Efficacy of topical testosterone in management of scrotal hypoplasia and agenesis.

BACKGROUND: Scrotal hypoplasia or agenesis may posses difficulty during orchidopexy or end with social anxiety around excessively small scrotal size when compared to peers, and where there may be concerns regarding the future sexual life. OBJECTIVE: Any conservative modality applicable to ameliorate scrotal underdevelopment partially or completely will be useful either solely or before reconstructive surgery. STUDY DESIGN: Seventeen child (3-8 years) were diagnosed with bilateral scrotal hypoplasia (SH) in 5 unilateral in 7, bilateral scrotal agenesis (SA) diagnosed in 4 cases, and unilateral in one. Testicles are either undescended, ectopic, or normal. All cases managed by Testogel 1% topical testosterone for 4 weeks. Clinical assessment by measurements of the scrotal skin surface area (scrotal length multiplied by width) and scrotal corrugations counting. Inguinal and renal ultrasound done for all cases and karyotyping for cases of agenesis and cases with bilateral undescended testicles. Total and free testosterone, LH, FSH and AMH hormones were assisted before treatment, weekly and one week after therapy. Data analyzed and evaluated, difference of means used to test for statistically significant differences between scores of scrotal development. RESULTS: Free and total testosterone elevated in the 1st week of treatment, but restored to normal or higher levels in 60% of cases at the 2nd week. Satisfactory response (Increasing numbers of scrotal rugae or scrotal surface area by 30-50% above the pretreatment status) obtained in 85% and 60% of unilateral and bilateral SH, but only a partial response (10-20% increase) was gained in 40% of cases with agenesis. No major adverse effect was appreciated. DISCUSSION: Response of some cases of SH to topical testosterone indicates presence of remnants of labioscrotal folds with testosterone receptors (Bell et al., 1971) [1]. Testosterone replacement therapy can improve the signs and well-being of a hypogonadal male by restoring serum testosterone concentrations to physiologic levels. In this study the mean average testosterone concentration one week after application of testogel was 13.47 ± 2.45 and 12.12 ± 2.5 within 2nd, 4th week, and after cessation of treatment. Anti-Mullerian hormone is significantly low in 12 cases; mainly in cases of SA (P-value <0.001). CONCLUSION: Short term topical testosterone proved to be effective in a considerable percentage of cases of either bilateral or unilateral scrotal hypoplasia; with a subsequent increase in scrotal surface area and number of rugae, it may substitutes the indication for surgical reconstruction. Long term follow up is a limitation of this study.

Posterior intrafocal pinning for extension-type supracondylar fractures of the humerus in children.

We describe a method of pinning extension supracondylar fractures of the humerus in children. Following closed reduction, a posterior intrafocal wire is inserted and a second lateral wire added when needed for rotational stability. Between May 2002 and November 2005 we performed this technique in 69 consecutive patients. A single posterior wire was used in 29 cases, and two wires in 40. The mean follow-up was two years (21 to 30 months). The results were assessed according to Flynn's criteria. In the single-wire group there were 21 excellent, five good and one poor result. Two patients were lost to follow-up. In the two-wire group there were 32 excellent, two good and three poor results. Three were lost to follow-up. The poor results were due to a failure to achieve adequate reduction, fixation or both. We conclude that the intact posterior periosteal hinge can be used successfully in the clinical situation, giving results that compare well with other techniques of pinning. The posterior route offers an attractive alternative method for fixation of supracondylar fractures of the humerus in children.

Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children.

Parasitic infestations, mainly enterobiasis and amoebiasis, and poor toilet training practices are commonly associated with rectal prolapse in developing countries. Injection sclerotherapy is one of the commonly used modalities for treating partial rectal prolapse in children. Various materials are available for such injection, but each has its advantages and complications. Comparing different materials used in the treatment of such pathology form the basis of this study trying to define the best material with the least complications. Data records of 130 children with partial rectal prolapse referred to the Department of Pediatric Surgery at Al Galaa Teaching Hospital, Cairo, over a 3-year period were analyzed. Their ages ranged from 6 months to 12 years (mean 6.14 years +/-3.4). Forty-five patients (3 5%) responded to conservative treatment, and 85 patients (65%) required injection sclerotherapy and were divided into three groups: Group 1 (35 patients) was injected with 98% ethyl alcohol, group 2 (22 patients) was injected with phenol in almond oil 5%, and group 3 (28 patients) was injected with Deflux (Q-Med, Uppsala, Sweden). The follow-up period ranged from 2 months to 3 years; clinical data and all complications were recorded. Submucosal injection of the three sclerosing materials showed no mortality in this series, but in group 1, seven had recurrence on short-term follow-up that required reinjection, and long-term follow-up in this group showed a recurrence rate of 11% (four patients), plus two patients had mucosal sloughing and one girl developed a rectovaginal fistula. Group 2 showed abscess formation and mucosal sloughing in four patients (18%), and two developed perianal fistula. Group 3 showed immediate postoperative prolapse in two cases that ameliorated spontaneously. No patients had mucosal ulceration or abscess formation, and long-term follow-up showed no recurrence. Deflux had the lowest complication rate with no recurrence on long-term follow-up. Phenol in almond oil 5% injection should not be used for treating such conditions because of its high complication rate. Alcohol is commercially cheap and available and should be considered an alternative for Deflux.

