[Tibial torsion and femoral torsion].
Explore the source record for details and available documents.
Femur↗
SEARCH · Search PubMed
Results for “TORSION”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The torsional component of "horizontal" congenital nystagmus.
OBJECTIVES: To study the relationship between the major horizontal and minor torsional components of congenital nystagmus to elucidate the diagnostic importance, effects on vision, and pathogenetic implications of the torsional components. METHODS: We recorded the eye movements of 13 subjects with congenital nystagmus using a three-dimensional magnetic search coil technique over a 15-year period. The subjects fixated on stationary targets straight ahead and along the horizontal and vertical meridians. Six of the 10 subjects with horizontal congenital nystagmus were asymptomatic; the remaining 4 (plus two with a vertical component to their congenital nystagmus) had adult-onset symptoms. An additional subject without symptoms had a vertical congenital nystagmus component plus seesaw nystagmus; one of the symptomatic subjects also had seesaw nystagmus. RESULTS: In all 13 subjects, the horizontal and torsional cycles were phase-locked, and positive horizontal (rightward), vertical (upward, if any), and torsional (clockwise) motion coincided in 10 subjects. That is, rightward horizontal eye rotation coincided with clockwise curvilinear motion (rightward and downward) of the upper pole of each eye. During the horizontal foveation periods, torsional motion was also of low velocity. In 2 of 13 subjects, the torsional waveforms differed from those in the horizontal plane; in others, the direction or the variation with gaze angle differed from that predicted by Listing. In each of the 13 subjects, the torsional components ranged from 8.16% to 94.42% (median, 32.94%) of the peak-to-peak magnitudes of the congenital nystagmus. In most cases, the measured torsion was far greater than that predicted by Listing's law for a worst-case analysis (range, 0.69-11.83%; median, 4.91%). The torsional components of the two subjects with seesaw nystagmus were 60.48% and 264.02%. CONCLUSIONS: The manner in which the horizontal and torsional components of "horizontal" congenital nystagmus were phase-locked made clinical detection of the torsional component difficult. Most "horizontal" congenital nystagmus is actually horizontal-torsional congenital nystagmus. Visual acuity during horizontal foveation periods is not significantly diminished by torsional motion. In only one subject did the torsional component of the congenital nystagmus have an amplitude equivalent to Listing torsion; in the other 12 subjects, torsion exceeded our estimate of what Listing's law would predict. The torsional components of the seesaw nystagmus in two subjects also greatly exceeded the torsion predicted by Listing torsion. The most parsimonious explanation for our data is that the cyclic torsion in congenital nystagmus was generated centrally and not a result of Listing torsion, mechanical crosstalk, or normal or abnormal extraocular-muscle (plant) dynamics. Further measurements are needed to confirm this hypothesis.
Adult↗
Deficits in vertical and torsional eye movements after uni- and bilateral muscimol inactivation of the interstitial nucleus of Cajal of the alert monkey.
