturbances in local milieu. Conclusion: Endometrial inflammation interferes with local expression of ER, PR and Ki-67. This may contribute to infertility regardless of other factors and other endometrial dysfunctional states. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | WOMEN IN DEVELOPMENT | ENDOMETRITIS | HORMONE RECEPTORS | CHRONIC DISEASES | HISTOLOGY | GRANULOMAS | ESTROGENS | PROGESTERONE | GENETICS | INFERTILITY | TUBERCULOSIS, FEMALE GENITAL | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Reproductive Tract Infections | Infections | Diseases | Membrane Proteins | Physiology | Biology | Signs and Symptoms | Hormones | Endocrine System | Progestational Hormones | Reproduction | Tuberculosis Document Number: 327383 |
| 2. Title: The need to reassess the value of fine needle aspiration in the diagnosis of tuberculous cervical lymphadenitis in Iran [letter] Author: Hasibi M; Rezaii J; Kermani ZM; Asadollahi M; Rashidi A Source: Scandinavian Journal of Infectious Diseases. 2007;39:750-751. Abstract: Iran is an endemic country for tuberculosis (TB). After the eradication and efficient control of some 'priority' infectious diseases such as polio and measles, TB has now turned into a major public health problem in Iran. Cervical lymphadenitis is the most common form of extrapulmonary TB, accounting for 30-40% of TB cases and fine needle aspiration (FNA) is widely accepted as the first diagnostic modality of choice in this entity, especially in countries where mycobacterial infection is endemic. FNA is easy, safe, rapid and noninvasive compared to excisional biopsy, which is usually considered the second choice. It is readily available in most centres and can safely be performed in outpatient departments. The diagnostic accuracy of FNA for tuberculous cervical lymphadenitis varies considerably among different studies, with a reported sensitivity of 25-100%. This variation might be due to differences in geographical location and endemicity, expertise of the clinician and pathologist, and the time lapsed before the lymphadenopathy comes to the patient's attention. Recently, we became aware of several small informal reports from different regions in our country warning about high false negative rates of FNA results, and that seemed especially worrying in cases of patients who referred early in the course of their disease. Therefore, we opted to assess the issue of FNA sensitivity for (early) tuberculous cervical lymphadenitis in Iran for the first time. (excerpt) Language: English Keywords: IRAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | PHYSICAL EXAMINATIONS AND DIAGNOSES | TUBERCULOSIS | CERVICAL EFFECTS | GRANULOMAS | TESTING | Developing Countries | Middle East | Studies | Research Methodology | Demographic Factors | Population | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Measurement Document Number: 318729 |
3.  Peer Reviewed Title: Application of polymerase chain reaction technique for laboratory diagnosis of cutaneous tuberculosis. Author: Khosravi AD; Omidian M Source: Pakistan Journal of Medical Sciences. 2006 Jul-Sep;22(3):291-294. Abstract: The objective was the evaluation of the role of polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis (MTB) DNA as a diagnostic aid in cutaneous tuberculosis. Study Design: Descriptive study. Duration and place of study: TB reference laboratory, PHLS, Ahvaz, Iran from May 2001 to December 2001. Thirty formalin-fixed, paraffin-embedded samples belonging to 28 patients were analyzed. Tissue sections were treated by lysis buffer containing proteinase K and DNA was extracted by using standard extraction kit. PCR amplification was performed using assay based on a repetitive sequence IS 6110 of MTB according to standard procedure. PCR was positive in six samples. Amongst them, two of the samples (7.1%) belonged to patients with chronic granulomatosis, which was previously confirmed histopathologically, were positive in entire applied tests, i.e. direct smear, culture and PCR. Using PCR technique, six out of the total specimens tested (21.4%), were positive for the presence of M. tuberculosis DNA. Statistically the difference between applied methods was significant (P < 0.0016). Accounting histopathology as gold standard, the sensitivity of PCR in this study was determined as 75%. Our study showed that from 8 cases of skin tuberculosis diagnosed by histopathology, 6 were positive by PCR technique, which shows the superiority of previous method to molecular technique. However, PCR assay has priority to conventional bacteriologic methods for detection of M. tuberculosis from cutaneous tuberculosis cases, and can be only used when the staining for acid fast bacilli is negative and there is a lack of growth on culture or when fresh material has not been collected for culture. (author's) Language: English Keywords: IRAN | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | TARGET POPULATION | TUBERCULOSIS | LABORATORY EXAMINATIONS AND DIAGNOSES | DERMATOLOGICAL EFFECTS | GRANULOMAS | HISTOCHEMICAL EFFECTS | Middle East | Developing Countries | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Design | Programs | Organization and Administration | Infections | Diseases | Physiology | Biology | Signs and Symptoms | Cytologic Effects Document Number: 307744 |
| 4. Title: Ano-perianal tuberculosis -- solving a clinical dilemma. Author: Gupta PJ Source: African Health Sciences. 2005 Dec;5(4):345-347. Abstract: Tuberculosis is one of the causes of granulomatous disease within the anorectal region. The clinical features, which include symptoms and signs of anal pain or discharge, multiple or recurrent fistula in ano and inguinal lymphadinopathy, are not characteristically distinct from other anal lesions. It is also difficult to distinguish it from other granulomatous diseases involving the same area. A Medline database was used to perform a literature search for articles relating to the term 'anal', 'tuberculosis' and 'Koch's'. Analysis of the available literature shows that Koch's lesion in and around the anus is not uncommon. The presentation is varied in nature and tuberculosis should be suspected in lesions not responding to the conventional approaches. The treatment is two-fold: surgical for the suppuration and medical for the tuberculosis. (author's) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | DATA COLLECTION | TUBERCULOSIS | GRANULOMAS | FISTULA | GASTROINTESTINAL EFFECTS | EXAMINATIONS AND DIAGNOSES | Research Methodology | Infections | Diseases | Signs and Symptoms | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 301575 |
| 5. Title: Malignant transformation of donovanosis. A case report. Author: Thappa DM; Senthikumar M; Laxmisha C Source: Indian Journal of Sexually Transmitted Diseases. 2004;25(2):77-78. Abstract: A 25-year old male truck driver married for last two years presented to us with single, painless, reddish ulcerated lesion over the penis of four years duration. On examination, a single, non-tender, fleshy, exuberant, beefy red granulation tissue involving most of the glans penis (including urethral meatus) was seen. Tissue smear from the edge of the genital sore stained with slow Giemsa stain showed "Donovan bodies" located within large vacuolated monocyte. Failure to respond to medical therapy made us suspect malignant transformation in donovanosis in our cases, which was confirmed by histophathology from the edge of the ulcer. This case is reported for its rarity and to make clinician aware about this complication in donovanosis. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CASE HISTORIES | CLIENTS | BACTERIAL AND FUNGAL DISEASES | GENITAL EFFECTS, MALE | GRANULOMAS | LABORATORY EXAMINATIONS AND DIAGNOSES | HISTOLOGY | CANCER | ANTIBIOTICS | Developing Countries | Asia, Southern | Asia | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Examinations and Diagnoses | Neoplasms | Drugs | Treatment Document Number: 287943 |
