Management of the undescended testis

Surgical correction of the undescended testis is frequently postponed beyond the optimal time, namely, 6 years of age.An accurate diagnosis of undescended testis may be made during the first year of life. Complications and mistakes arising from misdiagnosis of undescended testis and retracted testis may, therefore, be prevented by recording findings.The purpose of this article is to present the arguments in favour of early diagnosis and operative treatment of undescended testis, and to correct possible misconceptions.     

Testosterone reserve capacity in prepubertal and juvenile testes after sugery for undescended testis]

Tests testosterone reserve capacity of 6--15 year-old boys was estimated after operative correction of testicular maldescensus by a maximal stimulation test. Subnormal plasma testosterone levels were found in only 2 out of 14 patients with bilateral and 4 with unilateral orchidopexy. Prepubertal boys with unilateral anorchia had normal basal testosterone values and a normal testosterone rise after stimulation. In prepubertal boys with bilateral testes atrophy there was observed a diminished rise after stimulation. The basal testosterone levels were normal. The testosterone basal levels of pubertal boys with unilateral anorchia or bilateral atrophy were subnormal and the stimuation of testosterone production was reduced. The testicular volume of patients without atrophy or anorchia after orchidopexy was normal in prepuberty. During puberta a progressive relative decrease of the testicular volume was observed as compared to normal development. In conclusion, the results demonstrate that the endocrine function in most patients with unilateral or bilateral orchidopexy is in the normal range--a regular puberty can be expected.     

Treatment of an undescended testis with human chorionic gonadotropin (HCG)

Seventy one patients with ectopic testis of age between 2 and 11.5 years were treated with human chorionic gonadotropin (HCG) at doses recommended by the International Health Foundation. The descent of testis to the scrotum was achieved in almost half of the treated boys (49.3%). The descent was successful mainly in cases of lower inguinal position of the undescended testicle, and only rarely when the testicle was situated higher. The descent was never successful in cases when the scrotum was small and underdeveloped.     

Clinical, hormonal and semiological data in adult men operated in childhood for hypospadias

Examination of 16 adult men operated in childhood for hypospadias revealed signs of moderate injury of the male genital system. It appears that accessory sexual glands were mainly responsible for the observed abnormalities. Since testicular position and size, serum testosterone and FSH levels were normal it seems that hypospadias and the accompanied disturbances are connected with reduction of responsiveness of target tissues to androgen stimuli rather, than with lesion of the testicle. The coexistence of normal serum testosterone and elevation of serum LH suggests the decrease of sensitivity of hypothalamic or pituitary receptors to negative feedback influence of androgens. The consciousness of sexual inadequacy noted in some cases was mainly of emotional character.     

Extreme skewing of X chromosome inactivation in mothers of homosexual men

Human sexual preference is a sexually dimorphic trait with a substantial genetic component. Linkage of male sexual orientation to markers on the X chromosome has been reported in some families. Here, we measured X chromosome inactivation ratios in 97 mothers of homosexual men and 103 age-matched control women without gay sons. The number of women with extreme skewing of X-inactivation was significantly higher in mothers of gay men (13/97=13%) compared to controls (4/103=4%) and increased in mothers with two or more gay sons (10/44=23%). Our findings support a role for the X chromosome in regulating sexual orientation in a subgroup of gay men.     

阑尾炎术后医院感染危险因素分析

目的探讨阑尾炎术后医院感染情况及其主要危险因素。方法对普外科和肝胆外科在2005年1月1日至2007年1月1日之间的386例阑尾炎患者进行回顾性调查分析。结果被研究的病例中有28例发生院感（院感率为7.25%）,急性单纯性阑尾炎197例有3例发生院感,院感率为1.50%,化脓性阑尾炎189例中有25例发生医院感染,感染率为13.23%。发生院感的病例中,切口感染有12例,占42.85%,其余为上呼吸道感染（1例）、皮肤与软组织感染（1例）、其他感染（14例）。结论两种阑尾炎的院感率差异有显著性。引起阑尾炎院感的危险因素是抗生素使用时间过久和种类过多。     

Prostate cancer risk in testosterone-treated men

Men with classical androgen deficiency have reduced prostate volume and blood prostate-specific antigen (PSA) levels compared with their age peers. As it is plausible that androgen deficiency partially protects against prostate disease, and that restoring androgen exposure increases risk to that of eugonadal men of the same age, men using ART should have age-appropriate surveillance for prostate disease. This should comprise rectal examination and blood PSA measurement at regular intervals (determined by age and family history) according to the recommendations, permanently revisited, published by ISSAM, EAU, Endocrine Society….

Testosterone replacement therapy is now being prescribed more often for aging men, the same population in which prostate cancer incidence increases; it has been suggested that administration in men with unrecognised prostate cancer might promote the development of clinically significant disease. In hypogonadal men who were candidates for testosterone therapy, a 14% incidence of occult cancer was found. A percentage (15.2%) of prostate cancer has been found in the placebo group (with normal DRE and PSA) in the prostate cancer prevention study investigating the chemoprevention potential of finasteride.

