Beneficial effects of melatonin compared with allopurinol in experimental testicular torsion

Background/purpose

Several antioxidant agents such as allopurinol have been used to prevent ischemia-reperfusion (I/R) injury-induced tissue damage after experimental testicular torsion so far. The current study was designed to determine the effect of melatonin, which is a potent antioxidant agent, in preventing testicular damage following torsion.

Methods

Sixty prepubertal male Wistar-Albino rats were divided into 5 groups: control (C), torsion (T), torsion plus detorsion (TD), torsion plus allopurinol (200 mg/kg) plus detorsion (A), and torsion plus melatonin (50 mg/kg) plus detorsion (M). Left testes were rotated 720° for 6 hours. The torsed testes were detorsed. Detorsion time was 6 hours. In all groups, left orchiectomies were performed to determine the tissue levels of malondialdehyde (MDA) and histopathologic changes. Blood samples were taken to measure serum creatine phosphokinase (CPK) levels. The results were analyzed statistically.

Results

Serum CPK levels of groups A and M were found to be significantly lower than groups T and TD (P < .05). Tissue MDA levels in group M were statistically different from groups T and TD (P < .05). However, in groups A and T, MDA levels were similar (P > .05). The highest histologic grade was determined in group TD (3.8 ± 0.5). Histologic grade of group M was significantly lower than group TD (P < .001), but there was no histologic difference between testes of groups A and TD (P > .05).

Conclusions

These results have shown that melatonin treatment prevents I/R injury both biochemically and histopathologically, whereas allopurinol treatment prevents it only biochemically in experimental testicular torsion. Melatonin is a potent antioxidant agent more effective than allopurinol in preventing testicular I/R injury.     

The effects of short-interval postconditioning in preventing testicular ischemia-reperfusion injury in rats

Aim

Testicular torsion can lead to testicular damage. During reperfusion, tissue damage is more severe. The aim of this study was to investigate the protective effect of short-interval postconditioning and determine the optimal time of reperfusion for postconditioning.

Materials and Methods

Thirty-five adult male rats were divided into 5 subgroups: Sh (sham operated), TD (torsion + detorsion), PC5 (torsion + postconditioning 5 seconds), PC10 (torsion + postconditioning-10 seconds), PC20 (torsion + postconditioning 20 seconds). Torsion was created by rotating the left testis counterclockwise 1080° and the testis fixed to the scrotum with 3 sutures. Torsion was maintained for 4 hours. The testicular artery was visualized, and before detorsion of the testis, an atraumatic vessel clamp was applied to prevent reperfusion in all study groups. Then, detorsion of the testis was performed. In the TD group, the clamp was released just after detorsion; in the PC5 group, the clamp was released for 5 seconds and closed for 10 seconds (10 times); in the PC10 group, the clamp was released for 10 seconds and closed for 10 seconds (10 times); and in the PC20 group, the clamp was released for 20 seconds and closed for 10 seconds (10 times). Then, all testes were reperfused for a 1-hour period in all study groups. After this period, the rats were sacrificed, and the left testes were removed and evaluated histopathologically and biochemically. The Mann-Whitney U test was used for statistical analyses.

Results

Tissue malondialdehyde levels were 79.3 ± 10.6, 231.7 ± 102.3, 71.3 ± 12.6, 73.8 ± 13.7, and 124.3 ± 48.0 nmol/g tissue in the Sh, TD, PC5, PC10, and PC20 groups, respectively. Tissue malondialdehyde levels were significantly lower in the PC5 and PC10 groups (P < .05) compared to the other groups. However, mean histopathologic grade was lower in all postconditioning groups compared to the control group, but the difference was significant only in the PC5 group (P < .05).

Conclusion

We conclude that short-interval postconditioning can reduce reperfusion injury in ischemic tissue and the optimal mode of short-interval postconditioning is 5 seconds × 10 times. This technique seems easily applicable, and a similar technique may be used during testicular surgery.     

Dehydroepiandrosterone treatment attenuates reperfusion injury after testicular torsion and detorsion in rats

Purpose

We aimed to evaluate the effects of dehydroepiandrosterone (DHEA) on antioxidant enzyme activities, lipid peroxidation, and histopathologic changes in both testes after unilateral testicular torsion and detorsion.

