Cases Of Cryptorchidism Research Articles

13 ANTIGONADOTROPIC-CELLS ANTIBODIES IN THE SERUM OF CRYPTORCHID CHILDREN AND INFANTS AND THEIR MOTHERS

An indirect immunofluorescence test revealing serum antibodies directed against human and guinea pig pituitary gonadotropic cells (AGC-A) was used in 46 cases of common cryptorchidism, 26 unilateral and 20 bilateral, without associated abnormalities. Among 23 patients aged 1 to 11 years, 14 had AGC-A, without correlation with age, uni or bilaterality, or the results of further hormonal investigations using LHRH and hCG stimulation tests. No AGC-A were found in 24 control boys of same ages. Among 23 cryptorchid infants aged 1-3 months, 12 had AGC-C, without correlation with their plasma levels of testosterone, LH and FSH; follow-up in 9 showed that AGC-A persisted in 7, disappeared in 2. Paired study was done in 15 newborns and mothers and was concordant in 14, 7 with and 7 without AGC-A. In spite of the discrepancies, the study of auto-immunity could improve the understanding of congenital testicular maldescent.

Cryptorchidism: Review and Evaluation of the Fertility of Adult Cryptorchids

Twenty‐two cases of adult cryptorchidism were clinically examined and evaluated by semen analysis, Doppler ultrasound examination, and testicular biopsy. All of these patients had undergone orchiopexy after reaching puberty, and had been followed for a period ranging from two to ten years, with a mean of 5.7 years. Although 41% of the patients had testes that clinically appeared normal in size, only five had a normal semen analysis. Because of the usual association with low fertility, marked by oligozoospermia, and the increased risk of testicular malignancy, testicular biopsy followed by orchiectomy should be performed in cases of unilateral cryptorchidism diagnosed after puberty.

Microsurgical testis autotransplantation. A critical review.

Abdominal testes represent 15 to 25% of all cases of cryptorchidism. In 5% the testis is so high in the abdomen that it is impossible to perform a conventional orchidopexy. The authors report an experience of 5 cases of testicular autotransplantation achieved by temporarily severing the testicular vessels and then reanastomosing them to the inferior epigastric vessels using a microsurgical technique with an operating microscope at 25 times magnification. Compared to traditional methods, autotransplantation permits an easy replacement of an ectopic testis into the scrotum and a more physiological blood supply to the testis. The authors discuss surgical and microsurgical techniques, testicular ischemia time and follow-up of patients who have undergone autotransplantation.

Carnitine and acylcarnitines in semen from azoospermic patients

Carnitine and its short-chain acyl esters were assayed in semen from normospermic and azoospermic men. Extremely low concentrations of free carnitine and acylcarnitine were found in semen from patients with obstructive azoospermia where the ejaculate was primarily of prostatis origin, and low values were also obtained in obstruction of the vas deferens, where the epididymal contents were not ejaculated. Semen from patients whose azoospermia was caused by testicular dysfunction had low acylcarnitine concentrations and normal levels of free carnitine in most cases, but a group of patients with severe testicular failure (including cases of Klinefelter syndrome and cryptorchidism) had low semen free carnitine concentrations. Whereas treatment with human chorionic gonadotropin increased serum testosterone levels in azoospermic patients, it did not increase the free carnitine concentration in semen, although it increased the proportion of carnitine found in acylcarnitines.

Cryptorchidism and non-seminomatous testis cancer.

An analysis of 107 cases of cryptorchidism and non-seminomatous germ cell cancer treated between 1960 and 1976 is presented. The incidence of cryptorchidism in patients with testicular cancer is 9.8%. Eighty patients presented with ipsilateral inguinal tumours, 12 with contralateral intrascrotal tumours and 15 with abdominal tumours. There were 52 embryonal, 36 teratocarcinoma, 9 teratoma, and 10 choriocarcinoma tumours. The 5 year survival for all patients was 52.3%. The age distribution, pathology and stage of the patients was similar to non-seminomatous tumours not associated with cryptorchidism.

Cryptorchidism and malformations of the scrotum and testes of donkeys

Scrotal palpations of 274 donkeys revealed 74 cases of cryptorchidism, which is an incidence of approximately 30%. Three donkeys were found without scrotum evident and with ectopic testes. The histological changes in the ectopic testes were noted.

