MICROSURGICAL REPAIR OF THE ADOLESCENT VARICOCELE

Purpose

Since clinically apparent varicoceles may affect testicular volume and sperm production, early repair has been advocated. However, repair of the pediatric varicocele with conventional nonmagnified techniques may result in persistence of the varicocele after up to 16% of these procedures. Also testicular artery injury and postoperative hydrocele formation can occur after nonmagnified repair. The microsurgical technique has been successfully completed in a large series of adults with a dramatic reduction in complication and recurrence rates. We report our experience with the microsurgical technique in boys.

Materials and Methods

A total of 30 boys (average age 15.9 years) underwent 42 microsurgical varicocelectomies (12 bilateral). All patients had a large left varicocele. Indications for repair included testicular atrophy (size difference between testicles of greater than 2 ml.) in 20 boys, pain in 5 and a large varicocele without pain or testicular atrophy in 5. Six boys were referred following failure of conventional nonmicrosurgical techniques. All boys were examined no sooner than 1 month postoperatively (mean followup 12).

Results

Preoperative volume of the affected testis averaged 13.0 ml., and an average size discrepancy between testicles of 2.8 ml. was noted before unilateral varicocelectomy. No cases of persistent or recurrent varicoceles were detected, and 1 postoperative hydrocele resolved spontaneously. After unilateral varicocelectomy the treated testes grew an average of 50.1%, while the contralateral testes grew only 23%. Overall, 89% of patients with testicular atrophy demonstrated reversal of testicular growth retardation after unilateral varicocelectomy. In contrast, both testes showed similar growth rates after bilateral varicocelectomy (45% left testis, 39% right testis).

Conclusions

The meticulous dissection necessary to preserve arterial and lymphatic supply, and to ligate all spermatic veins in the pediatric patient is readily accomplished using a microsurgical approach, and results in low recurrence and complication rates. Rapid catch-up growth of the affected testis after microsurgical varicocelectomy suggests that intervention during adolescence is effective and warranted.     

Serum Oncogene Proteins in Hazardous-Waste Workers

Oncogene protein detection may be a valuable molecular epidemiologicalmarker of commitment to the carcinogenic pathway in worker populationsexposed to carcinogens. This paper reports the use of serumimmunoblotting with monoclonal antibodies to oncogene proteinsto screen hazardous waste workers with potential carcinogenexposure who employ state-of-the-art work practices and personalprotective equipment to minimize real exposures. Two individualsin this cohort were found to be trace positive for the ras oncogeneprotein in their serum, but this may have been due to theircigarette smoking. These results are contrasted to previousresults in hazardous waste workers with real workplace carcinogenexposures. Requests for reprints should be addressed to: Dr P. W. Brandt-Rauf, Director, Occupational Medicine, Division of Environmental Sciences, Columbia University School of Public Health, 60 Haven Avenue, B-1 Level, New York, New York 10032, USA     

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Abstract: Esthetic dentistry offers a myriad of opportunities for older adults wishing to improve their smile, oral function, and self-esteem. The challenge for dental professionals is to maintain oral health throughout the patient's lifetime, even through periods of dependence that may include residence in a nursing home. Dental professionals will have increasing opportunities to share their knowledge and expertise about the relation between oral health and overall health, with a variety of health professionals who care for the aging population.     

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After repeated, successful extradural injections in a parturient,the extradural catheter migrated into the subdural space. Theinjection of 3% chloro-procaine 10 ml resulted in an extensiveblock, which extended to the cranial nerves and paralysed therespiratory muscles. The position of the catheter tip was confirmedby fluoroscopy. Subdural injection should always be suspectedwhen tests for subarachnoid injection are negative, but an extensiveblock occurs gradually within 15–20 min. Respiration andcirculation should be supported until the block regresses.