[Letter Differing time for therapy of cryptorchism].
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Biomedical subjects
Publications and source records attributed to L Weissbach.
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Hamartomas of the kidney, often associated with tuberous sclerosis, have a typical angiographic appearance. Despite the similarity of the angiographic signs with malignant renal tumours, it is possible to differentiate these, as was shown in two patients which we have documented. If there is massive bleeding, fibrin embolisation carried out at the end of a diagnostic angiogram may lead to occlusion of the vessels and stop the bleeding. This was demonstrated in one of our patients.
For the radiologic diagnosis of secondaries of testicular tumors we use conventional plain films of chest and abdomen, IVP or infusion urography, tomography of the retroperitoneal space with or without contrast media and, according to the suspected site of metastases, further special radiologic techniques like lymphography, cavography, azygography, venography of the lumbar vein or, occasionally, aortography. The techniques are described, their value and limits discussed.
In 31 patients with unilateral idiopathic varicocele it was sought to correlate spermiogram and morphology of testis, particularly germinative epithelium, interstitial connective tissue and blood vessels. In both testes of all of 12 patients with pathological sperm striking morphological changes were found, from depletion of germinative cells to Sertoli-cell-only syndrome and including fibrosis of the interstitial tissue, reduction and occasionally diffuse or nodular hyperplasia of the Leydig cells as well as typical vascular changes. Due to alterations to the vascular walls the germinative epithelium had degenerated, this accounting for sub- and infertility, In the prophylaxis of fertility disturbances, the findings indicate that the same aspects apply to both varicocele and undecended testis.
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Undescended testis is of clinical importance because there are increased risks of milignancy and torsion and disturbances of fertility and psychosexual development. New quantitative morphologic investigations show that human prepubertal testicular maturation does not occur in phases but is continuous. This made it necessary to investigate afresh the causes of disturbance of fertility and the treatment of indescended testis. Our own investigations show that damage to the germ epithelium need not be congenital but may develop because of its ectopy. If, in dogs, a testis is placed into the abdomen, not only this but also the normally placed testis in the scrotum is damaged. The diameter of the tubules and their surfaces as well as the numbers of pachtenous primary spermatocytes are significantly reduced both in the displaced and the normally placed testis. Nuclear surfaces and density of the cells involved in spermatogenesis differ from those in the controls. The findings support the plea for early hormonal or surgical treatment in order to prevent later disturbances of fertility.
The behavior of various enzymes in the orthotopic and dystopic dog testis was examined under the conditions of experimental unilateral cryptorchism after HCG-treatment over a period of 3 months. The following findings could be obtained: 1. Under the HCG-application the orthotopic impuberal testis there was a change of behavior of the enzyme in the tubuli and Leydig-cells in comparison with test animals. A loss of LDH of the epithelium of the tubuli can be avoided through HCG-treatment. 2. In the dystopic testis of the impuberal animal, HCG cannot avoid this loss of LDH in the epithelium of the tubuli. In the Leydig cell complexes the Glucose-6-Phosphate-Dehydrogenase shows an increase of activity. 3. In the Leydig cell complexes of the impuberal testis an apparent loss of LDH is noticeable in the epithelium of the tubuli, while the non-specific esterase, SDH and the Glucose-6-Phosphate Dehydrogenase increases in activity. The activity of the Leydig cell complexes shows the expected stimulation. The present results prove that under a large dose of HCG-treatment can lead to different changes in the enzymes of the orthotopic testis of dogs.
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