Methods

Twenty-four adult male Sprague-Dawley rats were randomly divided into 4 groups (n = 6 for each group): sham operation, torsion/detorsion (T/D), T/D + vehicle, and T/D + DHEA. Three hours before detorsion, 50 mg/kg DHEA was given intraperitoneally to the T/D + DHEA group. Testicular ischemia was achieved by twisting the left testis 720° clockwise for 3 hours, and reperfusion was allowed for 24 hours after detorsion. In all groups, bilateral orchiectomies to determine the testicular tissue catalase (CAT) and superoxide dismutase activities and malondialdehyde (MDA) levels and histopathologic examination were performed.

Results

Compared with those from the sham group, CAT activities in the ipsilateral testis obtained from the T/D group were significantly lower and MDA levels were significantly higher (P < .05 for all).Administration of DHEA prevented increases in MDA levels and decreases in CAT and superoxide dismutase activities when compared to the T/D group. Specimens from the T/D and the T/D + vehicle groups had a significantly greater histologic injury than the specimens from the sham and the T/D + DHEA groups had (P < .01 for both).

Conclusions

The results suggest that DHEA may be a protective agent for preventing biochemical and histopathologic changes related to oxidative stress in testicular injury caused by testis torsion.     

Late hormonal function after testicular torsion

Introduction

Testicular torsion may be an important cause of male infertility. We aimed to investigate the late hormonal function in patients with testicular ischemia/reperfusion injury of the testis after orchidectomy or detorsion.

Methods

Twenty patients (mean age, 13.6 years) were prospectively evaluated at a mean of 5 years after testicular torsion. The serum follicle-stimulating hormone, luteinizing hormone (before and after gonadotropin-releasing hormone stimulation), testosterone, and inhibin B were measured. Fifteen age-matched adolescents without evidence of endocrine disease were used as controls for inhibin B values. Data are quoted as mean ± SEM.

Results

Twelve patients were treated with detorsion and orchidopexy, and 8 underwent orchidectomy. Serum follicle-stimulating hormone, luteinizing hormone, and testosterone were all within the reference range. Inhibin B levels were significantly reduced in the 2 groups compared with the controls (34.5 ± 5.2 vs 63.9 ± 12.8 pg/mL, P = .02), but were not significantly different between the orchidectomy group and the group that underwent detorsion (41.3 ± 9.7 vs 30.4 ± 5.9 pg/mL, P = .41).

Conclusion

Hormonal testicular function can be compromised after testicular torsion, although the type of surgery (orchidectomy or orchidopexy) does not seem to change the effect of this ischemia/reperfusion injury.     

Gradual detorsion of torsioned rat testis attenuates ischemia reperfusion injury

Aim

This study was designed to investigate effect of gradual detorsion on testicular ischemia reperfusion injury.

Materials and Methods

A total of 21 male rats were divided into 3 groups, each containing 7 rats. Torsion was created by rotating the left testis 720° in a clockwise direction. Group 1 underwent sham operation. Group 2 (sudden detorsion) served as a torsion/detorsion group, receiving 2 hours torsion and 2 hours detorsion. In group 3, 360° detorsion was done for 20 minutes after 720° torsion for 2 hours. Then, testis was done full detorsion for 100 minutes. At the end of the experiments (fourth hour), left orchiectomy was performed to measure the tissue levels of malondialdehyde (MDA), superoxide dismutase, and glutathione peroxidase and to perform histologic examination in testes.

Results

The MDA levels of testis tissues were significantly increased in the sudden detorsion group as compared with the sham group. We found decrease of the MDA level in gradual detorsion group, but it was not a statistically significant amount. Significant decrease was found in the superoxide dismutase and glutathione peroxidase activities in the sudden detorsion group as compared with the sham and gradual detorsion groups. Histologic examinations were in accordance with the testicular tissue MDA levels.

Conclusion

In the light of our biochemical and histopathologic findings, we can say that gradual detorsion has a trend to decrease the degree of testicular reperfusion injury in the rat torsion/detorsion model.     