Plasma gonadotropin values in prepubertal cryptorchid boys: Similar increase of FSH secretion in uni- and bilateral cases

THE CAUSES of nondescent of the testes are poorly understood. Endocrine data concerning prepubertal cryptorchid boys are scanty and contradictory: Job et aP reported data suggestive of LH deficiency in this syndrome, whereas Sizonenko et al'-' reported that the negative feedback mechanism between the seminiferous tubules and FSH secretion might be impaired in prepubertal boys with bilateral cryptorchidism. Histologic Studies showed bilateral testicular lesions in most cases of unilateral cryptorchidism? The present study was undertaken to investigate whether endocrine anomalies could be found in prepubertal boys with unilateral cryptorchidism. PATIENTS AND METHODS In order to deal with as homogenous a group as possible, the study was limited to boys one to 9 years of age. Forty prepubertal boys were investigated: 14 controls (1.0 to 8.5 years of age), 13 boys with unilateral cryptorchidism (1.8 to 8.5 years), and 13 boys with bilateral cryptorchidism (3.0 to 8.5 years). Boys with retractile testes were excluded by careful history and repeated clinical examination. In boys without palpable testes, a hCG stimulation test was performed after the LHRH test; if there was no increase of plasma testosterone concentration after hCG, the patient was considered as agonadic' and was excluded. Bone age in each boy was compatible with chronologic age. Informed consent was obtained from the parents. Each subject received a single intrave

An anatomic and genetic study of canine cryptorchidism.

Twelve cases of cryptorchidism were found in a colony of Minature Schnauzer purebred and crossbred dogs. At least nine affected dogs were derived from the same sire directly or indirectly. Of 12 affected dogs, five cases were unilateral and seven were bilateral. Eight of the 12 cases were subjected to anatomic study. Fixation of affected organs was by vascular perfusion or immersion. Testes were separated from epididymides and both were weighed. All unilateral retained testicles were on the right side, and right sided bilaterally retained testes were always smaller than their left sided counterparts. With only one exception, ectopic testes were in the abdominal positon. Developmentally, the morphologic appearance of the epididymis of abdominal testes was very primitive in bilateral cases but nearly normal in the unilateral cases. Degree of inbreeding was greater for bilateral cases than unilateral cases. High incidence of cryptorchidism in this colony provided good evidence for hereditary nature of the condition in the Miniature Schnauzer dog. Morphologic observations were suggestive of a multiple gene defect.

Congenital bilateral anorchia in childhood: a clinical, endocrine and therapeutic evaluation of twenty-one cases.

An evaluation of twenty-one boys, including a discordant pair of identical twins, is presented in whom bilateral anorchia was found with a negative family history and without history of breech presentation or of postnatal testicular trauma, torsion or orchitis. The most likely cause is prenatal testicular torsion. The incidence of the condition in our hospital is 1 in 177 cases of cryptorchidism. Prepubertal growth was normal before treatment, and testosterone replacement therapy allowed a normal pubertal growth spurt and skeletal maturation. Although demonstrable basal urinary testosterone was found in the subjects with a postpubertal bone age, most patients tested showed no increase after stimulation with human chorionic gonadotrophin. In the presence of a normal penis and scotum, such findings, together with a high basal FSH and an increased response of plasma LH to LHRH, make surgical exploration unnecessary. In the rare patient who shows a positive but subnormal response of testosterone to HCG, Leydig cells are presumed to be present either ectopically or in rudimentary testes, and further surgical exploration is indicated.

Plasma androgen responce to hCG stimulation in prepubertal boys with hypospadias and cryptorchidism.

Serum levels of testosterone, androstenedione and dehydroepiandrosterone were measured before and after 5 days of treatment with hCG (2000 IU/d) in 36 prepubertal boys with cryptorchidism and 11 with hypospadias in order to determine whether a defect in androgen synthesis could be a common cause for these disorders. Baseline and stimulated levels of testosterone, androstenedione and dehydroepiandrosterone were similar in patients with unilateral cryptorchidism, monorchism and hypospadias; baseline and stimulated levels of testosterone were lower in boys with bilateral cryptorchidism. Testosterone levels did not correlate with either the anatomical location of the testis in patients with unilateral cryptorchidism or with the site of the urethra in boys with hypospadias. Seven of 36 patients with cryptorchidism had a positive family history of a similar disorder; testosterone levels were similar in patients with and without a family history. It is concluded: 1) in all patients studied, the gonadotropin dependent phase of testosterone production is present; 2) hCG stimulation cannot detect unilateral Leydig cell dysfunction; and 3) in familial cases of cryptorchidism, some factor other than an abnormality in androgen synthesis may be responsible for the hereditary tendency.