In vivo and in vitro studies on the genotoxicity of cadmium chloride in mice.

The genotoxic effect of cadmium chloride was evaluated in chromosomes of experimental mice using in vivo and in vitro studies. In vivo the induction of micronuclei, sister chromatid exchange in mouse bone marrow and chromosomal aberrations in both somatic and germ cells was investigated. Doses 1.9, 5.7 and 7.6 mg kg(-1) body wt. (single i.p. treatment) induced a significant and dose-dependent increase in the percentage of polychromatic erythrocytes with micronuclei. Such a percentage reached 2.1% with the highest tested dose, compared with 0.57% for the control (non-treated) and 2.2% for mitomycin c as the positive control. The dose of 1.9 mg kg(-1) body wt. had no significant effect with respect to sister chromatid exchange (SCE) but the doses of 5.7 and 7.6 mg kg(-1)body wt. increased the frequency of SCEs significantly. The frequency of SCE reached 7.35 +/- 0.26 per cell after treatment with the highest tested dose, which is a less than twofold increase compared with the control frequency of 4.6 +/- 0.42 per cell. However mitomycin c induced a much higher effect (12.1 +/- 0.73). Cadmium chloride also induced a significant increase in the percentage of chromosomal aberrations in mouse bone marrow at the doses of 5.7 and 9.5 mg kg(-1) body wt. (single i.p. treatment). The effect is a function of cadmium chloride concentration. Moreover, cadmium chloride induced its maximum effect concerning the induction of chromosomal aberrations in mouse bone marrow cells 24 h after treatment, compared with 12 and 48 h. In germ cells, chromosomal aberrations were observed in mouse spermatocytes 12 days post-treatment with the dose of 5.7 mg kg(-1) body wt. Moreover, a pronounced reduction in the number of spermatocytes was observed after administration of cadmium chloride (0.9, 1.9 and 5.7 mg kg(-1) body wt.) In in vitro studies, the three tested concentrations of 10, 15 and 20 microgram ml(-1) cadmium chloride induced a statistically significant increase in the frequency of SCEs in cultured mouse spleen cells. The concentrations of 15 and 20 microgram ml(-1) also induced chromosomal aberrations in mouse spleen culture. The ability of vitamin C (l-ascorbic acid) to minimize the incidence of chromosomal aberrations induced by cadmium chloride in cultured mouse spleen cells was investigated. Vitamin C at the concentrations of 3 and 6 microgram ml(-1) significantly minimized the percentage of aberrant cells induced by cadmium chloride.

Genotoxicity evaluation of buprofezin, petroleum oil and profenofos in somatic and germ cells of male mice.

The two pest control agents, buprofezin and petroleum oil (Super Royal), were tested to evaluate their potential mutagenicity, in comparison with the organophosphorus insecticide profenofos. Chromosomal aberration analysis was used in both somatic and germ cells of male mice. Single oral treatment at three different dose levels (1/16, 1/8 and 1/4 LD50) for each insecticide induced an increase in the percentage of chromosomal aberrations in bone-marrow cells 24 h post-treatment, indicating a dose-dependent relationship. The percentage of chromosomal aberrations reached 23 +/- 0.73, 10.5 +/- 0.64 and 15 +/- 1.4 after treatment with the highest tested dose of profenofos, buprofezin and Super Royal, respectively. Such percentages did not exceed the corresponding value of the positive control, mitomycin C (29.2 +/- 0.69). The percentage of chromosomal aberrations induced by the different doses of profenofos was still highly significant even after excluding gaps. The same trend of results was noticed only at the highest tested dose of buprofezin and Super Royal. With respect to germ cells, profenofos is also a potent inducer of chromosomal aberrations in 1ry spermatocytes, giving percentages of 14 +/- 1.3 and 19 +/- 1.6 at the two higher doses of 4.25 and 8.5 mg kg(-1) body wt., respectively. Buprofezin and Super Royal had no significant effect on mouse spermatocytes at the tested concentrations. The various types of induced aberrations were examined and recorded in both somatic and germ cells. In conclusion, the present investigation indicates that the two pest control agents buprofezin and Super Royal are relatively much safer compounds than the conventional organophosphorus insecticides.

