Bone Status in a Mouse Model of Experimental Autoimmune-Orchitis

Investigations in male patients with fertility disorders revealed a greater risk of osteoporosis. The rodent model of experimental autoimmune-orchitis (EAO) was established to analyze the underlying mechanisms of male infertility and causes of reduced testosterone concentration. Hence, we investigated the impact of testicular dysfunction in EAO on bone status. Male mice were immunized with testicular homogenate in adjuvant to induce EAO (n = 5). Age-matched mice were treated with adjuvant alone (adjuvant, n = 6) or remained untreated (control, n = 7). Fifty days after the first immunization specimens were harvested. Real-time reverse transcription-PCR indicated decreased bone metabolism by alkaline phosphatase and Cathepsin K as well as remodeling of cell-contacts by Connexin-43. Micro computed tomography demonstrated a loss of bone mass and mineralization. These findings were supported by histomorphometric results. Additionally, biomechanical properties of femora in a three-point bending test were significantly altered. In summary, the present study illustrates the induction of osteoporosis in the investigated mouse model. However, results suggest that the major effects on bone status were mainly caused by the complete Freund's adjuvant rather than the autoimmune-orchitis itself. Therefore, the benefit of the EAO model to transfer laboratory findings regarding bone metabolism in context with orchitis into a clinical application is limited.

Prior and novel coronaviruses, Coronavirus Disease 2019 (COVID-19), and human reproduction: what is known?

OBJECTIVE

To summarize current understanding of the effects of novel and prior coronaviruses on human reproduction, specifically male and female gametes, and in pregnancy.

DESIGN

Review of English publications in PubMed and Embase to April 6, 2020.

METHOD(S)

Articles were screened for reports including coronavirus, reproduction, pathophysiology, and pregnancy.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Reproductive outcomes, effects on gametes, pregnancy outcomes, and neonatal complications.

RESULT(S)

Seventy-nine reports formed the basis of the review. Coronavirus binding to cells involves the S1 domain of the spike protein to receptors present in reproductive tissues, including angiotensin-converting enzyme-2 (ACE2), CD26, Ezrin, and cyclophilins. Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) may cause severe orchitis leading to germ cell destruction in males. Reports indicate decreased sperm concentration and motility for 72-90 days following Coronavirus Disease 2019 (COVID-19) infection. Gonadotropin-dependent expression of ACE2 was found in human ovaries, but it is unclear whether SARS-Coronavirus 2 (CoV-2) adversely affects female gametogenesis. Evidence suggests that COVID-19 infection has a lower maternal case fatality rate than SARS or Middle East respiratory syndrome (MERS), but anecdotal reports suggest that infected, asymptomatic women may develop respiratory symptoms postpartum. Coronavirus Disease 2019 infections in pregnancy are associated with preterm delivery. Postpartum neonatal transmission from mother to child has been reported.

CONCLUSION(S)

Coronavirus Disease 2019 infection may affect adversely some pregnant women and their offspring. Additional studies are needed to assess effects of SARS-CoV-2 infection on male and female fertility.

ASSOCIATION OF MEAN PLATELET VOLUME AND THE MONOCYTE/LYMPHOCYTE RATIO WITH BRUCELLA-CAUSED EPIDIDYMO-ORCHITIS

We evaluated the association between the mean platelet volume (MPV) and monocyte/lymphocyte ratio (MLR) with brucella-caused epididymo-orchitis to determine if they could be used to differentiate between brucella and non-brucella epididymo-orchitis. The charts of 88 patients with non-brucella and 14 patients with brucella epididymo-orchitis were retrospectively reviewed. Brucellosis was diagnosed by isolating Brucella spp from a blood culture or from a serum agglutination titer ≥ 1:160 along with accompanying clinical findings. The patients with brucella epididymo-orchitis were significantly more likely to have a lower MPV and a higher MLR than those with non-brucella epididymo-orchitis. Using a MPV cut-off level of less than 9.25 fl to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 78.6%, a specifity of 78.4%, a positive predictive value of 36.7% and a negative predictive value of 95.8%. Using a MLR cut-off level of greater than 0.265 to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 71.4%, a specifity of 65.9%, a positive predictive value of 25% and a negative predictive value of 93.5.%. MPV and MLR values may assist in differentiating between brucella and non-brucella epididymo-orchitis.

[Clinical characteristics of mumps infection in children and adult patients]

The aim of the article was to study clinical manifestations of mumps infection (infectious parotitis) - a viral illness that affects glands that produce saliva, pancreas, and nervous system in children and adult patients. 219 patients (42 children and 177 adults) with mumps infection were studied. The investigation showed that parotid salivary gland disorder was the most common in adults; sublinguitis - inflammation of the sublingual gland was the most common in children. Serous meningitis occurred exclusively in preschool and early school age. Pancreatitis was less common in children than in adults. Infectious parotitis involving the parotid salivary gland was taking its normal course with positive outcome. Pancreatitis and serous meningitis occurred at the 3-5 day of illness with infectious parotitis. Pancreatitis was with positive outcome, with the exceptions of adult patients with pain syndrome (repair process delayed to 1-1.5 months). Mean duration of hospitalization for children with infectious parotitis was 7 days, for adults - 10-14 days. Mean duration of hospitalization for patients with serous meningitis was 14 days. Study showed that in 20,1% of 16-27 years old males developed orchitis.