The mesencephalic interstitial nucleus of Cajal (iC) is considered the neural integrator for vertical and torsional eye movements and has also been proposed to be involved in saccade generation. The aim of this study was to elucidate the function of iC in neural integration of different types of eye movements and to distinguish eye movement deficits due to iC impairment from that of the immediately adjacent rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). We addressed the following questions: (1) According to the neural integrator hypothesis, all eye movements including the saccadic system and the vestibulo-ocular reflex (VOR) share a common neural integrator. Do iC lesions impair gaze-holding function for vertical and torsional eye positions and the torsional and vertical VOR gain to a similar degree? (2) What are the dynamic properties of vertical and torsional eye movements deficits after iC lesions, e.g., the specificity of torsional and vertical nystagmus? (3) Is iC involved in saccade generation? We performed 13 uni- and three bilateral iC inactivations by muscimol microinjections in four alert monkeys. Three-dimensional eye movements were studied under head-stationary conditions during vertical and torsional VOR. Under static conditions, unilateral iC injections evoked a shift of Listing's plane to the contralesional side (up to 20 degrees), which increased (ipsilesional ear down) or decreased (ipsilesional ear up) by additional static vestibular stimulation in the roll plane, i.e., ocular counterroll was preserved. The monkeys showed a spontaneous torsional nystagmus with a profound downbeat component. The fast phases of torsional nystagmus always beat toward the lesion side (ipsilesional). Pronounced gaze-holding deficit for torsional and vertical eye positions (neural integrator failure) was reflected by the reduction of time constants of the exponential decay of the slow phase to 330-370 ms. Whereas the vertical oculomotor range was profoundly decreased (up to 50%) and vertical saccades were reduced in amplitude, saccade velocity remained normal and horizontal eye movements were not affected. Bilateral iC injections reduced the shift of Listing's plane caused by unilateral injections, i.e., back toward the plane of zero torsion. Torsional nystagmus reversed its direction and ceased, whereas vertical nystagmus persisted. In contrast to unilateral injection, there was additional upbeating nystagmus. Time constants of the position integrator of the gaze-holding system did not differ between unilateral and bilateral injections. The range of stable vertical eye positions and saccade amplitude was smaller when compared with unilateral injections, but the main sequence remained normal. Dynamic vestibular stimulation after unilateral iC injections had virtually no effect on torsional and vertical VOR gain and phase at the same time when time constants already indicated severe integrator failure. Torsional VOR elicited a constant slow-phase velocity offset up to 30 degrees toward the contralesional side, i.e., in the opposite direction to spontaneous torsional nystagmus. Likewise, vertical VOR showed a velocity offset in an upward direction, i.e., opposite to the spontaneous downbeat nystagmus. Contralesional torsional and upward vertical quick phases were missing or severely reduced in amplitude but showed normal velocity. In contrast, bilateral iC injections reduced the gain of the torsional and vertical VOR by 50% and caused a phase lead of 10-20 degrees (eye compared with head velocity). We propose that the slow-phase velocity offset during torsional and vertical VOR reflects a vestibular imbalance. It therefore appears likely that the vertical and torsional nystagmus after iC lesions is not only caused by a neural integrator failure but also by a vestibular imbalance. Unilateral iC injections have clearly differential effects on the VOR and the gaze-holding function. (ABSTRACT TRUNCATED)
Animals↗
Experimental testicular torsion: reperfusion blood flow and subsequent testicular venous plasma testosterone concentrations.
OBJECTIVES: To examine the effect of torsion on subsequent testicular venous plasma testosterone concentrations (TVT) and to determine the relationship between the TVT values 30 days after torsion repair and testicular reperfusion immediately after torsion repair, because testicular torsion followed by repair induces an ischemia/reperfusion injury of the testis. METHODS: Adult male rats were subjected to 1 hour of 720 degrees testicular torsion, a time and degree of torsion that has been shown to cause severe impairment of spermatogenesis. Testicular microvascular perfusion before torsion, during torsion, and 5 minutes after torsion repair was determined by laser Doppler flowmetry. The animals were evaluated 3 days and 30 days later for microvascular perfusion and TVT. RESULTS: Experimental torsion significantly reduced testicular vascular perfusion. Five minutes after torsion repair, the mean flow values had returned to approximately 70% of the pretorsion values. Testicular torsion significantly reduced TVT at both 3 and 30 days after torsion repair. TVT 30 days after torsion repair was significantly, but inversely, related to reperfusion values immediately after torsion repair. CONCLUSIONS: These results demonstrate that the minimal duration and degree of torsion known to cause loss of spermatogenesis in the rat also causes a significant reduction in testicular androgen production in the long term. This effect was inversely related to the reperfusion values immediately after torsion repair. This suggests that reperfusion/oxidative stress may play a role in Leydig cell dysfunction, as well as by acting directly in germ cell apoptosis.
Animals↗
Microvascular blood flow is altered after repair of testicular torsion in the rat.