Perinatal testicular torsion: a unique strategy

Background/Purpose

Perinatal testicular torsion (PTT) is defined as testicular torsion occurring prenatally or within the first 30 days of life. The aim of this study was to evaluate the data obtained from patients with PTT and propose principles of management based on clinical, surgical, and histologic findings.

Methods

A retrospective analysis of 27 boys seen between 1990 and 2005 with surgically documented PTT was conducted. Patients were divided into 2 groups: A, prenatal testicular torsion; B, postnatal testicular torsion. The presence of acute scrotal inflammatory signs defined the urgency to operate.

Results

There were 4 clinical pictures in group A: A1, patients with a nubbin testis (n = 3); A2, patients with a small and hard testis (n = 12); A3, patients with a normal-sized and hard testis (n = 8); and A4, patients with an acute scrotum (n = 2). Group B (n = 2) presented no sign after birth and later developed an acute scrotum. Surgical exploration and histologic examination showed clear signs of a long-standing testicular torsion in groups A1, A2, and A3 or a recent-onset testicular torsion in groups A4 and B. Only one testis could be salvaged (group B).

Conclusions

Clinical signs correlated very well with surgical and histologic findings and can define the need and the urgency to operate. Although testicular salvage rate is very low, the affected side always should be explored to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral testicular torsion.     

Protective effect of erythropoietin on torsion/detorsion injury in rat model

Purpose

The aim of the study is to investigate the effects of erythropoietin on torsion/detorsion injury in rats.

Methods

Forty rats were divided randomly into 5 groups: group I (sham, S), sham operation; group II (torsion/detorsion 1, T/D₁), 3 hours ischemia and 1 hour reperfusion; group III (torsion/detorsion 2, T/D₂), 3 hours ischemia and 48 hours reperfusion; group IV (erythropoietin 1, EPO₁), 3 hours ischemia, 1 hour reperfusion, and a single dose of EPO; and group V (erythropoietin 2, EPO₂), 3 hours ischemia, 48 hours reperfusion, and 2 doses of EPO. Malondialdehyde (MDA) and nitric oxide (NO) levels and activities of superoxide dismutase and catalase were measured. Tissue damage to ovarian tissue was scored by histologic examination. Data were compared among groups with parametric tests.

Results

The MDA levels in the S and EPO groups were significantly lower than the T/D groups (P < .001). Catalase and superoxide dismutase activities, and NO levels in the S and EPO groups were significantly higher than in the T/D groups (P < .05). Ovarian tissue damage in the S and EPO groups was significantly less than in the T/D groups (P < .05). Levels of all biochemical markers and ovarian tissue damage scores were similar among the S, EPO₁, and EPO₂ groups (P > .05).

Conclusion

Erythropoietin attenuates ischemia-reperfusion injury when given during the acute phase of ovarian torsion-detorsion in a rat model.     

Ethyl pyruvate reduces germ cell-specific apoptosis and oxidative stress in rat model of testicular torsion/detorsion

Purpose

Testicular torsion/detorsion (T/D) results in enhanced formation of free radical metabolites, which contributes to the pathophysiology of tissue damage. We investigated the protective effects of ethyl pyruvate (EP) against testis tissue damage in an experimental model of testicular torsion.

Methods

Sprague-Dawley rats were divided into 5 groups. In those animals that underwent T/D, right testes were rotated 720° for 1 hour. Group 1 control rats underwent sham operation. In group 2, the rats underwent T/D. The EP was prepared and injected in the form of Ringer's ethyl pyruvate solution. The rats in group 3, 4, and 5 received 2 doses of 20, 50, and 100 mg/kg EP (30 minutes before and after detorsion), respectively. The right testes of 6 animals from each group were excised 4 hours after detorsion for the measurement of lipid peroxidation, myeloperoxidase (MPO), and antioxidant enzymes activities. Germ cell apoptosis was determined in right testes of 8 animals per group 24 hours after detorsion. The epididymal sperm concentration and motility were evaluated 1 month after treatments.