[Effectiveness of cycloferon in complex treatment of brucellosis patients with lesions of the scrotum]

The article presents the results of urological examination (spermograms and data of ultrasound examination) of 22 patients with chronic brucellosis and diseases of the scrotum (6 patients with orchitis, 16 with orchiepididymitis) before and after conventional therapy (10 patients) and combined treatment with the inclusion of cycloferon (2 courses of 5 intramuscular injection [0.25 g] with an interval of 10 days)--12 patients. It is shown that the administration of cycloferon leads to more effective relief of intoxication symptoms and inflammation in the testes and appendages (reduction of scrotal wall thickness, size of testes and/or adjuncts, and the incidence and severity of hydrocele), and has a positive effect on spermatogenesis (reduction of semen viscosity, the number of white blood cells in semen, sperm agglutination associated with the formation of sperm antibodies in most patients after treatment), as well as reduces the number of exacerbations of chronic orchitis/orchiepididymitis by 2.4 times.

Epididymoorchitis and pancytopenia caused by brucellosis

A 15 year old boy presented with fever and acute painful scrotal swelling. Complete blood count showed pancytopenia. Serum brucella antibodies were positive. Pancytopenia and epididymoorchitis are rare complications of brucellosis and clinicians must consider this entity in the differential diagnosis of adolescents with epididiymoorchitis associated with pancytopenia.

Death receptor and mitochondrial pathways are involved in germ cell apoptosis in an experimental model of autoimmune orchitis

BACKGROUND

Studies on experimental autoimmune orchitis (EAO) have helped to elucidate immunological mechanisms involved in testicular damage. We previously demonstrated that EAO is characterized by lymphomononuclear cell infiltrates and apoptosis of spermatocytes and spermatids expressing Fas and TNFR1. The aim of this work was to characterize the pathways involved in germ cell apoptosis in EAO and to determine the involvement of the Bcl-2 protein family in this process.

METHODS AND RESULTS

EAO was induced in rats by immunization with testicular homogenate (TH) and adjuvants, whereas control (C) rats were injected with saline solution and adjuvants. Testis of EAO rats showed procaspase 8 cleavage products (western blot) with high caspase 8 activity. Cytochrome c content increased in the cytosol and decreased in the mitochondrial fraction of testis from EAO rats compared with C, concomitant with increased caspase 9 activity. Bax was mainly expressed in spermatocytes and spermatids and Bcl-2 in basal germ cells (immunohistochemistry). Baxbeta isoform content increased in EAO rat testis compared with C, whereas content of Baxalpha remained unchanged (western blot). However, Baxalpha content decreased in the cytosol and increased in the mitochondrial and endoplasmic reticulum (ER)-enriched fractions of testis from EAO rats compared with C (western blot). Bcl-2 content also increased in the testes of EAO rats.

CONCLUSIONS

Our results demonstrated that extrinsic, mitochondrial and possibly ER pathways are inducers of germ cell apoptosis in EAO and that Bax and Bcl-2 proteins modulate this process.

Adeno-associated virus-mediated human IL-10 gene transfer suppresses the development of experimental autoimmune orchitis

Testicular germ cell-induced autoimmune orchitis is characterized by inflammatory cell infiltration followed by disturbance of spermatogenesis. Experimental autoimmune orchitis (EAO) is an animal model for human immunological male infertility; delayed-type hypersensitivity (DTH) response plays a key role in its induction. Interleukin-10 (IL-10) is a regulatory cytokine that is critical in preventing organ-specific autoimmune inflammation. To determine the effects on EAO of human IL-10 (hIL-10) gene transfer, C3H/He mice immunized by unilateral testicular injury were administered intramuscular (i.m.) injections of adeno-associated viral (AAV) vector-encoding hIL-10 on the day of immunization. Serum hIL-10 was detected beginning at 1 week postinjection, and peaked at 3 weeks. Histological examinations showed a significantly low incidence of orchitis and disturbance of spermatogenesis in AAV hIL-10-treated mice, and the DTH response to autologous testicular cells was significantly suppressed. Immunohistochemical analysis of IFN- and IL-2, T-cell-associated cytokines, in the spleen and testes revealed significantly fewer cytokine-expressing cells after treatment. We conclude that a single i.m. administration of AAV hIL-10 significantly suppresses EAO and hypospermatogenesis by regulating cell-mediated immunity in the testes.

[Effects of testis murine cytomegalovirus infection on sperm acrosome reaction and spermatic function of membrane in mice]

OBJECTIVE

To explore the effects of testis murine cytomegalovirus (MCMV) infection on mature sperm acrosome reaction and spermatic function of membrane in mice.

METHODS

BALB/c mice without MCMV infection were randomly devided into two groups: an experimental group (48 mice) and a control group (30 mice). The mice in the control group were treated by inoculation DMEM without MCMV into testis, while those in the experimental one were directly inoculated with MCMV into testis. Mice in two groups were sacrificed separately at 1, 2, 4, 6, 9, 14 d post inoculation (D1, 2, 4, 6, 9, 14 PI), and the MCMV M83 mRNA gene was detected inside the testes by in situ hybridization (ISH) with one episode MCMV late-mRNA probe labeled with digoxin, meanwhile acrosome reaction and the function of membrane of mature sperms in the epididymis tails was measured.

