The effects of vasodilatation and chemical sympathectomy on spermatogenesis after unilateral testicular torsion: a flow cytometric DNA analysis

OBJECTIVE

To evaluate the effects of vasodilator therapies and chemical sympathectomy on ipsilateral and contralateral testicular spermatogenetic activity after unilateral testicular torsion using DNA flow cytometry and thus determine whether contralateral testicular damage occurs through a reflexively decreased blood flow.

MATERIALS AND METHODS

The study comprised four groups of 20 rats each (groups 1-4) respectively receiving isotonic saline, verapamil, pentoxifylline and 6-hydroxy dopamine hydrobromide (6-OHD) intraperitoneally. Each group was further divided into two subgroups containing 10 rats which respectively underwent either a sham operation or 720 degrees clockwise torsion applied to the left testis. The testes were harvested after 24 h and the relative proportions of haploid, diploid and tetraploid cells determined by DNA flow cytometry for each testis. The proportion of haploid cells was used as an estimate of spermatogenesis. The mean proportions of haploid cells in the groups were compared using a one-way ANOVA and paired groups were compared using Student's t-test.

RESULTS

The proportions of haploid cells in the ipsilateral testes of rats undergoing torsion were significantly lower than in their contralateral testes and in the ipsilateral testes of the control groups. In group 4 (6-OHD) the proportion of haploid cells in the contralateral testes was significantly higher than those in the other groups after unilateral testicular torsion, but significantly lower than those in groups 1 and 4 after a sham operation. After unilateral testicular torsion the haploid cell proportions of the contralateral tests of groups 1-3 were not significantly different from each other.

CONCLUSIONS

Because the spermatogenetic activity in the contralateral testis is depressed within 24 h of ipsilateral testicular torsion, contralateral testicular damage is an acquired effect: 6-OHD offers some protection and thus the damage seems to result from the involvement of the sympathetic system.

Esophageal perforations encountered during the dilation of caustic esophageal strictures

BACKGROUND

The most common cause of esophageal stricture in children is the accidental ingestion of strong alkalies and the life-threatening complication of dilations for treating caustic esophageal strictures is esophageal perforation.

METHODS

During a 25-year period between 1971 and 1996, 195 patients with caustic esophageal strictures underwent repeated dilations program and 34 had 36 complicating perforations (17.4%) at the Hacettepe Children's Hospital Department of Pediatric Surgery. A retrospective clinical study was performed to evaluate the risks, results and outcome of esophageal perforations encountered among strictured esophaguses. Thirty-four patients, of whom 19 were male (56%) and 15 female (44%) with 25 (74%) being younger than 5 years of age, were evaluated retrospectively.

RESULTS

There was no relation between the type of therapy against stricture formation and perforation of the esophagus. Seventy-five percent of perforations occurred during antegrade dilations with stiff woven dilator and most perforations (69.4%) occurred in the first, second or third dilations. Esophageal perforation was suspected during dilation procedure in 7 perforations while the remaining 29 were diagnosed following a suggestive clinical course. The diagnosis of perforation was confirmed by chest X-ray, esophagography, and esophagoscopy in 30, 5, and 1 perforations respectively. The treatments included antibiotics, digoxin and drainage through gastrostomy among 13 patients, and additionally chest tube drainage among 12 patients, and additionally feeding jejunostomy among 7 patients while three patients underwent only feeding jejunostomy in addition to antibiotics, digoxin and drainage through gastrostomy. Six patients (18%) died, 6 patients (18%) required esophageal replacement for previous cervical esophagostomy or persisting stricture that impairs swallowing. Esophageal strictures in 22 patients (64%) have been treated by dilations. Redilation therapy started within 3 months following perforation and 68% of patients required 2 to 3 years of chronic dilations to be accepted as normal swallowers.

CONCLUSIONS

The esophageal perforations encountered during dilating caustic esophageal strictures present a spectrum from a minimal peri-esophageal leakage to massive rupture with pneumothorax causing mediastinal shift and sudden death. The diagnostic and therapeutic approaches should be individualised according to the place of the patient in this spectrum.

