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Peritoneal dialysis for hemolytic-uremic syndrome in post-operative peritonitis following ileocecal resection for intussusception
INTERNATIONAL
573
ABSTRACTS
Total Colonic Aganglionosis: Treatment and Follow-Up. C. Festen,
R. Severijnen.
F.v.d. Stauk, et al. 2 Kinderchir 44: 153- 155, (June),
1989. Eleven cases of total colonic aganglionosis were reviewed. Better knowledge of the clinical picture and greater alertness for the occurrence of this disease has led to earlier diagnosis. Definitive operative treatment is still controversial. Following ileostomy, a crucial point seems to be the allowance of sufficient time for the small bowel to adapt its absorptive ability. The authors are of the opinion that little is to be gained by the application of a difficult procedure, such as Martin’s operation, which involves the risk of serious complications. Their experience confirms that a standard Hischsprung’s operation is, in general, satisfactory. At present (mean follow-up, 6.7 years) all patients show normal growth and development, have no serious perianal problems, and are, with one exception, continent for feces.-Thomas A. Angerpointner Causes of Late Complicntions in Children Operated on for Hirschsprung’s Disease: A Preliminary Immunohistochemical Investigation Using Polyclonal Antibodies Against S-100 Protein. K. Joosten,
M. Pruszczynski,
R.S. V.&f. Severijnen,
et al. Z Kinderchir 44:213-
215, (August), 1989. Late follow-up of 5 1 children operated on for the classical form of Hirschsprung’s disease showed a large number of unsatisfactory results. It is well known from the literature that achalasia of the anal sphincter is one of the most important causes. Twenty-five patients underwent redilatation of the anal sphincter. Complaints in the form of constipation or diarrhea remained in 40% of the cases secondary to redilatation. Reinvestigation of the resected colon specimens using the conventional histological method disclosed the presence of ganglion cells in the proximal resection area in all patients. In the light of reports in the literature stating that despite normal histology innervation disturbances can, nevertheless, occur in the colon, the authors performed a pilot study using polyclonal antibodies against the S-100 protein. In three of four patients who were adequately resected in the sense of conventional histology, clear innervation abnormalities could be found by means of polyclonal antibody staining. Three of those four patients presented with unsatisfactory late results. It remains unclear whether the abnormal S-100 staining is limited to one segment or extends over the whole colon. The question also remains as to whether maturation occurs so that some improvement may be expected on a long-term basis with increasing age.-Thomas
A. Angerpointner
Anorectal Malformations Associated With a Presacral Tumor and Sacral Defect. Y. Tsuchida,
W. Waianasupt,
and T. Nakajo.
Pedi-
atr Surg Int 4:398-402, (October), 1989. The triad of anorectal malformation, presacral mass, and sacral bony defect is quite rare. During the past 18 years, five patients with this triad were treated in the authors’ institutions. Four had covered anal or anorectal stenosis; one infant had anorectal agenesis. There was a central defect of the sacral bone in three and sacral hemivertebrae in two patients. An additional case that had an intact sacrum but was otherwise associated with the same anomalies is also reported. In the literature, the authors could find 51 cases (including five cases of their own) that fall under this symptom complex. All patients had a presacral tumor, the most common being teratomas and meningoceles (20 cases each). Anal or anorectal stenoses were most frequently encountered (46 cases), whereas malformations such as anorectal agenesis (3) or anorectal stenosis plus rectovaginal fistula (2) were noted less frequently. Therefore, the authors contend that the spectrum of this symptom complex is broader than was previously considered. Among these patients, constipation was the
most common presenting symptom. Barium enema and computed tomographic studies were helpful in identifying the presence, extent, and nature of the mass. The embryogenesis is discussed, reviewing the clinical and pathological characteristics of these patients.Prem Puri
ABDOMEN The Efficacy of Hepatoportoenterostomy in Biliary Atresia. J.L.
