The present study deals with the diabetic neuropathies prevailing in the male population. In this investigation 100 insulin-dependent diabetes mellitus (IDDM) and 314 non-insulin-dependent diabetes mellitus (NIDDM) patients with and without an objective evidence of neuropathy, having an age span of 15 to 80 years and the duration of diabetes distributed over 1-33 years were included along with age-matched nondiabetic controls. The diabetic subjects were evaluated for semen analysis. Results of semen analysis showed a highly significant increase (p > .0005) in total sperm output and sperm concentration in both IDDM and NIDDM neuropathic diabetic men. On the other hand, sperm motility and semen volume were found to be about 30 and 60% less, respectively, in IDDM and NIDDM patients, where as sperm morphology and quality of sperm motility remained unaffected. A comparison between IDDM and NIDDM neuropathic and non-neuropathic diabetic groups further indicated a nonsignificant difference in the parameters of semen analysis, thus suggesting an endocrine basis for the sexual disturbances of diabetic neuropathy. A significant rise in total sperm output in both IDDM and NIDDM neuropathic diabetic patients and a significant decrease in semen volume in both types of diabetic patients thus suggests some kind of Leydig cell hyperplasia, which in turn may stimulate spermatogenesis and atonia of the bladder and urethra, resulting in retrograde ejaculation.
Two experimental methods for restoring flexor tendon sheath integrity and preventing adhesions around traumatized flexor tendons utilizing artificial tendon sheaths made of either hydroxyapatite (HAp) or alumina were studied in a flexor tendon-trauma model and compared to a standard tendon sheath repair and a control. Eighty toes were divided equally into a control group, a sheath repair group, an HAp group, and an alumina group. Profundus tendons in zone II were divided and repaired after sublimis excision in all groups. In the sheath repair group, the flexor sheath was also repaired after suturing the tendon. In artificial sheath groups, sheaths made of HAp and alumina were placed over the repair sites to protect them from the surrounding tissues. In the control group, after repairing the tendon, the flexor sheath was excised and no artificial sheaths were used. Each toe was immobilized in a plaster cast for 3 weeks. After three weeks, the plaster cast was removed followed by the removal of the sheaths in the artificial sheath groups through a small incision in the skin in zone II. Active mobilization was encouraged in each group. Postoperative adhesions were examined at 3, 6, 9, and 12 week intervals by using light microscopic techniques. To further explore the effects of artificial sheaths on tendon healing, transmission electron microscopy was done for the HAp and alumina groups at 3, 6, and 12 week intervals. Results demonstrated decreased severity of postoperative adhesions in the HAp as well as in the alumina groups in comparison with the sheath repair and controls. A space resembling the fibro-osseous canal was formed around the tendon after removing the sheaths. This space remained patent until 12 weeks, 9 weeks after removing the sheaths, and a newly formed tendon sheath-like structure lined by synovial cells and with a peritenon-like structure over the tendon surface was observed. In the sheath repair and control groups, the severity of adhesions was decreased with the passage of time, to some extent due to unrestricted mobility. However, a newly formed tendon sheath or peritenon-like structure was not observed. Electron microscopic studies confirmed good healing at the suture in the HAp and alumina groups with no evidence of necrosis. These results are qualitative in nature as no statistical tests were performed. From these results we conclude that if the tendon is separated from the surrounding granulation tissue by a barrier with good biocompatibility, the tendon can heal with fewer adhesions.(ABSTRACT TRUNCATED AT 400 WORDS)
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