Smoking and its association with cryptorchidism in Down syndrome / Associação entre tabagismo e criptorquidia na síndrome de Down

Summary Introduction: Cryptorchidism is a common and prevalent condition in patients with Down syndrome. Environmental factors, such as smoking, can be associated with malformations during fetal development. The study of the prevalence of cryptorchidism and its association with parental tobacco use in Down syndrome can contribute to alert health care professionals, patients and family members regarding the prevention of the harms caused by cryptorchidism and its possible predisposing factors. Objective: To evaluate the prevalence of cryptorchidism in Down syndrome and its association with maternal and paternal smoking. Method: Forty (40) patients of a public clinic specialized in Down syndrome were evaluated, using a semi-structured questionnaire for evaluation of antecedents and sociodemographic characteristics, as well as physical and complementary examinations. Results: Cryptorchidism was observed in 27.5% of the patients (95CI 15.98-42.96). Of these, 55% (5/9) were the children of mothers who smoked during pregnancy, and 19.35% (6/31) were the children of mothers who did not smoke during pregnancy (OR = 5.26 [95CI 1.06-25.41]; p=0.032). Similarly, paternal smoking was also observed in greater frequency among the parents of cryptorchid patients compared with subjects with descended testis, 63.36% (7/11) and 31.03% (9/29), respectively (OR = 3.89 [95CI 0.91-16.73]; p=0.060). Conclusion: The prevalence of cryptorchidism is high in patients with Down syndrome. We can show a strong association between smoking parents and the occurrence of cryptorchidism, especially when it comes to maternal smoking.

Resumo Introdução: A criptorquidia é uma condição comum e prevalente em pacientes com síndrome de Down. Fatores ambientais, como o tabagismo, estão associados a malformações fetais. A avaliação da prevalência do criptorquidismo e a associação com tabagismo dos pais na síndrome de Down podem contribuir para alertar os profissionais de saúde e familiares sobre a prevenção dos danos causados pelo criptorquidismo e os possíveis fatores predisponentes. Objetivo: Avaliar a prevalência de criptorquidismo na síndrome de Down e a associação com tabagismo materno e paterno. Método: Quarenta (40) pacientes acompanhados em um centro de referência para atendimento da síndrome de Down foram avaliados por meio de questionário semiestruturado para avaliação de antecedentes parentais e características sociodemográficas, bem como de exames físico e laboratoriais complementares. Resultados: Criptorquidia foi observada em 27,5% dos pacientes (IC95% 15,98-42,96). Nesses pacientes, o criptorquidismo foi encontrado em 55% (5/9) das crianças cujas mães fumavam e em 19,35% (6/31) daquelas cujas mães não fumavam (OR = 5,26 [IC95% 1,06-25,41]; p=0,032). Do mesmo modo, o tabagismo paterno foi observado com maior frequência entre crianças com criptorquidia, 63,36% (7/11) e 31,03% (9/29), respectivamente (OR = 3,89 [IC95% 0,91-16,73]; p=0,060). Conclusão: A prevalência de criptorquidismo é alta em pacientes com síndrome de Down. Podemos mostrar uma forte associação entre hábito tabágico dos pais e ocorrência de criptorquidismo, especialmente no caso de tabagismo materno.

Estudo retrospectivo de casos cirúrgicos de criptorquidismo equino no noroeste do Paraná / A retrospective study of surgical cases of equine cryptorchidism in northwestern Paraná

O criptorquidismo em equinos é uma afecção relativamente comum sendo caracterizada pela falha na descida de um ou ambos os testículos da cavidade abdominal para a bolsa escrotal.  O objetivo desta pesquisa foi obter dados clínico-cirúrgicos do criptorquidismo em cavalos determinando-se a frequência e distribuição da afecção com interesse na raça, idade, classificação da retenção e procedimento cirúrgico utilizado no tratamento. Para tanto utilizou-se dados do tratamento cirúrgico de 55 cavalos criptorquidas da região noroeste do Paraná, de variadas raças e idades. O acesso cirúrgico para orquiectomia nos criptórquios abdominais foi realizado através da laparotomia parainguinal direita ou esquerda seguida da remoção do testículo da cavidade e nos criptórquios inguinais, a gônada afetada foi removida por orquiectomia inguinal. O pós-operatório consistiu em ducha com água corrente e curativo diário da ferida cirúrgica e todos os animais foram mantidos no hospital veterinário por 14 dias. Concluiu-se que a frequência da afecção foi elevada em cavalos da raça Quarto de Milha, que totalizou 42 dos 55 casos atendidos e a forma mais frequente de criptorquismo observada nos animais desse levantamento foi a abdominal unilateral esquerda com 28 casos equivalendo à 50,9% de todos os animais.