| 6. Title: Prevalence of pregnancy related oral granuloma in a Nigerian population group and the possible role of contraceptives. Author: Lawoyin JO; Lawoyin DO; Arowojolu MO; Lawoyin T; Akande OO Source: African Journal of Medicine and Medical Sciences. 2003 Dec;32(4):409-412. Abstract: A clinicopathological survey on pregnancy related tumours was carried out on 400 randomly selected pregnant Nigerian women. Fifteen (15) cases of pregnancy granuloma or 'epulis gravidanum' were found. Of these subjects, 287 representing 71.8 percent were on birth control before conception, while 113 or 28.2 percent were not. Nine(9) cases of pregnancy tumour were found in the group on birth control pills and six (6) in the group not on birth control representing an incidence of 3.1 and 5.3 percent respectively. Literature review indicate a general incidence of between 0-2.5 percent. Five of the granuloma regressed post partum, while ten were excised. Patients were followed 1-2 years post partum and no recurrence was recorded, even in patients who have re- commenced on contraceptives. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | GRANULOMAS | ORAL EFFECTS | PREVALENCE | ORAL CONTRACEPTIVES, SIDE EFFECTS | PREGNANCY COMPLICATIONS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Signs and Symptoms | Diseases | Physiology | Biology | Measurement | Contraceptive Safety | Safety | Public Health | Health Document Number: 277963 |
| 7. Title: Donovanosis in developed countries: neglected or misdiagnosed disease? [letter] La donovanose dans les pays en développement : maladie négligée ou mal diagnostiquée? Author: Morrone A; Toma L; Franco G; Latini O Source: International Journal of STD and AIDS. 2003 Apr;14(4):288-289. Abstract: There is a possibility that in the developed world some cases of granuloma inguinale in human mobile populations are not identified by clinicians inexperienced in tropical diseases, or that they are treated and accidentally cured through aspecific use of antibiotics, which are more and more often self-administered. As a matter of fact the Calymmatobacterium granulomatis is responsive to a number of commonly used antibiotics. (excerpt) French Abstract: Il existe une possibilité que, dans le monde développé, quelques cas de granuloma inguinal dans les populations mobiles humaines ne soient pas identifiés par les cliniciens inexpérimentés dans les maladies tropicales, ou qu'ils soient traités et aient guéri par hasard à travers l'usage non spécifique d'antibiotiques qui sont souvent auto-administrés. En réalité le granulomatis Calymmatobacterium est sensible à plusieurs antibiotiques communément utilisés. (extrait) Language: English Keywords: ITALY | CRITIQUE | RETROSPECTIVE STUDIES | RURAL AREAS | GRANULOMAS | SEXUALLY TRANSMITTED DISEASES | Europe, Southern | Europe | Developed Countries | Studies | Research Methodology | Geographic Factors | Population | Signs and Symptoms | Diseases | Reproductive Tract Infections | Infections Document Number: 176751 |
| 8. Peer Reviewed Title: Ocular toxocariasis in a north Indian population. Author: Mirdha BR; Khokar SK Source: Journal of Tropical Pediatrics. 2002 Dec;48(6):328-330. Abstract: Sera form 68 patients aged 1–30 years, suffering from posterior pole granuloma, peripheral granuloma, uveitis, endophthalmitis, optic neuritis and with a clinical diagnosis of suspected ocular toxocariasis, were tested for the presence of anti-Toxocara antibodies. Antibodies to Toxocara were detected in 11 (17 per cent) subjects less than 15 years old and three (4 per cent) subjects more than 15 years of age using enzyme-linked immunosorbent assay. None of the controls sera (other helminthic diseases) were positive for anti-Toxocara antibody. (author’s) Language: English Keywords: INDIA | EVALUATION REPORT | CLINICAL RESEARCH | CONTROL GROUPS | INTERVIEWS | OPHTHALMOLOGICAL EFFECTS | GRANULOMAS | ANTIBODIES | LABORATORY PROCEDURES | Asia, Southern | Asia | Developing Countries | Evaluation | Research Methodology | Data Collection | Physiology | Biology | Signs and Symptoms | Diseases | Immunologic Factors | Immunity | Immune System | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 173521 |
| 9. Peer Reviewed Title: Study of tuberculous lymphadenitis spectrum of cytomorphologic changes and acid fast bacilli positivity in fine needle aspirates from lymph nodes affected by tuberculosis: an analysis of 215 cases. Author: Akhter S; Baba KM; Nabi A Source: JK-PRACTITIONER. 2001 Jan-Mar;8(1):23-6. Abstract: The study presents a detailed analysis of fine needle aspiration smears from 215 clinically diagnosed patients of tuberculous lymphadenitis with a correlation between gross appearance of the aspirate, cytomorphologic features and acid-fast bacilli (AFB) positivity. The aspirate was of three types: 1) mixed with blood, 2) purulent, and 3) cheesy. The main cytomorphologic feature was presence of epithelioid cell granulomas with or without Langhan's giant cells. These epithelioid cell granulomas were present in all (100%) cases in which the aspirate was mixed with blood but lowest AFB positivity of 23.3% was found in these cases. Highest AFB positivity was seen in cases in which aspirate was purulent (i.e., 74%), but had epithelioid cell granuloma formation in only 27 out of 73 (37%) cases. Epithelioid cell granulomas were present in 84.6% cases in which aspirate was cheesy with AFB positivity of 65.3%. These findings stress the importance of introducing Ziehl-Neelson staining in smears of all cases suspected of tuberculosis in etiology as a routine practice, particularly in purulent aspirates. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | TUBERCULOSIS | GRANULOMAS | Asia, Southern | Asia | Developing Countries | Research Methodology | Infections | Diseases | Signs and Symptoms Document Number: 157085 |
| 10. Title: [Sarcoidosis and pregnancy: one case] Sarcoïdose et grossesse: à propos d'un cas. Author: Hamdani Z; Yousfi MM; Hassirahou D; El Amrani S; Ouazzani MC Source: Espérance Médicale. 2001 Jul;8(74):359-361. Abstract: This article is based on pregnancy and sarcoidosis, or Besnier-Boeck-Schaumann disease (BBS), a multisystemic granulomatosis secondary to an immune response whose origin is still unknown, and involves a particular case. This case involves a 36-year-old woman, with no notable pathological history, 18 weeks pregnant and presenting several papular and modular lesions located on the face, neck, back of the hands of the elbows. Monitoring detected no sign of activity of the disease, nor of fetal abnormalities; the patient delivered a healthy newborn vaginally. The diagnosis of this sarcoidisis is based on clinical, histological, etiological, and biological and/or immunological criteria. For a definitive diagnosis, the histological criteria must be combined with two other criteria. Its frequency in pregnant women is estimated at between 0.02% and 0.06%, its course is usually favorable, it has a minimum duration of 6 months and often lasts up to 2 years and sometimes several years. The impact of sarcoidosis on pregnancy appears to be negligible, the inactive forms before the start of pregnancy do not justify special obstetrical monitoring. On the other hand, strict monitoring of fetal growth must be performed when sarcoidosis is active and treated with prednisone. In the same way, this illness has no negative effect on embryonic-fetal development. Nevertheless, its active forms and corticoid therapy involve a risk of fetal hypotrophy. Pregnancy does not influence the course of the disease. In nearly all cases, pregnancy does not incur any additional risk to the mother, except in the case of advanced respiratory or cardiac failure, or uncontrolled disease of the central nervous system. Thus the stage of the illness must be evaluated before pregnancy begins, and it is only after this evaluation that a pregnancy can be authorized and carried out without risk. Finally, the article presents the steps to be taken, including treatment and monitoring of sarcoidosis during pregnancy, childbirth, and after childbirth. French Abstract: Cet article s'articule