RESULTS

The positive signal of ISH of MCMV was mainly founded in the two kinds of testicular cells (spermatogenic cells and Leydig cells) in the experimental group. Compared with that of the control group, the sperm acrosome reaction in the experimental group was decreased significantly by the rate from (71 +/- 6)%, (70 +/- 7)% to (58 +/- 9)%, (56 +/- 9)% (P < 0.05) separately on D2 PI and D4 PI. And the sperm membrane hypo-osmotic swelling was decreased significantly by the rate from (60 +/- 7)%, (50 +/- 4)% to (48 +/- 9)%, (38 +/- 8)% (P < 0.05) separately also on D2 PI and D4 PI.

CONCLUSION

The model of CMV infection in murine testis was established. The sperm acrosome reaction and function of membrane in mice might be descented significantly by MCMV infection in the early period, which shows that MCMV infection might influent the sperm's function.

Experimentally induced orchitis associated with Arcanobacterium pyogenes: clinical, ultrasonographic, seminological and pathological features

The objectives of this study were to describe the features of experimentally induced orchitis associated with Arcanobacterium pyogenes and confirm the pathogenicity of the organism for the ovine testicle. One testicle of each of nine rams was inoculated with 1.3 +/- 10(4) colony-forming-units of an A. pyogenes isolate and regular clinical, ultrasonographic, bacteriological and seminological examinations were carried out up to 204 days after challenge. The rams were sequentially euthanatized 3, 6, 9, 18, 30, 50, 71, 113 and 204 days after challenge and a gross- and histopathological examination of their testicles was performed. All rams developed clinical orchitis and general signs. The initial ultrasonographic findings were changes of size and echogenicity of the genitalia, whilst in the long-standing phase they were wider appearance of the mediastinum testis, presence of hyperechogenic foci, changes of echogenicity of the genitalia and increased echogenicity of the scrotum and tunics. The following changes in semen evaluation parametres were recorded: the pH, the percentage of dead sperms, the percentage of abnormal sperms and the number of nonsperm round cells increased, whilst the mass motility, the individual motility and the sperm concentration decreased; the following sperm defects were observed: misshapen or piriform heads, sperms with coiled tails, sperms without tail and sperms with proximal cytoplasmic droplet; at the early stages neutrophils were the prevailing nonsperm round cell type, later the proportion of immature germ cells increased and in the long-standing phase there were enlogated spermatids and leucocytes; it is noteworthy that semen evaluation parametres were restored to normal at the late stages of the disease. A. pyogenes was consistently isolated from the semen samples after challenge, as well as from the dissected genitalia. The salient post-mortem findings were: initially, subcutaneous oedema, fluid into the vaginal cavity, congested and distended vessels, increased size of the genitalia and a hard dark area inside the testicles; subsequently, there were changes of size of the genitalia, thickening of scrotum and tunics and presence of fibrin on the testicular surface; in the long-standing phase of the disorder, there were induration of scrotum and tunics with adhesion between the tunics and discolouration of the surface of the genitalia. The prominent histopathological changes were observed in the inoculated testicles; milder changes were seen in the respective epididymides; interstitial oedema, diffuse neutrophilic infiltration and extravasation were observed in the early stages after challenge; lymphocytic infiltration with concurrent fibrosis, mineralization and inspissation of the tubular elements of the seminiferous tubules and presence of vacuolated Sertoli cells were seen later; finally, regeneration of the epithelium and presence of Sertoli cells and spermatogonia with various degrees of spermatogenic activity were evident. These findings, allied to the isolation of A. pyogenes from field cases of ovine orchitis, provide clear evidence that A. pyogenes is pathogenic for the ovine genitalia; however, the mechanisms of transition of the organism from commensal to pathogenic state are not clear. It is also noteworthy that some degree of fertility was restored in the late stages of the disorder. Ultrasonography appeared to be useful for the diagnosis of intra-scrotal abnormalities, especially during investigation of the long-standing stage of the disease, after clinical findings have subsided.

Acute painful scrotum

The ability of US to diagnose the pathogenesis of the acute scrotum is unsurpassed by any other imaging modality. It is the first imaging performed in patients with acute scrotum. Knowledge of the normal and pathologic sonographic appearance of the scrotum and proper sonographic technique is essential for accurate diagnosis of acute scrotum. High-frequency transducer sonography combined with color flow Doppler sonography provides the information essential to reach a specific diagnosis in patients with testicular torsion, epididymo-orchitis, and testicular trauma.

Intra-abdominal sepsis attenuates local inflammation-mediated increases in microvascular permeability at remote sites in mice in vivo

BACKGROUND

Given that leukocyte delivery to remote sites is diminished in states of systemic inflammation, such as sepsis, and activated leukocytes may be responsible for endothelial injury leading to vascular leakage, we hypothesized that intra-abdominal sepsis would diminish microvascular leakage at remote sites by altering leukocyte-endothelial interactions.

METHODS

Using a murine intravital microscopy model, we examined leukocyte-endothelial interactions and vascular leakage at a peripheral site in the presence of local and/or systemic inflammation. Forty mice were randomized to 1 of 4 study groups: local infection (orchitis), systemic infection (intra-abdominal sepsis by cecal ligation and puncture), local and systemic infection, and control. Postcapillary venules of the cremaster muscle were examined by bright light and fluorescence intravital microscopy. Microvascular leakage was determined after intravenous administration of fluorescent albumin.