Results

Germ cell apoptosis indices were significantly higher in group 2 compared with control group. The level of lipid peroxidation and MPO activity increased, whereas antioxidant enzymes activities decreased after T/D. Sperm count and motility were also reduced 1 month after T/D in group 2 rats. However, EP treatment at doses of 50 and 100 mg/kg significantly decreased the early apoptotic damage and improved long-term sperm count and motility. In the same dosing groups, we observed normalization of oxidant/antioxidant balance and decrement of MPO activity. However, administration of 20 mg/kg of EP conferred no protective effect.

Conclusions

Administration of Ringer's ethyl pyruvate solution (in appropriate doses) is protective against apoptotic tissue damage following testicular torsion and improves long-term testicular function. The antioxidant and anti-inflammatory properties of EP seem responsible for the protective effects. Our findings suggest this resuscitation solution as a possible substitute for fluid and electrolyte maintenance during surgical detorsion.     

Chemical sympathectomy by 6-OH dopamine during fetal life results in inguinal testis through altering cremasteric contractility in rats

Background/Purpose:

Androgens are proposed to influence testicular descent through modulating sympathetic tone. An experimental study was undertaken to evaluate the effects of prenatal chemical sympathectomy on testicular location associated with the alterations in contractile properties of cremaster muscles in rats.

Methods:

Time-mated pregnancies were started in 10 rats. Two groups, each receiving saline or 6-hydroxydopamine from day 15 to day 19 of intrauterine life were established. At 2 months of age, localization of testes were evaluated, cremaster muscles were removed, and contractile properties were studied. Twitch and tetanic contractions were recorded isometrically at 37°C. Effects of verapamil, isoprenaline, and L-NNA were investigated. Results were compared through analysis of variance (ANOVA), and P values less than .05 were considered to be significant.

Results:

Both testes of all male offspring in the control group (n = 19) were in the scrotum. Six offspring among 17 subjected to 6-hydroxydopamine had undescended testes. Treatment with 6-hydroxydopamine had no effect on force-frequency relationship of cremaster muscle strips. Cremaster muscles of rats exposed to 6-hydroxydopamine had lower sensitivity to voltage-sensitive Ca⁺⁺ channel blockade by verapamil (3 × 10⁴ mol/L; P < .05). These muscles displayed greater contractile response to isoprenaline (10⁻⁵ mol/L; P < .05) but not to nitric oxide synthase inhibition by N^ω-nitro-l-arginine. Alterations in contractile properties of the muscles did not differ according to localization of testes among rats subjected to 6-hydroxydopamine.

Conclusions:

Administration of 6-hydroxydopamine resulted in suprascrotally located testes. This localization has been associated with less exposure at sympathetic tonus. These findings support that sympathetic activity plays an important role in localization of testis.     

Autorevascularization of the testicle and spermatic vessels by bladder pedicle flap: an experimental study

Purpose

The aim of the study was to investigate revascularization of the testicle through its own tissue and spermatic vessels by a bladder pedicle flap in rabbits.

Methods

Thirty male rabbits were used in the study. In 10 animals, the Fowler-Stephens (FS) procedure was applied to the right testicles (FS group). The FS procedure and revascularization of the testicle by a bladder pedicle flap were applied to the right testicles in 10 animals (FSO group). No surgical procedure was performed in the control group. Scintigraphic study was performed 3 weeks after the high ligation procedure in the FS and FSO groups. Both testicles were evaluated by radionuclide scintigraphy in all the animals. Macroscopic testicle weights were evaluated. Testicular biopsy scores and mean seminiferous tubule diameters were determined in the histopathologic study.

Results

The testicular blood flow of the FSO group was better than the FS group (P < .05), but there was no statistically significant difference between the FSO and the control groups (P > .01). Testicle weights, testicular biopsy scores, and seminiferous tubule diameters in the FSO group were detected, and there was a statistically significant difference when compared with the FS group (P < .05) but not with the control group (P > .01).

Conclusion

We suppose that the surgical model of revascularization of the testicle through its own tissue and spermatic vessels by a bladder pedicle flap can be an alternative to the FS procedure in abdominal and high canalicular undescended testicles.     

