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Correlation of Sperm Nuclear Chromatin Condensation Staining Method with Semen Parameters and Sperm Functional Tests in Patients with Spinal Cord Injury, Varicocele, and Idiopathic Infertility  [cached]
Nasser Salsabili,Abdorasoul Mehrsai,Babak Jalalizadeh,Gholamreza Pourmand
Urology Journal , 2006,
Abstract: Introduction: Our aim was to investigate sperm nuclear chromatin condensation and its correlation with semen parameters and vitality test in infertile patients with spinal cord injury (SCI), varicocele, and idiopathic infertility. Materials and Methods: Sperm chromatin condensation was determined by aniline blue staining in 22 SCI-injured infertile men, 20 with varicocele, and 28 with idiopathic infertility. The results were compared with the semen analysis parameters and the hypo-osmotic swelling test results. Three grades of staining for sperm heads were distinguished: unstained, showing sperm maturity (G0); partially stained (G1); and completely stained, showing sperm immaturity (G2). The total score was calculated as: (G0 × 0) + (G1 × 1) + (G2 × 2). Results: In all groups, the total staining score was higher than 75%, corresponding to a high degree of immaturity of sperm. Patients with SCI had a less sperm nuclear chromatin condensation and chromatin stability than patients with idiopathic infertility and varicocele (total scores, 98% versus 89% and 88%, respectively; P < .01). All of the patients had normal hypo-osmotic swelling test results. Sperm counts for all patients were within the reference range. The mean percentages for normal motility and morphology of the sperm were 15.5% and 15% for patients with SCI, 43% and 15% for patients with varicocele, and 62.5% and 54% for patients with idiopathic infertility. There was no correlation between sperm nuclear chromatin condensation and semen analysis parameters. Conclusion: Aniline blue staining for sperm nuclear chromatin condensation is a method independent of semen analysis and demonstrates the internal structural defects of sperm. This method may have a predictive value in assessing fertility.
Physical activity and transcutaneous oxygen pressure in men with spinal cord injury  [PDF]
Beatriz Crespo-Ruiz, MSc,Antonio J. del-Ama, MScEng,Fernando J. Jiménez-Díaz, MD, PhD,Jennifer Morgan, MA
Journal of Rehabilitation Research and Development , 2012,
Abstract: This pilot study proposed a method for assessing the status of vascular flow measured by transcutaneous oxygen pressure (TcPO2) in the area of the ischium in people with spinal cord injury (SCI). In a sample of 38 men (two groups: 12 physically active and 26 sedentary) with thoracic SCI, the distribution of the physiological response of the tissues under load during sitting was assessed through analysis of ischium TcPO2 values obtained by an oximeter. TcPO2 baseline, recovery time of TcPO2 after sitting (Trec), the percentage of TcPO2 (%TcPO2) of maximum pressure TcPO2, and mechanic maximal pressure (Pmax) were evaluated. Trec in the physically active group was significantly lower (p < 0.05) than in the sedentary group. Likewise, significant differences in %TcPO2 between groups (p < 0.05) were also found. We concluded that the physiological response of the tissues under an individual with SCI’s own weight resulting from prolonged sitting is better in those who are physically active.
Erectile Function and Fertility in Patients With Spinal Cord Injury  [cached]
?etin DEM?RDA?,Bülent ALICI
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2012,
Abstract: Spinal cord injury (SCI) is predominantly seen in young men with the average patient age of 32 years. Ejaculation and erection disorders are common consequences of SCI, and result in decreased sexual satisfaction. Treatment modalities for erectile dysfunction in patients with SCI are similar to treatments for those without SCI. Some of the most common treatment modalities for the management of erectile dysfunction include penile implants, oral phosphodiesterase type 5 inhibitors, vacuum devices, intraurethral prostaglandins and intracavernous injections. Reproductive dysfunction in men with SCI is the result of combination of erectile dysfunction, ejaculatory failure, and abnormal semen parameters. The first line of therapy for infertility in men with SCI is collection of semen. Penile vibratory stimulation and electroejaculation are both effective in the treatment of ejaculatory dysfunction. In selected patients, intravaginal and intrauterine insemination and in patients with extremely low total motile sperm count, In vitro fertilization and intracytoplasmic sperm injection are feasible option for the treatment of infertility. Turk J Phys Med Re-hab 2012;58 Suppl 1: 33-7.
