Search

Introduction: Osteoarthritis (OA) or arthrosis represents an inflammatory disease of joints that develops as a result of interaction of mechanical and biological parameters. With disease development, degenerative changes on joint cartilage can be noticeable that affect and cause pathological changes on other parts of a joint resulting in pain and dysfunction of a joint. A. E. Garrod in 1907 described osteoarthritis as a special clinical entity and separated it from a rheumatoid arthritis. OA is characterized with loss of a joint cartilage, development of new bone tissue under affected cartilage (subchondral bone) and development of osteophytes on joint edge. First sign of a disease is pain after period of relaxation that slowly intensifies., Material and Methods: In this paper, 40 patients have been analyzed with clinical and radiological signs of OA of the knee joint. Radiological classification was done by Ahlback's classification., Results: In our study female gender was more affected with average age of 63 years. On Ahlback classification, grade II was represented the most. Comparison between clinical and radiological signs showed that there was no significant difference between established grade of OA. Wide spectrum of visible radiological osteoarthritis changes on joints is in correlation with the age of examinees., Competing Interests: • Conflict of interest: none declared.

Objective: To compare label-free interferometric phase microscopy (IPM) to label-free and label-based bright-field microscopy (BFM) in evaluating sperm cell morphology. This comparison helps in evaluating the potential of IPM for clinical sperm analysis without staining., Design: Comparison of imaging modalities., Setting: University laboratory., Patient(s): Sperm samples were obtained from healthy sperm donors., Intervention(s): We evaluated 350 sperm cells, using portable IPM and BFM, according to World Health Organization (WHO) criteria. The parameters evaluated were length and width of the sperm head and midpiece; size and width of the acrosome; head, midpiece, and tail configuration; and general normality of the cell., Main Outcome Measure(s): Continuous variables were compared using the Student's t test. Categorical variables were compared with the χ(2) test of independence. Sensitivity and specificity of IPM and label-free BFM were calculated and compared with label-based BFM., Result(s): No statistical differences were found between IPM and label-based BFM in the WHO criteria. In contrast, IPM measurements of head and midpiece width and acrosome area were different from those of label-free BFM. Sensitivity and specificity of IPM were higher than those of label-free BFM for the WHO criteria., Conclusion(s): Label-free IPM can identify sperm cell abnormalities, with an excellent correlation with label-based BFM, and with higher accuracy compared with label-free BFM. Further prospective clinical trials are required to enable IPM as part of clinical sperm selection procedures., (Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Supracondylar humerus fractures are the most common fractures of the humerus at the elbow in children. The key role belongs to the age and immaturity of the humerus region. Treatment, even today represents the problem of bone and joint surgery. Gartland classification divides these fractures into four types. Analysis of radiographic parameters will serve as an indicator for treatment selection., Goal: To demonstrate the role of radiographic evaluation by measurement of default radiographic parameters and indicate the choice of treatment for supracondylar fractures of type I and II by Gartland., Material and Methods: The study included 60 children aged 4-14 years, divided into two groups, first with initial radiographic analysis and the second one without radiographic analysis. All were treated at the Primary Health Care Center Novi Travnik and Nova Bila Hospital from 2009 to 2011. Analysis was performed using methods of descriptive statistics to calculate the mean and standard deviation, Student's t-test and Chi-square test., Results: In patients from first group hospitalization, immobilization duration, as well as physical treatment was shorter and more frequently surgical treatment was applied (manual reduction with K-wire fixation) with statistically significant difference (p = 0.042)., Conclusion: Radiographic evaluation is one way to choose methods of fracture treatment. The incidence of complications is low, with excellent outcome of treatment and a faster return of children to their daily activities.