autour de la grossesse et de la sarcoïdose ou maladie de Besnier Boeck Schuman (BBS), qui est une granulomatose multisystémique secondaire à une réponse immunitaire de cause jusqu'à maintenant inconnue, et ce à propos d'un cas particulier. Ce cas correspond à une femme âgée de 36 ans, 4ème geste 3ème pare, sans antécédents pathologique notables enceinte de 18 semaines, présentant de nombreuses lésions cutanées papulaires et modulaires siégeant au niveau de la face, du cou, du dos des mains et des coudes. La surveillance n'a noté aucun signe d'activité de la maladie, ni d'anomalies fœtales ,la patiente a accouché par voie basse d'un nouveau-né bien portant. Le diagnostic de cette sarcoïdose repose sur les critères cliniques, histologiques, étiologiques et biologiques et/ou immunologique. Pour un diagnostic de certitude, le critère histologique doit s'associer à deux autres critères. Sa fréquence chez la femme enceinte est estimée entre 0,02% et 0,06%, son évolution est plus souvent favorable, elle a une durée minimale de 6 mois et se plonge souvent jusqu'à 2 ans et parfois plusieurs années. Quand au retentissement de la sarcoïdose sur la grossesse, il paraît négligeable, les formes inactives avant le début de grossesse ne justifient pas une surveillance obstétricale particulière. En revanche une surveillance étroite de la croissance fœtale doit être effectuée lorsque la sarcoïdose est active et traitée par prednisone. De même cette maladie n'a aucun effet négatif sur le développement embryo-fœtal. Néanmoins, ses formes actives et la corticothérapie exposent à l'hypotrophie fœtale. D'une part la grossesse n'influence pas l'évolution de la maladie. Dans la quasi-totalité des cas, la grossesse ne fait courir aucun risque supplémentaire à la mère, sauf le cas d'insuffisance respiratoire avancée, cardiaque ou d'une atteinte non contrôlée du système nerveux central. Ainsi une évaluation du stade de la maladie avant tout début de grossesse est obligatoire, et ce n'est qu'après cette évaluation, qu'une grossesse peut être autorisée et menée sans risque. Enfin l'article présente la conduite à tenir, qui comprend le traitement et la surveillance de la sarcoïdose en cours de la grossesse, de l'accouchement et après l'accouchement. Language: French Keywords: MOROCCO | RESEARCH REPORT | CASE STUDIES | PREGNANT WOMEN | POSTPARTUM WOMEN | GRANULOMAS | DERMATOLOGICAL EFFECTS | PULMONARY EFFECTS | IMMUNE SYSTEM | TREATMENT | RECOVERY | PREGNANCY OUTCOMES | Developing Countries | Africa, Northern | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Signs and Symptoms | Diseases | Physiology | Biology | Health | Pregnancy Document Number: 188478 |
| 11. Title: Tuberculous cervical lymphadenitis in HIV positive and negative patients. Author: Rajasekaran S; Gunasekaran M; Jayakumar DD; Jeyaganesh D; Bhanumathi V Source: Indian Journal of Tuberculosis. 2001;48(4):201-204. Abstract: With the rising trend of extra-pulmonary tuberculous conditions among HIV positive patients, study of the proportion of HIV seropositives among patients with tuberculous cervical lymphadenitis, variations in clinical presentation, diagnostic yield of FNAC/biopsy, microbiological findings and pathological pattern of cervical lymph nodes in HIV positives and negatives gains importance. In all, 110 patients, considered as tuberculous cervical lymphadenitis cases, were screened by chest radiography, tuberculin test, fine needle aspiration cytology and/or histopathological examination and smear microscopy for AFB of biopsied lymphnodes. All these patients were also tested for HIV seropositivity by two different ETLISA tests, repeated at least twice. Of the 85 confirmed tuberculosis patients, 16 (18.8%) had HIV seropositivity, of whom 9 (56.2%) had demonstrable AFB in FNAC/biopsied cervical node specimens; only one HIV negative patient (1.4%) had positive smear microscopy for AFB. Among the 16 HIV positive patients, typical granuloma and/or casealion were found in 10 patients (62.5%) and atypical pathological features were found in the remaining 6 patients (37.5%). (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CLIENTS | PERSONS LIVING WITH HIV/AIDS | RURAL POPULATION | TUBERCULOSIS | HIV INFECTIONS | PREVALENCE | LABORATORY EXAMINATIONS AND DIAGNOSES | GRANULOMAS | LABORATORY PROCEDURES | Developing Countries | Asia, Southern | Asia | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Infections | Measurement | Examinations and Diagnoses | Signs and Symptoms Document Number: 287992 |
| 12. Title: Clinico-epidemiologic features of granuloma inguinale in the era of acquired immune deficiency syndrome. Author: Jamkhedkar PP; Hira SK; Shroff HJ; Lanjewar DN Source: Sexually Transmitted Diseases. 1998 Apr;25(4):196-200. Abstract: Infection with genital ulcer disease (GUD) facilitates the transmission of HIV. However, granuloma inguinale (GI), an endemic sexually transmitted disease (STD) in India, has been ignored as a cause of GUD. In the context of increasing prevalence of HIV infection among patients with STD at a clinic in Mumbai, a study was conducted to determine the clinico-epidemiologic features of GI and HIV, with the goal of identifying any possible interaction between the two. 21 consecutive cases of GI in HIV-seropositive individuals and 29 controls, HIV-seronegative individuals with GI, participated in the prospective follow-up study to determine how long it takes for GUD to heal. Healing was considered complete when total re-epithelization of the ulcer(s) was observed. All cases and controls received a standard treatment regimen of erythromycin under supervision until healing occurred. While the GI ulcers at recruitment were not significantly larger among HIV-seropositive individuals compared with those among HIV-seronegative individuals, the former took longer to heal completely; an average of 25.7 days compared to 16.8 days, respectively. The former ulcers also tended to produce greater tissue destruction. Slow-healing GI ulcers with underlying HIV infection can lead to the increased transmission of both infections. Language: English Keywords: INDIA | RESEARCH REPORT | HIV INFECTIONS | AIDS | SEXUALLY TRANSMITTED DISEASES | TIME FACTORS | TREATMENT | DERMATOLOGICAL EFFECTS | GRANULOMAS | Asia, Southern | Asia | Developing Countries | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Population Dynamics | Demographic Factors | Population | Physiology | Biology | Signs and Symptoms Document Number: 132601 |
| 13. Title: Conservative treatment of vaginal vault granulation tissue following total abdominal hysterectomy. Author: Saropala N; Ingsirorat C Source: International Journal of Gynecology and Obstetrics. 1998 Jul;62(1):55-8. Abstract: Vaginal vault granulation tissue, a common postoperative complication of total abdominal hysterectomy, is generally treated with cauterization with silver nitrate. A prospective study of 352 women who underwent total abdominal hysterectomy for benign conditions at Ramathibodi Hospital in Bangkok, Thailand, in 1995-96 investigated the incidence, symptoms, and spontaneous regression rate of vault granulation tissue in relation to lesion size. The overall incidence of vault granulation tissue in this series was 34%. 60% of the lesions were 5 mm or less in size. During the 20-week follow-up period, spontaneous regression occurred in 52% of cases. The rate of complete disappearance was 72% when the lesion was 5 mm or smaller compared with 33% when the lesion was larger than 5 mm (p < 0.001). Symptoms were experienced by 7% of patients in the former group and 18% in the latter group. These findings suggest that vault granulation lesions 5 mm in size or smaller should be treated conservatively with vault closure with synthetic polymer sutures rather than with the more invasive cauterization given the low incidence of symptoms and high likelihood of spontaneous regression. Language: English Keywords: THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | HYSTERECTOMY | GRANULOMAS | INCIDENCE | TREATMENT | SIGNS AND SYMPTOMS | COMPLICATIONS | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Gynecologic Surgery | Urogenital Surgery | Surgery | Diseases | Measurement Document Number: 135671 |