PURPOSE: Previous studies have shown that experimental testicular torsion with a duration of 1 hr. or longer causes irreversible damage to the rat testis, but that testicular blood flow values are normal 24 hrs. after repair of torsion. More acute evaluation of return blood flow after repair of torsion has not been performed and was the topic of this study. MATERIALS AND METHODS: Laser-Doppler flowmetry was used to evaluate testicular microvascular blood flow before application of 1, 2, or 4 hr., 720 degrees torsion, during torsion, and at several time points after repair of torsion. Experiments were performed in both adult and prepubertal rats. RESULTS: Testicular torsion essentially eliminated blood flow in both adult and prepubertal testes. Considering all the flow data within each group after torsion repair, increasing time of torsion was associated with significantly less return blood flow in both adult and prepubertal animals. Interestingly, only the four hour torsion data was associated with reduced return flow in prepubertal animals while both two and four hour torsion were associated with poor return flow in adult animals. Vasomotion, or pulsatile microvascular flow, often seen before torsion in both adult and prepubertal animals, was never seen after torsion repair. CONCLUSIONS: Increasing times of torsion are associated with lower microvascular blood flow values during the hour following the relief of torsion. Vasomotion is eliminated by torsion during the period studied. Whether vasomotion returns is unknown, but altering this flow pattern might be involved in the mechanism of injury caused by acute torsion.
Age Factors↗
Torsion of the testis and allied conditions.
In 15 years at Bristol there have been 293 cases of torsion of the testis, 55 cases of torsion of a testicular appendage and 5 cases of testicular ischaemia due to other causes. The risk of a male developing torsion of the testis or its appendix by the age of 25 is about 1 in 160. Both conditions occurred primarily in adolescents, but among prepubertal boys torsion of an appendage was as common as torsion of a normally descended testis. There was a slight left-sided preponderance in testicular torsion, more marked in torsion of the appendages; the incidence of bilateral torsion was 2-0 and 1-8 per cent respectively. The clinical features and differential diagnosis of the two conditions are compared. Torsion of a testicular appendage is the most commonly misdiagnosed scrotal lesion, the preoperative diagnosis being correct in only 11 per cent of cases compared with 90 per cent for torsion of the testis. Twenty-one cases of recurrent torsion underwent prophylactic bilateral orchidopexy. There were 20 cases of torsion of undescended testes, with a salvage rate of only 20 per cent. The overall testicular survival rate was 55-3 per cent. Viability depends upon the possibility of spontaneous reduction, the preoperative delay after the onset of symptoms, the degree of torsion of the cord and the length of follow-up in doubtful cases. Urgent scrotal exploration is advised in every case of acute testicular pain unless there is overwhelming evidence of epididymoorchitis. Exploration of the opposite side is mandatory in torsion of the testis and advisable in torsion of an appendage.
Adolescent↗
Spermatic cord torsion: loss of spermatogenesis despite return of blood flow.
Previous work in animal models has recapitulated and refined the clinical observation that longer periods of testicular torsion are associated within increased damage to the testis. Minimum times of damage-inducing torsion have not been established, however, nor has it been established to what degree blood flow returns to the testis on examination several hours or days after the torsion repair. Adult male rats were subjected to 0.5-h or 1.0-h 720 degrees torsion and examined for effects on testis weight, histology, and daily sperm production (DSP). None of the parameters examined were affected by 0.5-h, but all were affected by 1.0-h torsion. In a subsequent experiment, adult rats were subjected to unilateral, 1-h, 720 degrees torsion, and bilateral testicular blood flow as measured by radiolabeled microsphere distribution was determined during torsion and 4 h, 24 h, 2 days, 7 days, 15 days, and 30 days after repair of torsion. Ipsilateral testicular blood flow was reduced 94% during torsion. Blood flow was not significantly different from control or contralateral values by 4 or 24 h after repair of torsion. In spite of this return of blood flow, testis weights were significantly reduced by half by 7 days after torsion repair and spermatogenesis was clearly disrupted upon histological examination 30 days after torsion repair. Increasing the time of torsion to 2 or 4 h did not inhibit return of blood flow to the testis as measured 48 h after torsion repair. Unless the testis is infarcted, testicular blood flow in the rat model returns to normal after torsion repair.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Long-term and late results of treatment in patients with a history of testicular torsion].
