[Non-palpable testicular tumors in adults: A management based on imaging? Issue from the French Urologic Association Genital Cancer committee's edit]. / Tumeurs testiculaires non palpables chez l'adulte : vers une prise en charge guidée par l'imagerie ? Une mise au point du Groupe organe génitaux externes du comité de cancérologie de l'Association française d'urologie.

BACKGROUND: Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. OBJECTIVES: To review their characterization at imaging findings of non-palpable testicular tumors. DOCUMENTARY SOURCES: Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. RESULTS: Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. LIMITS: Non-randomized study - a very few prospective studies. CONCLUSION: The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors.

[Castration in the bull calf and ram lamb]. / Die Kastration beim männlichen Kalb und Lamm.

This paper aims to provide an overview of the accepted techniques of pain relief and castration and guidelines of how to best perform these painful interventions in an animal-friendly way under Swiss conditions. Calves should be castrated at the age of 14 days or less, at least 10 minutes after local anesthesia with lidocaine, applying a single rubber ring. Concurrently, a NSAID should be administered intravenously (ketoprofen, 3 mg/kg of bodyweight) and Tetanus-serum subcutaneously (off label use). If possible, ketoprofen(4.5 mg/kg BW) should be orally administered for 3 - 5 days postoperatively. At 10 days after applying the rubber ring, the dried-off scrotum including the rubber ring should be removed with a clean knife or a scalpel. Local anesthesia is not necessary for this procedure. Ram lambs should be castrated at the age of 14 days or less, at least 10 minutes after local anesthesia with lidocaine, applying a rubber ring. The toxic dose of 4 mg lidocaine/kg BW (corresponds to 1 ml lidocaine 2 % per lamb of 5 kg BW) should not be exceeded. Concurrently, a NSAID (off label use) and Tetanus-serum should be administered systemically. Immunization against GnRH represents an animal-friendly and economically feasible alternative to rubber ring castration. With two immunizations at an interval of 3 - 4 weeks testicular development can be inhibited for at least 3 months and the onset of puberty clearly delayed. However, a specific vaccine for use in ruminants is currently registered neither in Switzerland nor in Europe.

Le présent travail donne un aperçu des méthodes praticables pour l'anesthésie et la castration ainsi que des recommandations pour une réalisation de cette intervention dans le respect du bien-être animal dans les conditions suisses. Les veaux devraient être castrés dans les 14 premiers jours de vie au moyen d'un élastique posé au plus tôt 10 minutes après la réalisation de l'anesthésie locale avec de la lidocaïne. Il convient d'administrer simultanément un AINS (kétoprofène, 3 mg/kg PC) en i/v lente ainsi qu'un sérum antitétanique (reconversion). Dans la mesure du possible, il convient d'administrer oralement du kétoprofène (4.5 mg/kg PC) par voie orale pendant les 3 à 5 jours suivants. Le scrotum desséché y compris l'élastique doit être supprimé sans anesthésie au moyen d'un couteau propre ou d'un scalpel stérile 10 jours après la pose de l'élastique. Les agneaux doivent être castrés dans leurs 14 premiers jours de vie, comme les veaux avec un élastique posé au minimum 10 minutes après la réalisation d'une anesthésie à la lidocaïne. On prendra garde à ne pas dépasser la dose maximale de 4 mg/kg de lidocaïne (ce qui représente 1 ml de lidocaïne 2 % pour un agneau de 5 kg). Simultanément à l'anesthésie, on appliquera un AINS (reconversion) et un sérum antitétanique. La vaccination anti-GnRH représente une alternative pratique et économique ménageant les animaux pour la castration des veaux et des agneaux mâles. Une double vaccination à 3 à 4 semaines d'intervalle permet de bloquer le développement testiculaire pendant au moins 3 mois et de retarder ainsi la maturité sexuelle. Toutefois il n'existe actuellement pas en Suisse ni en Europe de vaccin spécifique enregistré pour l'application chez les ruminants.

A brief summary of European legislation regarding animal welfare.

An overview of the current European legislation concerning animal welfare is given. The legal requirements concern the housing and care of production animals (poultry, calves and swine), the transport of animals and the killing of animals (not only in slaughterhouses, but also in case of contagious animal disease outbreaks). General information concerning the principles and contents of European pieces of legislation as well as detailed information concerning requirements for individual animal species is given. Furthermore, other elements concerning animal welfare such as castration of piglets, ritual slaughter and animals used for experimental purposes are also reviewed. Finally, some recent initiatives in the field of animal welfare are mentioned and useful links are provided for finding the various legislative acts and additional supportive information.