RESULTS

Systemic infection attenuated the increases in both leukocyte adherence and local infection-induced microvascular permeability. Neutrophil cell-surface expression of L-selectin, as determined by flow cytometry, diminished with both local and systemic infection, whereas expression of CD11b increased with systemic, but not local, infection.

CONCLUSIONS

These data suggest that systemic (intra-abdominal) sepsis diminishes local inflammation-mediated vascular leakage by attenuating leukocyte adherence.

[Effect of immunological orchitis on sperm specific enzyme and fertility]

OBJECTIVE

To investigate the effect of immunological orchitis on spermatic specific enzyme and fertility.

METHODS

Experimental allergic orchitis (EAO) model of guinea pigs was duplicated. The histological and morphological changes of spermatic acrosomal protease and hyaluronidase, lactate dehydrogenase, sperm in epididymis and testes were observed by means of enzyme kinetical spectrophotometry and gelatin fixation of substrate thin membrane.

RESULTS

The activity of acrosomal protease, hyaluronidase and spermatic cytoplasmic lactic dehydrogenase in the epididymis acrosomal enzyme system became low, and so did the quality of sperm in epididymis. Remarkable morphological changes of spermatogenic cells developed in the convoluted seminiferous tubules.

CONCLUSIONS

EAO remarkably affects the fertility of male guinea pigs. The orchis and epididymal sperms might be the sites of action.

[Functional changes and structural features of the testis in patients after acute parotid orchitis]

Structural changes and functional features of the testes were studied in 20 patients who had had parotid orchitis (PO) 6 months to 1.5 years before the study. The examination including ultrasonography of the testes, investigation of ejaculate, radioimmunoassay for serum testosterone, FSH, LH brought out a significant reduction of the mean volume and echogenicity of the affected testicles by 44.7 and 50%, respectively, in 15 patients; a 58.2% decrease in the number of spermatozoa in ml; a 71.2% rise in FSH level in 6 patients. Morphometry of biopsy specimen of the testicles on the affected side has shown that mean sectional area of the tubules has diminished by 40%, the spermatogenesis index--by 77.1% while the volume of the intertubular connective tissue increased by 47.7%. Thus, after acute PO, the patients develop atrophic changes in the testes and a decline in spermatogenic function up to secretory infertility.

[Mumps virus and orchitis: towards a physiopathologic approach]

Mumps orchitis is a dreaded complication of mumps is pubescent men. The literature on this subject includes epidemiological, clinical, histological and endocrine findings, indicating a marked variability of the clinical features from one patient to another, an alteration of endocrine function that can persist in the long term and finally post-mumps infertility, which is exceptional. On the other hand, relatively few studies have investigated the pathophysiological mechanisms, and suggest replication of the mumps virus in the testis. Based on these data from the literature, this article reviews or proposes various hypotheses concerning the various pathophysiological aspects of this disease and discusses the lines of research that could advance the current knowledge in order to improve the therapeutic management of patients, while also providing a better knowledge of the mumps virus and basic testicular physiology.

Correlation between inhibin secretion and damage of seminiferous tubules in a model of experimental autoimmune orchitis

The aim of the present study was to evaluate inhibin secretion in rats with autoimmune orchitis. As we have previously described, experimental autoimmune orchitis (EAO) induced in rats by active immunization with testis homogenate and adjuvants is characterized by an interstitial mononuclear cell infiltrate and sloughing of the germinal epithelium. At 120 days after the first immunization 60% of the rats exhibited a severe orchitis with large areas of aspermatogenic seminiferous tubules in which only spermatogonia and Sertoli cells with cytoplasmic vacuolization remained attached to the tubular wall. None of the untreated (N) or control (C) rats revealed pathological alterations. Sixty percent decrease in testis weight was observed in rats with EAO compared with N or C groups. A 3-fold increase in serum FSH levels was observed in rats with EAO compared with N or C groups (19.8+/-3.7 vs 5.6+/-0.3 and 5.9+/-0.1 ng/ml respectively). A significant decrease in inhibin B levels was observed in rats with EAO when compared with N or C groups (40+/-4.6 vs 207+/-38.8 and 221.4+/-28.6 pg/ml respectively). An inverse correlation between inhibin B and FSH serum levels and a direct correlation between inhibin B and testis weight were found. Strong expression of the inhibin alpha-subunit in Sertoli cells of untreated and control rats was observed; this subunit was undetectable or poorly detectable in rats with orchitis. Positive staining for the inhibin alpha-subunit was also observed in Leydig cells of all groups studied. In conclusion, using a model of autoimmune orchitis our results show that circulating inhibin B levels and inhibin alpha-subunit expression in Sertoli cell cytoplasm closely correlate with the degree of damage of the germinal epithelium.

[Ischemic orchiditis: review of 5 cases diagnosed by color Doppler ultrasonography]

PURPOSE

To study color-doppler ultrasoundfeatures of testicular infarction caused by orchiepididymitis, a severe complication of orchiepididymitis.

MATERIAL

and Methods. Five patients were included over a 2 year period. All presented with more than 24 hours of pain. A final diagnosis of testicular infarction caused by orchiepididymitis and color doppler ultrasound was available in all cases.

RESULTS

All patients showed doppler ultrasound signs of testicular ischemia. Either vascularisation was not detectable or intratesticular resistive index was increased with a negative diastolic flow. Orchidectomy was performed in all patients.