Female breast masses during childhood: a 25-year review

Thirty females were treated at our unit with the diagnosis of breast mass between 1970 and 1995. Twenty-seven girls had surgical intervention; for fibroadenoma (n = 14), cystosarcoma phylloides (n = 5), fibrocystic disease (n = 4), intraductal papilloma (n = 2), metastatic carcinoma (n = 1) and fat necrosis (n = 1), while three patients with fibroadenoma were managed nonoperatively. Surgical complications included a nipple slough and hematoma requiring surgical drainage in two patients after the excision of giant fibroadenomas. Our experience revealed that most of the breast masses can be handled operatively through a circumareolar incision without any major complications. Protection of the developing breast bud, nipple and areola is as important as the appropriate excision of the lesion. A detailed physical examination accompanied with ultrasound scan is sufficient for the correct diagnosis in most cases. Female adolescents presenting with fibroadenoma, fibrocystic disease and cystosarcoma phylloides should undergo surgery after a reasonable observation period of 3-4 menstrual cycles. Excision of discrete, undiagnosed breast masses is warranted. This is indicated first to define the pathology and rule out the rare malignancy, second to obviate enlargement and asymmetry, and third to allay the apprehension of the child and family.

Persistent diffuse peritonitis in children

In adults, persistent diffuse peritonitis (PDP) having a special microbiologic spectrum is now defined as a distinct intraabdominal infection because of its aggressive clinical course. Considering also other types of peritonitis, this study was performed to determine characteristics of childhood PDP in regard to clinical picture, microbiologic features, treatment and outcome. Classification of 175 patients with peritonitis showed that nine patients had primary peritonitis and 121, 37 and eight patients had secondary peritonitis, PDP, and intraabdominal abscess, respectively. Rates of host defense affecting disease, extra-appendicular origin, and mortality were markedly higher in the PDP group. However, polymicrobic and anaerobic infection rates were lower in the PDP group than those of the secondary peritonitis group. While 26 of 37 patients with PDP underwent surgical intervention, the remaining 11 patients were managed by conservative measures. In the PDP group, mortality was 18 percent for conservatively and 23 percent for surgically treated patients. Being of young age, presence of an accompanying disease and fungal growth increased the mortality. The results indicate that PDP is a distinct type of peritonitis in children as well as in adults. In addition, accurate identification of these patients may prevent some unnecessary operations and improve survival by the choice of more conservative treatment plans.

Bilateral Poland anomaly

Bilateral absence of the pectoralis major muscle with accompanying abnormalities of shoulder muscles has been reported in patients without Poland anomaly (PA). However, symmetric absence of pectoralis major muscles, hypoplasia of breasts and nipples with symmetric chest wall deformity and bilateral hand anomaly has not previously been reported. A 6-year-old girl with bilateral absence of pectoralis major muscles and hand involvement and symmetric chest wall deformity is, to our knowledge, the first known case of bilateral Poland anomaly.

Hirschsprung-associated congenital anomalies

Between 1976-1993, 302 patients were diagnosed to have Hirschsprung's disease (HD) in Hacettepe University Children's Hospital. All patients have been searched for the occurrence of associated anomalies and other parameters including 1) sex, 2) gestational age, 3) birth weight, 4) length of aganglionic segment, 5) familial occurrence, 6) consanguinity. Forty-nine of 302 patients were proved to have 83 associated congenital anomalies together with HD. Distribution of anomalies was as follows; central nervous system and special senses 28.92%, genitourinary system 26.51%, skeletal 24.09%, gastrointestinal 12.05%, cardiovascular 8.43%. In eleven patients more than one anomaly involving different systems were detected; only one of these patients was female and six of them have shown short segment disease. Down's syndrome was present in 5 patients. Female: male ratio was 1:4.2 for the whole series and 1:6 for the patients with Hirschsprung associated congenital anomalies (HACA). In the HACA group the percentage increased in favor of long-segment and extensive aganglionosis without statistical significance (p>0.05). The majority of patients were term babies and their birth weights were between 2500g < 3500g. Consanguinity was present in 36 families. No affected parents were detected but two sisters and four brothers were proved to have HD. Three pairs of twins, one of which was monozygotic, and all showing discordance were detected. There was no difference between HACA group and HD without HACA in terms of sex, birth weight, length of aganglionic segment and consanguinity. Although HD seemed to be genetically heterogeneous HACA did not have a genetically different origin from that of HD.

