Initial experience with brachytherapy treatment adjuvant to surgical resection of keloid scars in the pediatric population. / Experiencia inicial del tratamiento braquiterápico en coadyuvancia a la resección quirúrgica de cicatrices queloideas en población pediátrica.

OBJECTIVES: The treatment of keloid scars is based on multiple lines of therapy, with varying levels of efficacy(1), and there is currently no single treatment that guarantees cure and prevents recurrence. In the pediatric population, the treatments used are not standardized, and there is insufficient evidence to support efficacy and complications. The objective of this study was to analyze the patients who required brachytherapy as an adjuvant to surgical resection in recurrent keloid scars. MATERIALS AND METHODS: A retrospective analysis of patients diagnosed with keloids and undergoing adjuvant brachytherapy in our institution was carried out, while assessing efficacy and implementation in our treatment protocol for keloid scarring. RESULTS: After various therapeutic lines, 4 patients aged 9-17 years old with recurrent keloid scars around the ear and eligible for adjuvant brachytherapy - administered after surgical resection, in two sessions - were studied and followed up for up to 18-21 months. CONCLUSIONS: Despite our limited experience in the use of adjuvant brachytherapy, the results obtained to date support its efficacy, as reported in the literature. We therefore consider its inclusion in the treatment of keloid scars that have recurred after other treatments to be appropriate.

OBJETIVOS: El tratamiento de las cicatrices queloideas se basa en múltiples líneas terapéuticas, con diferentes niveles de eficacia(1), sin existir actualmente un tratamiento que garantice su curación y prevenga su recurrencia. En la población pediátrica los tratamientos empleados no están estandarizados y no hay evidencia suficiente que avale su eficacia y sus complicaciones. Este trabajo tiene como objetivo analizar los pacientes que han precisado braquiterapia coadyuvante a la resección quirúrgica en cicatrices queloideas recidivantes. MATERIAL Y METODOS: Análisis retrospectivo de los pacientes diagnosticados en nuestro centro de cicatriz queloidea, en los que se realizó braquiterapia coadyuvante, valorando su eficacia y su implementación en nuestro protocolo de tratamiento de la cicatriz queloidea. RESULTADOS: Se estudiaron 4 pacientes entre 9-17 años con cicatrices queloideas a nivel auricular, recidivantes a varias líneas terapéuticas, que fueron candidatos para el uso de braquiterapia coadyuvante, administrada posterior a la resección quirúrgica, en dos sesiones, se realizó seguimiento hasta 18-21 meses. CONCLUSIONES: A pesar de nuestra limitada experiencia en el uso de la braquiterapia coadyuvante, los resultados obtenidos hasta la fecha avalan su eficacia, de acuerdo con lo publicado en la literatura. Consideramos adecuada su inclusión en el tratamiento de cicatrices queloideas recidivantes a otros tratamientos.

A new and simple scoring system to predict overall survival after irradiation for metastatic spinal cord compression.

PURPOSE: To develop a model that predicts survival in patients irradiated for metastatic spinal cord compression (MSCC), hence assisting in the decision between a short and a long-course radiotherapy (RT) regimen. METHODS: 138 patients diagnosed with MSCC and treated with RT alone were included. Based on a multivariate analysis, a scoring system was developed. It included four prognostic variables: age, number of vertebrae, ECOG and histology. Total scores ranged between 14 and 24 points and patients were divided into two groups. RESULTS: The 6-month survival rate was 22% for patients with a score of 14-18 points; and 69% for patients with a score of 19-24 points (P < 0.001). The system exhibits a high specificity and positive predictive value and an appropriate discriminative ability. CONCLUSIONS: Patients with scores between 19 and 24 points were found to survive longer, thus a long-course RT appears to be more appropriate.

18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer. / 18F-FDG PET/TC para la estadificación y la delineación del volumen de radioterapia en el cáncer de cabeza y cuello.

PURPOSE: The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. METHODS AND MATERIALS: One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. RESULTS: 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. CONCLUSIONS: 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.

[Diagnostic value of the gonadal biopsy in the disorders of sex development]. / Valor de la biopsia gonadal en el diagnóstico de los desórdenes del desarrollo sexual.