Safety and efficacy of sildenafil in Brazilian men with erectile dysfunction secondary to spinal cord injury
Carlos Eurico Dornelles Cairoli,Eric Roger Wroclawski,Carlos Hermann Schaal,Francisco Ricardo Nogueira de Azeredo Coutinho
Einstein (S?o Paulo) , 2008,
Abstract: Objective: To evaluate the effect of sildenafil in Brazilian patientswith erectile dysfunction secondary to spinal cord injury. Methods:Participants were examined at the time of enrollment and two andsix weeks later. Baseline and follow-up data on sexual functionwere collected. After the second week, the initial dose of sildenafil(50 mg) could be adjusted according to efficacy and tolerability.Efficacy was assessed primarily through the scores on questions 3and 4 of the International Index of Erectile Dysfunction. Secondaryanalyses included questions and domains of the index, globalefficacy evaluation, percentage of success in sexual intercourseattempts, answers to the Quality of Life and Erectile FunctionQuestionnaire, and partner’s satisfaction. Results: Ninety-onepatients were evaluated as to efficacy and 94 as to safety. Medianage of patients was 33 years, and median time between spinal cordinjury and study enrollment was three years. Sildenafil produceda significant increase in the mean scores of questions 3 and 4(p < 0.001 in both comparisons), as well as in other questionsand in all domains of the International Index of Erectile Dysfunction.Improved erections were reported by 89% of patients, and theproportion of successful sexual intercourse attempts went from6 to 74% (p < 0.001). Mean scores on the Quality of Life andErectile Dysfunction Questionnaire increased from 60 to 74%(p < 0.001). Ninety percent of 42 women reported being moderatelysatisfied to very satisfied with their partners’ treatment. The mostcommon adverse events were headache (16%), flushing (11%) andnasal congestion (10%). Conclusions: Sildenafil proved to be safeand effective in treating Brazilian men with erectile dysfunctionsecondary to traumatic spinal injury.
Male infertility in spinal cord trauma
Utida, Cristiano;Truzzi, Jose C.;Bruschini, Homero;Simonetti, Rogerio;Cedenho, Agnaldo P.;Srougi, Miguel;Ortiz, Valdemar;
International braz j urol , 2005, DOI: 10.1590/S1677-55382005000400013
Abstract: every year there are 10 thousand new cases of patients victimized by spinal cord trauma (sct) in the united states and it is estimated that there are 7 thousand new cases in brazil. eighty percent of patients are fertile males. infertility in this patient group is due to 3 main factors resulting from spinal cord lesions: erectile dysfunction, ejaculatory disorder and low sperm counts. erectile dysfunction has been successfully treated with oral and injectable medications, use of vacuum devices and penile prosthesis implants. the technological improvement in penile vibratory stimulation devices (pvs) and rectal probe electro-ejaculation (rpe) has made such procedures safer and accessible to patients with ejaculatory dysfunction. despite the normal number of spermatozoa found in semen of spinal cord-injured patients, their motility is abnormal. this change does not seem to be related to changes in scrotal thermal regulation, frequency of ejaculation or duration of spinal cord damage but to factors related to the seminal plasma. despite the poor seminal quality, increasingly more men with sct have become fathers through techniques ranging from simple homologous insemination to sophisticated assisted reproduction techniques such as intracytoplasmic sperm injection (icsi).
Spinal cord injury and male infertility: a review Lesión de la médula espinal e infertilidad masculina: una revision Traumatismo raquimedular e infertilidade masculina: revis o  [cached]
Asdrubal Falavigna,Guilherme Finger,Olívia Egger de Souza,Fabio Firmbach Pasqualotto
Coluna/Columna , 2012,
Abstract: Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility. La lesión de la médula espinal sigue siendo una causa importante de morbilidad y mortalidad en la sociedad actual, que afecta principalmente a hombres en la adolescencia a la edad adulta. Entre las varias secuelas resultantes de lesiones de la médula espinal, el deterioro del sistema sexual es de gran relevancia una vez que afectan la calidad de la vida sexual y la paternidad. La infertilidad es secundaria a varios eventos, tales como la disfunción eréctil, aneyaculación, modificación bioquímica seminal y la morfología de los espermatozoides. Los tratamientos para la infertilidad post-TRM, en general, tienen por objeto estimular la eyaculación seguida de inseminación in vitro, siendo la baja calidad seminal el factor determinante de la infertilidad de estos pacientes. En este escenario, la terapia con oxigenación hiperbárica, aún en estudio, representa un tratamiento alternativo ya que actúa sobre el sistema nervioso central lesionado por el trauma y sobre el tejido testicular para reducir el da o espinal y preservar la regulación fisiológica del sistema genital como una forma de evitar la infertilidad. O trauma raquimedular (TRM) é uma importante causa de morbimortalidade na sociedade atual, principalmente por acometer adultos jovens. Dentre as diversas sequelas decorrentes da les o medular encontram-se as altera es na qualidade de vida sexual e na paternidade. A infertilidade decorre de diversas altera es como: disfun o erétil, anejacula o, altera es bioquímicas no sêmen e estruturais nos espermatozoides. As terapias para a infertili
Improvement of Urodynamic Indices by Single Dose Oral Tadalafil in Men With Supra Sacral Spinal Cord Injury  [cached]
Karim Taie,Dinyar Khazaeli,Hayat Moombeini,Mohammad Salari Panah firouzabadi
Urology Journal , 2010,
Abstract: PURPOSE: To investigate the changes in urodynamic indices following a single dose of oral tadalafil in patients with supra sacral spinal cord injury (SCI). MATERIALS AND METHODS: Urodynamic study was accomplished on 20 patients with supra sacral SCI before and one hour after administration of 20 mg oral tadalafil as a single dose. Changes in the bladder capacity and compliance, maximum voiding detrusor pressure, and maximum detrusor filling pressure before and after tadalafil administration were recorded. RESULTS: Following administration of 20 mg oral tadalafil, there was a significant increase in the bladder compliance (from 12.7 to 18.5 mL/cmH20, P < .001), bladder capacity (from 169.8 to 198.5 mL, P < .001), maximum voiding detrusor pressure (from 64.8 to 48.6 cmH2O, P < .001), and maximum detrusor filling pressure (from 24.3 to 14.0 cmH2O, P < .001). CONCLUSION: Single dose of oral tadalafil has significant positive effects onurodynamic indices in patients with supra sacral SCI.