CONCLUSION

Color doppler examination of the scrotum should include measurement of intratesticular resistive index. An elevated RI can be suggestive of ischemia.

Mumps epididymo-orchitis: sonography and color Doppler sonographic findings

Eleven cases of mumps epididymo-orchitis were examined by gray-scale and color Doppler ultrasonography. Nine cases were unilateral and two were bilateral. In the initial examination, the volume and the vascularity of the affected testis and epididymis and the thickness of the scrotal wall was greater than of the normal site, whereas the testicular echogenicity was decreased homogenously, resistivity indexes of intratesticular arteries were decreased, and spontaneous venous flow was seen in all cases. In contrast to nonspecific epididymo-orchitis, no hydrocele was seen, but minimal reactive hydrocele was found in two cases. The diagnosis was confirmed by specific immunoglobulin-G examination. Patients were given interferon and were controlled by ultrasonography and Doppler ultrasonography at the third and seventh days of treatment and 3 months after treatment. Sonographic findings began to improve by the third day and fully disappeared in seventh day. No testicular atrophy was seen in the last control. To our knowledge, this is the first report on sonographic and color Doppler sonographic findings of mumps epididymo-orchitis.

[Usefulness of Doppler-color ultrasonography and identification of resistance indexes as early indicators of testicular infarction secondary to orchiepididymitis]

The testicular infarction can be a rare complication of the orchiepididymitis. The ultrasonography appearance of the partial infarctions creates confusion with expansive intratesticular processes. We present three cases of focal testicular infarction associated with orchiepididymitis, stressing the usefulness of the Color doppler sonography for detecting the avascular nature o these lesions. The determination of de indeces of resistance (IR) in the doppler spectrum of intratesticular arteries showed a highly increased vascular resistance in respect of the healthy testicle. In patients with grave orchiepididymitis vein drainage can be affected due to compressive edema or to thrombosis, causing the raising of the resistance indeces. Acknowledging the avascular resistance of the focal post-orchiepididymitis infarction we can prevent unnecessary orchiectomy.

Semen characteristics of goats with subacute, acute and chronic besnoitiosis

A study on the semen obtained from breeding goats suffering from mild to severe chronic besnoitiosis revealed marked changes in semen volume, colour, density, concentration, mass and individual motility and percentage live. There were also many neutrophils and spermatozoa with primary and secondary defects, including missing tails and deformed heads and tails. The observed changes were considered to be severe enough to account for the infertility observed in the flock. Sections of testes obtained for histopathology were characterised by massive blockage of the pampiniform plexus, degeneration of the germinal epithelium, tubular necrosis with an inflammatory infiltrate and, in some cases, accumulation of haemosiderin-like material in the tunica vaginalis.

Resistive index of the intrascrotal artery in scrotal inflammatory disease

PURPOSE

To investigate the utility of the resistive indices (RIs) of the epididymal and intratesticular arteries, and to establish diagnostic criteria for scrotal inflammatory disease on the basis of quantitative color Doppler sonography.

MATERIAL AND METHODS

We prospectively examined 29 consecutive patients with scrotal pain, and 15 normal control subjects. The RIs of the intratesticular and epididymal arteries were obtained from color Doppler sonographs.

RESULTS

The RIs of the testicular artery in epididymoorchitis were significantly lower than those in normal control subjects and in epididymitis (p < 0.01) while the RIs of the testicular artery in epididymitis and control subjects were similar (p > 0.5). With a cut-off value of RI = 0.5, sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 94%, 94%, 83%, and 77% respectively. The mean RI of the epididymal arteries in epididymitis and epididymoorchitis was 0.49 +/- 0.11. A high level of diagnostic accuracy in scrotal inflammatory disease was achieved when the RIs of the intratesticular and epididymal arteries were less than 0.5 and 0.7 respectively.

CONCLUSION

The RI of the intrascrotal artery would give a more objective evaluation than subjective assessment and could provide diagnostic criteria for scrotal inflammatory disease.

Interstitial orchitis with impaired steroidogenesis and spermatogenesis in the testes of rabbits infected with an attenuated strain of myxoma virus

The pathogenesis of infertility associated with acute viral orchitis was investigated in a rabbit model. Infection of postpubertal male European rabbits with an attenuated strain of myxoma virus caused systemic disease with viral replication to high titres in the testes. Infected rabbits developed an interstitial orchitis and epididymitis. This was associated with degeneration of the seminiferous epithelium, decreased serum testosterone concentrations and increased serum LH concentrations. Virus was localized within the interstitial cells. Clearance of infectious virus from the testis occurred between day 20 and day 30 after infection, although viral DNA could still be detected by polymerase chain reaction at 120 days. Viral clearance was associated with a return to normal serum testosterone and LH concentrations. Anti-sperm antibodies were present in the serum as early as 5 days after infection and declined during the recovery phase. Rabbits were infertile at 60 days but returned to normal fertility 60-90 days after infection.

Does treatment with human chorionic gonadotropin induce reversible changes in undescended testes in boys?

