Patients With and Without Varicocele: Biochemical Markers

Patients With and Without Varicocele: Biochemical Markers Differences in Biochemical Markers and Body Mass Index Between Patients With and Without Varicocele Background: Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes of male infertility. This study aimed to evaluate the differences in bio- chemical markers and body mass index (BMI) between patients with and without varicocele. Methods: Between January 2004 and June 2009, 102 patients with varicocele (Group A) were evaluated. Ninety-five age-matched male patients who did not have varicocele were selected as controls (Group B). Varicocele was diagnosed by physical examination and confirmed by Doppler ultrasonography. The range of ages was between 18 and 50 years old. BMI, testosterone, serum alkaline phosphatase, calcium, lactic dehydrogenase, inorganic phosphate, ÃŽ ³-glutamine transpeptidase, uric acid, albumin, iron, cholesterol, triglyceride, alanine aminotransferase, and aspartate aminotrans- ferase levels were measured for all the subjects. Results: The mean age was 35.4 years in group A and 36.5 years in group B. Of the 102 patients in group A, 20 were grade 1 varicocele, 55 were grade 2 and 27 were grade 3. The BMI (mean  ± SD) of patients with varicocele (22.8  ± 3.2) was significantly lower than that of patients without varicocele (24.9  ± 4.1). Patients with varicocele had significantly lower serum levels of cholesterol than patients without varicocele (176.5  ± 31.1 vs. 187.7  ± 42.1 mg/dL). There were no significant differences for the other biochemical markers between the groups. Patients with grade 3 varicocele had a lower BMI than patients with grades 1 and 2 varicocele, but this was not significant. No significant differences were found for the other biochemical markers among the patients with grade 1, 2 or 3 varicocele. Conclusion: Patients with varicocele had significantly lower serum levels of cholesterol than those without varicocele. In addition, the prevalence of varicocele was higher in patients with a lower BMI. Our findings suggest that patients with a greater BMI may have advantages in relieving the nutcracker phenomenon, which causes significant varicoceles. [J Chin Med Assoc 2010;73(4):194–198] Key Words: biochemical markers, body mass index, testosterone, varicocele Introduction Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes of male infertility. The prevalence of varicocele is approxi- mately 15–20% in the general population and 30–40% in infertile men.1 Furthermore, approximately 69–81% of men with secondary infertility have varicocele.2,3 Levinger et al proposed that varicocele prevalence is increased over time and the risk of incidence is approx- imately 10% for each decade of life.4 The definite eti- ology of varicocele is still unknown. Kumanov et al suggested that weight and body mass index (BMI) have a protective role, and height, penile length and penile circumference were negative factors in the *Correspondence to: Dr William J. Huang, Division of Urology, Depar tment of Surger y, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C. E-mail: [emailprotected] à ¢-  Received: October 16, 2009 à ¢-  Accepted: Januar y 21, 2010 194 J Chin Med Assoc †¢ April 2010 †¢ Vol 73 †¢ No 4  © 2010 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved. development of varicocele in 6,200 boys aged 0–19 years.5 Delaney et al demonstrated that patients with varicocele are significantly taller and heavier than age- matched controls.6 Nielsen et al reported that varico- celes are less likely to be diagnosed among obese men.7 The role of testosterone in the pathophysiology of varicocele is not established and testosterone might induce relaxation of the human internal spermatic vein.8 Sheriff showed that there was increased choles- terol and glyceride in the testes of patients with bilateral varicocele compared with those in controls.9 Odabas et al suggested that the levels of lactic dehydrogenase (LDH) were higher in the spermatic vein than those in the peripheral vein.10 Other than findings on age, BMI and testosterone levels, there is limited information about the correla- tion between biochemical markers and varicocele. Therefore, we conducted this prospective study to evaluate differences between patients with and with- out varicocele with regard to BMI, testosterone levels and serum biochemical markers including hemoglo- bin, alkaline phosphatase (Alk-p), calcium, LDH, inor- ganic phosphate, ÃŽ ³-glutamine transpeptidase, uric acid, albumin, iron, cholesterol (Cho), triglyceride (TG), alanine aminotransferase, and aspartate aminotrans- ferase levels. We also wished to determine possible risk factors in the pathogenesis of varicocele. Methods Patients From January 2004 to June 2009, 102 patients with varicocele (Group A) were included for evaluation for this study. Ninety-five male patients who did not have varicocele were selected as controls (Group B). All of the 197 patients were normal, healthy young to middle-aged males. They were from the outpatient Department of Urology or had received a regular physi- cal