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Morphologic Effects of Unilateral Cryptorchidism on the Contralateral Descended Testis
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PEDIATRIC UROLOGY
lized. The factors responsible for these 3 phases of renal function remain to be elucidated. 3 figures, 3 tables, 23 references Robert Kay, M.D. Cleveland, Ohio
Bladder Fungus Ball: A Reversible Cause of Neonatal Obstructive Uropathy L. KUMAR, Case Western Reserve University, and Departments of Pediatrics and Radiology, Cleveland Metropolitan General Hospital, Cleveland, Ohio Pediatrics, 81: 826-829 (June) 1988 Low birth weight infants less than 1,500 gm. are at high risk for invasive candidiasis. The genitourinary system usually is involved either as part of a rnultiorgan infection or as a single focus. Before this report all cases have involved a kidney with either microabscesses, or obstruction of 1 or both ureteropelvic junctions by debris or fungus balls. Although bladder fungus balls have been reported as a cause of obstruction in adults, this report describes a neonatal obstructive uropathic condition by a bladder fungus ball. A 1,000 gm. male infant had multiple organ candidiasis and subsequent uropathic conditions. Ultrasonography confirmed an echogenic mass. Bladder irrigation with amphotericin B was begun and within 48 hours the fungus ball had dissolved with complete resolution of the bilateral hydronephrosis. The patient was treated systemically with amphotericin B and 5flurocytosine. Recovery was complete. A review of the literature produced 18 cases of neonatal renal candidiasis with 11 having obstructing renal fungus balls. Mortality was 23.5 per cent in the over-all group. 4 figures, 1 table, 16 references Robert Kay, M.D. Cleveland, Ohio B. BAERTZ-GREENWALT, B. DEBAZ AND M.
Morphologic Effects of Unilateral Cryptorchidism on the Contralateral Descended Testis
F. T. SALMAN, E. S. ADKINS AND E.W. FONKALSRUD, Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, California J. Ped. Surg., 23: 439-443 (May) 1988 Unilateral cryptorchidism frequently is accompanied by infertility. Uncertainty exists as to whether the infertility is a genetic effect or is related to an autoimmune reaction to the elevated testis. The effects of unilateral cryptorchidism were evaluated in 50 mice by surgically elevating the left testicle of 21-day-old mice into the abdomen (group 1). A sham operation was performed on the left testicle of 50 control mice (group 2). The temperature of the abdominal testes measured 2.5C higher than the scrotal testes. The testes were removed from both sides at 1, 2, 3, 4 and 6 weeks postoperatively. After testicular weights were recorded, seminiferous tubule diameters were measured and germinal epithelium maturity was graded histologically with a modified Johnson testicular biopsy score. Progressive abnormal changes were seen in the contralateral descended testicles of group 1 compared to group 2. By 3 weeks, although testicular weight changes were similar mean seminiferous tubule diameter was smaller (p < 0.001) and the germinal epithelium was less mature (p < 0.001). These changes persisted
through week 6. By changing the physiological environment of 1 testicle we have induced alterations in the histological appearance of the contralateral testicle during the period of normal maturation. Authors' abstract 6 figures, 1 table, 22 references
Editorial comment. This interesting study clearly shows that producing artificial unilateral cryptorchidism in mice results in a measurable decrease in fertility in the contralateral, always normally descended testis. Many children with only unilateral cryptorchidism have a decrease in germ cells in the contralateral, always descended testis but it is by no means clear that this is an immunologically moderated effect in the human. Generally, patients who undergo torsion do not have the onset of abnormalities in the contralateral testis as do many common laboratory animals. It seems as likely that the abnormal conditions in the descended testis opposite a cryptorchid testis in the human are the result of bilateral end organ abnormalities. Lowell R. King, M.D. Durham, North Carolina
Crossed Testicular Ectopia With Bilateral Duplication of the Vasa Deferentia: An Unusual Finding in Cryptorchidism F. TOLETE-VELCEK, M. 0. BERNSTEIN AND F. HANSBROUGH,
Department of Surgery, Division of Pediatric Surgery, Health Science Center at Brooklyn, State University of New York, Kings County Hospital Center, Brooklyn, New York J. Ped. Surg., 23: 641-643 (July) 1988 A rare case of crossed testicular ectopia with bilateral duplication of the vas deferens is reported. The patient had bilateral cryptorchidism and at presentation there was a palpable left testis in the groin and an impalpable right testis. The authors discovered the anatomy at exploration for bilateral cryptorchidism. Repair was successful by bringing both testes down on the same side and using a trans-septal incision to separate the testis in each hemiscrotum. 3 figures, 20 references Robert Kay, M.D. Cleveland, Ohio
Prognostic Factors in 281 Children With Nonmetastatic Rhabdomyosarcoma (RMS) at Diagnosis C.
