Polyorchidism presenting with undescended testis.

We report on a case of polyorchidism that presented as undescended testis. Polyorchidism is defined as the presence of more than two testes. As in our case, most cases occur on the left side. The inferior testis is evidently larger than the accessory testis in all of the cases in the literature and, as far as we know, the present case is the first with the small testis located more distally than the larger one. The accessory testis had no reproductive potential due to a lack of attachment to a cord structure; therefore, it was removed because of the high risk of malignancy.

Post-traumatic duodenopancreatectomy in a child.

We describe a 5-year-old boy who complained of severe abdominal pain after a car accident. He was sitting on the lap of the driver and his abdomen was pressed closely between the pregnant driver and the steering wheel. At operation, associated injuries to the duodenum and pancreas were detected which could not be repaired. The transected pancreas and extensive duodenal injury underwent a Whipple-type reconstruction. On postoperative day six, the patient was re-operated due to extensive liver necrosis which was detected on abdominal computerized tomography and a partial liver resection was performed. He was discharged on day 16 after the second operation and has done well so far.

The role of surgery in intraabdominal Burkitt's lymphoma in children.

The role of surgery in intraabdominal Burkitt's lymphoma remains controversial and different opinions are present in the literature. In our institution, forty patients (30 boys and 10 girls) with intraabdominal Burkitt's lymphoma with ages ranging from 3 to 12 years have been treated and followed from 1989 through 2000. In ten cases, the patients underwent surgery because of their acute abdominal diseases (intestinal obstruction in 5, intussusception in 3, intestinal perforation in one, and acute appendicitis in one). The remaining thirty patients were referred to our clinic because of their abdominal masses, pain, anorexia and fatigue. Twelve children had localized tumors and total resection could be performed. There was one death in this group due to central nervous system involvement during chemotherapy. In the remaining 28 children, extensive intraabdominal diseases were detected. In four of them, debulking procedures were performed, while in 24 children only biopsies could be made; 8 of them underwent a second-look operation. In the debulking procedures group, two children were lost (50 %) due to tumorlysis and acute renal failure. In the biopsy group, there were six deaths (25 %). All patients received chemotherapy after operative recovery. In conclusion, our results suggest that when the tumor is localized, total resection results in a good outcome. However, in the presence of extensive intraabdominal diseases instead of resection, the operation should be limited to biopsy only.

The effect of the genitofemoral nerve division on the contralateral descended testis in the unilateral cryptorchidism model.

It is widely accepted that there are degenerative changes and decreased spermatogenesis in the contralateral descended testis (CDT) in unilateral undescended testis (UUDT). While some investigators have postulated that the mechanism may be related to primary (congenital) or secondary (autoimmune, vascular, and neural) events, the exact mechanism of the damage to the CDT is still unknown. The present study was planned to investigate the role of the genitofemoral nerve (GFN) on the changes in the CDT. Forty male Wistar albino rats were divided into four groups of 10 each. During the newborn period a UUDT model was created and at the age of 30 days ipsilateral GFN division was done (group A). In addition, UUDT with intact GFN (group B), divided right GFN with bilateral scrotal testes (group C), and control (group D) groups were formed. When the animals reached early adulthood, they were killed and the testes were removed. Mean seminiferous-tubular diameter (STD) and germinal-ephitelium maturity was determined using modified Johnson testicular biopsy scores (TBS). The mean STD and TBS of the study groups did not show any differences suggesting that ipsilateral division of the GFN has no effect on the CDT in the UUDT model.

The effect of surgical trauma on the bacterial translocation from the gut.

Bacterial translocation is the passage of viable bacteria from the lumen of the gastrointestinal tract through the intestinal mucosa to other sites. It is believed that bacterial translocation may lead to infection and septicemia. The purpose of this study was to determine what factors in experimental surgical trauma lead to bacterial translocation. Two-month-old Wistar albino rats were divided into five groups: (A) control; (B) anesthesia (ether inhalation); (C) anesthesia and surgery (median laparotomy and transient compression of the intestines); (D) fasting only; and (E) anesthesia, surgery, and fasting. After 48 hours, ileum, mesenteric lymph nodes, and blood were cultured for aerobic and anaerobic organisms. In each group the number of animals with bacteria overgrowth was calculated. The incidence of bacterial translocation to mesenteric lymph nodes and blood in groups B and D were similar to the controls (P greater than .01). There was a significant increase in the number of animals with bacterial translocation in groups C and E (P less than .001). The majority of translocating bacteria were E coli.

Effects of simulated Fowler-Stephens orchiopexy on testicular structure and function in rats.

To determine the effects of the Fowler-Stephens orchiopexy (FSO) on testicular structure and function, young rats underwent simulated FSO and concurrent contralateral orchiectomy, unilateral orchiectomy, or no operation. Rats were killed at 1, 2, 4, 6, 8, and 10 weeks postoperation, and serum testosterone, as well as testicular concentrations of the enzymes LDH & SDH, protein markers of testicular germinal cell development, were measured at the time of death. Although LDH and SDH concentrations decreased by 45 per cent in testes after simulated FSO at 4 weeks, control testes showed a 5 per cent increase in these enzymes. Serum testosterone decreased to one-fourth the initial value in rats after FSO, whereas control rats showed a slight increase. Within 2 weeks after simulated FSO, spermatocytes and sperm were sparse and there was marked disruption of tubular morphology; after 4 weeks interstitial fibrosis became prominent. Only a rare testis with good collateral vessels and resultant good histologic appearance and enzyme profile survived the FSO procedure, and these testes were considerably smaller than the controls.