Testicular torsion is a surgical urgency. It may lead to loss of that organ and moreover, as revealed by experimental studies and clinical findings in adults, induces autoimmunological reactions with subsequent male infertility. To elucidate these sequellae the following questions seem to be relevant 1. Are there any antisperm antibodies or shifts in T cell CD4+, CD8+ and NK subpopulations in boys with a history of testicular torsion? 2. Is production of antisperm antibodies initiated and maintained in childhood, and amplified after puberty? 3. Does the age at testicular torsion and duration of exposure to sperm antigens/testicular tissue have an effect on induction and levels of antisperm antibodies? 4. Is hormonal function of testis/testes and gonadotropic activity of the pituitary gland normal in these patients? 5. What conditions (duration, subjective and objective symptoms) are associated with testicular torsion; what kind of intraoperative findings can be expected; what is the influence of testicular torsion on the twisted testis? The study group (GB) consisted of 37 boys and men aged from 8 months to 27 years (mean 12.3 years) recruited from 86 patients seen for testicular torsion at the Department of Pediatric Surgery, Pomeranian Academy of Medicine in Szczecin, between 1967 and 1992. The control group (GK) comprised 42 healthy boys and men aged 3 to 33 years (mean 12.1 years) (Tab. 1). The analysis was based on: 1) clinical files; 2) follow-up results; 3) laboratory findings; 4) statistics. According to clinical data and physical examination, testicular torsion usually appeared during puberty, neonatal period and infancy and the mean duration of torsion was 12.4 days. The best prognosis for salvage of the twisted testis was for torsions lasting no longer than 8 hours. Only 8 of 37 twisted testes could be salvaged (including 4 hypotrophic testes; Tab. 2). There were 21 positive ELISA tests (level of antisperm antibodies exceeding 2 fg/pl) in the study group (mean 4.45 +/- 5.6 fg/pl), including 13 boys with testicular torsion in the prepubertal age and 8 during puberty (Tab. 3). A tendency to higher levels of antibodies with age was observed. In the control group there were 35 negative and 7 positive results (mean 1.05 +/- 1.86 fg/pl) (Tab. 4), significantly less than in the study group (p < 0.001). Trend curves (Fig. 1) and Pearson's correlation coefficients (Fig. 2) for levels of antibodies and age at presentation of testicular torsion were established for both groups. Mean percentages of CD4+, CD8+ and NK cells (indirect immunofluorescence test with monoclonal antibodies) were insignificantly lower in the study group (Fig. 3). Shifts in favor of CD4+ and NK subpopulations found in some patients correlated with high levels of antisperm antibodies (Tab. 5 and Fig. 4). Elevated LH and/or FSH (21 patients) and/or testosterone levels (13 patients) were usually observed during puberty (Tab. 6). The results indicate that antisperm antibodies are detected in more than half of the boys with a history of testicular torsion. This is accompanied in some cases by shifts in CD4+ and NK lymphocyte subpopulations correlating with high antibody levels. Production of antisperm antibodies initiated during prepuberty (in infancy or even in the neonatal period) persists and is amplified after puberty due to increasing amounts of antigen material. Age at testicular torsion (age at potential exposure to spermatic antigens/testicular tissue from the twisted or de-twisted testis with severe haemorrhagic lesions or left in the abdominal cavity) has an effect on the future production and levels of antisperm antibodies. Disturbances in the secretion of LH and/or FSH were observed in 2/3 of the boys/men with a history of testicular torsion. Abnormal secretion of testosterone was found in 1/3 of the patients. These hormonal disorders seem to have no influence on virilization, libido or sexual potency.
Adult↗
Endocrine and exocrine effects of testicular torsion in the prepubertal and adult rat.