Grosfeld,
J.F. Fitzgerald,
R. Predaina, et al. Surgery 106:692-701,
(October), 1989. This series outlines the treatment and outcome of 66 infants with biliary atresia. Forty-eight of these patients underwent hepatoportoenterostomy (HPE) and four underwent hepatoportocholecystostomy. Twenty-five percent of these patients had successful HPE, with improvement in 19% and no improvement in 43%. The success was predicted by the time of operation with a 31% overall success for those patients who underwent surgery at less than, 90 days of age. A number of different procedures were utilized in this series, with a preference for the Suruga and Sawaguchi procedures. Stomas allowed for bile clearance studies determined by ostomy:serum ratios. These ratios were found to be good prognostic determinants when greater than 15 at 12 weeks postsurgery. Reoperation for complications was only successful in that group of patients who had an initial clearance of jaundice. The report continues to describe those patients who were referred for liver transplantation and highlights the “hidden mortality” of those patients that die on transplant waiting lists.-Tom Tracy. Jr Long-Term Follow-Up Study of Petients With Cholangitb After Successful Kasai Operation in Biliary Atresia: Selection of Recipients for Liver Transplantation. N. Ohkohchi, T. Chiba, R. Ohi, et al. J Pediatr Gastroenterol Nutr 9:416-420, (November), 1989.
This report of 131 patients from Sendai, Japan covers the time period from 1970 to 1987. In 39 of these patients, jaundice persisted after portoenterostomy, and there were no survivors in this group IO years after the operation. Of those patients without jaundice, 90% were alive after 10 years. Twenty patients died after initially successful portoenterostomy, but the records of nine were reviewed in order to evaluate clinical outcome following episodes of recurrent cholangitis. In those nine patients, when the total bilirubin concentration rose above 10 mg/dL, there was no benefit derived from conservative therapy that included antibiotics, steroids, and choleretic agents. Apart from serum bilirubin levels, there was no prognostic value for liver enzyme and coagulation parameters. From their review of this group of patients, the authors recommend early transplantation for those patients with persistent jaundice after attempted portoenterostomy. It also appears that bilirubin levels greater than 10 mg/dL during bouts of cholangitis are unresponsive to conservative medical treatment and are highly predictive of impending hepatic failure or gastrointestinal bleeding and death within the year. Therefore, these patients should be prepared for liver transplantationTom Tracy, Jr Peritoneal
Dialysis for
Hemolytic-Uremic
Svndrome
in Post-
operative Peritonitis Following Ileocecal Resectien for Intussusception. C. Deindl. R. Eife. and H.-G. Dietz.
Z Kinderchir 44: 169- 171,
(June), 1989. The case of a 3-year-old girl who underwent laparotomy for ileocecal intussusception is reported. Immediately following laparotomy, she developed a hemolyticuremic syndrome with hemolytic anemia, thrombocytopenia, increased serum urea and creatine levels, and anuria. She also developed a subsequent peritonitis, enterocolitis, and sepsis. Following relaparotomy with establishment of an
574
INTERNATIONAL ABSTRACTS
ileostomy, peritoneal dialysis was performed over several days for treatment of the hemolyticuremic syndrome. This case demonstrates that peritoneal dialysis can be performed effectively despite fresh intraabdominal irritation and that simultaneous peritonitis can be managed by intraperitoneal administration of antibiotics via dialysis catheter. Following closure of the ileostomy 4 weeks later, the girl was discharged from the hospital on her 10th postoperative day in good condition--Thomas A. Angerpoinrner Acute Abdomen Due to Paraduodenal Hernia. H. Stallinger, Kees. andP. Wurnig. Z Kinderchir 44:164-165, (June), 1989.
A.
Internal hernias are rarely diagnosed. They are mostly found at laparotomy when complications and their symptoms (eg, palpable mass, abdominal pain, vomiting, and ileus) require surgical treatment. A case of an 1 l-year-old boy who was hospitalized for abdominal pain is presented. Appendicectomy resulted in only temporary pain relief. Subsequent laparotomy showed a left-sided paraduodenal hernia. Postoperative course was uneventful. Paraducdenal hernias, first described by Neubauer in 1786, result from a disturbed bowel rotation.-Thomas A. Angerpointner Hematuris: Trauma.