Evaluation of carbon dioxide anaesthesia for the castration of male suckling piglets by stress hormone concentrations, behaviour and clinical factors.

The objective of this study was to examine the effect of an anaesthesia using 70% carbon dioxide and 30% oxygen on endocrine stress reaction, behaviour and clinical parameters of male suckling piglets during castration. One hundred and seventy one male piglets, three to five days of age, were allocated to two experiments. They were assigned either to the procedures control handling, control castration, handling under anaesthesia or castration under anaesthesia in each experiment. In Experiment 1, adrenaline and noradrenaline plasma concentrations were measured in blood samples taken before (-15 min) and after (immediately, 2 min) handling/castration. In Experiment 2, behavioural observations and clinical parameters such as heart and respiratory rate, oxygen saturation, reflexes and recovery time were assessed at several sampling times. Measurement of adrenaline and noradrenaline concentrations revealed an increase in all groups after handling/castration (p < 0.0167), but higher concentrations were seen in the anaesthetized groups (25 to 93 times) than in control groups (two to four times). The excessive endocrine reaction suggests that carbon dioxide inhalation causes a more stressful situation in piglets compared to castration without anaesthesia. Behavioural abnormalities, significant decreases in the heart rate, the respiratory rate and the oxygen saturation (p < or = 0.001) including a cardiac arrhythmia (extrasystoles) underline the impression that CO2 inhalation anaesthesia negatively affects animal welfare. Based on the results of this study, this anaesthetic method is unsuitable to reduce stress induced by castration. Further research on alternatives is necessary to ensure the well-being of the piglets during castration.

[Stage-specific treatment for testicular germ cell tumours]. / Stadienspezifische Therapie testikulärer Keimzelltumoren.

Testicular germ cell tumours (GCT) represent the most common solid neoplasm of young men aged 20-40 years with an increasing incidence in Western countries during the last 50 years. It is mandatory for all physicians involved in the primary care of testis cancer patients to adhere to the guidelines of stage-specific treatment in order not to impair the high cure rate of about 90% and to prevent long-term toxicities due to inadequate therapy.Risk-adapted therapeutic options in stage I seminoma include active surveillance, retroperitoneal radiation therapy (RT) with 20 Gy or carboplatinum monotherapy depending on the presence of the risk factors tumour size > 4 cm and rete testis invasion. Retroperitoneal RT represents the standard therapeutic approach in stage IIA seminoma, whereas RT and PEB chemotherapy are alternative treatment options in stage IIB tumours. Primary chemotherapy with 3-4 cycles PEB according to the IGCCCG criteria is the treatment of choice in metastatic seminomas >/= stage IIC. In clinical stage I NSGCT active surveillance is the treatment of choice in low-risk patients, and primary chemotherapy with 1-2 cycles PEB is the preferred treatment for high-risk patients.Treatment of metastatic GCT is performed with 3-4 cycles PEB chemotherapy and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in cases of residual disease according to the IGCCCG risk classification. PC-RPLND is best performed in experienced centres due to the complex nature of surgery and the necessity for adjunctive surgery in 25% of the patients. PC-RPLND, primary treatment of patients with intermediate and poor prognosis and salvage therapy should be performed in tertiary referral centres only.

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis.

OBJECTIVE: To report the presence of microscopic neoplasms of the testis in men with anti-Ma2-associated encephalitis (Ma2-encephalitis) and to discuss the clinical implications. METHODS: Orchiectomy specimens were examined using immunohistochemistry with Ma2 and Oct4 antibodies. RESULTS: Among 25 patients with Ma2-encephalitis younger than 50 years, 19 had germ-cell tumors, and 6 had no evidence of cancer. These 6 patients underwent orchiectomy because they fulfilled five criteria: 1) demonstration of anti-Ma2 antibodies in association with MRI or clinical features compatible with Ma2-encephalitis, 2) life-threatening or progressive neurologic deficits, 3) age < 50 years, 4) absence of other tumors, and 5) new testicular enlargement or risk factors for germ-cell tumors, mainly cryptorchidism or ultrasound evidence of testicular microcalcifications. All orchiectomy specimens showed intratubular-germ cell neoplasms unclassified type (IGCNU) and other abnormalities including microcalcifications, atrophy, fibrosis, inflammatory infiltrates, or hypospermatogenesis. Ma2 was expressed by neoplastic cells in three of three patients examined. Even though most patients had severe neurologic deficits at the time of orchiectomy (median progression of symptoms, 10 months), 4 had partial improvement and prolonged stabilization (8 to 84 months, median 22.5 months) and two did not improve after the procedure. CONCLUSIONS: In young men with Ma2-encephalitis, 1) the disorder should be attributed to a germ-cell neoplasm of the testis unless another Ma2-expressing tumor is found, 2) negative tumor markers, ultrasound, body CT, or PET do not exclude an intratubular germ-cell neoplasm of the testis, and 3) if no tumor is found, the presence of the five indicated criteria should prompt consideration of orchiectomy.