| 14. Title: Is vasectomy harmful to health? Author: McDonald SW Source: BRITISH JOURNAL OF GENERAL PRACTICE. 1997 Jun;47(419):381-6. Abstract: Since the late 1960s, vasectomy has been a popular contraceptive option in Great Britain for couples who have achieved their desired family size. In recent years, however, considerable concern has been expressed about possible associations with cardiovascular disease and testicular and prostate cancer as well as long-term localized effects. This article reviewed the literature published during 1986-96 on these health concerns. Although vasectomized monkeys fed atherogenic diets appear to have a higher risk of peripheral artery disease, long-term studies of vasectomized men have failed to detect increased cardiovascular disease. No evidence has been found that vasectomy predisposes to testicular cancer or accelerates the growth of early testicular cancer. Studies demonstrating a 2-fold increase in the risk of prostate cancer after vasectomy were conducted in the US, where prostate cancer is common, and contained possible biases. European studies have not detected such an increased risk. Even if a relationship between vasectomy and prostate cancer is proven, further investigations would be required to determine if vasectomy causes prostate cancer through mechanisms such as hormonal changes, immunologic responses, or failure of growth inhibitors to reach the prostate due to obstruction of the reproductive tract, or whether vasectomized men are more exposed to the real causal agent. Moreover, even if the risk for vasectomized men in the UK is doubled, only 6/1000 men 65-74 years old would be expected to develop prostate cancer each year. The local effects of vasectomy on the reproductive tract are not fully determined. Distention of the epididymal duct occurs in most patients and granuloma formation is common. Vasectomy may also induce autoimmune orchitis. While many men develop structural changes in the reproductive tract after vasectomy, only a minority report discomfort. Although men considering vasectomy should be told that some studies have suggested a small increased risk of prostate cancer, they can be reassured that other health concerns are without foundation. Language: English Keywords: UNITED KINGDOM | LITERATURE REVIEW | VASECTOMY | LONGTERM EFFECTS | CARDIOVASCULAR EFFECTS | PROSTATE | TESTIS | CANCER | EPIDIDYMITIS | GRANULOMAS | SIDE EFFECTS | Developed Countries | Europe, Western | Europe | Male Sterilization | Sterilization, Sexual | Family Planning | Time Factors | Population Dynamics | Demographic Factors | Population | Physiology | Biology | Genitalia, Male | Genitalia | Urogenital System | Neoplasms | Diseases | Reproductive Tract Infections | Infections | Signs and Symptoms | Treatment Document Number: 126503 |
| 15. Title: Effects of vasectomy on the epididymis. Author: Flickinger CJ; Howards SS; Herr JC Source: MICROSCOPY RESEARCH AND TECHNIQUE. 1995 Jan 1;30(1):82-100. Abstract: The changes in the epididymal epithelium, luminal contents, inflammation in the epididymal interstitial tissue, and gross epididymal alterations after vasectomy are described. Studies of vasectomy and its reversal by vasovasostomy in the rat as a model system conducted over the decade prior to 1993 were reviewed. Common principles can be discerned in the response of the epididymis to vasectomy, despite species differences (rat, rabbit, guinea pig, and hamster). Increases in the size and number of lysosomes are the most frequent changes in the epididymal epithelium. The presence or absence of additional alterations such as changes in the height of the epithelium may be related to variations in distensibility of the vas deferens and epididymis. In the guinea pig and hamster the intratubular hydrostatic pressure in the seminiferous tubule was significantly lower (p < 0.001) than in the caput epididymis. Direct measurements by micropuncture of epididymal and seminiferous tubule hydrostatic pressure indicate that, contrary to dogma, increased pressure in the distal epididymis after vasectomy is not generally transmitted to the seminiferous tubules. The epididymal interstitium shows microscopic changes indicative of chronic inflammation, with infiltration of macrophages, lymphocytes, and plasma cells, and rats with these lesions have higher antisperm antibody levels than animals lacking epididymal changes. Cyst-like spermatic granulomas occur in virtually all species where the epididymis or vas deferens ruptures with escape of spermatozoa. The sites and timing of granuloma formation may depend on the mechanical properties of the tract in different species, and they are probably important in the immune response to vasectomy. Postvasectomy sera in Lewis rats recognize a consensus repertoire of dominant autoantigens that closely resembles the antigens bound by sera from rats immunized with isologous spermatozoa. There are multiple routes for disposal of the sperm that continue to be produced after vasectomy. Language: English Keywords: LITERATURE REVIEW | VASECTOMY | EPIDIDYMIS | VAS DEFERENS | ANTIBODIES | SPERM IMMOBILIZING AGENTS | GRANULOMAS | SIDE EFFECTS | Male Sterilization | Sterilization, Sexual | Family Planning | Testis | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Immunologic Factors | Immunity | Immune System | Spermicidal Contraceptive Agents | Contraceptive Agents | Contraception | Signs and Symptoms | Diseases | Treatment Document Number: 105475 |
| 16. Title: Vasectomy reversal. Author: Goldstein M Source: COMPREHENSIVE THERAPY. 1993 Jan;19(1):37-41. Abstract: About 500,000 men undergo vasectomy in the US yearly. 2-6% seek surgical reversal. Divorce is the main reason for vasectomy reversal in the US, while death of a child is in developing countries. Microsurgical techniques result in sperm's return to the ejaculate in more than 90% of reversal cases and in pregnancy in more than 50%. The clinician should conduct a complete physical examination and patient history to determine the prevasectomy fertility status of men wanting reversal, the surgical approach to use, and the success of reversal based on the location of the obstructed segment and the amount of vas removed. He/she should request a semen analysis, including serum and semen antisperm antibody assays. The surgeon should perform vas reanastomosis under general anesthesia or epidural anesthesia with sedation. Microsurgical vas reanastomosis requires considerable skill and 2-4 hours. Serial transection of the epididymis at high levels avoids rupture of the epididymis and secondary obstruction. The surgeon can usually discharge the patient the same day of the reversal. The patient can resume intercourse and normal activities in 3 weeks. The longer the time period between vasectomy and reversal, the less likely the reversal will be successful. Sperm granuloma at the vasectomy site increases the likelihood of successful vasectomy reversal, while sperm granuloma at the level of the epididymis or rete testis is linked to secondary obstruction and less successful reversal. As little as 50% of vasectomized men develop antisperm antibodies which may adversely affect the outcome of vasectomy reversal. If vas fluid samples from the testicular side have normal sperm, the possibility of a return to fertility is good; otherwise, it is less than 25%. A vasoepididymostomy may be needed in these cases. The most important factors in bringing about successful reversal surgery are the microsurgical technique and intraoperative judgment. In successful reversal cases, pregnancy usually does not occur until 6-18 months postoperatively. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | VAS REANASTOMOSIS | PREOPERATIVE PROCEDURES | PHYSICAL EXAMINATIONS AND DIAGNOSES | LABORATORY EXAMINATIONS AND DIAGNOSES | MICROSURGERY | TIME FACTORS | GRANULOMAS | SPERM AGGLUTINATION | SEMEN | Developed Countries | North America | Americas | Sterilization Reversal | Reversible Sterilization | Sterilization, Sexual | Family Planning | Surgery | Treatment | Examinations and Diagnoses | Population Dynamics | Demographic Factors | Population | Signs and Symptoms | Diseases | Antigen-Antibody Reactions | Antibodies | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Seminal Vesicles | Genitalia, Male | Genitalia | Urogenital System Document Number: 091822 |
