Long-term effects of orchiopexy and orchiectomy on the testes of rats with testicular torsion.

INTRODUCTION: Ischemia/reperfusion injury occurs after testicular torsion, levels of free oxygen radicals and inflammatory cytokines are increased in both the torsional and contralateral testis, leading to testicular injury. OBJECTIVE: The present study investigated whether orchiopexy or orchiectomy after testicular torsion was superior in terms of fertility potential in the long term. STUDY DESIGN: Following 720°, 4 h left testicular torsion, orchiectomy or orchiopexy was performed on 84 rats, which were then sacrificed and evaluated for testicular function at day 1, at 3 months and 6 months (n = 14 per group). An additional 14 rats were in the control group. RESULTS: Follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were significantly lower in the orchiopexy group than the orchiectomy and control groups after 3 months. However, there were no significant differences in hormone parameters among the three groups after 6 months. The hormone levels, Johnsen score, seminiferous tubule diameter, and inducible nitric oxide synthase (iNOS) expression at 3 and 6 months were not significantly different between the orchiectomy group and controls. Histopathological analyses at 3 and 6 months indicated significant decreases in Johnsen score and seminiferous tubule diameter in the ipsilateral testis in the orchiopexy group. At 3 months, the level of iNOS expression in the contralateral testis was significantly lower in the orchiopexy group than in other groups. At 6 months, however, it was not significantly different between the orchiopexy and control groups. There were no significant differences in iNOS expression at 3 or 6 months in the orchiectomy group compared to controls. DISCUSSION: The ipsilateral testis in the orchiopexy group began to atrophy at 3 months, and the degree of atrophy became more evident at 6 months. The level of iNOS expression was low in the bilateral testis at 3 months in the orchiopexy group, and sperm in the contralateral testis were not yet functionally healthy. The level of iNOS expression in the ipsilateral testis decreased further at 6 months in the orchiopexy group, while that in the contralateral testis returned to the normal level. CONCLUSION: Testicular functions were restored faster after orchiectomy compared to orchiopexy following testicular torsion. However, follow-up of the rats for 6 months demonstrated that orchiopexy or orchiectomy procedures conducted on the testicular torsion had no effect on future fertility potential after 4 h of torsion.

Solitary Bone Cyst Like Areas in Myositis Ossificans: A Breast Mass in a Child.

BACKGROUND: Myositis ossificans is an extraosseous, benign tumor-like condition characterized by prominent heterotopic ossification. Cystic degeneration in myositis ossificans is an uncommon entity. Case report: A 13-year-old girl presented with a large and painful breast lump. Physical examination revealed a mobile, hard mass, clinically resembling a fibroadenoma. The mass was excised and diagnosed as myositis ossificans with central bone cyst like changes. Conclusion: Our case represents the first myositis ossificans case with central bone cyst like changes in a child.

Congenital distal esophageal obstruction caused by intraluminal mucosal web.

Here, we report a case with intraluminal membrane (web) located in the lower esophagus causing complete obstruction. Esophagogram revealed complete obstruction near the esophagogastric junction. Surgical excision of the esophageal membrane was performed. To our knowledge, only a few cases with membranous esophageal atresia have been reported. It must be remembered in neonates who cannot tolerate feeding.

Self-inflicted urethrovesical foreign bodies in children.

We present two cases of self-inflicted urethrovesical foreign body in children. Case 1 was a 6-year-old girl admitted with a history of self-introduction of a pin. The X-ray revealed the pin as 3.5 cm in length and in the bladder. The foreign body was removed endoscopically. Case 2 was a 13-year-old boy with a self-introduced packing needle, 13 cm in length, partially in the urethra. The end and the tip of the needle passed through the urethra to the surrounding tissues. Foreign body removed via a little skin incision with endoscopic guidance. Foreign bodies are rarely found in the lower urinary tract of children. Definitive treatment is usually the endoscopic removal; however, sometimes surgical intervention may require.

Urethral polyps in children: a review of the literature and report of two cases.

A solitary polyp of the urethra is a rare benign fibroepithelial growth and has often been described in boys. Its occurrence in girls is exceptional. In the present paper, two children with solitary polyps of the urethra are presented and discussed. The first case was an 18-month-old boy with a posterior urethral polyp arising from the posterior urethra and extending to the bladder. It was excised by cystostomy because of an unsuccessful endoscopic removal attempt. The second case was a 2-year-old girl with an interlabial mass arising from the posterior wall of urethra and protruding from the external urethral meatus. It was excised transurethrally.

Plasma D-lactic acid level: a useful marker to distinguish perforated from acute simple appendicitis.

Early diagnosis of perforated appendicitis is important for reducing morbidity rates. The aim of this study was to determine the value and utility of plasma D-lactic acid levels in identifying the type of appendicitis. In this clinical study, plasma D-lactic acid levels were assessed in 44 consecutive paediatric patients (23 with acute appendicitis, 21 with perforated appendicitis) before laparotomy. D-lactic acid levels were determined by an enzymatic spectrophotometric technique using a D-lactic acid dehydrogenase kit. Patients with perforated appendicitis had higher D-lactic acid levels (3.970 +/- 0.687 mg/dL) than patients in the control group (0.478 +/- 0.149 mg/dL) and patients with acute appendicitis (1.409 +/- 0.324 mg/dL; p < 0.05). For a plasma D-lactic acid level greater than 2.5 mg/dL, the sensitivity and specificity of the D-lactic acid assay were 96% and 87%, respectively. The positive predictive value was 87%, the negative predictive value was 96%, and the diagnostic value was 91%. These results suggest that the measurement of plasma D-lactic acid levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute non-perforated appendicitis in children.

