"I will attend to college to give my family a better life": Indebtedness with the family and the challenges of building occupational plans for Peruvian adolescents.

Identifying a future occupation is an important achievement during adolescence, a process particularly complex for Peruvian adolescents. Perú is a postcolonial country with many forms of inequality, and one of them is the opportunity gap to attend a college. However, most adolescents aspire to go to university as a way out of poverty, and, since Perú is a collectivist society, this is a family task: it is adolescents' responsibility to go to college in order to give a better life to their families. Theories developed for WEIRD societies (Western, Educated, Industrialized, Rich and Democratic) do not provide an accurate explanation of Peruvian adolescents' occupational projects because they envision a person with autonomy and resources to choose a career. Thus, our goal is to analyze adolescents' occupational plans considering the role adolescent-caregivers relationships play in this configuration. This study is part of the project "Being an adolescent in Perú" (PUCP-UNICEF) which characterized Peruvian adolescence by studying 14 variables through a qualitative study with 66 participants. In depth interviews were conducted and the data was analyzed using thematic analysis. Results of the thematic analysis are organized in three topics that explain the relationship between occupational plans and adolescent-caregiver relationship (1) adolescents have occupational aspirations rather than achievable projects that are that are built alone, without adult support; (2) attending college as an occupational aspiration belongs to the family, not to the individual operating also a kind of "debt" to pay to their caregivers for being financially supported to be able to study in high school; and (3) caregivers do not have the possibility or resources of being able to accompany their adolescent's occupational plans. We conclude that Peruvian adolescents think about their future within the framework of their family's needs, rather than linked to personal and occupational goals, impeding adolescents from exploring and selecting a realistic occupational goal consistent with their interests. The results allow us to discuss the relevance of studying adolescent development taking into account the particularities of the adolescents' cultural and socioeconomic contexts as well as the core role that relationship with caregivers plays in this process in Perú.

Safety of bloodless open-heart surgery on cardiopulmonary bypass in selected children: A single center experience with minimal invasive extracorporeal circulation.

INTRODUCTION: Bloodless cardiac surgery refers to open-heart surgery without blood or blood products. The cardiopulmonary bypass (CPB) circuits are primed with crystalloid solely, and there is no intraoperative blood transfusion. METHODS: Our program considers bloodless congenital cardiac surgery with a minimal invasive extracorporeal circulation (MiECC) system for patients above 10 kg of weight. We performed a single-center retrospective cohort study of all consecutive patients undergoing bloodless cardiac surgery for congenital heart defects between January 2016 and December 2018. RESULTS: A total of 164 patients were reviewed (86 male and 78 female) at a median age of 9.6 years (interquartile range (IQR), 4.5-15), a weight of 32 kg (IQR, 16-55), preoperative hemoglobin 13.7 g/dl (IQR, 12.6-14.9), and preoperative hematocrit of 40.4% (IQR, 37.2-44.3). Median CPB time was 81.5 min (IQR, 58-125), and median hematocrit coming off CPB was 26% (IQR, 23-29.7). The congenital heart surgery risk (STAT) category was distributed in STAT 1 for 70, STAT 2 for 80, STAT 3 for 9, and STAT 4 for 5 patients. Most patients (95%) were extubated in the operating room with a low complication rate during the hospital stay (14.6%). Only 6 (4%) patients needed a blood transfusion during the postoperative period, with a higher incidence of complications during the hospital course (p < 0.001). CONCLUSIONS: Bloodless congenital heart surgery with MiECC system is safe in low-surgical-risk patients. Our patients had a low rate of complications and short hospital stays.

Predictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study.

