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PubMed1976

Comparison of allergic aspermatogenesis with that induced by vasectomy. I. In vivo studies in the guinea-pig.

Groups of male and female guinea-pigs were immunized with homologous epdidymal sperm in Freund's complete adjuvant (FCA) and skin tested at weekly intervals with a heat-treated extract of the sperm or with PPD. In females, the skin response to both antigens was similar to that to any standard protein antigen. In males, the response to sperm extract varied with the induced auto-immune orchitis, reaching a maximum immediately after testis lesion was most severe and as recovery was beginning (shown histologically): the response to PPD was decreased at 1 week after immunization, but subsequently was similar to that in females. Skin tests on guinea-pigs 8 months after bilateral vasectomy (when both ends of vasa were ligated), showed no evidence of delayed hypersensitivity to sperm, although there was marked histological evidence of reduced spermatognesis, due to back pressure atrophy.

Animals↗
PubMed1998

[Testicular microlithiasis].

Testicular microlithiasis is an uncommon condition in which calcified concretions fill the lamina of seminiferous tubules. It has a specific appearance on sonography with diffuse intra testicular echogenic foci without acoustic shadows. Testicular microlithiasis can be associated with various entities and frequently with primary testicular neoplasm. The authors report a new case of testicular microlithiasis diagnosed by sonography in a 14-year-old boy with epididymo-orchitis. Based on a review and discussion of the literature, the authors emphasize the importance of regular and protracted ultrasound follow-up and monitoring of serum tumour markers to allow early detection of primary testicular neoplasm.

Adolescent↗
PubMed1998

Management of sexually transmitted disease by surgeons.

The management of 63 patients diagnosed by surgeons as having sexually transmitted disease (STD) was audited. A diagnosis of STD was made in 51 (81%) of patients without taking a sexual history. Only 2 (3%) patients were referred to genitourinary medicine (GUM). Appropriate microbiological specimens were obtained from only two of 52 (4%) patients diagnosed with either pelvic inflammatory disease (PID) or epididymo-orchitis. Reliance was placed on inappropriate specimens in 22 (42%). There was widespread use of inappropriate antibiotics. The management of sexually transmitted disease by surgeons was very poor. These patients should all be referred to genito-urinary medicine.

Adolescent↗
PubMed2003

Are live kidney donors at risk?

OBJECTIVE: To share experience of live donor nephrectomy (including intraoperative variables, morbidity and ethical aspects) and to give an overview of surgical technique being practiced. DESIGN: A department-based prospective study. PLACE AND DURATION OF STUDY: Department of Urology and Kidney Transplantation, Lahore General Hospital, Lahore, (September 1998 to March 2002). SUBJECTS AND METHODS During the study period, 58 patients had undergone live donor nephrectomy through 11th rib bed flank incision. Evaluation of donors comprised of counseling, history taking, physical examination and laboratory testing and radiological studies to document bilaterally functioning kidneys. Medical ailments, immunological incompatibility and inability to make a valid consent were contraindications for kidney donation. RESULTS: Majority of the donors (58.5%) were 31-50 years old and 70.6% were first degree relatives. Left sided kidney was taken in 96.5% cases. Mean operative time was 145 minutes. Mean renal warm ischemia time from cross clamping of renal vessels to cold perfusion on the bench was 1.5 minutes per operation. Operative complications encountered were injury to lumbar veins in 5.1 % cases, slipping of satinsky clamp on vena cava stump in 1.7 % and accidental pleural damage in 5.1 % cases. Postoperative morbid complications found were urinary retention in 6.4% cases, epididymo-orchitis in 1.7 %, prolonged lymph drain in 3.4%, stitch infection in 1.7 % and prolonged wound discomfort in 5.1 % patients. CONCLUSIONS: Open live donor nephrectomy appears to be safe procedure for harvesting kidney. Related or emotionally related donors must be the choice in all cases. Non-related donors may be entertained in selected cases despite the probability of organ vending in our society.

Acute Kidney Injury↗
PubMed2006

Role of testicular interleukin-1alpha tIL-1alpha in testicular physiology and disease.