Teratoma arising from anomalous common bile ducts: a case report.

Teratoma arising from extrahepatic common ducts is very rare entity. The authors found 2 teratoma cases originating from common bile duct in the literature. As a third case, the authors report on a 4-month-old girl with benign cystic teratoma arising from distal common hepatic bile duct and with anomalous common bile ducts. Surgical management of the patient also is discussed.

Interferon-alpha reduces the development of experimental necrotizing enterocolitis.

Cytokines had important role in the pathogenesis of necrotizing enterocolitis (NEC). The aim of this study is to investigate if IFN-alpha has a prophylaxic effect on experimental NEC development in newborn rat pups. Twenty eight Wistar Albino newborn rat pups were divided into three groups. Control group rats were breast-fed, NEC group and interferon (IFN) group rat pups were hand-fed with premature newborn formula. IFN-alpha was administered subcutaneously at a dose of 50,000 IU/rat/day in IFN group. NEC was induced experimentally by cold stress twice a day in IFN and NEC groups. On the fourth day, the rats were killed, and all the intestine were removed to determine the tissue level of malonaldehyde (MDA) and histologic changes. The microscopic lesions in the NEC group rats were virtually the same as those seen in neonatal NEC, with severe separation of submucosa and/or lamina propria, loss of villi and in some cases necrosis to extention the muscularis. In contrast, in the rats treated with IFN, lesions were moderate separation of submucosa and/or lamina propria, edema in submucosal and muscular layers. Intestinal injury score and MDA levels in NEC group were significantly higher than in the IFN group (P<0.05). In conclusion it was suggested that IFN-alpha was effective in reducing the severity of NEC in rat pups.

Bardet-Biedl syndrome associated with vaginal atresia: a case report.

This is a case report of Bardet-Biedl syndrome associated with vaginal atresia diagnosed in a 15-year-old girl. She had mild mental retardation; obesity; nistagmus, retinitis pigmentosa and optic atrophy in both eyes; accessory digit on the left hand; polydactyly in lower extremities; a mobile, painful, nonfixed mass of 6 cm in diameter in the pelvic region; a palpable cystic mass in front of the rectal wall; and no vaginal opening. Secondary sex characteristics were determined. The vaginal atresia was distinguished from vaginal agenesis by the presence of proximal vagina in radiological examination.

The use of silver nitrate for chemical de-epithelialization and urothelialization of intestine in a rabbit model of augmentation cystoplasty.

Urinary tract reconstruction using bowel segments can result in complications such as electrolyte abnormalities, infections, stones and cancer. Intestinal mucosa is the primary site responsible for these complications. De-epithelialization of the mucosa and subsequent urothelialization might alleviate these problems. We recently reported our success in de-epithelialization and subsequent uroepithelialization of intestinal segments using 10 g/100 ml AgNO(3) solution in a rat model of augmentation. In this study, chemical de-epithelialization of a colonic segment was attempted using 10 g/100 ml AgNO(3) solution in a rabbit model of augmentation. Sigmoid cystoplasty was performed in 20 male New Zealand rabbits using a 6 cm patch of sigmoid colon. There were two groups, including one group of five rabbits (control, group 1) that underwent augmentation alone, while another group (15 rabbits, treatment group or group 2) was treated with 10 g/100 ml AgNO(3 )solution before augmentation. Control rabbits were killed at the week 8 of experimentation. Treatment rabbits were killed at 2-, 4-, 6- and 8-week intervals. Immediately before augmentation and at the end of the 8 week experimental period each rabbit underwent cystometry. De-epithelialization of the bowel epithelium without urothelialization was apparent in the treatment rabbits killed at 2 and 4 weeks. Histological analysis revealed almost complete urothelialization of the augmented sections treated with 10 g/100 ml AgNO(3 )solution at the end of the 6 and 8 week of experimental periods. The preoperative and postoperative bladder capacities increased substantially in all groups. There was no obvious histologic difference in the amount of collagen present in the augmented tissues in any of the experimental groups. The present study confirmed that the treatment of intestinal segments with 10 g/100 ml AgNO(3 )solution led to chemical de-epithelialization and urothelialization of the augmented segments. This procedure could, theoretically, have applications to human surgery.

Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experience in 1,554 children.

BACKGROUND/PURPOSE: Although caudal and spinal blocks are modern and safe techniques, in many centers children still are operated on under general anesthesia (GA), or the blocks are used for postoperative analgesia after GA in infraumbilical operations. The authors aimed to document the results and the complications of 1,554 regional anesthesia cases, thereby assessing their validity. METHODS: The analysis of 1,459 caudal and 95 spinal blocks cases collected until January 2001 in children from newborn to 12 years of age are documented retrospectively. The types of anesthesia analyzed in the study were caudal block (CB) only, CB plus GA, GA plus CB, GA plus spinal block, and spinal block only. RESULTS: There were 1,338 caudal and 95 spinal block cases that clinically were satisfactory. Because the duration of CB was not sufficient in 39 cases, GA was used. Failure to produce a CB occurred in 82 cases (5.57%). There were 257 of 1,338 patients operated on under GA and supported by caudal block for postoperative analgesia. CONCLUSIONS: Caudal anesthesia seems to be an inexpensive, simple, and effective technique not only as a supplement for postoperative analgesia, but also as a single method of anesthesia. and the authors recommend its use in a wider setting of clinical entities in infraumbilical surgical procedures of children.