An increased level of antisperm antibodies has been demonstrated in infertile men with varicocele compared with normal fertile men, suggesting a possible cause and effect relationship. To evaluate the possible etiological role of antisperm antibodies in varicocele patients, we performed a prospective study of 32 infertile men undergoing varicocele ligation. Semen analyses and antisperm antibodies as measured by the immunobead test were performed preoperatively and postoperatively at 3 and 6 months. Of the infertile men with varicocele 28% had a positive immunobead test compared with 0% of normal fertile men. The average total motile sperm count was significantly different (p < 0.05, 2-tailed t test) for 9 varicocele patients with sperm-bound antibody (3.2 x 10(6)) compared with 23 without antibody (8.4 x 10(6)). Postoperatively, 68% of all patients exhibited improved semen parameters, with no change in antibody status in either group. Among the antibody positive group 71% showed an increase in motile sperm per ml. of 2.8 x 10(6) to 17.2 x 10(6) (525% increase, p < 0.05), while in the antibody negative group 67% showed an increase of 3.8 x 10(6) to 24.9 x 10(6) (553% increase, p < 0.05). Our study suggests that there is an increased incidence of sperm-bound immunoglobulin in infertile varicocele patients and an apparent adverse effect on semen parameters in these patients. However, the presence of sperm-bound immunoglobulin did not affect the percentage response to surgical correction, nor can we postulate an immunological mechanism as a major etiological factor in varicocele induced infertility.

The serial technetium 99 T DIAGNOSIS approximately 40% of prostate cancer A patients have metastatic disease' and 84% of patients with prostatic carcinoma will have bone involvement at autopsy.* Technetium 99m-labeled methylene diphosphonate (99mTc-MDP) bone scans have become a standard method of staging and monitoring prostate c a n~e r .~ Although several investigator^^-^ attempted to objectively quantify isotope uptake in individual scans, the differences in isotope activity, scanning equipment, and computer programs have frustrated these efforts. Efforts at computerizing the interpretation of bone scans to remove viewer bias have not gained widespread use. However, use of bone scans as a stratification variable for protocols involving advanced prostate cancer has more recently been appreciated. Ishikawa et a1. ' suggested that the absolute number of discrete bone lesions could be a stratification variable. The Southwest Oncology Group ( SWOG)9 reported that involvement of axial versus axial plus appendicular skeleton served the same purpose.To better define the natural history of the osseous metastatic process we analyzed the serial bone scans of 76 patients with advanced prostate cancer. Particular attention was directed to the predictive value of the initial From the Division