Synonyms for nonobstructive or Related words with nonobstructive
Examples of "nonobstructive"
Some studies have shown that letrozole can be used to promote spermatogenesis in male patients suffering from
Couples who are infertile secondary to
azoospermia and concurrent varicocele, may benefit from proceeding directly to microsurgical testicular sperm extraction (microTESE) and deferring varicocele repair.
He described it as "
saccular or fusiform multifocal segmental dilatation of the intrahepatic bile ducts"; basically, he observed cavernous ectasia in the biliary tree causing a chronic, often life-threatening hepatobiliary disease.
After reviewing 46 cases of Caroli disease before 1990, 21.7% of the cases were the result of an intraheptic cyst or
biliary tree dilation, 34.7% were linked with congenital hepatic fibrosis, 13% were isolated choledochal cystic dilation, and the remaining 24.6% had a combination of all three.
In cases of infertility due to
azoospermia, surgical sperm retrieval for IVF-ICSI is successful 40-60% of the time without prior knowledge of the geography of testis sperm production. With the addition of diagnostic FNA mapping, the rate of successful sperm retrieval can be increased substantially. In addition, based on sperm quantity and distribution in the testes as assessed by the map, sperm retrieval can proceed from the least invasive to the most invasive methods. From a review n=159 cases of
azoospermia, one group observed that 44% of mapped cases required sperm retrieval by needle aspiration (TESA); 33% required open, directed surgical biopsies (TESE); and 23% needed microsurgically-assisted dissection of the entire testis parenchyma (mTESE) for successful sperm retrieval. In addition, the majority (78%) of these cases required only unilateral sperm retrieval to find sufficient sperm for IVF-ICSI. Overall, sufficient sperm for all oocytes retrieved was possible in 95% of cases with prior maps, ranging from 100% in simple aspiration cases to 80% of microdissection cases. In addition, among men who underwent a second sperm retrieval procedure, sperm was successfully retrieved in 91% of attempt; and among patients who had a third sperm retrieval, sperm was retrieved in 100% of attempts. Thus, knowledge of sperm location with FNA mapping can simplify and streamline sperm retrieval procedures in very difficult cases of
From a comprehensive study of 118 consecutive azoospermic, infertile men who underwent FNA mapping, much has been learned about the geography of spermatogenesis in both normal (obstructed) and abnormal (nonobstructed) testes. In men with obstructive azoospermia, sperm is found in all sites and in all locations on the FNA map. However, in men with
azoospermia, sperm is found in about 50% of cases. In the subgroup of men with no sperm on a prior testis biopsy, FNA maps revealed sperm in 27% of cases. This increased sensitivity in sperm detection is likely due to sampling a larger volume of the testis. There was also an intratesticular (site-to-site within the same testis) variation in sperm presence in 25% of cases and an intertesticular (side-to-side in the same individual) discordance rate of 19%. This suggests that bilateral examinations are crucial to fully informing men with
azoospermia about opportunities for fatherhood., FNA mapping has also been used to determine whether particular geographic sites are more likely to have sperm than others. In one study, individual testis maps from each side were pooled, and from this analysis all FNA sites showed sperm at about the same frequency; there was no suggestion of sperm “hot spots” in
testes. Thus, FNA mapping is a valuable diagnostic tool that not only guides the treatment of infertile men but can also provide a wealth of phenotypic information about the infertility condition.
About 10–15% of human couples are infertile, unable to conceive. In approximately in half of these cases, the underlying cause is related to the male. The underlying causative factors in the male infertility can be attributed to environmental toxins, systemic disorders such as, hypothalamic–pituitary disease, testicular cancers and germ-cell aplasia. Genetic factors including aneuploidies and single-gene mutations are also contributed to the male infertility. Patients suffering from
azoospermia or oligozoospermia show microdeletions in the long arm of the Y chromosome and/or chromosomal abnormalities, each with the respective frequency of 9.7% and 13%. A large percentage of human male infertility is estimated to be caused by mutations in genes involved in primary or secondary spermatogenesis and sperm quality and function. Single-gene defects are the focus of most research carried out in this field.
