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Adult Ecmo And Gastrointestinal Bleeding From Small Bowel Arteriovenous Malformations: A Novel Treatment Using Spiral Enteroscopy., Konrad Sarosiek, Hitoshi Hirose, Harrison T Pitcher, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Hemorrhagic complications on extracorporeal membrane oxygenation (ECMO) are common because of the need for anticoagulation to maintain the oxygenator and circuitry. Gastrointestinal bleeding (GIB) is reported to occur in 3-6% of ECMO patients, 1 requiring frequent transfusions as well as multiple diagnostic and therapeutic interventions. Multiple transfusions can result in volume overload, coagulopathies and infections leading to significant morbidity and mortality. We present the first published case of GIB from an arteriovenous malformation (AVM) treated with a novel therapy termed spiral enteroscopy while the patient remained on venoarterial (VA) ECMO.

Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas Cavarocchi, Paul Mather

Nicholas C Cavarocchi MDJ

This is invited commentary to the following article: Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Determination Of Cutpoints For Low And High Number Of Symptoms In Patients With Advanced Cancer, Stephanie Gilbertson-White, B. Aouizerat, T. Jahan, S. Paul, C. West, K. Schumacher, M. Dodd, M. Rabow, A. Abu Raddaha, C. Miaskowski

Stephanie Gilbertson-White

While patients with advanced cancer experience a wide range of symptoms, no work has been done to determine an optimal cutpoint for a low versus a high number of symptoms. Analytic approaches that established clinically meaningful cutpoints for the severity of cancer pain and fatigue provided the foundation for this study. The purpose of this study was to determine the optimal cutpoint for low and high numbers of symptoms using a range of potential cutpoints and to determine if those cutpoints distinguished between the two symptom groups on demographic and clinical characteristics and depression, anxiety, and quality of life (QOL). …

Documentation On Withdrawal Of Life Support In Adult Patients In The Intensive Care Unit [Corrected] [Published Erratum Appears In Am J Crit Care 2004 Sep;13(5):370], K. Kirchhoff, P. Anumandla, K. Foth, S. Lues, Stephanie Gilbertson-White

Stephanie Gilbertson-White

BACKGROUND: Patients' charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research. OBJECTIVE: To assess the documentation of end-of-life care of patients and their families by care providers in the intensive care unit. METHOD: Charts of 50 adult patients who died in the intensive care unit at a large midwestern hospital after initiation of withdrawal …

Teasaponin Reduces Inflammation And Central Leptin Resistance In Diet-Induced Obese Male Mice, Yinghua Yu, Yizhen Wu, Alexander Szabo, Zhixiang Wu, Hongqin Wang, Duo Li, Xu-Feng Huang

Yizhen Wu

Chronic inflammation is involved in the pathogenesis of obesity and type 2 diabetes. Recently, teasaponin, an extract from tea, has been shown to have anti-inflammatory effects. We examined the effect of teasaponin on obesity, inflammation, glucose metabolism and central leptin sensitivity, in obese mice fed a high-fat (HF) diet for 16 weeks. Intraperitoneal injections of teasaponin (10mg/kg, daily) for 21 days significantly decreased the food intake and body weight of HF diet-induced obese mice. Teasaponin treatment also reduced the protein levels of pro-inflammatory cytokines (TNF-α, IL-6 and/or IL-1β) and NF-κB signaling (p-IKK and p-IκBα) in adipose tissue and the liver. …

Teasaponin Reduces Inflammation And Central Leptin Resistance In Diet-Induced Obese Male Mice, Yinghua Yu, Yizhen Wu, Alexander Szabo, Zhixiang Wu, Hongqin Wang, Duo Li, Xu-Feng Huang

Yizhen Wu

Chronic inflammation is involved in the pathogenesis of obesity and type 2 diabetes. Recently, teasaponin, an extract from tea, has been shown to have anti-inflammatory effects. We examined the effect of teasaponin on obesity, inflammation, glucose metabolism and central leptin sensitivity, in obese mice fed a high-fat (HF) diet for 16 weeks. Intraperitoneal injections of teasaponin (10mg/kg, daily) for 21 days significantly decreased the food intake and body weight of HF diet-induced obese mice. Teasaponin treatment also reduced the protein levels of pro-inflammatory cytokines (TNF-α, IL-6 and/or IL-1β) and NF-κB signaling (p-IKK and p-IκBα) in adipose tissue and the liver. …

