Presentación atípica de histoplasmosis diseminada / Atypical presentation of disseminated histoplasmosis

La histoplasmosis es una micosis sistémica producida por una variedad de hongo dimorfo perteneciente al complejo Histoplasma capsulatum. Es una enfermedad prevalente en nuestro medio y sobre todo en pacientes viviendo con HIV con recuento de <200 linfocitos CD4/ml y con cargas virales mayores a 100.000 copias/ml. La presentación de la forma diseminada raramente suele afectar al aparato reproductor; siendo la forma más frecuente pulmonar

Chronic exposure of bisphenol S (BPS) affect hypothalamic-pituitary-testicular activities in adult male rats: possible in estrogenic mode of action

BACKGROUND@#The industrial revolution has resulted in increased synthesis and the introduction of a variety of compounds into the environment and their potentially hazardous effects have been observed in the biota. The present study was aimed to evaluate the potential endocrine-disrupting effects of chronic exposure to the low concentrations of bisphenol S (BPS) in male rats.@*METHODS@#Weaning male Sprague-Dawley rats (22 days old) were either exposed to water containing 0.1% ethanol for control or different concentrations of BPS (0.5, 5, and 50 μg/L) in drinking water for 48 weeks in the chronic exposure study. After completion of the experimental period, animals were dissected and different parameters (hormone concentrations, histology of testis and epididymis, oxidative stress and level of antioxidant enzymes in the testis, daily sperm production (DSP), and sperm parameters) were determined.@*RESULTS@#Results of the present study showed a significant alteration in the gonadosomatic index (GSI) and relative reproductive organ weights. Oxidative stress in the testis was significantly elevated while sperm motility, daily sperm production, and the number of sperm in epididymis were reduced. Plasma testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) concentrations were reduced and estradiol levels were high in the 50 μg/L-exposed group. Histological observations involved a significant reduction in the epithelial height of the testis along with disrupted spermatogenesis, an empty lumen of the seminiferous tubules, and the caput region of the epididymis.@*CONCLUSION@#These results suggest that exposure to 5 and 50 μg/L of BPS for the chronic duration started from an early age can induce structural changes in testicular tissue architecture and endocrine alterations in the male reproductive system which may lead to infertility in males.

Antioxidant action of alpha lipoic acid on the testis and epididymis of diabetic rats: morphological, sperm and immunohistochemical evaluation

ABSTRACT Introduction Chronic hyperglycemia is caused by diabetes mellitus-committed genital morphophysiology, and oxidative stress is one of the main factors involved in this process. Alpha lipoic acid (ALA) can prevent metabolic and morphological changes in diabetic individuals. Objectives In present study, we evaluated the effects of regular ALA consumption on the spermatogenesis and histoarchitecture in the male genital system of diabetic rats. Materials and Methods Thirty-two Wistar rats were divided into groups: Control (CG); Diabetic Control (DCG), receiving commercial diet: ALA Group (ALAG) and Diabetic ALA Group (DALAG), fed diets with added ALA (300 mg/Kg bw). The diabetic groups received a single injection of streptozotocin (60 mg/kg). After sixty days of the diet, the animals were euthanized, and semen, testis and epididymis samples were collected. A histomorphometric analysis was performed to determine the epithelial height, tubular and luminal diameter, tubular and luminal area of seminiferous tubules and each epididymal region. Sertoli cells were evidenced using the antivimenti antibody and were quantified. The results were statistically analyzed by the ANOVA test. Results At the end of the experiment, the DALAG glycemia was significantly lower than DCG. The histomorphometric parameters of the seminiferous and epididymal tubules did not show improvement in the DALAG. However, there was an improvement in the DALAG in terms of the concentration, motility and percentage of spermatic pathologies, as well as in the number of Sertoli cells (p<0.001). Conclusions The results demonstrated that supplementation with the ALA antioxidant retards testicular lesions and preserve the process of spermatogenesis in diabetes.

Does total testicular volume predict testicular volume difference in adolescent males with varicocele?

ABSTRACT Introduction: We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described. Materials and Methods: We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were created for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies. Results: 209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05). Discussion: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent population. We looked at the direct relationship between low TTV and high TVD. In our population, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations. Conclusions: Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele, despite their reported independent associations with impaired fertility in other studies.

