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Incidence of varicocele in children and adolescents: a population-based study on 1200 young Bulgarian males
cycles). Of the remaining 50 women, 34(68%) exhibited 2 waves of follicular development and 16 (32%) exhibited 3 waves during the IOI. Twentynine of the women with 2 waves (58%) exhibited a minor-major wave pattern of follicular development, and 5 women (10%) exhibited a majormajor wave pattern. Ten of the women with 3 waves (20%) exhibited a minor-minor-major wave pattern, 3 women (6%) exhibited a minor-majormajor wave pattern, and 3 women (6%) exhibited a major-major-major wave pattern. None of the women evaluated exhibited a single wave of follicular development. Follicle diameter and follicle number (p ⬍0.0001) changed during the IOI; however, no differences were detected among women with different wave patterns for either endpoint (p ⫽ 0.33, p ⫽ 0.99). In all women, only the dominant follicle of the final wave ovulated. Serum estradiol and LH levels changed during the IOI (p ⬍0.0001); however, a change in FSH was not observed (p ⫽ 0.22). Conclusions: Women exhibit major and minor wave patterns in ovarian follicle diameter and number profiles during the menstrual cycle. Our interpretion is that selection of a dominant follicle occurs only in major waves, not in minor waves. The enhanced understanding of major and minor waves of folliculogenesis provides a new model of ovarian follicular development during the human menstrual cycle, and will greatly improve our interpretation of normal and abnormal ovarian function and its implications on fertility and contraception. Supported by: The Canadian Institutes for Health Research.
Tuesday, October 15, 2002 4:45 P.M. O-176 Use of Oxiplex威 to inhibit adhesion reformation in a rabbit adhesiolysis model. Richard A. Berg, Kathy E. Rodgers, Stephanie Cortese, Terry Espinoza, Norma Roda, Gere S. diZerega. FzioMed, Inc, San Luis Obispo, CA; Livingston Research Institute, Los Angeles, CA. Objective: Prevention of post-surgical adhesion reformation is a challenge for adhesion prevention devices. Three Oxiplex威 gels, composed of carboxymethylcellulose (CMC) and polyethylene oxide (PEO), were administered to the site of lysis where adhesions were induced to form between the sidewall and cecum or bowel in a rabbit model, and evaluated for effectiveness in reducing reformation. Design: Gels of CMC/PEO, 3.7 % w/v (Gel 1); 2.9% w/v (Gel 2); low viscosity gel, 3.7% w/v (Gel 3); and non-treated surgical controls (Control). Two studies were performed using different volumes of gel. Materials/Methods: Gels of CMC/PEO, 3.7% w/v (Gel 1); same gel 2.9% w/v (Gel 2); or a low viscoscity gel, 3.7% w/v (Gel 3); and non-treated surgical controls (Control). In study 1 the amount of gel applied to the area of adhesiolysis was 3 mL and in study 2 the amount was 5 mL. Subserosal bleeding was developed by digital pressure over the cecum and bowel during the first surgery. The cecum and bowel was then lightly abraded to remove the mesothelial layer. A 5 x 3 cm area of sidewall peritoneum was removed on the right lateral abdominal wall. The animals were closed and after seven days a second surgery was performed to lyse adhesions. After adhesiolysis, the treatment groups received one of three gels at the site of lysis. After 7 days animals were subject to necropsy and the percentage of the sidewall injury area involved in adhesions was determined. A reduction in the area of adhesions was analyzed by the Student’s t-test. The statistical significance of the incidence was analyzed using a Chi-Square test. Results: Oxiplex威 Gel 1, 3.7 % w/v at a dose of 3 mL or 5 mL significantly decreased the area of adhesion reformation compared with surgical controls (p ⬍.001, study 1, and p ⬍.002, study 2) in a rabbit adhesiolysis model of post-surgical adhesions. Gel 2, 2.9% w/v was not significantly effective (p ⫽ 0.127) and gel 3 (low viscosity) was not effective (p ⫽ 0.437) indicating that the effectiveness of gels appeared to be proportional to viscosity of the gel formulations. Conclusions: An Oxiplex威 Gel consisting of CMC/PEO effectively reduced adhesion reformation in a rabbit adhesiolysis model. Gel 1 at a dose of 3 mL was effective in reducing adhesion formation by 87.5% (Study 1) and in a dose of 5 mL was effective in reducing adhesion reformation by 91.2% (Study 2). Adhesion prevention by gels composed of CMC and PEO deserve clinical evaluation.
S68
Abstracts
Reduction of Adhesion Reformation in Rabbit Adhesiolysis Model Study
Treatment
% Area Reformed
1
Control (n ⫽ 3) Gel 1 (n ⫽ 5) Gel 2 (n ⫽ 5) Gel 3 (n ⫽ 4) Control (n ⫽ 5) Gel 1 (n ⫽ 8)
100 ⫾ 0.0 22.5 ⫾ 9.5 52 ⫾ 20.4 80 ⫾ 20 80 ⫾ 22.4 8.8 ⫾ 6.5
2
Supported by: private study.