This review focuses on the role of the cytokine interleukin-1alpha (IL-1alpha) in the testis; elaborating upon its importance during the complex process of spermatogenesis while relating this cytokine to some of the pathophysiological states affecting the testis. IL-1alpha, a proinflammatory cytokine, is expressed constitutively by the intact adult rat testis where it acts on germ, Sertoli and Leydig cells to regulate germ cell proliferation and steroidogenesis. The sequence identity of testicular IL-1alpha matches with the one secreted by activated macrophages in systemic immunity. The classical macrophage IL-1alpha is produced as 32 kDa precursor protein which is processed to mature 17 kDa IL-1alpha and a 16 kDa propiece. The rat testicular IL-1alpha, mainly secreted by Sertoli cells, was found to have molecular heterogeneity that can be observed both at the transcriptional and the translational levels. In the rat testis, two transcripts were found to be expressed with 941 bp and 767 bp (that lacks 174 bp) which were translated into 32 kDa and 24 kDa precursor proteins, respectively. The 32 kDa precursor protein is processed to the 17 kDa mature IL-1alpha. Identical transcripts are also shown to be present in cat, dog and pig. Most of the functional role is assigned to the mature 17 kDa IL-1alpha isoform. However, functional analysis of recombinant rat IL-1alpha isoforms showed that there was a clear biopotency difference between these forms in order of 17 kDa IL-1alpha>32proIL-1alpha>24proIL-1alpha. Furthermore, the mature 17 kDa tIL-1alpha has also been implicated in pathologies such as orchitis, relapse of acute lymphoblastic leukemia (ALL) in the testis and infertility disorders in men. Thus, tIL-1alpha may play an important functional role both in coordination of normal testicular physiology as well as in contributing to the disease states in the testis.

Animals↗
PubMed1978

Nonspecific peritesticular fibrosis manifested as testicular enlargement.

Nine cases of peritesticular fibrosis initially appeared to be enlargement of the testes. Seven patients under went orchiectomy and two had biopsy specimens taken of the grossly thickened tunica albuginea. In six patients, a hydrocele was present with intramural fibrosis and minimal chronic inflammation. Active epididymitis and chronic interstitial orchitis were present in two patients, with some spread of the inflammation into the fibrotic peritesticular tissues. One case, without associated hydrocele or epididymitis, showed dense fibrosis of the peritesticular tissues with focal edema, lymphangiectasis, and minimal perivascular round cell infiltration. This clinicopathological entity of diffuse peritesticular fibrosis is an unrecognized cause of benign testicular enlargement. The hypothesis is advanced that the primary process is a congenital hypoplasia of the peritesticular lymphatics progressing at various speeds into a state of chronic lymphedema and end stage noninflammatory fibrosis.

Adult↗
PubMedDate not supplied

Mumps and rubella eliminated from Finland.

Many countries use trivalent measles-mumps-rubella (MMR) vaccine for their mumps and rubella immunization programs. In Finland, a national 2-dose MMR vaccination program for children, free of charge and on a voluntary basis, was launched in 1982. Serological confirmation of all suspected cases of mumps and rubella has been required since 1987. Despite intensive surveillance, no persistent sequelae or deaths attributable to vaccination have been detected. Indigenous mumps and rubella were eliminated in 1996, but 4 imported cases of mumps and 2 of rubella occurred from 1997 to 1999. Lack of secondary cases indicates sufficient immunity in the community. Compared with an epidemic year, up to thousands of cases of mumps meningoencephalitis and orchitis and around 50 cases of congenital rubella syndrome are now avoided annually. A 2-dose vaccine regimen in children during the last 17 years (1983-1999) has interrupted circulation of the target viruses entirely. Finland is the first country documented to be free of indigenous mumps and rubella (measles was eliminated in 1996). Despite the ongoing possibility of imported disease, major outbreaks probably can be avoided by maintaining high vaccination coverage and the 2-dose policy. JAMA. 2000;284:2643-2647.

Child↗
PubMed1996

Ultrasound in the assessment of the acute scrotum.