Between May 1993 and November 1995, 71 cryptorchid boys were treated with human chorionic gonadotropin (hCG); 42 were operated upon following unsuccessful hCG treatment. A routine orchiopexy was performed in each case. In 10 cases a testicular biopsy was made during orchipexy within 3 days following hCG treatment; in another 10 biopsies were taken 6 to 9 months after treatment. Testicular biopsies were taken at the time of orchiopexy in 5 cryptorchid boys who were not treated with hCG as a control group. A mild, inflammation-like reaction was found in the cryptorchid testes in the period immediately following the last hCG injections, but those studied 6 to 9 months after the last injection there were no apparent such reactions. In contrast to the inflammation-like reaction, the volume density of blood vessels, interstitial bleeding, and diameter of the seminiferous tubules had not regressed. The numbers of spermatogonia per tubular transverse section and the percentage of tubular transverse sections containing spermatogonia (the fertility index) were increased.

Evaluation of acute scrotal pain by color-coded duplex sonography

In light of the high sensitivity of color-coded duplex sonography (CCDS), we analyzed a group of patients with acute scrotal pain to evaluate the use of CCDS in routine clinical examination. During March 1988 through April 1991, CCDS was used in 31 patients with acute scrotal pain before they underweight surgery in our department. In 15 patients, the structural and perfusion changes of the scrotal contents were such that a definitive diagnosis was possible. In the rest of the patients, the pathologic changes seen with CCDS were more complex, and the correct interpretation needed more expertise; this was especially true in patients with partial torsion, posttorsion status, and torsion of hydatids. CCDS with the simultaneous display of anatomic scrotal structures and blood flow over the entire scan field is an excellent method for evaluating patients with acute scrotal pain. However, apart from the classical case of no perfusion (as in testicular torsion) and increased perfusion (as in inflammation), more complex changes are more difficult to interpret. The correct diagnosis in the latter cases requires considerable experience and evaluation of all facts, including clinical history, results of palpation, and structural and perfusion changes of the scrotal contents.

Quantitative Doppler assessment of acute scrotal inflammation

PURPOSE

To establish quantitative Doppler criteria for acute unilateral epididymitis and/or orchitis.

MATERIALS AND METHODS

Triplex ultrasonography (US) was used to prospectively evaluate 31 patients with acute hemiscrotal pain and 15 asymptomatic control subjects. Morphology and perfusion were assessed, and peak systolic velocities (PSVs) were recorded. Ratios of PSV were calculated by using values from the right and left sides.

RESULTS

PSVs in control subjects differed significantly from those in patients (P < .0001). A PSV > or = 15 cm/sec produced diagnostic accuracy of 90% for orchitis and 93% for epididymitis: Five of six false-negative findings were in patients younger than age 15 years. Epididymal PSV ratios > or = 1.7 or testicular ratios > or = 1.9 were diagnostic of acute inflammation (P < .0001). In three cases, morphologic and color Doppler findings were normal and only the PSV ratios were diagnostic.

CONCLUSION

PSV and PSV ratios provide diagnostic criteria for acute unilateral epididymitis and/or orchitis that are more accurate than morphologic evaluation and color flow imaging either alone or in combination.

Alterations of testicular function after induced autoimmune orchitis in rats

The endocrinological profile of animals with experimental autoimmune orchitis (EAO) has not been sufficiently explored. With this purpose orchitis was induced in adult rats by active immunization with testicular homogenate (TH) and adjuvants. Animals were sacrificed 50 or 80 days after the first immunization. Forty-three percent of rats immunized with TH developed orchitis. Different degrees of cell sloughing and atrophy of the seminiferous tubules and numerous macrophages and lymphocytes in close association with Leydig cells were seen. A significant increase in the number of Leydig cells was observed in rats with orchitis killed at 50 and 80 days. An enhanced number of interstitial non-Leydig cells was also detected in rats with testicular damage killed at 80 days. Levels of serum follicle-stimulating hormone (FSH) were two- to threefold higher in rats with EAO compared to concentrations detected in other groups. Moreover, rats with orchitis had significantly increased testicular testosterone. Serum luteinizing hormone (LH) did not change in animals of any group. In vitro studies showed an increase in the basal and human chorionic gonadotropin (hCG)-stimulated testosterone production in rats with EAO. The increase in testicular steroidogenesis without a concomitant enhancement in serum LH levels detected in rats with autoimmune orchitis suggests the existence of local control mechanisms.

The incidence of the cremasteric reflex in normal boys

The presence or absence of the cremasteric reflex was documented in 225 normal male subjects ranging in age from birth to 12 years. The reflex was initiated by stroking the skin of the inner aspect of the thigh. The cremasteric reflex was present in 48 of 100 newborns (48%), 32 of 71 subjects (45%) between 1 and 30 months old, and all 54 boys older than 30 months. The presence of the cremasteric reflex may be clinically significant in boys with suspected cryptorchidism or acute scrotal inflammation.

Mumps orchitis among soldiers: frequency, effect on sperm quality, and sperm antibodies

This study reports on 72 young soldiers who suffered from a recent epidemic of acute mumps, with special emphasis on 19 who suffered from mumps orchitis and whose spermograms were in the fertility range. The immunological work-up for antibodies in sera or seminal plasma gave normal results for the patients diagnosed with orchitis, as well as the controls. The only remarkable finding was an increased risk of borderline significance for orchitis in smokers. The present study has proven that the presence of antisperm antibodies does not play a role in the etiology of mumps orchitis.