BACKGROUND: An adequate bowel preparation prior to colonoscopy is a major quality-limiting factor that determines both the diagnostic and therapeutic yield of a colonoscopy. Colonoscopy is considered the gold standard for colon cancer screening and it is the primary approach to the workup of hematochezia, diarrhea and iron deficiency anemia (IDA). Several modifiable factors of bowel prep adequacy have been identified, that account for around 25% of inadequate bowel preparations in outpatient colonoscopies. However, the literature is sparse when examining the factors associated with inadequate preparations and procedure cancellations in an inpatient hospital setting. We aim to identify factors that affect bowel preparation adequacy and procedure cancellations among diagnostic colonoscopies performed during hospitalization. METHODS: We retrospectively reviewed the electronic medical records of 1,500 consecutive patients who had a diagnostic colonoscopy as an inpatient at a tertiary level hospital over a 2-year period. All patients were administered a clear liquid diet the day prior to the colonoscopy. Patients were then instructed to drink 4 L of polyethylene glycol (PEG, Golytely) between 5 am to 9 am on the day of the procedure. The clinical course of each case was followed to identify quality of preparations, cancelled procedures and the reasons for cancellations. We applied univariate and multivariate logistic regression analysis to identify variables to predict cancellation and poor preparation. RESULTS: A total of 1,029 patients were included in the study. 194 (18.8%) patients had colonoscopy cancellations and 268 (26.0%) had poor bowel preparations. Multivariate analysis revealed these factors to be associated with colonoscopy cancellations: education at the graduate school level [odds ratio (OR) =1.93, P=0.04], Hispanic ethnicity (OR =0.47, P<0.01), hemoglobin level <10 g/dL (OR =1.41, P=0.05) and if the colonoscopy was done for other indications (OR =0.53, P=0.04). Factors associated with poor bowel preparation on multivariate analysis, were dementia (OR =2.44, P=0.02), gastroparesis (OR =3.97, P=0.01) and inpatient opioids use (OR =1.69, P=0.04). CONCLUSIONS: The rate of colonoscopy cancellations and poor bowel preparations in inpatient colonoscopies were high, and we were able to identify predictors of inadequate colon preparation and procedure cancellations. Exploring more individualized colon preparation regimens based on personal risk factors could reduce the number of inadequate and cancelled colonoscopies in an inpatient setting.

B-type natriuretic peptide (BNP) predicts 90-day mortality and need for paracentesis in cirrhotic patients without systolic heart failure.

Fluid overload is a common complication in patients with cirrhosis. B-type natriuretic peptide (BNP) is a marker of increased blood volume, commonly used in heart failure, that has been shown to be elevated in patients with liver disease. This study examined if BNP levels can be used to determine prognosis and predict worsening of ascites in patients with cirrhosis without concomitant heart disease. A retrospective study was performed at a large urban hospital in Chicago, Illinois and included 430 patients with cirrhosis who had BNP levels ordered during their hospital stay. Patients with clinical heart failure, arrhythmias or pulmonary hypertension were excluded. The primary outcome was 90-day mortality and the secondary outcome was a requirement for therapeutic paracentesis in the 90 days following BNP results. 53 patients (12%) had BNP levels ≥ 300 pg/mL. They had significantly increased serum levels of creatinine, bilirubin, and International Normalized Ratio (INR) when compared to those with BNP < 300 pg/mL. Patients with higher BNP had significantly higher mortality rates (HR 3.49; p = 0.037) and were more likely to require therapeutic paracentesis (HR 2.26; p = 0.02) in the next 90 days. A BNP ≥ 300 pg/mL had specificity of 88.2% in predicting 90-day mortality. BNP may serve as a practical and reliable marker of underlying disease severity in patients with cirrhosis, with potential to be included in prognostication tools for assessment of end-stage liver disease.

Evaluation of Ferritin and Transferrin Ratio as a Prognostic Marker for Hepatocellular Carcinoma.

PURPOSE OF THE STUDY: Hepatocellular carcinoma (HCC) has tripled in incidence over the past 20 years and now ranks as the third leading cause of mortality attributed to cancer. Underlying pathophysiology is sustained hepatic inflammation which results in hepatocellular dysplasia and thus an environment prone to HCC. Considering the essential role of inflammation in the pathogenesis of HCC, we evaluated the prognostic utility of ferritin-transferrin ratio (FTR) in HCC. METHODS: We retrospectively reviewed the electronic medical records of patients with HCC (diagnosed on radiographic criteria and/or biopsy) from 2000 through 2015. We collected data regarding the patient demographics, laboratory investigations at the time of HCC diagnosis and prior to the initiation of treatment. Overall survival was calculated from the time of diagnosis, cases were censored at the date of last follow-up, if date of death was not known. Kaplan-Meier curves were estimated to evaluate the prognostic significance of FTR. Receiver operating characteristics (ROC) curve was plotted for FTR to predict mortality and identify cut-off value by optimized Youden's index. RESULTS: Among the 176 patients identified by initial screening, 116 patients were eventually included for analysis. Overall median survival was 11.9 months. FTR, of note, was significantly lower in alive (6.9, p < 0.001). In univariate analysis, alfa-fetoprotein (AFP), aspartate aminotransferase (AST), serum ferritin (SF), transferrin (TFS), and FTR were significantly associated with mortality. On multivariate analysis for mortality, FTR, AFP, and epidemiologic factors predictive of mortality including male gender and advanced HCC were significant. CONCLUSION: The ferritin-transferrin ratio (FTR), calculated at the time of HCC diagnosis could predict mortality in our cohort of patients. With an optimal cut-off of 7.7 for FTR were stratified into high- and low-risk groups. The hazard ratio between the two groups was 2.36 (p < 0.003). Future studies with longitudinal follow-up of FTR at intervals and important time points (e.g., perioperative) might provide more insights to its prognostic value.