Temporary stretch of the testicular pedicle may damage the vas deferens and the testis

Background/Purpose

The authors aimed to investigate the effects of temporary stretching of the spermatic cord, a commonly performed manipulation during inguinal surgery, on the vas deferens and the testis.

Methods

Forty adult male Wistar-Albino rats were divided equally into 4 groups. The right spermatic cord and testis were exposed via a transverse suprascrotal incision. In the study groups, a continuous horizontal stretch force was applied to the vas deferens and vessels in a distal direction for 60 seconds. In group 1 (G1) a 1.25-Newton (N), and in group 2 (G2) a 0.75-N stretch force was applied. Group 3 (G3) and group 4 (G4) served as sham and control groups, respectively. The animals were killed 28 days later. Sections of the vas deferens were examined histologically and their dimensions measured. Both testes were excised, weighed, and examined microscopically. Kruskal-Wallis test and Mann-Whitney U test were used to compare means in the different groups.

Results

The mean wall thickness of the vas deferens was 378 ± 133 μm in G1 and was significantly diminished compared to G2, G3, and G4, in which the mean wall thickness was 497 ± 142 μm, 500 ± 10 μm and 521 ± 95 μm, respectively (P < .05). The mean right testicular weights were 1.18 ± 0.10 g and 1.23 ± 0.17 g in G1 and G2, respectively, and each was significantly lower than in G3 (1.23 ± 0.09 g) and G4 (1.25 ± 0.08 g; P < .05). The mean right testicular weights showed no difference between G1 and G2 (P > .05). Necrosis was seen in the right testes in 50.0% and 42.9% of the animals in G1 and G2, respectively. No histopathologic alterations were observed in the vas deferens in all groups. Microscopic examination of the left testes was normal.

Conclusions

In an experimental animal model, temporary stretching of the spermatic cord resulted in significant thinning of the smooth muscle layer of the vas deferens and testicular atrophy.     

Protective effect of rutin on testicular ischemia-reperfusion injury

Purpose

The pathophysiology of testicular torsion-detorsion is an ischemia-reperfusion injury caused by overgeneration of reactive oxygen species (ROS). This study aimed to investigate the effect of rutin, a well-known antioxidant, on testicular ischemia-reperfusion injury.

Methods

Sixty male Sprague-Dawley rats were randomly divided into 3 groups, each containing 20 rats. Rats in the control group underwent a sham operation of the left testis. In the torsion-detorsion group, the left testis was rotated 720° for 2 hours. Rats in the treatment group received the same surgical procedure as the torsion-detorsion group, but rutin was administered intravenously at the time of detorsion. Bilateral orchiectomy was performed on half of the rats in each experimental group at 4 hours after detorsion for measurement of malondialdehyde, an indicator of intratesticular ROS content, and for evaluation of superoxide dismutase and catalase, which are endogenous antioxidant enzymes. Orchiectomy was performed on the remaining rats at 3 months after detorsion for analysis of testicular spermatogenesis.

Results

Unilateral testicular torsion-detorsion caused a significant increase in malondialdehyde level and caused significant decreases in superoxide dismutase, catalase activities, and spermatogenesis in ipsilateral testes. The rats treated with rutin had a significant decrease in malondialdehyde level and had significant increases in superoxide dismutase, catalase activities, and spermatogenesis in ipsilateral testes, compared with torsion-detorsion group.

Conclusions

Rutin protects testes from ischemia-reperfusion injury. The protective effect of rutin may be caused by scavenging ROS by increasing superoxide dismutase and catalase activities.     

Retractile testes: an outcome analysis on 150 patients

Background/Purpose

Retractile testes are testicles that can be brought down into their normal position in the scrotum but then immediately retract upward and out of the scrotum. The purpose of this study is to provide data on the outcome of pediatric patients with retractile testes.

Methods

A retrospective analysis was conducted on prospectively collected data on the outcome of 150 consecutive patients with retractile testis examined and followed up by one pediatric surgeon from April 1982 to April 1999, inclusive.