A Marker
of Abdominal
Injury in Children
G.A. Taylor, M.R. Eichelberger,
After
Blunt
and B.M. Potter. Ann
Surg 208:688-693, (December), 1988. Hematuria was evaluated in 378 consecutive children by the trauma service of Childrens’ Hospital National Medical Center to establish a marker of abdominal injury in children. Average age was 7.6 years (range, 1 month to 18 years) with a typical distribution of etiology (motor vehicle accident (48), auto pedestrian (149). falls (36), assaults (12), other (11). Twenty-seven percent had abnormal computed tomography (CT) scans of the abdomen, and of that group, 75% had hematuria. The most common injuries associated with hematuria were those of the spleen (37%) and liver (33%). Renal injuries occurred in 26%. Asymptomatic hematuria was not associated with abdominal injury no matter what the degree of hematuria. This study clearly demonstrates that the child suffering from trauma with hematuria should not be evaluated with excretory urography, but rather by CT scan of the abdomen. This is because the injury profile of patients with hematuria is one of significant intraabdominal injury and not GU injury. The authors suggest that children be selected for CT evaluation if after stabilization (1) they are hemodynamically stable but abdominal injury is suspected; (2) there is multisystem injury with a difficult or impossible adequate abdominal examination (head trauma); (3) there is continued hypotension without obvious source of bleeding; or (4) hematuria. Asymptomatic children with hematuria were also studied, even if there were no other indications for abdominal CT. These data clearly show that those children who are asymptomatic will have negative CT studies. Three of 122 children with renal injuries did not have hematuria (2.4%). Hematuria with abdominal symptoms is a significant marker of injury to both the urinary and nonurinary organs in the pediatric patient with blunt abdominal trauma.-Edward G. Ford
(33%) of nine patients with bilateral undescended testes fathered children. Over-all sperm counts in 16 patients were low but were not predictive of paternity. Testicular biopsy specimens were reviewed and the fertility index was determined. In most cases a good correlation was found between histological status and paternity status.G. W. Holcomb, Jr Postnatal
Testicular
ism. D.S.
Huff, F. Hadziselimovic.
Maldevelopment
in Unilateral
H.M. Snyder.
Cryptorchid-
et al. J Urol
142:546-548, (August), 1989. Histomorphometric analysis of semithin sections was performed on testicular biopsies of 232 unilaterally cryptorchid testes and 195 of their contralateral descended partners. The results demonstrated a decreased number of germ cells detectable from the first year of life. There was delayed and defective transformation of gonocytes to Ad spermatogonia, which normally is complete at the age of 6 months, delayed or failed transformation of Ad spermatogonia to primary spermatocytes, which normally commences at aged 3 years, and decreased numbers of Leydig cells. These abnormalities were present in the unilaterally cryptorchid testes and their contralateral descended partners, but they were more severe, of earlier onset, and more progressive in the cryptorchid testes. These findings arecompatible with the hypothesis that hypogonadotropic hypogonadism is the cause of the increased incidence of infertility observed in unilateral cryptorchidism.-G. W. Holcomb. Jr Recovery of Testicular
Blood Flow Following Ligation of Testicular
Vessels. J.A. Pascual. J. Villanueva-Meyer,
E. Salido, et al. J Urol
142:549-552, (August), 1989. To determine whether initial ligation of the testicular vessels of the high undescended testis followed by a delayed secondary orchiopexy is a viable alternative to the classical Fowler-Stephens procedure, a series of preliminary experiments were conducted in the rat in which testicular blood flow was measured by the xenon washout technique before, and 1 hour, and 30 days after ligation of the vessels. In addition, testicular histology and testis and sex-accessory tissue weights were measured in six control, six sham-operated, and six testicular vessel ligated rats 54 days after vessel ligation. The data demonstrate that ligation and division of the testicular blood vessels produce an 80% decrease in testicular blood flow 1 hour after ligation of the vessels. However, 30 days later testis blood flow returns to the control and pretreatment value. There were no significant changes in testis or sex-accessory tissue weights 54 days after vessel ligation. Histologically, four of the surgically operated testes demonstrated necrosis of less than 25% of the seminiferous tubules, whereas one testis demonstrated more than 75% necrosis. The rest of the tubules in all six testes demonstrated normal spermatogenesis. From this study it is concluded that initial testicular vessel ligation produces an immediate decrease in testicular blood tlow. With time the collateral vessels are able to compensate and return the testis blood flow to its normal pretreatment value. These preliminary observations lend support for the concept that initial ligation of the testicular vessels followed by a delayed secondary orchiopexy in patients with a high undescended testis may be a possible alternative to the classical Fowler-Stephens approach.-G. W. Holcomb. Jr
GENITOURINARY TRACT Cryptorchidism, Retrospective
Orchiopexy Analysis.