Do Patient-Reported Androgen-Deprivation Therapy Side Effects Predict Anxiety And Depression Among Prostate Cancer Patients Undergoing Radiotherapy? Implications For Psychosocial Therapy Interventions, Christopher Sharpley, Vicki Bitsika, David Christie

Vicki Bitsika

Antiandrogen therapy (AAT) is a common adjunct treatment for prostate cancer (PCa) patients and has shown significant benefits to long-term outcomes from radiation or surgery. Although AAT has some adverse side effects and data from breast cancer patients indicate that such side effects from hormonal therapies may contribute to anxiety and depression and may also hinder AAT treatment compliance, this issue has not been investigated within a sample of PCa patients. This study explores the incidence of AAT side effects in a sample of PCa patients, the links between those side effects and anxiety and depression, the possible ways in …

Dha Prevents Altered 5-Ht1a, 5-Ht2a, Cb1 And Gabaa Receptor Binding Densities In The Brain Of Male Rats Fed A High-Saturated-Fat Diet, Yinghua Yu, Yizhen Wu, Craig Patch, Zhixiang Wu, Alexander Szabo, Duo Li, Xu-Feng Huang

Yizhen Wu

Low levels of docosahexaenoic acid (DHA) have been linked to a number of mental illnesses such as memory loss, depression and schizophrenia. While supplementation of DHA is beneficial in improving memory and cognition, the influence of dietary fats on the neurotransmitters and receptors involved in cognitive function is still not known. The aim of this study was to investigate serotonin receptor (5-HT1A and 5-HT2A), cannabinoid receptor (CB1) and gamma-aminobutyric acid type A (GABAA) receptor binding densities in the brain of male rats fed a high-saturated-fat (HF) diet, as well as the effect of DHA supplementation on HF diet. Alterations of …

Reduction Of Histamine H1 Receptor Binding Induced By High-Fat Diet Can Be Prevented By Dha And Dietary Fiber In Specific Brain Areas Of Male Rats, Zhixiang Wu, Yinghua Yu, Yizhen Wu, Craig S. Patch, Alexander Szabo, Xu-Feng Huang

Yizhen Wu

High-fat (HF) diet and obesity are risk factors for a number of mental health problems including depression, cognitive dysfunction, dementia, and neurodegenerative diseases. Histamine H1 receptors (H1Rs) are involved in many of these conditions. This study examined H1R receptor binding density in the brain of male rats fed a high-saturated fat (HF) diet, as well as the effect of docosahexaenoic acid (DHA), galacto-oligosaccharide (GOS) and resistant starch (RS) supplementation of HF diet. Alterations of H1R expression in the post-mortem rat brain were detected by [ 3H]-pyrilamine binding autoradiography. We found that HF diet significantly decreased H1R binding densities in the …

Who's Contented Now? Gainsharing And The Paradoxical Female Worker, Theresa M. Welbourne, Mary E. Graham

Theresa M. Welbourne, PhD

The "paradox of the contented female worker" describes the phenomenon of women reporting higher work and life satisfaction levels than men, despite being objectively worse off than their male counterparts. Using models of pay satisfaction and theories of equity, distributive justice, and relative deprivation, we examined the existence of this paradox in four companies with gainsharing plans. Results confirm that the paradox prevails for all under traditional pay systems, but under gainsharing, there is no paradox for lower-paid employees and a strong paradox among higher-paid employees.

Treatment With Monoclonal Antibodies Against Clostridium Difficile Toxins, Israel Lowy, Deborah Molrine, Brett Leav, Barbara Blair, Roger Baxter, Dale Gerding, Geoffrey Nichol, William Thomas, Mark Leney, Susan Sloan, Catherine Hay, Donna Ambrosino

William D Thomas Jr

BACKGROUND: New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.