The hypothesis that high levels of circulating androgens is a risk factor for prostate cancer is supported by the dramatic regression, after castration, of tumour symptoms in men with advanced prostate cancer. However these effects, seen at a very late stage of cancer development, may not be relevant to reflect the effects of variations within a physiological range at an earlier stage.

Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer. A study on a large prospective cohort of 10,049 men, contributes to the gathering evidence that the long standing “androgen hypothesis” of increasing risk with increasing androgen levels can be rejected, suggesting instead that high levels within the reference range of androgens, estrogens and adrenal androgens decrease aggressive prostate cancer risk. Indeed, high-grade prostate cancer has been associated with low plasma level of testosterone. Furthermore, pre-treatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer; as testosterone decreases, patients have an increased likelihood of non-organ confined disease and low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy.

A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations (patch or gel) that achieve physiological testosterone serum levels without supra physiological escape levels. During the clinical development of a new testosterone patch in more than 200 primary or secondary hypogonadal patients, no prostate cancer was diagnosed.     

Immunocytochemical and quantitative study of the tunica albuginea testis in young and ageing men

 A light and electron microscope immunohistochemical study of the tunica albuginea from both young and elderly men was carried out to determine the distribution of the cells that contain actin, vimentin and/or desmin, and to evaluate the possible variations with ageing by means of quantitative studies. Testicular volume and testicular parenchyma volume decreased significantly with age whereas the tunica albuginea volume remained unchanged. These results agree with the scanty quantitative changes observed in the testicular connective tissue with age, and the notion that age-related changes in testicular volume are principally restricted to the seminiferous tubules. Three connective tissue layers could be distinguished in the tunica albuginea in both young and elderly men. The middle and inner layers increased in width with age while the width of the outer layer decreased. The average width of the tunica albuginea increased significantly with ageing. The tunica albuginea of young men and elderly men presented two types of fusiform cells: (1) fibroblast-like cells, which immunoreacted to actin and vimentin, but not to desmin; and (2) myoid cells, which immunoreacted to actin, vimentin and desmin. In both young men and elderly men, the total number of desmin-positive cells (myoid cells) was significantly lower than that of fibroblasts. However, the total number of desmin-positive cells was significantly increased in ageing men. In young testes, desmin-positive cells were more abundant in the outer layer of the tunica albuginea, whereas in elderly men these cells predominated in the middle layer. The increased desmin immunoexpression in the tunica albuginea of ageing men contrasts with the decrease in desmin immunoreaction in other myoid cells of the testis, the peritubular myoid cells, but only in seminiferous tubules that showed severe germ cell depletion. This suggests that changes in intermediate filament immunoexpression in peritubular cells are focalised, and thus, under local control, whereas changes in the tunica albuginea cells are generalised and possibly related to factors also affecting the connective tissue in other organs Accepted: 15 January 1997     

Cancer risk among young men with weight gain after smoking cessation: A population-based cohort study

BackgroundSmoking cessation may help the current smokers to reduce cancer risk. However, weight gain following smoking cessation may attenuate the protective association of cessation with cancer.Patients and methodsOur study included 1,278,794 men who were aged 20–39 years and underwent two consecutive health examinations by the National Health Insurance Service, without previous diagnosis of cancer. Participants were categorized into continual smokers, quitters with different degree of body weight change, and never smokers based on the biennial national health screening program (2002–2003 and 2004–2005) and were followed from January 1, 2006 to December 31, 2015. Cox proportional hazard models and restricted cubic spline model was used to evaluate the association of post-cessation weight change and cancer risk after adjustment for potential confounders.ResultsDuring the 10 years of follow-up, the analyses included 1,278,794 men with 21,494 cancer incidences. Compared to continual smokers, quitters without weight gain of 2.0 kg had significantly lower risk of obesity-related cancer (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97), smoking-related cancer (HR, 0.90; 95% CI, 0.83 to 0.98), and gastrointestinal cancer (HR, 89; 95% CI, 0.80 to 0.98). Weight gain among quitters attenuated the risk reduction of cancer compared to continual smoking. Among quitters, weight gain up to 5.0 kg with smoking cessation showed protective association with cancer risk among quitters without weight gain.ConclusionExcessive weight gain with smoking cessation among quitters was not associated with reduced risk of several cancer types. This association should be taken into account when recommending smoking cessation to prevent cancer     

Cancer risk models and preselection for screening

Objective: The invitation to population screening is based on age criteria in many countries. Screening is not offered to younger or older participants, because the benefits in these age groups do not outweigh the harms. One could argue that it is not so much age that determines the benefits but the risk of developing preclinical and treatable cancer. Cancer risk varies with age but is also affected by other factors. Methods: We performed a systematic review for risk models for the three types of cancer for which population screening programs exist: breast, cervical and colon cancer. We used an evaluation scheme that distinguishes three phases of model development: model derivation, validation and impact analysis. Data were collected in August 2010. Results: We identified two colorectal, four breast and three cervix cancer risk models. One colorectal, four breast and none of the cervix cancer models have been externally validated. We could not identify evaluations of the impact on population screening effectiveness. Conclusion: We conclude that risk models for the pre-selection of screening have been developed. These models could improve the pre-selection for screening, help in making personal decisions about participation, and reduce adverse effects of population screening. The validity of this hypothesis, as well as practicalities and issues of equity and reliability, have to be tested in further studies.     