check-up at the hospital. Varicocele was diagnosed by physical examination and confirmed by Doppler ultra- sonography. Varicocele grades were defined as: grade 1, palpable only with the Valsalva maneuver; grade 2, palpable without the Valsalva maneuver; and grade 3, visible from a distance.11 Patients with subclinical vari- cocele were excluded from the study. The range of ages was between 18 and 50 years old. BMI, and testos- terone, Alk-p, calcium, LDH, inorganic phosphate, glu- tamine transpeptidase, uric acid, albumin, iron, Cho, TG, alanine aminotransferase, aspartate aminotrans- ferase and hemoglobin levels were mea sured in all of the patients (normal ranges: BMI testosterone, 241–827 ng/dL; Alk-p, 100–280 U/L; calcium, 8.1–10.7 mg/dL; LDH, 95–213 U/L; inor- ganic phosphate, 2.1–4.7 mg/dL; glutamine transpepti- dase, 8–60 U/L; uric acid, 2.5–7.2 mg/dL; albumin, 3.7– 5.3 g/dL; iron, 35–200 ÃŽ ¼g/dL; Cho, 125–240 mg/dL; TG, 20–200 mg/dL; alanine aminotransferase, 0–40 U/L; aspartate aminotransferase, 5–45 U/L; hemo- globin, 12–16 g/dL). Patients with poor control of diabetes mellitus, hypertension or other systemic dis- ease or BMI 40 were excluded from the study. Patients were examined in a warm room while standing up and the scrotum was inspected and pal- pated. All the patients received Doppler ultrasonogra- phy of the scrotum. All the patients signed informed consent, and the study was approved by the Institu- tional Review Board of Taipei City Hospital. Statistical analysis The Mann-Whitney U test and Kruskal-Wallis test were used for statistical analysis, with p Results The mean age was 35.4 years in group A and 36.5 years old in group B. Data for age, BMI, testosterone levels and biochemical markers for patients in both groups, and different grades of varicocele are shown in Tables 1 and 2. There were no significant differences in age between the patients of groups A and B and among the patients with different grades of varicocele (grades 1, 2 and 3). Of the 102 patients in group A, 19.6% were grade 1, 53.9% were grade 2 and 26.5% were grade 3. The BMI of patients with varicocele was significantly lower (p = 0.03) than that in patients without varicocele (Table 1). Patients with varicocele had lower serum levels of Cho, TG and testosterone and higher serum levels of LDH and Alk-p than patients without varicocele, but only Cho was significantly dif- ferent (p = 0.03, Table 1). There were no significant differences in the other biochemical markers between the patients of groups A and B (Table 1). Patients with grade 3 varicocele had a lower BMI than patients with grades 1 and 2 varicocele, but this was not significantly different (Table 2). Patients with grade 3 varicocele had lower serum levels of Cho and testosterone and higher serum levels of LDH and Alk-p than patients with low grade varicocele (grades 1 and 2), but this was not significant. There were no signifi- cant differences in any of the other biochemical markers among the patients with grades 1, 2, and 3 varicocele (Table 2). Table 1. Age, serum biochemical markers, testosterone and BMI in groups A and B* A (n = 102) B (n = 95) p†  *Data presented as mean  ± standard deviation; † statistical analysis by Mann-Whitney U test. A = group A, with varicocele; B = group B, without varicocele; Alk-p = alkaline phosphatase; LDH = lactic dehydrogenase; IP = inorganic phosphate; g-GT = g-glutamine transpeptidase; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index. Table 2. Age, serum biochemical markers, testosterone and BMI according to different grades of varicocele* Grade 1 (n = 20) Grade 2 (n = 55) Grade 3 (n = 27) p†  *Data presented as mean  ± standard deviation; † statistical analysis by Kruskal-Wallis test. Alk-p = alkaline phosphatase; LDH = lactic dehydrogenase; IP = inorganic phosphate; g-GT = g-glutamine transpeptidase; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index. Discussion Tsao et al showed that the prevalence and severity of varicoceles is inversely correlated with obesity, which indicates that obesity may result in a decreased nut- cracker effect.12 Handel et al reported that the preva- lence of varicocele decreases with increasing BMI, and the reason for this is that increased adipose tissue decreases compression of the left renal vein and pre- vents detection due to adipose tissue in the spermatic cord.13 In the present study, patients with varicocele had a lower BMI than normal age-matched controls, but patients with grade 3 varicocele did not have a sig- nificantly lower BMI than patients with lower-grade varicocele. The different etiology between our study and that of Tsao et al may be because patients in the previous study were young males serving in the army, which was different from our patients, but the etiol- ogy needs further evaluation. We found that obese or overweight (BMI ≠¥ 25) patients might have higher serum levels of Cho and TG than normal subjects (BMI Kumanov et al demonstrated that gynecomastia is negatively correlated with BMI.15 Low serum follicle- stimulating hormone and high testosterone are good prognostic factors for varicocelectomy.16 