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.

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.

Intraoperative contrast-enhanced urosonography during endoscopic treatment of vesicoureteral reflux in children.

BACKGROUND: There are many controversies surrounding the effectiveness of endoscopic treatment of vesicouretheral reflux (VUR) in children, thus it is of highest priority to analyze factors influencing the outcome of therapy and to search for new methods that would increase the success rate and reduce the number of reinjections. OBJECTIVE: The aim of the study was to analyze whether intraoperative contrast-enhanced urosonography (ce-US) may increase the effectiveness of endoscopic anti-reflux therapy. MATERIALS AND METHODS: Intraoperative contrast-enhanced urosonography (ce-US) with SonoVue® was performed in 17 patients (25 ureteral units) undergoing endoscopic treatment of VUR. Ce-US was performed in the operating room before the procedure and after injection of the bulking material. When VUR persisted, the operator repeated the injection, which was followed by ce-US. The results were compared with those obtained from a control group (15 patients; 22 ureteral units). RESULTS: A repeat injection during a single endoscopic treatment was required in 24% of cases. The overall success rate confirmed at 6-12 months' follow-ups was 84%. The success rate was significantly higher in comparison to the control group (success: 64%). CONCLUSION: Intraoperative ce-US performed during endoscopic treatment of VUR enables immediate monitoring of outcome and provides the opportunity for repeat injection during the same procedure, thus increasing the efficacy of the procedure and reducing the number of reinjections.

Comparison of fluoroscopy and fluoroscopy-based 2D computer navigation for iliosacral screw placement: a retrospective study.

PURPOSE: Treatment of pelvic fractures is often complicated. Here, we intended to evaluate the intraoperative benefits of using 2D computer navigation when compared with traditional fluoroscopy on X-ray burden, surgical time and screw placement accuracy. METHODS: In this study, we retrospectively evaluated the records of 25 patients who underwent osteosynthesis of a posterior pelvic fracture using fluoroscopy at the University Hospital Ostrava, Czech Republic between 2011 and 2019, and 32 patients from the same department and period in whom 2D computer navigation was used. RESULTS: Intraoperative X-ray burden was significantly lower in the group with 2D computer navigation (median 650 vs 1024 cGy/cm2), as was the duration of the surgery (41 vs 45 min). This was most obvious where two screws were inserted (X-ray dose of 994 vs 1847 cGy/cm2 and 48 vs 70 min, respectively). Correction of the path for wire placement after the original drilling was necessary in 2 patients (6%) from the 2D computer navigation group and 15 patients from the fluoroscopy group (60%). Still, no malposition of the screws nor dislocation of the posterior pelvic segment after 12 months was observed in any patient of either group; of complications, only three superficial infections in the 2D navigation group and 2 in the fluoroscopy group were observed. CONCLUSION: 2D computer navigation is a safe and accurate method for placement of screws during posterior pelvic fracture osteosynthesis, associated with lower intraoperative radiation burden and shorter surgical times compared to standard fluoroscopy, especially if two screws are inserted.

Psoriatic erythroderma coexisting with erythema multiforme-like lesions induced by retinoids or retinoids combined with an antibiotic: case report.

Psoriasis is currently considered a multifactorial disease, which can coexist with many somatic and psychological disorders. We present the case of a 50-year-old woman referred to our department due to erythroderma with concomitant peculiar violaceous, polycyclic lesions most likely induced by medications. Past medical history revealed numerous systemic disorders, including metabolic syndrome, hypertension, cardiac insufficiency, obesity, and depression. Additional examinations and consultations demonstrated dyslipidemia, xanthelasma, incomplete block of the right branch of His bundle, thyreocardiac syndrome, benign adrenal tumor, and delusions. Recently, psoriasis has been intensively studied. We present the case in which erythroderma was most likely triggered by acitretin combined with ceftriaxone. Treatment of many diseases and psychiatric disturbances coexisting with psoriasis is extremely difficult and requires cooperation of various specialists.

Multiple glomangiomas involving the glans penis in pediatric patient.

UNLABELLED: Glomus tumors, especially multiple ones, are uncommon skin and soft tissue neoplasms occasionally seen in various internal organs. Involvement of the external genital organs including penis is extremely rare, and until now, scarce cases have been reported in the available literature. MATERIALS AND METHODS: A routine histologic and immunohistochemical staining for pan-muscle actin, α-smooth muscle actin, desmin, CD31, and CD34 was applied for diagnosis of the lesions. RESULTS: Three soft, bluish, and tender tumors localized on the ventral aspect of the glans penis in a 9-year-old boy were found. Furthermore, 3 other lesions situated on the fingers and the plantar surface of the foot were later sequentially noted. Local excisions of all tumors were performed, and glomangiomas were diagnosed based on typical microscopic features as well as immunohistochemical findings, that is, positive immunoexpression for actin but negative for desmin, CD31, and CD34. No recurrence was noted during the 5-year follow-up. CONCLUSIONS: On the basis of our experience, conservative surgical procedure is sufficient for penile glomus tumors. However, each patient should be carefully examined for possible extragenital lesions.

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.

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.

Cytokines and anticytokines in psoriasis.

