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David K Warren - One of the best experts on this subject based on the ideXlab platform.
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the impact of preBiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis
Clinical Infectious Diseases, 2011Co-Authors: Jonas Marschall, Kavita P Bhavan, Margaret A Olsen, Victoria J Fraser, Neill M Wright, David K WarrenAbstract:Background. Biopsy specimens are often obtained in the evaluation of hematogenous vertebral osteomyelitis. The effect of preBiopsy antibiotic exposure on pathogen recovery is unknown. Methods. We conducted a retrospective cohort study of adult inpatients with hematogenous vertebral osteomyelitis at a tertiary care hospital from 1 January 2003 through 31 July 2007. Antibiotic exposure within 14 days before Biopsy was evaluated. Results. Of 150 patients with hematogenous vertebral osteomyelitis, 92 (61%) underwent a Biopsy (60 [65%] needle and 32 [35%] Open biopsies). The median time from admission to Biopsy was 3 days (range, 0–69 days). Patients who underwent Biopsy were more likely to have weakness (53 [58%] Biopsy vs 15 [26%] no Biopsy; P , .001) and sensory loss (27 [29%] vs 6 [10%]; P 5 .006), but were less likely to have a positive blood culture result (28 [30%] vs 30 [52%]; P 5 .01). Pathogens were recovered in 61 patients (66%). Open Biopsy had a higher yield than needle Biopsy (29 [91%] of 32 vs 32 [53%] of 60; P , .001). Sixty patients (65%) who had biopsies performed received antibiotics <14 days before the procedure (median duration, 4 days; range, 1–37 days). Open Biopsy predicted positive Biopsy culture results (adjusted odds ratio, 8.4; 95% confidence interval, 2.2–31.8), but there was no association of preBiopsy antibiotics with culture results (adjusted odds ratio, 2.3; 95% confidence interval, 0.8–6.2). Conclusions. A pathogen was recovered from 61 (66%) of 92 patients who had biopsies performed in this cohort of hematogenous vertebral osteomyelitis. Open biopsies had a higher microbiological yield than did needle biopsies. Antibiotic exposure before Biopsy did not negatively impact pathogen recovery and should not be the sole reason for foregoing biopsies.
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the epidemiology of hematogenous vertebral osteomyelitis a cohort study in a tertiary care hospital
BMC Infectious Diseases, 2010Co-Authors: Kavita P Bhavan, Jonas Marschall, Margaret A Olsen, Victoria J Fraser, Neill M Wright, David K WarrenAbstract:Background: Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis. Methods: We performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital. Results: Seventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (±15.0) and 38 (54%) were male. Common comorbidities included diabetes (43%) and renal insufficiency (24%). Predisposing factors in the 30 days prior to admission included bacteremia (19%), skin/soft tissue infection (17%), and having an indwelling catheter (30%). Back pain was the most common symptom (87%). Seven (10%) patients presented with paraplegia. Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33%) cases], and methicillin-resistant S. aureus [10 (22%)]. Among the 44 (63%) patients who had a diagnostic Biopsy, Open Biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with Open Biopsy vs. 14 (48%) of 29 with needle Biopsy; p = 0.003]. Sixteen (23%) patients required surgical intervention for therapeutic purposes during admission.
Raphael Ronel - One of the best experts on this subject based on the ideXlab platform.
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testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by Open Biopsy in men with non obstructive azoospermia
Human Reproduction, 1997Co-Authors: S Friedler, A Raziel, D Strassburger, Y Soffer, D Komarovsky, Raphael RonelAbstract:The efficiency of testicular sperm retrieval by testicular fine needle aspiration (TEFNA) was compared with Open Biopsy and testicular sperm extraction (TESE), in 37 rigorously selected patients with non-obstructive azoospermia. All patients underwent TEFNA and TESE consecutively. Thus, each patient served as his own control. The case was regarded as successful if at least one testicular spermatozoon was found allowing intracytoplasmic sperm injection (ICSI) of at least one oocyte. The mean age of the male patients was 32.7 years (range 24-47). Whereas by TEFNA spermatozoa enabling performance of ICSI were found in only four patients out of 37 (11%), Open Biopsy and TESE yielded spermatozoa in 16 cases (43%). The negative predictive value of high serum follicle stimulating hormone (FSH) concentrations (d0 IU/I) (predicting failure to find spermatozoa for ICSI) was low (38.4%). The positive predictive value (predicting the chance to find spermatozoa for ICSI) of normal-sized testicle was not different from that of small-sized (<15 ml) testicle (50%). Complications included one case of testicular bleeding following fine needle aspiration, treated locally, and two cases of extratunical haematomata following TESE requiring no intervention. In patients with non-obstructive azoospermia, TEFNA has a significantly lower yield compared to TESE. Performance of ICSI with testicular sperm in these cases resulted in satisfactory fertilization and high embryo transfer rates. The implantation and pregnancy rates per embryo transfer were 13 and 29% respectively. Neither serum FSH values nor testicular size were predictive of the chances to find spermatozoa for ICSI. Some complications may occur even following TEFNA.
Basak Balaban - One of the best experts on this subject based on the ideXlab platform.