Previous studies of experimental torsion have suggested that there may be important differences between the adult testis and the prepubertal testis in their responses to torsion, especially with regard to the potential for contralateral damage following unilateral testicular torsion. In the present study, adult Sprague-Dawley rats and prepubertal Sprague-Dawley rats (35 days of age) were subjected to unilateral 1-, 2-, and 4-hour periods of 720 degrees or 360 degrees testicular torsion. Ipsilateral and contralateral testes were examined 30 and 60 days after torsion repair for effects on testis weight, histology, and daily sperm production (DSP). Other animals were subjected to 1-/or 4-hour 720 degrees torsion, and testicular vein testosterone concentrations were determined 30 days later. In adult animals, 1-, 2-, and 4-hour 720 degrees torsion resulted in a significant decline in ipsilateral testis weight within 30 days. Endocrine and exocrine function were also clearly disrupted. In prepubertal animals, 1-hour 720 degrees torsion significantly reduced testis weight 60 days after surgery. Also, prepubertal DSP values and testicular vein testosterone concentrations were not significantly reduced from control values by 1-hour 720 degrees torsion when examined 30 days after surgery. Longer periods of 720 degrees torsion resulted in damage similar to that seen in the adult animals. Neither adult nor prepubertal animals regained any lost function when examined 60 days after insult. Torsion of 360 degrees induced no testicular injury in adult or prepubertal animals. Contralateral testes were not affected by degree or duration of torsion in either adult or prepubertal animals. These results suggest that the prepubertal testis may be more refractory to the effects of short periods of torsion than the adult. More importantly, these results demonstrate that ipsilateral torsion does not result in contralateral testicular damage in either adult or prepubertal animals.
Animals↗
Independent effects of preload, afterload, and contractility on left ventricular torsion.
Shortening of oblique left ventricular (LV) fibers results in torsion. A unique relationship between volume and torsion is therefore expected, and the effects of load and contractility on torsion should be predictable. However, volume-independent behavior of torsion has been observed, and the effects of load on this deformation remain controversial. We used magnetic resonance imaging (MRI) with tagging to study the relationships between load and contractility, and torsion. In ten isolated, blood-perfused canine hearts, ejection was controlled by a servopump: end-diastolic volume (EDV) was controlled by manipulating preload parameters and end-systolic volume (ESV) by manipulating afterload using a three-element windkessel model. MRI was obtained at baseline, two levels of preload alteration, two levels of afterload alteration, and dobutamine infusion. An increase in EDV resulted in an increase in torsion at constant ESV (preload effect), whereas an increase in ESV resulted in a decrease in torsion at constant EDV (afterload effect). Dobutamine infusion increased torsion in association with an increase in LV peak-systolic pressure (PSP), even at identical EDV and ESV. Multiple regression showed correlation of torsion with preload (EDV), afterload (ESV), and contractility (PSP; r = 0.67). Furthermore, there was a close linear relationship between torsion and stroke volume (SV) and ejection fraction (EF) during load alteration, but torsion during dobutamine infusion was greater than expected for the extent of ejection. Preload and afterload influence torsion through their effects on SV and EF, and there is an additional direct inotropic effect on torsion that is independent of changes in volume but rather is force dependent. There is therefore potential for the torsion-volume relation to provide a load-independent measure of contractility that could be measured noninvasively.
Animals↗
Saccades from torsional offset positions back to listing's plane.
Rapid eye movements include saccades and quick phases of nystagmus and may have components around all three axes of ocular rotation: horizontal, vertical, and torsional. In this study, we recorded horizontal, vertical, and torsional eye movements in normal subjects with their heads upright and stationary. We asked how the eyes are brought back to Listing's plane after they are displaced from it. We found that torsional offsets, induced with a rotating optokinetic disk oriented perpendicular to the subject's straight ahead, were corrected during both horizontal and vertical voluntary saccades. Thus three-dimensional errors are synchronously reduced during saccades. The speed of the torsional correction was much faster than could be accounted for by passive mechanical forces. During vertical saccades, the peak torsional velocity decreased and the time of peak torsional velocity was delayed, as the amplitude of vertical saccades increased. In contrast, there was no consistent reduction of torsional velocity or change in time of peak torsional velocity with an increase in the amplitude of horizontal saccades. These findings suggest that 1) the correction of stimulus-induced torsion is neurally commanded and 2) there is cross-coupling between the torsional and vertical but not between the torsional and horizontal saccade generating systems. This latter dichotomy may reflect the fact that vertical and torsional rapid eye movements are generated by common premotor circuits located in the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). When horizontal or vertical saccade duration was relatively short, the torsional offset was not completely corrected during the primary saccade, indicating that although the saccade itself is three-dimensional, saccade duration is determined by the error in the horizontal or the vertical, but not by the error in the torsional component.