Nivel de información sobre el síndrome de declinación de la función testicular en el envejecimiento masculino / Level of information on the declining testicular function syndrome in male aging

Introducción: el síndrome de declinación de la función testicular del hombre que envejece ha cobrado relevancia reciente, pero se asume que se conoce poco. Objetivo: identificar el nivel de información, en población y proveedores de salud, sobre este síndrome. Métodos: estudio descriptivo transversal, que involucró a 452 personas de población general, 109 médicos especialistas afines al tema y 406 de atención primaria. Se emplearon cuestionarios autoadministrados, estadísticas descriptivas y prueba chi2. Resultados: de la muestra poblacional 70,30 por ciento de las mujeres y 56,0 por ciento de los hombres reconocieron que el hombre experimenta un proceso equivalente al climaterio femenino; 64,04 por ciento no conocía los síntomas y 47,12 por ciento de los hombres mayores de 40 años señalaron edad de comienzo superior a la suya. De los especialistas afines, solo 10 habían oído hablar de todos los términos que se emplean para referirse al síndrome, 77,06 por ciento habían escuchado frecuentemente andropausia y 70,65 por ciento climaterio masculino; 27,52 por ciento dio definiciones incorrectas. De atención primaria, 28,57 por ciento no reconoció ningún término, 21,18 por ciento había escuchado frecuentemente andropausia y 19,95 por ciento climaterio masculino; 51,7 por ciento no definió correctamente el síndrome. El 74,14 por ciento no mencionó síntomas, 76,85 por ciento señaló contraindicaciones excesivas al tratamiento y 85,22 por ciento valoró su conocimiento como insuficiente. El nivel de información no se relacionó con edad, sexo o tiempo de graduado (p> 0,05). Conclusiones: la población, principalmente las mujeres, reconoce el síndrome, pero no domina sus manifestaciones. En médicos, con independencia de la edad, sexo o tiempo de graduado, la información se limita mayoritariamente a términos como andropausia y climaterio masculino; el dominio conceptual, del cuadro clínico y tratamiento, es insuficiente(AU)

Introduction: declining testicular function syndrome of the aging man has gained recent relevance but it is accepted that little is known about it. Objective: to find out the level of information of the population and of the health providers on this syndrome. Methods: cross-sectional and descriptive study involving 452 people from the general population, 109 medical specialists related to this topic and 406 primary care physicians. Self-administered questionnaires, summary statistics and chi-square test were all used. Results: in the population sample, 70.30 percent of women and 56 percent of men admitted that man experiences a process similar to the female climaterium; 64.04 percent did not know the symptoms and 47.12 percent of men older than 40 years stated that this process occurred at an age above that of theirs. As to the related specialists, just 10 had heard about all the terms used to mention this syndrome, 77.06 percent had often heard the term andropause and 70.65 percent the term male climaterium, and 27.52 percent gave incorrect definitions. In the primary health care physician group, 28.57 percent did not recognize any term, 21.18 percent had frequently heard about andropause and 19.95 percent about male climaterium, and 51.7 percent did not give a correct definition of the syndrome. In the sample 74.14 percent did not mention any symptom, 76.85 percent pointed out excessive treatment contraindications and 85.22 percent assessed their knowledge as poor. The level of information was not associated to age, sex or time of graduation (p> 0.05). Conclusions: the population, mainly women, recognizes the syndrome but did not know well the symptoms. Regardless of age, sex or time of graduation, the physicians' information about the syndrome is mostly limited to terms such as andropause and male climaterium but they did not master the concept, the clinical picture or the treatment(AU)

Scrotal pain: Evaluation and management

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.