METHODS: We performed a randomized, double-blind, placebo-controlled study of two neutralizing, fully human monoclonal antibodies against C. difficile toxins A (CDA1) and B (CDB1). The antibodies were administered together as a single infusion, each at a dose of 10 mg per kilogram of body weight, in patients with symptomatic C. difficile infection who were receiving either metronidazole or vancomycin. The primary outcome was laboratory-documented recurrence of infection during the 84 days after the administration of monoclonal antibodies or placebo.

RESULTS: …

Lineage-Specific T-Cell Responses To Cancer Mucosa Antigen Oppose Systemic Metastases Without Mucosal Inflammatory Disease., Adam Snook, Peng Li, Benjamin J Stafford, Elizabeth J Faul, Lan Huang, Ruth C Birbe, Alessandro Bombonati, Stephanie Schulz, Matthias Schnell, Laurence Eisenlohr, Scott Waldman

Adam E Snook

Cancer mucosa antigens are emerging as a new category of self-antigens expressed normally in immunologically privileged mucosal compartments and universally by their derivative tumors. These antigens leverage the established immunologic partitioning of systemic and mucosal compartments, limiting tolerance opposing systemic antitumor efficacy. An unresolved issue surrounding self-antigens as immunotherapeutic targets is autoimmunity following systemic immunization. In the context of cancer mucosa antigens, immune effectors to self-antigens risk amplifying mucosal inflammatory disease promoting carcinogenesis. Here, we examined the relationship between immunotherapy for systemic colon cancer metastases targeting the intestinal cancer mucosa antigen guanylyl cyclase C (GCC) and its effect on inflammatory …

Fibre: Male Participants Not Getting Enough, Rebecca Thorne, Jane O'Shea, Qingsheng Zhang, Linda Tapsell, Marijka Batterham, Karen Charlton

Qingsheng Zhang

A regular intake of dietary fibre has been associated with a number of health benefits. Consuming a high fibre diet may significantly lower the risk of developing heart disease, stroke, hypertension, diabetes and obesity (Anderson et al, 2009). Foods high in fibre such as fruit, vegetables, legumes and wholegrains are regularly included in diets targeting weight loss as they are low in fat, sugar and salt and contain a number of vitamins and minerals. Participants in trials using healthy background diets may increase their fibre intake in addition to the study variables. The aim of this study was to report …

The Gamete And Embryo Compatibility Of Various Synthetic Polymers., Stephen Hunter, J. Scott, D. Hull, R. Urry

Stephen K. Hunter

Several popular and well-characterized polymeric materials were evaluated for their biocompatibility toward the cells unique to reproduction. To accomplish these studies, several in vitro tests were developed that evaluated biocompatibility between the polymers and spermatozoa, ova, and embryos. The data indicated significant differences between the materials with respect to their biocompatibility toward sperm motility, the sperm's ability to penetrate zona-free hamster eggs, and the ability of two-cell mouse embryos to divide. Polytetrafluoroethylene (PTFE-Teflon; PTFE, Chemplast Inc., Wayne, NJ), polyethylene glycol (PEG), and polyhydroxyethyl methacrylate (PHEMA) appear to be the most inert of the materials studied. Polyvinyl chloride (PVC; Tygon-Norton, Akron, …

A Mouse Model For Beta 0-Thalassemia., Baoli Yang, S. Kirby, J. Lewis, P. Detloff, N. Maeda, O. Smithies

Baoli Yang

We have used a "plug and socket" targeting technique to generate a mouse model of beta 0-thalassemia in which both the b1 and b2 adult globin genes have been deleted. Mice homozygous for this deletion (Hbbth-3/Hbbth-3) die perinatally, similar to the most severe form of Cooley anemia in humans. Mice heterozygous for the deletion appear normal, but their hematologic indices show characteristics typical of severe thalassemia, including dramatically decreased hematocrit, hemoglobin, red blood cell counts, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration, as well as dramatically increased reticulocyte counts, serum bilirubin concentrations, and red cell distribution …

Appropriate Tissue- And Cell-Specific Expression Of A Single Copy Human Angiotensinogen Transgene Specifically Targeted Upstream Of The Hprt Locus By Homologous Recombination., B. Cvetkovic, Baoli Yang, R. Williamson, C. Sigmund