MALE REPRODUCTION AND UROLOGY Tuesday, October 15, 2002 2:00 P.M. O-177 Incidence of varicocele in children and adolescents: A population-based study on 1200 young Bulgarian males. Ramadan A. Saleh, Ashok Agarwal, Mehmet Oder, Stanislav Hubaveshki, Analia Tomova, Philip Kumanov. Cleveland Clin Fdn, Cleveland, OH; Clin Ctr of Endocrinology, Medical Univ, Sofia, Bulgaria. Objective: The incidence of varicocele in the general adult population is approximately 15%. In addition, varicocele is found in about 19% to 41% of men presenting for infertility investigations. However, data are lacking as to the age at which varicocele starts to appear and the overall incidence among younger males. In this study, we examined the incidence of varicocele among 1200 young Bulgarian males. Design: A population-based cross-sectional study. Materials/Methods: The subjects of this study were 1200 healthy boys randomly selected from all socioeconomic classes and districts in Sofia, the capital of Bulgaria. The sample represents, to a great extent, the Bulgarian population as a whole. The subjects were divided according to their age at the time of examination into 3 groups: group 1 (few months after birth to 6 years, n ⫽ 420), group 2 (from 7 to 12 years, n ⫽ 360) and group 3 (from 13 to 19, n ⫽ 420). The same investigator (P.K.) examined all boys. Testicular volume (in mL) was determined using Prader’s orchidometer. Examination for varicocele included scrotal palpation while standing, and Valsalva maneuver for non-palpable varicocele. Results: A left-sided varicocele was found in 67/1200 (5.6%) boys. In group 1, only 1 six years old boy had varicocele (1/420, 0.2%) compared to 22/360 (6.1%) in group 2 and 44/420 (10.5%) in group 3 (P ⬍0.0001). The median (25% & 75% interquartile range) age of boys with varicocele was 14 (12, 18). Logistic regression analysis indicated that the age of the subject was a significant risk factor for diagnosis of varicocele (odds ratio ⫽ 1.61 at 95% confidence interval, P ⬍0.0001). Left testicular volume in boys with varicocele ⬍9 (4, 12) mL⬎was not significantly different from the volume of an age-matched group of boys without varicocele ⬍8 (2, 12) mL⬎(P ⫽ 0.13). Conclusions: This is the first report on the incidence of varicocele in young Bulgarian males. Our study shows that varicocele can be detected as early as the age of 6 years and that its prevalence increases progressively with age. In addition, our study indicates that varicocele had no impact on testicular volume in children and adolescents. Studies are underway to examine spermatogenic function of the testes in boys who have varicocele as they reach puberty. Supported by: None.
Tuesday, October 15, 2002 2:15 P.M. O-178 A prospective double blind placebo controlled cross over trial of carnitine therapy in selected cases of male infertility. Francesco Lombardo, Loredana Gandini, Ashok Agarwal, Paolo Sgro, Franco Dondero, Andrea Lenzi. Univ of Rome La Sapienza, Rome, Italy; Cleveland Clin Fdn, Cleveland, OH.
Vol. 78, No. 3, Suppl. 1, September 2002
Tuesday, October 15, 2002 4:45 P.M. O-176 Use of Oxiplex威 to inhibit adhesion reformation in a rabbit adhesiolysis model. Richard A. Berg, Kathy E. Rodgers, Stephanie Cortese, Terry Espinoza, Norma Roda, Gere S. diZerega. FzioMed, Inc, San Luis Obispo, CA; Livingston Research Institute, Los Angeles, CA. Objective: Prevention of post-surgical adhesion reformation is a challenge for adhesion prevention devices. Three Oxiplex威 gels, composed of carboxymethylcellulose (CMC) and polyethylene oxide (PEO), were administered to the site of lysis where adhesions were induced to form between the sidewall and cecum or bowel in a rabbit model, and evaluated for effectiveness in reducing reformation. Design: Gels of CMC/PEO, 3.7 % w/v (Gel 1); 2.9% w/v (Gel 2); low viscosity gel, 3.7% w/v (Gel 3); and non-treated surgical controls (Control). Two studies were performed using different volumes of gel. Materials/Methods: Gels of CMC/PEO, 3.7% w/v (Gel 1); same gel 2.9% w/v (Gel 2); or a low viscoscity gel, 3.7% w/v (Gel 3); and non-treated surgical controls (Control). In study 1 the amount of gel applied to the area of adhesiolysis was 3 mL and in study 2 the amount was 5 mL. Subserosal bleeding was developed by digital pressure over the cecum and bowel during the first surgery. The cecum and bowel was then lightly abraded to remove the mesothelial layer. A 5 x 3 cm area of sidewall peritoneum was removed on the right lateral abdominal wall. The animals were closed and after seven days a second surgery was performed to lyse adhesions. After adhesiolysis, the treatment groups received one of three gels at the site of lysis. After 7 days animals were subject to necropsy and the percentage of the sidewall injury area involved in adhesions was determined. A reduction in the area of adhesions was analyzed by the Student’s t-test. The statistical significance of the incidence was analyzed using a Chi-Square test. Results: Oxiplex威 Gel 1, 3.7 % w/v at a dose of 3 mL or 5 mL significantly decreased the area of adhesion reformation compared with surgical controls (p ⬍.001, study 1, and p ⬍.002, study 2) in a rabbit adhesiolysis model of post-surgical adhesions. Gel 2, 2.9% w/v was not significantly effective (p ⫽ 0.127) and gel 3 (low viscosity) was not effective (p ⫽ 0.437) indicating that the effectiveness of gels appeared to be proportional to viscosity of the gel formulations. Conclusions: An Oxiplex威 Gel consisting of CMC/PEO effectively reduced adhesion reformation in a rabbit adhesiolysis model. Gel 1 at a dose of 3 mL was effective in reducing adhesion formation by 87.5% (Study 1) and in a dose of 5 mL was effective in reducing adhesion reformation by 91.2% (Study 2). Adhesion prevention by gels composed of CMC and PEO deserve clinical evaluation.