Results

Age at presentation was 5.2 ± 3.0 years, and follow-up duration was 3.8 ± 3.0 years. The number of retractile testes was 205, right-sided for 58 patients (38.6%), left-sided for 37 (24.6%), and bilateral for 55 (36.7%). Family history of retractile testis was positive in 8 patients (5.3%). Thirty-four patients required surgery (22.7%); indication for surgery was given when retractile testes ascended and became cryptorchid or if testicular size decreased during follow-up. Orchidopexy was required more frequently (P < .001) in patients with an associated hernia (68.8% of cases) than in patients without hernias (9.2%). One patient with spontaneous testicular descent during follow-up had a testicular carcinoma.

Conclusions

These findings suggest that the majority of patients (77.3%) with retractile testes have a spontaneously favorable evolution by 14 years of age and do not require surgical treatment. The authors report the first case of testicular carcinoma in a patient with retractile testis, and this indicates that these patients should be followed up even after testicular descent.     

Emotional-Type Psychopathologic Symptoms among Patients with Terminal Chronic Alcohol-Induced Liver Cirrhosis

Introduction

Patients with toxic substance abuse syndrome, such as alcohol abuse, have elevated psychopathologic morbidity and mortality such as mood disorders.

Objective

To evaluate the emotional-type psychopathologic symptoms in patients with alcohol-induced hepatic cirrhosis on the liver transplant waiting list.

Materials and methods

Patients with alcoholic liver cirrhosis who were candidates for liver transplant (n = 41) completed the SA-45 questionnaire (González y Cuevas; 88), which assesses nine dimensions: somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. A control group consisted of patients with chronic nonalcoholic terminal hepatopathies (n = 22).

Results

Seventy-six percent of patients had some kind of psychopathologic symptom compared to 68% of the patients in the control group with other nonalcoholic etiologies (P > .05). The emotional-type clinical symptoms were: (1) somatizations: 37% of patients with alcoholic cirrhosis had this type of clinical symptoms compared to 32% of the control group (P > .05); (2) obsessive-compulsivity: 56% versus 46%, respectively (P > .05); (3) interpersonal sensitivity: 19% versus 9%, respectively (P > .05); (4) depression: 54% versus 27%, respectively (P = .045); (5) anxiety: 59% versus 46%, respectively (P > .05); (6) hostility: 29% versus 5%, respectively (P = .021); (7) phobic anxiety: 10% versus 14%, respectively (P > .05); (8) paranoid Ideation: 7% versus 5%, respectively (P > .05); (9) psychoticism: 5% versus 4%, respectively (P > .05).

Conclusions

The patients with alcoholic liver cirrhosis on the liver transplant waiting list had elevated psychopathologic symptoms. Depressive- and hostile-type emotional alterations were most frequent in this type of patients.     

Protective effect of polyunsaturated phosphatidylcholine pretreatment on stress ulcer formation in rats

Purpose

The aim of this study was to investigate whether polyunsaturated phosphatidylcholine. (PPC) pretreatment has any protective effect on gastric mucosal damage induced by cold-restraint stress (CRS) in rats.

Methods

Forty swiss albino rats were divided into 3 groups. Group 1 (n = 10) was control, group 2 (n = 15) was stress ulcer, and group 3 (n = 15) was PPC-treated rats with stress ulcer. Stress ulcer was induced by the cold-restraint method for 4 hours at 4°C after a starvation period of 72 hours. In the group 3 rats, PPC treatment was started 10 days before stress at a dose of 100 mg/d by oral route. Rats were terminated, stomachs were excised. Macroscopic ulcer index (UI), gastric tissue malondialdehyde (MDA) and superoxide dismutase (SOD) activities, plasma total nitrite, and erythrocyte catalase (CAT) concentrations were assayed.

Results

Histopathologic examination showed a stress ulcer index of 0.12 ± 0.19 mm in the treatment group and 23.6 ± 8.97 mm in the stress ulcer group (P < .001). Tissue MDA and SOD concentrations were higher in the stress ulcer group than in the treatment group, the differences were statistically significant (P < .001). Plasma NO₃⁻+ NO₂⁻ levels were higher (P< .005) and CAT levels were lower (P < .001) in the nontreatment group. There were no significant differences with respect to Ul, MDA, and SOD levels among the control and treatment groups (P > .05).