Scrotal inflammatory disease: color Doppler US findings

A study of 45 patients with 51 cases of hemiscrotal inflammatory disease was done to determine the color Doppler ultrasonographic appearance of scrotal inflammatory disorders. The diagnosis was ultimately established by means of appropriate response to antibiotic treatment (47 cases) or surgery (four cases). In all cases, there was evidence of hyperemia: an increased number and concentration of detectable vessels in the affected portion of the scrotum. In 17 cases, the gray scale images were normal, and the only evidence of inflammation was the presence of hypervascularity. Abnormally decreased epididymal vascular resistance was detected in 14 cases of epididymitis; abnormally decreased testicular vascular resistance was detected in six cases of orchitis. Spontaneous venous flow was present in 18 patients. The authors conclude that color Doppler can demonstrate the hyperemic response to scrotal inflammatory disease and that, in the proper clinical setting, it can supplement the gray scale findings and increase diagnostic confidence.

Testicular function after unilateral bacterial epididymo-orchitis

In order to determine whether bacterial infection of the gonads may account for some male-related infertility, the fertility status of 45 young men who developed gonococcal urethritis and then epididymo-orchitis were studied prospectively. The fertility potential of the subjects was evaluated through history of paternity, repeated semen examinations, serum follicle-stimulating hormone determinations, and testicular biopsy. Before infection, 14 married men (100%) had proved their fertility through their children. Two years after infection, only 21% of these fathers and 40% of all subjects produced semen considered adequate for conception. The semen values in the rest were comparable to those of infertile/subfertile men. Although the lesion was clinically confined to one testis, testicular biopsy and follicle-stimulating hormone studies showed that testicular damage involved both testes. The study showed that bacterial gonadal infection may result in permanent azoospermia or oligospermia and this without question may result in male-related barrenness.

[The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps]

The paper emphasized the role of mumps complicated by orchitis in the etiology of male subfertility with allowances for a possible development of testicular degeneration in the course of epidemic parotiditis alone, i.e. without clinically evident orchitis. To distinguish the impact of mumps sustained in childhood on the infertility development clinical and laboratory investigations would be advisable in the majority of subfertile males. The results of clinical and statistical study of 865 infertile males aged between 20 and 36 yrs whose marital life varied from 8 mos to 12 yrs were reported. Anamnestic evidence of epidemic parotiditis sustained at the age of 5-13 yrs was found in 174 examinees (20.1 per cent). Spermographic data on subfertile males with a history of mumps were exposed to statistical computation and correlated with the data on 200 subfertile males who avoided the disease and the data on 22 healthy fertile males. The authors noted significantly low (p less than 0.05) contents of ejaculate spermatozoa in subfertile males with a history of mumps and a significantly low number of morphologically normal spermatozoa (p less than 0.001) in comparison to those values in subfertile males without a history of epidemic parotiditis.

Dracunculus orchitis: a case report

The clinical features of dracunculus orchitis as a definite clinical entity are summarized and a case reported.

Role of beta 2-adrenoceptors in the biological effect of autoimmune orchitis spleen cells

Autoimmune orchitis induced an increment in beta 2-adrenoceptor populations in intact mouse spleen lymphocytes. Normal and autoimmune lymphocytes incubated with soterenol increased the mechanical response of isolated atria. Autoimmune cells were more effective than normal cells in inducing this response. Soterenol or spleen cells alone did not modify the contractility at the concentration used. Inhibitors of beta 2-adrenoceptors of spleen cells completely blunted the reaction between soterenol and lymphocytes, while when atria were exposed to butoxamine, mechanical activity induced by soterenol plus lymphocytes was not affected. Cell-free supernatants of lymphocytes exposed to soterenol elicited the reaction in the same way as soterenol-treated lymphocytes. Direct contact of cells with the assay organ was not necessary. Inhibitors of cyclooxygenase on lymphocytes blocked the reaction of soterenol-treated lymphocytes on atria, while inhibitors of lipoxygenase(s) completely blocked the reaction of atria exposed to soterenol-stimulated lymphocytes or supernatants. These results suggest that soterenol reacts with beta 2-adrenoceptors of normal and autoimmune cells. From this reaction, soluble factors are released that in turn trigger stimulation of the atrial contractility as a consequence of the release of oxidative products of the lipoxygenase(s) pathway of arachidonic acid from atria. The high activity of atria in the presence of autoimmune spleen cells is probably related to the increment in number of beta 2-adrenoceptors of these cells.

The diagnosis and treatment of the acute scrotum in children and adolescents

Diagnosing acute scrotal pain and swelling in children and adolescents is urgent and often difficult. A review of 395 boys hospitalized with acute scrotal pain and/or swelling shows that a useful approach is to divide these patients into four groups--those with intermittent but recurrent episodes of pain, those with pathognomonic physical findings, those with definite epididymitis, and a remaining group with nonspecific swelling and tenderness. Five per cent of boys in this series presented with recurring episodes of scrotal pain; these boys should undergo a simple scrotal operation that yields excellent results. Eight per cent had pathognomonic physical findings; treatment in these boys is straightforward. Eighteen per cent had a definite diagnosis of acute epididymitis (i.e., three nonpathognomonic but suggestive findings of acute epididymitis or two suggestive findings plus a radionuclide scan showing bilateral perfusion); nonoperative therapy is indicated in this group. In the remaining boys, scrotal exploration is the diagnostic (and usually therapeutic) procedure of choice.

