Unilateral Lichtenstein tension-free mesh hernia repair and testicular perfusion: a prospective control study.

PURPOSE: Compare testicular perfusion between the herniated and the healthy side pre- and post-surgery. MATERIALS AND METHODS: Our study was done on patients with unilateral inguinal hernia. A Doppler ultrasound study was performed in the healthy and herniated side before surgery and 3 months after it. RESULTS: 31 patients were included, 74.2% on the right and 25.8% on the left side. When comparing the pre-surgical values of testicular resistance index from the healthy side with those on the herniated side, there was a significant difference at the spermatic cord levels (0.73 ± 0.11 and 0.81 ± 0.13, p = 0.018) and the extra-testicular level (0.66 ± 0.92 and 0.74 ± 0.10, p = 0.032), but a significant difference was not present at the intra-testicular level (0.62 ± 0.07 and 0.65 ± 0.08). Three months after the surgery, there were no statistically significant differences at any of the levels studied. CONCLUSION: There are no intra-testicular perfusion differences caused by the presence of hernia, nor during post-surgery.

Twisting of the spermatic cord: ischemia and reperfusion, toxicogenetic evaluation, and the effects of phosphatidylcholine in pre-clinical trials.

Phosphatidylcholine is the main phospholipid present in cell membranes and in lipoproteins, and can interfere with various biological processes. This lipid also has antioxidant activity, and protects against damage caused by free radicals under conditions of ischemia/reperfusion. Therefore, the present study was designed to evaluate toxicogenetic damage caused by twisting of the spermatic cord in ischemia/reperfusion, and whether phosphatidylcholine plays a role in conditions of ischemia/reperfusion in preclinical trials. The results indicate that spermatic cord torsion does not cause genotoxic damage or mutagenesis. A dose of 300 mg/kg of phosphatidylcholine is toxic and is thus not recommended. However, a dose of 150 mg/kg does not promote toxicogenetic damage, and though it does not statistically prevent tissue damage occurring from lack of oxygenation and nutrition of testicular cells, it has a tendency to reduce this damage. Therefore, this research suggests that further studies should be conducted to clarify this tendency and to provide a better explanation of the possible therapeutic effects of phosphatidylcholine in cytoprotection of germ cells affected by ischemia/reperfusion.

[Amyand's hernia and complicated appendicitis; case presentation and surgical treatment choice]. / Hernia de Amyand y apendicitis complicada; presentación de un caso y elección de tratamiento quirúrgico.

BACKGROUND: A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08-0.13%. CLINICAL CASE: Male of 43 years old, began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. DISCUSSION: Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. CONCLUSION: An extremely rare condition is presented, with a surgical choice that led to a favourable outcome.

Aspectos morfológicos dos componentes do funículo espermático do javali(sus scrofa) / Morphological aspects of the spermatic cord of wild boar ( sus scrofa)

Introdução - O estudo dos aspectos morfológicos dos funículos espermáticos do javali (Sus scrofa), adultos, busca subsídios necessários para o melhor conhecimento do aparelho reprodutor. Métodos - Para a descrição histológica utilizou-se seis pares de funículos espermáticos, corados com hematoxilina-eosina, tricômico de Masson, reticulina de Gordon, Verhoeff e Picrosirius, e um par para o estudo do arranjo vascular com a injeção de acetato de vinil. Resultados e Conclusões- Os componentes envolvidos pela túnica vaginal, sob esta, observamos tecido conjuntivo frouxo e adiposo. Artéria testicular apresenta-se sinuosa, lúmen amplo, túnica interna, média e externa, a qual é contínua ao tecido intervascular e adventícia das veias, há fibras elásticas interligando segmentos arteriais, função relacionada ao retorno venoso. As veias testiculares constituem o plexo pampiniforme, lumens irregulares, desprovidas de válvulas.(au)

Assessment of efficacy of bothropic antivenom therapy on microcirculatory effects induced by Bothrops jararaca snake venom.

Intravenous administration of antibothropic antivenom (BAv) neutralises the systemic effects, but does not efficiently reverse the local symptoms elicited by the Bothrops jararaca venom (BjV). The mechanisms involved in this poor protection have not been clarified. In this work, intravital microscopy studies were carried out to determine the efficacy of different schedules of BAv treatment on local effects evoked by topical application of BjV in the microcirculatory network of the internal spermatic fascia of Wistar rats. Results demonstrated that BAv administration 15 min before, simultaneously with, or 15 min after BjV application did not totally reverse the local symptoms, represented by disturbances of coagulation, development of haemorrhage lesions, vascular permeability increase and increment on leukocyte-endothelium interactions. This lack of effectiveness neither reflects an inadequate amount of specific antibodies in the antivenom against toxins responsible for local effects nor an insufficient dose of circulating BAv during the assays. Administration of fluorescein isothiocyanate (FITC) labelled-BAv showed the dynamics of distribution of the antivenom in the microcirculatory network. Images obtained from prior and simultaneously treated animals showed that the antivenom remains at luminal side of vessels before venom application, and the latency time to antivenom leakage is coincidental to that for local effects evoked by the venom. In addition, images from posterior treatment demonstrated that the intense alterations in the microcirculatory network impair antivenom distribution at the site of injection. Together, our data show that the lack of effectiveness of antivenom therapy is due to impaired and delayed venom and antivenom interaction at the site of injury.

[The pampiniform plexus in the chronic phase of human Chagas disease: histologic assessment]. / O plexo pampiniforme na fase crônica da doença de Chagas humana: avaliação histológica.