Cryptorchidism in horses is a relatively common disease and is characterized by failure in the descent of one or both testicles theabdominal cavity to the scrotum. The objective of this research was to obtain clinical and surgical data of cryptorchidism in horsesby determining the frequency and distribution of disease with an interest in race, age , classification and retention of surgicalprocedure used to treat . For this we used data of surgical treatment of 55 horses cryptorchids the northwestern region of Paraná, of varying breeds and ages . Surgical access to the abdominal cryptorchid orchiectomy was performed through the right and leftfollowed by removal of the testicle cavity parainguinal or laparotomy and inguinal cryptorchid , the affected gonad was removedby inguinal orchiectomy . The postoperative course was to shower with running water and daily dressing of the wound and allanimals were kept at the hospital for 14 days . It was concluded that the frequency of the disease was high in race horses QuarterHorses , totaling 42 of the 55 treated cases and the most frequent form of cryptorchidism observed in animals of this survey wasthe unilateral abdominal left with 28 cases amounting to 50.9 % all animals.

Exposición prenatal a los plaguicidas organoclorados y criptorquidia / Prenatal exposure to organochlorine pesticides and cryptorchidism

Los productos en desarrollo y los niños son particularmente vulnerables a los tóxicos ambientales. Nuestro objetivo es determinar los niveles de plaguicidas organoclorados (HCB, ß-HCH, pp'DDT, op'DDT y pp'DDE) en lípidos séricos de madres de niños con criptorquidia y comparar los niveles con un grupo control de madres de niños con testículos descendidos. El grupo de los casos fue constituido por recién nacidos con diagnóstico de criptorquidia (n=41). El grupo control (n=41) se conformó por niños con testículos descendidos. A las madres de ambos grupos se les determinaron los niveles de plaguicidas organoclorados. La criptorquidia fue diagnosticada al nacimiento por neonatólogo. Residuos de plaguicidas organoclorados fueron encontrados en lípidos séricos de ambos grupos. Los niveles de la mediana (mgkg-1 en base lipídica) fueron mayores para los metabolitos pp'DDT (0.464 vs. 0.269) y ß-HCH (0.263 vs. 0.192) en el grupo con criptorquidia comparado con el grupo control. (p<0.01). Los niveles de los metabolitos pp'DDT y ß-HCH son mayores entre las madres de los recién nacidos con criptorquidia. Es posible que sustancias con efectos antiandrogénicos puedan producir disrupción endocrina y criptorquidia durante el desarrollo fetal.

Fetuses and children are more susceptible to the effects of environmental toxins. The objective of this article is to determine the levels of organochlorine pesticides (HCB, ß-HCH, pp'DDT, op'DDT and pp'DDE) in the serum lipids of mothers of newborns with cryptorchidism and compare the levels to a control group of mothers of newborns with descended testicles. The cases were composed of newborns with cryptorchidism (n=41), and the controls (n=41) newborns with descended testicles. Blood samples from both groups of mothers were used to determine the organochlorine pesticide levels. Cryptorchidism was diagnosed at birth by a neonatologist. The results showed that the organochlorine pesticide residues were found in the serum lipids of both groups of mothers. The median serum lipid levels (mgkg-1 lipid-based) were statistically higher for the metabolites pp'DDT (0.464 vs. 0.269) and ß-HCH (0.263 vs. 0.192) in the cryptorchidism group compared to the control group (p<0.01). It could be concluded that the levels of the metabolites pp'DDT and ß-HCH are higher among mothers of newborns with cryptorchidism. It is possible that substances with anti-androgenic effects could produce endocrine disruption, such as cryptorchidism, during fetal development.

Un caso de criptorquidia / A case of cryptorchism

Tomando como excusa un caso de criptorquidia, los autores describen la epidemiología, el pronóstico y las dos alternativas terapéuticas de esta condición clínica (quirúrgica y hormonal). Se explayan sobre la eficacia del tratamiento en términos de disminuir las principales complicaciones de la criptorquidia -infertilidad y cáncer testicular- y del mejor momento de instituirlos.

