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Genetic causes can be directly responsible for various clinical conditions of male infertility and spermatogenic impairment. With the increased use of assisted reproduction technologies our understanding of genetic basis of male infertility has large implications not only for understanding the causes of infertility but also in determining the prognosis and management of such couples. For these reasons, the genetic investigations represent today an essential and useful tool in the treatment of male infertility. Several evidences are available for the clinical practice regarding the diagnosis; however, there are less information relative to the treatment of the genetic causes of male infertility. Focus of this review is to discuss the main and more common genetic causes of male infertility to better direct the genetics investigation in the treatment of spermatogenic impairment.

Objective To examine the diagnostic and therapeutic role of fiber-optic and rigid bronchoscopy in pediatric patients with foreign body inhalations. Methods From January 1986 to December 2004, we observed 128 young patients with suspicion of foreign body aspiration. Patients were divided into 3 groups: group I, patients with negative chest X-ray; group II, patients with radiological direct signs; group III, patients with radiological indirect signs. Results Removal of the foreign body was effected in 105 patients by rigid bronchoscopy and in 13 patients by fiber-optic bronchoscopy. In 3 group II patients a thoracotomy with a bronchotomy was necessary. Conclusions Fiber-optic bronchoscopy showed a diagnostic accuracy rate of 100 % but played a poor therapeutic role with a case resolution of 10.7 %. Rigid bronchoscopy was the main technique, permitting the removal of the tracheobronchial foreign body in 97.2 % of patients.

Surgical tracheostomy morbidity led the authors to investigate new election techniques. The aim of this retrospective study was to assess the translaryngeal tracheostomy (TLT), complications and cost.From January 1998 to January 2001, 104 patients were treated with TLT modified: 69 males (66.3%) and 35 females (33.7%), average age 52.6 +/- 9.5 years. The original pathologies were: traumatical (36), neurological (37), surgical (9), heart (4), respiratory (18). The average time between intubation and execution of TLT was 4.2 +/- 1.3 days.Fifty four patients died (52%) and 50 patients lived (48%). Two complications (1.9%) occurred in those who survived: a breaking of the guidewire in traction. Extraction of the tracheostomy tube by clamp, a haemorrhage in 2nd post-operative day due to a thyroid vessel lesion. The haemostasis was performed by classical tracheostomy. The average number of days to decannulation was 25 +/- 1 days.TLT reduces trauma or trachea and neighbouring structures. This technique is safe and easy. TLT is an effective method, in non-urgent situations, in children and adults, as well as in brachytypes and the obese.

The aim of this work was to evaluate the different surgical repair procedures and to discuss their technical applications according to the indications. From april 1989 to november 1999 we observed 18 patients, 12 males (66.7%) and 6 females (33.3%) presenting tumors of the chest wall. All patients were submitted preoperatively to a general respiratory check-up, and to an assessment of loco-regional and metastatic lesions. In 13 patients (72.2%), on the basis of topographical and morphological characteristics of the mass, we performed a transthoracic needle biopsy under scanner monitoring. The exeresis, in 6 patients (33.3%), implied a large resection of osteo-muscular structures. In 10 patients (55.6%), the benign nature of lesion, required extirpation solely of the tumor. In 2 patients (11.1%), owing to the extensive infiltration of the primary neoplasm, solely complementary treatment was carried out. Reconstruction of the thoracic wall was performed using associated myoplasty in all cases. In 3 subjects a prosthesis was installed; in 1 case a costal transposition association is necessary. Histological observation of the excised material revealed 16 primary tumors, 12 benign (75%) and 4 malignant (25%). Transthoracic needle biopsy under scanner monitoring confirmed the diagnosis in 100% of the cases operated. Fourteen patients (87.5%) are alive 73 +/- 35 months after intervention, without resumption of the disease. Two patients died (12.5%) VIII and VI months following the operation. Two patients not operated, died after VI and V months. Appropriate choice of techniques and of repair materials allowed valid oncological, aesthetical and functional results independently from the extent of the parietal defect.

Between January 1980 and December 1997 twenty-one patients with a mass in the posterior mediastinum came under our observation. All of the patients underwent chest radiography, bronchoscopy, respiratory function tests, perfusional and ventilatory radionuclide scans, a computed tomography (CT) of the chest and blood gas analysis. In cases involving neurogenic tumours magnetic resonance imaging (MRI) was used. Ten patients underwent CT guided transthoracic needle biopsy. The excision was performed by means of a thoracotomy in 12 cases (57.1%) and by video assisted thoracoscopy surgery (VATS) in the other 9 (42.9%); no deaths were recorded. Eleven neurilemmomas, two bronchogenic cysts, two paragangliomas, two neuroepitheliomas, one neurogenic sarcoma and three esophageal duplications were found. The authors believe an accurate pre-operative assessment of the lesion can be obtained using CT and MRI. The video assisted thoracoscopy (VAT) is a useful method of diagnosis and treatment as it can be converted into VATS if the lesion is benign or cystic. Thoracotomy is necessary when the mass is malignant or when there is adhesion to or invasion of surrounding tissues.

The aim of this study was to evaluate the benefits of total intravenous anaesthesia (TIVA), with the administration of drugs intravenously and the maintenance of pulmonary ventilation with oxygen enriched air, with respect to inhalatory anaesthesia, in thoracotomies with single lung ventilation.The study, devoloped in collaboration between the Service of Anaesthesia and Resuscitation and the Division of Thoracic Surgery of the Hospital of Teramo, was carried out in two groups of patients chosen at random; fifty patients divided into two groups of twenty-five were studied. Pre-medication and induction was similar in both groups; maintenance, however, varied: a total intravenous anaesthesia was given to patients in group A whereas patients in group B received an inhalatory anaesthesia. These parameters were considered: pressure values, heartbeat, PaO2 and PaCO2 levels, SatO2 and EtCO2.Both protocols respected anaesthetic guidelines in terms of controlling pressure values, heartbeat and levels of PaCO2 during bipulmonary ventilation. Significantly statistical differences were observed in the oxygenation during one lung ventilation: the mean values of PaO2 being significantly higher in group A.On the basis of this experience, it can be conclude that TIVA offers the following advantages: a better oxygenation during one lung ventilation, good recovery of post operative consciousness with no psychomotor disturbances, absence of pollution in the operating theatre.

