ABSTRACT
Objective To study the clinical features, diagnosis and treatment of torsion of testes in newborn. Method Neonates who were diagnosed with neonatal testicular torsion and admitted to Shenzhen Children's Hospital from March 2008 to July 2018 were studied. The clinical data such as days in age, time of onset, clinical manifestations, time of ultrasound examination, characteristics of ultrasound examination, surgery time, surgical types, postoperative conditions, pathological findings, and follow-up results were retrospectively analyzed. Result A total of 12 infants with torsion of testes were enrolled. The average onset time was 2.9 d, ranged from 1～10 d. The time of onset was within 24 h after birth in six infants. The median duration from onset to seeing a doctor was 3.5 d, ranged from 2 h to 28 d. First manifestations being reported grammer were scrotal swelling or mass, including 7 cases on the left side and 5 cases on the right side. Among them, 9 cases were associated with redness or cyanosis of the scrotum. Ultrasound was characterized by the disappearance or significant reduction of testicular parenchymal blood flow signal, and the sensitivity of ultrasound was 100％. The average time from admission to operation was (2.1±1.1) h. All the 12 infants had orchiectomy,after necrosis of unilateral testicle was confirmed. Eight of them underwent contralateral test icular fixation. The average operation time was 46 min. There was no wound bleeding or infection postoperatively, and the average hospital stay was 6.4 d. The pathological features were blurred residual contour of the seminiferous tubule (9 cases) or the disappearance of the seminiferous tubule structure (3 cases). After 3 to 24 months of follow-up, no contralateral testicular torsion or atrophy was found. Conclusion The rate of testicular necrosis in children with torsion of testes is high. The newborn with scrotal swelling should be diagnosed promptly with color Doppler ultrasound. If necessary, surgical exploration should be performed in time.
ABSTRACT
Objective To investigate the effect of cold autologous blood cardioplegia and HTK solution on changes of superoxide dismutase (SOD) and Matrix metalloproteinase-2 (MMP-2) in infant coronary sinus vein blood,which underwent ventricular septal defect suture in extracorporeal circulation,in order to reveal their protective effect of autologous cold blood cardioplegia on immature myocardium.Methods Sixty cases with ventricular septal defect,aged less 1-year-old,were randomly divided into experimental group (n =30) and control group(n =30).Autologous cold blood cardioplegia was obtained on aortic blood before aortic root draw in extracorporeal circulation with K + concentration of 20 mmol/L and 4 ℃ temperature.The experimental group was used cold autologous blood cardioplegia as arresting and protecting cardioplegia,while the control group used HTK solution.Blood sample from coronary sinus and vein was obtained at immediately before aortic cross-clamping,1 minute and 15 minutes after aortic cross-opening.SOD and MMP-2 levels were determined by enzyme-Linked Immuno Sorbent Assay (ELISA).Results The levels of SOD and MMP-2 levels within the group,between the groups and interaction were significant difference (P ＜ 0.05).After aortic cross-opening,the level of SOD and MMP-2 of the experimental group and the control group were increased (P ＜ 0.05).Before aortic cross-clamping,The activity of SOD in experiment was(85.37 ± 16.82) mU/L,as same as that in the control group((91.51 ± 15.02) mU/L,P ＞ 0.05).The MMP-2 concentration was in experiment group was (362.29 ±29.52) μg/L,as same as that in the control group((372.32 ± 31.42) μg/L,P ＞ 0.05).At 1 minute after aortic cross-opening,there were significant differences regarding of SOD and MMP-2 levels between the both groups(SOD ∶ (106.97 ± 17.46) mU/L vs.(98.74 12.54) mU/L,P ＜ 0.05 ; MMP-2 ∶ (439.48 ± 51.62) μg/L vs.(465.49 ±48.83) μg/L,P ＜0.05) ;The same trend was seen at 15 minutes after aortic cross-opening in two groups in terms of SOD and MMP-2 level (SOD:(104.03 ± 12.63) mU/L vs.(97.94 10.87) mU/L,P ＜0.05; MMP-2:(390.16 ±45.63) μg/L vs.(425.21 ±48.24) μg/L,P ＜0.05).Compare to group B,arrhythmia incidence(x2 =8.223,P ＜ 0.05) and positive inotropic drug dependent degree was lower in group A (x2 =4.022,P ＜ 0.05).Conclusion The cold autologous blood cardioplegia could promote the release of SOD in immature myocardium and reduce the production of MMP-2,which has endogenous protective effect for the infant Imature myocardium.