The gonadal biopsy provides essential information for the identification, classification and early detection of neoplasias in patients with disorders of sex development. Histopathological findings in these cases must be analysed together with clinical, hormonal, genetic and molecular information before deciding a therapeutic option. Sexual differentiation is the result of multiple and complex genetic and endocrinal mechanisms; therefore, we first present the events taking place during gonadal embryonic development, focusing on the genetic mechanisms involved in sexual determination and the differentiation of the testis and the urogenital tract. In second place, we describe the different gonads in the intersexual states -in testicular regression syndrome, fibrous streak, testicular dysgenesis, streak testes, ovotestes and microscopically normal testes and ovaries-, highlighting the histological features and the differential findings that allow the pathologist to distinguish between these entities with the aid of clinical, genetic, hormonal and molecular information that are characteristic for each situation. In third place, we studied the incidence of neoplasias in gonadal dysgenesis, male pseudohermaphroditism and true hermaphroditism. Finally, we discuss the limitations of gonadal biopsy to achieve a correct diagnosis in the disorders of sex development.

Experiencia inicial del tratamiento braquiterápicoen coadyuvancia a la resección quirúrgica decicatrices queloideas en población pediátrica / Initial experience with brachytherapy treatment adjuvant to surgical resection of keloid scars in the pediatric population

Objetivos: El tratamiento de las cicatrices queloideas se basa enmúltiples líneas terapéuticas, con diferentes niveles de eficacia (1) , sinexistir actualmente un tratamiento que garantice su curación y prevengasu recurrencia. En la población pediátrica los tratamientos empleados noestán estandarizados y no hay evidencia suficiente que avale su eficaciay sus complicaciones. Este trabajo tiene como objetivo analizar lospacientes que han precisado braquiterapia coadyuvante a la resecciónquirúrgica en cicatrices queloideas recidivantes.Material y métodos: Análisis retrospectivo de los pacientesdiagnosticados en nuestro centro de cicatriz queloidea, en los quese realizó braquiterapia coadyuvante, valorando su eficacia y suimplementación en nuestro protocolo de tratamiento de la cicatrizqueloidea. Resultados: Se estudiaron 4 pacientes entre 9-17 años con cicatricesqueloideas a nivel auricular, recidivantes a varias líneas terapéuticas,que fueron candidatos para el uso de braquiterapia coadyuvante, admi-nistrada posterior a la resección quirúrgica, en dos sesiones, se realizóseguimiento hasta 18-21 meses.Conclusiones: A pesar de nuestra limitada experiencia en el usode la braquiterapia coadyuvante, los resultados obtenidos hasta la fechaavalan su eficacia, de acuerdo con lo publicado en la literatura. Conside-ramos adecuada su inclusión en el tratamiento de cicatrices queloideasrecidivantes a otros tratamientos.(AU)

Objectives: The treatment of keloid scars is based on multiple linesof therapy, with varying levels of efficacy (1) , and there is currently nosingle treatment that guarantees cure and prevents recurrence. In thepediatric population, the treatments used are not standardized, and thereis insufficient evidence to support efficacy and complications. The objective of this study was to analyze the patients who required brachytherapyas an adjuvant to surgical resection in recurrent keloid scars.Materials and methods. A retrospective analysis of patients diagnosed with keloids and undergoing adjuvant brachytherapy in ourinstitution was carried out, while assessing efficacy and implementationin our treatment protocol for keloid scarring.Results: After various therapeutic lines, 4 patients aged 9-17 yearsold with recurrent keloid scars around the ear and eligible for adjuvantbrachytherapy – administered after surgical resection, in two sessions– were studied and followed up for up to 18-21 months.Conclusions: Despite our limited experience in the use of adjuvant brachytherapy, the results obtained to date support its efficacy,as reported in the literature. We therefore consider its inclusion in thetreatment of keloid scars that have recurred after other treatments tobe appropriate.(AU)

Androgen receptor distribution in adult human testis.

The distribution of the androgen receptor (AR) in archival human testes was determined immunocytochemically using an affinity-purified peptide-specific rabbit antibody, PG21, and employing a modified biotin-streptavidin-immunoperoxidase method that incorporated a biotin amplification step. In combination with microwave epitope retrieval, the biotin amplification step increased the sensitivity of the immunostaining assay approximately 20-fold. Thus, the useful range at which PG21 rendered a robust, specific immunostaining signal without also increasing nonspecific background was extended dramatically. Broadening the useful range of the PG21 antibody made it possible to resolve the relative amounts of immunopositive AR in different cell types of the human testis. At a high PG21 concentration, for example, all AR-positive cells exhibited a robust immunostaining intensity, but it was not possible to distinguish between nuclei exhibiting either high or moderate immunostaining intensities. In contrast, as the concentration of PG21 was decreased, distinct populations of testicular cells exhibited differential AR immunostaining intensities in their nuclei. AR immunostaining of Sertoli cell nuclei was present at low PG21 concentrations at which no immunostaining of peritubular myoid cells or Leydig cells could be detected. In turn, AR immunostaining of peritubular myoid cells was detected at PG21 concentrations that did not immunostain Leydig cells. Moreover, within the seminiferous epithelium, Sertoli cell nuclear AR staining intensity was less at stages V and VI of the cycle of the seminiferous epithelium than that at stage III, and stage III staining intensity was greater than that at stages I and II. This AR immunostaining pattern in human Sertoli cell nuclei as a function of the cycle of the seminiferous epithelium is reminiscent of the pattern observed in rodent species. Finally, no AR immunostaining of germ cells was observed at any of the PG21 concentrations examined.

