Torsion of undescended testis.

Torsion of an undescended testis is uncommon. When encountered, this entity represents a surgical emergency and must be dealt with immediately. A report of 2 cases, one in a five-month-old child and the other in a twelve-year-old mentally retarded child, is made and the pertinent literature is reviewed.     

Inter-observer reliability in the assessment of heterotopic ossification: proposal of a combined classification

We applied four published classifications for assessment of heterotopic ossification after total hip arthroplasty (Arcq, Brooker, DeLee and Della Valle [1, 2, 5, 6]. The average incidence of heterotopic ossification varied from 19.8% to 27.7%. The inter-observer reliability of the various classifications was determined by Cohens Kappa statistic. Kappa values ranged from 0.897 for Arcqs to 0.814 for Brookers classification. In order to increase the reliability and consistency, we propose a new classification system combining Brookers and Della Valles classifications. This new classification preserves the high reliability of Della Valles system and is comparable to previous publications since it includes Brookers criteria.

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Résumé Nous avons utilisé quatre classifications publiées pour lestimation des ossifications hétérotopiques après arthroplastie total de la hanche (Arcq, Brooker, DeLee and Della Valle [1, 2, 5, 6]. La fréquence moyenne de ces ossifications variait de 19,8 à 27,7%. La précision inter-observateurs des classifications a été déterminée par le kappa statistique de Cohen. Les valeurs Kappa ont varié de 0.897 pour Arcq à 0.814 pours la classification de Brooker. Pour augmenter la précision et la cohérence, nous proposons un nouveau système qui combine les classifications de Brooker et de Della Valles. Cette nouvelle classification conserve la haute précision du système de Della Valle et est comparable aux publications antérieures puisque elle inclut les critères de Brooker.

     

Inter-observer reliability of the Stulberg classification in the assessment of Perthes disease

Purpose  

Accurate and reliable radiographic classifications are of great importance as a basis of treatment decisions and prognosis in Perthes disease. The classification of Stulberg is widely used as a predictor of long-term outcome. The aim of the present study was to determine whether the Stulberg classification is sufficiently reliable for routine clinical use in the assessment of Perthes disease.     

Dermoid cyst in undescended testis in a 9-year-old boy.

Testicular dermoid cysts are rare in the pediatric age group: their discovery in an undescended testis is exceptional. The origin of this lesion is still unclear, but it should be considered as a monolayer expression of a mature teratoma. Though surgeons when confronted with these intratesticular cysts have traditionally opted for castration, in presence of small, compact masses, simple enucleation may be recommended, provided that the integrity of the neighboring parenchyma is not affected.     

Fatty metaplasia in a postpubertal undescended testis: a case report.

The first case of intratesticular fatty metaplasia in a postpubertal undescended testis is presented. Its differential diagnosis and etiology are discussed briefly.     

Inter-observer reliability of radiographic classifications and measurements in the assessment of Perthes' disease

We evaluated the inter-observer agreement of radiographic methods when evaluating patients with Perthes' disease. The radiographs were assessed at the time of diagnosis and at the 1-year follow-up by local orthopaedic surgeons (O) and 2 experienced pediatric orthopedic surgeons (TT and SS). The Catterall, Salter-Thompson, and Herring lateral pillar classifications were compared, and the femoral head coverage (FHC), center-edge angle (CE-angle), and articulo-trochanteric distance (ATD) were measured in the affected and normal hips. On the primary evaluation, the lateral pillar and Salter-Thompson classifications had a higher level of agreement among the observers than the Catterall classification, but none of the classifications showed good agreement (weighted kappa values between O and SS 0.56, 0.54, 0.49, respectively). Combining Catterall groups 1 and 2 into one group, and groups 3 and 4 into another resulted in better agreement (kappa 0.55) than with the original 4-group system. The agreement was also better (kappa 0.62-0.70) between experienced than between less experienced examiners for all classifications. The femoral head coverage was a more reliable and accurate measure than the CE-angle for quantifying the acetabular covering of the femoral head, as indicated by higher intraclass correlation coefficients (ICC) and smaller inter-observer differences. The ATD showed good agreement in all comparisons and had low interobserver differences. We conclude that all classifications of femoral head involvement are adequate in clinical work if the radiographic assessment is done by experienced examiners. When they are less experienced examiners, a 2-group classification or the lateral pillar classification is more reliable. For evaluation of containment of the femoral head, FHC is more appropriate than the CE-angle.     

Basic study of microsurgical orchidopexy for high undescended testis; assessment of clinical applicability.

An experimental microvascular surgical technique to bring an intraabdominal testis to the scrotum was used on rats and dogs. It appears that the method may be applicable to clinical cases in children.     

Plasminogen activator in cultured cells of human undescended testis.

To know the secretory potential of Sertoli cells in pubertal testes of males who underwent orchiopexy at a prepubertal age, the plasminogen activator (PA) activity of 12 patients was measured in vitro and compared with that of pubertal testes of patients with varicocele. The assay system for PA activity was based on the solubilization of 125I-fibrin in the presence of plasminogen, and the PA activity in each patient was obtained as the maximum increment with stimulation by ovine FSH in the culture medium of testicular cells. The mean value of PA activity in patients after orchiopexy was remarkably lower than that in varicocele patients (p less than 0.005), which corresponded with histological differences in spermatogenesis between the two groups. These results suggest that in comparison to those patients with varicocele, the patients with prepubertal undescended testis showed impaired potential for protein biosynthesis despite successful orchiopexy.     