¿Existen relaciones entre los factores ambientales rurales y la salud reproductiva en la Pampa Húmeda Argentina? / Is there any relationship between rural environmental factors and reproductive health in the Pampa Humeda in Argentina?

La relación entre factores ambientales y salud es un hecho reconocido. La influencia de ambientes rurales sobre la salud reproductiva ha sido fehacientemente probada en diferentes regiones del mundo, tanto en la fauna como en humanos. En América Latina pocas investigaciones han sido realizadas en este campo. El presente proyecto se establece sobre la base de la describir las relaciones entre salud reproductiva y factores ambientales en poblaciones rurales, caracterizada por aspectos ambientales particulares. Tres variables han sido evaluadas: relación de nacimientos masculinos/femeninos; incidencia de malformaciones uro-genitales masculinas (hipospadias y criptorquidias); e incidencia de cánceres hormono-dependientes. Se seleccionaron cinco comunidades rurales de la Pampa Húmeda de Argentina, comparándose los datos obtenidos con medias nacionales. Los datos bio-médicos y las fuentes ambientales de riesgo fueron relacionados entre sí a través de un sistema de geo-referenciación. La relación de nacimientos no mostró significación. Las malformaciones presentaron una muy significativa incidencia. Los cánceres hormono-dependientes presentaron incidencia mayores a las medias nacionales, particularmente en algunas de las comunidades estudiadas. Se concluye que existe una relación entre condiciones de salud reproductiva y factores ambientales en esta región.

The relationship between environmental factors and health is well known. Rural environmental influences on reproductive health have been properly proved, both in animals and humans. In Latin America, few studies have been conducted in this area. The current project is based on the description of relationships between reproductive health and environmental factors in rural populations, characterized by specific environmental characteristics. Three variables were evaluated: male-to-female birth ratio, male urogenital malformations (cryptorchidism and hypospadias), and endocrine-related cancer incidence. Five rural communities in the Pampa Humeda in Argentina were selected, and the data were compared to the national mean. Biomedical data and environmental risk factors were correlated through a geographic information system. The ratio of male to female births did not show any differences. Malformations showed very significant differences. Endocrine-related cancers showed higher incidence rates compared to the national mean, particularly in some communities. In conclusion, there is a relationship between environmental factors and reproductive health conditions in this region.

[External genital anomalies in newborn babies]

External genital anomalies are common congenital anomalies, especially in male newborns. It seems that the incidence of these anomalies is increasing. Although the etiology of these anomalies is obscure in most cases, genetic and environmental factors have important roles. This study aimed to determine the types and frequency of these anomalies in newborn babies and to compare the results with those of a study which was conducted in the same hospital in 1991. In a descriptive analytic and cross-sectional study, all babies born March 2005 to February 2006 in Alzahra Hospital, Tabriz, were recruited. 6800 newborns consisting of 3475 [51.1%] boys and 3325 [48.9%] girls were studied. No anomaly was found in girl newborns, but 6.6% of boys had external genital anomalies. Undescended testis and hypospadias were first and second common anomalies. In comparison with the previous study, the frequency of anomalies was higher in preterm and low birth weight babies, babies of related parents and older mothers. The frequency of external genital anomalies had an ascending trend in the last decade. Low birth weight, preterm delivery, high maternal age, and related parents are risk factors for these anomalies

Association between testicular microlithiasis, testicular cancer, cryptorchidism and history of ascending testis

OBJECTIVE: To prospectively determine the prevalence of testicular microlithiasis in symptomatic patients who were referred for scrotal ultrasound examination and to evaluate the possible association of testicular microlithiasis with testicular cancer and other conditions such as cryptorchidism or history of ascending testis. MATERIALS AND METHODS: 391 men who were referred to our institutions between July 2002 and May 2005 for any type of symptoms from the testicles, underwent physical and scrotal ultrasound examination. The presence of testicular microlithiasis, the number of lesions and the involvement of both testicles in relation to the symptoms as well as the coexistence of other lesions were studied. RESULTS: Eighteen (4.6 percent) of 391 men enrolled into the study had testicular microlithiasis. Two out of the eighteen patients (11 percent) had concomitant testicular cancer, which was confirmed by pathological evaluation of the orchidectomy specimen. One of the patients with testicular microlithiasis presented a rising in biochemical tumor markers (LDH, and HCG) and underwent orchidectomy one year later. Five of the remaining 373 (1.3 percent) patients without microlithiasis were diagnosed with testicular cancer. Thirty six men reported having a history of ascending testis, but none of them was found with testicular cancer. Two cases of testicular torsion in a cryptorchid position had testicular microlithiasis, but the orchidectomy specimen (after surgery) was negative for testicular cancer. The correlation between testicular cancer and testicular microlithiasis found in our study was statistically significant (p < 0.05). CONCLUSION: There seems to be an association between testicular microlithiasis and testicular cancer.