Conclusions

These results suggest that pretreating rats with PPC inhibits cold-restraint stress-induced gastric mucosal injury and might be useful in preventing stress-induced stomach ulcers.     

Perioperative surgical findings in congenital and acquired undescended testis

Purpose

Perioperative surgical findings in congenital and acquired undescended testis (UDT) were prospectively assessed.

Methods

We included all boys with congenital or acquired UDT who underwent orchidopexy at our hospital between January 2006 and August 2009. Perioperatively, we scored the position and volume of the testis, the insertion of the gubernaculum, the patency of the processus vaginalis, and the obtained position.

Results

We included 69 boys (aged 0.9-14.6 years) with 76 congenital UDT and 28 boys (aged 2.2-18.5 years) with 30 acquired UDT. In the congenital group, the testis was in intracanalicular position in 55 cases (72%), whereas in the acquired UDT group, this was in 11 cases (37%; P < .001). The insertion of the gubernaculum was at the bottom of the scrotum in 13 cases (17%) of the congenital UDT group and in 12 cases (40%) of the acquired UDT group (P < .05). The processus vaginalis was open in 63 cases (83%) of the congenital and in 9 cases (30%) of the acquired UDT group (P < .001).

Conclusion

Compared to congenital UDT, acquired UDT are more likely to be situated in the superficial inguinal pouch, to have a normal insertion of the gubernaculums, and to have a closed processus vaginalis.     

Outcomes of intestinal failure—a comparison between children with short bowel and dysmotile intestine

Background

We investigated whether mortality, intestinal adaptation, and liver function differ between intestinal failure (IF) patients with either short bowel (SB) or bowel dysmotility (DM).

Patients and methods

Twenty-six consecutive patients with SB (n = 20) or DM (n = 6) treated between 2000 and 2007 were retrospectively assessed. Intestinal failure was defined as less than 25% of age-adjusted small intestinal length or dependence on parenteral nutrition (PN) more than 6 months.

Results

Median age-adjusted small intestinal length (17% vs 45%) and gestational age (35 vs 40 weeks) were (P < .05) shorter, whereas proportion of the remaining colon (86% vs 0%) was (P < .05) higher in the SB group relative to the DM group. Overall survival was 92%. Median peak serum bilirubin (80 vs 25 μmol/L) and rate of cholestasis (11/20 vs 0/6) were higher (P < .05) in the SB group. Short bowel rather than DM as an etiology of IF predicted weaning off PN (RR, 39.3; 95% confidence interval [CI], 1.43-526; P < .01) and development of cholestasis (risk ration [RR], 18.3; 95% CI, 0.658-127; P < .05). Three SB children developed liver failure and two died, whereas neither of these occurred in the DM group.

Conclusions

Children with SB are more likely to wean off PN but more prone to cholestatic liver disease than those with DM as an etiology of IF.     

Analysis of outcome in 298 extremely low-birth-weight infants with patent ductus arteriosus

Purpose

Indomethacin is accepted therapy for patent ductus arteriosus (PDA) in ELBW infants (<1000 g). We hypothesize that surgical ligation may provide comparatively superior outcomes in select ELBW infants.

Methods

Predischarge outcomes of 298 ELBW infants with echocardiography-proven PDA were retrospectively compared by treatment provided: no treatment (group 1, n = 54), indomethacin (group 2, n = 140), ligation (group 3, n = 46), and ligation after indomethacin failure (group 4, n = 58). χ² and Wilcoxon rank sum tests were used to test for significance. Institutional review board approval was obtained (IRB/05-00395).

Results

Group 3 had significantly lower gestational age (P < .001), birth weight (P = .006), and 5-minute Apgar scores (P = .03) compared with group 2. Group 3 and group 1 had a higher rate of pretreatment intraventricular hemorrhage (IVH) compared with group 2 (P < .001). By contrast, posttreatment complications including acute renal failure, necrotizing enterocolitis, thrombocytopenia, and IVH occurred more frequently in groups 2 (P = .004) and 4 (P = .001) compared with group 3. Survival was 57.7% in group 1 compared with groups 2, 3, and 4 (82.4%, 86.0%, and 92.7% respectively; P = .001). Preoperative conditions associated with nonsurvival include gestational age (P = .009), birth weight (P = .002), maternal preeclampsia (P = .015), 5-minute Apgar score (P = .013), and sepsis (P = .018). Posttreatment complications associated with nonsurvival include acute renal failure (P = .002), thrombocytopenia (P = .002), and necrotizing enterocolitis (P = .034). Survival was not influenced by any congenital comorbidity, pre- or posttreatment IVH, diameter of the PDA, or recurrence of the PDA after indomethacin therapy.

