Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion.

ABSTRACT: We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.

Testicular torsion: its effect on autoimmunisation, pituitary-testis axis and correlation with primary gonadal dysfunction in boys.

BACKGROUND: Torsion of the testis is an urgent surgical condition that endangers the viability of the gonad and the fertility of the patient. Our aim was to assess potential autoimmune processes and hormonal abnormalities in boys operated on due to that illness. METHODS: The authors evaluated the levels of antibodies against sperm and Leydig cells, concentrations of follicle-stimulating, luteinizing and anti-Müllerian hormone, testosterone, oestradiol and vascular endothelial growth factor in the serum in 28 boys operated on due to torsion of the testis. Patients' sexual maturity was assessed according the Tanner scale (group G1, G4 and G5). RESULTS: No antibodies against sperm or Leydig cells were found in the serum. Statistically significant differences in follicle-stimulating and anti-Müllerian hormone concentrations were observed in the G1, and they were higher in the study than in the control group. There were no statistically significant differences in luteinizing hormone, testosterone, oestradiol and vascular endothelial growth factor concentrations in the study group or control group. Testosterone concentration was unrelated to total testicular volume. CONCLUSIONS: Results did not confirm the autoimmune process in boys with torsion of the testis. The pituitary-testis axis seems to have sufficient compensation capabilities. However, study results suggest that primary gonadal dysfunction may predispose to torsion. IMPACT: Significant differences exist between the literature data and own results on the formation of antibodies and hormonal changes due to testicular torsion in boys. It is a novel, prospective study on antibodies against sperms and Leydig cells in the serum and on hormonal processes occurring as a result of the testicular torsion from the prenatal period to the adolescence with division into pubertal groups. The study has revealed sufficient compensation capabilities of the pituitary-testis axis and no autoimmune process in boys with torsion of the testis.

The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study.

The management of pelvic floor dysfunctions might need to be based on a comprehensive neuro-musculoskeletal therapy such as The Rolf Method of Structural Integration (SI). The aim of the study was to evaluate the pelvic floor muscle (PFM) after the tenth session of SI by using surface electromyography (sEMG). This was a randomized, interventional study. Thirty-three healthy women were randomly assigned to the experimental (SI) or control group. The outcome measures included PFM bioelectrical activity, assessed using sEMG and endovaginal probes. An intervention in the SI group included 60 min of SI once a week, and teaching on how to contract and relax PFMs; in the control group, only the teaching was carried out. In the SI group, a significant difference was found between the PFM sEMG activity during "pre-baseline rest" (p < 0.014) and that during "rest after tonic contraction" (p = 0.021) in the supine position, as were significant increases in "phasic contraction" in the standing position (p = 0.014). In the intergroup comparison, higher PFM sEMG activity after the intervention "phasic contraction" (p = 0.037) and "pre-baseline rest" (p = 0.028) was observed in the SI group. The SI intervention significantly changes some functional bioelectrical activity of PFMs, providing a basis for further research on a new approach to PFM facilitation, particularly in clinical populations.

The Rolf Method of Structural Integration on Fascial Tissue Stiffness, Elasticity, and Superficial Blood Perfusion in Healthy Individuals: The Prospective, Interventional Study.

Introduction: There are multiple theories surrounding the physiological impact of structural integration (SI) with little evidence or research corroborating any of these. The aim of the study was to assess the effectiveness of 10 sessions of SI on fascial tissue (FT) superficial blood perfusion, stiffness, and elasticity in 13 healthy women. Methods: This was a prospective, interventional study. The primary outcome measures were FTs' superficial blood perfusion, stiffness, and elasticity of bilateral selected FT points on the body. Data were collected before and after 10 sessions of SI intervention. Statistical analysis was performed using the non-parametric Wilcoxon test (intragroup comparison). Results: The superficial blood perfusion increased significantly in the most selected FT points on the body (p < 0.05). SI interventions produced significant decreases in selected points (brachioradialis, biceps brachii, and trapezius; p < 0.05) of FT stiffness and significant increases in elasticity (brachioradialis, biceps brachii, triceps surae, and trapezius; p < 0.05), especially in the FT of the right (dominant) upper limb. Conclusion: A 10-session of SI demonstrated positive effects on increasing superficial blood perfusion contributed to a decrease in FT stiffness and an increase in elasticity properties in the dominant upper limb. Data collection for this study is currently underway, and the trial is registered at ISRCTN.com with the identifier: ISRCTN46707309.

Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele.

