How to Reverse Testicular Atrophy
Klinefelter syndrome Persons who have Klinefelter syndrome, which occurs with a frequency of about 1 in 1000 male births, have cells with one or more Y chromosomes and multiple X chromosomes. The cells of most males having this condition are XXY, but cells of a few Klinefelter males are XXXY, XXXXY, or XXYY. Persons with this condition, though male, frequently have small testes, some breast enlargement, and reduced facial and pubic hair ( FIGURE 4.11). They are often taller than normal and sterile most have normal intelligence.
Sifakas are seasonal breeders, mating in December or January. Male testicles begin to increase in size three months before the mating season (when the females come into estrus). Female sifakas have a 10-36 hour interval when they are in estrus, and they may come into estrus 1-3 times each year. In the wild they usually are pregnant after one breeding season. Females have swollen, bright pink vulvas when in estrus. Sifaka mating occurs when a male clasps a female around the waist and thrusts 10-50 times. Indris mate face-to-face, while hanging from a branch. Indris gestate for about six months. The smaller verraux's sifaka has a gestation of five months, while the larger diademed sifaka gestate for six months. A single infant is born fully furred and able to cling. Weights at birth are small, less than 0.2 of the mother's weight. Weaning occurs at about six months of age.
Physical examination is often of great importance in clarifying suspected etiologies. Start with a general examination, and keep in mind some of the vascular, endocrinological, and neurological causes of ED. Assess the degree of androgen-ization checking for body hair and any evidence of gynecomastia. Examine the genitalia carefully for any abnormalities. Check whether the foreskin can be retracted, and look for conditions such as phimosis or balanitis. Deep palpation of the penis can reveal fibrotic thickening (Peyronie's plaques) in a proportion of men presenting to sexual dysfunction clinics. Cremasteric and bulbocavernous reflexes should be elicited as well as saddle sensation and deep tendon reflexes of the legs. The size and consistency of the testicles should be assessed. If urinary symptoms are present, rectal sphincter tone and prostatic examination are necessary. Cardiovascular risk assessment should be undertaken see Appendix and Jackson et al. (17) .
Cryptorchidism is a common congenital disorder in which one or both testicles fail to descend into the scrotum before birth. Over half of the boys who are born with cryptorchidism experience spontaneous testicular descent during the first year of life. A history of persistent cryptorchidism, in which spontaneous descent does not occur, is the major established risk factor for testicular cancer. Epidemiologic studies consistently find associations between a personal history of cryptorchidism and risk of testicular cancer, and reported estimates of relative risk range from 2.5 to 18.1 5 11 42-60 Some studies found cryp-torchidism to be more strongly associated with seminoma than with other histologic types. istries are inadequate, for two reasons. First, some registries classify cryptorchidism as a minor malformation and record it only when it occurs in conjunction with an additional major malformation. Second, the frequent occurrence of spontaneous testicular descent complicates the...
Torsion may cause testicular infarct if not treated quickly. This usually occurs in the first year of life or also towards puberty due to trauma . It is associated with incomplete descent, absent scrotal ligaments, absent gubernaculum testis or testicular atrophy causing the testis to be abnormally mobile. Torsion must last at least 6-24 hours to cause an infarct. Treatment consists of untwisting and fixing the testis to dartos muscle or orchidectomy. The opposite testis should be fixed to dartos muscle as a preventive measure.
The majority (more than 75 ) of patients with seminoma present with clinical stage I disease that is, no apparent involvement is found outside the testis.1,2 The classic presentation of stage I disease is painless testicular enlargement although up to 30 of patients can have some pain at presentation. The traditional management of patients with stage I semi-noma involves inguinal orchiectomy, which provides detailed information on tumor pathology, information on the extent of primary disease, and local tumor control. Local recurrence in the scrotum following surgery is exceedingly uncommon, at least in the case of surgery performed (and presentation with small- to moderate-sized tumors) in the developed world. The current management options for patients with stage I seminoma include (1) adjuvant postoperative external beam radiotherapy directed to para-aortic lymph nodes alone or to para-aortic and pelvic lymph nodes, (2) surveillance, and (3) adjuvant chemotherapy. The usual approach...
Delayed sexual maturation is a potential cause of HSDD. It is present in boys if there is no testicular enlargement by age 13-and-a-half or if there are more than five years between the initial and complete growth of the genitalia. In girls, delayed sexual maturation is characterized by a lack of breast enlargement by age 13, or by a period greater than five years between the beginning of breast growth and the onset of menstruation. Delayed puberty may be the result of familial constitutional disorders, genetic defects such as Turner's syndrome in females and Klinefelter's syndrome in males, central nervous system disorders such as pituitary conditions that interfere with the secretion of gonadotropic hormones, and chronic illnesses such as diabetes mellitus, chronic renal failure, and cystic fibrosis.
