Abdominoscrotal hydrocele in infancy.

Abdominoscrotal hydrocele is an uncommon clinical entity. Fewer than 200 cases have been reported in the literature, only two of which described bilateral involvement. We present five cases of abdominoscrotal hydrocele occurring in infancy, three of which revealed bilateral disease. The first case represents the youngest patient ever reported with this condition and the first reported with secondary bilateral upper tract dilatation. The historical background, pathophysiology, diagnosis, and treatment are reviewed.

Multiple molecular weight forms of immunoreactive alpha-inhibin in human seminal plasma.

The purpose of these studies was to determine whether the total immunoreactive alpha-inhibin protein concentration in seminal plasma correlated with serum gonadotropin levels or semen characteristics and to identify the forms of alpha-inhibin present in seminal plasma. Thirty-eight serum samples from men being evaluated for infertility were selected for study based on their serum hormone profiles and semen parameters. Serum LH and testosterone levels were normal, but FSH levels ranged from normal to hypergonadotropic (> 20 IU/L). Most semen parameters were within normal ranges, but germ cell numbers ranged from normal to azoospermic. Thus, seminal plasma from these men provided a unique opportunity to examine the antigenic forms of alpha-inhibin in individuals in whom strong correlations between inhibin and FSH levels might be predicted because of the observed ranges of FSH levels and germ cell numbers. Seminal plasma alpha-inhibin was characterized by RIA or Western blotting, using an antiserum directed against the N-terminal of the alpha-subunit of mature [32,000 mol wt (M(r))] inhibin. The antiserum recognized the alpha-subunit of dimeric inhibin as well as free alpha-inhibin and alpha-inhibin precursor proteins. Total immunoreactive alpha-inhibin ranged from 8.21-43.99 nmol/L in seminal plasma. However, alpha-inhibin levels were not statistically correlated with serum FSH levels or any of the measured semen parameters (including germ cell number). In contrast, the immunoreactive alpha-inhibin concentration in seminal plasma was negatively correlated (P < 0.01) with the serum LH level. Western blot analyses revealed that multiple forms of immunoreactive alpha-inhibin are present in seminal plasma. The majority of immunoreactivity was associated with monomeric proteins (ranging from 58,000-95,000 M(r)) that were larger than the alpha-subunit (21,000 M(r)) predicted for mature dimeric human inhibin (32,000 M(r)). The relative amounts of individual forms of immunoreactive alpha-inhibin varied among the patients studied, but could not be correlated with other serum or seminal parameters measured. Our observations demonstrate that various monomeric alpha-inhibin proteins are present in human seminal plasma. It is unlikely that these proteins alone or combined with inhibin beta-subunit proteins have identical biological activities. Thus, until assays specific for each of the various forms of immunoreactive alpha-inhibin are developed, their role as well as that of inhibin in the endocrine or local modulation of testicular function cannot be deduced from RIA data alone.

The effect of varicocelectomy on testicular volume in 89 infertile adult males with varicoceles.

The presence of a varicocele has been associated with reduced testicular volumes both in the adult and pediatric patient populations. An increase in testicular volume after varicocelectomy, however, has been documented only in the latter group and then only in the ipsilateral testicle. We present our experience with 89 infertile male patients with varicoceles who underwent operative repair. An increase in testicular volume was observed in 72 of the 89 patients, with the right side showing a greater increase, regardless of whether bilateral or unilateral left varicoceles were present preoperatively. No greater increase in testicular volume was noted among the patients who went on to achieve a pregnancy with their spouses. In addition, the age of the patient did not influence the observed change in testicular volume. No correlation between varicocele grade and pregnancy nor between improvement in semen parameters and improvement in testicular volume could be demonstrated.

Pulmonary embolism from left subclavian vein thrombus following suprapubic prostatectomy.

Deep venous thrombosis (DVT) of the axillary and subclavian veins accounts for approximately 1-2 percent of all recorded deep venous thrombosis. Pulmonary embolism from an upper extremity DVT has been reported to vary between 2 percent and 35.7 percent. We report the occurrence of a left subclavian vein DVT with subsequent nonfatal pulmonary embolism in a sixty-two-year-old patient twenty-four hours following suprapubic prostatectomy. A review of the literature is presented, along with pathophysiology, diagnosis, and treatment.

"Urethrolithotomy": an ingenious approach of the ancients.

A major postoperative complication of the surgical removal of urethral calculi is formation of a fistula. Celsus, a Roman medical author living around the turn of the millennium, discussed a procedure for removing such stones that all but eliminated this complication. Preoperatively, the flaccid skin of the penis is pulled distally and bound in an advanced position with a ligature, as the penis itself is pushed proximally. Incisions are made ventrally into the penis and urethra. The stone can then be removed and the ligature cut, allowing the penile skin to assume its natural position. The effect of this procedure is to avoid 2 overlying incisions, greatly reducing the chance for fistula formation. Today the 2 incisions mentioned by Celsus would be closed with sutures, although in his time the wounds were left open and allowed to heal spontaneously.