AIM: The aim of the study was an assessment of the effects of varicocele on testis parenchyma and microcirculation with the use of the dynamic tissue perfusion measurements. METHODS: Color Doppler sonographic dynamic testis parenchyma perfusion measurements were performed with Pixel-Flux software in 30 children with left testis varicocele. The right testes without varicocele comprised the control group. RESULTS: Testicular parenchymal perfusion in testes with varicocele was reduced when compared to the control testes. The differences were found in all measured perfusion parameters. Statistical significance was found in the case of mean velocity and resistance index parameters. According to the grade of varicocele, the perfusion was the most reduced in patients with grade III of varicocele. CONCLUSION: Testicular parenchymal perfusion decreases in patients with varicocele, mostly in higher grades of varicocele. In case of validation, the method can be used in determining the damage of the testis with varicocele and the need for surgery.

Nuck Canal Hernias, Typical and Unusual Ultrasound Findings.

BACKGROUND: Inguinal hernia in girls is a very rare condition. The cause of this pathology is incomplete closure of the processus vaginalis of the peritoneum, in girls named the canal of Nuck. Failed obliteration of this canal could result in hernia or hydrocele. Also less frequent findings, such as uterus herniated to the canal, were observed. OBJECTIVE: The purpose of this study was to describe the possible findings in female inguinal hernias and its ultrasound appearance. METHODS: Thirty-five patients with surgically confirmed hernias of the canal of Nuck were identified at our institution between January 2007 and November 2015. All the patients underwent ultrasonography before surgery. RESULTS: In 14 cases, there was hydrocele of the canal of Nuck. In 9 cases, intestinal hernia was found. In 10 patients, the hernia content appeared as mass-containing cysts and was confirmed at surgery as ovary. In 1 patient, the ovary was herniated together with uterus. In 1 patient, atypical hypoechoic lesion was found, which turned out to be angiofibrolipoma. In all patients, ultrasound diagnosis was confirmed by surgery. CONCLUSIONS: Ultrasound examination performed with high-frequency transducer is an examination of choice in female patients with pathological mass in inguinal region.

The use of testicular prostheses in boys.

Lack of the testis is an important factor in psycho-sexual development of the boys, and implantation of the prosthesis plays a very essential role in the treatment of that group of patients. Currently there are no standards regarding when prosthesis should be implanted, and which access is connected with minimal rates of complications. We present our experience of primary prosthesis implantations in boys treated in our department.From 2000 to 2014, primary implantation of the testicular prosthesis was performed in 290 boys. The early and late post-operative complications and long-term therapeutic results were analyzed, considering age at the time of implantation, the time between the initial operation and implantation of the prosthesis, and the surgical approach.Best results were observed in 267 patients and bad outcome in 23 patients. Prosthesis implantation in young boys operated within the first three years of life or during the first year after primary surgery was connected with statistically fewer complications (P = .002 and P < .05, respectively). Supra-scrotal access was connected with the lowest rate of complications (P = .01).Long-term therapeutic results in boys with testicular prostheses were good in the majority of cases. Implantation of the first prosthesis should be performed early between 1 and 3 years of life in boys with lack of the testis. Implantation of a prosthesis should also be performed within 1 year after removing of testis or during orchiectomy. Supra-scrotal access should be chosen for testicular prosthesis implantation due to the best long-term results.

3D/4D contrast-enhanced urosonography (ceVUS) in children - is it superior to the 2D technique?

BACKGROUND: By now, two-dimensional contrast-enhanced voiding urosonography (ceVUS) has become a well-established method for the diagnosis and treatment monitoring of vesicoureteral reflux in children, particularly after the recent approval for this application in children in the USA and in Europe. The introduction of three-dimensional static (3D) and real-time (4D) techniques with ultrasound contrast agents opens up new diagnostic opportunities for this imaging modality. OBJECTIVE: To analyze whether 3D and 4D ceVUS is a superior technique compared to standard 2D ceVUS in diagnosing vesicoureteral reflux in children. MATERIAL AND METHODS: The study included 150 patients (mean age 3.7 years) who underwent 2D and 3D/4D ceVUS for the diagnosis and grading of vesicoureteral reflux. RESULTS: 2D ceVUS and 3D/4D ceVUS diagnosed the same number of vesicoureteral refluxes, however, there was a statistically significant difference in grading between the two methods. Performing 3D/4D ceVUS resulted in changing the initial grade compared to 2D ceVUS in 19 out of 107 refluxing units (17.76%) diagnosed. The 4D technique enabled a more conspicuous visualization of vesicoureteral reflux than the 3D technique. CONCLUSIONS: 2D ceVUS and 3D/4D ceVUS diagnosed the same number of vesicoureteral refluxes, however, there was a statistically significant difference in grading between the two methods. Thus 3D/4D ceVUS appears at least a valid, if not even a more conspicuous technique compared to 2D ceVUS.