Surveyed attitudes, perceptions and practices in Norway regarding the use of local anaesthesia in piglet castration.

The last two years piglet castration in Norway has been performed by veterinarians and with the use of anaesthesia. In order to evaluate this new policy, veterinarians and pig producers were asked to fill out a questionnaire regarding their experiences with the new castration practices. The answers showed that the piglets were most often castrated using a combination of subcutaneous and intratesticular administration of lidocaine with adrenaline at an average age of 10 days. The effect of the anaesthesia was regarded as good by 54% of the veterinarians and 19% of the producers. Post-operative complications were rare. The overall evaluation showed that two-thirds of the veterinarians, but only one-third of the pig producers were satisfied or very satisfied with the implemented policy. However, while two-thirds of the pig producer had a negative attitude to the policy before it was implemented, only one-third were dissatisfied after two years experience.

Castration in male pigs: techniques and animal welfare issues.

Castration in male pigs is usually performed during the first weeks of life without prior anesthesia. This technique, however, is known to induce acute pain and stress and will therefore not be tolerated any longer by animal welfare organizations. Practical and animal-friendly alternatives to surgical castration are the production of entire male pigs, semen sexing or immunological castration. Fattening boars has the benefits of better feed efficiency, higher lean meat yield and increased animal welfare due to no pain and stress of castration. The most important disadvantage in raising entire male pigs is the incidence of boar taint ranging between 10 and 75%. To identify tainted carcasses an accurate and rapid on-line method for detection of odorous compounds is absolutely necessary. Sperm sexing through flow cytometry is the only commercially available method at the moment but speed of separation is too low for practical application. Active immunization of boars against gonadotropin-releasing-hormone (GnRH) at the end of the fattening period results in a significant reduction of testicular weight and androstenone production while the benefits of daily growth gain, meat quality as well as welfare remain the same as in entire males. In the present review more detailed information is given about the various techniques, especially the practical application of immunocastration on a large scale base.

[Delegation of castration of calves and lambs to the livestock owner: internet survey of members of the Swiss Association for Ruminant Medicine]. / Delegation der Kastration von Kälbern und Lämmern an die Tierhalter: Internetumfrage bei den Mitgliedern der Schweizerischen Vereinigung für Wiederkäuermedizin.

According to the Swiss Federal law on animal protection and welfare, painful manipulations in animals have to be performed by a veterinarian under local or general anaesthesia, except for some specifically listed surgical interventions (article 65 of the by-law on animal protection). On September 1, 2001, castration of calves and lambs has been deleted from this list of exceptions. Since then, several pressure groups have requested these interventions to be delegated to the producers for economical reasons. The current article describes the results of a web-based survey on this subject, conducted among the members of the Swiss Association of ruminant practitioners (SARP). Two separate questionnaires--one focused on calves and one on lambs--were made available to the members of the SARP for a duration of 3 months as pdf-files on the homepage of the SARP (www.svwasmr.ch). On December 31, 2002, the deadline for submission of the completed questionnaires, the membership of the SARP was constituted of 360 practicing veterinarians. The response rate was 25%. Close to a hundred percents of the responding veterinarians expressed the expectation that the SARP publish guidelines on the castration of calves and lambs. An overwhelming majority refused the delegation of castrations to the producers, and further stated that they were not ready to accept any responsibility for interventions performed by the producers. However, a third of the responding veterinarians judged the expected workload for the castration of lambs to presumably exceed their current capacity. It is concluded from the results of this survey that the board of the SARP should urgently elaborate, discuss, and propose novel and innovative concepts to solve the issue of castration of calves and lambs.

Surgical castration and the effect on aggression in rock hyrax (Procavia capensis).

Lincoln Park Zoo acquired five intact, male rock hyraxes (Procavia capensis) from three separate institutions to exhibit as a group. The animals were of varying ages at the time of acquisition. During quarantine, all five were surgically castrated via a midline laparotomy technique in an attempt to reduce expected aggression within the group. Recommendations for successful castration, based on these five procedures, include performing the procedure on sexually immature hyraxes or sexually inactive adults, the use of a second surgeon during the procedure, and the use of stainless steel surgical clips for ligation of vessels and spermatic cord. Although combinations of the castrated animals coexisted for longer periods than those documented for other nonrelated male groups, aggression was significant and resulted in the death of one individual. Ultimately, all animals were housed individually.