Androgen receptor expression in sertoli cells as a function of seminiferous tubule maturation in the human cryptorchid testis.

Androgen receptor (AR) immunohistochemistry was performed in an archival collection of adult human cryptorchid testes to determine whether AR cellular distribution and intensity of immunostaining were functions of the severity of cellular dysgenesis. The seminiferous tubule histology of cryptorchid testes collected from adults is marked by three specific patterns. 1) Seminiferous tubules are characterized as maintaining focal areas of germinal cell differentiation (albeit incomplete) that are interspersed with 2) tubules composed of Sertoli cells only, these latter cells being principally of the adult type, although dysgenetic and immature Sertoli cells may also be detected. 3) In contrast, there is a class of tubule that is characterized as being composed exclusively of Sertoli cells that are extremely dysgenetic in appearance. The majority of adult-type Sertoli cells found in the first types of tubules exhibited either robust or moderate AR staining intensity. Peritubular cells of these tubules also expressed a similar AR staining intensity. In contrast, in the more dysgenetic and immature type Sertoli cells found in the second type of tubules, the intensity of AR staining was significantly less, if not missing altogether. Finally, in the most dysgenetic tubules, Sertoli cell AR staining was never detected. To our knowledge, this is the first report in the literature that addresses the intensity of AR immunostaining in Sertoli cells of cryptorchid testes. The results presented herein are consistent with the interpretation that the intensity of AR staining in Sertoli cells diminishes as a function of the severity to which the cells are afflicted within a cryptorchid testis and that focal absence of AR expression in Sertoli cells correlates with a lack of local spermatogenesis in the tubules.

Oncostatin M in the normal human testis and several testicular disorders.

The immunohistochemical reaction to oncostatin M (OSM) was studied in normal human testes at different ages (fetuses, newborns, children, pubertal boys, adults, and elderly men), as well as in several testicular disorders including carcinoma-in-situ cells (CIS), germ cell tumors, benign functioning Leydig cell tumor, androgen insensitivity syndrome, Klinefelter's syndrome, and cryptorchidism. Positive OSM immunostained Sertoli cells were only observed in fetuses. In normal testes, intense OSM immunoreaction was found in the Leydig cells of fetuses, newborns, and adults. Leydig cell immunoreaction was weak in elderly men and absent in children and pubertal boys. In some testicular disorders (Leydig cell tumor, cryptorchidism, and CIS), Leydig cell immunoreaction was as intense as in normal adult testes. This immunoreaction was heterogeneous in androgen insensitivity syndrome and was absent in Klinefelter's syndrome and intratubular seminoma. No recognizable Leydig cells were observed in the other testicular tumors. The findings of our study suggest that, in humans, the down-regulation of OSM immunoexpression in Sertoli cells occurs early, and that OSM immunoreaction in the Leydig cells is associated with functionally active and differentiated Leydig cells.

Macro-orchidism: light and electron microscopic study of four cases.