Baoli Yang

Development of experimental models by genetic manipulation in mice has proven to be very useful in determining the significance of particular genes in the development of or susceptibility to hypertension. Advances in molecular genetics, transgenic mouse technology, and physiological measurements in mice provided an opportunity to go a step further and develop models to analyze the physiological significance of specific gene variants potentially causing hypertension. In this report, we describe the development of a human angiotensinogen transgenic mouse model generated by targeting the human angiotensinogen gene upstream of the mouse HPRT locus by homologous recombination. The main benefit of this …

Chymase Inhibition Prevents Fibronectin And Myofibrillar Loss And Improves Cardiomyocyte Function And Lv Torsion Angle In Dogs With Isolated Mitral Regurgitation., Betty Pat, Yuanwen Chen, Cheryl Killingsworth, James D Gladden, Ke Shi, Junying Zheng, Pamela C Powell, Greg Walcott, Mustafa I Ahmed, Himanshu Gupta, Ravi Desai, Chih-Chang Wei, Naoki Hase, Tsunefumi Kobayashi, Abdelkarim Sabri, Henk Granzier, Thomas Denney, Michael Tillson, A Ray Dillon, Ahsan Husain, Louis J Dell'italia

Ravi V Desai MD

BACKGROUND: The left ventricular (LV) dilatation of isolated mitral regurgitation (MR) is associated with an increase in chymase and a decrease in interstitial collagen and extracellular matrix. In addition to profibrotic effects, chymase has significant antifibrotic actions because it activates matrix metalloproteinases and kallikrein and degrades fibronectin. Thus, we hypothesize that chymase inhibitor (CI) will attenuate extracellular matrix loss and LV remodeling in MR.

METHODS AND RESULTS: We studied dogs with 4 months of untreated MR (MR; n=9) or MR treated with CI (MR+CI; n=8). Cine MRI demonstrated a >40% increase in LV end-diastolic volume in both groups, consistent with …

Managed Care, Hospice Use, Site Of Death, And Medical Expenditures In The Last Year Of Life, Ezekiel Emanuel, Arlene Ash, Wei Yu, Gail Gazelle, Norman Levinsky, Olga Saynina, Mark Mcclellan, Mark Moskowitz

wei yu

BACKGROUND: We examined deaths of Medicare beneficiaries in Massachusetts and California to evaluate the effect of managed care on the use of hospice and site of death and to determine how hospice affects the expenditures for the last year of life.

METHODS: Medicare data for beneficiaries in Massachusetts (n = 37 933) and California (n = 27 685) who died in 1996 were merged with each state's death certificate files to determine site and cause of death. Expenditure data were Health Care Financing Administration payments and were divided into 30-day periods from the date of death back 12 months.

RESULTS: …

Decreased Expression Of The Heat Shock Protein Hsp70-2 Is Associated With The Pathogenesis Of Male Infertility, H. Feng, J. Sandlow, Amy Sparks

Amy E.T. Sparks

OBJECTIVE: To examine the expression of the heat shock protein hsp70-2, and the possible relationship with the pathogenesis of male infertility. DESIGN: Prospective study. SETTING: Reproductive testing laboratory in a university hospital. PATIENT(S): Men undergoing testicular biopsy during an investigation of subfertility. INTERVENTION(S): Testicular tissues were obtained from biopsies of men undergoing infertility evaluation and subdivided into three groups: normal testes, maturational arrest and Sertoli cell-only syndrome. Immunostaining and Western blotting techniques determined expression of the heat shock protein hsp70-2 MAIN OUTCOME MEASURE(S): Expression of the heat shock protein hsp70-2 in the testes. RESULT(S): The experimental data demonstrated that the …

Semen Quality In Fertile Men In Relation To Psychosocial Stress, A. Gollenberg, F. Liu, C. Brazil, E. Drobnis, D. Guzick, J. Overstreet, J. Redmon, Amy Sparks, C. Wang, S. Swan

Amy E.T. Sparks

OBJECTIVE: To examine the association between stressful life events and semen parameters. DESIGN: Cross-sectional analysis in a pregnancy cohort study. SETTING: Prenatal clinics in five U.S. cities. PATIENT(S): Fertile men (n = 744) in the Study for Future Families, a cohort study of pregnant women and their partners. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sperm concentration, percent motile, and percent normal morphology and classification above/below World Health Organization (WHO) cutoffs for semen quality. RESULT(S): After adjusting for confounders, men reporting 2+ recent stressful life events had an increased risk of being classified below WHO thresholds for "normal" defined by concentration, motility, …