Temporal trend in inpatient mortality in inflammatory bowel disease-associated colorectal cancer vs non-inflammatory colorectal cancer: a nationwide retrospective study.

BACKGROUND: Early detection and advancement in therapy have successfully achieved a steady decrease in colorectal cancer (CRC) mortality over the last two decades. On the other hand, studies investigating mortality trends in inflammatory bowel disease-associated CRC (IBD-CRC) are scarce and inconclusive. We conducted a retrospective analysis aiming to identify differences between inpatient mortality trends in IBD-CRC vs non-IBD-CRC and possible contributing factors. METHODS: The National Inpatient Sample (NIS) database from 2006-2014 was queried to identify all patients admitted with a diagnosis of CRC. The main outcome was the prevalence and trend of mortality among IBD-CRC and non-IBD-CRC. The secondary outcome was the evaluation of predictors of inpatient mortality. RESULTS: A total of 1,190,759 weighted cases with the admission diagnosis of CRC were included in the study. Of which 10,997 (0.9%) had a co-diagnosis of IBD. The population with non-IBD-CRC had a statistically significant downward temporal trend in mortality (p < 0.001), while patients with IBD-CRC did not have any statistically significant temporal trend in inpatient mortality (p = 0.067). After subgroup analysis, patients with Crohn's disease-CRC had an upward temporal trend in mortality (p = 0.183) compared to patients with ulcerative colitis-CRC with a downward trend in mortality (p = 0.001). Sepsis resulted to be a stronger predictor of mortality for CD-CRC, while VTE for UC-CRC. CONCLUSION: Multiples strategies established to prevent morbidity and mortality in CRC have been fruitful in non-IBD-CRC population, but have not been enough for IBD-CRC population to cause the same effect. Further strategies are needed to achieve a reduction in IBD-CRC mortality trend.

A Novel Score to Predict Esophageal Varices in Patients with Compensated Advanced Chronic Liver Disease.

BACKGROUND AND AIMS: Several criteria have been described to noninvasively predict the presence of high-risk esophageal varices in patients with compensated advanced chronic liver disease (cACLD). However, a recent study showed that treatment with ß blockers could increase decompensation-free survival in patients with clinically significant portal hypertension, thereby making it important to predict the presence of any esophageal varices. We aimed to develop a simple scoring system to predict any esophageal varices. METHODS: We retrospectively reviewed patients who had vibration-controlled transient elastography (VCTE) at Cook County Hospital, Chicago, USA. Patients with cACLD and liver stiffness measurement (LSM) ≥ 10 kPa with esophagogastroduodenoscopy performed within one year of VCTE were analyzed. We generated a novel score to predict esophageal varices, using the beta coefficient of predictive variables. The score was validated in an external cohort at the University of Iowa Hospital, USA. RESULTS: There were 372 patients in the development cohort and 200 patients in the validation cohort. LSM, platelet count, and albumin were identified as predictors of esophageal varices and were included for generating the Cook County score as "platelet count * - 0.0155872 + VCTE score * 0.0387052 + albumin * - 0.8549209." The area under receiver operating curve for our score was 0.86 for any varices and 0.85 for high risk varices and avoided more endoscopies than the expanded Baveno VI criteria while maintaining a very low miss rate (negative predictive value > 99%). CONCLUSION: We propose a new, highly accurate, and easy-to-use scoring system to predict the presence of not only high-risk but any esophageal varices in patients with cACLD.

The importance of skin exam in chronic pulmonary blastomycosis.

