Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood.Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism.Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment.Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH.Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or age of initial treatment exerts no definite effect on testicular volume improvement or hormonal levels at 18 years of age.
Oesophageal dilatation is associated with a high incidence of bacteraemia. The organisms most commonly responsible were alpha-haemolytic streptococci. We recommend the use of antibiotic prophylaxis as a routine measure prior to oesophageal dilatation.
Gastric volvulus has traditionally been considered a rare entity in children, and standard texts on paediatrics typically make scant reference to it. In our experience, however, careful radiographic study of children with digestive symptoms reveals gastric volvulus to be more frequent than is commonly thought. We report 52 cases of this disorder, and discuss its diagnosis and treatment. Material and Methods. We performed a retrospective study of all children treated for chronic gastric volvulus in our department since 1976. Results. All 52 patients (27 boys, 25 girls) were term infants, mean age 2.8 months at diagnosis. The principal symptoms were crying and colic (90 %), vomiting and nausea (67 %). The mean age at onset of symptoms was 1.1 months. Diagnosis was in all cases on the basis of upper intestinal transit studies. The most frequent radiological signs were high greater curvature (87 %) and greater curvature crossing the oesophagus (83 %). Nine of the 52 children underwent primary surgery. The remaining 43 patients underwent conservative (i.e. postural) treatment; 11 of these patients showed no significant improvement and thus underwent surgery. We performed 20 surgical interventions (19 simple anterior gastropexies and one a percutaneous endoscopic gastrostomy). All patients showed good recovery after surgery. Conclusion. Careful examination of patients with vomiting, abdominal distension, gastro-oesophageal reflux, colic, crying, retarded growth, sleep problems, anxiety, and even repeated respiratory infections will reveal chronic gastric volvulus with greater frequency than has traditionally been thought. We believe that this entity is often undetected, and that, as a result, it is often inappropriately treated.
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