The Authors carried out an retrospective analysis on 81 patients, 67 men and 14 women, suffering from non post-surgical thoracic empyema, to evaluate the different therapeutic procedures and respective indications. The unsuccessful response to the preserving approach (intercostal drainage and pleural lavage twice a day with specific antibiotics or antiseptics) in 56 cases, induced the Authors to carry out a video-thoracoscopy (VAT), that allowed them to define the infection stage and subsequent treatment (the carrying on of a pleural drainage-lavage in 32 cases, the transcurrent pleural irrigation in 10 cases, the open window thoracostomy followed by myoplasty in 6 cases with bronchopleural fistula, the decortication with associated pleural exeresis in 6 cases with bronchopleural fistula, the decortication with associated pleural exeresis in 6 cases, the streptokinase in pleural cavity in 2 cases). There were registered totally 3 deaths (3.7%). The Authors in conclusion assert that the VAT, carried out after the unsuccessful preserving treatment, allows the evaluation of the infection stage and consequently suggests therapy.

Clinical research on 75 cases of mediastinal masses has been carried out with the aim of evaluating the diagnostic value of Magnetic Resonance (MR). Results which have been achieved point to a remarkable potentiality of MR especially in the characterization and spatial definition of the masses and in the study of the spinal canal. These results, as well as the non-invasivity of the procedure, lead us to consider MR as an investigation of primary importance in the diagnostic assessment of mediastinal pathology.

Non-small cell lung cancer (NSCLC) shows a complex cytogenetic heterogeneity and up to now no particular chromosomal aberration seems to characterize its malignant evolution. We therefore performed cytogenetic analyses of 20 primary NSCLC, 8 adenocarcinomas and 12 squamous cell carcinomas on direct preparations or short-term cultures. Only 1 case was analyzed after long-term culture. Results were obtained from 11 samples and clonal rearrangements were found in 3 cases, a diploid and a near-triploid clone with several aberrations such as i (9q), rob (14; 15) and rob (21; 21) in 1 case, a near-triploid clone in 1 case, and Y chromosome loss in 1 case. Other aberrations found were sporadic, but + 7 aneuploidy and translocations involving 1p were detected in 2 and 3 samples respectively. Although to date it has been very difficult to recognize primary changes in NSCLC, nevertheless a literature review and our results indicate that i(9q) and robertsonian translocations are relevant findings.

Fifty patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. Results of CT and MR were compared with the surgical and pathology findings. No statistically significant difference was found between the two imaging methods for the evaluation of node involvement (N2). MR appear to be superior to CT in the aortopulmonary and subcarinal areas.

Twenty-five patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. MR scans included contiguous axial and coronal slices. Results of CT and MR studies were compared with the surgical and pathological findings. Although no significant difference was found between the two imaging methods for the evaluation of mediastinal nodes. MR appear to be superior to CT in the aortopulmonary and subcarinal node areas.

The diagnostic significance of the histological typing of lung cancer carried out on preoperative bronchoscopic biopsy samples is assessed in relation to final morphological diagnosis on operating material. In this connection 176 of 624 cases of lung cancer documented histologically from January 1980 to December 1987 in which preoperative biopsy sample was followed by removal of the lung are analysed. The 4 basic histotypes of lung cancer according to the WHO (1981) classification are considered. A positive diagnosis for cancer was encountered in 138 cases (78.4%) with histotype confirmed in 122, whereas a negative diagnosis was encountered in 38 cases (21.6%). These findings also permitted further considerations, including the possible limitations of the technique.

A series of 39 operated cases of small cell cancer were analysed. In 15 cases (38.4%) an exploratory thoracotomy only was carried out. 24 patients (61%) had a pulmonary excision: 12 pneumonectomies, 3 bilobectomies and 9 lobectomies were carried out. The hospital mortality was 7.7%. After a study of the surgical specimens these 21 cases were grouped as follows: 5 stage I, 1 stage II and 15 stage III. After surgery 4 patients were treated with radiotherapy alone, 3 chemotherapy alone and 10 by a combination of radiotherapy followed by chemotherapy, finally 4 patients had no post operative treatment. For the 21 patients who had resections the actuarial survival was 12.8% at 5 years and the mean survival 24 +/- 17.2 months. These results were judged as satisfactory and lead one to consider the current place of surgery in the treatment of small cell bronchial cancer.

From July 1979 to July 1986, 215 patients with non-oat cell carcinoma of the lung were treated by surgery at our institution. Of these, 169 had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The extent of pulmonary resection consisted of pneumonectomy in 70 patients, lobectomy in 78 patients, bilobectomy in 18 patients and wedge resection in 3 patients. All were staged according to the AJG staging system. There were 88 patients without lymph node metastases (N0), 10 patients with peribronchial lymph node metastases (N1) and 60 patients with regional lymph node metastases (N2). All patients with N2 disease received radiation therapy to the mediastinum after surgery. The overall survival rate was 62% at 1 year, 36% at 3 years and 27% at 5 years. Survival in patients with N2 disease was 56% at 1 year, 23% at 3 years and 12.4% at 5 years. We conclude that patients with mediastinal lymph node metastases can be effectively treated by combined resection and radiation therapy, with prolonged survival.