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Bilateral neonatal torsion
INTERNATIONAL ABSTRACTS
in 119 (77%), stab wounds in 30 (19%), and blunt injury in five (3%), were evaluated. The overall mortality rate was 46%; 100% for blunt injury, 49% for gun shot wounds, and 23% for stab wounds. Injuries to the inferior vena cava occurred in 56 (59%) mortality), iliac vein in 16 (65% mortality), aorta 22 (68% mortality), iliac artery 21 (57% mortality), and superior mesenteric artery 12 (67% mortality). Of the 84 patients who presented to the emergency room with BP <70 mm Hg, 60 (71%) died. Of the 42 with shock for more than 30 minutes, 38 (90%) died, Of the 93 patients who received > 10 units of blood, 60 (64%) died. Of the 60 patients presenting to the OR with a BP of <70 mm Hg, 52 (87%) died. Prelaparotomy cross clamping of the thoracic aorta was performed in 26 patients; 12 responded with a sustained increase in BP with five survivors (42%). Of the 14 nonresponders, none survived. Of the 17 patients with persistent shock without prelaparotomy thoracotomy, only one (6%) survived. In the high risk group (admission systolic BP <70 mm Hg and four or more associated injuries), if shock was kept to <30 minutes and bleeding to 10 units or blood or less, the mortality was reduced from 92% (24/26) to 0% (0/12). The researchers feel that in those patients presenting to the OR with a BP <70 mm/Hg, in spite of continuing volume resuscitation, a prelaparotomy cross clamping of the aorta should be considered, and when there is no response, further surgical efforts should probably be a b a n d o n e d . Eugene S. Wiener Analysis of Hyperamylasemia in Patients With Severe Head Injury.
G.C, Vitale, G.M. Larson, P.R. Davidson, et al. J Surg Res 43:226-233, (September), 1987. Amylase isoenzyme profiles were studied for 14 days post-injury in 60 patients with severe central nervous system trauma and in 14 multiple-trauma patients without head injury. The patients with severe head injury had a Glascow Coma Scale score <10 and had no abdominal trauma. The control multiple-trauma group had patients with no head injuries and no abdominal trauma. Total serum amylase, pancreatic amylase, and nonpancreatic amylase were elevated in both groups of patients and were slightly higher in those patients with head injury. Thirty-eight percent of the patients with head trauma developed hyperamylasemia, which was predominantly pancreatic amylase as opposed to nonpancreatic (salivary, prostate, breast, lung, liver, fallopian tube, ovary, and endometrium) amylase. The presence or absence of shock had no impact on the incidence of hyperamylasemia in this study. In addition, the type of brain injury did not correlate with the amylase profile. The authors conclude that hyperamylasemia is a nonspecific response to severe head injury and multiple trauma which is not dependent on a specific injury site or type of injury. Thus, serum amylase is not a reliable index of pancreatic injury in patients with multiple trauma or with severe injury.--Richard R. Ricketts GENITOURINARY TRACT Congenital Penile Angulation. J. Ennehoj and P. Metz. Br J Urol
60:264-266, (September), 1987. Congenital penile angulation without epispadias and hypospadias is more frequent than previously believed, and the prevalence seems to be >0.4/1,000. The malformation, which may threaten the sex life of young patients, can be corrected by a simple out-patient operation.--Prem Puri Congenital Penile Deviation and its Treatment With the NesbitKelami Technique. A. Kelami. Br J Urol 60:261-263, (September),
1987. Ten years of experience in the treatment of 100 cases of congenital penile deviation using the Nesbit-Kelami technique showed excel-
683
lent results in 96 patients, all of whom had a straight penis with full ability to penetrate. Only four patients wished to have a "straighter" penis, although penetration was possible.--Prem Puri Bilateral Neonatal Torsion. M. LaQuaglia, S. Bauer, A. Eraklis, et al. J Urol 138:1051-1054, (October), 1987.
Extravaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Bilateral neonatal torsion is even more uncommon. Only one previous case of asynchronous neonatal torsion has been reported. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not at risk for torsion. Four consecutive cases of bilateral neonatal torsion seen between 1966 and 1986 are reported. Two cases were asynchronous, one of which with a previously normal-appearing contralateral gonad which was rendered anorchid. In the other patient, a testicle was salvaged by prompt intervention. A policy of prompt exploration with contralateral orchiopexy has been adopted in all cases of unilateral neonatal torsion. Treatment of the ipsilateral testicle is determined by operative findings.--George Holcomb, Jr Testlcular Torsion After Previous Orchidopexy. D.A. Steinbruchel
and M.K. Hanson. Br J Surg 75:47, (January), 1988. Two cases of testicular torsion where orchidopexy had previously been performed for nondescended testis are reported. The investigators conclude that previous testicular surgery does not always guarantee permanent fixation of the testis. If torsion is suspected clinically, scrotal exploration is mandatory, regardless of past history of surgery. Fixation following torsion is achieved by allowing adhesions to form between the tunica albuginea and the scrotal wall, and through the use of nonabsorbable suture material.--John D. Orr Technique of Testicular Fixation for Torsion of the Testis. F.C.
Hamdy and A.E. MacKinnon. Br J Surg 74:1174, (December), 1987. The investigators describe a simple method of testicular fixation through a single transverse scrotal incision. The tunica vaginalis is incised and the testis untwisted. Fixation is then performed with 3-0 silk or Vicryl sutures placed through the tunica albuginea and the median septum bilaterally.--John D. Orr Long-Term Effect of Luteinizing Hormone-Releasing Hormone Analogue (Buserelin) on Cryptorchid Testes. F. Hadziselimovic, D.
Huff, J. Duckett, et al. J Urol 138:1043-1045, (October), 1987. A study of 48 prepubertal boys with cryptochidism between 1 year 3 months and 11 years of age who were treated with buserelin every other day for 6 months is reported. Urinary lutenizing and folliclestimulating hormones, and testosterone remained unchanged during the entire treatment period. In boys >7 years of age, a slight but significant increase in testosterone was noted in the first morning voided urine at the end of treatment. Testicular biopsies were obtained at orchiopexy in all patients in whom testicular descent was not complete (83%). A significant increase in the number of germ cells was observed in patients with unilateral and bilateral cryptorchidism, indicating that 6 months of buserelin therapy improved the fertility status even when testes were in an undescended position during treatment. Until further controlled studies have proved these findings, treatment with buserelin should be given only after orchiopexy in those boys whose germ cell number is lower than 0,1 germ cell per tubular cross section, and should not be used to induce testicular descent.--George Holcomb, Jr
in 119 (77%), stab wounds in 30 (19%), and blunt injury in five (3%), were evaluated. The overall mortality rate was 46%; 100% for blunt injury, 49% for gun shot wounds, and 23% for stab wounds. Injuries to the inferior vena cava occurred in 56 (59%) mortality), iliac vein in 16 (65% mortality), aorta 22 (68% mortality), iliac artery 21 (57% mortality), and superior mesenteric artery 12 (67% mortality). Of the 84 patients who presented to the emergency room with BP <70 mm Hg, 60 (71%) died. Of the 42 with shock for more than 30 minutes, 38 (90%) died, Of the 93 patients who received > 10 units of blood, 60 (64%) died. Of the 60 patients presenting to the OR with a BP of <70 mm Hg, 52 (87%) died. Prelaparotomy cross clamping of the thoracic aorta was performed in 26 patients; 12 responded with a sustained increase in BP with five survivors (42%). Of the 14 nonresponders, none survived. Of the 17 patients with persistent shock without prelaparotomy thoracotomy, only one (6%) survived. In the high risk group (admission systolic BP <70 mm Hg and four or more associated injuries), if shock was kept to <30 minutes and bleeding to 10 units or blood or less, the mortality was reduced from 92% (24/26) to 0% (0/12). The researchers feel that in those patients presenting to the OR with a BP <70 mm/Hg, in spite of continuing volume resuscitation, a prelaparotomy cross clamping of the aorta should be considered, and when there is no response, further surgical efforts should probably be a b a n d o n e d . Eugene S. Wiener Analysis of Hyperamylasemia in Patients With Severe Head Injury.