The occurrence of Trypanosoma cruzi intracellular clusters and phlebitis was searched for on pampiniform plexus vein walls of chronic chagasic patients. For this purpose, 23 pairs of spermatic cords, epididymides and testes (17 from chagasic patients and 6 from non-chagasic controls) were obtained, at autopsy. Trypanosoma cruzi was investigated by immuno-histochemistry on slides obtained from several sections of the gonads and vessels of each case. Only discrete and focal undetermined chronic phlebitis was observed, with no parasites, in 5 chagasics (bilateral in 3) and 2 controls (chi 2: p < 0.10), and discrete mononuclear interstitial infiltration in the funiculi of 13 chagasics and 5 controls (chi 2: p < 0.75). In conclusion, on the contrary to that published regarding the supra-renal central veins, it seems that the hormonal environment provided by testosterone does not favor the infection of the gonadal vessel wall.

Characterization of local tissue damage evoked by Bothrops jararaca venom in the rat connective tissue microcirculation: an intravital microscopic study.

The aim of this study was to investigate the dynamic of the effects after topical application of Bothrops jararaca venom (BjV) on the microcirculation of the internal spermatic fascia of Wistar rats. The administration of 1 microg of BjV induced marked disturbances in capillaries and postcapillary venules, characterized by vasodilatation, fibrin clot formation, hemorrhagic lesions and alterations in the leukocyte-endothelial interactions. The installation and development of these effects occurred simultaneously. The application of higher dose of venom (10 microg) induced more intense effects, observed by the time-course of the beginning, evolution and intensity of the effects. The time-course of events suggests that an interaction of different effects occurs during the development of local symptoms following the exposure of tissues to BjV.

Differential effects of superior and inferior spermatic nerves on testosterone secretion and spermatic blood flow in cats.

It has been postulated that testosterone secretion is partially regulated by signals from the spermatic nerves. To further examine this hypothesis in vivo, the superior (SSN) or the inferior (ISN) spermatic nerves were stimulated electrically (varying intensity, 25 Hz, 0.2 msec, 10 min) in anesthetized cats, determining the testosterone concentration and the blood flow in the spermatic vein. In some additional experiments arterial blood was sampled, and norepinephrine (NE) output was calculated. Stimulation of the SSN (25-35 V) increased the testosterone concentration in spermatic vein blood (P < 0.01 compared with prestimulation levels). The response varied among animals, reaching a 50-100% increase in some animals, whereas in others it ranged from almost undetectable to more than 10 ng/100 g x min. Under the same experimental conditions, the NE output increased from 135.4 +/- 99 to 1614.2 +/- 347 pg/ml (P < 0.01), and spermatic blood flow decreased from 24.1 +/- 1.42 to 20.2 +/- 1.65 ml/min x 100 g (P < 0.05) during nerve stimulation. By contrast, stimulation of the ISN (25-35 V) modified neither the testosterone concentration, the NE output, nor the blood flow in the spermatic vein. High intensity stimulation (36-70 V) of each spermatic nerve evoked different vascular and hormonal effects. SSN activation induced a marked decrease in spermatic blood flow during stimulation and an increase in the testosterone response, whereas ISN activation resulted only in an enhanced spermatic blood flow. Our results suggest that testosterone secretion, although mainly dependent on gonadotropin secretion, could be further regulated by neural inputs from the SSN acting directly or alternatively through changes in blood flow. It would appear that the SSN mainly supplies the vasoconstrictor fibers to the testis, whereas the ISN provides vasodilator fibers.

Condideraçöes sobre a disposiçäo dos vasos sangüíneos no funículo espermático e no testículo do cäo (Canis familiaris, L) / On the arterial and venous patterns in the spermatic cord and testis of the dog (Canis familiaris, L)

Neste trabalho säo descritas observaçöes anatômicas macroscópicas e mesoscópicas sobre o suprimento arterial e a drenagem venosa testiculares no cäo. As disposiçöes dos vasos arteriais e venosos em nível da cápsula testicular e na intimidade do cordäo espermático säo comparadas com descriçöes preexistentes

Morphology, distribution and types of valves in the adult male's testicular veins.

Morphologically, the pampiniform plexuses investigated had, in their majority, no vascular spiraling on the left side, the same occurring on the right side; however, as for the total number of valves, except for those of the pampiniform plexuses, the left side was found contain a greater number of valves. As regards valve types, there is a predominance of double semilunar one on both sides rather than single semilunar valves.

Contribuiçäo ao estudo do funículo espermático em eqüinos sem raça definida (Equus caballus, L.) / Contribution to the study of the spermatic cord in crossbred horses

Utilizando 35 pares de funículos espermáticos de eqüinos sem raça definida, estudaram-se os aspectos histológicos dos envoltórios funiculares, dos vasos arteriais e venosos e dos tecidos intervasculares, assim como o seu arranjo vascular e o comprimento do segmento da artéria testicular nele contido

Blood supply to the testis of a Brazilian marsupial (Didelphis azarae) and its abdominotesticular temperature gradient.

The testicular arteries of Didelphis azarae originate from the abdominal aorta either independently from each other or by way of a common trunk. Accessory testicular arteries may be found. At the spermatic cord they form a rete mirabile having 26.8 +/- 5.0 and 29.3 +/- 4.9 slender branches on the right and left sides, respectively. The arterial branches are intermingled with veins of similar caliber and number. Near the testis the branches of the rete reunite in a single vessel which then penetrates the parenchyma of the testis. Inside the testis the artery divides usually into two main branches that course toward the caudal pole. The rectal, scrotal and testicular temperatures were 32, 28.5 and 30.4 degrees C, respectively, appearing than an abdominotesticular gradient temperature exists in this animal. Whether this mechanism is thermoregulatory for the normal spermatogenesis cannot be inferred from the present work.