Cutaneous blastomycosis is the most common extrapulmonary manifestation of disseminated blastomycosis, a disease caused by Blastomyces dermatitidis, a dimorphic fungus endemic of North America. Initially, the organism enters the respiratory system by inhalation of the infectious conidia and produces an acute pulmonary infection that may eventually disseminate if it is left untreated. Blastomycosis may represent a diagnostic challenge and its definitive diagnosis requires direct visualization of the distinctive yeast or a positive fungal culture. The objective of this case report is to highlight the importance of the skin exam and tissue biopsy in the diagnosis of blastomycosis. We present a previously healthy patient with chronic pneumonia, evaluated at Pulmonary clinic with non-diagnostic thoracentesis and bronchoscopy, found to have disseminated blastomycosis after biopsy of a scalp lesion in Dermatology clinic.

Effectiveness of bezafibrate and ursodeoxycholic acid in patients with primary biliary cholangitis: a meta-analysis of randomized controlled trials.

BACKGROUND: Ursodeoxycholic acid (UDCA) and obeticholic acid are currently approved treatments for primary biliary cholangitis (PBC). Since some patients do not respond adequately to UDCA, other therapies, such as bezafibrate, have been developed. In this meta-analysis we evaluated the efficacy and safety of using both UDCA and bezafibrate in patients with an inadequate response to UDCA. METHODS: We evaluated all randomized controlled trials comparing the combination of UDCA and bezafibrate with UDCA monotherapy. Standardized mean difference (SMD) was used to assess the treatment effect of combination therapy compared with UDCA alone. RESULTS: Ten trials with a total of 369 patients were analyzed. UDCA and bezafibrate combination therapy was more effective than UDCA monotherapy in improving alanine aminotransferase (SMD -2.04, 95% confidence interval [CI] -3.30 to -0.79), alkaline phosphatase at both less than 12 months (SMD -3.63, 95%CI -6.43 to -0.84) and more than 12 months (SMD -2.33, 95%CI -4.03 to -0.63), gamma-glutamyltransferase (SMD -1.29, 95%CI -2.67 to 0.08), triglyceride (SMD -0.80, 95%CI -1.41 to -0.19), immunoglobulin M (SMD -1.48, 95%CI -2.39 to -0.56), and cholesterol (SMD -4.61, 95%CI -7.34 to -1.89). There was no difference between the 2 groups in bilirubin, aspartate aminotransferase or albumin. None of the adverse effects differed statistically between the 2 groups. CONCLUSION: UDCA and bezafibrate combined treatment is superior to UDCA alone in UDCA non-responders with regard to decreasing liver biochemistry markers, without any significant increase in side effects in patients with PBC.

A Rare Case of Hemophagocytic Lymphohistiocytosis in an Adult with Diffuse Large B-Cell Lymphoma.

A 71-year-old Indian female presented with a 3-month history of weight loss and fatigue. Further review confirmed a histological diagnosis of diffuse large B-cell lymphoma. Although bone marrow analysis did not reveal hemophagocytosis, she had some clinical and laboratory pointers to hemophagocytic lymphohistiocytosis (HLH). Her clinical state deteriorated rapidly with development of acute respiratory distress syndrome, diffuse alveolar hemorrhage, and subsequently death.

Total Laparoscopic Hysterectomy Under Regional Anesthesia.

BACKGROUND: Laparoscopic hysterectomies comprise a large proportion of all hysterectomies in the United States. Procedures completed under regional anesthesia pose a number of benefits to patients, but laparoscopic hysterectomies traditionally have been performed under general anesthesia. We describe a case of total laparoscopic hysterectomy under epidural anesthesia with the patient fully awake. CASE: A 51-year-old woman with abnormal uterine bleeding underwent an uncomplicated total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. The procedure was completed under epidural anesthesia without intravenous sedation or systemic narcotics. Pneumoperitoneum with a pressure of 12 mm Hg and Trendelenburg to 15° allowed for adequate visualization. Anesthesia was achieved with midthoracic and low lumbar epidural catheters. Bilevel positive airway pressure was used for augmentation of respiratory function. CONCLUSION: With a committed patient, adequate planning, and knowledge of the potential intraoperative complications, regional anesthesia is an option for select women undergoing laparoscopic hysterectomy.

Omental adipose tissue is a more suitable source of canine Mesenchymal stem cells.