| 17. Title: Treatment of chancroid, lymphogrnuloma venereum and granuloma inguinale. Author: Latif AS Source: [Unpublished], 1993. Background paper for the WHO Advisory Group Meeting on STD Treatments, Geneva, Switzerland, February 18-19, 1993. 9 p. Abstract: This paper, which reviews the literature on chancroid, lymphogranuloma venereum, and granuloma inguinale and recommends treatment for these sexually transmitted diseases, opens by noting the difficulty of diagnosing genital ulcerative conditions in developing countries. This difficulty, caused by incidences of multiple infections and a lack of suitable laboratories, has been exacerbated by the HIV/AIDS epidemic. Because genital ulcerative conditions facilitate the spread of HIV, it is important that they receive rapid and effective treatment. Ideal treatments for all sexually transmitted diseases would be effective in single doses, oral, free of side effects, and affordable. The recommended treatment for chancroid involves administration of ciprofloxacin, erythromycin, or cefixime, and an alternative treatment can be effected with ceftriaxone or spectinomycin. The results of four recent clinical trials are tabulated, as is a summary of the recommended treatment. In the case of lymphogranuloma venereum, no recent clinical trials have been undertaken. Recommended treatment involves administration of doxycycline or erythromycin with tetracycline or sulphadiazine used as alternatives. Granuloma inguinale can be treated with cotrimoxazole or, alternatively, with either doxycycline or tetracycline. No recent clinical trials were available in this case either. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | RECOMMENDATIONS | TREATMENT | SEXUALLY TRANSMITTED DISEASES | CHANCROID | GRANULOMAS | HIV INFECTIONS | DRUGS | ADMINISTRATION AND DOSAGE | Reproductive Tract Infections | Infections | Diseases | Signs and Symptoms | Viral Diseases Document Number: 111573 |
| 18. Title: Male sterilization. Author: Ackman CF Source: In: Practice of fertility control: a comprehensive textbook. 3rd ed., [edited by] S.K. Chaudhuri. New Delhi, India, B.I. Churchill Livingstone, 1992. :140-50. Abstract: Many men accept and understand permanent male sterilization achieved by vasal occlusion, but vasectomy is less popular than female sterilization. Today vasectomy protects 45 million couples in the world from pregnancy (27.3% of all couples protected by voluntary sterilization). Most of these couples live in China, India, the US, the UK, Canada, and the Netherlands. The vasectomy site is below the level from where most of the ejaculate derives thus vasectomy has little effect on ejaculation. Since mature sperm are still in the upper genital tract following vasectomy, men are fertile until these sperm leave. They must use a contraceptive for 2-3 months or until azoospermia has been achieved. Before surgery, the health worker performing the vasectomy should clearly communicate to the patient this temporary need for contraception and other important points, e.g., vasectomy does not influence masculinity, sexual behavior, or mental health. The vasectomy site should be as high as possible on the vas to allow vasovasostomy. Health workers can use various techniques to occlude the vas, e.g., removal of a piece of the vas or using metal clips. The no-scalpel technique developed in China is new and allows vasal occlusion via a 1 mm puncture. Some postvasectomy advice includes using scrotal support for 2 weeks, refraining from strenuous work for 2 days and cleaning the vasectomy site with soap and water each day for 2-3 days after the vasectomy. Possible complications are pain, discomfort, hematomas, subcutaneous ecchymosis, sperm granuloma, and infection. 45-50% of vasectomy patients have circulating sperm antibodies which induce agglutination or immobilization. Language: English Keywords: DEVELOPING COUNTRIES | CHINA | DEVELOPED COUNTRIES | MALE STERILIZATION | VASECTOMY | COUNSELING | VAS OCCLUSION | POSTOPERATIVE PROCEDURES | GRANULOMAS | TREATMENT | IMMUNOLOGICAL EFFECTS | CONTRACEPTION FAILURE | PSYCHOLOGICAL FACTORS | SIDE EFFECTS | Asia, Eastern | Asia | Sterilization, Sexual | Family Planning | Clinic Activities | Program Activities | Programs | Organization and Administration | Surgery | Signs and Symptoms | Diseases | Immunity | Immune System | Physiology | Biology | Contraceptive Usage | Contraception | Behavior Document Number: 079634 |
| 19. Title: Diagnosis of tuberculosis in children. Author: Anane T; Grangaud JP Source: CHILDREN IN THE TROPICS. 1992;(196-197):20-9. Abstract: Diagnosis of tuberculosis (TB) in children is usually based on presumptions from several elements: clinical picture and course, x-rays, tuberculin test, and culture of pathology later on. TB is usually found in a child because of symptoms of primary disease, or through case-finding of a contact. TB is children is often a primary infection and may be gradual or acute in onset. Some of the symptoms of primary TB are low-grade fever, pallor, fatigue, and anorexia. The child may have erythema nodosum, a yellow module on the conjunctiva, hilar or mediastinal lymphadenopathy, a primary TB complex on the lung (3-10 mm), segmental density, or a positive PPD test. Children with pulmonary disease do not have adult-type cavity lesions, but may have a primary cavity that drains into the bronchi, mechanical complications, fistulas, or atelectasis. Acute TB often appears as meningitis. The pathognomonic signs are cerebrospinal fluid high in lymphocytes with very high albumin (0.6-2 g) and low glucose (0.4-0.2 g/l). TB organisms are rarely seen, but may be cultured. TB meningitis is also notable for choroidal tubercles, which are yellow nodules visible in the fundus. These presumptive signs, as well as increasing neurological findings, prompt immediate treatment. Children also may have acute miliary TB, marked by high fever, gastrointestinal symptoms, hepatosplenomegaly, dyspnea, cyanosis, and respiratory distress, with characteristic diffuse grainy spots on the chest x-ray. A child may have both conditions and may also have localized TB infection elsewhere. Thus, clinical findings may point to possible cultures of urine, gastric lavage, pleural fluid or biopsy, pericardial fluid, bone marrow, or ascitic fluid, any of which should be cultured to rule out other causes. The most common sites for extra-pulmonary TB are cervical nodes, spine, knee. shoulder, hip and peritoneum. Pelvic and urinary tract infections are rare in children. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | TUBERCULOSIS | CHILD | INFANT | HISTOLOGY | CENTRAL NERVOUS SYSTEM EFFECTS | LEUKOCYTOSIS | NEUROLOGIC EFFECTS | OPHTHALMOLOGICAL EFFECTS | PULMONARY EFFECTS | RESPIRATORY INSUFFICIENCY | ERYTHEMA NODOSUM | PERITONEAL DISEASES | FATIGUE | GRANULOMAS | LABORATORY EXAMINATIONS AND DIAGNOSES | PHYSICAL EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | Infections | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | Central Nervous System | Physiology | Hematological Effects | Hemic System | Dermatitis | Examinations and Diagnoses Document Number: 081991 |
