Why HCG?

An anesthesiologist told me that he could not understand why Manny Ramirez would use HCG as a performance enhancing steroid. He admitted he did not understand how HCG would affect testosterone levels.
Let me explain:
HCG is a natur substance present in pregnant women. It promotes growth of the placenta. HCG can also be manufactured. Manufactured HCG has legitimate medicinal applications, such as ovulation induction in women and in men the initiation of spermatogenesis.
HCG chemically resembles a hormone called LH, or luteinizing Hormone. LH is produced in the pituitary and in men causes the testicles to produce testosterone. LH does not come in medicinal form, but HCG is a great substitute and works just as well.
HCG can be given to men with low sperm counts or no sperm as a result of a pituitary problem. One could use HCG to increase a man's testosterone level as well if direct administration testosterone is contraindicated, such as in a man who is trying to have a baby.
An athlete would use HCG to raise his testosterone legitimately if he was trying to have a baby. Of course, if he wanted to evade drug testing aimed at detecting testosterone or its derivatives, HCG would be a good option.
I have not been following the Manny Ramirez case, but either he was trying to have a baby or he was trying raise his testosterone nefariously.
For those who are reading and wondering if I would prescribe HCG for a non-indicated use, do not try and contact me. The answer is no, no, no.
I just thought this would make for a nice post.
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It is ok to get CT scans for stone evaluations in pregnant women.

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Gastric bypass may increase kidney stone risks

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It is official!

A large and well done European study found a large survival adantage in screening for prostate cancer.
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Kidney stones on the rise

Kidney stones are common in adults but in recent years have increased in frequency in children.
In the past, stones were so uncommon in kids that the diagnosis of stones in a child usually meant that a serious metabolic illness coexisted.
Nowadays, kids are getting adult diseases like high blood pressure, adult diabetes, and now kidney stones. Like adults, these stones are diet related, namely too much salt and meat.
Sad, really! My advice, stay off the processed fast foods, encourage fruits and vegetables, and cook at home.
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Free at last

After blasting the stone, contrast easily passes into the bladder.
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Localizing stones

Sometimes stones can be difficult to locate on the day of a lithotripsy. Sometimes this means the stone has passed but othertimes the stone is obscured by overlying bowel contents. Still other stones can look like phleboliths, which are calcifications in veins and of no other significance.
When it becomes difficult to locate a stone, we can use contrast and fluoroscopy, as in the image above.
The stone is in the crosshairs and about to be blasted.
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Where is the stone?

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Kidney stones

Kidney stones come in basic types:
Calcium stones
Uric acid stones
Cystine stones

Calcium stones are the most common type. These stones are visible on plain x-rays which can make them easier to treat. Calcium stones are diet related in general.

Uric acid stones are invisible on plain x-rays but can be seen on CT scans. They can only form in acidic urine. It is possible to dissolve these stones with medication.

Cystine stones are very rare and are caused by inherited derangements in biochemical processes. These stones appear faint on x-ray but are very hard. They tend to not respond to non-invasive forms of treatments, like lithotripsy.

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A isolated right sides varicocele

Someone asked me this the other day: can an isolated right sides varicocele be a sign of something bad?

Yes it can be caused by a large right sided renal mass, at least according to the textbooks, because in practice--since 2000--I have never seen an isolated right varicocele be associated with a renal mass.

But here is why it can happen:

• On the left side, the testicular vein drains into the left renal vein.  The insertion of the testicular vein into the renal vein forms right angle and blood backs up.  When venous blood backs up, varicose veins form.  Varicoceles are varicose veins of the testicle.
• On the right side, the right testicular vein drains directly into the vena cava, which is the bodies largest vein.  Blood rarely ever backs up here, but if the vein is occluded, say from a large renal cancer, it can.  In this case, the man would develop an isolated right varicocele.

Bilateral varicoceles are common and not associated with kidney cancer.

Disclaimer:  this post is meant to be educational only.  It does not indicate or imply that any medical advice is being given.  No doctor-patient relationship exists.  If the reader is concerned, seek the advice of a doctor. 

Absence of the vas deferens

The vas deferens is the muscular tube that transports sperm from the testicle to the urethra and ultimately to its target destination.  Most have have 2 of them, one for on the right and one on the left side.  But some men have only one vas and some are missing both.  This condition is known as congenital absence of the vas deferens.  It is uncommon, but I see 2 cases per year, at least, in my busy male infertility practice.

Most men with only one absent vas never know what they are missing.  They are fertile.  In these men, the discovery is made when the man goes to the urologist for a physical exam, say before a vasectomy.
Men with 2 missing vasa (plural of vas), are infertile.  Actually, this is not true.  They are very fertile, only the sperm cannot get out of the epididymis and testicle.  In order for these men to impregnate a partner, they sperm must be retrieved surgically.   This can be done quite easily, in about 5 minutes actually, and that terrifically healthy sperm can then be used with IVF or ICSI.  This sperm retrieval procedure is called "a sperm retrieval." 

The sperm can be harvested from either the epidiymis or testicle or both.  The procedure can be done in the office, underl local anesthetic, with a very skinny needle, and is successful ~99% of the time. 

About 10% of men with a missing vas deferens will have a missing kidney as well.  This happens because the kidney, ureter, and vas deferens all form at the same time in-utero--or when the baby is in the womb--and all come from something called the wolfian duct.  No patient would ever need to know this, but I find it interesting.  When I diagnose a man with a missing vas deferens, I order a renal sonogram.  People like to know if they have one or two kidneys.

That's it..