Serum Inhibin-B In Fertile Men Is Strongly Correlated With Low But Not High Sperm Counts: A Coordinated Study Of 1,797 European And Us Men, N. Jorgensen, F. Liu, A. Andersson, M. Vierula, D. Irvine, J. Auger, C. Brazil, E. Drobnis, T. Jensen, P. Jouannet, J. Overstreet, J. Redmon, Amy Sparks, J. Toppari, C. Wang, N. Skakkebaek, S. Swan

Amy E.T. Sparks

OBJECTIVE: To describe associations between serum inhibin-b and sperm counts, adjusted for effect of time of blood sampling, in larger cohorts than have been previously reported. DESIGN: Cross-sectional studies of spermatogenesis markers. SETTING: Four European and four US centers. PATIENT(S): Fertile men (1,797) were included and examined from October 1996-February 2005. INTERVENTION(S): The study was observational and therefore without any intervention. MAIN OUTCOME MEASURE(S): Associations between inhibin-b and semen variables controlled for time of blood sampling and other covariates. RESULT(S): Inhibin-b decreased about 2.00% per hour from 8 am-12 pm and then about 3.25% per hour from 12 pm-4 pm. …

Decreased Expression Of The C-Kit Receptor Is Associated With Increased Apoptosis In Subfertile Human Testes, H. Feng, J. Sandlow, Amy Sparks, A. Sandra, L. Zheng

Amy E.T. Sparks

OBJECTIVE: To examine the expression of the c-kit receptor and its ligand, stem cell factor, and their possible relation with apoptosis in infertile men. DESIGN: Prospective laboratory study. SETTING: Urology laboratory in a university hospital. PATIENT(S): Men undergoing testicular biopsy during an investigation of subfertility. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Expression of the c-kit receptor protein, stem cell factor, and apoptosis in the testes. RESULT(S): The c-kit receptor was strongly present in Leydig cells and type A spermatogonia of normal testes, with decreased staining in Leydig cells and type A spermatogonia of testes with maturational arrest, and staining in only …

Psychological Empowerment And Job Satisfaction Between Baby Boomer And Generation X Nurses, Amy Sparks

Amy E.T. Sparks

AIM: This paper is a report of a study of differences in nurses' generational psychological empowerment and job satisfaction. BACKGROUND: Generations differ in work styles such as autonomy, work ethics, involvement, views on leadership, and primary views on what constitutes innovation, quality, and service. METHOD: A secondary analysis was conducted from two data sets resulting in a sample of 451 registered nurses employed at five hospitals in West Virginia. One data set was gathered from a convenience sample and one from a randomly selected sample. Data were collected from 2000 to 2004. RESULTS: Baby Boomer nurses reported higher mean total …

One Semen Sample Or 2? Insights From A Study Of Fertile Men, A. Stokes-Riner, S. Thurston, C. Brazil, D. Guzick, F. Liu, J. Overstreet, C. Wang, Amy Sparks, J. Redmon, S. Swan

Amy E.T. Sparks

No abstract provided.

Effect Of Exogenous Testosterone On Prostate Volume, Serum And Semen Prostate Specific Antigen Levels In Healthy Young Men, C. Cooper, P. Perry, Amy Sparks, J. Macindoe, W. Yates, R. Williams

Amy E.T. Sparks

PURPOSE: We investigate and define the effects of exogenous testosterone on the normal prostate. MATERIALS AND METHODS: A total of 31 healthy volunteers 21 to 39 years old were randomized to receive either 100, 250 or 500 mg. testosterone via intramuscular injection once a week for 15 weeks. Baseline measurements of serum testosterone, free testosterone and prostate specific antigen (PSA) were taken at week 1. Semen samples were also collected for PSA content and prostate volumes were determined by transrectal ultrasound before testosterone injection. Blood was then drawn every other week before each testosterone injection for the 15 weeks, every …

Characterization Of Human Sperm Antigens Reacting With Anti-Sperm Antibodies From An Infertile Female Patient's Serum, H. Feng, Y. Han, Amy Sparks, J. Sandlow