Testicular blood flow in experimental torsion and epididymo-orchitis measured by 133Xe clearance technique in rabbits

Testicular blood flow was measured by intratesticular injection of 133Xe both under control conditions and in experimental 720 degree intravaginal torsion (10 rabbits) and in epididymo-orchitis (5 rabbits). The results were statistically compared with each other. The blood flow was 35.8 +/- 13.7 ml/100 g/min to the right testis and 35.4 +/- 12.7 ml/100 g/min to the left testis under control conditions. The blood flow decreased to 16% and 8% of the control values 1 h and 8 h after torsion respectively. In epididymo-orchitis testicular blood flow stayed within normal limits. There was a significant difference in blood flow between the torsion and epididymo-orchitis groups (p less than 0.001). Further investigation in man will demonstrate whether the 133Xe clearance method can be used in the differential diagnosis of these two pathologies.

Prevalence, testicular function and seminal parameters in men with sperm antibodies

A prospective survey of 289 unselected men, attending a male infertility clinic (200 subjects) or as donors presenting for an artificial insemination programme (89 subjects) was performed. High titres of sperm agglutinating antibodies (greater than 1/32) were present only in a group of (6.5%) of infertile men but not in volunteer donors. Low titres occurred with similar frequencies (12%) in both groups. The sperm immobilizing antibody test was less sensitive and more specific but of no additional diagnostic benefit. Patients with high titres of sperm antibodies had evidence of testicular damage with decreased testicular volumes, elevated serum FSH and LH levels and reduced sperm density and motility whereas low titres were not associated with any testicular or seminal pathology. These data suggest a sub-group of infertile men have evidence of spermatogenic damage and impaired sperm function associated with high titres of sperm antibodies. Immunologic infertility in these men may reflect either an underlying autoimmune orchitis or a secondary immune reaction following testicular damage of various causes.

Androgen and estrogen production in elderly men with gynecomastia and testicular atrophy after mumps orchitis

Gynecomastia developed in three men 1-30 yr after the occurrence of testicular atrophy due to mumps orchitis. At the time of study, these men were 63-68 yr of age. In these men the mean plasma production rate of testosterone was 816 microgram/24 h, a value 20% of that found in normal elderly men without gynecomastia. The plasma production rate of androstenedione averaged 1317 microgram/24 h. The mean production rates of 17 beta-estradiol and estrone in these subjects were 33 and 48 microgram/24 h, values comparable to those of normal young men. Extraglandular formation of estrogen from plasma prehormones accounted for all of the 17 beta-estridiol and most of the estrone produced by these elderly men with gynecomastia. Serum gonadotropin concentrations were elevated in these men, probably because plasma testosterone production rates were decreased. These findings are consistent with the view that the capacity of Leydig cells to secrete testosterone was impaired after mumps orchitis in these subjects, but the capacity to form estrogen was not similarly impaired, since most estrogen is formed in extraglandular sites. Thus, the impairment in Leydig cell testosterone secretion after mumps orchitis together with the normal increase in extraglandular aromatization that accompanies aging bring about a striking reduction in the ratio of testosterone to estrogen production rates, and gynecomastia may result.

Pituitary-testicular interrelationships in mumps orchitis and other viral infections

Leydig-cell function was assessed in 27 men with acute mumps orchitis by measuring plasma testosterone concentrations before and after the administration of human chorionic gonadotrophin (HCG). The test was also performed on groups of patients with other febrile viral infections and mumps without orchitis and on healthy euspermic men. The concentrations both before and after HCG were significantly lower in patients in the acute phase of mumps-but not in those with other viral infections and mumps without orchitis-than in the healthy men. Basal concentrations of follicle-stimulating hormone (FSH) and luteinising hormone (LH) were significantly increased in patients with acute mumps orchitis, while an exaggerated response to LH-releasing hormone was noted in four patients after the acute phase of the disease. Raised plasma LH concentrations were also found in several patients with viral infections, including mumps without orchitis. There appeared to be no particular merit of any of the treatments used (aspirin, prednisolone, and cold baths). In patients reevaluated three to five and 10 to 12 months after the acute phase of their disease the basal testosterone concentrations were similar to those of the healthy men, but several of the patients showed a severely impaired response to HCG. Mean basal FSH and LH concentrations were significantly increased 10 to 12 months after the acute phase, while the mean LH concentration was also raised at three to five months.It is concluded that mumps orchitis impairs Leydigcell function during the acute phase of the disease but may also have a more permanent damaging effect, similar to that found in the germinal epithelium.

The relationship between nutrition and androgenic activity in pubescent twin calves, and the effect of orchitis

The inhibitory effect of underfeeding on the process of male pubescence was studied in three pairs of bovine identical twin calves by feeding one twin on a normal and the other on a low plane of nutrition. As a result of malnutrition the development of the androgenic function of the testes was retarded much more markedly than spermatogenesis.

In the undernourished twin the testes contained and secreted less testosterone, and showed a lower testosterone: androstenedione ratio, than in the control animal. This nutritionally conditioned androgen deficiency was clearly reflected in a markedly retarded onset of production of fructose and citric acid by the seminal vesicles.

After castration the underfed twin responded to testosterone injections much more sluggishly than the control twin, as shown by the delayed appearance of fructose and citric acid in electrically-induced ejaculates.

Observations were also made on the effects of orchitis and cryptorchidism. Both these conditions lowered markedly the androgenic activity in the calves.