G.C, Vitale, G.M. Larson, P.R. Davidson, et al. J Surg Res 43:226-233, (September), 1987. Amylase isoenzyme profiles were studied for 14 days post-injury in 60 patients with severe central nervous system trauma and in 14 multiple-trauma patients without head injury. The patients with severe head injury had a Glascow Coma Scale score <10 and had no abdominal trauma. The control multiple-trauma group had patients with no head injuries and no abdominal trauma. Total serum amylase, pancreatic amylase, and nonpancreatic amylase were elevated in both groups of patients and were slightly higher in those patients with head injury. Thirty-eight percent of the patients with head trauma developed hyperamylasemia, which was predominantly pancreatic amylase as opposed to nonpancreatic (salivary, prostate, breast, lung, liver, fallopian tube, ovary, and endometrium) amylase. The presence or absence of shock had no impact on the incidence of hyperamylasemia in this study. In addition, the type of brain injury did not correlate with the amylase profile. The authors conclude that hyperamylasemia is a nonspecific response to severe head injury and multiple trauma which is not dependent on a specific injury site or type of injury. Thus, serum amylase is not a reliable index of pancreatic injury in patients with multiple trauma or with severe injury.--Richard R. Ricketts GENITOURINARY TRACT Congenital Penile Angulation. J. Ennehoj and P. Metz. Br J Urol
60:264-266, (September), 1987. Congenital penile angulation without epispadias and hypospadias is more frequent than previously believed, and the prevalence seems to be >0.4/1,000. The malformation, which may threaten the sex life of young patients, can be corrected by a simple out-patient operation.--Prem Puri Congenital Penile Deviation and its Treatment With the NesbitKelami Technique. A. Kelami. Br J Urol 60:261-263, (September),
1987. Ten years of experience in the treatment of 100 cases of congenital penile deviation using the Nesbit-Kelami technique showed excel-
683
lent results in 96 patients, all of whom had a straight penis with full ability to penetrate. Only four patients wished to have a "straighter" penis, although penetration was possible.--Prem Puri Bilateral Neonatal Torsion. M. LaQuaglia, S. Bauer, A. Eraklis, et al. J Urol 138:1051-1054, (October), 1987.
Extravaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Bilateral neonatal torsion is even more uncommon. Only one previous case of asynchronous neonatal torsion has been reported. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not at risk for torsion. Four consecutive cases of bilateral neonatal torsion seen between 1966 and 1986 are reported. Two cases were asynchronous, one of which with a previously normal-appearing contralateral gonad which was rendered anorchid. In the other patient, a testicle was salvaged by prompt intervention. A policy of prompt exploration with contralateral orchiopexy has been adopted in all cases of unilateral neonatal torsion. Treatment of the ipsilateral testicle is determined by operative findings.--George Holcomb, Jr Testlcular Torsion After Previous Orchidopexy. D.A. Steinbruchel
and M.K. Hanson. Br J Surg 75:47, (January), 1988. Two cases of testicular torsion where orchidopexy had previously been performed for nondescended testis are reported. The investigators conclude that previous testicular surgery does not always guarantee permanent fixation of the testis. If torsion is suspected clinically, scrotal exploration is mandatory, regardless of past history of surgery. Fixation following torsion is achieved by allowing adhesions to form between the tunica albuginea and the scrotal wall, and through the use of nonabsorbable suture material.--John D. Orr Technique of Testicular Fixation for Torsion of the Testis. F.C.
Hamdy and A.E. MacKinnon. Br J Surg 74:1174, (December), 1987. The investigators describe a simple method of testicular fixation through a single transverse scrotal incision. The tunica vaginalis is incised and the testis untwisted. Fixation is then performed with 3-0 silk or Vicryl sutures placed through the tunica albuginea and the median septum bilaterally.--John D. Orr Long-Term Effect of Luteinizing Hormone-Releasing Hormone Analogue (Buserelin) on Cryptorchid Testes. F. Hadziselimovic, D.
Huff, J. Duckett, et al. J Urol 138:1043-1045, (October), 1987. A study of 48 prepubertal boys with cryptochidism between 1 year 3 months and 11 years of age who were treated with buserelin every other day for 6 months is reported. Urinary lutenizing and folliclestimulating hormones, and testosterone remained unchanged during the entire treatment period. In boys >7 years of age, a slight but significant increase in testosterone was noted in the first morning voided urine at the end of treatment. Testicular biopsies were obtained at orchiopexy in all patients in whom testicular descent was not complete (83%). A significant increase in the number of germ cells was observed in patients with unilateral and bilateral cryptorchidism, indicating that 6 months of buserelin therapy improved the fertility status even when testes were in an undescended position during treatment. Until further controlled studies have proved these findings, treatment with buserelin should be given only after orchiopexy in those boys whose germ cell number is lower than 0,1 germ cell per tubular cross section, and should not be used to induce testicular descent.--George Holcomb, Jr