| 20. Title: Epidemiology of tuberculosis in children. Author: Chaulet P Source: CHILDREN IN THE TROPICS. 1992;(196-197):7-19. Abstract: This is a review of the epidemiology of tuberculosis in children covering the classical aspects of sources, prevalence, annual risk, risk of active disease, frequency of childhood tuberculosis (TB) in the population, and mortality, ending with descriptions of the course of active TB. post-primary pulmonary disease, disease of other systems, and the impact of control measures and poverty. The source of TB is always expectorating adults with active TB-positive sputum. The prevalence of TB in children in developing countries is estimated at 10-20%. Each untreated source infects about 10-13 new persons per year, yet, if treated, that person would only infect 2-3 people per year. The risk of a TB infection evolving into an active infection is about 10% and is highest in the first 2 years after primary infection. The frequency of childhood TB in the population ranges from 2.5% in Japan, to 18.5% in Tanzania with its younger population. The morbidity rate varies with ethnic and socioeconomic group; for example, from 1.3% in White to 17.2% of American Indian children up to age 4 in the U.S. In children, TB rarely follows the typical course seen in adults; post-primary pulmonary disease. Children under 2 often develop hematogenous complications of TB, i.e., extrapulmonary disease. When children get pulmonary disease, they rarely have cavitation, so they do not expel infective sputum. Thus, only 3-13% of children are smear-positive, while 29% may have positive cultures. In children, primary infection may appear as visible mediastinal lymphadenopathy. The highest mortality rates are in children under age 5, mostly from TB meningitis. Case-finding, followed by chemotherapy, has the greatest impact on control of the disease. BCG vaccination of infants prevents active primary disease in the young, but neither BCG nor chemoprophylaxis of children has any effect on controlling the spread of TB in the population. It is likely that HIV disease and the growth of poverty will increase the incidence of TB in developing countries. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | TUBERCULOSIS | CHILD | INFANT | EPIDEMIOLOGIC METHODS | BIOLOGICAL CHARACTERISTICS | IMMUNITY, CELLULAR | MORBIDITY | CHILD MORTALITY | GRANULOMAS | VACCINATION | ETHNIC GROUPS | CROWDING | RISK FACTORS | PREVALENCE | TREATMENT | SIGNS AND SYMPTOMS | Infections | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Research Methodology | Biology | Immunity | Immune System | Physiology | Mortality | Population Dynamics | Immunization | Primary Health Care | Health Services | Delivery of Health Care | Health | Cultural Background | Population Density | Population Distribution | Geographic Factors | Measurement Document Number: 081990 |
| 21. Title: Reversal of vasectomy. Author: Schmidt SS Source: In: Practice of fertility control: a comprehensive textbook. 3rd ed., [edited by] S.K. Chaudhuri. New Delhi, India, B.I. Churchill Livingstone, 1992. :229-38. Abstract: A surgeon must consider various factors before deciding to rejoin the vas deferens of a vasectomized man. For example, was this man able to impregnate a woman before the vasectomy? If not, perhaps he was already infertile or subfertile or even the wife may be infertile. Further, perhaps too much of the vas was removed during the vasectomy making it impossible to rejoin the vas ends. Moreover, vasectomized men with high sperm antibody titers in semen tend to be infertile. Other possible drawbacks include epididymal obstructions and spermatic granuloma. A surgeon must interview a patient and be willing to answer any questions upon determining that the patient is a good candidate for vasectomy reversal. A subcutaneous injection of Demerol sedates the patient for several hours. Lidocaine without epinephrine is often used to bring about total regional anesthesia. After transection of the vas, the surgeon removes some spermatic fluid to detect sperms and sperm heads. If they are present, the surgeon performs the vasovasostomy. The surgeon can use either a microscope or loupes. Inert polyester sutures are superior for rejoining the vas. The patient should wear a suspensory for 2 weeks after the procedure and can recommence sexual intercourse in 7-10 days. Experienced surgeons can achieve patency rates of at least 80%. Pregnancy rates after vas reanastomosis tend not to be greater than 50%. Patency and pregnancy rates are usually 50% lower after epididymovasostomy than after vasovasostomy because there is a fistula between epididymis and vas instead of a watertight mucosa to mucosa anastomosis. Postoperative complications are minimal, but may include infection, bleeding, and minimal pain. Language: English Keywords: DEVELOPED COUNTRIES | DEVELOPING COUNTRIES | VAS REANASTOMOSIS | VAS DEFERENS | EPIDIDYMIS | PREOPERATIVE PROCEDURES | STERILIZATION REVERSAL | SPERM COUNT | MICROSURGERY | SPERM AGGLUTINATION | PREGNANCY RATE | INFERTILITY | GRANULOMAS | Reversible Sterilization | Sterilization, Sexual | Family Planning | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Testis | Surgery | Treatment | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Antigen-Antibody Reactions | Antibodies | Immunologic Factors | Immunity | Immune System | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Reproduction | Signs and Symptoms | Diseases Document Number: 079640 |
| 22. Title: Factors influencing first relapse in patients with Crohn's disease. Author: Wright JP Source: JOURNAL OF CLINICAL GASTROENTEROLOGY. 1992 Jul;15(1):12-6. Abstract: A surgeon followed 239 people diagnosed with Crohn's disease while they were patients at Groote Schuur Hospital in Cape Town, South Africa between 1970 and 1988 until 1st relapse or for 10 years to determine whether risk factors of the disease predicts the clinical disease course. 156 (65%) had suffered from a relapse. The relapse type of about 70% of these cases was of the same type as the 1st attack. Cigarette smokers were more likely to experience ileocolitis than nonsmokers (47% vs. 32%; p=.028). Ileocolitis was linked to an increased number of inflammatory attacks (47% vs. 35% for ileitis and 14% for colitis; p=.001). Thus the researcher concluded that cigarette smoking is linked to Crohn's disease and influences the underlying disease process. A nonsignificant trend existed for combined oral contraceptive use and increased numbers of inflammatory attacks and ileocolitis. Histological granulomas did not effect the relapse pattern of the patients. The Quetelet Index indicated that females were more likely to be malnourished than males (561 vs. 645; p<.0001). They presented with more severe Crohn's disease at diagnosis. Obstruction was responsible for 40% of relapses in patients with ileitis. Other than the fact that the type of attack 1st experienced by an individual tends to be the same as the relapse attack, this study did not provide physicians any additional information to help with prognosis of early diagnosis of Crohn's disease. Language: English Keywords: SOUTH AFRICA | METHODOLOGICAL STUDIES | PROSPECTIVE STUDIES | GASTROINTESTINAL EFFECTS | SIGNS AND SYMPTOMS | RISK FACTORS | TOBACCO USE | ORAL CONTRACEPTIVES, COMBINED | GRANULOMAS | MALNUTRITION | NUTRITION INDEXES | SIDE EFFECTS | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Physiology | Biology | Diseases | Behavior | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Nutrition Disorders | Nutrition | Health | Treatment | Demographic Factors | Population | Contraceptive Safety | Safety | Public Health Document Number: 077860 |