and Infertility:
A Critical
Long-Term
M. Cendron. h4.A. Keating, D.S. Huff, et
Effects of External
lnguinoscrotal
Compression
on Descent
Testis in Bats. M. Luthra, J.U. Hutson, and F.D. Stephens.
of the
Pediatr
al. J Urol 142:559-562, (August), 1989.
Surg Int 4:403-407, (October), 1989.
The fertility of 40 patients who underwent orchiopexy between 1950 and 1960 was assessed. Testicular biopsies also had been performed at the time of surgery, a practice exceptional for the era. Of 23 patients with unilateral undescended testes who attempted to have children, 20 (87%) were successful. In contrast, only three
Intrauterine compression of the developing genitalia by the feet in early fetal development may be a cause of delayed descent of the testes. The purpose of the authors’ experiments on neonatal rats was to determine whether compression on the inguinoscrotum would impair testicular descent, which normally occurs during the first
573
ABSTRACTS
Total Colonic Aganglionosis: Treatment and Follow-Up. C. Festen,
R. Severijnen.
F.v.d. Stauk, et al. 2 Kinderchir 44: 153- 155, (June),
1989. Eleven cases of total colonic aganglionosis were reviewed. Better knowledge of the clinical picture and greater alertness for the occurrence of this disease has led to earlier diagnosis. Definitive operative treatment is still controversial. Following ileostomy, a crucial point seems to be the allowance of sufficient time for the small bowel to adapt its absorptive ability. The authors are of the opinion that little is to be gained by the application of a difficult procedure, such as Martin’s operation, which involves the risk of serious complications. Their experience confirms that a standard Hischsprung’s operation is, in general, satisfactory. At present (mean follow-up, 6.7 years) all patients show normal growth and development, have no serious perianal problems, and are, with one exception, continent for feces.-Thomas A. Angerpointner Causes of Late Complicntions in Children Operated on for Hirschsprung’s Disease: A Preliminary Immunohistochemical Investigation Using Polyclonal Antibodies Against S-100 Protein. K. Joosten,
M. Pruszczynski,
R.S. V.&f. Severijnen,
et al. Z Kinderchir 44:213-
215, (August), 1989. Late follow-up of 5 1 children operated on for the classical form of Hirschsprung’s disease showed a large number of unsatisfactory results. It is well known from the literature that achalasia of the anal sphincter is one of the most important causes. Twenty-five patients underwent redilatation of the anal sphincter. Complaints in the form of constipation or diarrhea remained in 40% of the cases secondary to redilatation. Reinvestigation of the resected colon specimens using the conventional histological method disclosed the presence of ganglion cells in the proximal resection area in all patients. In the light of reports in the literature stating that despite normal histology innervation disturbances can, nevertheless, occur in the colon, the authors performed a pilot study using polyclonal antibodies against the S-100 protein. In three of four patients who were adequately resected in the sense of conventional histology, clear innervation abnormalities could be found by means of polyclonal antibody staining. Three of those four patients presented with unsatisfactory late results. It remains unclear whether the abnormal S-100 staining is limited to one segment or extends over the whole colon. The question also remains as to whether maturation occurs so that some improvement may be expected on a long-term basis with increasing age.-Thomas
A. Angerpointner
Anorectal Malformations Associated With a Presacral Tumor and Sacral Defect. Y. Tsuchida,
W. Waianasupt,
and T. Nakajo.