Correlation the size of undescended testis with its location in various age groups

To assess the correlation of the size of undescended testis with its location in children of various age groups, peroperatively. Cross-sectional study. Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005. Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations [haemoglobin, ultrasound for location and size of testes] were performed. Patients were divided randomly into three age groups, group I [8 months - 2.5 years], group II [2.6 - 8 years], group III [8.1-13 years]. At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A [intra-abdominal], group B [intra-canalicular], group C [distal to superficial inguinal ring - pubic]. Where no testis was found, a separate group D was assigned. The size of undescended testis at different locations in various age groups was compared with reference to normal descended testicular size in the respective age group, for statistical significance. ANOVA test was used for intergroup comparison for the size of undescended testis and Student t- test was applied for comparison with reference to normal values of the size of testis. A total of 102 patients with undescended testis were included in the study. The total number of 107 testicular units were assessed. Group I had 28, group II, 41 and group III, 38 testes. There were 24 intra-abdominal, 68 intra-canalicular and 12 pubic in location. In 3 cases, no testis was found at exploration. We found no statistically significant difference amongst groups [p- value=0.090] between the size of the undescended testis at different peroperative locations. The size of undescended testis grew with the age as undescended testis of larger size were found in older age group as compared to younger age group. By applying Student t-test, we did not find statistically significant difference in relation to The size of undescended testis in various age groups in comparison to the reference of mean volume of normally descended testis in the respective age groups. Pre-pubertal size of undescended testis does not differ significantly from that of normal reference value of descended testis in relation to age and location. The ultimate size of the testis can only be assessed after puberty whether it is a normally descended or undescended testis

Inguinal hernias and genital abnormalities in young Jordanian males

This study was carried out to document the prevalence of inguinal hernia, hypospadias, undescended testis and varicocele in 3057 male applicants to the military wing of Mu'ta University in the south of Jordan. Age range was 17-20 years. A total of 250 men had one of the 4 conditions: 93 [3.0%] had inguinal hernia; 15 [0.5%] had undescended testis [26.7% bilateral]; 59 [1.9%] had hypospadias; 83 [2.7%] had varicocele [98.79% on the left side]. Prevalence of inguinal hernia and undescended testis were comparable with international prevalence rates, while the rate for hypospadias was higher and that for varicocele lower. A birth defects registration system would help in planning preventive and treatment strategies

Mathieu repair in distal penile hypospadias with or without stent

To compare the outcome of two techniques for repair of distal penile hypospadias: Mathieus repair with and without stent. Prospective observational descriptive study. Department of Paediatric Surgery, Mayo Hospital, Lahore from September 2000 to September 2002. Sixty boys were randomly assigned the two groups of thirty boys each. Detailed scrutiny of procedure done and analyses of the clinical outcome made prospectively. A total of sixty patients were treated in two separate groups. All the boys had Mathieus repair done for distal hypospadias. In group A stent/ indwelling catheter was used for 7-8 days while in group B no stent was used. Stratification was done using Chi square test. Median age was 4 years and most of them belonged to low socioeconomic class [61.6%]. A high percentage [48.3% were born to mothers of age ranging from 30-40 years. Sixteen [26.66%] patients had a family history of hypospadias. Only twelve mothers [2 0%] gave a positive history of drug intake in first trimester. Sixteen [26.66%] patients had associated anomalies of undescended testis / inguinal hernia. Twenty four [40%] patients were brought because of the abnormal appearance of the childs penis while their stream [21.66%] and dysuria [25%] were presenting complaints of two other major groups. Mathieus repair was done in all cases with group A. Thirty boys [50%] having a stent post operatively and the group B thirty boys [50%] were without stent. Total complications rate is 46.66% with group a showing eight cases [26.66%] and group B having twenty [66.66%] cases with compliec. Major complication in group B was urinary retention in eleven cases [36.66%] while no patient had retention in group A. overall twenty six [86.66%] in group A and twenty one [70%] in group B showed satisfactory results. Mathieus repair without stent has been advantage of shorter hospital stay but a fair proportion of patients [36.66%] having urinary retention calls for further studies on a larger scale

