Acquired Undescended Testis

We report an unusual case of a 22-year-old man who presented with the left testis spontaneously ascended to a non-scrotal position. The testis had been documented to be intrascrotal without any sign of up-migration when the man was 12 years old. On surgery, the cryptorchid testis was found to be located within the superficial inguinal pouch. The testis was atrophic with the spermatic cord too short. On dissection, a remnant string of the closed processus vaginalis was observed within the cord, and the distal end of the gubernaculum was abnormally attached to the fascia near inguinoscrotal junction. Histopathologic findings of the testis were that of the Sertoli-cell-only syndrome which may represent the end-stage of germinal cell hypoplasia, a pathologic sequela common in postpubertal undescended testis. We recommend 3 diagnostic criteria for the acquired undescended testis and emphasize that testicular descent should be confirmed in infancy and re-confirmed periodically through puberty by the health care physician. Our observations seem to support the theory that acquired undescended testis may be caused by a postnatal failure of the spermatic cord to elongate in proportion to somatic growth.     

男性不育伴睾丸微石症患者精液质量及睾丸血流分析

目的:探讨男性不育伴睾丸微石症患者的睾丸血流状况及其与精液质量相关参数之间的关系。方法:自2007年1月~2007年5月,对在我院就诊符合入选标准的男性不育症患者进行彩色多普勒检查及精液常规检查。结果:符合标准的患者共有88例,伴睾丸微石症17例(19.3%),其中符合经典型睾丸微石症(classic testic-ular microlithiasis,CTM)诊断标准者7例(8.0%),符合局限型睾丸微石症(limited testicular microlithiasis,LTM)者10例(11.3%)。CTM、LTM及阴性组3组间的发病年龄、双侧睾丸体积、双侧睾丸动脉阻力指数(RI)、精液量及其精子畸形率均无明显差异(P>0.05)。CTM组的双侧睾丸动脉峰值流速(PSV)及精子密度、精子活力均明显低于LTM组及阴性组(P<0.05),但在LTM组及阴性组间并无明显差异(P>0.05)。结论:睾丸微石症可能是造成不育患者精液质量下降的原因之一。     

Changes in the volume and histology of retractile testes in prepubertal boys

Testicular development was studied in prepubertal boys with retractile testes. Testicular volume, the diameter of the seminiferous tubules and the number of spermatogonia in the tubules were decreased in cases of unilateral retractile testis, when compared with values for the contralateral normally descended testis. On the other hand, in patients with a unilateral retractile testis and contralateral inguinal testis, there was no difference in the developmental parameters between the two testes. These results suggest that the retractile testis has developmental failures characteristic of a cryptorchid testis and therefore requires orchiopexy.     

蒙古族睾丸肿瘤35例临床分析

目的:提高对蒙古族睾丸肿瘤的诊断和治疗水平。方法:多中心回顾性分析1990年2月~2004年12月35例蒙古族睾丸肿瘤患者的临床资料。结果:主要症状为无痛性睾丸肿大或结节。平均延误诊断(40.03±53.45)周,16例(45.7%)延迟诊断6个月~5年。睾丸肿瘤病理类型:精原细胞瘤21例(60%),占生殖细胞瘤的67.7%(21/31),非精原细胞瘤10例(28.6%),恶性淋巴瘤2例(5.7%),神经纤维瘤和平滑肌瘤各1例(5.7%)。生殖细胞瘤I期22例,II期2例,III期5例。治疗手段以睾丸肿瘤根治性切除和放疗及化疗为主。随访29例睾丸恶性肿瘤患者2个月~10年,其中精原细胞瘤20例,3、5年生存率分别为95.0%、95.0%;非精原细胞瘤7例,3、5年生存率分别为57.1%、42.8%;2例恶性淋巴瘤患者,1例健在,1例化疗中。结论:本组蒙古族睾丸肿瘤患者精原细胞瘤比例高于一般人群,平均延误诊断时间较长。非精原细胞瘤患者3、5年生存率均低于精原细胞瘤患者。睾丸肿瘤知识的宣教和诊疗技术的提高,有助于改善睾丸肿瘤患者的疗效和预后。     