Hypothalamic-pituitary-gonadal function in men with liver cirrhosis before and after liver transplantation / Função do eixo hipotálamo-hipófise-gonadal em homens cirróticos antes e após o transplante hepático

Objective: To evaluate the influence of end-stage liver disease and orthotopic liver transplantation in the pituitary function and hormone metabolism before and after liver transplantation. Methods: In a prospective study, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) of 30 male patients with cirrhosis were determined two to four hours before and six months after liver transplantation. The results were compared according to the Model for End-stage Liver Disease (MELD). Results: male patients with liver cirrhosis have hypogonadism. FSH was normal, but inappropriately low due to androgen failure; E2 and PRL, on their turn, were high. After liver transplantation, FSH and LH levels increased (p < 0.05), whereas E2 and PRL normalized (p < 0.05). The MELD score did not influence changes in FSH, PRL and LH, however, the more severe the cirrhosis was, the more significant was the normalization of E2 (p = 0.01). Conclusion: Patients with cirrhosis and male hypogonadism have inappropriately normal levels of FSH and LH, associated with an increase in E2 and LRP. After liver transplantation, FSH and LH increased, while E2 and PRL returned to normal. Changes in E2 levels were most pronounced in patients with MELD > 18. The severity of cirrhosis had no influence on FSH, PRL and LH. .

Objetivo: avaliar a influência da doença hepática terminal e do transplante hepático ortotópico na função hipofisária e no metabolismo hormonal através da aferição dos níveis séricos dos hormônios folículo estimulante (FSH), hormônio luteinizante (HL), estradiol (E2) e prolactina (PRL) antes e após o transplante hepático. Métodos: em um estudo prospectivo, níveis séricos dos hormônios folículo estimulante (FSH), hormônio luteinizante (HL), estradiol (E2) e prolactina (PRL) de 30 paciente masculinos com cirrose foram determinados duas a quatro horas antes e seis meses após o transplante hepático. Os resultados foram comparados de acordo com o Model for End-stage Liver Disease (MELD). Resultados: acientes masculinos com cirrose hepática apresentam hipogonadismo. O FSH encontravam-se normais, porém inapropriadamente baixos devido à falência androgênica; já o E2 e o PRL estavam elevados. Após o transplante hepático, os níveis de FHS e HL aumentaram (p < 0,05), enquanto o E2 e o PRL normalizaram (p < 0,05). O MELD não influenciou as alterações no FSH, HL ou PRL, todavia, quanto mais grave a cirrose, mais significante foi a normalização do E2 (p=0,01). Conclusão: pacientes masculinos com cirrose e hipogonadismo apresentam níveis inapropriadamente normais de FSH e HL, associados com elevação do E2 e PRL. Após o transplante hepático, FSH e HL aumentaram, enquanto E2 e PRL retornaram aos valores normais. As alterações nos níveis de E2 foram mais pronunciadas em pacientes com MELD > 18. A gravidade da cirrose não teve influência no FSH, HL e PRL. .

Testicular biohistochemical alterations following experimental varicocele in rats

The exact pathophysiology of testicular degeneration, following varicocele has not been completely understood yet. The current study was designed to determine the effect of varicocele on germinal epithelium [GE] cytoplasmic biohistochmical alterations. To follow-up this study, left varicocele was induced in test groups. Non-varicocelized rats were served as control-sham [n=6]. Following 4, 6 and 8 months, right and left testes were dissected out and the blood serum sample was taken. The GE cytoplasmic carbohydrate, lipid accumulation, lipase and alkaline-phosphates [ALP] ratios were analyzed. Serum levels of LH, FSH and testosterone were measured. Observations demonstrated that in varicocele-induced rats, the spermatogenesis cell lineage exhibited lower number of cells with periodic acid shift positive cytoplasm, higher number of cells with lipid and ALP positive stained cytoplasm in comparison to control animals. Lipase enzyme decreased by the time in the test animals. In varicocelized groups the number of Leydig cells decreased in to 2.25 +/- 0.41 and 1.16 +/- 0.75 per one mm[2] in left and right testicles respectively after 8 months, and these cells demonstrated an ALP positive feature. In test groups, the serum levels of LH and FSH reduced into 1.12 +/- 0.01 and 2.03 +/- 0.05 ng/ml respectively after 8 months. Although testosterone level diminished by the time in the test animals, and this decreasing was significant [p=0.031] after 8 months [3.08 +/- 0.10 ng/ml]. Our results suggest that following varicocele induction major alterations occur in GE, which may lead to loss of GE cells physiological function and ultimately result in fertility problems

Chronology of meiosis & synaptonemal complex abnormalities in normal & abnormal spermatogenesis.

