MICROSCOPIC TESTICULAR SPERM EXTRACTION

Azoospermia, the complete absence of sperms in the ejaculate is found in 1% ofnormal males and 10-15% of infertile couples. Surgical sperm retrieval (SSR) and use of spermsfor ICSI/IVF offers an opportunity of parenting to the male factor infertile couples. Micro-TESEgives higher surgical sperms retrieval rates in those patients in whom the chances of spermretrieval otherwise are very low. Objectives: To evaluate the outcome of Microscopic TesticularSperm Extraction (Micro-TESE) in different patients groups of non-obstructive azoospermia,in terms of testicular volume, histopathology, hormones levels as well as cytogenetic variants.Study Design: Retrospectively reviewed. Setting: Urology Division, King Fahd Medical City,Riyadh in collaboration with King Abdullah Reproductive Medical Unit (RMU). Period: January2011 to January 2016. Material & Methods: Fifty-four patients of primary and secondary infertilityage range of 29 to 65 years who had undergone Microscopic Testicular Sperm Extraction(Micro-TESE). Outcome measures: Finding of sperm in testicular specimen extracted bymicroscopic testicular dissection. Results: Out of 54 patients, hormonal abnormalities werefound in 45% patients and 65% had low volume testes. Abnormal histology was found in 23%patients and 9% had chromosomal abnormalities. Overall sperm retrieval rate in all groups was33%. Sperm retrieval rate was 34 % in patients with small volume testes (<15ml), 42% patientswith abnormal hormones (FSH), 33% patients with abnormal histology and 38% in patientswith chromosomal abnormalities. Minor complications (small hematoma and orchalgia) wereobserved in two (3.7%) patients. Conclusion: Micro-TESE is a valid option for sperm retrieval inpatients in which probability of sperm retrieval is otherwise very low.

Intracerebral Hematoma Following Evacuation of Chronic Subdural Hematoma: A Case Report and Review of Literature

Intracerebral hematoma is an unusual complication following surgical evacuation of chronic subdural hematoma. We report a case of 61-year-old patient operated at our department for a right-sided chronic subdural hematoma (CSDH), who presented with mild headache and left hemiparesis (4/5, Medical Research Council [MRC] grade). Postoperatively, the patient developed a small hematoma in ipsilateral frontal lobe. Serial computed tomography (CT) of the head showed progressive increase in size of hematoma with development of motor dysphasia. Frontal hematoma was evacuated by craniotomy and the patient improved in motor dysphasia. We emphasize the rarity of this complication and discuss the pathogenesis as well as management of this condition.

Transorbital penetrating wound to contralateral hemisphere: case report

There are few reports in the literature of transorbital penetration brain damage. We reported a transorbital craniocerebral injury caused by a barbecue skewer in a child in the context of domestic-accident. A 7-year-old male child accidentally fell and a barbecue skewer penetrated his right orbit. The object was pulled out immediately by the boy's father. On admission, he demonstrated disproportioned right hemiparesis and Axial CT images showed no evidence of fracture of orbital wall on the right side and a small hematoma and traumatic subarachnoid hemorrhage on the left hemisphere. Surgery was not indicated, antibiotics were administered for 14 days, his neurological impairment recovered completely on seven days. On the 12th post-admission day, a CT was done which showed no hematoma. At the time of discharge, the boy was alert without any physical sequelae or complication. Children are frequently harmed during play and are mainly jeopardized by accidents at home, and it is necessary more governmental investment to objectively lowering penetrating wounds to the head in children and divulgated for general population that foreign body penetrating the intracranial cavity must be removed only during surgery.

Discomfort reported by patients after cardiac catheterization, performed by the Judkins technique

