Torsion of the Testis in the Newborn

A series of 12 patients with torsion of the testis in the newborn is reported. In all patients the torsion occurred above the investment of the tunica vaginalis. Torsion occurred on the right side in six patients, on the left side in. five, and was bilateral in one. The clinical features, operative findings and treatment are described     

Torsion of the Vermiform Appendix: a Case Report

This case report describes a rare condition, namely a torsion of the vermiform appendix. Its clinical condition is indistinguishable from acute appendicitis.     

小儿腹股沟不可触及睾丸的隐睾症诊治

目的:总结腹股沟不可触及睾丸的小儿隐睾症诊治经验。方法:回顾性分析收治腹股沟不能触及睾丸的隐睾患儿36例临床诊治资料。分析腹腔镜手术指征,腹股沟探查指征,术前超声检查的作用和术式的选择。结果:腹股沟不能触及的隐睾共36例(41侧),占总数的10.0%(36/361),经腹腔镜和腹股沟探查确定睾丸缺如18例(侧),腹内型隐睾16例(21侧),阴囊内睾丸残余2例(侧)。将腹腔镜下所见分4型,I型9例(侧),II型9例(侧)(其中IA型7例,IB型2例),III型11例(13侧),IV型7例(10侧)[其中IVA型5例(7侧),IVB型2例(3侧)]。分别采用经腹股沟睾丸下降固定,腹腔镜辅助睾丸下降固定术,分期Fowler-Stephen术。术前超声结果阳性诊断率为75%(27/36),睾丸缺如患儿对侧睾丸体积明显大于腹内型隐睾及睾丸残余患儿对侧睾丸体积。术后随访睾丸萎缩1例。结论:对于腹股沟未能查到睾丸的小儿隐睾症应行腹腔镜检查,腹腔镜下II型者,无需再行腹股沟探查,I型需探查腹股沟及阴囊。III型和IVB型可经腹股沟或腹腔镜辅助下行睾丸下降固定术,IVA型隐睾需在腹腔镜辅助下行睾丸下降固定或行分期Fowler-Stephen术。术前超声检查对侧睾丸大小有利于判断是否有睾丸缺如。     

黄芪对大鼠睾丸扭转/复位模型保护作用的研究

目的:探讨黄芪注射液对大鼠睾丸扭转/复位模型的保护作用。方法:将30只健康雄性Wistar大鼠分为3组。分别为假手术对照组(A组,n=10);睾丸扭转/复位组(B组,n=10);睾丸扭转/复位+腹腔内注射黄芪注射液组(C组,n=10)。按Turner法建立睾丸扭转模型,喂养至术后7d处死,切取扭转侧睾丸检测凋亡指数(AI)及谷胱甘肽过氧化物酶活力及丙二醛含量。结果:A、B、C三组扭转侧睾丸AI分别为5.82±1.21、36.18±8.40、20.39±3.57,B、C组明显高于对照组(P(0.05),B组明显高于C组(P(0.05)。A、B、C三组扭转侧睾丸谷胱甘肽过氧化物酶活力分别为48.03±2.01、30.93±1.25、38.44±1.06U/mg;丙二醛含量分别为1.43±0.17、3.98±0.36、2.57±0.53nmol/ml,三组之间比较均有显著性差异(P(0.05)。结论:黄芪注射液可明显减少扭转侧睾丸生殖细胞凋亡,保护谷胱甘肽过氧化物酶活力,减轻脂质过氧化程度。     

儿童睾丸扭转的诊治探讨

目的:探讨如何早期发现儿童睾丸扭转。方法:回顾性分析24例睾丸扭转的临床资料。结果:年龄4个月~15岁,平均8.5岁。左睾丸17例,右睾丸7例。发病到手术时间1 h~4个月。初诊确诊为睾丸扭转16例,延误诊断8例。术前均行彩超检查,1例4个月患儿拒绝治疗,手术探查23例,6例保留睾丸,17例行睾丸切除。结论:睾丸坏死不仅与扭转度数和时间有关,还和扭转的松紧度有关;彩色多普勒超声对睾丸扭转的早期诊断具有重要的参考价值;小儿阴囊急症疑为睾丸扭转应早期手术探查。     

Laparoscopic Evaluation and Management of Nonpalpable Testis in Children

We evaluated the outcome of children with nonpalpable testis managed and treated laparoscopically in our department over a 6-year period. One hundred nine boys aged 12 months to 14 years were included in the study; most were between the ages of 12 months and 18 months. Diagnostic laparoscopy and eventual orchiectomy were performed in 50 patients (45.8%) with atrophic testicles. A normal sized intraabdominal testicle was found in 59 patients (54.1%). Seven of the intra-abdominal testicles were bilateral (6.4%), and 12 were located in the vicinity of the inguinal ring (11%). All patients underwent both the first and second stages of the Fowler-Stephens procedure, except for those whose testicles were located in the vicinity of the internal inguinal ring. They underwent an immediate one-stage laparoscopic-assisted orchiopexy without difficulty. Only two patients had atrophic testicles observed in the scrotal area after the complete Fowler-Stephens procedure (3.4%). The good results reported in most series establish the laparoscopic management of the nonpalpable testis as "state of the art," with results superior to those obtained with the open technique regarding morbidity, complication rate, and length of hospital stay.     