The diagnosis and treatment of H-type tracheoesophageal fistula

BACKGROUND

H-type tracheoesophageal fistula (TEF) was diagnosed in 12 patients during the 25 years from 1971 to 1996. Although all patients were symptomatic since birth, in 58% of the cases, there was a diagnostic delay ranging from 26 days to 4 years.

METHODS

Esophagography and/or cineesophagography, or bronchoscopy and simultaneous methylene blue administration confirmed the diagnosis of H-type TEF. Although cineesophagography is highly effective in demonstrating H-type TEF today, bronchoscopy must be used in every patient suspected of having fistula, especially when the radiological methods fail. Bronchoscopy is helpful in diagnosis, in evaluation of associated respiratory tract anomalies, and in treatment.

RESULTS

Two newborn patients could not have been operated on because of pulmonary insufficiency resulting from delayed recognition of fistula. Ten patients underwent fistula repair, nine through cervical approach, and one through thoracotomy, with seven survivors.

CONCLUSIONS

The results suggest that early diagnosis is essential in the newborn period. Oversight in identification of H-type TEF, unsatisfactory radiological method, masquerading symptoms related to associated anomalies, and minute symptoms in some patients may cause delay in diagnosis. Radiological and endoscopic procedures are complementary in both diagnosis and treatment of H-type TEF.

Comparative trial of four antibiotic combinations for perforated appendicitis in children

OBJECTIVE

To compare the therapeutic efficacy of four antibiotic regimens: penicillin, tobramycin, and clindamycin; penicillin, tobramycin, and ornidazole; piperacillin alone; and ceftriaxone and ornidazole in the treatment of children operated on for perforated appendicitis.

DESIGN

Prospective randomised study.

SETTING

Teaching hospital, Turkey.

SUBJECTS

200 patients aged between 1 and 16 years treated from December 1991 to December 1995 who were randomly assigned to one of four groups each consisting of 50 patients.

INTERVENTIONS

Preoperative antibiotics given intravenously, peritoneal drainage by Penrose drains without irrigation, appendicectomy with the inversion of the stump by a purse string, taking peritoneal swabs, and primary skin closure.

MAIN OUTCOME MEASURES

Comparability of the groups, duration of fever, leucocytosis, antibiotic treatment, stay in hospital, nasogastric intubation, and drainage, as well as results of cultures and complications.

RESULTS

There were no significant differences between the groups for any variable studied. The predominant bacterial species were Escherichia coli, Klebsiella spp, Pseudomonas spp, Fusobacteria, and Peptostreptococci which were appropriately covered by all the antibiotic regimens. Fourteen patients had complications including wound infections (n = 10), prolonged ileus (n = 2) and intra-abdominal abscess (n = 2) all of which were treated conservatively. There was no mortality and no major complications. All regimens had the same clinical and bacteriological efficacy.

CONCLUSION

There is no gold standard for antimicrobial chemotherapy in perforated appendicitis. Different antibiotic combinations or a single broad spectrum antibiotic, which include both aerobic and anaerobic coverage, can safely be used in children with perforated appendicitis.

Rare congenital abnormalities of the anterior urethra

Congenital abnormalities of the anterior urethra other than hypospadias (valve, diverticulum, and megalourethra) are rare conditions and can be difficult to diagnose. Based on five recent cases of these urethral abnormalities, we review the embryology and the English literature, and have found reports of about 100 cases of valve and diverticulum and 50 cases of megalourethra. For all these abnormalities, the clinical presentation depends on age and the diagnosis depends essentially on voiding cystourethrography, which must show the entire urethra, and careful urethroscopic examination.

Urolithiasis in patients with Hirschsprung's disease

Although patients with Hirschsprung's disease (HD) carry some factors that increase the risk of urolithiasis this fact seems to be underestimated. Among 302 patients with HD, four patients (1.32%) with urolithiasis were encountered. Since factors increasing the risk of urolithiasis such as urinary tract infection, constipation, vesicoureteral reflux, enteric resections and malabsorption may be encountered during the course of HD, an increased risk of urolithiasis in these patients should be expected.