The Comparison of the Body Composition of Children at the Early School Age from Urban and Rural Area in Southwestern Poland.

The aim of the study was to compare the segmental body composition with the use of fat-fat-free (FFF) index in children at early school age, depending on sex and place of residence, with particular emphasis on urban and rural areas. The study consisted of 329 children aged 7.78 (SD = 0.88; mean age in years). The study group was divided according to the place of residence and sex. The height and body mass, Body Mass Index (BMI), segmental body composition (Tanita BC-418MA), and FFF were calculated. A more frequent occurrence of excessive body weight was observed in children from rural areas (over 20%) compared to their peers from the urban area (10%). Statistically significant lower values of FFF index as well as in the lower limbs and torso were observed in the case of the examined children from the urban area as compared with their peers from the rural areas. The body composition of children living in metropolitan and rural areas is diverse. Lower values of FFF indexes were found in children from the city than in children living in villages. There are more children in the city with signs of being underweight and of normative body mass and paradoxically more overweight ones in the village.

Treatment of impalpable testis - one clinic's experience.

INTRODUCTION: Undescended testes are recognised in 1% to 2% of boys during the first year of life, and about 20% of them are impalpable. Ultrasonography (US) may establish the localisation of the testis but the final diagnosis is usually determined laparoscopically. AIM: To evaluate long-term results of laparoscopic treatment of boys with impalpable testes and sensitivity of preoperative ultrasound. MATERIAL AND METHODS: Between 2011 and 2015, we operated on 545 boys with undescended testes. Sixty-two of them with 65 impalpable testes were treated laparoscopically - the study group. Mean age was 3.5 years. The study group was divided into 5 groups according to type of treatment. The volume and position of the operated gonad were assessed manually and by ultrasound. RESULTS: In group 1 testicular agenesis was observed in 19 patients. In group 2 revision of the inguinal canal revealed testicular agenesis in 7 and atrophy in 4 patients. In group 3 conversion to classic orchiopexy was performed in 10 patients. In group 4 one-stage orchiopexy was performed in 9 patients on 12 testes. In group 5 a two-stage F-S procedure was performed in 13 patients. Ten testes in group 4 had a volume in the normal range (84%) and also 10 testes in group 5 (77%). CONCLUSIONS: Laparoscopy in impalpable testes is the procedure of choice and allows definitive management, even when conversion to open procedure is necessary. Sensitivity of preoperative ultrasound is generally about 60% for true intra-abdominal testes, so diagnostic laparoscopy is necessary.

Physical fitness of secondary school adolescents in relation to the body weight and the body composition: classification according to Bioelectrical Impedance Analysis. Part II.

BACKGROUND: Underweight and obesity are important factors affecting the level of physical fitness. The aim of this study was to assess physical fitness of lower secondary school adolescents in relation to BMI. METHODS: Two-hundred students, aged 14-16, were examined. Respondents were divided into 4 groups according to BMI classification. The body height and weight were determined. Physical fitness was assessed on the basis Zuchora's ISF tests. RESULTS: The body weight deficiency occurred in 3% of girls and 5% of boys, overweight was noted in 14% of both groups, and obesity in 6% and 12% accordingly. Statistically significant differences were determined in the components of physical fitness. They were noted in both genders between the group of children with standard body weight and overweight as well as obese children. Significant negative correlations were determined between and the components of physical fitness. More significant correlations giving evidence to the decrease of Zuchora's ISF score along with the increase of BMI were more significant in girls. CONCLUSIONS: Statistically significant differences between the boys and girls were determined in all five Zuchora's tests. The highest scores in physical fitness were achieved by the boys and girls with weight deficiency.

Physical fitness of secondary school adolescents in relation to the body weight and the body composition: classification according to World Health Organization. Part I.

BACKGROUND: Underweight and obesity are important factors affecting the level of physical fitness. The aim of this study was to assess physical fitness of lower secondary school adolescents in relation to BMI. METHODS: Two-hundred students, aged 14-16, were examined. Respondents were divided into 4 groups according to BMI classification. The body height and weight were determined. Physical fitness was assessed on the basis Zuchora's ISF tests. RESULTS: The body weight deficiency occurred in 3% of girls and 5% of boys, overweight was noted in 14% of both groups, and obesity in 6% and 12% accordingly. Statistically significant differences were determined in the components of physical fitness. They were noted in both genders between the group of children with standard body weight and overweight as well as obese children. Significant negative correlations were determined between and the components of physical fitness. More significant correlations giving evidence to the decrease of Zuchora's ISF score along with the increase of BMI were more significant in girls. CONCLUSIONS: Statistically significant differences between the boys and girls were determined in all five Zuchora's tests. The highest scores in physical fitness were achieved by the boys and girls with weight deficiency.