未成熟大鼠睾丸单侧扭转后对健侧血流和组织学的影响

目的:观察未成熟大鼠睾丸单侧扭转后对健侧睾丸血流供应和组织学的影响,并比较不同处理方法的疗效。方法:建立Wistar3周龄大鼠左侧睾丸扭转模型,分别建立对照组、扭转组、扭转复位组和扭转切除组,每组10只。彩色多普勒测量各组术前、术后8h(即扭转复位或切除术后2h)、12h、24h、72h右侧睾丸动脉收缩期最大血流速度,并于对照组和扭转组术后2h,扭转复位组和扭转切除组第1次术后12h各取2只大鼠右侧睾丸进行组织病理学观察。各组喂养至9周龄时分别取右侧睾丸进行组织学观察及检测各组大鼠右侧睾丸的生精小管直径(STD)、生精上皮细胞计数(CMSE)和睾丸活检评分(TBS)。结果:①未成熟睾丸左侧扭转后,右侧睾丸的血供呈持续性增加。②扭转组、扭转复位组和扭转切除组右侧睾丸均有不同程度的间质水肿和超微结构改变。③9周龄时扭转组、扭转切除组右侧睾丸重量均较对照组显著增加(P<0.01);各组大鼠STD、CMSE、TBS均无显著性差异(P>0.05)。结论:未成熟大鼠睾丸单侧扭转后可引起对侧睾丸的血供增加和组织学改变,轻微损伤后扭转复位和睾丸切除预后效果相似。     

Retrospective Evaluation of Carcinoid Tumors of the Appendix in Children

Carcinoids of the appendix are rare in children and are usually diagnosed incidentally on histologic investigation following appendectomy for appendicitis. To investigate the significance of the diagnosis of appendiceal carcinoid in children, we conducted a retrospective study of the treatment and follow-up of 36 children with histologically confirmed carcinoid tumors of the appendix. Between 1970 and 2000 a total of 36 patients (25 girls, 11 boys) were diagnosed with appendiceal carcinoid. The median age of the patients at diagnosis was 12.3 years (range 6–16 years). The indication for appendectomy was acute lower right quadrant pain in 27 cases and chronic right lower quadrant pain in 9 patients. In 27 specimens the tumor was localized at the apex, in 7 at the midportion, and in 2 at the base of the appendix. The median tumor diameter was 6 mm (range 3–17 mm). Concomitant severe appendicitis was diagnosed in 14 patients 2 with a perforated appendicitis. In only one tumor were mucin-producing cells detectable. After a median follow-up of 10 years (range 2 months to 30 years) all patients were tumor-free. None of the patients had a synchronous or metachronous noncarcinoid malignant tumor. Appendiceal carcinoids are usually asymptomatic, and the indication for surgical intervention is acute or chronic abdominal pains in the right lower quadrant. For most patients the prognosis is excellent after appendectomy. As in adults, appendectomy is the appropriate treatment.     

黄芪注射液对大鼠扭转复位后睾丸组织的保护作用

目的:探讨黄芪注射液对雄性Wistar大鼠扭转复位后睾丸的保护作用。方法:30只大鼠随机分为假手术组(A组)、睾丸扭转复位组(B组)、黄芪注射液治疗组(C组),每组10只,Turner法建立单侧睾丸扭转复位模型,原位缺口末端标记法检测各组睾丸组织中生殖细胞凋亡,化学比色法测定超氧化物歧化酶(SOD)和丙二醛(MDA)含量。结果:黄芪注射液治疗组与睾丸扭转复位组比较,SOD含量明显升高,MDA含量明显降低,生精细胞凋亡指数明显降低。睾丸扭转复位组、黄芪注射液治疗组与假手术对照组比较,SOD含量明显降低,MDA含量明显升高,生精细胞凋亡指数明显升高。结论:黄芪注射液可减少大鼠睾丸扭转复位后睾丸组织的双侧睾丸生殖细胞凋亡,对扭转复位后睾丸生殖细胞有保护作用。其机理可能与提高抗氧化酶活性及减少氧自由基的产生从而减轻大鼠睾丸扭转复位后的缺血再灌注损伤有关。     