邻苯二甲酸二(2-乙基)己酯对小鼠胎鼠睾丸及睾丸引带的影响

目的:研究邻苯二甲酸二(2-乙基)己酯(DEHP)对小鼠胎鼠睾丸与睾丸引带形态结构及功能的影响,探讨隐睾发生的可能机制。方法:30只健康KM孕鼠随机均分为3组:空白对照组、玉米油对照组、DEHP组。DEHP组以剂量500mg/(kg.d)的DEHP灌胃作用于怀孕12～19d(GD12～GD19)的KM母鼠,观察DEHP对每胎胎鼠数、雌雄性胎鼠比例、雄性胎鼠体重、睾丸重量、睾丸引带形态结构、位置、睾丸到膀胱颈之间的相对距离(TBD)、颅侧悬韧带残留情况、引带内雄激素受体(AR)、雌激素受体(ER)、肌动蛋白、增殖细胞核抗原(PCNA)表达水平的影响。结果:DEHP对每胎胎鼠数、雌雄性胎鼠比例、雄性胎鼠体重无明显影响;DEHP可影响胎鼠睾丸重量及TBD;DEHP组睾丸均有一定程度的下降不全,睾丸引带形态结构无明显差异;光镜下见DEHP组睾丸生精小管、支持细胞存在明显的发育障碍,睾丸Leydig细胞明显增生;DEHP组睾丸引带AR阳性表达率降低(P<0.01)。结论:DEHP可通过抗雄激素效应导致睾丸引带功能障碍,使睾丸下降发生异常而诱导小鼠隐睾;同时造成睾丸Ser-toli细胞、睾丸Leydig细胞和生精细胞的发育障碍和功能改变。     

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。     

睾丸扭转(8例)的诊断和治疗

目的：报道睾丸扭转 ８ 例,结合文献讨论睾丸扭转的病因、临床表现、诊断和治疗。　方法：为增强对此病的认识,采用彩色多普勒超声（ Ｃ Ｄ）和放射性核素显像（ Ｒ Ｉ Ｓ）检查,并分析其诊断价值。　结论：应尽早手术探查和治疗。     

LH/hCG Responsive Adenylyl cyclase in Rat Testis and Testes from Testicular Feminized Male (Tfm) Rats and Mice: Desensitization by Homologous Hormone

Testes of testicular feminized (tfm) rats and mice, as well as of normal male rats contain an LH/hCG responsive adenylyl cyclase. Basal, as well as hCG stimulated activities were higher in tfm rats and mice than in normal rats. The presence of an LH/hCG responsive adenylyl cyclase in the testis of tfm rats and mice shows that the greatly elevated LH levels present in males having this syndrome, giving 80–90% reduction in LH//hCG receptors, do not cause an uncoupling of the remaining receptors from the adenylyl cyclase. It also shows that androgens are not essential for coupling of the LH/hCG receptors to the adenylyl cyclase.
Injection of 200 IU of hCG into adult normal rats and tfm rats caused, after 48 h, a complete loss of LH/hCG stimulated adenylyl cyclase, whereas the FSH responsive adenylyl cyclase in both animal preparations was maintained. Desensitization of the LH responsive adenylyl cyclase by hCG in normal rats, confirms previous studies showing lack of hCG stimulated cyclic-AMP secretion after a comparable dose of hCG in vivo. Similarly, hCG (50 IU) caused a transient loss of LH/hCG responsive adenylyl cyclase in tfm mice, with a complete disappearance of response after 24 h. At 48 and 72 h after injection of hCG the response gradually returned to normal. The fact that hCG caused a complete desensitization of the LH/hCG responsive adenylyl cyclase in both tfm rats and mice, proves that androgen receptor mediated events are not involved in hCG desensitization of the adenylyl cyclase in Leydig cells.     

A Comparative Study of the Effects of Non-Union of Testis and Epididymis and Cryptorchidism on Testicular Development and Spermatogenesis in the Rat

Malunion of testis and epididymis is a congenital anomaly of human undescended testicles which may be of considerable clinical importance. In an experimental model in rat the effects of early disconnection of testis and epididymis (16 days) on testicular development have been testis and puberty. The results are compared with corresponding effects of cryptorchidism and sham-operation. The testes were weighed, and the relative proportions of haploid, diploid and tetraploid cells were quantified by DNA flow cytometry. The histology was evaluated by light and electron microscopy. The non-union operated testes showed a close to normal weight development until about 40 days of age, whereafter a decline occurred. The progression of the maturation division was only slightly reduced at 30 and 37 days of age, but later the spermatogenesis was significantly inhibited. At 58 days of age the maturation division had practically ceased in non-union operated testes. In cryptorchid animals the onset and progression of maturation divisions were almost totally depressed, and only traces of haploid cells were seen in some specimens. The transient increase in tetraploid cells, reflecting primary spermatocytes seen at about 30 days during normal testicular development, was neither depressed in non-union operated nor in cryptorchid animals. This indicates that the major block in spermatogenesis in both situations is at the stage of the primary spermatocytes. At 58 days of age the testicular histology was similar in non-union operated and cryptorchid testicles with many tubular sections showing only Sertoli cells. Scattered and partly degenerated germinal cells were seen in some sections. No histological signs of increased intratubular fluid pressure were detected, suggesting that pressure atrophy is not decisive for the reduced spermatogenesis in non-union operated gonads.     