| 23. Title: Epididymectomy for post-vasectomy pain: histological review. Author: Chen TF; Ball RY Source: BRITISH JOURNAL OF UROLOGY. 1991 Oct;68(4):407-13. Abstract: Epididymectomy was performed on 10 men with intractable post-vasectomy pain, on 7 with chronic epididymo-orchitis and 7 with epididymal cysts. The vasectomy patients had pain of mean 6 years duration, 6 months-20 years after surgery. In 9 the pain was a constant, dull ache. 5 had unilateral, and 5 bilateral epididymectomy. Only 5 were relieved of pain: 1 subsequently had orchidectomy with symptomatic improvement. The other 4 were offered orchidectomy. There was no obvious association of clinical findings with results. All 7 patients with epididymo-orchitis were relieved, although 1 required orchidectomy. 4 of the 7 with cysts had complained of pain, and all were asymptomatic after surgery. The most common pathological findings in the vasectomy patients were obstruction and dilatation of the efferent and epididymal ducts with interstitial fibrosis, and perineural inflammation and fibrosis around nerves, particularly in the tail of epididymis. So-called "late vasectomy syndrome" or unremitting pain is rare, and probable related to sperm granuloma. Language: English Keywords: UNITED KINGDOM | CASE STUDIES | VASECTOMY | PAIN | EPIDIDYMIS | GENITAL EFFECTS, MALE | GRANULOMAS | MALE UROLOGIC SURGERY | COMPLICATIONS | United Kingdom | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Male Sterilization | Sterilization, Sexual | Family Planning | Signs and Symptoms | Diseases | Testis | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Urogenital Surgery | Surgery | Treatment Document Number: 070814 |
| 24. Title: Vas deferens abscess six years post vasectomy [letter] Author: Gilbert BR; Harrison K Source: UROLOGY. 1991 Aug;38(2):191-2. Abstract: The emergency room of a New York university hospital admitted a 49 year old white heterosexual male with a fever of 104 degrees Fahrenheit and pain in his right scrotum and groin area. He had multiple sex partners. These lone symptoms were present 2 days prior to admittance. When these symptoms began, he took cephalosporin which was left over from when he had an earlier upper respiratory tract infection. 6 years earlier, he underwent a successful vasectomy and right herniorrhaphy with no complications. Further, 15 years earlier, he had a bilateral scrotal hydrocelectomy. The physicians found a large, tender mass jutting down from the right inguinal canal. His yellow urine was cloudy and full of red and white blood cells (too numerous to count) and debris. A urine culture revealed 1000 colony forming units of Escherichia coli/cc. The physicians then ordered intravenous broad spectrum antibiotic therapy. Despite this therapy, his fever and pain continued. A sonogram showed bowel gas indicating a possible incarcerated hernia. Physicians then performed exploratory surgery on the right inguinal area. Instead of finding a hernia, they found a tubular mass <1 cm in diameter which was blind ended above the testis and full of pus. Upon closer examination, the physicians realized that the tubular structure was the vas deferens. They removed it. The vas deferens exhibited fibrous obliteration, acute and chronic inflammation, and foreign body granuloma. E. coli was again isolated. Perhaps the E. coli moved backward from the ejaculatory ducts toward the blind ending vas. Yet the seminal vesicles and ampulla of the vas deferens were not inflamed. The fever subsided in 24 hours. Physicians discharged him 72 hours after the operation and prescribed an oral antibiotic. No other case of abscess of the vas deferens 6 years after vasectomy has been recorded. Language: English Keywords: UNITED STATES OF AMERICA | NEW YORK | CASE STUDIES | VAS DEFERENS | INFECTIONS | VASECTOMY | PAIN | SURGERY | ULTRASONICS | MULTIPLE PARTNERS | GRANULOMAS | TREATMENT | SIDE EFFECTS | Developed Countries | North America | Americas | Studies | Research Methodology | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Diseases | Male Sterilization | Sterilization, Sexual | Family Planning | Signs and Symptoms | Sexual Partners | Sex Behavior | Behavior Document Number: 068947 |
| 25. Title: The response of the regional lymph node to epididymal sperm granulomas after vasectomy. Author: McDonald SW; Al Saffar R; Scothorne RJ Source: JOURNAL OF ANATOMY. 1991 Jun;176:35-44. Abstract: 2 experiments involving inbred Albino Swiss rats after vasectomy suggest that variations in the lymphatic drainage of sperm granulomas are not, as previously suggested, a major factor in the variability of the regional testicular lymph node's response to this procedure. More significant to the antigenic stimulation of the node seems to be leukocytes released from sperm granulomas. In the 1st experiment, the ductus deferens was divided at its junction with the epididymal duct and sperm granulomas were induced to form in the cauda, which drains into the testicular node. The resultant testicular nodes exhibited a range of weights and cortical nodule content and 1 experimental node was indistinguishable from control nodes. The presence of an epididymal granuloma did not inevitably lead to an immune response in the regional node; spermatozoa were relatively numerous in the node of only 1 of 8 experimental rats. In the 2nd experiment, the intrinsic lymphatics of the epididymis in rats with epididymal granulomas after vasectomy were compared with those in sham-operated controls. Lymphatics in the epididymis adjacent to the granuloma in vasectomized rats contained numerous macrophages and lymphocytes--findings that were not recorded in control animals or vasectomized rats in which a granuloma had not developed. The abundance of macrophages and lymphocytes adjacent to (a granuloma suggests that these cells came from the granuloma and are most likely active agents in antigen transport from granuloma to node. Language: English Keywords: COMPARATIVE STUDIES | LABORATORY ANIMALS | SPERMATOZOA | VASECTOMY | EPIDIDYMIS | GRANULOMAS | IMMUNITY, CELLULAR | SIDE EFFECTS | Studies | Research Methodology | Clinical Research | Germ Cells | Genitalia | Urogenital System | Physiology | Biology | Male Sterilization | Sterilization, Sexual | Family Planning | Testis | Genitalia, Male | Signs and Symptoms | Diseases | Immunity | Immune System | Treatment Document Number: 070024 |
| 26. Title: Leprosy and AIDS: a review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae. Author: Miller RA Source: INTERNATIONAL JOURNAL OF LEPROSY AND OTHER MYCOBACTERIAL DISEASES. 1991 Dec;59(4):639-44. Abstract: A literature search of coinfection with HIV and leprosy retrieved 4 case reports, 4 epidemiologic studies, 2 primate studies, and an editorial The 1st case was a 43-year old male with borderline tuberculoid leprosy who was successfully treated with dapsone and clofazimine, but later developed Kaposi's sarcoma and pulmonary tuberculosis. The 2nd case was a 28-year old male from Martinique who had been treated with triple therapy (dapsone, rifampin, and clofazimine) for lepromatous disease with erythema nodosum leprosum for 9 years, but later developed reactive polyarthritis and 1+ bacterial index along with generalized lymphadenopathy with his HIV. A 3rd case was a 27-year old male who had been treated for cutaneous leprosy for 4 years. 5 years later he had polyneuropathy and palpable nerve trunks suggestive of a reversal reaction, and candida esophagitis with a CD4/CD8 ratio of 0.3. The 4th case was a 35-year old woman with BT-BB leprosy on clinical grounds, but apparent BL leprosy by histology. It was also noted that her granulomas had a high CD4+ lymphocyte count, while her circulating CD4/CD8 ratio was 0.6 with a low CD4 count of 300. The 4 epidemiologic series were from Zambia, Haiti, Ethiopia, and a large series of cases from Ivory Coast, Congo, Senegal, and Yemen. Some preliminary conclusions from these data were that HIV infection does not affect the clinical classification of leprosy, that HIV infection may confer anergy to lepromin, that HIV infection may cause relapse of leprosy, and that leprosy may accelerate the progression of HIV. There were 2 cases where leprosy grading reaction reversed or downgraded in coinfected patients. In the primate model, coinfection with SIV and M. leprae increases susceptibility of monkeys to leprosy. Language: English Keywords: ZAMBIA | HAITI | ETHIOPIA | COTE D'IVOIRE | REPUBLIC OF THE CONGO | SENEGAL | YEMEN | MARTINIQUE | LITERATURE REVIEW | CASE STUDIES | EPIDEMIOLOGIC METHODS | HIV INFECTIONS | AIDS | BACTERIAL AND FUNGAL DISEASES | HISTOLOGY | CYTOLOGIC EFFECTS | IMMUNOLOGICAL EFFECTS | ERYTHEMA NODOSUM | GRANULOMAS | CYTOLOGY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Caribbean | Americas | Africa, Eastern | Africa, Western | Middle East | Studies | Research Methodology | Viral Diseases | Diseases | Infections | Biology | Physiology | Immunity | Immune System | Dermatitis | Signs and Symptoms Document Number: 073630 |