Venographic localization of the non-palpable undescended testis in children.

In cases of bilateral non-palpable undescended testes in which human chorionic gonadotropin stimulation has shown the presence of testicular tissue and in cases of unilateral non-palpable undescended testes selective transfemoral gonadal venography with a modified Seldinger technique has been used for the preoperative localization of the non-palpable testis. since the undescended testis may be located anywhere along the course of its embryologic descent, that is from the level of the renal fossa to its exit from the inguinal canal, preoperative localization will aid in the surgical management. Gonadal venography has proved to be accurate and safe, and has aided in the determination of the extent of surgical exploration in 9 children with 12 non-palpable undescended testes (6 right and 6 left).     

Torsion of undescended testis in a man with Down''s syndrome

Undescended testis is one of the most common disorders in Down's syndrome. We present an extremely rare case of torsion of an inguinal undescended testis in a 35-year-old patient with Down's syndrome. Surgical exploration revealed a rotated gangrenous testis, radical orchiectomy was performed, and pathological examination confirmed the diagnosis of testicular torsion.     

Malformations of the epididymis in undescended testis

Epididymal abnormalities in undescended testes are probably more common than suggested in the literature but only sporadic reports are found on this subject. For many years discussions have centered around the ideal age to operate on patients with undescended testes and consequently increase chances for future fertility. We analyzed 66 patients (82 testes) treated for undescended testis in our department, with special distinction between ectopia and cryptorchidism. Abnormalities ranged from simple epididymal elongation to more complex forms, such as complete disruption between the testis and epididymis. Among 49 ectopic testes the epididymides of 19 (38.8%) displayed more severe abnormalities in addition to elongation, while 16 (32.6%) showed only an elongated epididymis and 14 (28.6%) were normal. Among the 33 cryptorchid testes 29 (87.9%) showed the more complex anomalies and elongation, 3 (9.1%) were normal and only 1 (3%) was elongated. Our results demonstrate a much higher incidence of complex epididymal abnormalities in cryptorchidism (p less than 0.001). Elongated epididymis may present problems for sperm maturation and transportation, although with no other associated abnormality most can be regarded as patent. In our theory cases of elongation plus other major abnormalities probably are associated with severe impairment in sperm maturation and hindered transportation, with the future intrascrotal or extrascrotal position of the testis or early surgical repair being of little importance in terms of fertility.     

Giant seminoma of undescended testis in down syndrome

A giant seminoma of undescended testis in a forty-one-year-old Japanese male with Down syndrome is reported as is a review of the literature. The relationship between Down syndrome and testicular cancer are discussed. To our knowledge this is the largest seminoma of undescended testis (weight 3,500 Gm) so far recorded.     

Natural course of acquired undescended testis in boys

BACKGROUND: Although orchidopexy is commonly performed for acquired undescended testis, therapy is still controversial. A prospective study on the natural course of acquired undescended testis in boys was initiated. METHODS: At present, the study includes 63 boys with 74 acquired undescended testes in whom treatment and follow-up has been completed. In 15 boys with 20 acquired undescended testes, orchidopexy was performed before the onset of puberty, mainly at the request of the parents. In the remaining 48 boys with 54 acquired undescended testes, the onset of puberty was awaited. Of these, four boys with four acquired undescended testes were lost to follow-up. RESULTS: In 42 of 50 boys the testis descended spontaneously at puberty with a testicular volume appropriate for age. In the remaining eight boys the testis failed to descend at puberty and orchidopexy was performed. CONCLUSION: The preliminary results of this study indicate that spontaneous descent at puberty commonly occurs in boys with acquired undescended testes, with testicular volume appropriate for age. It is suggested that surgical intervention before onset of puberty may not always be necessary in acquired undescended testis.     

The use of microsurgery in the treatment of the undescended testis.

An experimental method of orchidopexy for high inguinal or abdominal testes, in the dog, using microsurgical anastomosis of the testicular vessels to vessels of the thigh or inferior epigastric vessels, is described. Experimental results suggest that this is a feasible method of treatment of such testes. A clinical trial of the method has commenced.     

A simple alternative technique of orchiopexy for high undescended testis.

Medial displacement of the testicular vessels constitutes an important principle for a successful operation for high undescended testis. Prentiss's manoeuvre involving division of the fascia transversalis attempts to achieve this objective but has not found favour with surgeons because it is more invasive. A simple alternative procedure of rerouting the testicular pedicle behind the fascia transversalis is described. The technique has been reported earlier and this paper aims to illustrate the steps with the help of intraoperative photographs. This method serves as a fixation procedure owing to the 'button-hole' effect of a small pathway and may be combined with other techniques of scrotal fixation such as formation of a dartos pouch and suturing.     

Inflammatory myofibroblastic tumor of spermatic cord in undescended testis

Inflammatory myofibroblastic tumor (IMT) is an uncommon condition and only a few cases of IMT in the spermatic cord have been reported, with none associated with an undescended testis. We present the case of a man with an undescended left testis who had an IMT involving the spermatic cord. He was treated with surgery and no adjuvant therapy afterward. He was disease free at 2.5 years of follow-up. A brief discussion of the pathologic features and management of the condition is also provided.