Pedi-
atr Surg Int 4:398-402, (October), 1989. The triad of anorectal malformation, presacral mass, and sacral bony defect is quite rare. During the past 18 years, five patients with this triad were treated in the authors’ institutions. Four had covered anal or anorectal stenosis; one infant had anorectal agenesis. There was a central defect of the sacral bone in three and sacral hemivertebrae in two patients. An additional case that had an intact sacrum but was otherwise associated with the same anomalies is also reported. In the literature, the authors could find 51 cases (including five cases of their own) that fall under this symptom complex. All patients had a presacral tumor, the most common being teratomas and meningoceles (20 cases each). Anal or anorectal stenoses were most frequently encountered (46 cases), whereas malformations such as anorectal agenesis (3) or anorectal stenosis plus rectovaginal fistula (2) were noted less frequently. Therefore, the authors contend that the spectrum of this symptom complex is broader than was previously considered. Among these patients, constipation was the
most common presenting symptom. Barium enema and computed tomographic studies were helpful in identifying the presence, extent, and nature of the mass. The embryogenesis is discussed, reviewing the clinical and pathological characteristics of these patients.Prem Puri
ABDOMEN The Efficacy of Hepatoportoenterostomy in Biliary Atresia. J.L.
Grosfeld,
J.F. Fitzgerald,
R. Predaina, et al. Surgery 106:692-701,
(October), 1989. This series outlines the treatment and outcome of 66 infants with biliary atresia. Forty-eight of these patients underwent hepatoportoenterostomy (HPE) and four underwent hepatoportocholecystostomy. Twenty-five percent of these patients had successful HPE, with improvement in 19% and no improvement in 43%. The success was predicted by the time of operation with a 31% overall success for those patients who underwent surgery at less than, 90 days of age. A number of different procedures were utilized in this series, with a preference for the Suruga and Sawaguchi procedures. Stomas allowed for bile clearance studies determined by ostomy:serum ratios. These ratios were found to be good prognostic determinants when greater than 15 at 12 weeks postsurgery. Reoperation for complications was only successful in that group of patients who had an initial clearance of jaundice. The report continues to describe those patients who were referred for liver transplantation and highlights the “hidden mortality” of those patients that die on transplant waiting lists.-Tom Tracy. Jr Long-Term Follow-Up Study of Petients With Cholangitb After Successful Kasai Operation in Biliary Atresia: Selection of Recipients for Liver Transplantation. N. Ohkohchi, T. Chiba, R. Ohi, et al. J Pediatr Gastroenterol Nutr 9:416-420, (November), 1989.
This report of 131 patients from Sendai, Japan covers the time period from 1970 to 1987. In 39 of these patients, jaundice persisted after portoenterostomy, and there were no survivors in this group IO years after the operation. Of those patients without jaundice, 90% were alive after 10 years. Twenty patients died after initially successful portoenterostomy, but the records of nine were reviewed in order to evaluate clinical outcome following episodes of recurrent cholangitis. In those nine patients, when the total bilirubin concentration rose above 10 mg/dL, there was no benefit derived from conservative therapy that included antibiotics, steroids, and choleretic agents. Apart from serum bilirubin levels, there was no prognostic value for liver enzyme and coagulation parameters. From their review of this group of patients, the authors recommend early transplantation for those patients with persistent jaundice after attempted portoenterostomy. It also appears that bilirubin levels greater than 10 mg/dL during bouts of cholangitis are unresponsive to conservative medical treatment and are highly predictive of impending hepatic failure or gastrointestinal bleeding and death within the year. Therefore, these patients should be prepared for liver transplantationTom Tracy, Jr Peritoneal
Dialysis for
Hemolytic-Uremic
Svndrome
in Post-
operative Peritonitis Following Ileocecal Resectien for Intussusception. C. Deindl. R. Eife. and H.-G. Dietz.