Color Doppler imaging (CDI) has become the study of choice in evaluation of the scrotum due to technological advances resulting in superior resolution and sensitive Doppler systems. CDI has become particularly helpful in evaluating the scrotum in the setting of acute disorders, such as torsion of the spermatic cord, epididymal and testicular inflammation, and scrotal trauma. CDI should be the study of choice to evaluate for torsion of the spermatic cord and demonstrates a high degree of accuracy. CDI in such a setting, however, does require operator experience, sensitive Doppler ultrasound equipment, and operator knowledge of the limitations of CDI. With epididymitis or epididymo-orchitis, CDI has proven to be quite helpful in evaluating the scrotal contents for the presence of inflammation and associated complications. In scrotal trauma, CDI's utility remains somewhat controversial, but with further investigation its appropriate application in this situation may become clear.

Acute Disease↗
PubMed1996

Ultrasound assessment of testicular and paratesticular masses.

This article discusses the role of ultrasound in the workup of patients with suspected or palpable scrotal masses. By characterizing masses as intra- or extratesticular, the differential diagnosis can be narrowed considerably. Neoplasm is the primary concern with intratesticular masses, although non-neoplastic conditions, such as hematoma and focal orchitis, may have a similar appearance. Correlation with the patient's history is essential. The sonographic presentation of extratesticular pathology, including varicocele and masses of epididymal origin, is also described.

Diagnosis, Differential↗
PubMedDate not supplied

Testicular plasmacytoma: appearance on gray-scale and power Doppler sonography.

A case of testicular plasmacytoma, a very rare neoplasm, is presented. The gray-scale and power Doppler sonographic findings are illustrated. The lesion appeared as a hypoechoic, intratesticular mass that was markedly hypervascular. When marked hypervascularity is present in a testicular mass in a patient unlikely to have orchitis on clinical grounds, plasmacytoma should be considered in the differential diagnosis.

Adult↗
PubMed1998

Mode of migration of normal lymphocytes inside murine testis.

BACKGROUND: Previous studies have shown that in murine experimental autoimmune orchitis (EAO), lymphocytes preferably infiltrate into (1) the testicular capsule near the rete testis, (2) the subcapsular interstitium away from the rete testis, and (3) the interstitium surrounding the tubuli recti and rete testis. Therefore, these three sites might provide tissue environments in which specific lymphocytes can easily gain access to testicular autoantigens. However, there is another possibility that infiltrating lymphocytes in the testis spontaneously accumulate at these three sites via the lymphatic flow inside this organ during EAO. METHODS: To examine this possibility, normal lymphocytes were locally injected into the peripheral testis regions of recipient mice. Testes were then collected at various times for investigating the chronological pattern of lymphocytic migration inside the testes at a light microscopic level. RESULTS: The injected lymphocytes first stayed in the lymphatic space around the seminiferous tubules and then moved to the subcapsular lymphatic space away from the rete testis. The lymphocytes accumulated under the testicular capsule and then gradually infiltrated into the adjacent capsular tissue. In the capsule, the cells surrounded the arteriolae and then accumulated in the capsular tissue near the rete testis. Thereafter, the cells finally left the testes through the lymphatics running in the spermatic cords. In the course of the lymphocytic drainage, it was noted that the injected lymphocytes appeared not to pass through the testicular interstitium around the tubuli recti and rete testis. CONCLUSIONS: The regional distributions of the testicular lymphocytes imply that the lymphatic flow in the testis may somewhat influence murine EAO pathology characterized by lymphocytic accumulation in (1) the testicular capsule near the rete testis and (2) the subcapsular interstitium away from the rete testis. However, the pathology exhibiting lymphocytic accumulation in (3) the interstitium around the tubuli recti and rete testis is independent on the intratesticular lymph flow.

Animals↗
PubMed1996

A study of the efficacy and safety of transurethral needle ablation (TUNA) treatment for benign prostatic hyperplasia.