Gastroschisis: a ten year review

From 1983 to 1993, 30 cases of gastroschisis were managed at the Mayaguez Medical Center. Ninety percent of these patients underwent primary closure of their abdominal wall defect. Three of 30 patients (10%) required silastic or goretex silos with final closure in an average of 8 days. There was no sex predilection, the average birth weight was 2.4 kg and the mean gestational age was 36 weeks. Thirty percent had associated anomalies, the majority were intestinal atresia, and/or undescended testicles. Twenty one (70%) of infants were delivered vaginally. Nine children (30%) were delivered via cesarean section. Four cesarean sections were done solely after prenatal ultrasonic identification of gastroschisis. There was no improvement in hospital stay, complications, or days until enteral feeds were tolerated when vaginally delivered patients were compared to those born by c-sections. In seven patients mesh sheeting (Marlex) was used for closure of late hernia defects. The mean hospital stay was 50 days and the mean time to enteral feedings 20 days. All patients required postoperative mechanical ventilation for an average of 4 days. There was no mortality. Our data and review of the literature do not support gastroschisis prenatal diagnosis as a sole indication for cesarean section. Our data showed favorable prognosis for most babies. Primary fascial closure can be accomplished safely in the majority of patients. No single operative strategy is ideal for all patients, and treatment of individual defects should be tailored to the degree of visceroabdominal disproportion

Incidencia de criptorquidia e hidrocele en recién nacidos / Cryptorchidism and hydrocele in healthy newborn babies

Para determinar la incidencia de criptorquidia e hidrocele en niños y su correlación con la edad gestacional, peso, número de gestación y tipo de nacimiento, fueron estudiados niños menores de 24 horas de vida extrauterina, nacidos en un hospital general entre 1994 y 1996, en buenas condiciones físicas y sin evidencia de otra enfermedad. Los datos fueron recabados del expediente de la madre y el examen inguinoescrotal lo realizaron residentes que cursaban el segundo o tercer año de cirugía general. La significación estadística de las asociaciones se estableció mediantes X². De 2156 neonatos examinados fueron hallados 46 con criptorquidia (2.1 por ciento) y 54 con hidrocele (2.5 por ciento). La tasa de criptorquidia se incrementó significativamente (p<0.05) en los niños que al nacer pesaron menos de 2500 g (8.9 por ciento, en aquéllos con menos de 37 semanas de edad gestacional (7 por ciento) y en los primogénitos (3.1 por ciento). Las tasas de criptorquidia e hidrocele fueron también más altas en niños obtenidos por cesárea (3.3 por ciento 4.7 por ciento respectivamente) en comparación con los nacidos por vía vaginal (1.7 y 1.6 por ciento). El riesgo relativo de criptorquidia en recién nacidos con bajo peso fue de 4.7, de 3.7 para los prematuros, de 1.9 para los de primera gestación y de 1.9 para los nacidos con cesárea. El riesgo relativo de hidrocele para el nacimiento por cesárea fue de 2.9. Se concluye que la criptorquidia y el hidrocele no son hallazgos infrecuentes y deben ser especialmente buscados entre los primogénitos, los niños pretermino, con bajo peso al nacer y los obtenidos por cesárea

Prevalence of late orchidopexy is consistent with some undescended testes being acquired.

To diagnose the incidence of orchidopexy versus age over a 15-year period, a study was conducted of all patients discharged from a single institution for orchidopexy with reference to age during operation. The hypothesis drawn was that some boys have acquired UDT and therefore, will present late despite recommendations for early diagnosis and treatment. The study was conducted on patients from Royal Children's Hospital, Melbourne (1980-94). The results suggested that while the optimal age for management of congenital UDT has been lowered to one to two years of age by under-graduate education, the persistence of a significant number of older children undergoing surgery suggests that some UDT's are acquired. It also showed that the proportion of orchidopexies performed in infancy increased over the 15-year period while the proportion performed in late childhood remained constant.