The role of ultrasound in the management of undescended testes before and after orchidopexy - an update.

The aim of this study was to evaluate the testicular volume and structure using ultrasound (US) before and up to 3 years after orchidopexy in children with different age.A total of 128 patients underwent orchidopexy for undescended testes. Afterwards, patients were invited for annual follow-up and control scrotal US. The total number of analyzed testes after orchidopexy was 184. Patients were divided according to age at the time of surgery: group I (2-4 years old), group II (5-7), and group III (8-10). In all patients, the testicular volume ratio was calculated as the operated testes volume versus the control testes mean volume.There was an increase in the median ratio in all age groups, from 0.86 to 0.95 in group I, 0.82 to 0.92 in group II and 0.78 to 0.90 in group III. In group of the patients 2 to 4 years old the growth of the ratio 3 years after surgery was statistically significant.Abnormalities in the structure of the testes, which may indicate severe damage to the testis, were seen in approximately 20% of patients on initial exams. On follow-up exams, this type of structure remained in 7% of patients. Testes with an initial ratio <0.25 and inhomogeneous structure did not show any significant growth.Scrotal US can be used for an accurate comparative assessment of the structure and growth of the testes before and after orchidopexy.Abnormalities in the structure of the testes may identify testes requiring more advanced methods of evaluation.

Ultrasound screening for neoplasms in children up to 6 years old.

The aim of the ultrasound (US) screening program was to detect neoplastic lesions in children, together with other pathologies of the developmental age in the area of the neck, abdomen, female pelvis, and scrotum in boys.US screening scans, including cervical, abdominal, pelvical, and scrotal US, were performed in the population of asymptomatic children aged from 9 months to 6 years. The children were scanned in Mobile Pediatric US Unit, consisting of 2 independent consulting rooms.The scans of 14,324 children were analyzed, 7247 boys and 7077 girls. Totally 42,538 US examinations were performed, including 14,187 cervical scans, 14,259 abdominal scans, 6942 female pelvical scans, and 7150 scrotal scans. Totally 5426 abnormalities were detected, which represent 12.7% of all examinations and 30% of patients. Three tumors were recognized, which are renal malignant tumor diagnosed as Wilms tumor, neurogenic tumor of the rib, and teratoma of the testis.US screening in pediatric population can be used to reveal lesions inaccessible to clinical examination, like tumors or other pathologies of developmental age before the onset of clinical symptoms. Due to the large number of detected abnormalities it should be recommended to the whole population of certain age.

Testicular adrenal rest tumors in boys with congenital adrenal hyperplasia: 3D US and elastography--do we get more information for diagnosis and monitoring?

BACKGROUND: Testicular adrenal rest tumors (TART) are the nodular testicular lesions deriving from the adrenal remnant tissue reported in boys and men with congenital adrenal hyperplasia. Until now, the diagnostics of TART have been based on a combination of clinical features, imaging methods (primarily two dimensional ultrasound--2D US), response of the foci to glycocorticosteroid (GCS) therapy and exclusion of the neoplastic process. Application of 2D US supplies however a limited range of information about the volume, demarcation, structure and vascularization of the lesions. OBJECTIVE: To define whether the use of 3D US, power Doppler and elastography changes the algorithm of the diagnostics and monitoring or treatment of TART. MATERIAL AND METHODS: In this study, modern ultrasound techniques such as 3D US and elastography were introduced in two boys with TART. RESULTS: The 3D power Doppler option gives the opportunity for accurate assessment of the volume of testes and adrenal tissue foci and their vascularization. Sonographic elastography allows the assessment of stiffness of adrenal tissue areas compared to normal testis parenchyma. CONCLUSION: The use of these modern techniques enables more adequate and advanced diagnostics, and more precise monitoring of the effects of treatment in patients with TART.

Multiparametric ultrasonography of the pediatric scrotum and in boys with undescended testes.

