ICSI outcomes in obstructive azoospermia: influence of the origin of surgically retrieved spermatozoa and the cause of obstruction

BACKGROUND

Spermatozoa can be retrieved from the testis and epididymis of men with obstructive azoospermia (OA) and used for ICSI. However, it is unknown whether the outcome of ICSI depends on the cause of obstruction or the origin of surgically retrieved spermatozoa.

METHODS

A cohort of 171 men with OA and normal spermatogenesis were included in this retrospective study. They were divided into three groups according to the site and origin of obstruction: 83 men had congenital bilateral absence of vas deferens; 55 and 33 had acquired epididymal and deferent duct obstructions, respectively. The outcome of 368 ICSI cycles was determined and compared according to the origin of spermatozoa: epididymal (n = 253) or testicular (n = 115).

RESULTS

Fertilization and clinical pregnancy rates did not differ between spermatozoa of different origin (58.9% versus 51.9% and 22.1% versus 24.3% with epididymal and testicular spermatozoa, respectively). However, the miscarriage rate was significantly higher for testicular spermatozoa (35.7% versus. 12.5% P < 0.05, chi2 test). Findings were similar whatever the aetiology of the OA.

CONCLUSION

This study suggests that the use of testicular spermatozoa, even those generated during normal spermatogenesis, alters embryonic development and that epididymal spermatozoa should be preferentially used, irrespective of the aetiology of OA.

Ganglion cysts of the knee: articular communication revealed by delayed radiography and CT after arthrography

OBJECTIVE

The diagnosis of ganglion cysts of articular origin may sometimes be uncertain when communication with the joint is not evident. Because we have observed that opacification of ganglion cysts revealed by arthrography can be significantly delayed, the purpose of this study was to determine retrospectively in 20 cases the time delay needed to show with arthrography a communication between the articular cavity and ganglion cysts of the knee.

CONCLUSION

Arthrographic evidence of a communication between the articular cavity of the knee and communicating ganglion cysts requires delayed radiography performed at least 1 hr after intraarticular injection of contrast material. The best results are obtained with additional CT performed 1-2 hr after injection.

[Ultrasonography of dorsal elastofibroma. Apropos of 6 cases]

Elastofibroma dorsi is a benign soft-tissue tumor. Its sub- and pre-scapular location and its appearance on CT and MRI generally lead to the diagnosis. We have analyzed with sonography 6 elastofibromas in 4 patients; the diagnosis was confirmed with CT scan or MRI. Some sonography imaging features supported the diagnosis of elastofibroma dorsi. In all the cases, (1) the tumor occurred typically in a sub- and pre-scapular location, and (2) showed a streaky echostructure (3). A similar symptomatic or asymptomatic mass in the opposite subscapular location is highly suggestive.

[Radiologic aspects of the loosening of cemented hip prostheses: mechanical, septic or granulomatous etiology?]

Radiologic diagnosis of hip prosthesis loosening is based on the evaluation of each component (prosthesis, cement, bone) and of their interfaces. Both the prosthesis and the cement may deteriorate and the prosthesis/cement interface or cement/bone interface may become abnormal in prosthesis loosening of any etiology. In contrast, the aspect of the bone changes (erosion, periostitis) and their distribution vary according to the condition etiology. It appears from a retrospective study of 50 cases of chronic hip prosthesis loosening that the most specific signs for infection are unsharp bone resorption and acute-like or multifocal periostitis. In granulomatous loosening, bone resorption is sharp (as in mechanical loosening), but its distribution is not conform to the prosthesis shape (as in septic loosening), and periosteal changes are not observed.