In experimental animals, vitamin E deficiency results in resorption of fetuses and testicular atrophy. Dietary deficiency of vitamin E in humans is unknown, though patients with severe fat malabsorption, cystic fibrosis, and some forms of chronic liver disease suffer deficiency because they are unable to absorb the vitamin or transport it, exhibiting nerve and muscle membrane damage. Premature infants are born with inadequate reserves of the vitamin. Their erythrocyte membranes are abnormally fragile as a result of peroxidation, which leads to hemolytic anemia.
The perils of anabolic steroid use are well known. In Olympic sport, the most notable, systematic state-supported program of doping with anabolic steroids was conducted by the East Germans from 1974 until the Berlin Wall fell. One of the anabolic substances developed by the East Germans as part of their doping program was androstenedione. In the body, androstenedione metabolizes into the anabolic steroid, testosterone. The documented side effects of the East German steroid program, particularly for women athletes, were tragic. These side effects include damage to the liver and reproductive system, susceptibility to cancers, and permanent masculinization of women. It is also well known that men who abuse steroids and steroid precursors risk serious health consequences including gynecomastia, baldness, shrunken testicles, infertility and susceptibility to aggressive behavior or rage. For adolescents who use steroids the side effects can include all of the above, as well as a strong...
Some species are uniformly blackish, while others are almost completely whitish other species are rusty reddish, gray, brown, tan, or yellowish brown. Un-derparts are nearly always paler than the dorsum. The venter of the water opossum is silvery white. Two genera have distinct dark blotches above the eyes they are called four-eyed opossums. Some genera have characteristic dark and pale patterns, sometimes broad, dark saddle-like bands across the back, sometimes a longitudinal stripe along the dorsal spine and continuing along the top of the snout and to the tip of the nose. The hair can be short or long depending on the species, but it is always dense. In females of some genera, there is a distinct ventral pouch where young are kept in the developmental stages. The pouch opens circularly and can be almost completely closed. Mammae number 12 to 18 and are arranged in a circle with one in the center. One species, the water opossum, has a pouch that seals...
Nal defect in a gene or chromosome is present in all cells of the body and is caused by an error in one or both of the gametes. Alternatively, a chromosomal abnormality may occur relatively early in gestation, resulting in a portion of cells with the defect termed mosaicism, the condition is usually defined by the percentage of abnormal cells and or the cell types associated with the abnormality. Rarely, the testicles or ovaries, may exhibit mosaicism with some cell lines containing a mutation of a gene or chromosomal aberration.
Ginseng extract has been shown to be beneficial in the prevention and treatment of testicular damage induced by environmental pollutants. Dioxin is one of the most potent toxic environmental pollutants. Exposure to dioxin either in adulthood or during late fetal and early postnatal development causes a variety of adverse effects on the male reproductive system. The chemical decreases spermatogenesis and the ability to conceive and carry a pregnancy to full term. Pretreatment with 100 or 200 mg kg ginseng aqueous extract intraperitoneally for 28 days prevented toxic effects of dioxin in guinea pigs. There was no loss in body weight, testicular weight or damage to spermatogenesis (Kim et al 1999). In guinea pigs P. ginseng also improves the survival and quality of sperm exposed dioxin (Hwang et al 2004).
The macules can be present at birth or arise early in life. The cutaneous lesions can fade with time, but the mucosal hyperpigmentation remains. The hyperpigmented macules in PJS can be distinguished from freckles by their mucosal involvement and the fact that they are commonly present at birth. The mucocutaneous lesions in PJS precede the gastrointestinal manifestations. The median time to presentation with polyps is 11 years of age, but the age of onset varies greatly. There are reported cases of patients presenting with polyposis at birth, but this is very rare. Extraintestinal polyposis may develop and can involve the nares, pelvis, bladder, and lungs. Although the rate of neoplastic potential of the intestinal lesions is low, 48 of patients with PJS have been reported to develop intestinal and extraintestinal malignancies that include neoplasms of the colon, esophagus, rectum, stomach, small intestine, breast, pancreas, ovaries, cervix, testicles, and...