Ishikawa and Fujisawa showed that the vasodilatory effect of testosterone is decreased in high grade varicocele and they suggested that serum free testosterone will be in- creased after varicocele repair.17 Ghosh and York have reported that testosterone levels are lower and Alk-p levels are higher in the testis of varicocele-created rats.18 In our study, patients with varicocele had lower serum levels of testosterone and higher serum levels of Alk-p than patients without varicocele. In addition, patients with grade 3 varicocele had lower serum levels of testosterone and higher serum levels of Alk-p than patients with low grade varicocele. Both parameters did not reach statistical significance, and the reason might be due to a large standard deviation for testo- sterone and Alk-p levels. Therefore, the role of testo- sterone and Alk-p in patients with varicocele needs further evaluation; however, we did not measure folli- cle-stimulating hormone in this study. Our previous study showed that more free radicals might be gener- ated in varicocele veins than in the corresponding peripheral veins in patients with varicocele, because 8-hydroxy-2 -deoxyguanosine levels of leukocyte DNA in spermatic veins are higher than in the correspond- ing peripheral veins in these patients.19 Yesilli et al showed that LDH and malondialdehyde levels are greater in the sperm of infertile men with varicocele, but the levels of LDH and malondialdehyde does not decrease after varicocelectomy.20 In the present study, serum levels of LDH were higher in patients with varic- ocele than in patients without varicocele. Further- more, higher serum levels of LDH were found in patients with high-grade varicocele than in patients with lower-grade varicocele. Neither of these findings was statistically significant. Therefore, the effect of LDH in patients with varicocele needs further evaluation. Our findings suggest that an increase in body fat might be associated with relieving the nutcracker phe- nomenon of the superior mesenteric artery to the left renal vein. However, this study had some limitations. First, we did not compare the change in severity of varicocele in the same individual as BMI changed over time. Second, we did not use other imaging studies, such as computed tomography or magnetic resonance imaging, to demonstrate the relationship between vis- ceral fat and the region of the superior mesenteric artery, left renal vein and aorta. Third, the case numbers were small from an epidemiological view, because all of the subjects needed to have data for biochemical mark- ers, which restricted the patient numbers. Therefore, we need to include more cases in future studies. In conclusion, patients with varicocele might have significantly lower serum levels of cholesterol than patients without varicocele. In addition, our findings support the hypothesis that patients with a greater BMI may have advantages in relieving the nutcracker phe- nomenon causing significant varicoceles, but further studies are required to clarify this issue. References 1. Jarrow JP. Effects of varicocele on male infertility. Hum Reprod Update 2001;7:59–64. 2. Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology 1993;42:541–3. 3. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993;59:613–6. 4. Levinger U, Gornish M, Gat Y, Bachar GN. Is varicocele preva- lence increasing with age? Andrologia 2007;39:77–80. 5. Kumanov P, Robeva RN, Tomova A. Adolescent varicocele: who is at risk? Pediatrics 2008;121:53–7. 6. Delaney DP, Carr MC, Kolon TF, Snyder HM, Zderic SA. The physical characteristics of young males with varicocele. BJU Int 2004;94:624–6. 7. Nielsen ME, Zderic S, Freedland SJ, Jarrow JP. Insight on patho- genesis of varicocele: relationship of varicocele and body mass index. Urology 2006;68:392–6. 8. Irkilata HC, Yildiz O, Yildirim I, Seyrek M, Basal S, Dayanc M, Ulku C. The vasodilator effect of testosterone on the human internal spermatic vein and its relation to varicocele grade. J Urol 2008;180:772–6. 9. Sheriff DS. The lipid composition of human testis in patients with bilateral varicocele as cause of infertility. Andrologia 1982;14: 150–3. 10. Odabas O, Yilmaz Y, Atilla MK, Tarakcioglu M, Aydin S. Can LDH activity in spermatic vein indicate testicular damage? A preliminary report. Int Urol Nephrol 1998;30:599–601. 11. Dubin L, Amelar RD. Varicocelectomy: 986 cases in a twelve- year study. Urology 1977;10:446–9. 12. Tsao CW, Hsu CY, Chou YC, Wu ST, Sun GH, Yu DS, Fan PL, et al. The relationship between varicoceles and obesity in a young adult population. Int J Androl 2009;32:385–90. 13. Handel LN, Shetty R, Sigman M. The relationship between varicoceles and obesity. J Urol 2006;176:2138–40. 14. Sultan Sheriff D. Further studies on testicular lipids and glyco- gen in human patients with unilateral varicocele. Andrologia 1984;16:442–5. 15. Kumanov P, Deepinder F, Robeva R, Tomova A, Li J, Agarwal A. Relationship of adolescent gynecomastia with varicocele and somatometric parameters: a cross-sectional study in 6200 healthy boys. J Adolesc Health 2007;41:126–31. 