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INTRODUCTION: The postpubertal effects of testis-sparing surgery on prepubertal testicular tumors are not fully understood. OBJECTIVE: In this study, we aimed to evaluate the effect of different durations of warm and cold ischemia during a rat prepubertal testis-sparing surgery model on the ischemic and contralateral normal testes in the postpubertal period. STUDY DESIGN: The study encompassed a group of 54 male rats in the prepubertal stage who were then arranged to be put into nine groups: sham (Sh), control-cold (Cc), control-biopsy (Cb), 30, 60 or 90min warm ischemia (WIb30,WIb60,WIb90) and cold ischemia (CIb30,CIb60,CIb90). In the ischemia groups, a microvascular clamp was applied to the right spermatic cord, then testicular biopsy was taken. In the cold ischemia groups, the testicles were preserved in sterile ice mud. After the experiment, the rats were observed for 4 weeks to pinpoint any changes during their progression into the post-pubertal period. Bilateral orchiectomy materials were examined histopathologically, and Johnsen scores were used to evaluate postpubertal fertility potential. RESULTS: In our investigation, rats in all groups exhibited similar weight gains. The postpubertal size of the right testis in the testicular biopsy groups was found to be smaller compared to the remaining groups. In the warm ischemia group, testicular atrophy occurred after ischemic duration exceeding 30 min. Conversely, no testicular atrophy was observed in the cold ischemia groups. The dimensions of the rats' left testicles were similar. On histopathology, right testicular Johnsen scores were significantly lower in the warm ischemic groups than in the cold ischemic groups. DISCUSSION: Our study is the first to investigate the postpubertal effects of varying durations of warm and cold ischemia in a prepubertal testis-sparing surgery model. In our study, the Johnsen scores of testes subjected to 30, 60, and 90 min of ischemia were found to be higher in the cold ischemia groups compared to the warm ischemia groups. As the ischemia duration prolonged, a discernible progression of testicular atrophy was observed in the warm ischemia groups, contrasting with the sustained stability of testicular sizes in the cold ischemia groups. CONCLUSIONS: Warm ischemia applied to the testis causes damage to the testicle within the first 30 min and leads to atrophy after 30 min. In the cases of warm ischemia, both the Johnsen scores, which serve as indicators of post-pubertal fertility, and the testicular size decline in parallel with the duration of ischemia.
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BACKGROUND: The published experience concerning autologous peripheral blood stem cell collection in children is very limited. METHODS: The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. RESULTS: We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). CONCLUSIONS: Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.