Changes in plasma levels of LH, FSH and testosterone following the administration of synthetic luteinizing hormone-releasing hormone to cryptorchid patients.

The levels of LH, FSH and testosterone of three adult groups consisting of normal subjects, unilateral and bilateral cryptorcids were compared before and after LH-RH loading. It was found that both groups of cryptorchid had comparatively high plasma base line levels for both LH and FSH, particularly high in the bilateral group; and both groups responded to LH-RH loading. This indicates that their hypothalamo-hypophyseal systems were probably functioning normally. The plasma base line levels of testosterone were higher in unilateral cryptorchids than in the control group, and lowest in the bilateral cryptorchid group. But the reaction of testosterone levels to LH-RH loading was generally poor in both groups of cryptorchids, suggesting that, in cryptorchid cases, unilateral and bilateral, the capacity of the testicle to secrete testosterone is generally depressed, freeing central suppression. This probably accounts for the high values of plasma lh and FSH observed in such patients.

The prostate in the neonate and infant in cryptorchism and hypospadias.

The prostates of 8 neonates with cryptorchism and of 4 neonates and 1 infant with hypospadias have been examined and the findings have been compared with those in 127 controls. The processes of proliferation of the prostatic tubule epithelium, squamous metaplasia and secretion were normal in 7 of the 8 cases with cryptorchism and in all 5 cases with hypospadias. These findings are in contrast to 4 other cases where cryptorchism was associated with congenital renal malformations and all of whom showed an abnormal appearance of the prostate (as described elsewhere). The secretory activity of the prostate was markedly reduced in a neonate with cryptorchism who also had extreme testicular hypoplasia and marked underdevelopment of the penis, probably indicating a prenatal hormonal imbalance. 2 cases with hypospadias showed a very large and distended utricle and the possible significance of this has been discussed. Associated congenital malformations, involving other than the genital system, were present in 7 of the 8 cryptorchid cases and in all 5 cases with hypospadias, as compared with 17 of the 127 controls.

Incidence of congenital abnormalities in a beagle colony.

The incidence and type of congenital abnormalities occurring in a closed beagle colony over a 7-year period is recorded. Examination included 1 360 pups at birth, 758 of which were also autopsied at an age of about 20 months: 9 major abnormalities and 6 cases of cryptorchidism were found, an overall incidence of 1.1%.

Cryptorchidism. Roentgenological and surgical aspects.

Summary60 cases of cryptorchidism and 5 intersexes were examined with andrography (pneumo‐pelvigraphy). Of these, 36 were operated upon.The roentgen findings are compared with the palpatory and surgical findings. The value of the method is discussed and the indications for it are given.

CRYPTORCHID AND SCROTAL HUMAN TESTES. I. CYTOLOGICAL, CYTOCHEMICAL AND QUANTITATIVE STUDIES.

Quantitative studies concerning the variation in cell population and cytochemical characteristics of the undescended testis at different ages were carried out in 58 cases of unilateral cryptorchidism. This population was compared with 40 of the contralateral scrotal testes and with 55 testes of normal subjects of similar age. The cryptorchid testis showed arrest of development of the germinal epithelium and Serotoli cells which started at early infancy and reached a maximum in adulthood. At puberty, decreased extravascular diffusion of serum proteins and fibrotic changes were noted in the stromal connective tissue; these changes reached a maximum in adulthood. No differences were observed, at any age, in the Leydig cells of the cryptorchid testes as compared to those of the contralateral and/or of the testes of normal subjects. It is assumed that the arrest of development of the germinal epithelium and the progressive alterations observed in the stromal connective tissue are responsible for the irreparable damage observed in the cryptorchid testis in adulthood.

New aspects of thyroid therapy.

Hormonal therapy of glandular deficiency has been, so far, more or less in the nature of replacement therapy, deficient production of a certain hormone being replaced by its extraneous administration. As the organism produces and requires only minute amounts of hormonal agents, comparatively small doses of the active principles as a rule suffice for this purpose. Only occasionally are large unphysiological quantities required to produce the desired results. This may be true e.g. of certain cases of cryptorchidism, testicular aplasia or other forms of hypogonadism, of certain forms of hypothyroidism, 1 or of diabetes mellitus such as diabetic coma. The nature of the mechanisms underlying such states of refractoriness is in the majority of cases yet obscure, notwithstanding extensive study of the subject. We can only assume that either hormone antagonists of various nature or physiochemical alterations in the reactivity of the peripheral tissues are causally involved. 2 The present

Results of Treatment in 40 Selected Cases of Cryptorchidism

FOR MANY YEARS the management of cryptor chidism has been an intriguing problem to the medical profession. The four major concerns have been with (a) anatomical restitution of the affected organs to a normal position in the scrotum, (b) proper development of the affected organs, (c) normal functional results so as to insure both fertility and the elaboration of male sex hormone, and finally (d) the possibility of degenerative and malignant changes occurring in testes occupying a faulty position, or in testes the position of which has been corrected. Up to recent years the most satisfactory approach to proper placement of the testes was surgical, even though many surgeons have expressed dissatisfaction with the frequency of lack of development following surgery. Numerous reports of operative results have been recorded in the literature, the percentage of cures ranging from 42 to 92%.

