Laparoscopic ligation of varicoceles: an anatomically superior operation.

Since December 1991, 25 consecutive symptomatic male patients with 26 varicoceles were treated by laparoscopic ligation of internal spermatic veins under general anaesthesia. Twenty-one patients had either scrotal discomfort or painful swelling and four patients presented with infertility. The mean follow-up period is 5 months (range 3 weeks to 9 months). The procedure has provided a satisfactory outcome in 19 out of 21 patients (90.5%) with scrotal symptoms. Of the four patients presenting with infertility due to oligospermia, three had significantly elevated sperm counts at 3 months which resulted in one pregnancy. So far there has been no recurrence of the varicocele. The main potential advantage of the laparoscopic approach is better visualisation of the anatomy, especially the testicular artery and the collateral venous circulation at the level of the internal inguinal ring. In addition to being less invasive with implied benefits, the endoscopic procedure has enabled identification of multiple veins in 22 out of 26 (84.6%) varicoceles in our series.

Serum immunoglobulins in patients with chronic tonsillitis.

In this work, the serum immunoglobulin (IgG, IgA, IgM and IgD) levels were determined in ten patients with chronic tonsillitis. The serum immunoglobulins were estimated before and two months after tonsillectomy, using the radial immuno-diffusion method. Ten normal individuals with intact tonsils were chosen as a control group. The patients had elevated serum levels of IgG and IgA. These high levels may be due to repeated antigenic stimulation. The IgM and IgD were not significantly higher than in the normal controls. The serum IgG level did decrease significantly following tonsillectomy; the other three immunoglobulins were reduced, but insignificantly. The fall in immunoglobulins may be due to a reduction in the antigenic load, to the removal of immunoglobulin-producing tissue, or to alteration in the oropharyngeal pathogenic bacteria. Tonsillectomy does not seem to compromise immunological integrity or the immunoglobulin-producting apparatus. Estimations of the serum immunoglobulin, or simply of IgA, may help us to select those candidates for adeno-tonsillectomy who will have a good prognosis, or at least to exclude those with an underlying sub-clinical immunodeficiency disease.

Dentigerous cysts of the maxilla.

Four cases of dentigerous cysts of the maxilla are recorded representing the three known types, namely: central, and multiple. The etiological theories are reviewed and treatment described.