The objective of this early phase III study was to determine the efficacy and safety of transurethral needle ablation (TUNA) in patients presenting in acute urinary retention due to benign prostatic hyperplasia (BPH). Between September 1993 and August 1994, 20 patients of mean age 68.8 years were entered into a two-center study and treated with TUNA after presenting in acute urinary retention and having failed at least one trial of voiding. A mean of 5.4 lesions at shield temperatures of 54.6 degrees C were produced. Patients were reviewed at 1, 3, 6, and 12 months (mean, 6.2 months). In 17 of 20 patients, voiding was reestablished in a mean of 2.6 days. Three patients required TURP for persistent retention, and 2 patients had delayed TURP for bothersome symptoms. Two voiders died later of unrelated causes. Five patients were lost to follow-up at 6 months but were voiding when last reviewed. Symptom scores decreased from a mean of 19.0 (range 4-35) to 8.25 (range 1-20) at 12 months (p = 0.06). Mean peak flow rate was 11.4 ml/sec (range 6.6-16.8) at 12 months (p = 0.001). Mean prostatic volume at baseline was 65.8 cc and decreased to 56 cc at 12 months (p = 0.111). The treatment was well tolerated by all patients, and side effects were mild, including urinary tract infection and epididymo-orchitis. This study demonstrates the safety and effectiveness of TUNA procedure in patients with urinary retention due to benign prostatic hypertrophy.

Aged↗
PubMed1986

Malignant testicular germ cell tumors in a father and two sons. Case report and literature review.

The authors report the 17th case of primary malignant testicular tumors in father-son pairs, the 61st case occurring in male first-degree relatives, and the first case identified in a father and two sons. The father had bilateral seminomas at ages 31 and 44 years. His oldest son developed left testicular teratoma with elements of seminoma and embryonal carcinoma at age 29 years. The second son developed pure seminoma of the right testicle at age 26 years. The father had mumps orchitis at age 17 years. None of the three had a history of cryptorchism, trauma, or hernia. Literature reports of familial testicular neoplasia are becoming more frequent, and evidence is presented that family history may represent a risk factor independent of cryptorchism for the development of testicular cancer. Aggressive follow-up of closely-related male relatives is advocated.

Adult↗
PubMed1987

The spectrum of disease in lymphatic filariasis.

Lymphatic filariasis affects predominantly the poorer sector of a community, who can least afford to have the disease. According to an estimate by the World Health Organization in 1984, more than 90 million people are currently infected. It is postulated that the different disease manifestations of filariasis are caused by different host immune responses. An understanding of the clinical spectrum of lymphatic filariasis is essential for the effective treatment and control of the disease, and for correctly correlating clinical status with host immune responses. The disease should be divided into lymphatic filariasis caused by adult worms and occult filariasis due to hyper-responsiveness of the host against microfilariae. The acute stage of filariasis is characterized by episodic adenolymphangitis, followed by obstructive lesions one or more decades later. In brugian filariasis, adenolymphangitis is most commonly observed at the inguinal region, and elephantiasis predominantly involves the leg below the knee. In bancroftian filariasis, the lymphatics of the male genitalia are frequently affected, leading to epididymo-orchitis and hydrocele. Lymphatic filariasis runs an accelerated clinical course in previously unexposed adult migrants. Occult filariasis is not a disease of public health importance. It is characterized by lymphadenopathy, asthmatic bronchitis, hypereosinophilia, and an increase in the production of antibodies, especially immunoglobulin, against microfilarial antigens.

Animals↗
PubMed1981

Effects of immunization with Freund's complete adjuvant and isologous spermatozoa on the seminiferous epithelium and blood-testis barrier in guinea pigs.