Objective: To evaluate sperm quality and fertility potential of men with psychogenic anejaculation treated by electroejaculation (EEJ) and intracytoplasmic sperm injection (ICSI). Treatment results were compared to spinal cord injured (SCI) patients treated similarly., Design: Retrospective clinical study., Setting: Academic tertiary referral fertility center., Patient(s): Couples with isolated psychogenic anejaculation or SCI., Intervention(s): Electroejaculation and ICSI., Main Outcome Measure(s): Semen analysis, fertilization rate, implantation rate, pregnancy rate, delivery rate and safety of the procedure., Result(s): Fifteen patients diagnosed with psychogenic anejaculation underwent 40 EEJ/ICSI cycles. The semen retrieved was characterized by low motility (mean 10.7% ± 12.3%), normal volume (2.2 ± 1.9 mL) and normal count (25.1 ± 29.9 × 10(6)/mL), according to World Health Organization criteria. Results of EEJ/ICSI were compared with 22 SCI patients treated by 66 EEJ/ICSI cycles during the same period. Mean female age and the number of oocytes retrieved per cycle were similar between the groups. Similar semen parameters after EEJ were found between psychogenic and SCI patients. Fertilization rate was significantly lower in the psychogenic patients compared to SCI (47.0% and 57.0%, respectively). No significant differences were found regarding pregnancy rates (20% and 22.7%, respectively), implantation rate (10.2% and 11.6%, respectively) or delivery rates (15% and 18.2%, respectively)., Conclusion(s): Sperm retrieved by EEJ is characterized by asthenospermia and normal count. In spite of the lower fertilization rate in psychogenic patients, combination of EEJ and ICSI gives adequate results to couples with psychogenic anejaculation similar to the results obtained for SCI patients. Current results give these couples a reasonable chance of pregnancy achievement., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Prostate cancer is the most common internal cancer in Australian men; more than 3000 men die annually from it. Public awareness of prostate cancer is an important factor in early detection and treatment. Women are known to act as 'health managers' for their families and may have a role to play in early detection., Objective: To describe community perceptions of prostate cancer and identify information needs within the Australian context., Method: A qualitative study using focus group and individual interviews with 44 community volunteers, 18 men with recent diagnosis of prostate cancer and nine of their wives/partners (n=71)., Discussion: Men in the community are poorly informed about prostate cancer, prefer to ignore (male) health issues, and expect their general practitioners to provide authoritative advice on testing for prostate cancer. While women are also poorly informed, they are keen to change the prevailing situation of silence and lack of information in the community, and need to be included in public education campaigns.

There is currently very little research on how physicians respond to patients with cancer who decide to forgo or stop medically recommended "curative" therapy. The purpose of this article is to report on a qualitative study with 12 oncology specialists in Israel and Australia that addresses this question. The findings indicate that physicians tend to construct patients and their decisions in terms of mutually exclusive categories that focus on curability of the disease, rationality of the patient's decision, and patients' personal attributes. Physicians' constructions of their experience focus on uncertainty and concern. Although contextual factors play a role in how physicians act in this situation, Israeli and Australian oncologists are remarkably similar in how they describe their own and their patients' experiences.

The incidence of chronic pain amongst elderly people in nursing homes is very high, making pain in this population a serious problem for aged care facilities. Research studies reveal a pattern of poor pain management in this setting despite the high incidence of pain suggesting that the management of pain in nursing homes is limited in scope and only partially effective. What is not fully appreciated by health professionals is the impact pain has on the lives of elderly people who live in nursing homes. In the study reported here a phenomenological method was used involving several in depth interviews with elderly people over a period of 9 months. Field notes of observations were also recorded as the participants went about their everyday lives in the nursing home. The discussion focuses on some of the themes drawn from the study with an emphasis on a key theme 'being constantly pained'. The findings of the study highlight what it is like to experience pain and how this impacts on everyday lives of elderly people. The paper concludes with some suggestions for health professional for improving care in this area.

Background: There is limited information about general practice nurses in Australia and the role they play., Methods: A qualitative study, using semistructured interviews conducted with 27 general practitioners and 15 practice nurses (PNs) from 19 general practices in New South Wales., Results: Practice nurses are typically middle aged women, employed part time with extensive professional experience. Their role is influenced mostly by the demographic characteristics of the practice population, their expertise, and GPs' attitudes and past experiences of working with PNs, rather than the size or urban/rural location of the practice., Discussion: Practice nurses are an important, but not always fully used, resource in general practice. They can reduce the workload of GPs, extend the range of services provided and enhance the quality of primary health care. Their current and potential contribution to primary care needs to be documented and evaluated more fully.