Testicular implants and patient satisfaction: a questionnaire-based study of men after orchidectomy for testicular cancer.

OBJECTIVES: To assess the satisfaction of men with their testicular implants after undergoing orchidectomy for testicular cancer, and to determine their reasons for accepting or declining a prosthesis. PATIENTS AND METHODS: In all, 424 men who had undergone radical orchidectomy and were part of the testicular cancer follow-up programme were sent an anonymous questionnaire comprising 10 questions covering two main areas. First, the reasons for accepting or declining an implant and second (if they received an implant) their satisfaction with the size, position, feel, shape and overall comfort; 234 men (55%) responded. RESULTS: About a third (71 men) accepted an implant, a third declined and a third were not offered the choice. Of the men who replied 91% felt that it was extremely important to be offered an implant at the time of surgery. Of the 71 who received an implant, 19 (27%) were dissatisfied and felt that they had an average or poor cosmetic result. The reasons for this dissatisfaction are presented and discussed. CONCLUSIONS: All men undergoing orchidectomy should be offered a testicular implant, irrespective of age. Sample implants in all sizes should be available in the outpatient department. This will give men realistic expectations and allow them to choose a suitable size of implant. The dimensions of the available implants should be improved to create a more elliptical prosthesis, to avoid dissatisfaction with the shape. Adequate fixation to the base of the scrotum is important to avoid the 'high riding' implant.

Commentary on maximal androgen blockade in prostate cancer: a theory to put into practice?

The population at risk of prostate cancer is on the increase, and so is public awareness of this disease. There has been an unresolved controversy surrounding the benefits of maximal androgen blockade (MAB) as a valid approach to treatment of non-curative prostate cancer since it was first proposed in 1945. How are we to interpret the data on MAB in order to give each patient the best advice on treatment? Studies of MAB using medical castration (luteinizing hormone-releasing hormone [LHRH] analogue plus antiandrogen) vs. LHRH analogues alone are inconclusive when viewed collectively, although the largest showed objective benefits for MAB. The remaining studies have insufficient power to show the expected effect size. Studies of MAB using surgical castration plus antiandrogen vs. surgical castration alone also gave inconsistent results, although a meta-analysis is in favor of MAB on objective criteria of response. Among trials of MAB using an LHRH analogue vs. surgical castration alone, one is positive and the remaining two are neutral for MAB. No study shows MAB to be worse than either medical or surgical castration alone. An overall meta-analysis shows a trend for benefit with MAB but is not statistically significant. The existing data have strongly suggested that there may be a particular benefit for certain subgroups of patients (including those with minimal disease) but numbers studied have been too small to allow valid conclusions. The INT 0105 trial in progress may permit firmer conclusions to be drawn on this and other questions. In the meantime one of the drawbacks to current MAB regimens is the exchange of modest clinical advantages for the side effects of nilutamide and flutamide. Given that the disease is noncurative, improved quality of life is the main goal of therapy, and excellent tolerability of treatment is fundamental to this. In a comparative trial, bicalutamide (Casodex) was more effective than flutamide (each in combination with an LHRH analogue) in terms of time to treatment failure and produced a significantly lower incidence of diarrhoea. In conclusion, the evidence supports early use of adequate hormonal treatment, and this should mean either medical or surgical castration, ideally augmented by an antiandrogen. Tolerability of the antiandrogen is a key consideration in gaining an improvement in quality of life with MAB.

["Surveillance" of non-seminomatous testicular tumors. A prospective study of 100 patients in the first stage of illness]. / La "surveillance" des tumeurs non-séminomateuses du testicule. A propos d'une étude prospective de cent malades au premier stade de la maladie.

In a prospective study, 100 patients with clinical stage I nonseminomatous testicular tumours were investigated by a surveillance policy, which consisted of regular follow-up after orchiectomy alone until disease progression was confirmed. Follow-up revealed that 65 of the 100 patients were free of disease at 25 to 90 months after orchiectomy. Disease progression was detected in 35 patients at 3 to 27 months following orchiectomy. Patients with progression were treated by PVB chemotherapy. Patients with non-seminomatous testicular tumours in clinical stage I represent a group which is not homogeneous and can therefore not be treated by means of a single modality. It is necessary to individually define optimal treatment based on prognostic factors. The surveillance policy is available in patients without risk factors and regular follow-up is mandatory. Multidisciplinary collaboration and cooperation with patients are essential.