Cor triatriatum dextrum is extremely rare and results from the complete persistence of the right sinus valve of the embryonic heart. The membrane divides the right atrium into a proximal (upper) and a distal (lower) chamber. The upper chamber receives the venous blood from both vena cavae and the lower chamber is in contact with the tricuspid valve and the right atrial appendage. The natural history of this defect depends on the size of the communicating orifice between the upper and lower atrial chambers. If the communicating orifice is small, the patient is critically ill and may succumb at a young age (usually during infancy) to congestive heart failure and pulmonary edema. If the connection is larger, patients may present in childhood or young adulthood with a clinical picture similar to that of mitral stenosis. Cor triatriatum may also be an incidental finding when it is
. The disorder can be treated surgically by removing the membrane dividing the atrium.
The number of aspiration sites varies with testis size and ranges from 4 (to confirm obstruction) to 15 per testis (for
azoospermia). FNA is performed with a sharp-beveled, 23-gauge, one-inch needle using the established suction cutting technique. Precise, gentle, in-and-out movements, varying from 5 mm to 8 mm, are used to aspirate tissue fragments. Ten to 30 needle excursions are made at each site. Suction is released, and then the tissue fragments are expelled onto a slide, gently smeared, and immediately fixed in 95% ethyl alcohol. Pressure is applied to each site for hemostasis. A routine Papanicolaou stain is performed. Smears are reviewed by experienced cytologists for (a) specimen adequacy (defined as at least 12 clusters of testis cells or at least 2000 well-dispersed testis cells) and (b) the presence or absence of mature sperm with tails. For immediate interpretation, fixed slides are stained with undiluted toluidine blue and read with brightfield microscopy after 15 seconds. Patients take an average of two pain pills after the procedure. Complications in over 800 patients have included one episode of hematospermia and, in another patient, post-operative pain for 7 days.
Although the correlation of testis FNA cytology to testis biopsy histology is clear in the literature, how do the global organ findings from testis FNA mapping compare to biopsy histology? In other words, what is the chance of finding sperm on the map with each specific biopsy pattern? In a study of 87 patients, in whom a mean of 1.3 biopsies and 14 FNA sites were taken per patient, striking correlations were observed between FNA and histological results. Overall, sperm was found by FNA mapping in 52% of
azoospermic patients. Pure histologic patterns of Sertoli cell-only and early maturation arrest were associated with a very poor likelihood of sperm detection (4-8%). In contrast, patients with other pure pattern histologies or mixed patterns had high rates of FNA sperm detection (77-100%). Thus, sperm detection with FNA showed wide variation depending on testis histology. In addition, certain histologic patterns may reflect a more global testicular dysfunction due to underlying genetic causes, and thus a poorer likelihood of sperm identification.
Recently, NR5A1 mutations have been related to human male infertility (MIM 613957). These findings substantially increase the number of NR5A1 mutations reported in humans and show that mutations in NR5A1 can be found in patients with a wide range of phenotypic features, ranging from 46, XY sex reversal with primary adrenal failure to male infertility. For the first time, Bashamboo et al. (2010) conducted a study on the
infertile men (a non-Caucasian mixed ancestry n = 315), which resulted in the report of all missense mutations in the NR5A1 gene with 4% frequency. Functional studies of the missense mutations revealed impaired transcriptional activation of NR5A1-responsive target genes. Subsequently, three missense mutations were identified as associated with and most likely the cause of the male infertility, according to computational analyses. The study indicated that the mutation frequency is below 1% (Caucasian German origin, n = 488). In another study the coding sequence of NR5A1 has been analysed in a cohort of 90 well-characterised idiopathic Iranian azoospermic infertile men versus 112 fertile men. Heterozygous NR5A1 mutations were found in 2 of 90 (2.2%) of cases. These two patients harboured missense mutations within the hinge region (p.P97T) and ligand-binding domain (p.E237K) of the NR5A1 protein.
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