Testicular enlargement in patients with 11-hydroxylase deficiency

Testicular nodules or tumors have been well described in patients with congenital adrenal hyperplasia (CAH) and usually associated with 21-hydroxylase deficiency. The authors report on a 11-hydroxylase--deficient patient presenting bilateral testicular enlargement and review the literature. Testicular biopsy was not very helpful to make differential diagnosis between adrenal rest hyperplasia and Leydig cell tumor. The size of testes regressed after steroid replacement therapy, and this observation was suggestive for adrenal rest hyperplasia. These findings suggest that bilateral testicular enlargement in patients with CAH may occur after excessive adrenocorticotrophic hormone stimulation of cells differentiated from unknown origin. Orchiectomy is not required but bilateral testicular biopsy must be performed.

Spontaneous rupture of choledochal cyst: an unusual cause of acute abdomen in children

Rupture is one of the rare complications of choledochal cysts. The cause of rupture is unknown in many cases and is considered to be spontaneous. Two patients admitted to the hospital with acute abdominal picture were initially thought to have postoperative abscess and appendicitis. However, the presence of bilelike fluid suggested a bile tract pathology, and evaluation showed rupture choledochal cysts. Although spontaneous rupture of a choledochal cyst is a rare complication, and can sometimes be the initial manifestation of a choledochal cyst, it should be considered in the presence of bilelike fluid and differentiated from spontaneous perforation of the bile tract. In spontaneous rupture of choledochal cyst, cystectomy, cholecystectomy, and Roux-Y hepaticoportoenterostomy is the treatment of choice.

Is fetal thoracic compression really the underlying mechanism of lung hypoplasia in oligohydramnios? An experimental study in a rabbit model

Compression of the fetal thorax by the uterine wall is one of the theories proposed to explain the mechanism of lung hypoplasia in association with oligohydramnios. However, the reduction in the intrathoracic space and the evidence of compression on the fetal thorax have not been demonstrated in detail. Therefore an experimental study was planned to determine the effects of oligohydramnios on available intrathoracic space and lung volume in the rabbit fetus. Amniotic fluid was shunted into the peritoneal cavity between 23 and 31 days of gestation. Intrathoracic space and lung volumes (TV and LV), and lung and body weight (LW and BW) values were measured in our study and control fetuses at term. Lung weight/body weight, lung volume/thorax volume, thorax volume/body weight ratios were calculated and the values of the fetuses with shunting and controls were compared. The difference between TV/BW ratios was not significant. LW/BW and LV/TV ratios were significantly reduced in experimental fetuses compared to the controls. Chronic drainage of amniotic fluid into the peritoneal cavity resulted in reduced LW/BW and LV/TV ratio, but did not effect TV/BW ratio. The low LV/TV ratio in the fetuses with shunting despite similar TV/BW ratio suggested that the diaphragm had been elevated. This is also an explanation for the observation of reduced chest circumference and chest circumference/abdominal circumference ratio in prolonged premature rupture of the membranes in vivo. The developing fetal lungs would undergo not only transthoracic but also trans-abdomino-diaphragmatic compression. However, it is unlikely in the tubular shaped rabbit uterus. In oligohydramnios amniotic fluid dynamics or physical characteristics with its contents should be disturbed. A previous experimental study with herniation of the amniotic sac causing lung hypoplasia through reduced intraamniotic pressure without oligohydramnios also questioned the role of fetal compression. Although fetal lung development was significantly impaired, the thoracic cage was not affected by amniono-peritoneal shunting. Therefore, we suggest that lung hypoplasia resulted from another mechanism rather than thoracic compression.

Clinical risk factors of Hirschsprung-associated enterocolitis. I: Preoperative enterocolitis

Enterocolitis is still the main source of mortality and morbidity in Hirschsprung's disease (HD). Between 1976 and 1993, 79 (26%) of 302 Hirschsprung patients proved to have Hirschsprung-associated enterocolitis (HAEC). Mortality was 7.6 percent (6 patients). HAEC patients, those who died of HAEC and those without HAEC were analyzed for differences in 34 parameters. The length of the aganglionic segment was found not to be a risk factor for HAEC, but early diagnosis and prompt treatment were found to decrease the occurrence of preoperative HAEC. Although we defined HAEC as foul-smelling, explosive diarrhea, some other symptoms and signs, such as abdominal distention on physical examination, vomiting, dehydration, and a history of nonspecific diarrhea were encountered with significant frequency. None of the patients had Down's syndrome. Sepsis was detected in all of the patients who died of HAEC. The severity of HAEC did not increase with the number of attacks of HAEC, and mortality was greater in the first three attacks. Differences in results between some series seemed to be related to differing definitions of HAEC.