16. Kondo Y, Ishikawa T, Yamaguchi K, Fujisawa M. Predictors of improved seminal characteristics by varicocele repair. Andrologia 2009;41:20–3. 17. Ishikawa T, Fujisawa M. Varicocele ligation on free testosterone levels in infertile men with varicocele. Arch Androl 2004;50:443–8. 18. Ghosh PK, York JP. Changes in testicular testosterone and acid and alkaline phosphatase activity in testis and accessory sex organs after induction of varicocele in Noble rats. J Surg Res 1994;56:271–6. 19. Chen SS, Huang WJ, Chang LS, Wei YH. 8-Hydroxy-2 deoxyguanosine in leukocyte DNA of spermatic vein as a bio- marker of oxidative stress in patients with varicocele. J Urol 2004;172:1418–21. 20. Yesilli C, Mungan G, Seckiner I, Akduman B, Acikgoz S, Altan K, Mungan A. Effect of varicocelectomy on sperm creatine kinase, HspA2 chaperone protein, LDH, LDH-X, and lipid peroxidation product levels in infertile men with varicocele. Urology 2005;66:610–5.

Fancy Footwork

Most countries have their own cultural traditions, and China is no exception. Street dancing is not very popular in the United States, especially in Sacramento, since people have busy life styles and urban management law enforcement. Sometimes people go to clubs dancing when they have free time or hang out with friends. However, in China, we can see a lot of ladies dancing in square or open spaces like parks or parking lots during morning time or after dinner time. People can join the street dances everywhere from big cities to small towns. Many community owners and residents oppose the square dance in the community due to their loud music, and some people think this loud music has seriously affected their lives, so residents expelled dancing ladies at the beginning. As time went by, people started to accept and adjust to the environment around them. Street dances have become one aspect of culture in China. Moreover, it is also considered a social phenomenon in China. The streets have become a colorful world at night. Why? Since there are elderly people or middle-aged people enjoy the dancing in the square. Some people dance and sing, other people are into fitness, and some naughty children follow the funny action of the dancing ladies. Even though the dancers are old, they still have vibrant vitality and graceful dance posture. They are well-behaved and rhythmic. They have neatly arranged team, and the people dressed uniform clothing wearing a blue and white T-shirt, trousers, and white gloves, really like the people's liberation army in the military parade. My grandma couldn't help to join the team when she saw the spectacular scenery. When I was a child, my grandma always took me to the square dance because it was her routine. Her joints are flexible and soft like snakes. Her beautiful dance leisurely soft like butterfly flying and smooth wicker twisting. Street dance in the Chinese mainland; both north and south are very common, mostly participants experienced the Cultural Revolution generations of the elderly. In China, the middle-aged and elderly women who dance at street dance have been given the title of â€Å"Guang Chang Da Ma Wu† which is street dance. Accompanied by elegant music and lightweight pace of dancers, people know where they should go for dancing, and usually they have stable places. Although sometimes rain couldn't stop their activities, they go to indoor grounds. Many people join the street dancing because it is very cheap and avoid traffic to go far away to clubs. For example, it is reported as being 5 RMB per month. It depends where you live. If you live in the big cities like Guangzhou, Shanghai, or Beijing, it will be about 20 RMB, which is three dollars. I still enjoyed dinner with my family while the music is open as loud as trains outside of my home. It is very convenient being next door. It seems to tell people that it is time go out dancing. When foreign tourists travel to China, they are completely impression by â€Å"Guang Chang Da Ma Wu†. They may think dancers are so ridiculous since they play loud music and occupy a lot of public places; also, they annoy many other residents. Because so many dancers like to dance very early in the morning, for example, around 6:00am, this does not allow sleeping-in on weekends. The noise also bothers some people at work when the dancers are active during working hours. Additionally, this can cause a lot of trafficproblems and displace other sports. Street dancing seems weird in other countries, but it creates a good atmosphere of helping, learning, exchange of feeling, friendship, growth of knowledge and fitness, bringing together people of different levels qualities and interests. When I look back at the life in China, I have vivid images of the street dance around my home in my head. Loud music has been coming in my ear which seems to have happened yesterday. â€Å"Guang Chang Da Ma Wu† has become significant, not only in my family, but it is a major culture of Chinese society. Street dance has become the soul of Chinese culture. It is inherited from generation to generation.

Mass Merger - the Case of Aon Singapore - 1964 Words

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