Effectiveness of programme for reducing cardiovascular risk for men in one general practice.

OBJECTIVES--To assess the effectiveness of a programme for reducing cardiovascular risk in men in terms of clinical measurements and perceptions of patients. DESIGN--Collection of paired data on men attending well person clinics over three to five years. Questionnaire to determine changes in risk related habits. SETTING--Well person clinics in rural general practice with five partners in mid-Wales. SUBJECTS--The first 687 men seen in the clinic: analysable data obtained on 520. Initial age range 28-60 years. MAIN OUTCOME MEASURES--Analysis of serum cholesterol concentration (mmol/l) and blood pressure (mm Hg). Changes in diet, exercise, smoking, and drinking. RESULTS--Mean (SD) cholesterol concentration for all subjects increased from 5.8 (1.0) to 6.0 (1.0), p < 0.001. Overall percentage of ideal weight and mean systolic blood pressure also increased. Mean diastolic blood pressure was unchanged at 84 mm Hg. Professed dietary change, age, and number of visits all had significant effects on final cholesterol concentration. Those seen more often showed a significant decrease in cholesterol concentrations (in those seen more than twice mean (SD) initial value 6.7 (0.9) mmol/l v final value 6.5 (1.0) mmol/l, p < 0.001). Those over 45 years at start of study showed a significant decrease in diastolic blood pressure (mean (SD) initial value 89 (9) mm Hg v final value 86 (7) mm Hg, p < 0.001). CONCLUSIONS--These clinics are not effective in achieving a reduction in mean cholesterol concentration or blood pressure, despite evidence that the message of reduction in risk had been successfully transmitted. Success was achieved in older patients and those in whom a definite problem was identified. Identification of high risk groups and clinical case finding with appropriate long term follow up may be more cost effective in reducing cardiovascular risk than non-specific screening of the whole population.     

Localization of inhibin/activin subunits in the testis of adult nonhuman primates and men

The localization and distribution of inhibin/activin subunits was evaluated in the testes of three nonhuman primate species (Macaca fascicularis, M. mulatta, M. arctoides), of young (31 to 43 years) and old (60 to 85 years) men, and of men with disturbed or arrested spermatogenesis using immunohistochemical techniques (peroxidase-anti-peroxidase and alkaline-phosphatase/ anti-alkaline-phosphatase technique). Specific polyclonal (anti-porcine inhibin -1-32 and anti-bovine activin A) and monoclonal (anti-human inhibin -1-32 and anti-human activin A-82-114) antisera were employed. Among all nonhuman primate species and in men, inhibin/activin subunits were present in the cytoplasm of Sertoli cells and Leydig cells but not in germ cells. No relationship could be established between the staining pattern for inhibin/activin subunits and the completeness or the stage of the spermatogenic process. The staining for the A-subunit in Sertoli cells appeared more intense in the testes of old men compared with that of young men. The majority of Leydig cells contained either the -subunit and A-subunit or the A-subunit alone. The signal for the A-subunit was remarkably intense in normal and hyperplastic human Leydig cells. These observations demonstrate the presence of inhibin/activin subunits in Sertoli cells and Leydig cells of adult primates and raise the possibility that these subunits or their respective dimers (inhibin A/activin A) might subserve a paracrine/ autocrine role in the adult primate testis. Also, the possibility of specific differences in the -1-32 subunit and the A-82-114 subunit region among certain primate species arises from the observation that the monoclonal antisera failed to detect the respective antigens in M. fascicularis and M. mulatta.     

Proteomic analysis of testis biopsies in men treated with transient scrotal hyperthermia reveals the potential targets for contraceptive development

Mild testicular heating safely and reversibly suppresses spermatogenesis. In this study, we attempted to clarify the underlying molecular mechanism(s) involved in heat‐induced spermatogenesis suppression in human testis. We conducted global proteomic analyses of human testicular biopsies before, and at 2 and 9 wk after heat treatment. Thirty‐one and Twenty‐six known proteins were identified with significant differential expression at 2 and 9 wk after heat treatment, respectively. These were used to characterize the cellular and molecular events in the testes when seminiferous epithelia became damaged (2 wk) and recovered (9 wk). At 2 wk post‐treatment, the changed expression of a series of proteins could promote apoptosis or suppress proliferation and cell survival. At 9 wk post‐treatment, the changed expression of proteins mainly promoted cell proliferation, differentiation and survival, but resisted cell apoptosis. Among those heat‐regulated proteins, HNRNPH1 was selected for the further functional study. We found that HNRNPH1 was an anti‐apoptosis protein that could regulate the expression of other heat‐induced proteins. In conclusion, heat‐induced reversible suppression of spermatogenesis occurred by modulating the expression of proteins related to proliferation, differentiation, apoptosis and cell survival pathways. These differentially expressed proteins were found to be key molecular targets affecting spermatogenesis after heat treatment.