THE BULLETIN OF THE ASSOCIATION FOR THE STUDY OF INTERNAL SECRETIONS

IT is NOW generally agreed that the anterior pituitary′like hormone from pregnancy urine and placenta are of definite value in the treatment of some types of hypogenitalism and cryptorchidism. Also, some enthusiasm has been shown relative to the correction of these conditions by the administration of beef and sheep anterior pituitary extracts. However, there are definite limitations to the value of these preparations. The urinary and pla′ cental extracts are not true pituitary gonadotropic hormones (they fail to prevent atrophy of the gonads in the hypophysectomised animal), and there′ fore cannot actually be considered substitution therapy. In the female, the principal effect of these extracts is that of luteinization of the ovaries, and in the male, stimulation of growth of the interstitial tissue of the testes. Success in the treatment of some cases of cryptorchidism may possibly be explained by the increased weight of the testes, or by growth and elongation of the supporting structures produced by the...

Effect of Synthetic Male Hormone Substance on Descent of Testicles in Human Cryptorchidism.

Anterior pituitary-like substance has been employed with some degree of success in a certain percentage of cases of cryptorchidism.1 The action is possibly effected through stimulation of the production of male hormone,2 since male hormone (androgen) is responsible at least in part for testicular descent in monkeys,3 rats,4 and as shown in the present report, humans.Thirty-two cryptorchid males between the ages of 1 1/2 and 27 years received subcutaneous injections of 5 to 20 mg of testosterone propionate† 3 to 7 times weekly, the amount being adjusted to the size and age of the individual and the response to the material. Standard tests5 were used to differentiate spastic from true retention of the testicle, a procedure vital for the evaluation of the results of any therapy. Twelve cases were pseudocryptorchid (spastic retention); 20 presented a state of true cryptorchidism, 8 bilaterally, 12 unilaterally. There was indication of endocrine abnormality in 8, of familial endocrine disturbance in 6.Eight ca...

Testicular Tumors Associated with Mammary, Prostatic, and Other Changes in Cryptorchid Dogs

Cases of unilateral or bilateral cryptorchidism in dogs are only occasionally seen by breeders and are apparently quite infrequent. Vennerholm (1897), a veterinarian of wide experience, reported having encountered six such cases in his extensive practice, three of which were inguinal and three intra-abdominal. The same author stated that one specimen of unilateral and one of bilateral cryptorchidism in the dog are preserved in the anatomical museum of the Institute for Veterinary Medicine in Stockholm. It may be assumed that the undescended testes in Vennerholm9s cases showed no externally discernible pathological change, since it seems reasonable to suppose that he would have mentioned them had any such been present. So far as the present writers have been able to determine, there is no published report of testicular tumors in cryptorchid dogs in which the condition was associated with the abnormal enlargement of the mammary papillae, prostatic metaplasia, and the other remarkable features present in the two animals about to be described. Dog No. I: The first animal studied was a four-year-old male Boston terrier which had been given by its owner to Professor C. H. Danforth, of Stanford University, to whose kindness we are indebted for the opportunity to describe it. The dog had been disposed of by its original owner because it seemed to attract other male dogs in much the same way as a bitch in heat. That peculiarity, together with the fact that its mammary papillae were abnormally large, had given rise to the belief that the animal was an hermaphrodite. Its attraction for male dogs was verified after it was received at the laboratory. When an apparently normal male dog was brought into the room in which this animal was confined the former would, after a very brief olfactory reconnaissance, attempt to mount it. Two other males behaved similarly towards it in the same experimental situation. It seemed to the observer that this behavior was much too spontaneous to be confused with the somewhat similar homosexual activity which is frequently seen among male dogs. It appeared, rather, as if the males found something especially compelling about the odor or the appearance of this abnormal animal, for their overt sexual advances began almost as soon as they entered the room in which it was kept. The latter appeared to resent their behavior and attempted to fight them off.