Adult↗
Length and torsion of the lower limb.
Corrective osteotomies are often planned and performed on the basis of normal anatomical proportions. We have evaluated the length and torsion of the segments of the lower limb in normal individuals, to analyse the differences between left and right sides, and to provide tolerance figures for both length and torsion. We used CT on 355 adult patients and measured length and torsion by the Ulm method. We excluded all patients with evidence of trauma, infection, tumour or any congenital disorder. The mean length of 511 femora was 46.3 +/- 6.4 cm (+/-2SD) and of 513 tibiae 36.9 +/- 5.6 cm; the mean total length of 378 lower limbs was 83.2 +/- 11.4 cm with a tibiofemoral ratio of 1 to 1.26 +/- 0.1. The 99th percentile level for length difference in 178 paired femora was 1.2 cm, in 171 paired tibiae 1.0 cm and in 60 paired lower limbs 1.4 cm. In 505 femora the mean internal torsion was 24.1 +/- 17.4 degrees, and in 504 tibiae the mean external torsion was 34.9 +/- 15.9 degrees. For 352 lower limbs the mean external torsion was 9.8 +/- 11.4 degrees. The mean torsion angle of right and left femora in individuals did not differ significantly, but mean tibial torsion showed a significant difference between right (36.46 degrees of external torsion) and left sides (33.07 degrees of external torsion). For the whole legs torsion on the left was 7.5 +/- 18.2 degrees and 11.8 +/- 18.8 degrees, respectively (p < 0.001). There was a trend to greater internal torsion in femora in association with an increased external torsion in tibiae, but we found no correlation. The 99th percentile value for the difference in 172 paired femora was 13 degrees; in 176 pairs of tibiae it was 14.3 degrees and for 60 paired lower limbs 15.6 degrees. These results will help to plan corrective osteotomies in the lower limbs, and we have re-evaluated the mathematical limits of differences in length and torsion.
Adolescent↗
Division of the genitofemoral nerve and late orchiectomy: effects on the contralateral testis in ipsilateral testicular torsion.
Unilateral torsion of the spermatic cord has been demonstrated to damage the contralateral testis; however, the pathogenesis has not yet been examined in detail. The purpose of this study was to evaluate the influence of unilateral torsion on the contralateral testis in rats by performing ipsilateral division of the genitofemoral nerve (GFN) and/or late orchiectomy. Male 25-day-old, prepubertal Wistar albino rats were divided into five groups: (1) sham operation; (2) unilateral testicular torsion; (3) simultaneous unilateral testicular torsion and ipsilateral GFN division; (4) unilateral testicular torsion and orchiectomy on the 4th day after torsion; and (5) simultaneous unilateral testicular torsion and GFN ipsilateral division, and orchiectomy on the 4th day after torsion. Torsions performed were 720 degrees, all on the right testes. On day 55 after torsion, which represents the early postpubertal period of the rat, the contralateral testes were removed. Tubular biopsy score (TBS) was calculated, and seminiferous tubular diameters (STD) were measured. Student's t-test was used for statistical analysis. There was no contralateral testicular damage in the control group, but in all of the study groups destructive changes were found in the left gonad after torsion of the right testicle. The mean TBS of the study groups was higher than that of the control group. STD values were lower in the study groups, but the differences were not statistically significant between groups. In prepubertal rats, unilateral torsion causes histologically measurable changes in the contralateral testis. Ipsilateral division of the GFN and late orchiectomy did not cause any significant alterations in terms of contralateral damage. Further investigations are needed to determine the role of the GFN in testicular torsion.
Animals↗
The protective role of erdosteine on testicular tissue after testicular torsion and detorsion.