Cytogenetic effect of griseofulvin in mouse spermatocytes.

The genotoxic effects of griseofulvin (GF) in mouse primary spermatocytes at diakinesis metaphase I of meiosis were investigated. Griseofulvin was administered orally as a single dose of 500, 1000, 1500 and 2000 mg kg-1 body wt. and a multiple treatment with a daily dose of 1000 mg kg-1 body wt. for three and five successive doses. Both single and multiple treatment induced a statistically significant increase in the percentage of chromosomal aberrations which have a dose and time-dependent relationship. The frequency of chromosomal aberrations peaked 6 and 12 h post treatment; with the highest dose of the drug it reached 27.8% +/- 0.87 and 27.66% +/- 0.48 6 and 12 h respectively, compared with 5.6% +/- 0.39 and 5.2% +/- 0.48 for the control. The types of aberrations recorded were structural, including X-Y and autosomal univalent, gaps, breaks, fragments, chain IV and numerical in the form of diploid, triploid, tetraploid and aneuploid. The results of this study suggest that griseofulvin has a genotoxic effect in mouse spermatocytes.

Cytogenetic effect of some insecticides in mouse spleen.

Several insecticides were tested for their ability to induce chromosomal aberrations in mouse spleen. They were injected i.p. in doses representing approximately 1/8-1/10 of the respective LD50 values. Doses were: DDT, 5.5 mg kg-1 body wt.; malathion, 30 mg kg-1 body wt.; Dursban, 4 mg kg-1 body wt.; Sevin, 7 mg kg-1 body wt.; and Lannate, 1 mg kg-1 body wt. 'Mitomycin C' at a dose of 1 mg kg-1 body wt. was used as a positive control. Mice were sacrificed 6, 24 and 48 h after treatment. DDT, malathion, dursban and lannate caused maximum chromosomal aberrations 24 h after injection, whereas Sevin induced its maximum effect 6 h after the treatment. All the insecticides induced statistically significant chromosomal aberrations even after excluding the number of metaphases with gaps. The results indicate genotoxicity in mouse spleen cells.

Toxicological potential of malathion residues in stored soybean seeds.

Succinate-14C-malathion penetrates readily into soybean seeds. The total internal residues inside the seeds amounted to 58-65% of the applied dose after 30 weeks, of which 8-9% were in the form of bound residues. The major part of the internal methanol extractables are chloroform soluble metabolites which include malathion (about 60%), monocarboxylic acid (15%) and its decarboxylation product (8%). The water soluble metabolites contained only one radioactive substance, namely malathion dicarboxylic acid. The toxicological potential of the total internal residues was studied by feeding mice with the washed seeds for about 2.5 months. Treated mice suffered from deterioration of hepatic and renal function as indicated by the observed increased level of blood serum esterases and blood urea nitrogen. The results of blood biochemistry are supported by the histopathological changes observed in the liver, kidney, stomach and intestine. The organs showed degenerative changes including leucocytic aggregation, congestion and dilatation of blood vessels. Other adverse effects caused by malathion residues are indicated from cytogenetic studies on bone marrow of treated mice. Studies showed an initial bone marrow toxicity as indicated by increase in percentage of polychromatic erythrocytes over controls. This effect diminished upon prolongation of feeding period over one month. Feeding with malathion residues affected a gradual increase, with feeding period, in the percentage of polychromatic erythrocytes with micronuclei, a parameter recommended for detecting chemical mutagenes in animal test systems.

Cytogenetic effects of pesticides. II. Induction of micronuclei in mouse bone marrow by the insecticide gardona.

The induction of micronuclei in mouse bone marrow by the organophosphorus insecticide gardona (also known as tetrachlorvinphos) was tested. 3 routes of administration were used for the pure insecticide: intraperitoneal, oral and dermal. The different routes of treatment with gardona caused toxicity of marrow indicated as significant increases in the percentage of polychromatic erythrocytes over that of the control. Intraperitoneal and oral treatments induced a statistically significant percentage of micronucleated PE.

Cytogenetic effects of pesticides. I. Induction of micronuclei in mouse bone marrow by the insecticide Dursban.

The induction of micronuclei in mouse bone marrow by the organophosphorous insecticide 'Dursban' was tested. 3 routes of administration were used for the pure insecticide: intraperitoneal, oral and dermal. The different routes of treatment with Dursban induced a statistically significant increase in the percentage of polychromatic erythrocytes over that of the control. Both intraperitoneal and oral treatments with the insecticide induced a high percentage of polychromatic erythrocytes with micronuclei, whereas dermal treatment did not induce micronuclei.