Background & objectives: The study was taken up to define criteria of normality for meiosis by assessing the frequency of meiotic prophase cell types, the frequency of pachytene substage in normal and abnormal spermatogenesis and to determine what synaptonemal complex. Methods: A quantitative and qualitative analysis of the first meiotic prophase was performed in 10 patients presenting with non-obstructive infertility and 10 controls, using dual colour immunocytochemistry with SCP3 and BRCA1 which visualise axial elements and synaptonemal complexes (SC). The respective frequencies of the leptotene, zygotene and pachytene stages as well as the frequencies of the four substages of pachytene were evaluated. The frequencies of the main types of meiotic abnormalities at pachytene were also assessed. Results: The frequencies of leptotene and zygotene stages were significantly higher in patients (7.95 and 9.75%) than in controls (2.30 and 1.45%), whereas the frequency of pachytene was significantly higher in controls than in patients (96.25 vs. 75.30%). Detailed analysis of the sex chromosomes revealed that the controls showed a presence of late pachytene substages (P3 + P4 = 64.40%), whereas the patients showed a early pachytene substages (P1 + P2 = 63.40%). From these results, a new index was defined to evaluate spermatogenesis: the Pachytene Index, or PI (PI = P1 + P2 / P1 + P2 + P3 + P4). The same abnormalities (asynapsis, fragmented SC, dotted SC, thin SC) were observed in controls and in patients, but with different frequencies. The most frequent abnormality was fragmented SC, with a significant difference between patients and controls (15.28 vs. 9.74%). There was a significant difference between patients and controls for the frequency of asynapsed nuclei (7.97 vs. 2.95%) while the difference in other abnormalities were not significant. Interpretation & conclusion: The accumulation of early primary spermatocytes is an indication that progression of meiosis is defective in spermatogenesis failures. The value of the PI less than 0.50 indicates that the kinetic of meiosis is normal at pachytene. There is no normal spermatogenesis when the frequency of one or several SC abnormalities is significantly higher than in controls and/ or when the PI is more than 0.50.

[ study of Bax protein expression in dexamethasone induced apoptosis in spermatogenic cells in mice]

Some studies have shown that glucocorticoids affect testis homeostasis by decreasing testosterone level. In this study the influence of dexamehasone [Dex], a widely used glucocorticoid drug, was evaluated on expression of Bax protein in mice testicular germ cells and spermatogenesis process. In this experimental study thirty five adult male mice randomly divided into 5 groups. Test groups [T1-T4] received 2, 4, 7 and 10 mg/kg Dex per day for 7 days, respectively. Control group received only saline daily for 7 days. Then the mice were sacrificed and their testes were incubated in formalin for immunohistochemistry and histology studies. T1 and T2 groups, which received 7 and 10 mg/kg Dex, showed significant decrease in the number of germ cells and somatic cells of testes, and also in the maturity of spermatogenesis [p<0.05]. Immunohistochemical studies showed that Dex with doses of 7 and 10 mg/kg significantly increased Bax expression at all stages of spermatogenesis cycle except stage IX. It seems that glucocorticoid drugs such as Dex induce apoptosis in testicular germ cells by affecting proapoptotic proteins and causing defect in spermatogenesis process

Aspectos ultra-sonográficos das alterações não-neoplásicas do testículo / Sonographic findings in non-neoplastic testicular lesions

Processos patológicos dos testículos são muito comuns, incluindo-se lesões tumorais e não-tumorais neste contexto. A ultra-sonografia com transdutor de alta freqüência tornou-se a modalidade de imagem de escolha para a avaliação desses órgãos. Este método ajuda a melhor caracterizar lesões intratesticulares e em muitas situações sugere um diagnóstico mais específico, principalmente nos casos em que há manifestações clínicas similares, tais como dor, inchaço e aumento volumétrico locais. O mapeamento com Doppler colorido é importantíssimo para demonstrar padrões anormais de perfusão testicular e auxilia no diagnóstico de condições clínicas agudas. Neste ensaio iconográfico os autores sumarizam os mais comuns achados clínicos, patológicos e as principais características diagnósticas de lesões testiculares, tais como microlitíase, cisto simples, espermatocele, varicocele, ectasia tubular da rete testis, orquite, hematomas e condições mais raras. A familiaridade com as características ecográficas e clínicas destas alterações é essencial para o estabelecimento do diagnóstico correto e início da terapêutica mais eficaz, quando necessária.