BACKGROUND: Mesenchymal Stem Cells (MSCs) are a promising therapeutic tool in veterinary medicine. Currently the subcutaneous adipose tissue is the leading source of MSCs in dogs. MSCs derived from distinct fat depots have shown dissimilarities in their accessibility and therapeutic potential. The aims of our work were to determine the suitability of omental adipose tissue as a source of MSCs, according to sampling success, cell yield and paracrine properties of isolated cells, and compared to subcutaneous adipose tissue. RESULTS: While sampling success of omental adipose tissue was 100% (14 collections from14 donors) for subcutaneous adipose tissue it was 71% (10 collections from 14 donors). MSCs could be isolated from both sources. Cell yield was significantly higher for omental than for subcutaneous adipose tissue (38 ± 1 vs. 30 ± 1 CFU-F/g tissue, p < 0.0001). No differences were observed between sources regarding cell proliferation potential (73 ± 1 vs. 74 ± 1 CDPL) and cell senescence (at passage 10, both cultures presented enlarged cells with cytoplasmic vacuoles and cellular debris). Omental- and subcutaneous-derived MSCs expressed at the same level bFGF, PDGF, HGF, VEGF, ANG1 and IL-10. Irrespective of the source, isolated MSCs induced proliferation, migration and vascularization of target cells, and inhibited the activation of T lymphocytes. CONCLUSION: Compared to subcutaneous adipose tissue, omental adipose tissue is a more suitable source of MSCs in dogs. Since it can be procured from donors with any body condition, its collection procedure is always feasible, its cell yield is high and the MSCs isolated from it have desirable differentiation and paracrine potentials.

Childhood lymphoma incidence patterns by ICCC-3 subtype in Mexico City metropolitan area population insured by Instituto Mexicano del Seguro Social, 1996-2010.

PURPOSE: We reviewed the childhood lymphomas epidemiological data for the Mexico City metropolitan area (MCMA). METHODS: Data analysis from children (0-14 years old) diagnosed with lymphoma during the period 1996-2010 was performed at the Mexican Childhood Cancer Registry. Histological subtype was determined according to the International Classification of Childhood Cancer 3 (ICCC-3). Age-adjusted incidence rates were calculated per 1,000,000 children/year by age, gender, and ICCC-3 subtype; trends, by average annual percent change (AAPC). RESULTS: A total of 328 lymphoma cases included in the study had an incidence rate of 11.8, showing a decreasing trend [AAPC: -3.5; CI 95% (-5.9, -1.0)], primarily due to non-Hodgkin lymphomas (NHL) and Hodgkin lymphoma (HL) mixed cellularity subtype. NHL had the major incidence (5.8), with the precursor cell subtype being the most frequent (38.3%). Nodular sclerosis was the most frequent HL subtype. The incidence of Burkitt lymphoma was low (1.3). During the study period, there was an important reduction in the not-otherwise-specified subtype of NHL, which translated into a relative increase in the IIb3 subtype [AAPC: 7.3 (1.2, 13.8)]. Low incidences of NHL and of HL and NHL were found for < 1-year-olds and for 10- to 14-year-olds, respectively. Incidence rates for children in the MCMA, particularly the < 1 and 10-14 age groups, were lower than those for developed countries. The overall male/female ratio was 2.3. CONCLUSIONS: There was a trend toward a reduced incidence, for some lymphoma subtypes, in particular for NOS lymphomas, which may be the result of improvement in diagnostic techniques.

Estómago de conejo: modelo animal para cirugía experimental / Rabbit stomach: animal model for experimental surgery

La cirugía veterinaria experimental en pequeños animales, particularmente en perro, tiene principalmente restricciones de tipo afectivas, por lo que es necesario contar con otro modelo animal, para poder realizar diferentes procedimientos destinados a su aplicación en dicha especie. Dicho modelo debe cumplir con características anatómicas homologables al perro y también con facilidades de uso y manejo. Al ser una especie tradicionalmente utilizada en experimentación, el conejo podría constituir un excelente modelo animal para este propósito. El objetivo de este estudio es describir la anatomo-topografía del estómago del conejo para luego compararla con el perro. Se utilizaron 14 conejos que fueron sometidos a distintas técnicas de conservación para su estudio anatómico posterior; los instrumentos y materiales para realizar dicho estudio morfológico y un registro bibliográfico de parámetros anatómicos del estómago del perro. Los resultados de este ensayo muestran que el conejo posee un estómago de morfología, ubicación y orientación similar a la del perro, con algunas variaciones en sus relaciones con otras estructuras anatómicas. Asimismo la irrigación de este órgano es muy similar a la del perro. De acuerdo a lo observado, en estómago, el conejo podría ser utilizado como modelo animal para someter a prueba distintos ensayos quirúrgicos experimentales.