A hormonal and quantitative light microscopy study of one man with macro-orchidism associated with mental retardation and fragile X chromosome (case no. 1) and three men with idiopathic macro-orchidism (cases no. 2 to 4) is reported. Hormonal study revealed slightly increased follicle-stimulating hormone serum levels in cases no. 1 to 3. The testes from cases no. 1 (orchidoepididymoectomy specimen) and 2 (testicular biopsy) presented interstitial edema and three different tubular patterns that were arranged in a mosaic-like manner. Type I tubules had an increased diameter (less than 220 microns), dilated lumen, and thin seminiferous epithelium usually consisting of Sertoli cells, spermatogonia, primary spermatocytes, and sometimes a few spermatids. Type II tubules had a normal diameter (180 to 220 microns) and germ cell development varied between complete spermatogenesis and Sertoli-cell-only tubules. Type III tubules had decreased diameter (less than 180 microns), atrophic seminiferous epithelium, and thickened tunica propria. The appearance of the nuclei of the Sertoli cells in the three types of tubules could be either mature or immature. Some of the mature Sertoli cells presented a granular cytoplasm. A few of these granular cells grouped together, forming nests that protruded into the tubular lumen. The testicular biopsies from cases no. 3 and 4 only presented type II tubules that contained both mature and immature Sertoli cells. Quantitative study revealed that the large testicular size was principally due to an increased tubular length in all four cases. Although the seminiferous tubule lesions and interstitial edema suggest an obstructive process, the testicular excretory ducts (studied in case no. 1) appeared normal or only slightly dilated. It is possible that the seminiferous tubule lesions (dilated lumen and germ cell depletion) might be secondary to the Sertoli cell lesions (granular cytoplasm and nuclear immature-like pattern.

Adenomatous hyperplasia of the rete testis. A review and report of new cases.

Adenomatous hyperplasia of the rete testis (AHRT) is an uncommon benign lesion that preferentially involves the septal rete testis and mediastinal rete testis. It is usually an incidental finding in surgical specimens from cryptorchidism and testicular tumour. It can be found in autopsy specimens from patients dying with different chronic diseases and newborns with kidney diseases. Since its first description many articles have been published communicating new cases and putting forward some hypotheses on its aetiology and pathogenic mechanisms. Some authors suggest a role for hormonal changes, tumour invasion and action of chemical agents. We think that AHRT should be categorised into two main aetiological categories: congenital and acquired. The cases associated with different kidney and spermatic duct diseases, most cases associated with cryptorchidic testis and some cases associated with testicular germ cell tumour should be included in the congenital group. The remaining cases associated with chemical agents, some hormonal changes (i.e. androgen blockade) and most of the germ cell tumour cases can be considered as acquired AHRT. Differential diagnosis must be established mainly with metastatic adenocarcinoma of prostate to testis and primary adenocarcinoma of the rete testis. Pseudohyperplasia of the rete testis must also be considered in atrophic testes. Here we review the papers published on this subject and report our recent cases.

Sustained gastrointestinal colonization and systemic dissemination by Candida albicans, Candida tropicalis and Candida parapsilosis in adult mice.

The ability of nine clinical isolates of Candida species (three C. albicans, three C. tropicalis and three C. parapsilosis) to colonize and invade the gastrointestinal (GI) tract of adult male CD-1 (ICR) mice was determined. The effect of dietary tetracycline plus glucose supplementation on colonization was evaluated. Strains were intragastrically inoculated. Tetracycline and glucose altered substantially aerobic flora, especially streptococci (average fall 1.1 +/-0.3 log(10) CFU/g, p<0.01 by the Student's t test). At two weeks after oral challenge, sustained and high colonization of GI tract by Candida (mean 5,28 +/- 0.18 log(10) CFU/g, p<0.01) was achieved in all mice receiving glucose-tetracycline supplementation, excepting in animals inoculated with one of C. tropicalis isolates. Histologic sections of the stomachs revealed multiple intraepithelial micro-abscesses associated with hyphae in the region of the cardial-atrium fold. Under immunosuppression, systemic spread of C. albicans and C. tropicalis was observed in 62% and 24% of animals receiving dietary supplementation respectively. Dissemination was not noted for C. parapsilosis isolates. We have developed a simple and inexpensive murine model of sustained colonization of GI tract. This model could be useful for analyzing prophylaxis, treatment and diagnosis of systemic Candida infections and for evaluating virulence of strains.

Hyperplasia of spermatic cord nerves: a sign of testicular absence.

The comparative histologic study of the spermatic cord in the absence of testis, epididymis-testis separation, and normal development of both testis and epididymis, revealed that there is nerve trunk hyperplasia and hypertrophy in absence of the testis. This finding may greatly aid the diagnosis of testicular absence in the management of impalpable testes.

Nifedipine, losartan and captopril effects on hyperplasia of vascular smooth muscle from Ren-2 transgenic rats.