BACKGROUND: Psoriasis is a chronic autoimmune hyperproliferative skin disease of varying severity affecting approximately 2-3% of the general population in the USA and Europe. Although the pathogenesis of psoriasis has not been fully elucidated, an immunologic-genetic relationship is likely. Cutaneous and systemic overexpression of various proinflammatory cytokines (TNF, interleukins, interferon-gamma) has been demonstrated in psoriatic patients. METHODS: We reviewed the current database literature and summarized the involvement of cytokines and their receptors in the pathogenesis and treatment of psoriasis. RESULTS: Although many cytokine/anti-cytokine therapies have been conducted, TNF antagonists in the treatment of both psoriasis arthropatica and vulgaris appear to be the most widely used clinically. Interestingly, the efficacy and tolerability of some cytokines (rhIL-11 or ABX-IL-8,) were found to be much lower than expected. CONCLUSIONS: Preliminary results obtained with cytokine and anti-cytokine therapies appear promising and as such continued research is clearly indicated.

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.

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.

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.

Closure of the thoracic duct from the left-side access: A case report.

BACKGROUND: We report a 16-year-old patient with a massive left-sided chylothorax after chemotherapy due to mixed germinal tumor of the testis with massive metastases located in the retroperitoneal space and posterior mediastinum. Chemotherapy resolved the metastases in the mediastinum but evoked a huge pleural effusion in the left pleural cavity, requiring surgical intervention.Left-sided access was used. The 5-mm camera and 3 5-mm working ports were inserted. The parietal pleura was incised and the esophagus located and protected. Behind the esophagus, the thoracic duct and concomitant tissue were clipped with titanium clips, and additionally, thrombin glue was used. Stopping of the lymph leakage was observed during surgery. A local argon pleurodesis was used to finish the procedure. The thoracic tube was removed on the third postoperative day. CONCLUSION: Left-side access may be a good alternative in the left-sided chylothorax, but the crucial points are location and protection of the esophagus during the procedure, which is also the landmark that allows for locating the thoracic duct.

[Size of testes and epididymes in boys up to 17 years of life assessed by ultrasound method and method of external linear measurements]. / Wielkosci jader i najadrzy u chlopców do 17 roku zycia okreslone metoda ultrasonograficzna i metoda zewnetrznych pomiarów linijnych.

AIMS: 1. Determination of the size of testes and epididymes on the right and left side, in healthy boys in various age groups with use of non-invasive ultrasound examination method and the method of external linear measurements. 2. Determination of age, when intensive growth of testicular and epididymal size starts. 3. Determination whether there are statistically significant differences between the size of the right and the left testis, as well as between the right and left epididymis. 4. Evaluation of the ultrasound method and method of external linear measurements in their use for scientific investigations. MATERIAL AND METHODS: 309 boys, aged from 1 day to 17 years of life, treated in the Clinical Department of Paediatric Surgery and Traumatology of the Medical University in Lublin from 2009 to 2010 due to diseases needed to be treated surgically, but not the scrotum, were examined in this study. No pathologies influencing the development of genital organs were found in these boys. Dimension of the testes was studied with ultrasound method and with method of external linear measurements. Dimension of epididymes was only examined with ultrasound method. In every age group the author calculated mean arithmetical values for: testiscular length, thickness, width and volume, as well as epididymal depth and basis. With consideration of standard deviation (X+/-1 SD) it was possible to define the range of dimension of healthy testes and epididymes and their change with age. Final dimensions of the right and left testis as well as of the right and left epididymis were compared. Dimensions of the testis on the same side of body acquired with the ultrasound method and acquired with the method of external linear measurements were compared. Statistical work-up with Wilcoxon test for two dependent groups was implemented. RESULTS OF STUDIES: Ultrasound evaluation pointed to intensive 2.5-times increase in testicular length and width, and 2-times increase in testicular thickness in boys aged 10 to 17 years. Mean volume of neonatal testis is 0.35 ml. From 10th year of life, the testicular volume increases 10-times from 1.36 ml to 12.83 ml in 17th year of life. Depth of epididymis measured with ultrasound method is always greater than its basis. Both these dimensions increase quickly from the 10th year of life. Measurements done with the caliper on the average overestimate testicular length by 5.7 mm, its thickness by 2.9 mm and its width by 1.4 mm, comparing with ultrasound method. There were no statistically important differences between dimension of the right and left testis. Differences between dimension of the right and left epididymis are statistically significant. CONCLUSIONS: 1. Age is the main factor influencing testicular size in boys. 2. Intensive growth of testes starts in the 10th year of life, of epididymes in 12th year of life. 3. Testicular volume is the most precise description of its size. There are no statisticallysignificant differences between volume of the right and left testis. Differences between dimension, described by the depth and basis of the right and left epididymis are statistically significant. 4. Ultrasound method and method of external linear measurements with the caliper have similar diagnostic value in comparing the size of both testes. 5. Measurements of testicular size with ultrasound method have much greater value for detail evaluation than the method of external linear measurements with the caliper, which does not regard thickness of the skin and testicular coats, as well as the epididymal head which is often situated on the upper end of the testis.

Genes and structure of selected cytokines involved in pathogenesis of psoriasis.

Psoriasis is a common skin disease involving 1-4% of human population worldwide, of strong genetic background. The following cytokines are directly involved in psoriasis: TNF, IL-1, IL-2, IL-6, IL-7, IL-8, IL-15, IL-18, IL-19, IL-20, IL-23 whereas IL-4, IL-10, IL-12 as well as IL-11, IL-17 and IFN-gamma are rather indirectly engaged. This work is a review of some genetic factors and structure of selected cytokines and receptors and their genes location.