Appendiceal perforation: a potentially lethal initial mode of presentation of Hirschsprung's disease

In Hacettepe University Children's Hospital, between 1976 and 1993 two patients among 302 with Hirschsprung's disease were diagnosed with appendiceal perforation (AP) at initial admission. Both patients were less than 2 months of age. One of them was a boy with total colonic aganglionosis and the latter a girl with long-segment disease. In both cases the site of AP was the base, and periappendicitis without mucosal involvement was detected. The present cases and review of the literature suggest that longer aganglionic segment carries a higher risk of AP.

Clinical risk factors of hirschsprung-associated enterocolitis. II: Postoperative enterocolitis

Among 302 Hirschsprung patients diagnosed between 1976 and 1993, 213 patients who had undergone definitive operations for Hirschsprung's disease (HD) were reviewed for the occurrence of postoperative Hirschsprung-associated enterocolitis (HAEC). The role of 42 parameters were analyzed. We detected 34 patients (14.0%) with postoperative HAEC with no mortality. In nine patients (26.5%) HAEC persisted postoperatively but no effect of preoperative HAEC on postoperative HAEC was detected. The length of the aganglionic segment did not have any effect on HAEC. Down's syndrome was not present in any of our patients with HAEC. Enterocolitis appeared after Swenson, Duhamel and Boley operations in 23, 10 and one patient, respectively. The incidence of HAEC was inversely proportional to age and weight at the time of definitive operation. The presence of colostomy before or during definitive operation had no effect on postoperative HAEC. Complications of definitive operations, including stricture, did not have any effect on HAEC.

Colonic volvulus: a rare presentation of Hirschsprung's disease

Although rare, patients with Hirschsprung's disease (HD) may be admitted with colonic volvulus. Among 302 patients with HD two patients were admitted with colonic volvulus (0.66%). Involved segments were cecum and sigmoid colon. During the same period, 11 patients including those with HD were diagnosed with colonic volvulus. An aganglionic segment below sigmoid colon, and a freely mobile mesosigmoid seem to be the cause of sigmoid volvulus. However, extension of aganglionosis above the sigmoid colon in addition to anatomic tendency seems to result in volvulus of proximal segments. Because HD has been associated with colonic volvulus, children who present with colonic volvulus should be suspect for underlying HD.

Appendicitis after blunt abdominal trauma: cause or coincidence?

The association of appendicitis and blunt abdominal trauma (BAT) is an exceptionally rare occurrence with a few case reports in the literature. The main question whether this association is a result of causative or coincidental relationship has not been evaluated among children. A retrospective clinical study was performed to clarify the pathogenesis, incidence, clinical characteristics and outcome of appendicitis diagnosed in children during the hospitalization period following blunt abdominal trauma (BAT). The records of 554 patients with BAT who were admitted to our unit between 1979 and 1993 inclusive were reviewed. Five patients (0.90%), 3 males and 2 females, with a mean age of 9.4 +/- 1.4 were found to have appendicitis. None of these patients had any signs or symptoms related to appendicitis prior to BAT. Bruising and rupture of the mesoappendix were noted in 3 patients while edema and hematoma of appendix and terminal ileum were found in two. Full recovery was achieved in all patients following appendicectomy. Our incidence of 0.90% is statistically significantly higher than the highest incidence rate of appendicitis stated in the literature during childhood (t-test for population proportion, t = 2.892; p < 0.05). We emphasise the possibility of a causative relationship between appendicitis and BAT depending on the clinical characteristics, operative findings, statistically significant high incidence rate and literature review.