Vascular smooth muscle cells from hypertensive transgenic rats for the mouse Ren-2 gene exhibited radioimmunoassayable angiotensin II and hyperplasia in comparison with cells from Sprague-Dawley rats. However, neither captopril, losartan, saralasin, nor PD123319 (all at 10 microM) modified DNA synthesis or cell number observed in 4-day growth curves with 10% fetal calf serum. Nifedipine reduced DNA synthesis in both cell types, the concentration required being significantly higher in Sprague-Dawley- (1 microM) than in transgenic-derived cultures (100 nM). The EC50 values were of 2.43 +/- 0.32 and 1.0 +/- 0.17 microM, respectively (P < 0.05). In both cell types, only 10 microM nifedipine reduced serum-induced cell proliferation, but inhibition percentage was higher in transgenic-derived cultures. In conclusion, hyperplasia of transgenic-derived vascular smooth muscle cells is not blocked by angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, but these cells are more sensitive to the antiproliferative effects of nifedipine.

Diverticula of human seminiferous tubules in the normal and pathologic testis.

The occurrence of diverticula in human seminiferous tubules was investigated in the adult human testis in normal as well as physiologic (aging) and pathologic (germ cell depletion, obstruction of male excretory ducts, varicocele and systemic arteriosclerosis) conditions. Diverticula, which are evaginations of the seminiferous epithelium surrounded by a thin tunica propria, were present in all groups studied. The number of diverticula per mm2 testis was higher in the testis with obstruction than in those without obstruction at each age considered. The number of diverticula increased with age in both the obstructed and nonobstructed testis. No changes in the number of diverticula per mm2 testis were found in relation to systemic arteriosclerosis or different degrees of germ cell depletion. Varicocele was only associated with increased numbers of diverticula when it was also associated with obstruction. The formation of diverticula in human seminiferous tubules seems to be an obstructive process related to increasing age.

Epididymal growth and differentiation are altered in human cryptorchidism.

Despite the knowledge and histological classification of testicular lesions, epididymal lesions associated with cryptorchidism are not well defined and only macroscopic alterations have been reported. We have evaluated the alterations in the growth of both the epithelium and muscular wall of efferent ducts and epididymis in human patients with cryptorchidism from infancy to adulthood. In addition, by cytokeratin immunostaining we have also evaluated the stage of differentiation of each segment along the human postnatal life in these patients. A decrease is shown in the size of efferent and epididymal ducts in cryptorchid children compared with normal, age-matched controls. The height of the epithelium, muscular wall, and lumen of the cryptorchid epididymis were reduced at every age studied. This decrease in all regions was seen even in the testicular quiescent period (1 to 4 years of age). In addition, the cryptorchid epididymis grows more slowly during the transition to the pubertal period. The smaller size of the cryptorchid epididymis in pubertal and adult men compared with that of normal men is due primarily to underdevelopment of the muscular wall and a reduction in epithelial height. The pattern of growth of cryptorchid efferent ducts and ductus epididymides parallels that in normal men, except that development of the lumen and muscular layer in the cauda epididymis region are delayed. Epithelial differentiation, monitored by cytokeratin expression, is minimal in efferent ducts and throughout the epididymis of the cryptorchid male, and this is already seen in children. In conclusion, our immunohistochemical and morphometric results show a reduced development of the human cryptorchid epididymis that is already evident in childhood. They indicate that cryptorchidism is a primary congenital illness of the testis and spermatic ducts, with evident lesions from the first years of life, and suggest that surgical descent would probably not be able to completely reverse these alterations.

Morphometric and immunocytochemical study of the fetal, infant, and adult human vas deferens.

The human vas deferens (VD) is often considered simply as a conduit to transfer mature sperm from the epididymis to the ejaculatory duct. The cells that make up the epithelium of the VD, however, exhibit many characteristics of cells found in more complex epithelia, which are involved in absorption and/or secretion. In the present investigation, morphometry was utilized to characterize in detail the changes incurred by the human VD during its development, growth, and aging and to determine if these changes correlate with testicular maturation. In addition, the specific types of keratins present in the epithelial cells were defined, as well as desmin distribution in the muscular layers, during the various phases of the development, growth, and involution of the human VD. Results of the morphometric study are consistent with the interpretation that the development, growth, and aging of the VD are delayed, but parallel to, the identical phases exhibited by the human testis. Further, a differential expression of distinct keratin types was observed in the VD during the various phases examined in this study. Taken together, these two correlations may suggest that the VD is unlikely to function solely as a conduit for sperm. The rationale for this interpretation is as follows: 1) the complex developmental and maturational changes measured in the present investigation in the human VD are common to other absorptive and/or secretory epithelia; and 2) these changes parallel developmental changes observed in other androgen-dependent epithelia of the male reproductive tract, which also function to contribute components to seminal fluid as well as to provide a conduit for sperm.