精索扭转的诊断及治疗研究（附54例报告）

目的：总结精索扭转的早期诊断及治疗方法,提高精索扭转的诊治水平。方法：对54例精索扭转患者的I临床资料进行回顾性分析。结果：对54例试行手法复位成功10例,失败3例;手术探查44例,20例予以保留睾丸,24例行睾丸切除,12例未行对侧睾丸预防性固定,随访有1例发生对侧精索扭转,32例行对侧睾丸预防性固定,未见精索扭转发生。结论：对本病应保持足够的警惕与认识,并通过详细地询问病史细致地体格检查,适当地辅助检和及时地手术探查来诊断本病;睾丸毁损与扭转的时间密切相关,延迟就诊是睾丸丢失的重要原因,临床高度怀疑时应及早手术探查。常规预防性固定健侧睾丸不是很必要。     

Seasonality in Endocrine and Exocrine Testicular Function of the Adult Rhesus Monkey (Macaca mulatta) Maintained in a Controlled Laboratory Environment

Testicular exocrine and endocrine function was monitored in adult male rhesus monkeys maintained for up to 4 years in a controlled environment isolated from seasonal changes in light, humidity and temperature and from female animals.
Marked circannual variations were found in both functions. Spermatogenesis and exocrine function were maximal in the autumn and winter months as indicated by histological studies and the measurement of testicular volume, frequency of spontaneous and provoked ejaculations and in sperm output. The serum level and metabolic clearance rate and production rate of testosterone were also maximal during this period as were the serum concentrations of dihydrotestosterone, cortisol and biologically active luteinizing hormone. By contrast the serum prolactin and dehydroepiandrosterone levels showed an inverse pattern, achieving their highest levels in spring, during the period of reduced testicular function.
Since such marked circannual variations in testicular and pituitary functions persist in monkeys isolated from external environmental influences, the existence of an inherent regulatory mechanism can be postulated. Such distinct variations in testicular function must be taken into consideration when using the male rhesus monkey as an experimental model for human reproductive function.     

Bone Mineral Density and Muscle Strength in Young Men with Mental Retardation (With and Without Down Syndrome)

The objective of this study was to compare the bone mineral density (BMD) of men with Down syndrome (DS) to otherwise mentally retarded (MR) men and to investigate whether leg muscle strength of these patients is related to BMD. Two groups with MR (with and without DS) participated in the study, having met the following criteria: similar age, moderate to mild mental retardation, Tanner stage V of sexual development, similar age of beginning to walk, and equal motor activities. The DS group consisted of 8 men 23.9 ± 4.2 years, and the MR group without DS consisted of 8 men 23.5 ± 3.6 years. The two groups were compared with 10 sedentary students of the same age range (25.9 ± 2.9 years) attending our University. The BMD of the 2^nd to 4^th lumbar vertebrae was measured in the PA projection and the mean density was expressed as g/cm². The isokinetic muscle strength of the right quadriceps femoris and hamstrings muscles was measured on a Cybex II isokinetic dynamometer. The value measured was peak torque at angular velocities at 60, 120, and 300°.sec⁻¹. The results showed that BMD in DS individuals versus young adults (reference group of the scanner) was lower at the 26% level (T-score − 2.66 ± 0.29) and significantly lower (P= 0.002) than that of the MR group. Significantly different muscle strength was observed between the DS and non-DS MR group (in quadriceps at 300°.s⁻¹: P < 0.01, at 120 and 60°.s⁻¹: P < 0.05; in hamstrings at 300°.s⁻¹: P < 0.05). Higher differences in muscle strength were found between MR and control men, but no significant difference existed in BMD between them. Bivariate correlation showed that quadriceps strength significantly predicted the BMD in the DS patients. Active lifestyle and increased physical exercise to improve muscular strength should be instituted to avoid the development of osteoporosis in DS patients. Received: 22 July 1998 / Accepted: 30 September 1999