Pathological processes of the testis are very frequently found, and include non-tumoral and tumoral lesions. Ultra-sonography performed with a high-frequency transducer has become the imaging modality of choice for examination of these organs. This method is of help to improve intratesticular lesions characterization, and in many instances the findings suggest a more specific diagnosis, especially in the presence of similar clinical manifestations such as pain, swelling and local increase in volume. Color Doppler is an invaluable tool for demonstrating anomalous patterns of testicular perfusion and aids in the diagnosis of acute clinical conditions. In the present iconographic essay, the authors summarize the most frequent clinical, pathological findings as well as the main diagnostic features of benign intratesticular lesions such as microlithiasis, simple cysts, spermatocele, varicocele, tubular ectasia of the rete testis, orchitis, hematomas and more rare conditions. Familiarity with clinical and sonographic features is essential for the correct diagnosis and starting of the most effective therapy, as necessary.

Síndrome testicular agudo / Acute scrotal syndrome

Cuando el pediatra recibe a un paciente con dolor intenso en la zona escrotal, de inicio brusco y al examen verifica aumento de volumen, debe realizar un diagnóstico diferencial rápido para dilucidar si requiere tratamiento médico o debe derivarse a cirugía de urgencia para evitar compromiso vital del testículo. Es de gran ayuda revisar el tema periódicamente para actualizar los conocimientos e incorporar nuevos procedimientos diagnóstico que son de gran utilidad.

Role of testicular interleukin-1 alpha tIL-1alpha in testicular physiology and disease

This review focuses on the role of the cytokine interleukin-1a [IL-1a] in the testis; elaborating upon its importance during the complex process of spermatogenesis while relating this cytokine to some of the pathophysiological states affecting the testis. IL-1a, a proinflammatory cytokine, is expressed constitutively by the intact adult rat testis where it acts on germ, Sertoli and Leydig cells to regulate germ cell proliferation and steroidogenesis. The sequence identity of testicular IL-1a matches with the one secreted by activated macrophages in systemic immunity. The classical macrophage IL-1a is produced as 32 kDa precursor protein which is processed to mature 17 kDa IL-1a and a 16 kDa propiece. The rat testicular IL-1a, mainly secreted by Sertoli cells, was found to have molecular heterogeneity that can be observed both at the transcriptional and the translational levels. In the rat testis, two transcripts were found to be expressed with 941 bp and 767 bp [that lacks 174bp] which were translated into 32 kDa and 24 kDa precursor proteins, respectively. The 32 kDa precursor protein is processed to the 17 kDa mature IL-1a. Identical transcripts are also shown to be present in cat, dog and pig. Most of the functional role is assigned to the mature 17 kDa IL-1a isoform. However, functional analysis of recombinant rat IL-1a isoforms showed that there was a clear biopotency difference between these forms in order of 17 kDa IL-1a>32proIL-1a>24proIL-1a. Furthermore, the mature 17 kDa tIL-1a has also been implicated in pathologies such as orchitis, relapse of acute lymphoblastic leukemia [ALL] in the testis and infertility disorders in men. Thus, tIL-1a may play an important functional role both in coordination of normal testicular physiology as well as in contributing to the disease states in the testis

Función espermática post-hipoxia simulada en ratón / Simulated post-hypoxia spermatic fuction in mice

Se propone evaluar los cambios reproductivos en ratones sometidos a hipoxia-normoxia simulando condiciones laborales de la faena minera en el norte de Chile. Se estudió hipoxia hipobárica en cámara hipobárica, simulando 4.100 msnm, en tres grupos experimentales y un grupo control (500 msnm, altura promedio de Santiago), estando cada grupo integrado por seis animales. Ratones (Mus musculus) machos adultos fueron sometidos a regímenes de hipoxia (H)-normoxia (N) los siguientes días: 4H; 8H y 4H-4N-4H (4x4x4) y el grupo control en normoxia continua. Se evaluaron: hematocrito, peso testicular y epididimario, y recuento espermático total en testículo y cauda epididimaria. El peso testicular disminuye a los ocho días de exposición hipóxica hipobárica y se recupera con intervalos de cuatro días de normoxia, al igual que el recuento de espermatozoides en cauda; sin embargo, este valor permanece bajo ocho días post-hipoxia. La producción espermática permanece baja en todos los grupos experimentales. Dado que la alternancia 4x4x4 días se utiliza como régimen habitual de trabajo en las faenas mineras chilenas, es imprescindible estudiar los efectos de la altura sobre la fertilidad humana en estas condiciones.