Study Design: Male infertility caused by anejaculation is common among patients with spinal cord injury (SCIP). The fertility options for SCIP have improved impressively over the past 10 years. We present the Israeli experience in the treatment of infertility in a large series of SCIP. The issues which are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility management in SCIP., Setting: Sexual rehabilitation clinic, Neuro-Rehabilitation department, Sheba Medical Center, Israel., Methods: Between June 1992 and May 1998, a total of 84 consecutive SCIP were treated in our clinic with electro-ejaculation (EEJ), representing a sample of the SCIP population, composed mostly of young men traumatically injured. The patients have sustained different levels and completeness of spinal injury. Among the patients 33 were interested in achieving pregnancy (39.3%), while the rest were interested in determining fertility potential for family. With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done. The collected semen is used for fertility determination or for fertilization., Results: Eighty-four patients were treated by EEJ. Mean age was 31.3 and mean age at injury was 21.7. There were 29 cervical, 50 thoracic and five lumbar lesions. Sixty-three had complete injury (ASIA A) and 21 incomplete (ASIA B -15, ASIC C -5, ASIA D -1). Fifty-nine had upper motor neuron lesions, and 25 had lower motor neuron. A total of 355 stimulations were performed. Ejaculate was obtained in all patients in 350 stimulations (98.6%), and sperm was present in 74 patients (88.1%) in 296 of the stimulations (83.4%). Fairly good numbers of spermatozoa were obtained, whereas sperm motility and morphology of spermatozoa were low in most cases. A significant difference in sperm count, motility and morphology was noted between antegrade and retrograde samples. No significant improvement in sperm quality after four repeated consecutive stimulations was noted in 38 SCIP. Side effects were minor and encountered in 16 patients (19.1%). Out of 33 couples who wished to achieve pregnancy, 26 reached the stage of insemination. Four pregnancies were achieved after 33 cycles of In-Uterine-Insemination (pregnancy rate 28.6% per couple), and 15 after 68 cycles of In-Vitro-Fertilization (micromanipulation) (pregnancy rate of 68.75% per couple). In all, of 101 conception attempts 23 were successful, resulting in pregnancies in 18 couples, and accounting for an overall pregnancy rate of 70% per couple., Conclusion: The high percentage of pregnancies imply that, despite the typically poor sperm motility noted in EEJ, rectal probe EEJ combined with assisted reproductive techniques, and performed by a team approach, is an efficient and safe technique for treating infertility among SCIP.

Objective: To report the successful use of testicular sperm aspiration and intracytoplasmic sperm injection in the presence of an Escherichia coli-infected ejaculate that previously caused repeated embryo degeneration., Design: Case report., Setting: University medical center., Patient(s): A 38-year-old woman who did not conceive for 6 years with repeated IVF attempts. Escherichia coli was isolated from both the oocyte culture dish and her male partner's ejaculate., Intervention(s): Testicular sperm aspiration and intracytoplasmic sperm injection followed by ET., Main Outcome Measure(s): Clinical outcome., Result(s): Establishment of a pregnancy delivered at term., Conclusion(s): Patients undergoing IVF treatment who have repeated embryo degeneration caused by bacterial infection originating in the ejaculate may be treated successfully with testicular sperm aspiration and intracytoplasmic sperm injection.

The aim of the phenomenological study described in this article was to depict the lived world of caring for a family member with chronic mental illness. Through two individual in-depth interviews, 14 participants were asked to describe their experience of caring for a son, daughter, or parent affected by chronic mental illness. The main themes emerging from the study related to temporality, the need to "live each day as it comes" without being able to make long-term plans, and to relationality, the need to "look at the world through the other's window," always aware of how the world responds, not only to oneself but also to the person with mental illness.

