Successful pregnancy and birth after intrauterine insemination using caput epididymal sperm by percutaneous aspiration

<abstract>Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with congenital bilateral absence of the vas deferens (BAVD, n=58) or bilateral caudal epididymal obstruction (BCEO, n=32) requesting for fine needle aspiration (FNA), PESA and IUI were recruited. The obstruction was diagnosed by vasography and determination of the fructose, carnitine and alpha-glucosidase levels in the seminal fluid. Results: The mean sperm motility, density, abnormal sperm and total sperm count of the caput epdidymis were 16 %±22 %, (12±31) ×106/mL, 55 %±36 % and (16±14)×106, respectively. In the 90 couples, a total of 74 PESA procedures and 66 cycles of IUI were performed. Three pregnancies resulted, including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception. The pregnancy rate per IUI cycle was 4.5 %. Conclusion: The birth of normal, healthy infants by IUI using PESA indicates that the caput epididymal sperm possess fertilization capacity. The PESA-IUI programme is a practical and economical procedure for the management of patients with obstructive azoospermia.

Endovascular treatment of acute proximal deep venous thrombosis secondary to iliac vein compression syndrome： a novel technique for thrombus removal

Iliac vein compression syndrome （IVCS）,also known as May-Thurner syndrome or Cockett syndrome,is caused by compression of the left common iliac vein between the right common iliac artery and the vertebrae.A recent imaging study have demonstrated that at least a 25%compression of the left iliac vein at the arterial crossover point may be present in 66% of the asymptomatic patient population.1 With the development of interventional technique,endovascular management as a less invasive means is becoming the first-line treatment,which can not only treat the thrombosis but also correct the venous anatomic abnormalities.2 In this study,we described a novel technique combining percutaneous aspiration thrombectomy （PAT） with Fogarty catheter thrombectomy （FCT） as the thrombus removal therapy without femoral venotomy in patients with acute deep vein thrombosis （DVT） due to IVCS and evaluated its technical feasibility and short-term outcomes.

老年胆石症患者的治疗:手术与非手术治疗的比较

背景:本研究旨在评估内镜逆行胆胰管造影术(ERCP)、ERCP+胆囊切除术(EC)和经皮抽吸术(PA)三种方法治疗老年胆总管结石患者的疗效。方法:研究纳入43,338例老年(≥60岁)和45,295例年龄<60岁的胆总管结石病例。病例来自美国全国住院样本库2011-2014年间因胆石并发症入院的病例,其诊断基于ICD 9。采用多因素逻辑回归模型计算住院死亡的风险,并比较各治疗组(ERCP、EC、PA)、各年龄组(<60岁、60-69岁、70-79岁、≥80岁)及性别组的差异。采用单变量线性回归模型比较各年龄组间住院时间和再入院频率的差异。结果:在排除治疗方式的影响后,患者年龄会影响病死率和住院时间。在各个年龄组中,PA组均有最高的死亡风险和最长的住院时间,而EC组病死率最低,ERCP组住院时间最短。年龄和治疗方式均不影响再住院率。性别不影响病死率和再住院率。然而,在60-69岁的患者中,女性住院时间更短。结论:患者年龄越大,胆总管结石及其相关并发症的治疗效果越差。无论是什么年龄段的胆石症患者,胆囊切除术可能都是一种有效的治疗方法。