Z Kinderchir 44: 169- 171,
(June), 1989. The case of a 3-year-old girl who underwent laparotomy for ileocecal intussusception is reported. Immediately following laparotomy, she developed a hemolyticuremic syndrome with hemolytic anemia, thrombocytopenia, increased serum urea and creatine levels, and anuria. She also developed a subsequent peritonitis, enterocolitis, and sepsis. Following relaparotomy with establishment of an
574
INTERNATIONAL ABSTRACTS
ileostomy, peritoneal dialysis was performed over several days for treatment of the hemolyticuremic syndrome. This case demonstrates that peritoneal dialysis can be performed effectively despite fresh intraabdominal irritation and that simultaneous peritonitis can be managed by intraperitoneal administration of antibiotics via dialysis catheter. Following closure of the ileostomy 4 weeks later, the girl was discharged from the hospital on her 10th postoperative day in good condition--Thomas A. Angerpoinrner Acute Abdomen Due to Paraduodenal Hernia. H. Stallinger, Kees. andP. Wurnig. Z Kinderchir 44:164-165, (June), 1989.
A.
Internal hernias are rarely diagnosed. They are mostly found at laparotomy when complications and their symptoms (eg, palpable mass, abdominal pain, vomiting, and ileus) require surgical treatment. A case of an 1 l-year-old boy who was hospitalized for abdominal pain is presented. Appendicectomy resulted in only temporary pain relief. Subsequent laparotomy showed a left-sided paraduodenal hernia. Postoperative course was uneventful. Paraducdenal hernias, first described by Neubauer in 1786, result from a disturbed bowel rotation.-Thomas A. Angerpointner Hematuris: Trauma.
A Marker
of Abdominal
Injury in Children
G.A. Taylor, M.R. Eichelberger,
After
Blunt
and B.M. Potter. Ann
Surg 208:688-693, (December), 1988. Hematuria was evaluated in 378 consecutive children by the trauma service of Childrens’ Hospital National Medical Center to establish a marker of abdominal injury in children. Average age was 7.6 years (range, 1 month to 18 years) with a typical distribution of etiology (motor vehicle accident (48), auto pedestrian (149). falls (36), assaults (12), other (11). Twenty-seven percent had abnormal computed tomography (CT) scans of the abdomen, and of that group, 75% had hematuria. The most common injuries associated with hematuria were those of the spleen (37%) and liver (33%). Renal injuries occurred in 26%. Asymptomatic hematuria was not associated with abdominal injury no matter what the degree of hematuria. This study clearly demonstrates that the child suffering from trauma with hematuria should not be evaluated with excretory urography, but rather by CT scan of the abdomen. This is because the injury profile of patients with hematuria is one of significant intraabdominal injury and not GU injury. The authors suggest that children be selected for CT evaluation if after stabilization (1) they are hemodynamically stable but abdominal injury is suspected; (2) there is multisystem injury with a difficult or impossible adequate abdominal examination (head trauma); (3) there is continued hypotension without obvious source of bleeding; or (4) hematuria. Asymptomatic children with hematuria were also studied, even if there were no other indications for abdominal CT. These data clearly show that those children who are asymptomatic will have negative CT studies. Three of 122 children with renal injuries did not have hematuria (2.4%). Hematuria with abdominal symptoms is a significant marker of injury to both the urinary and nonurinary organs in the pediatric patient with blunt abdominal trauma.-Edward G. Ford
(33%) of nine patients with bilateral undescended testes fathered children. Over-all sperm counts in 16 patients were low but were not predictive of paternity. Testicular biopsy specimens were reviewed and the fertility index was determined. In most cases a good correlation was found between histological status and paternity status.G. W. Holcomb, Jr Postnatal
Testicular
ism. D.S.