S68
Abstracts
Reduction of Adhesion Reformation in Rabbit Adhesiolysis Model Study
Treatment
% Area Reformed
1
Control (n ⫽ 3) Gel 1 (n ⫽ 5) Gel 2 (n ⫽ 5) Gel 3 (n ⫽ 4) Control (n ⫽ 5) Gel 1 (n ⫽ 8)
100 ⫾ 0.0 22.5 ⫾ 9.5 52 ⫾ 20.4 80 ⫾ 20 80 ⫾ 22.4 8.8 ⫾ 6.5
2
Supported by: private study.
MALE REPRODUCTION AND UROLOGY Tuesday, October 15, 2002 2:00 P.M. O-177 Incidence of varicocele in children and adolescents: A population-based study on 1200 young Bulgarian males. Ramadan A. Saleh, Ashok Agarwal, Mehmet Oder, Stanislav Hubaveshki, Analia Tomova, Philip Kumanov. Cleveland Clin Fdn, Cleveland, OH; Clin Ctr of Endocrinology, Medical Univ, Sofia, Bulgaria. Objective: The incidence of varicocele in the general adult population is approximately 15%. In addition, varicocele is found in about 19% to 41% of men presenting for infertility investigations. However, data are lacking as to the age at which varicocele starts to appear and the overall incidence among younger males. In this study, we examined the incidence of varicocele among 1200 young Bulgarian males. Design: A population-based cross-sectional study. Materials/Methods: The subjects of this study were 1200 healthy boys randomly selected from all socioeconomic classes and districts in Sofia, the capital of Bulgaria. The sample represents, to a great extent, the Bulgarian population as a whole. The subjects were divided according to their age at the time of examination into 3 groups: group 1 (few months after birth to 6 years, n ⫽ 420), group 2 (from 7 to 12 years, n ⫽ 360) and group 3 (from 13 to 19, n ⫽ 420). The same investigator (P.K.) examined all boys. Testicular volume (in mL) was determined using Prader’s orchidometer. Examination for varicocele included scrotal palpation while standing, and Valsalva maneuver for non-palpable varicocele. Results: A left-sided varicocele was found in 67/1200 (5.6%) boys. In group 1, only 1 six years old boy had varicocele (1/420, 0.2%) compared to 22/360 (6.1%) in group 2 and 44/420 (10.5%) in group 3 (P ⬍0.0001). The median (25% & 75% interquartile range) age of boys with varicocele was 14 (12, 18). Logistic regression analysis indicated that the age of the subject was a significant risk factor for diagnosis of varicocele (odds ratio ⫽ 1.61 at 95% confidence interval, P ⬍0.0001). Left testicular volume in boys with varicocele ⬍9 (4, 12) mL⬎was not significantly different from the volume of an age-matched group of boys without varicocele ⬍8 (2, 12) mL⬎(P ⫽ 0.13). Conclusions: This is the first report on the incidence of varicocele in young Bulgarian males. Our study shows that varicocele can be detected as early as the age of 6 years and that its prevalence increases progressively with age. In addition, our study indicates that varicocele had no impact on testicular volume in children and adolescents. Studies are underway to examine spermatogenic function of the testes in boys who have varicocele as they reach puberty. Supported by: None.
Tuesday, October 15, 2002 2:15 P.M. O-178 A prospective double blind placebo controlled cross over trial of carnitine therapy in selected cases of male infertility. Francesco Lombardo, Loredana Gandini, Ashok Agarwal, Paolo Sgro, Franco Dondero, Andrea Lenzi. Univ of Rome La Sapienza, Rome, Italy; Cleveland Clin Fdn, Cleveland, OH.
Vol. 78, No. 3, Suppl. 1, September 2002