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outcome of testicular sperm retrieval procedures in non obstructive azoospermia percutaneous aspiration versus Open Biopsy
Human Reproduction, 2000Co-Authors: Ramazan Mercan, Bulent Urman, Cengiz Alatas, Senai Aksoy, Alp Nuhoglu, Aycan Isiklar, Basak BalabanAbstract:The aim of this study was to evaluate whether the extraction of testicular spermatozoa with percutaneous versus Open Biopsy has an effect on the treatment outcome with intracytoplasmic sperm injection (ICSI) in men with non-obstructive azoospermia. Regardless of testicular size, follicle stimulating hormone concentration, and previous Biopsy result, percutaneous testicular sperm aspiration (PTSA) using a 21-gauge butterfly needle was attempted first and if this failed testicular sperm extraction (TESE) was performed. In 63 men spermatozoa were found with PTSA whereas in 228 men TESE had to be undertaken. More men in the PTSA group had previously been diagnosed with hypospermatogenesis (82 versus 50%). Compared with the PTSA group, more men in the TESE group had germ cell aplasia (27 versus 10%) or maturation arrest (22 versus 8%). There was no difference between the groups regarding mean age of men and their partners, duration of stimulation, oestradiol concentration on the day of human chorionic gonadotrophin, number of oocytes retrieved, fertilization rate, and embryo quality between the two groups. The number of embryos transferred (4.38 versus 3.90) was significantly higher in the PTSA group (P < 0.05), reflecting the increased number of embryos available for transfer. Implantation rate per embryo was 20.7% in the PTSA and 13.3% in the TESE group (P < 0.05). Clinical pregnancy rates were 46 and 29% in the PTSA and TESE groups respectively (P < 0.05). Clinical abortion rates were similar (21.2 versus 24%). It is concluded that in men with non-obstructive azoospermia, easier sperm retrieval, which is most likely indicative of a more favourable histopathology, is associated with higher implantation rates per embryo.
P Devroey - One of the best experts on this subject based on the ideXlab platform.
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fine needle aspiration versus Open Biopsy for testicular sperm recovery a controlled study in azoospermic patients with normal spermatogenesis
Human Reproduction, 1998Co-Authors: Herman Tournaye, Koen Clasen, Ayse Aytoz, Z P Nagy, A Van Steirteghem, P DevroeyAbstract:This retrospective controlled study aimed at comparing two techniques for recovering testicular spermatozoa in azoospermic patients undergoing intracytoplasmic sperm injection (ICSI). 102 men suffering from infertility because of obstructive azoospermia had ICSI using testicular spermatozoa recovered either by Open excisional Biopsy (n = 51), or by fine needle aspiration (FNA) (n = 51). A higher average number of spermatozoa were recovered after Open Biopsy than after FNA, but no significant differences in either fertilization rates or cleavage rates were observed after ICSI with spermatozoa retrieved by the two techniques. Neither was there any significant difference in ongoing pregnancy and implantation rates: in the FNA group, these figures were respectively 19.6% per cycle and 7.8% per embryo transferred and in the Open Biopsy group 21.6 and 7.1%. We conclude that ICSI with testicular spermatozoa recovered by FNA yields results comparable to those obtained with spermatozoa recovered by Open Biopsy in azoospermic patients with normal spermatogenesis. However a prospective study is needed to confirm the present results and to assess recovery rates and patient comfort for the two methods.
Outi Hovatta - One of the best experts on this subject based on the ideXlab platform.
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testicular biopty gun needle Biopsy in collecting spermatozoa for intracytoplasmic injection cryopreservation and histology
Human Reproduction, 1999Co-Authors: Timo Tuuri, Seija Kaukoranta, Sirpa Makinen, Saija Kotola, J Moilanen, Outi HovattaAbstract:Using testicular spermatozoa from either Open Biopsy (29 cycles) or biopty gun needle Biopsy (49 cycles), a total of 81 intracytoplasmic sperm injection (ICSI) cycles among 57 couples were carried out from January, 1994 to September, 1997. In six cycles, no spermatozoa were obtained, and in three cycles spermatozoa from both needle and Open biopsies were used. The fertilization (37% after Open and 41% after needle Biopsy) and pregnancy rates (29% per embryo transfer compared with 16% per embryo transfer) were similar after both Open and needle biopsies. Five pregnancies were achieved among the 14 couples with non-obstructive azoospermia of the male partner, four of these after needle Biopsy. It was possible to use cryopreserved testicular spermatozoa after both needle and Open biopsies, and one pregnancy started after using cryopreserved testicular spermatozoa in both groups. Histological needle Biopsy was carried out in 62 cases, and they were all diagnostic, giving 15-20 cross-sections of seminiferous tubuli per Biopsy. Testicular needle Biopsy using a 14 gauge Biopsy needle gave a sufficient amount of tissue and spermatozoa for ICSI, cryopreservation and histology, even in non-obstructive azoospermia. This technique is simpler and cheaper than Open Biopsy and, hence, it can be regarded as the optimal method for the retrieval of testicular spermatozoa.
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testicular needle Biopsy Open Biopsy epididymal aspiration and intracytoplasmic sperm injection in obstructive azoospermia
Human Reproduction, 1995Co-Authors: Outi Hovatta, J Moilanen, K Von Smitten, Ilkka ReimaAbstract:Testicular or epididymal spermatozoa were obtained for in-vitro fertilization and intracytoplasmic sperm injection (ICSI) in 27 cycles out of 33 (in six men the azoospermia proved to have testicular causes). Testicular needle Biopsy carried out in addition to surgical Open Biopsy proved to be an effective method to obtain spermatozoa for ICSI from patients with obstructive azoospermia. Thus it might be possible to replace scrotal operations by simple needle biopsies. Embryos resulting from ICSI with testicular spermatozoa were used in 19 transfers that resulted in six pregnancies. One pregnancy resulted from six embryo transfers from ICSI after microsurgical-epididymal sperm aspiration (MESA). The normal fertilization rates with testicular (37.3%) and MESA spermatozoa (53.7%) did not differ significantly from each other, but with testicular spermatozoa the rate was significantly lower than that obtained with ejaculated spermatozoa and ICSI (59.7%) in the matched couples. The abnormal fertilization of oocytes with one pronucleus was significantly higher with testicular spermatozoa than with ejaculated spermatozoa in the control couples.
