Undescended testicle: An update on fertility in cryptorchid men.

Cryptorchidism or undescended testis is one of the most common anomalies encountered in paediatric urology and is estimated to affect 1 to 4 per cent of full term and upto 30 per cent of preterm male neonates. The associated problems of sub-fertility or infertility and malignant transformation have been recognized for long. Fertility is impaired after both unilateral and bilateral cryptorchidism. The reported paternity rates in adults are about two-third for unilateral undescended testis and less than one-third for bilateral disease. Over the last five decades, the concepts related to cryptorchidism have changed dramatically as knowledge about its effects has accrued from research conducted worldwide. The recommended age of orchidopexy has fallen progressively from adolescence to less than one year. The realization that the infantile testes are not in a state of ‘suspended animation’ and the recognition of the defect in the androgen dependent transformation of gonocytes into adult dark spermatogonia in cryptorchidism have been recognized as the primary cause of sub-fertility in these patients. This has paved the way for hormone therapy in an attempt to simulate the ‘post-natal gonadotropin surge’ or ‘mini-puberty’. This review summarizes the current knowledge about the various factors affecting the fertility status in cryptorchidism with a particular focus on the derangements in the development and maturation of the germ cells and the role of surgery, hormone therapy and antioxidants in reversing these changes.

Managing immunisation waste in a tertiary healthcare facility.

Immunisation protects children and adults against harmful infections before they come into contact with them in the community. Immunisation is given as an injection or, in the case of polio vaccine, taken as drops by mouth. The waste generated during the whole immunisation process must be disposed off properly. Improper waste disposal leads to serious health risks to recipients, health workers and the public. In King George’s Medical University (KGMU) immunisation programmes are conducted regularly. Waste generated during the process are properly mutilated, collected, transported and disposed off. In KGMU a well established biomedical waste management system which disposed offs the waste as per the norms and legislation.

Retroperitoneal teratomas in children.

OBJECTIVE: This paper aims to highlight the clinical features, investigations and treatment of retroperitoneal teratomas condition. METHODS: 12 patients (8 females and 4 males, age range-2 months to 14 yrs) of retroperitoneal teratoma admitted to the department of Pediatric Surgery, King George Medical University, Lucknow between 1980 and 2004 were studied. Investigations included hematology, plain X-ray of the abdomen, intravenous urography, ultrasound, computerised tomography (CT) of the abdomen (after 1990, 8 patients) and serum alpha-fetoprotein assay (after 1991, 6 patients, preoperatively). All patients underwent surgery. Serum alpha-fetoprotein assay was used during follow-up to detect recurrence. RESULTS: Majority of the tumors were left pararenal in location. In two patients there was bilateral involvement. In all except one, the tumor could be excised easily preserving the kidneys. In one child with a massive cystic tumor with bilateral involvement, the tumor was marsupialised in the first stage and excised subsequently. One child died postoperatively, the other 11 children are well and there has been no tumor recurrence on follow-up. CONCLUSIONS: Retroperitoneal teratomas are uncommon lesions in children mostly arising in close relation to the kidneys. The majority are benign but complete excision is necessary for cure. Even large tumors with bilateral involvement of the retroperitoneum can be excised while preserving adjacent organs. Serum alpha-fetoprotein assay is a reliable method of detecting recurrence.

Nocardiosis in patients of chronic idiopathic thrombocytopenic purpura on steroids.

We present two cases of chronic idiopathic thrombocytopenic purpura (ITP) on prolonged steroid therapy who developed subcutaneous and brain abscesses due to Nocardia asteroides. The special diagnostic and therapeutic challenges encountered in the patients because of severe thrombocytopenia are being highlighted.

Eosinophilic fasciitis.

Eosinophilic fasciitis presents with skin thickening involving the extremities, and sparing the hands. Raynaud's phenomenon is usually absent. It can be precipitated by undue exertion and is characterized by eosinophilia and infiltration of skin and subcutaneous tissue by mixed inflammatory infiltrate including eosinophils. We present a young man who developed eosinophilic fasciitis following severe gymnastic activity.

Low levels of anti-histone antibodies in north Indian children with juvenile rheumatoid arthritis.

BACKGROUND & OBJECTIVES: Early onset pauciarticular disease with uveitis is distinctly uncommon in Indian children with juvenile rheumatoid arthritis (JRA). The occurrence of anti-histone antibodies (AHA) in serum is strongly associated with presence of uveitis. There is a paucity of information from India on the levels of AHA in patients of JRA. In this study, an attempt was made to evaluate the levels of IgG and IgM antibodies to histones in children with JRA in north India. METHODS: Serum samples of 148 children with JRA (84 boys, 64 girls) were collected. Clinical details including onset, symptoms and course of the disease in each patient were recorded. Detailed eye examination including slit lamp examination was done in all patients at presentation and yearly thereafter to rule out uveitis. The presence of antihistone IgG and IgM antibodies was studied by ELISA. Antinuclear antibodies (ANA) were measured by indirect immunofluorescence using HEP-2 cells as substrate at a screening dilution of 1:40. RESULTS: Of the 148 children, 54 had pauciarticular (12 early onset and 42 late onset), 64 polyarticular and 30 systemic onset disease respectively. ANA were present in two children. AHA were raised in 15 (10%) children, of whom 10 had IgM antibodies, 3 had IgG and 2 had both isotypes. None of the children with early onset pauciarticular disease had uveitis, ANA or AHA. INTERPRETATION & CONCLUSION: The low occurrence of AHA and uveitis in our subset of patients with JRA is in contrast to that reported from Western countries. The low occurrence is unlikely due to technical reasons as the antigen that has been used consistently showed significant binding to serum from patients with systemic lupus erythematosus (SLE). This is in accordance with the rarity of early onset pauciarticular disease and chronic uveitis in these patients. More studies from other parts of the country are required to validate this observation.

An unusual presentation of pulmonary echinococcosis.

A case of pulmonary hydatid disease presenting with right supraclavicular cystic swelling is being reported. Radiologically, the cyst had an extension into the chest wall with bony involvement in the form of destruction and thinning of the first and second ribs on the right side. The patient responded to albendazole therapy.

Bladder teratoma: a case report and review of literature.

A very rare case of Teratoma of the bladder in an eight year old girl is presented. The diagnosis was made on cyctoscopy and confirmed histopathologically. Complete excision was possible. No recurrence was seen at four years follow up. Only one such case has been reported in the literature and this is the first such case reported from India and Asian continent.

Inguinal herniotomy in children: a decade's experience.

We reviewed our experience with 1369 inguinal herniotomies in 1340 children performed over the last one decade. Different grades of surgeons were assigned work according to the complexity of cases. Except for the minor scrotal hematoma, other complications were hardly seen. Recurrences were seen in only 2 cases. Careful training and supervision of junior staff in the technique of inguinal herniotomy has led to results that compare favorably to those of specialized units in developed countries.