Monorchidism or unilateral anorchidism.

Unilateral anorchidism, or monorchidism, refers to the absence of one testis. It is defined as the unilateral or bilateral partial or complete absence of testicular tissue, with or without rudimentary epididymal and spermatic cord remnants, in the presence of internal Wolffian duct development and normal external genitalia. In the case of monorchidism with derivatives of the Wolffian duct an ipsilateral testis must be present at least up to the 16th week of gestation to induce the formation of an epididymal structure. Few studies have been devoted to the etiology of monorchidism or to management of the contralateral solitary testis. With the aid of a personal series of 36 cases and a review of the literature the etiopathology of monorchidism is discussed; the long-term fate of the contralateral testis is considered, and an answer to the question of whether protection of the solitary contralateral testis by orchidopexy is really indicated, as stated by most authors, is offered. Ischemia due to intrauterine torsion is thought to be the cause of monorchidism; it is thus a syndrome of testicular regression. The histopathological findings are characteristic, if not specific, for atrophy secondary to ischemia. Vas deferens, epididymis, calcification or hemosiderin pigmentation is noted in almost 90% of cases. In the absence of these remnants, clinical and surgical findings and the presence of a richly vascular stroma support the diagnosis. According to the author's experience, exploration and fixation of the contralateral testis is neither necessary nor desirable.

Microsurgical reconstruction of pancreatic ducts in dogs.

The incidence of traumatic injuries of the pancreas has increased in patients sustaining abdominal trauma. The purpose of this study was to perfect the microsurgical technique of anastomosis of pancreatic ducts in dogs as a contribution to conservative treatment of the injured pancreas with salvage of the spleen to avoid sepsis after splenectomy. Eighteen mongrel dogs weighing an average 20 kg were used. The anastomoses were performed with an operating microscope with monofilament nylon 10-0 (Ethilon) and polyglactin 910 (Vicryl) 10-0 (0.2 m) swaged to a BV-6 taper-point needle. Retrograde pancreatography was performed before and after operation. Serum amylase determinations were made. Histologic and scanning electron microscopic examinations of the anastomoses were performed at different intervals after operation. Primary healing occurred in all cases. Reepithelialization of the suture line was completed between the twenty-eighth and forty-second postoperative days. Patency of the pancreatic ducts was revealed by pancreatography 4 months after surgery. In conclusion microsurgery offers an interesting perspective to reconstructive pancreatic surgery.

Microsurgical extramucous ureteroureterostomy in rats.

The purpose of this study was to perfect the microsurgical technique of ureteroureterostomy in rats as a contribution to reconstructive surgery of the urinary tract in congenital malformations in newborns and infants. Microsurgical ureteroureterostomy was performed in 100 rats with Nylon and Vicryl 10-0 and 11-0 swaged on a BV-6 and BV-8 needle. Postoperative investigation of renal function and permeability of the anastomoses was realized by macroscopic examination and by IM urography. The healing of the anastomoses was studied at different intervals after operation by histologic and scanning electron microscopic evaluation. Results include 1) per primam healing without stenosis in 98% of the cases; 2) urine proof anastomosis achieved to avoid scarification; 3) extramucous sutures preferable to prevent leakage and also crystallization that rapidly occurs in the rat and 4) tubing or nephrostomy is unnecessary.

Microsurgical reconstruction of the biliary duct: experimental study in rats and dogs.

Surgery of the biliary ducts remains a problem in traumatologic and iatrogenic injuries as well as in liver transplantation. The purpose of this study was to perfect microsurgical technique of anastomosis of the common bile duct and to study the healing and tissue reaction at the anastomotic site. The healing of microsurgical closure of longitudinal choledochotomies was studied as well. Light microscopic and scanning electron microscopic examination were performed at different intervals after operation. The permeability of the anastomosis was studied by transduodenal retrograde choledochography. Reepithelialization was obtained in 2 weeks. Microsurgery offers an interesting perspective to reconstructive biliary and transplantation surgery.

An unusual hamartomatous malformation of the rectosigmoid presenting as an irreducible rectal prolapse and necessitating rectosigmoid resection in a 14-week-old infant.

A 14-week-old female infant presented with an irreducible rectal prolapse and a large polypoid tumor at the tip of the prolapsed mucosa. The tumor and prolapsed rectum were resected. Four weeks after the operation, profuse rectal bleeding occurred and a second similar tumor was diagnosed by endoscopy in the sigmoid colon. Laparotomy, rectosigmoid resection, and endorectal pull-through were performed. At operation, the serosal surface showed ragged polypoid lesions and an abnormal angiomatous vascularization. The postoperative course was uneventful. The histology suggested a congenital mucosal malformation. This pathology is unique in our experience and we have been unable to find anything resembling it in the literature. At age two years a Sertoli cell tumor developed in the girl with pubertas precox and a recurrent colonic polyp of the Peutz-Jeghers type.

Massive thymic hyperplasia in infants.

Report of a case of massive thymic hyperplasia in a 7-month-old female infant causing a respiratory distress syndrome by displacement and compression of the bronchopulmonary system. Steroid therapy and ventilation were ineffective. Thymectomy had to be performed because of severe respiratory distress. In a review of the literature we did not find any report on a similar case.