Management of uncommon complications of definitive operations of Hirschsprung's disease

In Hacettepe University Children's Hospital, 229 Hirschsprung patients who had undergone definitive operations of Hirschsprung's disease (HD) between 1976-1993 were evaluated for the occurrence of uncommon complications. Two hundred and thirteen of these patients were operated on in our hospital and 16 of them referred to us after definitive operation. The most uncommon complication in the presented series was the fistula; namely rectourinary, rectovaginal, ileorectal and perianal. One patient acquired rectourethral fistula after Swenson operation. He had undergone redo Swenson operation after an unsuccessful attempt of fistula repair. In our series we detected two patients with ileorectal fistula one of them has also a perianal fistula. These two patients were presented with intractable enterocolitis that caused a delay in treatment. Both of them had undergone ileorectal fistula repair with success. We encountered two rectovaginal fistulae among patients who were referred to us after definitive operations. Both of them were managed with redo operation. One patient was referred to us after Swenson operation with perianal fistula and had undergone fistulotomy. The management of rectourinary and rectovaginal fistulae other than redo operation was proved to be unsuccessful.

Esophageal ligation: effects on the development of fetal organic systems

The role of amniotic fluid ingestion on the development of various fetal organic systems was evaluated in the rabbit model. The fetuses from 24 New Zealand white rabbits were studied on the 23rd day of gestation. Right ovarian-end fetuses underwent esophageal ligation (EL) or sham (SH) operations. Rabbits were submitted to hysterectomy on gestational day 30, and various organic systems of live fetuses were examined by weight and histological evaluations. Additionally, small intestinal enzymes were determined. Three fetal deaths, one in EL and two in SH groups, occurred with a total survival rate of 85%. EL resulted in increased amniotic fluid volume. Although fetal body weights (BW), lung, heart, liver and renal weights and liver weight/BW, lung weight/BW ratios did not differ, gastric, small intestinal and total gastrointestinal tract weights significantly decreased in EL group (p < 0.05). Additionally, gastric weight/BW, small intestinal weight/BW, total gastrointestinal tract weight/BW and renal weight/BW ratios were also significantly decreased (p < 0.01). Sucrase and maltase activities were not detectable in either group. Lactase activity in proximal small intestinal tissue was significantly decreased in EL group (p < 0.05). Mid and distal small intestinal tissue lactase activities did not reveal any significant difference among groups. Histologically, alveolar enlargement and alveolar thickening in fetal lungs, decreased glomerular count and tubular degeneration in fetal kidneys, and slight changes in fetal livers such as cellular vacuolization and reduction in central vein count were observed in the fetuses with esophageal ligation. While small intestinal tissues showed no marked changes, fetal stomach tissues in EL group revealed marked histological alterations consistent with erosive gastritis. This study suggests that amniotic fluid ingestion has no important effects on fetal somatic growth but effects the development of various fetal organic systems. Since the nutritional role of amniotic fluid is obscure, changes in amniotic fluid dynamics, and/or impairment of release of some possible fetal organotrophic factors, and/or unused states of the organs may be responsible for the morphologic changes secondary to esophageal ligation.

In utero defecation by the normal fetus: a radionuclide study in the rabbit

An experimental study was performed to investigate the excretion function of the liver, gastrointestinal motility, and in utero defecation by radionuclide techniques in 24 New Zealand white rabbit fetuses at 25 days' gestation (fullterm, 31 to 32 days). 0.1 mL of technetium 99m (99mTc)-HIDA (a derivative of iminodiacetic acid) containing 1 mCi of radioactivity was injected into the gluteus muscle of each fetus which had been exposed through the uterus. After replacing the fetus and uterus into the abdomen, and beginning 1 hour after injection, a live fetus was killed each hour for 24 hours Tissue samples from the lung heart, stomach, kidney, bladder, liver, meconium in the proximal, mid and distal bowel, and amniotic fluid were taken. The radioactivity of each sample was determined by a gamma counter and the percentage uptake per gram of tissue was calculated. The very low radioactivity levels detected in the stomach, kidneys, and bladder indicated the in vivo stability of 99mTc-HIDA 99mTc-HIDA is predominantly trapped by the liver via systemic circulation and is excreted into the gastrointestinal tract through which it passes into the amniotic fluid. Demonstrated passage of excreted 99mTc-HIDA through the fetal liver and into the gastrointestinal tract and amniotic fluid strongly suggests that fetal defecation is a physiological event.