E. QUINTANA, M. P. A. VOUTE, Gustave Roussy Institute, Villejuif, Children's Hospital, Nancy, Curie Institute, Paris and Leon Berard Center, Lyon, France; Saint Pierre Hospital, Brussels, Belgium; Emma Kinderziekenhuis Hospital, Amsterdam, Holland and R.M.S. Committee of the International Society of Pediatric Oncology RODARY, A. REY, D. OLIVE, F. FLAMANT, BRUNAT-MENTIGNY, J. OTTEN AND
Med. Ped. Oncol., 16: 71-77, 1988 To evaluate potentially important prognostic factors in rhabdomyosarcoma in children, a common protocol was used by 30 European centers. A total of 281 patients less than 16 years old was available for study with followup ranging from 3.5 to 12 years. Seven variables (sex, age, stage, primary site, regional lymph node involvement, histology and cytology) were studied for their effect upon survival and interval free of disease. Analysis revealed that primary site, clinical stage and sex in decreasing order were the most prognostically important fac-
PEDIATRIC UROLOGY
lized. The factors responsible for these 3 phases of renal function remain to be elucidated. 3 figures, 3 tables, 23 references Robert Kay, M.D. Cleveland, Ohio
Bladder Fungus Ball: A Reversible Cause of Neonatal Obstructive Uropathy L. KUMAR, Case Western Reserve University, and Departments of Pediatrics and Radiology, Cleveland Metropolitan General Hospital, Cleveland, Ohio Pediatrics, 81: 826-829 (June) 1988 Low birth weight infants less than 1,500 gm. are at high risk for invasive candidiasis. The genitourinary system usually is involved either as part of a rnultiorgan infection or as a single focus. Before this report all cases have involved a kidney with either microabscesses, or obstruction of 1 or both ureteropelvic junctions by debris or fungus balls. Although bladder fungus balls have been reported as a cause of obstruction in adults, this report describes a neonatal obstructive uropathic condition by a bladder fungus ball. A 1,000 gm. male infant had multiple organ candidiasis and subsequent uropathic conditions. Ultrasonography confirmed an echogenic mass. Bladder irrigation with amphotericin B was begun and within 48 hours the fungus ball had dissolved with complete resolution of the bilateral hydronephrosis. The patient was treated systemically with amphotericin B and 5flurocytosine. Recovery was complete. A review of the literature produced 18 cases of neonatal renal candidiasis with 11 having obstructing renal fungus balls. Mortality was 23.5 per cent in the over-all group. 4 figures, 1 table, 16 references Robert Kay, M.D. Cleveland, Ohio B. BAERTZ-GREENWALT, B. DEBAZ AND M.
Morphologic Effects of Unilateral Cryptorchidism on the Contralateral Descended Testis
F. T. SALMAN, E. S. ADKINS AND E.W. FONKALSRUD, Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, California J. Ped. Surg., 23: 439-443 (May) 1988 Unilateral cryptorchidism frequently is accompanied by infertility. Uncertainty exists as to whether the infertility is a genetic effect or is related to an autoimmune reaction to the elevated testis. The effects of unilateral cryptorchidism were evaluated in 50 mice by surgically elevating the left testicle of 21-day-old mice into the abdomen (group 1). A sham operation was performed on the left testicle of 50 control mice (group 2). The temperature of the abdominal testes measured 2.5C higher than the scrotal testes. The testes were removed from both sides at 1, 2, 3, 4 and 6 weeks postoperatively. After testicular weights were recorded, seminiferous tubule diameters were measured and germinal epithelium maturity was graded histologically with a modified Johnson testicular biopsy score. Progressive abnormal changes were seen in the contralateral descended testicles of group 1 compared to group 2. By 3 weeks, although testicular weight changes were similar mean seminiferous tubule diameter was smaller (p < 0.001) and the germinal epithelium was less mature (p < 0.001). These changes persisted
through week 6. By changing the physiological environment of 1 testicle we have induced alterations in the histological appearance of the contralateral testicle during the period of normal maturation. Authors' abstract 6 figures, 1 table, 22 references
Editorial comment. This interesting study clearly shows that producing artificial unilateral cryptorchidism in mice results in a measurable decrease in fertility in the contralateral, always normally descended testis. Many children with only unilateral cryptorchidism have a decrease in germ cells in the contralateral, always descended testis but it is by no means clear that this is an immunologically moderated effect in the human. Generally, patients who undergo torsion do not have the onset of abnormalities in the contralateral testis as do many common laboratory animals. It seems as likely that the abnormal conditions in the descended testis opposite a cryptorchid testis in the human are the result of bilateral end organ abnormalities. Lowell R. King, M.D. Durham, North Carolina
Crossed Testicular Ectopia With Bilateral Duplication of the Vasa Deferentia: An Unusual Finding in Cryptorchidism F. TOLETE-VELCEK, M. 0. BERNSTEIN AND F. HANSBROUGH,
Department of Surgery, Division of Pediatric Surgery, Health Science Center at Brooklyn, State University of New York, Kings County Hospital Center, Brooklyn, New York J. Ped. Surg., 23: 641-643 (July) 1988 A rare case of crossed testicular ectopia with bilateral duplication of the vas deferens is reported. The patient had bilateral cryptorchidism and at presentation there was a palpable left testis in the groin and an impalpable right testis. The authors discovered the anatomy at exploration for bilateral cryptorchidism. Repair was successful by bringing both testes down on the same side and using a trans-septal incision to separate the testis in each hemiscrotum. 3 figures, 20 references Robert Kay, M.D. Cleveland, Ohio
Prognostic Factors in 281 Children With Nonmetastatic Rhabdomyosarcoma (RMS) at Diagnosis C.
E. QUINTANA, M. P. A. VOUTE, Gustave Roussy Institute, Villejuif, Children's Hospital, Nancy, Curie Institute, Paris and Leon Berard Center, Lyon, France; Saint Pierre Hospital, Brussels, Belgium; Emma Kinderziekenhuis Hospital, Amsterdam, Holland and R.M.S. Committee of the International Society of Pediatric Oncology RODARY, A. REY, D. OLIVE, F. FLAMANT, BRUNAT-MENTIGNY, J. OTTEN AND
Med. Ped. Oncol., 16: 71-77, 1988 To evaluate potentially important prognostic factors in rhabdomyosarcoma in children, a common protocol was used by 30 European centers. A total of 281 patients less than 16 years old was available for study with followup ranging from 3.5 to 12 years. Seven variables (sex, age, stage, primary site, regional lymph node involvement, histology and cytology) were studied for their effect upon survival and interval free of disease. Analysis revealed that primary site, clinical stage and sex in decreasing order were the most prognostically important fac-