Effects of spermatic vascular division for correction of the high undescended testis on testicular function.

Orchiopexy with division of the spermatic artery and veins is a commonly used technique for correcting the high undescended testis, although the longterm results have not been clearly defined. The left spermatic artery and veins of 22 adult Wistar albino rats were divided while preserving the vessels associated with the vas and cremaster muscle (DT). A sham operation was performed on the left testicle of six additional rats (ST). At 3 weeks postoperatively, both testes from all rats were removed. All testes were viable and bled when incised, although bleeding was considerably reduced in testes with DT. Mean testicular weights after DT were 1,061 +/- 423 mg compared with 1,634 +/- 125 mg for ST rats (p less than 0.02) and 1,508 +/- 119 mg for contralateral testes. The mean tubular diameter after DT was 220 +/- 37 mu compared with 303.1 +/- 10.7 mu for ST testes (p less than 0.02). The testicular biopsy score based upon the morphology of the spermatic tubules was 4.46 +/- 3.32 for DT testes and 8.65 +/- 0.23 for ST testes (p less than 0.02) compared with 8.38 +/- 0.18 for contralateral testes and an absolute normal value of 10. No morphologic abnormalities were observed in the contralateral unoperated testes from any of the rats. The contralateral testes in 12 additional rats were removed before DT. The mean testosterone values in these rats with one testicle was 1.43 +/- 0.75 ng/mL. Three weeks after DT, testosterone values were 0.19 +/- 0.31 ng/mL (p less than 0.01). It is concluded that division of the main spermatic artery and vein in rats produces testicular atrophy with spermatogenic arrest and interstitial cell dysfunction. Although collateral blood flow to the testis may be demonstrated, tissue perfusion is inadequate for normal spermatogenesis and endocrine function.

Triglyceride absorption in transperitoneal alimentation.

In 17 fasted rabbits, a 20% solution of Intralipid was administered into the peritoneal cavity. Oral and intravenous feedings were not provided. Eight of the rabbits underwent resection of 50% of the intestine. Serial samples of serum and peritoneal fluid showed that half of the triglyceride was absorbed within 1 hour in rabbits with intact viscera, but not until 2 hours in rabbits with intestinal resection. The caval-arterial gradient for triglycerides was consistently positive in rabbits with intact intestine, whereas it was smaller and erratic after intestinal resection. The portal-arterial gradient was never significantly different from zero. These data indicate that the major triglyceride absorption occurred across the visceral peritoneum through lymphatic vessels, with little portal venous absorption. Transperitoneal absorption of triglycerides occurred to a sufficient degree to provide substantial nutritional supplementation in rabbits with intact intestine; absorption was less in rabbits with intestinal resection.

Morphologic effects of orchiopexy or orchiectomy on the contralateral testis in experimental unilateral cryptorchidism.

For evaluation of the effects of orchiopexy and orchiectomy on the contralateral descended testis, unilateral cryptorchidism was produced in 60 21-day-old mice by suturing of the left testis to the inner abdominal wall. A sham operation was performed on the left testis of 20 control mice (S). After creation of unilateral cryptorchidism, orchiopexy (P) or orchiectomy (O) was performed on the left testis at 2 (group I) and 10 (group II) weeks (ten mice each). All testes were removed for examination 2 weeks after orchiopexy or orchiectomy. In both groups the mean values of testicular weight, seminiferous tubular diameter, and tubular biopsy score of contralateral O testes were always statistically similar to the values of contralateral S testes (p greater than 0.01). The difference between TBS values of contralateral P and S testes was not significant in group I (p greater than 0.01), but it was significant in group II (p less than 0.01). The data from this murine experiment suggest that orchiectomy for unilateral cryptorchid testis is almost always helpful in improving contralateral morphology; however, orchiopexy can be helpful if it is not performed late in the period of maturation.

Morphologic effects of unilateral cryptorchidism on the contralateral descended testis.

Unilateral cryptorchidism is frequently accompanied by infertility. Uncertainty exists as to whether the infertility is a genetic effect or is related to an autoimmune reaction to the elevated testis. The effects of unilateral cryptorchidism were evaluated in 50 mice by surgically elevating the left testicle of 21-day-old mice into the abdomen (AT). A sham operation was performed on the left testicle of 50 control mice (SHT). The temperature of the abdominal testes measured 2.5 degrees C higher than the scrotal testes. The testes were removed from both sides at 1, 2, 3, 4 and 6 weeks postoperation. After testicular weights were recorded, seminiferous tubule diameters were measured, and germinal epithelium maturity was graded histologically using a modified Johnson testicular biopsy score. Progressive abnormal changes were seen in the contralateral descended testicles of AT as compared to SHT. By 3 weeks, though testicular weight changes were similar, mean seminiferous tubule diameter was smaller (P less than .001), and the germinal epithelium was less mature (P less than .001). These changes persisted through the sixth week. By changing the physiologic environment of one testicle, we have induced alterations in the histologic appearance of the contralateral testicle during the period of normal maturation.