Tissue hypoxia in ipsilateral and contralateral testes undergoing surgically induced maldescent

The mechanism of deterioration of ipsilateral and contralateral testes during unilateral maldescent remains controversial. Proposing that alterations in tissue perfusion may play a role in ipsilateral and contralateral testicular deteriorations, an experimental study has been planned to evaluate the status of parameters of tissue hypoxia in ipsilateral and contralateral testes following surgically induced maldescent, in rats which preoperatively underwent placebo or chemical sympathectomy. 60 male albino rats were used for the experiment. At the age of 21 days each 30 rats that were treated by placebo or chemical sympathectomy agent were divided into 3 groups undergoing sham operation, abdominal fixation of one testis or abdominal fixation of both testes. At the age of 3 months the rats underwent bilateral orchidectomies and lactic acid (LA) and hypoxanthine (HX) levels were measured in testicular tissues. Maldescent of the testis resulted in a marked increase of LA and HX values in the ipsilateral testis compared to controls, and also resulted in increased levels of LA and HX in the contralateral testis. Although the levels of LA and HX were lower compared to ipsilateral undescended counterparts the levels in contralateral testis were significantly elevated compared to the contralateral testes of rats undergoing sham operation following placebo treatment. Bilateral maldescent resulted in similar elevations of LA and HX in both of the testes. Administration of 6-hydroxydopamine did not result in decreased levels of LA and HX values in the ipsilateral testis following unilateral testicular undescendence. However the LA levels in the contralateral descended testis did not reveal a significant difference compared to the contralateral testis of rats undergoing sham operation. The present experimental design reveals that abdominal fixation of the testis results in tissue hypoxia not only in the ipsilateral but also in the contralateral testis. Chemical sympathectomy has some protective effects on contralateral testicular hypoxia during unilateral maldescent. Tissue hypoxia during maldescent may result from relative inadequacy of testicular blood flow to overcome the increased metabolic demands under hyperthermic conditions.

Helicobacter pylori infection in symptomatic and asymptomatic children: a prospective clinical study

It is well known that Helicobacter pylori infection is extremely common throughout the world, but most infected persons do not develop ulceration and remain asymptomatic. This study was undertaken in order to determine the prevalence of H. pylori infection, the age distribution, and the factors that may affect the frequency of H. pylori infection. We evaluated the presence of antibody against H. pylori in children and adolescents, we also assessed the efficacy of non-invasive and invasive methods for detection of H. pylori infection in children who had undergone upper gastrointestinal endoscopy. We evaluated 43 males and 18 females whose ages ranged from 1 to 17 years (mean age: 9.4 +/- 4.2). 29 of all cases were symptomatic and 32 were asymptomatic. H. pylori infection was present in 49% of the studied cases. The data were analysed by Fisher's exact chi-square and Mantel-Haenszel tests. It was found that H. pylori infection graphically increased with age in both groups from 25% at ages 3-5 to 80% at ages 16-20. But no association was determined statistically between age and H. pylori positivity (p < 0.05). H. pylori infection was determined in 14 (48%) and 16 (50%) cases in symptomatic and asymptomatic groups respectively. There was no significant difference between H. pylori and either group (p > 0.05). According to the endoscopy findings, the symptomatic group was divided into two subgroups: children with peptic ulcer and children with non-ulcer dyspepsia (NUD). An attempt was made to compare ulcer, non ulcer dyspepsia and asymptomatic cases with H. pylori positivity, but no significant relation could be established between the groups (p > 0.05). 14 (23%) of the cases had previous gastric and/or intestinal complaints in their parents (positive family history). There was a significant, statistically positive relation between family history and symptoms (p < 0.01). Nevertheless, no association was found between H. pylori infection and family history (p > 0.05). There were no significant differences in H. pylori infection related to sex, type of housing, location of housing, socio-economic status (SES) or source of water supply. It is concluded that H. pylori infection has a high prevalence in our country. Although endoscopic evaluation is an invasive method, under our conditions, histopathological examination with 97% is shown to be much more sensitive in determination of H. pylori infection. Since no community difference was determined in the prevalence of H. pylori infection, all children should be considered to be under the threat of the same risk.