Conclusions

(1) Patent ductus arteriosis requires treatment in ELBW infants to maximize survival. (2) Indomethacin and surgical ligation permit equivalent survival in low-risk ELBW infants, but indomethacin results in a high failure and complication rate requiring operative salvage in a number of patients. (3) Surgical ligation permits survival of high-risk ELBW infants with a low complication rate and is preferable to indomethacin in ELBW infants with the above risk factors.     

Splenectomy leads to a persistent hypercoagulable state after trauma

Background

It was hypothesized that splenectomy following trauma results in hypercoagulability.

Methods

A prospective, nonrandomized, single-center study was performed to evaluate coagulation parameters in trauma patients with splenic injury.

Results

Patients with splenectomy (n = 30) and nonoperative management (n = 50) were enrolled. Splenectomy patients were older, had higher Injury Severity Scores, and had longer intensive care unit and hospital stays (P < .05). Splenectomy patients had significantly increased white blood cell counts and platelet counts at baseline and follow-up (P < .01). Fibrinogen was initially elevated in both groups and remained elevated in the splenectomy group (P < .05). Tissue plasminogen activator, plasminogen activator inhibitor-1, and activated partial thromboplastin time were higher in splenectomy patients only at baseline (P < .05). Baseline thromboelastography showed faster fibrin cross-linking and enhanced fibrinolysis following splenectomy (P < .05). Only clot strength was greater at follow-up in the splenectomy group (P < .01). Deep venous thrombosis developed in 7% of splenectomy patients and no control patients (P = .03).

Conclusions

A significant difference in deep venous thrombosis formation was noted, and coagulation assays indicated persistent hypercoagulability following splenectomy for trauma.     

The enhancing role of vitamin A deficiency on chemically induced nephroblastoma in rats

Purpose

Vitamin A plays an important role in the prevention of neoplasia. The occurrence of nephroblastoma, a common renal malignancy of childhood, is said to be closely correlated with retardation of differentiation of metanephric blastema. The aim of this study was to clarify the effect of vitamin A deficiency (VAD) in experimental nephroblastoma.

Methods

Sixty weaning outbred female Wistar rats weighing 40 to 50 g were injected with 0.35% dimethylhydrazine dihydrochloride (DMH) subcutaneously and divided into 2 groups. Animals were fed with diets containing vitamin A, normal diet (ND group; n = 30), and vitamin A-deficient diet (VAD group; n = 30). Serum concentrations of vitamin A on day 120 after DMH injection were assayed. The incidence of nephroblastomas in 2 groups was recorded. The renal tissues were prepared for morphological studies and WT1 messenger RNA (mRNA) detection on day 365 after DMH injection.

Results

The average serum concentrations of vitamin A in the ND group (2.60 ± 0.53 μmol/L) were significantly higher than that in the VAD group (0.51 ± 0.26 μmol/L, P < .05) 120 days after DMH injection. On day 365, the incidence of renal tumors in the VAD group (36.7%) was significantly higher than that of the ND group (13.3%, P < .05). Certain histological and ultrastructural features and WT1 mRNA expression patterns observed in these tumors showed that they had a resemblance to human nephroblastomas. Nephrogenic rests (NRs) could be seen in the adjacent normal renal parenchyma. The incidence of NRs in the VAD group (16.7%) was significantly higher than that in the ND group (3.3%, P < .05). The mutant WT1 mRNA expression levels in the VAD group (0.75 ± 0.11) were significantly higher than those in the ND group (0.24 ± 0.06, P < .05).

Conclusions

Vitamin A deficiency can increase development of nephroblastomas in rats, probably via a mechanism of elevated NR remnants and WT1 expression.