| 27. Title: [Effect of pregnancy and use of medications on a healthy periodontium] Raskauden ja ehkaisytablettien kayton vaikutus parodontiumiin. Author: Pentti P; Knuuttila M Source: SUOMEN HAMMASLAAKARILEHTI. 1991 Aug 15;38(14):952-9. Abstract: Changes in hormone balance have been associated with susceptibility to infection of the gingiva and mouth mucous membrane. Estrogen and progestogen amounts which increase during pregnancy cause changes in the permeability and the number of blood vessels, and the volume of blood and blood circulation also increase. In chronically inflamed gingiva, the increase of pocket fluid was noticed during pregnancy. IN healthy gingiva, the amount did not increase despite pregnancy. A slight, but statistically significant, increase of the horizontal looseness of teeth has even been confirmed among pregnant women. The cause of the looseness is change in the periodontal ligament as well as an edema produced by the increased permeability of blood vessels which extrudes the teeth out of the alveolus. It has also been observed that hormonal changes during pregnancy cause thinning of mouth flora; subgingival flora becomes more anaerobic as pregnancy advances. In relation to the increased amount of estrogen and progesterone, the amount of Prevotella intermedius bacteria increases noticeably more than others. The cause of this is found in the ability of Prevotella intermedius to replace its requirement of vitamin K by estrogen and progesterone. During pregnancy, the peroxidase activity of the saliva increases, and, thus, protection against the destruction caused by bacteria increases. Besides gingivitis, tumor-like alterations in the gums are also encountered during pregnancy. Histologically, these are similar to pyogenic granuloma. These tumors are considered to be a normal strong inflammatory reaction to a local irritation because of the changed endocrinological state of pregnancy. Changes in the gums similar to pregnancy-related gingivitis were encountered in women using the formerly-prescribed, higher-dose oral contraceptives. The hormonal amount in present contraceptives could be of no clinical significance for the occurrence or worsening of inflammation of gums, even if a risk of inflammation is theoretically possible, especially if mouth hygiene is deficient. Language: Finnish Keywords: PREGNANCY COMPLICATIONS | GINGIVITIS | VITAMINS AND MINERALS | ESTROGENS | PROGESTERONE | ENDOCRINE SYSTEM | GRANULOMAS | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE METHODS | SIDE EFFECTS | Diseases | Physiology | Biology | Hormones | Progestational Hormones | Signs and Symptoms | Contraceptive Safety | Safety | Public Health | Health | Contraception | Family Planning | Treatment Document Number: 079302 |
| 28. Title: [Sperm granulomata] Spermagranulomer. Author: Gade J; Brasso K Source: UGESKRIFT FOR LAEGER. 1990 Aug 6;152(32):2282-4. Abstract: Sperm granulomata are frequent complication of bilateral vasectomy ranging between 35% and 42% in case of conventional ligation. New investigations have hinted at the beneficial effect of refertilization. 9000 vasectomies and 200-300 refertilizations are performed annually in Denmark. Granulomas are knot like tumors localized in the testis, epididymis, or ductus deferens and usually measure 3-7 mm. The earliest changes appear 4 days after vasectomy, and the fully developed granuloma appears after 208 days. Clinical symptoms can include pain radiating to the groin imitating kidney spasms. The pains are usually of modest intensity but can last from months to a year. Almost half of them granulomas are without symptoms. Their incidence after vasectomy ranges between 5% and 97% depending on the type of surgery; they occur most often after open ended vasectomy and least often after electrocoagulation. Finding a sperm granuloma at the testicular duct end means less dilatation, and such a patient with good sperm quality has normal fertility after vasovasostomy. Between 34% and 73% of vasectomized men develop sperm antibodies. The development of sperm antibodies did not affect fertility. It seems that refertilization is easier in the presence of sperm granuloma, and likewise sperm quality is the best if there has been a sperm granuloma. However, this is contrasted with the fact that out of 9000 vasectomized patients barely 3% regretted it. Antibodies developing after vasectomy do not have a definite relationship to sperm granulomata, and did not affect the conception rate after a well-executed vasovasostomy. Language: Danish Keywords: DENMARK | CLINICAL RESEARCH | VASECTOMY | GRANULOMAS | REVERSIBILITY | SIDE EFFECTS | Europe, Northern | Europe | Developed Countries | Research Methodology | Male Sterilization | Sterilization, Sexual | Family Planning | Signs and Symptoms | Diseases | Treatment Document Number: 067314 |
| 29. Title: [Physical complaints and formation of granulomas following vasectomy] Fysiske gener samt granulomdannelse efter vasektomi. Author: Glavind K; Lauritsen NP Source: TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1990 Jun 20;110(16):2078-9. Abstract: 42 patients were followed for 4 years after vasectomy. 86% complained of pain 10 days after the operation and 27% still had pain 3 months afterwards; 12% had pain for longer than 3 months. 35% of the patients experienced formation of granulomas in the scrotum. In many patients, vasectomy lead to increased pressure, as well as dilation of the ductus epididymis, with subsequent reaction and formation of granulomas. This probably caused temporary scrotal pain. Some patients experience repeated incidents of increased pressure and pain. Patients should be informed of these conditions prior to vasectomy. (author's modified) (summary in ENG, NOR) Language: Norwegian Keywords: FOLLOW-UP STUDIES | NORWAY | VASECTOMY | PAIN | INCIDENCE | GRANULOMAS | COMPLICATIONS | Studies | Research Methodology | Developed Countries | Europe, Northern | Europe | Male Sterilization | Sterilization, Sexual | Family Planning | Signs and Symptoms | Diseases | Measurement Document Number: 064322 |
| 30. Title: Donovanosis: report of two cases with rare complications. Author: Kumar B; Gupta R; Sharma SC Source: INDIAN JOURNAL OF SEXUALLY TRANSMITTED DISEASES. 1990;11(2):68-70. Abstract: 2 cases of Donovanosis with unusual presentations, anal stricture in a 25-year old man, and massive enlargement of the labia in a 25-year old woman, are described. The man had a 15 x 6 cm laque from the natal cleft to the scrotum, constricting the anus so that he could only pass painful ribbon stools. The center was ulcerated for 4 cm around the anus. The patient had no other positive laboratory or clinical findings. The lesion had developed from a pustule that developed into an ulcerative lesion 7 years ago, just after a homosexual contact. A tissue smear, but no a biopsy, showed Donovan bodies. The patient was cured with 21 days of oral sulfamethoxazole-trimethoprim, 2 tablets of 400/80 mg twice daily. The woman's labia were both solidly enlarged and edematous, surrounded by ulceration of the groins and perineum. She also had no positive laboratory or systemic clinical findings. Her biopsy showed a few Donovan bodies, but repeated tissue smears were negative. Her ulcer was healed completely in 20 days with oral tetracycline, 2.0 g daily, but her labia remained swollen. Language: English Keywords: INDIA | CASE STUDIES | SEXUALLY TRANSMITTED DISEASES | BACTERIAL AND FUNGAL DISEASES | HOMOSEXUALS | GENITALIA, FEMALE | GENITALIA, MALE | GRANULOMAS | ANTIBIOTICS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Reproductive Tract Infections | Infections | Diseases | Sex Behavior | Behavior | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Drugs | Treatment Document Number: 071384 |
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