Anomalias congênitas macroscópicas do epidídimo em crianças com criptorquia unilateral / Macroscopic congenital anomalies of the epydidymis in children with unilateral cryptorchidism

Em estudo caso-controle, com análise transversal, clínico-cirúrgica, verificou-se a incidência geral e a incidência dos grupos e dos tipos das anomalias congênitas macroscópicas do epidídimo (ACME) em crianças com criptorquia unilateral, correlacionando-as com a sua idade e cor, a lateralidade da criptorquia, a presença de hérnia inguinal/hidrocele associadas à criptorquia, a localizaçäo do testículo críptico e a representaçäo anatômica do conduto peritônio-vaginal. A casuística compöe-se de 95 crianças com criptorquia unilateral, com idade média de cinco anos e três mêses. O grupo-controle consta de 44 crianças do sexo masculino, com idade média de três anos e 11 meses, sem criptorquia, submetidas ao tratamento cirúrgico de hérnia inguinal/hidrocele. Durante o ato operatório, identificou-se a localizaçäo do testículo críptico, a representaçäo anatômica do conduto peritônio-vaginal, as anomalias congênitas macroscópicas do epidídimo, quando presentes, e confirmou-se o diagnóstico pré-operatório de hérnia inguinal/hidrocele. As ACME foram observadas em 59 crianças com criptorquia unilateral (62,1 ñ 9,74 por cento) e em apenas duas crianças do grupo-controle ( 4,5 ñ 6,19 por cento), sendo esta diferença estatisticamente significativa. A incidência geral das ACME é estatisticamente maior quando o conduto peritônio-vaginal estava aberto (67,5 por cento) que quando fechado ou ausente (33,3 por cento). A correlaçäo da incidência geral destas anomalias com a idade e a cor das crianças, a lateralidade da criptorquia, a presença de hérnia inguinal/hidrocele associadas à criptorquia, e a localizaçäo anatômica do testículo críptico näo têm significaçao estatística. As anomalias da fusäo testículo-epididimária constituem o grupo de maior frequência (71,2 ñ 11,5 por cento), seguido pela anomalia de alongamento do epidídimo (18,6 ñ 9,9 por cento) e pelas anomalias obstrutivas do epidídimo (10,2 ñ 7,7 por cento). As anomalias obstrutivas do epidídimo têm incidência estatisticamente maior na criptorquia esquerda (17,7 por cento) que na direita (0,0 por cento). Considerando-se a elevada incidência das ACME em crianças com criptorquia, é relevante pesquisá-las durante a orquiopexia, uma vez que o epidídimo anômalo teria participaçäo na etiologia da criptorquia e no prognóstico da futura fertilidade da criança, além de implicaçöes cirúrgicas durante o ato operatório da criptorquia.

Modificaciones bioquímicas en el suero de pacientes con criptorquidea / Biochemical alterations in serum of patients with cryptorchidism

Teniendo en cuenta que el criptorquismo es un factor de riesgo de malignidad testicular, fue estudiado el perfil isoenzimático de la fosfatasa alcalina sérica (FAL), en 42 pacientes con criptocardia unilateral o bilateral; los mismos fueron divididos en dos grupos, según que dicho perfil correspondiera al encontrado en dadores sanos (grupo A) o al de pacientes con alto riesgo de desarrollar cáncer (grupo B). En ambos grupos se efectuó el estudio de la actividad sérica de fosfatasa alcalina total (FAT), fosfatasa ácida total (FAcT), fosfatasa ácida prostática (FAcP), hexosaminidasa (Hex) y fracciones proteicas, comparándose los resultados con los obtenidos para el grupo C o control. Fue observado un incremento de la actividad de FAT en los grupos A y B, notándose niveles elevados de FAcT y FAcP en el 28,0% y 19,0% respectivamente, del grupo A y en el 43,0% y 25,0% del grupo B. La actividad de Hex presentó niveles elevados en el 50,0% y 63,6% de los grupos A y B respectivamente. La relación albúmina/globulinas estuvo disminuida en el 33,3% del grupo A y en el 85,0% del B, a expensas del incremento de las fracciones globulínicas y al descenso de albúmina. Los pacientes del grupo B generalmente no responden a la terapia hormonal ni quirúrgica, mientras los del grupo A sí. Los resultados sugieren la existencia de marcadas modificaciones en el metabolismo proteico, como asimismo en la actividad de algunas enzimas séricas en los pacientes criptorquídicos