Testicular torsion and detorsion are important clinical problems for infertile man and oxidative stress may have a role in this clinical situation. The aim of this study was to investigate the protective role of erdosteine, an antioxidant, on unilateral testicular reperfusion injury in rats. The rats were divided into four groups including seven rats in each group: control, torsion, torsion/detorsion and torsion/detorsion+erdosteine. Rats, except the sham operation group, were subjected to left unilateral torsion (720( composite function) rotation in the clockwise direction) without including the epididymis. The experiments were finished after sham operation time for control, 120 min torsion for torsion group and 120 min torsion and 240 min detorsion for torsion/detorsion groups. Bilateral orchiectomy was performed for all groups of rats. The ipsilateral and controlateral testis were divided into two pieces to analyse biochemical parameters and to investigate the light microscopic view. Malondialdehyde level of ipsilateral testis was increased in torsion and torsion/detorsion groups in comparison with the other groups (p < 0.05). Erdosteine treatment ameliorated lipid peroxidation after torsion/detorsion in ipsilateral testis (p < 0.05). Also, xanthine oxidase activity of ipsilateral testis was increased in torsion/detorsion group in comparison with the others (p < 0.05). Nitric oxide (NO) level of ipsilateral testis was higher in all experimental groups than sham operated control group (p < 0.05). Also, NO level of torsion group was increased in comparison with detorsion groups (p < 0.05). Erdosteine treatment caused increased glutathione peroxidase activity in comparison with torsion and torsion/detorsion groups and catalase activity in comparison with the other groups in ipsilateral testis (p < 0.05). Superoxide dismutase activity of ipsilateral testis was higher in torsion/detorsion and torsion/detorsion+erdosteine groups than control and torsion groups (p < 0.05). The biochemical parameters were not affected in controlateral testis in all groups. Torsion, torsion/detorsion and torsion/detorsion+erdosteine groups showed ipsilateral testicular damage in the histological examination, but the specimens from torsion/detorsion had a significantly greater histological injury than those from the other groups (p < 0.05). Control rats showed normal seminiferous tubule morphology. Rats in torsion group had slight-to-moderate disruption of the seminiferous epithelium. Rats in torsion/detorsion group displayed moderate-to-severe disruption of the seminiferous epithelium. In all animals from torsion/detorsion+erdosteine group, the testicular tissues were affected with slight-to-moderate degenerative changes of the seminiferous epithelium. Administration of erdosteine resulted in a significantly reduced histological damage associated with torsion of the spermatic cord compared with torsion/detorsion. In all groups, the contralateral testes were histologically normal. In conclusion, the results clearly displayed that erdosteine treatment may have a protective role on testicular torsion/detorsion injury.
Animals↗
[Spermatic cord torsion in the newborn: role of surgical exploration].
UNLABELLED: Torsion of the spermatic cord is frequent in neonates suffering from acute scrotal distress. A retrospective study was carried out to determine the viability and the outcome of testis treated by surgical exploration. PATIENTS AND RESULTS: Surgical exploration of 30 neonates presenting acute scrotal distress found: 18 torsions of the spermatic cord, six intrascrotal bleedings or hematoma due to delivery trauma, five tunica vaginalis inflammations and one ischemia without torsion. The torsion occurred in utero in 16 cases and after birth in two cases. The contralateral uninvolved testis was fixed to the scrotum in all cases. The torsion was extravaginal in 17 cases and intravaginal in one case. In all cases of prenatal torsion, there was total necrosis of the testis. One case of postnatal torsion operated on four hours after the beginning of the torsion was saved. CONCLUSION: Although the viability of the torsioned testis is compromised in cases of prenatal torsion, surgical exploration is necessary to confirm diagnosis and to avoid any contralateral torsion because bilateral torsion exists. Only emergency surgical exploration can save a testis that has undergone post-natal torsion as reported in others series.
Age Factors↗
Adnexal torsion involving hydatids of Morgagni: a rare cause of acute abdominal pain in adolescents.