Changes in surface area and number of Leydig cells in relation to the 6 stages of the cycle of the human seminiferous epithelium.

In order to evaluate the occurrence of a Leydig cell cycle related to the cycle of the seminiferous epithelium in man, the numbers of peritubular Leydig cells and surface area of these cells along 1 mm of tubular basement membrane at each stage of the cycle were calculated on histological sections of young adult testes. The Leydig cells that were located separated from the tubules (perivascular Leydig cells) were also classified according to the stage of the cycle shown by the nearest seminiferous tubule; the surface area and number of these cells were also calculated. The total surface area and numbers of Leydig cells (peritubular plus perivascular) along 1 mm of tubular basement membrane did not change during the cycle of the seminiferous epithelium. Both the surface area and the numbers of peritubular Leydig cells were greater in stages I and II of the cycle, when spermatozoa are released; they decreased in stages III and IV and increased again in stages V and VI, whereas the contrary occurred in perivascular Leydig cells. The average surface area of each Leydig cell type remained constant throughout the stages of the cycle.

Magnetic resonance imaging in the evaluation of inflammatory lesions in muscular and soft tissues: an experimental infection model induced by Candida albicans.

We have developed an experimental model to monitor inflammatory lesions in muscle and soft-tissues during the different stages of the disease by means of Magnetic Resonance Imaging (MRI). MRI of mice legs infected with Candida albicans was performed by standard two-dimensional spin echo and fast spin echo (RARE) using customized coils. The MRI findings were compared with pathologic examinations at the initial acute and established acute inflammatory stages, which provided accurate and detailed information on the evolution of the processes involved. The yeast caused inflammation within the first hours post-inoculation, appearing on T2-weighted images as an inhomogeneous mass with increased signal intensity. The presence of fungal hyphae was observed as hypointense signal areas in both T2 and T1 weighted images, with histologic confirmation. Areas of decreased signal intensity on T2 weighted images were apparent on the last experimental day and were attributed to the granulation tissue located within the capsule surrounding the abscess. The close correlation found between MRI and histopathology suggests that MRI is an ideal radiologic technique for monitoring the clinical and therapeutic follow-up of fungal infections in muscle and soft tissues.

Pre- and post-natal growth of the human ductus epididymidis. A morphometric study.

A histometric study of the development of the human epididymis from the fetal period to adulthood has been carried out in males without testicular or related pathology, distributed into the following groups: (I) fetuses (between the 28th and 37th week of pregnancy); (II) newborns (1-30 days of age); (III) infants (2-4 months of age); (IV) infants (5-12 months of age); (V) infants (1-4 years of age); (VI) children (5-14 years [prepubertal]); and (VII) adults (15-60 years of age). For each age group and each epididymal portion (efferent ducts, caput, corpus and cauda epididymidis) the parameters measured were (1) total surface (epithelium + muscular layer + lumen); (2) the surface occupied by the lumen; (3) the surface occupied by the muscular layer; (4) total diameter of the duct; (5) total diameter of the lumen; and (6) the height of the epithelium. The results of the present study revealed that the development of the efferent ducts and ductus epididymidis follows a biphasic pattern. A progressive development occurs from the fetal period to infants 2-4-months of age. However, this development is transient and regresses during infancy (groups IV and V). At childhood (group VI), a definitive development is initiated and completed at puberty (group VII). These changes seem to be related to the androgen-dependence of the epididymis, the different stages of testicular maturation, and the steroidogenic activity of Leydig cells.

Testis, epididymis, and spermatic cord in elderly men. Correlation of angiographic and histologic studies with systemic arteriosclerosis.

Autopsy specimens of the testes, epididymides, and spermatic cords from 20 adult young and 60 elderly men were studied by angiographic and histologic techniques. Testicular alterations in elderly men were correlated to the degree of aortic atheromatosis. Elderly men without manifest atheromatosis showed no lesions. Elderly men with slight atheromatosis showed a spiculated outline of the testicular artery and intraparenchymatous zones with scarce filling of small arteries. These zones exhibited peritubular and interstitial fibrosis. Elderly men with severe atheromatosis showed large zones of the testicular parenchyma with scarce filling of centrifugal and centripetal arteries that exhibited fibrosis of the tunica intima and lumen reduction; the testicular parenchyma appeared fibrosed with sclerosed tubules. Epididymal lesions were parallel to testicular lesions. These results suggest that systemic arteriosclerosis is involved in the decline of testicular function with age.