The absorption of chlortetracycline following transscrotal instillation for the treatment of primary hydrocele testis

We describe the absorption of chlortetracycline from the emptied hydrocele sac, which was instilled to treat a primary hydrocele of the testis. The study included 7 patients and 2 control subjects who were given 500 mg. chlortetracycline. Plasma concentration was determined at 0, 1/2, 1, 2, 4, 6, 12 and 24 hours after instillation, and in 2 patients plasma levels also were determined at 48 and 72 hours. The area under the plasma concentration-time curve (AUC1) was calculated in each case by using the trapezoidal rule. In the control group the plasma level was determined at 0, 1, 2, 4 and 6 hours after instillation. The area under the plasma concentration-time curve (AUC2) was calculated by the formula AUC2 = Co/Kc. The fraction F of absorption can be expressed as F = AUC1/AUC2; median F = 0.67 (range 0.41 to 0.92). We conclude that chlortetracycline passes readily and almost completely through the tunica vaginalis lining the hydrocele sac.

[Undescended testis treated by intranasal application of luteinizing hormone-releasing hormone (LH-RH)]

In a double-blind, placebo-controlled study, 118 boys, aged 2-12 years, with 161 undescended testes were treated with luteinising-hormone releasing-hormone (LH-RH), 1.2 mg daily intranasally for four weeks. According to randomization, 60 boys with 85 undescended testes received LH-RH and 58 boys with 76 undescended testes received the placebo. 17 testes (20%) in 12 boys (20%) descended in the LH-RH group and 2 testes (3%) in 2 boys (3%) descended in the placebo group. This difference is statistically significant (chi 2, 0.01 greater than p greater than 0.001). A second LH-RH course, offered three months later to the boys who did not respond to the first LH-RH course, increased the success rate to 35%. The primary location of the testis was a significant factor for the effect of treatment. The highest success rate (63%) was registered in testes located in a high scrotal position. There was no significant difference in success of treatment between unilateral and bilateral cryptorchidism, nor between age groups. No serious adverse effects of treatment were noted. It is concluded, that LH-RH administered intranasally can be used in the treatment of boys with unilateral and bilateral cryptorchidism.

[Hormonal treatment of undescended testis]

Failure of the testes to descend is probably mostly due to dysfunction of the hypothalamo-pituitary-testis axis. The primary treatment of testicular non descent should therefore be pharmacological in the form of HCG injections or LH-RH intranasally. Contraindications for hormonal therapy are coexistent inguinal hernia or hydrocele testis or previous inguinal operations. HCG and LH-RH treatment lead to testicular descent with about the same frequency, 20-50% in boys above five years of age, whereas HCG therapy before this age results in 10-20% success only. Reversible androgenic side effects are described in approximately 30% following HCG treatment, but only limited side effects are seen in less than 10% after LH-RH therapy. Because of the non-invasive mode of administration, the good response to treatment in the age of 2-5 years and the very limited side effects, LH-RH is recommended as the primary treatment of testicular nondescent.

Functional hemispherectomy for treatment of epilepsy associated with hemiplegia: rationale, indications, results, and comparison with callosotomy

Hemispherectomy is effective in arresting seizures associated with maximal or near maximal hemiparesis. This procedure, however, carries an unacceptable 33% risk of late complications due to cerebral hemosiderosis. Anatomically partial but functionally complete hemispherectomy was devised to avoid these complications. The frontal or occipital lobes, or both, were left in place with the blood supply intact but with connections to commissures and brainstem divided. The central strip and parietal and temporal lobes were removed. Twenty patients were so treated with a follow-up of 4 to 13 years (average, 7.3 years) in 14. Ten of these are seizure free, 1 had a single nocturnal seizure, 1 had occasional focal twitching, and 2 had a worthwhile but lesser reduction in the seizure tendency. None has developed cerebral hemosiderosis, to date. In appropriately selected patients, functional hemispherectomy is an effective procedure preferable to callosotomy or to partial hemispherectomy. When there is no independent ictal discharge from the opposite hemisphere, arrest of seizures may be expected, leading to improvement in cognitive functioning (mean increase, 10 IQ points), social behavior, and a reduction in or discontinuation of anticonvulsant medication. In these patients, gait and hand use remain unchanged.

Natural history of the maldescended testis

In a series of 545 boys with undescended testis, 91 had bilateral spontaneous descent after the age of 10. Forty-five accepted to take part in an investigation of their fertility based on history, clinical examination, sperm analysis and estimation of serum FSH levels. In the majority, the volume of the testis was below normal and the sperm concentration was below the lower limit of the normal range. It is concluded that late spontaneous bilateral descent of the testis carries a serious risk of later impaired spermatogenesis.

Closed treatment of Achilles tendon rupture

In order to minimize rerupture after closed treatment of Achilles tendon rupture, the period of immobilization was prolonged from 8 to 12 weeks and an above-knee plaster cast was used the first 3 weeks. In 37 consecutive patients, followed for an average of 3 years, rerupture had occurred in two patients. It is concluded that modified closed treatment is a good alternative to surgical treatment.

Surgical treatment of complex partial seizures: results, lessons, and problems

The underlying seizure tendency of complex partial seizures often involves the temporal region of the brain, but the frontal lobe can also produce similar complex partial seizures. By the end of 1980, 1,210 patients with medically refractory temporal lobe epilepsy had been operated on at the Montreal Neurological Institute. Nontumoral epileptogenic lesions were present in 1,034 patients, 169 had tumors, and 7 had major vascular malformations. Thirty-seven percent of the 894 evaluable patients with nontumoral epileptogenic lesions have become and remained seizure-free. Two hundred thirty-six (26%) patients had a marked reduction of seizure tendency. Within the seizure-free group, 63% had a complete or nearly complete reduction of their medically refractory tendency following temporal lobectomy. Of the patients with temporal lobe epilepsy due to tumoral lesions, 46% of the evaluable patients have become and remained seizure-free, and 76% have had a complete or nearly complete reduction of seizure tendency.

Fetomaternal bleeding during attempts at external version

The frequency and size of fetomaternal bleeds during the first attempt at external version of the fetus in breech presentation in 50 pregnant women were investigated. Fetomaternal bleeds of 0.1 to 1.5 ml were detected in 14 women (28 per cent). It is concluded that rhesus negative women should be given anti-D before attempts at external version are made.