Purpose: Our purpose was to evaluate whether the source of spermatozoa influences the results of intracytoplasmic sperm injection (ICSI) treatment in couples with severe male-factor infertility., Methods: A retrospective analysis of 40 cases of ICSI with testicular-retrieved spermatozoa, matched with 40 cases of ICSI with ejaculated spermatozoa, was performed. We included only couples with normoovulatory females younger than 37 years who were matched according to the day of ovum pickup with the patients in the study group., Results: Eighty cycles were analyzed: 40 cycles using testicular spermatozoa and 40 cycles using ejaculated spermatozoa. In 32 (80%) of the 40 ICSI transcutaneous needle aspiration cycles, we obtained enough spermatozoa to inject all the mature oocytes retrieved. In eight (20%) cases there were not enough spermatozoa to inject all the oocytes. Only 76 (54%) of 141 available oocytes were injected in these eight patients. The oocyte fertilization rates were 42% for the study group and 55.5% for the controls (P < 0.005). Thirty-six (90%) patients in the group with nonobstructive a zoospermia (NOA) and 37 (92.5%) patients in the oligoteratoasthenospermia (OTA) group had embryos for replacement. The mean cleavage rates per cycle (96% with testicular and 93% with ejaculated spermatozoa), the mean number of embryos per transfer (3.72 +/- 1.6 in the NOA group and 4.24 +/- 1.5 in the OTA group), the embryo quality (cumulative embryo scoring = 34.03 +/- 22.62 in the testicular sperm group and 36.08 +/- 19.28 in the ejaculated sperm group), and the clinical pregnancy rates (22.5% in the NOA patients and 20% in the ejaculate group) were not significantly different between groups., Conclusions: High fertilization, cleavage, and pregnancy rates can be achieved with intracytoplasmic testicular sperm injection from patients with NOA, reaching levels comparable with those of ICSI using ejaculated spermatozoa.

The splicing variant, 5T allele, in intron 8 of the cystic fibrosis transmembrane conductance regulator (CFTR) gene was shown to be associated with partial penetrance of the clinical expression. This splicing variant leads to two possible transcripts: one normal and the other aberrantly spliced that lacks exon 9. The aim of this study was to analyze the molecular basis of the partial penetrance in individuals carrying the 5T allele. We analyzed the level of the correctly spliced RNA transcribed from the 5T allele in nasal and epididymal epithelium and correlated it with disease expression. Semiquantitative nondifferential reverse-transcriptase-PCR showed a considerable variability (6%-37%) in the total level of correctly spliced RNA transcribed from the 5T allele in nasal epithelium from 11 patients. A significant nonlinear correlation (r = .82, P = .002) between the level of the normal CFTR transcripts and the severity of lung disease was shown. No individuals with normal lung function and minimal or no lung disease (FEV1 >80% predicted) had <25% of normal transcripts, and individuals with <15% of normal transcripts did not have FEV1 >80%. The level of normal transcripts in epididymal epithelial cells from four infertile males with congenital bilateral absence of the vas deferens was low (6%-24%). In infertile males with normal lung function the level of correctly spliced transcripts in the nasal epithelium was higher than the level in the epididymal epithelium. These results indicate that there is variability in the efficiency of the splicing mechanism, among different individuals and between different organs of the same individual. This variability provides the molecular basis of the partial penetrance of cystic fibrosis disease in patients carrying the 5T allele.

In this paper we discuss differing discourses of research ethics committees and the clinical research field. Reflections on our experience of conducting research in a nursing home are used to highlight the tensions and inconsistencies that arise from these discourses and the need to behave ethically in the field. While accepting the need for adherence to guiding principles of duty based ethics, we have found that practical moral decisions in the field required that, as individual researchers, we needed to exercise discretionary judgement, informed by the ethic of care and the concern for the well-being of research participants.

Ureteral obstruction is a frequent complication of transitional cell carcinoma (TCC), known as a poor prognostic sign and indicative of advanced disease. We investigated retrospectively the medical records of 122 consecutive patients who suffered from invasive TCC of the urinary bladder during a 6-year period. Unilateral or bilateral ureteral obstruction was found in 66 patients (54.1%). High stage (T3-T4) and grade (III-IV) tumors were correlated with ureteral obstruction in 89.4% and 83.3% respectively compared to 67.9% and 66.1%, respectively, among patients with normal upper tracts (P < 0.001); 10.6% of the patients with ureteral obstruction had low stage disease, and all of them proved to have involvement of the ureteral orifices on the affected side. The 5-year survival rate of patients with and without ureteral obstruction was 32.2% and 65.9%, respectively (P < 0.001). The presence of ureteral obstruction, particularly in the absence of intravesical involvement of the ureteral orifices, signified a high stage, muscle invasive, and often metastatic tumor in more than 90% of the patients. Ureteral obstruction was an accurate criterion for poor prognostic and was associated with significantly lower, overall and stage-specific, survival rates, despite of radical surgery. We conclude that evidence of ureteral obstruction is an important staging standard and significant prognostic indicator in transitional cell carcinoma of the urinary bladder.