Who are the women and men in Veterans Health Administration’s current spinal cord injury population?  [PDF]
Catherine M. Curtin, MD,Paola A. Suarez, MPH,Lisa A. Di Ponio, MD,Susan M. Frayne, MD, MPH
Journal of Rehabilitation Research and Development , 2012,
Abstract: Spinal cord injury (SCI) care is a high priority for the Veterans Health Administration (VHA). Aging Veterans, new cases of SCI from recent conflicts, and increasing numbers of women Veterans have likely changed the profile of the VHA SCI population. This study characterizes the current Veteran population with SCI with emphasis on healthcare utilization and women Veterans. We analyzed VHA administrative data from 2002–2003 and 2007–2008, analyzing composition, demographics, and healthcare use. The population is mostly male (>97%) and largely between 45 and 64 years old. Over 30% are over the age of 65. They are frequent users of healthcare, with an average of 21 visits per year. Women Veterans with SCI form a small but distinct subpopulation, being younger and less likely to be married and having a higher burden of disease. We must understand how the VHA population with SCI is changing to anticipate and provide the best care for these complex patients.
Insulin growth factors may explain relationship between spasticity and skeletal muscle size in men with spinal cord injury  [PDF]
Ashraf S. Gorgey, MPT, PhD, FACSM,David R. Gater, MD, PhD
Journal of Rehabilitation Research and Development , 2012,
Abstract: The major objectives of this cross-sectional study were to (1) measure insulin-like growth factor-1 (IGF-1) in individuals with complete spinal cord injury (SCI) and spasticity and (2) determine the relationships between IGF-1 and cross-sectional areas (CSAs) of thigh skeletal muscle groups. Eight individuals with motor complete SCI underwent magnetic resonance imaging to measure the CSA of the whole thigh, knee extensor, and knee flexor skeletal muscle groups and dual-emission X-ray absorptiometry to measure fat-free mass. After participants fasted for 12 h, we measured their IGF-1 levels and determined spasticity using the Modified Ashworth Scale (MAS). Spearman rho correlations were used to test for the relationships among the tested variables, and independent t-tests were used to determine the difference in plasma IGF-1. Plasma IGF-1 was 44% greater in those with MAS scores of 2 or higher (p < 0.05). Plasma IGF-1 was positively related to knee extensor skeletal muscle CSA (r = 0. 83, p < 0.01). IGF-1 was strongly related to knee extensor and flexor spasticity (r = 0.88, p < 0.004). The findings suggest that IGF-1 is greater in SCI individuals with increased spasticity, and this may explain the strong positive relationships that were noted between spasticity and skeletal muscle CSA.
Hypothermia in spinal cord injury
Guadalupe A Castillo-Abrego
Critical Care , 2012, DOI: 10.1186/cc11270
Abstract: Other physicians like Hippocrates and Claudius Galen made historical reference to the management of spinal cord injury. Galen studied injuries in gladiators, and described 'that injury of the spinal cord caused paralysis and loss of sensation below the level of injury ... and determined that high spinal cord injuries are incompatible with life' [2,3].Chaulic Guy (1300 to 1360) carried out innovations in the management of traumatic bone injuries by introducing boards and suspensions to treat these fractures; however, he gave a pessimistic view on spinal injuries [4,5].Ambrose Pare (1510 to 1590) developed spine surgery, and along with Hildanus Fabricius (1560 to 1634) used traction techniques, reduction and utilization of wood frames to treat cervical spine fractures [6].Louis Pasteur's (1822 to 1895) surgical innovations and discoveries and the advent of asepsis and antisepsis by Semmelweis (1816 to 1868) and others, and primarily the application of general anesthesia by Morton (1819 to 1868) and others gave a new impulse to this field. Together these developments helped reduce surgical mortality and infections [5,7].In the nineteenth century, anatomy and physiology of the central nervous system were studied. The neuron doctrine was developed by Santiago Ramon y Cajal (1852 to 1934), who demonstrated the individuality of nerve cells and the connections that they have with each other [8,9].Alfred R Allen between 1908 and 1911 developed a reproducible and quantifiable model that allowed induction of a uniform traumatic injury to the spine, and also explained the pathophysiological changes seen in spinal trauma, including key aspects of secondary spinal cord injury. In 1972 Tarlov showed that symptoms caused by compression of the spinal cord for more than 12 hours could sometimes still be reversed. During this period 'progressive central hemorrhagic necrosis' was identified, which consists of bleeding from the gray matter of the spinal cord central necrosis and destruc
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