OBJECTIVE: Hydatids of Morgagni are common embryonal remnants of the müllerian duct and among the infrequent causes of adnexal torsion. The purpose of this study was to investigate the occurrence of adnexal torsion involving hydatids of Morgagni, as well as its possible mechanisms. METHODS: A database search was conducted for cases of adnexal torsion treated in our institution from January 2002 to July 2005. These cases were analyzed, focusing on a subgroup of adolescents with adnexal torsion involving the hydatids of Morgagni. RESULTS: There were 76 patients with adnexal torsion. The rate of hydatid of Morgagni torsion was 26% (4 of 15 cases, 95% confidence interval [CI] 0.15-0.51) in the adolescent subgroup (10-19 years old), compared with 0% (0 of 61 cases, 95% CI 0-0.048) in the adult subgroup. The difference between the hydatid torsion rates in the two subgroups was statistically significant (P = .01, 95% CI 0.001-0.532). The four patients with hydatid torsion (postmenarchal girls, aged 13-18 years) were managed with laparoscopic adnexal detorsion and cystectomy of the affected hydatid of Morgagni. At surgery, we noted three different mechanisms of hydatid torsion: torsion of the adnexa together with torsion of the hydatid of Morgagni, torsion of the hydatid of Morgagni with intact adnexa (n = 2), and entanglement of the hydatid's pedicle around the distal fallopian tube. The hydatids of Morgagni were observed on the preoperative transabdominal ultrasonogram in only one patient and appeared as a simple cyst. CONCLUSION: Adnexal torsion involving the hydatids of Morgagni appears to be more common in adolescents than previously thought. LEVEL OF EVIDENCE: III.
Abdominal Pain↗
Management of perinatal torsion: today, tomorrow or never?
PURPOSE: Management of perinatal testicular torsion is a highly controversial issue. Despite uncommon salvage of the affected gonad, exploration for ipsilateral orchiectomy and empiric contralateral orchiopexy have been recommended due to the unlikely but unfortunate possibility of asynchronous torsion. Observation with serial examination is the alternative. Risk of general anesthesia must be weighed against the risk of anorchia. We describe our collective experience with bilateral perinatal torsion, solidifying our recommendation for early exploration in all cases of perinatal torsion. MATERIALS AND METHODS: All cases of perinatal torsion from 3 practices during a 3-year period were reviewed. All practices were at an academic center or in a major metropolitan area. Early exploration for contralateral orchiopexy was performed in all cases. RESULTS: In 18 patients examination was consistent with unilateral perinatal torsion. Contralateral torsion was discovered at the time of exploration in 4 cases (22%). Despite orchiopexy of the better perfused gonad, atrophy was universal in these 4 cases. Findings potentially related to contralateral torsion were identified in 2 additional cases. No anesthetic or operative complications occurred. CONCLUSIONS: Bilateral asynchronous perinatal torsion is an uncommon but serious event. In our experience torsion of the contralateral gonad was not associated with signs or symptoms of acute torsion. Observation and serial examinations are then a challenging proposition. Due to the consistently poor outcome from bilateral asynchronous torsion, we continue to recommend early exploration and empiric contralateral orchiopexy for all cases of perinatal torsion. Parents must be counseled regarding the relative risks of exploration and anesthesia versus observation.
Humans↗
The effect of prepubertal spermatic cord torsion on subsequent fertility in rats.
This study was undertaken to determine the effects of various durations of testicular torsion in prepubertal rats on their subsequent fertility, and to determine whether these effects could be altered by removal of the torsioned testis. Sixty rats (35 days old) were subjected to 720 degrees unilateral spermatic cord torsion for 0, 1, 3, 5, 9, or 12 hours. The torsioned testis was then either detorsioned or removed. At 65 days of age each male was housed with two females for three weeks. Rats undergoing detorsion of the spermatic cord demonstrated a linear decrease in fertility with respect to the duration of torsion (r = -0.904). However, all of the animals undergoing unilateral torsion with subsequent orchiectomy were fertile, regardless of the duration of torsion. In addition, the percentage of females impregnated, the number of embryos produced, and the mean embryo size decreased with increasing intervals of torsion (r = -0.834 to r = -0.979); the sharpest decline occurred between 5 and 9 hours of torsion. All of these parameters were significantly lower (P less than 0.001 to P less than 0.05) in the detorsioned group as compared to the orchiectomized group. There was a decrease in seminiferous tubule diameter in the contralateral testis with respect to the duration of torsion (P less than 0.01). These data indicate that unilateral spermatic cord torsion in young rats significantly reduced their subsequent fertility with respect to duration of the torsion, and that this detrimental effect may be minimized if the damaged testis is removed rather than untwisted and replaced into the scrotum.
Animals↗