Effect of Gonadotropins and LH-RH on Functional Differentiation of Immature Monkey Testis

Response of the immature monkey testis to gonadotropins and LH-RH has been assessed by measuring plasma and testicular testosterone concentrations. Administration of 50 μg of LH or FSH for 5 days to immature animals, did not significantly increase the plasma or testicular testosterone levels. When a daily dose of 200 μg of LH or 150 IU hCG was given, there was a marked increase in testosterone levels in the plasma and the testicular tissue. In vitro experiments indicate that whereas the testicular tissue of normal and FSH-primed monkeys is refractory to gonadotropins, the testicular tissue of monkeys sensitized with LH shows enhanced androgenesis when incubated with LH. Unlike the adult, the plasma testosterone levels did not increase following an intravenous injection of 2 μg of LH-RH. This amount of LH-RH, however, produced a measurable increase in plasma testosterone in gonadotropin-primed immature monkeys.     

睾丸扭转反复误诊致坏死1例并文献复习

目的:提高临床医生对睾丸扭转的诊断能力。方法:报道1例睾丸扭转因延迟就诊和2次误诊致坏死。结合文献,对其解剖、临床表现、超声诊断及误诊原因进行复习与分析。结果:1例表现为下腹痛的睾丸扭转患者,2次分别被误诊为肠痉挛和输尿管结石。术中探查证实睾丸扭转,睾丸已经坏死并切除。术后病理证实为睾丸坏死并弥漫性出血。结论:发病后及时就诊、准确诊断和正确治疗是避免睾丸丢失的关键。彩色多普勒超声检查为明确本病的一种理想影像学检查方法,并对手术有指导作用。     

Bacterial Studies of Peritoneal Cavity and Postoperative Surgical Wound Drainage Following Perforated Appendix in Children

This study reports bacterial specimens obtained from 112 children presenting with a ruptured appendix. Additional samples were studied from 11 of these patients who developed a postoperative surgical draining wound. Bacterial growth occurred in 100 peritoneal fluid specimens. Anaerobic bacteria alone were present in 14 specimens, aerobes alone in 12, and mixed aerobic an anerobic flora in 74 specimens. There were 144 aerobic isolates (1.4 per specimen). The predominant isolates were: E. coli (57 specimens); alpha-hemolytic steptococcus (16 specimens); gamma-hemolytic streptococcus (15 specimens); Group D streptococcus (12 specimens); and P. aeruginosa (9 specimens). There were 301 anaerobic isolates (three per specimen). The predominant isolates were: 157 Bacteroides spp. (including 92 B. fragilis group and 26 B. melaninogenicus group); 62 gram-positive anaerobic cocci (including 30 Peptococcus sp.; 29 Peptostreptococcus sp.); 27 Fusobactenium sp.; and 16 Clostridium sp. B. fragilis and Peptococcus sp. occurred in 23 patients. Beta lactamase production was detectable in 98 isolates recovered from 74 patients. These included all isolates of B. fragilis and six of the 23 Bacteroides sp. Forty-nine organisms (16 aerobic and 33 anaerobic) were recovered from the draining wounds. The predominant organisms were: B. fragilis (8 specimens); E. coli (6 specimens); Peptostreptococcus sp. (5 specimens); and three specimens each of P. aeruginosa and Peptococcus sp. Most of these isolates were also recovered from the peritoneal cavity of the patients. These findings demonstrate the polymicrobial aerobic and anaerobic nature of peritoneal cavity and postoperative wound flora in children with perforated appendix, and demonstrate the presence of beta lactamase-producing organisms in three-fourths of the patients.     

单纯性附睾结核的诊治分析

目的:提高对单纯性附睾结核的诊治水平。方法:在35例附睾结核患者中通过尿路影像学检查无肾结核及尿抗酸杆菌检测阴性者,定义为单纯性附睾结核20例进行回顾性分析,均行强化抗结核治疗,即异烟肼(INH)、利福平(RFP)、链霉素(SM)或乙胺丁醇(EB)联合用药,2周后行病灶切除术,术中均行附睾结核病灶清除,术后继续常规抗结核治疗6～9个月。结果:随访6个月～5年,16例无异常情况,3例分别于术后3、3.5、5年出现泌尿系结核感染,1例于术后3.5年出现对侧附睾结核。结论:单纯性附睾结核可能为唯一或早期泌尿生殖系结核首发的表现,及时手术治疗,预后较好。