Experimental veterinary surgery on small animals -particularly dogs- has restrictions, mainly regarding affect; therefore it is necessary to have a model of the animal to perform such procedures. This model must have anatomic characteristics which homologate those of dogs, but it must also fulfill ease of use and handling. Being a species traditionally used in experimentation, rabbits could be an excellent animal model for this purpose. The goal of this study is to describe the anatomotopography of the stomach of the rabbit and then compare it with the dogs. Three elements were considered: 14 rabbits exposed to various conservation techniques for their later anatomical study, the instruments and supplies to develop such morphological study and a bibliographic record of anatomical parameters of the dog's stomach. The results of this essay show that rabbits have a stomach with a morphology, location and orientation similar to the one of a dog, varying on its relation to other anatomical structures, the irrigation of this organ is as well very similar to the one of the dog. According to what was observed on the stomach, rabbits may be used as an animal model to perform different experimental surgical essays.

Túnicas testiculares durante la fase de reposo y actividad sexual del conejo macho (Oryctolagus cuniculus) / Morphology of testes and it´s covers during the phase of rest and sexual activity of the male rabbit (Oryctolagus cuniculus)

La domesticación del conejo (Oryctolagus cuniculus), ha permitido el paso de una reproducción de tipo anual a una de tipo no estacional, observándose pariciones durante todo el año. Sin embargo, existen parámetros reproductivos que nos indican que aún existe cierta estacionalidad, por ejemplo, la ubicación testicular, correspondiendo el conejo a un estacional de días largos. El presente estudio analiza la morfología de testículos y epidídimos, comparando la bioestructura de las cubiertas testiculares del conejo macho (Oryctolagus cuniculus), durante los meses de Enero y Septiembre. Para esto, se utilizaron seis conejos machos, tres correspondientes al mes de Enero, y tres al mes de Septiembre. Los ejemplares se encontraban clínicamente sanos y sexualmente maduros, de peso promedio 2,5 kg. Se obtuvieron los testículos junto a sus respectivos sacos escrotales, los que se procesaron mediante técnica histológica corriente y tricrómico. Se consignó el Indice espermatogénico (IE) e índice celular interticial (ICI) según Grocock & Clarke. Durante el mes de Enero, se evidenció una clara disminución de los parámetros reproductivos testiculares, con un IE =3, y un ICI=4. Por el contrario, durante el mes de Septiembre, se observó un IE=5 y ICI=5. La túnica albugínea mostró diferencias de espesor en ambos períodos. Sin embargo, se encontró un gran desarrollo de la musculatura cremastérica en ambas etapas, por lo que se concluye que ésta última no sufre atrofia durante el mes de Enero, atribuible posiblemente, a la criptorquidia facultativa que posee esta especie.

The domestication of the rabbit (Oryctolagus cuniculus) has allowed the passage of a reproduction of the annual rate to a non-seasonal type, observing calving throughout the year. However, there are reproductive parameters which indicate that there is still some seasonality, for example, testicular position, which corresponds the rabbit to seasonal long days. This study examines the morphology of testes and epididymis, comparing the biostructure of testicular coverings of male rabbit (Oryctolagus cuniculus) during the resting phase and sexual activity. For this, six male rabbits were used, three for the month of January, and three in September. The specimens were clinically healthy, sexually mature, and had an average weight of 2.5 kg. Testes were obtained with their scrotal sacs, which are processed using current histological and trichromic technique. Spermatogenic index and interstitial cell index were recorded according to Grocock & Clarke. During the month of January, it showed a clear decrease in testicular reproductive parameters, with IE = 3, and ICI = 4. By contrast, during the sexual activity it was observed IE = 5 and ICI = 5. During both periods, the albuginea tunic showed no large variations in thickness. Further, there is a great development of the cremasteric muscle in both stages, it was concluded that it does not undergo atrophy during the regression phase, possibly attributable to the voluntary cryptorchidism that this species has.