Fertilizaçäo e gestaçäo após ICSI e cultura de tecido testicular em casos de azoospermia näo obstrutiva: relato de três casos / Fertilization and pregnancy after ICSI and testicular tissue culture in cases of non-obstructive azoospermia: three case reports

Descrever os resultados iniciais do programa de biópsia antecipada e cultura de tecido testicular, seguida de injeçäo intracitoplasmática de espermatozóides (ICSI) e transferência de embriöes (TE) em casos de azoospermia näo obstrutiva. Säo relatados 3 casos. Em todos os casos houve fertilizaçäo dos oócitos. Em dois deles procedeu-se à transferência de embriöes, ambos resultando em gestaçäo, uma com bebê nascido ao termo e a outra em curso, com 8 semanas por ocasiäo deste relato. A técnica de biópsia antecipada e cultura de tecido testicular, seguida por ICSI e transferência de embriöes, é factível e oferece um bom prognóstico de gestaçäo, sendo, em nossa opiniäo, a opçäo terapêutica indicada para pacientes com azoospermia näo obstrutiva.

Cisto simples de testículo: relato de caso e revisão da literatura / Simple testicular cyst: case report and review of the literature

O autor relata um achado de cisto simples no testículo de um paciente adulto durante estudo ultra-sonográfico. Faz uma revisão da literatura, sugere acompanhamento e conduta conservadora

The author reports a case of an adult patient with a simple testicular cyst diagnosed by ultrasound. A review of the literature is presented and a conservative treatment approach and follow-up is recommended.

Cáncer de testículo: tratamiento con el esquema BEP. Experiencia del Hospital Alvarez

Introducción: Los tumores de celulas germinales de testículo constituyen las neoplasias sólidas más frecuentes en adultos jovenes. Con el advenimiento del cisplatino y cirugías agresivas, se consiguen tasas de curación del 80 por ciento. BEP es considerado el tratamiento estándar. Se presenta la experiencia del Servicio de Oncología del Hospital Alvarez. Material y metodos: Desde 4/96 a 11/98 fueron admitidos 12 pacientes con cáncer de testículo, con un rango de edad de 22 a 42 años. Cuatro de ellos presentaron diagnóstico de seminoma, y ocho, de no seminoma. Un paciente recibió solo radioterapia y los otros un esquema de bleomicina 20 mg/m2 semana, etopósido 100 mg/m2 días 1 a 5 y cisplatino 100 mg/m2. Ochenta y dos por ciento de los pacientes presentaban marcadores tumorales elevados al diagnóstico. Resultados: Once pacientes fueron evaluables para toxicidad y respuesta. Dos pacientes presentaron toxicidad hematológica grado 4 (uno trombopenia y otro neutropenia). Tres pacientes tuvieron toxicidad hematológica grado 3 (dos anemia y uno leucopenia). Ocho pacientes presentaron vómitos, moderados 6 y 2 severos. Seis pacientes alcanzaron respuesta completa; 2, respuesta parcial y 3 progresión de enfermedad. Se observaron 4 muertes como resultado de su enfermedad de base. En 2 pacientes con E III se alcanzó respuesta y 3 fallecieron por progresión de enfermedad. Discusión: El esquema BEP presentó un perfil de toxicidad hematológico aceptable. Las respuestas obtenidas son algo inferiores a las publicadas por otros autores. Cabe preguntarse, si existen características particulares que hacen indispensable una casuística propia

Ligation of the left renal vein in epm1-Wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands

Objective: The ligation of the left renal vein (LLVR) in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. Material and Methods: 64 male adult EPM1-WISTAR rats were used, divided into 8 groups - 4 for LLRV and four control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. Results: We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice. The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance Conclusion: Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.

Tumor de testículo criptorquídico / Cryptorchid testicular tumor

Os autores apresentam um caso de tumor de testículo criptorquídico que se manifestou por massa abdominal volumosa em paciente de 43 anos. São analisados os aspectos epidemiológicos, diagnósticos e terapêuticos da doença.