Huff, F. Hadziselimovic.
Maldevelopment
in Unilateral
H.M. Snyder.
Cryptorchid-
et al. J Urol
142:546-548, (August), 1989. Histomorphometric analysis of semithin sections was performed on testicular biopsies of 232 unilaterally cryptorchid testes and 195 of their contralateral descended partners. The results demonstrated a decreased number of germ cells detectable from the first year of life. There was delayed and defective transformation of gonocytes to Ad spermatogonia, which normally is complete at the age of 6 months, delayed or failed transformation of Ad spermatogonia to primary spermatocytes, which normally commences at aged 3 years, and decreased numbers of Leydig cells. These abnormalities were present in the unilaterally cryptorchid testes and their contralateral descended partners, but they were more severe, of earlier onset, and more progressive in the cryptorchid testes. These findings arecompatible with the hypothesis that hypogonadotropic hypogonadism is the cause of the increased incidence of infertility observed in unilateral cryptorchidism.-G. W. Holcomb. Jr Recovery of Testicular
Blood Flow Following Ligation of Testicular
Vessels. J.A. Pascual. J. Villanueva-Meyer,
E. Salido, et al. J Urol
142:549-552, (August), 1989. To determine whether initial ligation of the testicular vessels of the high undescended testis followed by a delayed secondary orchiopexy is a viable alternative to the classical Fowler-Stephens procedure, a series of preliminary experiments were conducted in the rat in which testicular blood flow was measured by the xenon washout technique before, and 1 hour, and 30 days after ligation of the vessels. In addition, testicular histology and testis and sex-accessory tissue weights were measured in six control, six sham-operated, and six testicular vessel ligated rats 54 days after vessel ligation. The data demonstrate that ligation and division of the testicular blood vessels produce an 80% decrease in testicular blood flow 1 hour after ligation of the vessels. However, 30 days later testis blood flow returns to the control and pretreatment value. There were no significant changes in testis or sex-accessory tissue weights 54 days after vessel ligation. Histologically, four of the surgically operated testes demonstrated necrosis of less than 25% of the seminiferous tubules, whereas one testis demonstrated more than 75% necrosis. The rest of the tubules in all six testes demonstrated normal spermatogenesis. From this study it is concluded that initial testicular vessel ligation produces an immediate decrease in testicular blood tlow. With time the collateral vessels are able to compensate and return the testis blood flow to its normal pretreatment value. These preliminary observations lend support for the concept that initial ligation of the testicular vessels followed by a delayed secondary orchiopexy in patients with a high undescended testis may be a possible alternative to the classical Fowler-Stephens approach.-G. W. Holcomb. Jr
GENITOURINARY TRACT Cryptorchidism, Retrospective
Orchiopexy Analysis.
and Infertility:
A Critical
Long-Term
M. Cendron. h4.A. Keating, D.S. Huff, et
Effects of External
lnguinoscrotal
Compression
on Descent
Testis in Bats. M. Luthra, J.U. Hutson, and F.D. Stephens.
of the
Pediatr
al. J Urol 142:559-562, (August), 1989.
Surg Int 4:403-407, (October), 1989.
The fertility of 40 patients who underwent orchiopexy between 1950 and 1960 was assessed. Testicular biopsies also had been performed at the time of surgery, a practice exceptional for the era. Of 23 patients with unilateral undescended testes who attempted to have children, 20 (87%) were successful. In contrast, only three
Intrauterine compression of the developing genitalia by the feet in early fetal development may be a cause of delayed descent of the testes. The purpose of the authors’ experiments on neonatal rats was to determine whether compression on the inguinoscrotum would impair testicular descent, which normally occurs during the first