Fertility Potential after Unilateral Orchiopexy: An Age Independent Risk of Subsequent Infertility when Biopsies at Surgery Lack Germ Cells

Fertility Potential after Unilateral Orchiopexy: An Age Independent Risk of Subsequent Infertility when Biopsies at Surgery Lack Germ Cells
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  1326 INTERNATIONAL ABSTRACTS Accurate diagnosis was established by laparotomy, resection of the tumor, and histological examination. The patient remained asymp- tomatic during the 2-year follow-up period. Inflammatory pseudo- tumor of the liver should be considered in the differential diagnosis of liver tumors. Although accurate diagnosis may be difficult to achieve, treatment of such cases might be more conservative. Searching the literature, the authors found 48 cases published since 1953. The pathogenesis and etiology remain unknown.- Thomas A. Angepointner Effects of Bupivicaine Infiltration on Beta-Endorphin and Cor- tisol Release and Postoperative Pain Following lnguinal Her- niorrhaphy in Children. H. Okur M. Kucudaydin S. Muhtaroglu et al. Pediatr Surg Int 11:41-44, (January), 1996. Children aged 1 month to 2 years who underwent inguinal herniorrhaphy were subjects of the study. They were divided into three groups: (A) those who received bupivicaine before incision, (B) those who received bupivicaine after hernia repair but before skin closure, and (C) those who received no local anesthetic. There . were 10 patients in each group. This study showed that wound infiltration with a local anesthetic decreases the stress response to surgery. Patients who received a local anesthetic achieved a pain score of 0 much more quickly than those in the control group. The difference in beta-endorphin level between group A and group C was greater than the difference between group B and group C. The authors suggest that routine wound infiltration with a local anes- thetic should be the norm.-V Kalidasan Gastroschisis in the Decade of Prenatal Diagnosis: 1983- 1993. G. Haddock C.F. Davies and P.A.M. Raine. Eur J Pediatr Surg 6:18-22, (February), 1996. Fifty cases (24 males, 26 females) operated on for gastroschisis between 1983 and 1993 are reported. The mean birth weight was 2.17 kg and mean gestational age was 35.8 weeks. Prenatal diagno- sis was made by ultrasonography in 39 cases (78 ), and 33 (66 ) were delivered immediately adjacent to the neonatal pediatric surgical unit. Spontaneous delivery occurred in 23 (46 ), and cesarean section was performed in 27 (54 ). Sixteen cesarean sections were emergencies and 11 were elective. Associated bowel problems were noted in 11 (22 ) cases-atresia (5), stenosis (2), ischemia (I), duodenal perforation (I), ileal perforation (I), and jejunal band obstruction (1). Primary closure was achieved in 42 cases (84 ), and there were 5 deaths (lo. ). Prenatal diagnosis and mode of delivery had no direct correlation with mortality in this series. Emergency cesarean section was necessary for fetal indications in 28 . The prediction of compromised or damaged intestine by ultrasonography was unreliable, and the majority of cases of atresia and stenosis escaped detection. However, it is concluded that prenatal diagnosis and delivery in a regional center offer the best outcome for the fetus.-Thomas A. Angevointner Abdominal Wall Defects in the Era of Prenatal Diagnosis. O.H. Nielsen N. Kvist and V. Brocks. Pediatr Surg Int 11:4-7, (January), 1996. The authors present the outcome for 141 cases of abdominal wall defects treated between 1980 and 1994. Sixty-five of these were diagnosed antenatally, and 76 were referred immediately after birth for management. There were 12 pregnancy terminations among those diagnosed antenatally to have omphalocele, and seven among those diagnosed to have gastroschisis. The authors found that although there were advantages in counseling the parents and in detecting associated anomalies in children who had prenatal diagnosis, there was no significant difference in the final outcome between the two groups. They stress the fact that there was no advantage to cesarean section over vaginal delivery, and they could not show an unfavourable effect of labor.-P. Pun’ Is Computed Tomography a Useful Adjunct to the Clinical Examination for the Diagnosis of Pediatric Gastrointestinal Perforation From Blunt Abdominal Trauma in Children? C. T. Albanese M.P. Meza M.J. Gardner et al. J Trauma 40:417-421, (March), 1996. The authors reviewed 350 childhood cases of blunt abdominal trauma and identified 30 (8.5 ) with gastrointestinal (GI) perfora- tion. Blows to the abdomen and seat-belt injuries were the most common mechanisms of injury. The small bowel was involved in 24 (80 ) of the 30 cases. Eighteen of the 30 had preoperative abdominal computed tomography (CT) scans of “sufficient qual- ity” for detailed review. Findings suggestive of GI perforation included free air (without mediastinal air), unexplained free fluid, mesenteric infiltration, and localized fluid-filled thick-walled bowel loops. The authors conclude that abdominal CT scans may be helpful for children who do not have obvious peritonitis or other immediate indications for surgery at the time of presentation. The authors maintain that serial physical examinations are the gold standard for diagnosing pediatric GI perforation because many CT scans were only suggestive but not diagnostic. Five (26 ) of 19 CT scan results were normal despite GI injury.--Steven Stylianos GENITOURINARY TRACT Fertility Potential After Unilateral Orchiopexy: Simultaneous Testicular Biopsy and Orchiopexy in a Cohort of 87 Patients. D. Cartes .J.M Thorup and S. Lindenberg J Urol 155:1061-1065, (March), 1996. A total of 87 consecutively treated lo- to 12-year-old cryptorchid boys underwent testicular biopsy simultaneously with unilateral orchiopexy. In adulthood, 56 of the 87 patients agreed to measure- ment of serum follicle-stimulating hormone, luteinizing hormone, testosterone, and testicular volume; and 54 provided specimens for semen analysis. The number of spermatogonia per tubular cross section correlated with the volume of the operated testis and total testicular volume in adulthood. Serum follicle-stimulating hor- mone correlated negatively with these volumes and with sperm concentration and total sperm count. Contralateral testicular vol- ume correlated with sperm concentration, total sperm count, and percentage of living and mobile sperm. When the biopsy specimen showed Sertoli cells only or one spermatogonium per 100 tubular cross sections, the age-matched number of spermatogonia per tubular cross section was 1 or less. Of these patients, 33 later presented with 5 5 million spermatozoa per milliliter, no normal motility, and generally lower sperm concentrations than those with more than one spermatogonium per 100 tubular cross sections (> 1 ) in the biopsy specimen. When the value was greater than l , later sperm quality was not significantly reduced in comparison to that of the general population. The age-matched number of spermatogonia per tubular cross section is significant in regard to fertility potential, and a value of 1 or less (approximately Sertoli cells only) may predict low fertility potential. The authors report that, to their knowledge, Sertoli cells only have not been observed before 15 months of age, which makes it logical to treat cryptorchi- dism before this age, even unilateral cases.-George W Holcomb Jr
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