ABSTRACTObjective: to describe the discomfort reported by patients at rest after cardiac catheterization, performed by the Judkins technique. Methodology: this is a cohort study was conducted in a service of hemodynamics. Data collection was performed at admission in the recovery room, the 4th and 6th hours after the procedure, using a questionnaire and systematic observation. This study follows the norms of Resolution 196/96 of the National Health Council and was approved by the Ethics in Research ISCMPA (nº 311709). Results: from the 42 patients analyzed, 52.4% were men, with mean age of 62 years. As for symptoms, the most relevant was the neck pain reported by 28.7% at the 6th hour, the urinary discomfort was mentioned by 23.8% in the early hours, remaining in the 4th and 6th hours. The presence of headache was reported by 19.2% in the initial hours and at the 4th hour. The neck pain was present in 16.7% as moderate at the 6th hour and the lumbar pain was reported by 9.5% as moderate at the 4th hour, with a low percentage of severe pain being reported by the patients. Among all described signs, a small hematoma was made by 9.5% after removal of the sheath. Conclusion: the discomfort reported by patients during the recovery period after cardiac catheterization showed no significant worsening between the 4th and 6th hours. Descriptors: cardiac catheterization; signs and symptoms; nursing care; nursing; hemodynamics.RESUMO Objetivo: descrever os desconfortos relatados pelos pacientes durante o repouso após cateterismo cardíaco, realizado através da técnica de Judkins. Metodologia: trata-se de estudo de coorte, realizado com pacientes submetidos ao cateterismo cardíaco em um serviço de hemodinâmica. A coleta de dados foi realizada no momento da admissão na sala de recuperação, na 4ª e 6ª hora pós procedimento, através da utilização de um questionário e observação sistemática. Este estudo segue as normas da Resolução 196/96 do Conselho Nacional de Saúde, sendo aprovado pelo Comitê de Ética em Pesquisa da ISCMPA (nº 311709). Resultados: dos 42 pacientes, 52,4% eram homens, com idade média de 62 anos. Quanto aos sintomas apresentados, o mais relevante foi a dor cervical relatada por 28,7% na 6ª hora, o desconforto urinário foi mencionado por 23,8% na hora inicial, permanecendo na 4ª e 6ª hora, a presença de cefaléia foi referida por 19,2% na hora inicial e 4ª hora. A dor cervical foi presente em 16,7% como moderada na 6ª hora e a dor lombar foi relatada por 9,5% como moderada na 4ª hora, sendo baixos os percentuais de dor intensa. Entre os sinais, o hematoma pequeno foi apresentado por 9,5% após a retirada da bainha. Conclusão: os desconfortos referidos pelos pacientes durante o período de repouso pós cateterismo cardíaco não demonstram piora significativa entre a 4ª e 6ª hora. Descritores: cateterismo cardíaco; sinais e sintomas; cuidados de enfermagem; enfermagem; hemodinâmica.RESUMENObjetivos: describir las molestias informadas por los pacientes durante el reposo después de la cateterización cardiaca, realizado mediante la técnica de Judkins. Metodologia: se trata de un estudio del corte, realizado en uno servicio de hemodinâmica. La captura de los datos fue hecha en el momento de la admisión el la habitación de recuperación, en la 4ª y la 6ª hora después del procedimiento, por la utilización de uno cuestionario y la observación sistemática Este estudio sigue las normas de la Resolución 196/96 del Consejo Nacional de Salud y fue aprobado por la Ética en la Investigación ISCMPA (nº 311709). Resultados: de los 42 pacientes, 52,4% eran hombres, con media de edad de 62 años. Acerca de los sintomas presentados, lo más pertinente fue el dolor cervical informada por 28,7% en la 6ª hora, la molestia urinaria fue mencionado por 23,8% en la hora del inicio restante hasta la 4ªy 6ª hora, la presencia del dolor de cabeza fue informado por 19,2% en la hora del inicio y la 4ª hora. El dolor cervical estuvo presente en 16,7% como moderado en la 6ª hora y el dolor lumbar fue informada por 9,6% como moderado en la 4ª hora, siendo baja las porcentajes del dolor intenso. Entre los señales, el hematoma pequeño fue presentado por 9,5% después de la retirada de la vaina. Conclusión: las molestias informadas por los pacientes en el período de reposo después del cateterismo cardiaco no enseñaron empeoramiento significativo entre la 4ª y la 6ª hora. Descriptores: cateterismo cardíaco; signos e síntomas; atención de enfermeira; enfermeíra; hemodinâmica.

Hemiarthroplasty in the Treatment of Hallux Rigidus

Background: Osteoarthritis of the first metatarsophalangeal (MTP) joint is a painful, disabling condition. It can interfere with the ability to run and even walk without pain. An implant of cobalt-chrome steel alloy to replace the base of the proximal phalanx is one solution. The purpose of this study is to review our results with one of these implants. Materials and Methods: A series of 23 cases of hemiarthroplasty for the treatment of hallux rigidus from June 2000 to October 2001 has been evaluated using the AOFAS rating system, and the results are presented. Results: The average preoperative AOFAS score was 57 (range, 39 to 80). The AOFAS score after hemiarthroplasty was 88 (range, 75 to 100) at last followup (34 to 72 months). There were no perioperative complications except for a small hematoma. Only one patient has required further surgery after 3 years for worsening of a preexisting tendency to hallux valgus. Conclusion: A hemiarthroplasty retained, in most cases, joint mobility, strength, and alignment while relieving pain. There was no evidence, at last followup, of component loosening or osteolysis.

Stereotaxic Vacuum Core Breast Biopsy - Experience of 560 Patients

The purpose of our study was the assessment of the diagnostic value of vacuum core biopsy, which promises high accuracy. The material used were a digital stereotaxic biopsy table (Fischer Imaging) and a Mammotome-gun (Biopsys). A total of 560 patients with 594 predominantly indeterminate lesions underwent vacuum core biopsy (VCB). Verification was a follows: (a) demonstration of complete or partial removal of the lesion or replacement of the lesion by a small hematoma by comparison of the pre- and post- VCB mammogram; (b) reexcision of 105 malignant and 13 borderline lesions; (c) radiologic-histologic correlation; (d) 6-month-follow-up mammograms in 460 cases. Five puncture errors occurred which, however, were immediately recognized and VCB was repeated. Based on the above verification a 100% accuracy was achieved. Only one relevant hematoma that required surgical excision occurred. Except for one case mammographically any severe scaring was visible. Based on the excellent accuracy and excellent tolerance of the procedure VCB appears to be the future method of choice for the workup of those indeterminate mammographically detected lesions that up to now have still required surgical biopsy.