Due to its noninvasiveness and high resolving power, ultrasound examination is the examination of choice for the imaging of the structures of the pediatric scrotum. It allows to reveal changes impossible to find in the course of a clinical examination. Its significance has increased over the past few years due to the technological developments. The introduction of transducers with frequency of 10-17 MHz has improved the resolution of pediatric testes images as well as the resolution of the inguinal canals images, which has been of particular importance for the evaluation of undescended, retractile and abdominal testes. New diagnostic tools have also been introduced, such as 3D imaging or elastography, whose application has helped provide valuable additional information for the evaluation of pediatric testes, for treatment monitoring, and for post-surgical follow-up examinations. 3D imaging facilitates a more accurate evaluation of the location of an undescended testicle, testicular volume, and vascularization. Elastography may be used for the evaluation of focal lesions, post-ischemic lesions, unclear fluid spaces, undescended testes, and following orchiopexy.

Perfusion imaging of cerebral arteriovenous malformations: a study comparing quantitative continuous arterial spin labeling and dynamic contrast-enhanced magnetic resonance imaging at 3 T.

Assessment of hemodynamics in arteriovenous malformations (AVMs) is important for estimating the risk of bleeding as well as planning and monitoring therapy. In tissues with perfusion values significantly higher than cerebral cortex, continuous arterial spin labeling (CASL) permits both adequate representation and quantification of perfusion. Thirteen patients who had cerebral AVMs were examined with two magnetic resonance imaging (MRI) techniques: perfusion imaging using a CASL technique with two delay times, 800 and 1200 ms, and T(2)-weighted dynamic contrast-enhanced MRI (T(2)-DCE-MRI). The signal-to-noise ratio obtained in our study with the CASL technique at 3 T was sufficient to estimate perfusion in gray matter. Both nidal and venous perfusion turned out larger by factors of 1.71±2.01 and 2.48±1.51 in comparison to T(2)-DCE-MRI when using CASL at delay times of 800 and 1200 ms, respectively. Moreover, the venous and nidal perfusion values of the AVMs measured at T(2)-DCE-MRI did not correlate with those observed at CASL. Evaluation of average perfusion values yielded significantly different results when using a shorter versus a longer delay time. Average gray matter perfusion was 15.8% larger when measured at delay times of w=800 ms versus w=1200 ms, while nidal perfusion was 15.7% larger and venous perfusion was 34.6% larger, respectively. In conclusion, the extremely high perfusion within an AVM could be successfully quantified using CASL. A shorter postlabeling delay time of w=800 ms seems to be more appropriate than a longer time of w=1200 ms because of possible inflow of unlabeled spins at the latter.

Uterus and ovary hernia of the canal of Nuck.

Hernia of the canal of Nuck is a rare condition occurring in female infants. The canal of Nuck is a portion of the processus vaginalis of the peritoneum within the inguinal canal. The processus vaginalis is an evagination of parietal peritoneum of the embryonic lower anterior abdominal wall that passes into the inguinal canal. Normally, it loses its connection with the peritoneal cavity, but when it fails to close a hydrocele or hernia may result. We present a 2-month-old girl with a palpable movable mass in the right inguinal region. Ultrasonography revealed a hernia containing uterus and ovary. Ultrasonography is the examination of choice in female infants with a pathological mass in the groin. Its availability and accuracy facilitate diagnosis and proper surgical treatment.

Types of ethmoid sinus morphology on the basis of computed tomography examination.

The aim of the study was the application of computed tomography (CT) in the evaluation of types of ethmoid morphology. The material consisted of 197 CT examinations performed, using the Somatom AR.T (Siemens) CT scanner, in patients referred for CT for reasons other than sinus pathology. The examinations were performed in 2-mm contiguous axial scans. Ethmoid morphology was evaluated by means of classification into 3 types according to the degree of aeration and the relationship of the anterior ethmoid cells to the lacrimal sac on transversal scans. The most common was the II type (medium relationship to the lacrimal sac) found in 38.32% of the cases. Type III (large ethmoid sinus extending in front of the lacrimal sac) occurred in 32.49% of the patients, while the smallest sinus (Type I) was detected in the remaining 29.19% of the cases. In almost 1/5 of the cases asymmetry of the bilateral ethmoid anatomy was noted. It was concluded that CT examination was useful in the evaluation of ethmoid sinus morphology in respect to the lacrimal sac.

Non-tumoral non-infectious intracranial calcifications.

Intracranial calcifications are often an accidental finding on conventional radiograms or computed tomography (CT) scans. They can be physiologic or pathologic, accompanying various diseases of the central nervous system. Pathologic calcifications can be found in tumors as well as in other non-neoplastic diseases. In differential diagnosis of intracranial calcifications there should be mentioned two groups: infectious and non-infectious calcifications. In the paper there were discussed non-tumoral non-infectious intracranial calcifications. Although more sporadic than tumoral or infectious calcifications, calcified lesions in non-infectious diseases should also be taken into account in differential diagnosis of intracranial calcifications.