Amy E.T. Sparks

Identification of sperm antigens that elicit immunoglobulin (Ig) production and knowledge of their roles in sperm transport and fertilization may enhance diagnosis and treatment of immunologic infertility. Sperm antigens recognized by a female patient's serum anti-sperm antibodies were characterized using an indirect immunobead-binding test, immunoblot analysis, and immunochemical labeling. The anti-sperm antibodies' effect on sperm function was evaluated by acrosome induction by calcium ionophore. Immunobeads specific for IgG were bound to the head of 79% of motile donor sperm. Immunochemical labeling of antibody-binding sites was restricted to the plasma membrane over the acrosomal crescent. No labeling was observed on the …

Social Cognition, Empathy And Functional Outcome In Schizophrenia, Amy Sparks, S. Mcdonald, B. Lino, M. O'Donnell, M. Green

Amy E.T. Sparks

Social and occupational functioning difficulties are a characteristic feature of schizophrenia, and a growing body of evidence suggests that deficits in social cognition contribute significantly to these functional impairments. The present study sought to investigate whether the association between social cognition and social functioning in schizophrenia would be mediated by self-reported levels of empathy. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder, and twenty-five healthy controls completed a well-validated facial affect processing task (Ekman 60-faces facial task from the Facial Expressions of Emotion - Stimuli and Tests; FEEST), The Awareness of Social Inference Test (TASIT; to assess emotion …

Development Of An Immunocontraceptive Vaccine. Current Status, H. Feng, J. Sandlow, Amy Sparks, A. Sandra

Amy E.T. Sparks

Development of an effective and modern contraceptive vaccine is a key factor in the global issue of regional population growth as well as agricultural, medical, economic and social development. A review was done of the current medical literature concerning development of an immunocontraceptive vaccine and relative molecular biology technology. Various approaches have been taken to identify candidate-specific antigens for immunocontraceptive development, such as sperm, zona pellucida and hormonal antigens. Suppressed fertility and the reversibility of these effects on mammalian species, including humans, have been demonstrated. The successful results obtained so far support the continued investigation for an effective immunocontraceptive vaccine.

Are Environmental Levels Of Bisphenol A Associated With Reproductive Function In Fertile Men?, J. Mendiola, N. Jorgensen, A. Andersson, A. Calafat, X. Ye, J. Redmon, E. Drobnis, C. Wang, Amy Sparks, S. Thurston, F. Liu, S. Swan

Amy E.T. Sparks

BACKGROUND: Rodent and in vitro studies have demonstrated the estrogenicity of bisphenol A (BPA). However, few studies have examined the relationship between human exposure to BPA and male reproductive function. OBJECTIVES: We investigated the relationships between environmental BPA exposure and reproductive parameters, including semen quality and male reproductive hormones, in prospectively recruited fertile men. METHODS: Participants (n = 375) were partners of pregnant women who participated in the Study for Future Families in four U.S. cities, and all of the men provided blood, semen, and urine samples. BPA was measured in urine. Serum samples were analyzed for reproductive hormones, including …

Comparison Of Microscopic Epididymal Sperm Aspiration And Intracytoplasmic Sperm Injection/In-Vitro Fertilization With Repeat Microscopic Reconstruction Following Vasectomy: Is Second Attempt Vas Reversal Worth The Effort?, J. Donovan, M. Dibaise, Amy Sparks, J. Kessler, J. Sandlow

Amy E.T. Sparks

Since 1986, we have performed microscopic reconstruction in 18 men following failed microscopic vasectomy reversal. Between 1994 and 1996, nine couples have undergone microscopic epididymal sperm aspiration (MESA)/ intracytoplasmic sperm injection (ICSI) treatment for male infertility due either to congenital absence of the vas deferens (CAVD) or inoperable excurrent duct obstruction. We compared the cost efficiency of repeat vasectomy reversal to that for MESA combined with ICSI/in-vitro fertilization (ICSI/IVF). The cost of male partner procedures (vasectomy reversal, MESA) was based on physician and hospital charges, while the cost of ICSI/IVF included preparation of the female partner (medications and physician charges) …