In order to gain insight into the earliest pathological changes underlying the development of autoimmune aspermatogenic orchitis (AIAO) the blood-testis barrier was studied by light and electron microscopy, freeze-etching, and cytochemical techniques early (from 1 to 8 days after adjuvant treatment of isoimmunization). At later times (16 to 21 days) the study was carried out by light microscopy only. Adult male guinea pigs were used either as controls or immunized with Freund's complete adjuvant alone or together with pertussis vaccine. An additional group comprised animals immunized with a suspension of isologous spermatozoa emulsified in Freund's complete adjuvant and with pertussis vaccine. Ultrastructural studies of the testes of experimental animals showed, at earlier periods, apparently normal Sertoli junctions. However, in the adluminal compartment, distended gaps were seen between the facing membranes of adjacent Sertoli cells. At later periods, a massive destruction of the germinal cells were observed. In freeze-fracture replicas, the Sertoli junctions of testes belonging to all the experimental groups were characterized by an irregular network of occasionally interrupted strands of particles associated with the P face (PF). Large concavities determined distensions between interconnecting ridges. The gap junctions were increased in number and in surface. Tracer studies using horseradish peroxidase showed that the marker permeated the myoid cells of a greater proportion of tubules than in control animals. Within the seminiferous epithelium there was only a limited passage of the marker towards the lumina of the tubules. Yet the tracer was always excluded from the adluminal compartment by the Sertoli tight junctions. Our observations suggest the possibility that the FCA causes a loosening of the Sertoli junctions. This condition could enhance exchanges between two antigenically different cellular compartments and, thus, favor occurrence of an autoimmune reaction when cytotoxic factors are experimentally induced, as in iso- or autoimmunization.

Animals↗
PubMed1990

Early testicular changes after vasectomy and vasovasostomy in Lewis rats.

The testes of Lewis rats were studied at intervals from 2 weeks to 3 months after bilateral vasectomy, vasectomy followed 1 month later by vasovasostomy, or sham operations. Aims were to determine the nature of early alterations after vasectomy, and to determine whether vasovasostomy after 1 month would result in reversal of vasectomy-induced changes. Approximately one-fourth of the testes in the vasectomy and vasovasostomy groups displayed histological changes, which consisted mainly of depletion of germ cells. The extent of the depletion varied greatly in different seminiferous tubules. In testes altered in this way, no abnormal infiltrations of lymphocytes, macrophages, or other cells were observed in the seminiferous epithelium or in the interstitium. The rete testis and straight tubules were normal in testes with altered seminiferous epithelium. A few testes in the vasectomy and vasovasostomy groups had necrotic centers. The results suggest that depletion of germ cells occurred as a result of shedding from the seminiferous epithelium into the lumen of the tubules. A cellular immune response, such as occurs in experimental allergic orchitis in other species, did not appear to be responsible for the observed loss of germ cells. This suggests a possible role for humoral antibody in this model, since there is an association between testicular changes and serum antisperm antibodies at longer intervals after vasectomy. Testicular alterations were not reversed by performance of a vasovasostomy 1 month after vasectomy.

Animals↗
PubMed1984

Computer aided diagnosis in acute testicular pain.

Over an 11-year period in Edinburgh, 495 patients with a proven diagnosis of testicular torsion or acute epididymo-orchitis were admitted to hospital. The final diagnosis in 227 was epididymitis, in 236 torsion of the testis and in 32 torsion of a testicular appendage. The immediate salvage rate from torsion of the testis was 67 per cent. To try to improve diagnostic accuracy in these three conditions, a computer program was constructed using a data base derived from the literature. On retrospective analysis of the 495 patients, the program achieved a 92.3 per cent accuracy in differentiating torsion from epididymitis. If the computer's diagnosis had been followed it would have reduced the exploration rate in epididymitis from 18 to 1.8 per cent. It would further have increased the diagnostic accuracy of a junior doctor to that of a senior colleague, but the number of torsions 'missed' by the computer and senior doctor would have been similar. The technique is inexpensive, rapid, immediately available, non-invasive and easy to use. It is suggested that such a program will increase diagnostic accuracy in acute testicular pain and, hopefully, the salvage rate from torsion of the testis.

Acute Disease↗
PubMed1997

Hernia repair in elderly patients.

BACKGROUND: This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population. METHODS: From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (range 66-93) years). Concomitant diseases were present in 157 patients. A mesh repair was performed with 'tension-free' or 'plug' techniques in all but 23 inguinal and two femoral hernia repairs, in which the Bassini or Shouldice procedures were adopted. Ten emergency hernia repairs were performed for strangulation. A total of 232 operations, including four emergency hernia repairs, were carried out under local anaesthesia. RESULTS: There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diverticular disease. Urinary retention occurred once following emergency hernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scrotal haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldice inguinal herniorrhaphy. No recurrence was observed after mesh repair. CONCLUSION: Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.

Aged↗