Klinefelter's syndrome (KS) is a genetic disorder of men that is characterized clinically by gynecomastia, testicular atrophy, and increased levels of follicle-stimulating hormone40 and is characterized genetically by the 47,XXY karyotype. An association between MNSGCT and KS exists. At Indiana University, 22 consecutive MNSGCT patients had chromosome studies performed on blood or a bone mar
The polyps in PJS are benign hamartomas and have a low rate of malignant transformation, but because the polyps progress with age, they can lead to recurrent abdominal pain, bleeding, anemia, intussusception, and obstruction. Patients with PJS are susceptible to a multitude of internal malignancies, including tumors of the gastrointestinal tract, pancreas, testicles, ovaries, cervix, and uterus aggressive screening protocols as mentioned above are recommended to decrease morbidity and mortality.
Expansion of the CAG microsatellite to 40 or more repeats causes a rare, X-linked, adult-onset, neurodegenerative disorder called spinal and bulbar muscular atrophy (SBMA), or Kennedy's disease.26,27 In addition to progressive muscle weakness and atrophy due to loss of brain stem and spinal cord motor neurons, men with this disorder frequently present with symptoms of partial androgen insensitivity (i.e., gy-necomastia and testicular atrophy), indicative of aberrant AR function.28,29 Receptor proteins encoded by SBMA AR alleles have normal andro-
WHEREAS The term dioxin refers to a group of chemicals that includes furans and biphenyl compounds (the most well-known dioxin being 2,3.7.8-TCDD), and dioxin is a potent human carcinogen and an endocrine-disrupting chemical affecting thyroid and steroid hormones, scientifically linked to endometriosis, immune system impairment, diabetes, neurotoxicity, birth defects, testicular atrophy and reproductive dysfunction and
Different field studies suggest pair bonds or polygynous social organization. Births occur throughout the year, with a conspicuous increase in frequency by the end of the rainy season between February and June. The giant baby, weighing about one quarter of its mother's weight, is able to climb on the first day of its life. Some skeletally adult males have small testes, suggesting the existence of a social category of reproductively inactive spare males.
Experimental animals injected with soluble cadmium salts decreased serum testosterone, a decreased size and weight of the testes, epididymis, vas deferens, prostate and seminal vesicles, decreased sperm production and motility, and suppressed libido and reproductive capacity (Laskey et al., 1984 Lau et al., 1978 Nordberg, 1971, 1975 Parizek, 1960 Saksena and Lau, 1979 Waalkes and Rehm, 1994). Testicular atrophy and necrosis and decreased fertility have been observed in animals at nearly fatal doses of cadmium (Bomhard et al., 1987). In rats, long-term exposure to cadmium through the drinking water (10 mg L for 52 weeks) led to pathological testicular changes, as well as liver and kidney damage, whereas reproductive capacity was reduced in 40 of animals (Saygi et al., 1991).
Vantageous in repairing the axillary wound of obese robust patients. Posteriorly based flaps are elevated from the inframammary area and rotated into the defect of the axilla 25 . The submammary donor site is closed primarily. Local flaps have been used by many for this repair. The combination of a regional flap and split thickness skin graft furnishes another means of axillary repair. Z-plasty is one of the most useful plastic surgery procedures and deserves first consideration in the prevention and contracture of scars. Generally, the length of the arms of the Z should be equal. In modified Z-plasty, first the upper and lower portions of the wound are approximated to form an elliptical central defect, which lies in the line of election. The Z-plasty is then carefully planned and the flaps developed. Free skin grafts, tubed and pedicle flaps can be used to reconstruct large deep defects of the perineum, pubis, and groin. Such flaps provide satisfactory coverage for exposed testicles...
Askanazy, in 1907, was the first to propose that totipotential undifferentiated cells could undergo a metamorphosis to produce teratomas.13 Several clin-icopathologic studies in the following half century supported this fundamental concept,11416 as did a series of preclinical studies (see below). In particular, support for the germ cell origin of testicular cancer has been provided by the demonstration of a preinvasive intratubular carcinoma in situ, or atypical germ cell. 1718 These atypical cells, which differ from normal germ cells in their increased size, irregular chromatin patterns, increased deoxyribonucleic acid (DNA) content, and mitotic index,19 have been found in infertile males,19,20 in the contralateral testes of patients with germ cell tumors,21 in cryp-torchid and ectopic testicles,22 and in normal tissue adjacent to germ cell tumors.23
Most of the etiologic and epidemiologic associations appear to point to an origin in atypical germ cells. The association of testicular maldescent and the formation of testicular tumors has been known for more than 200 years,84,85 and atypical germ cells have been identified in cryptorchid testicles.22 Similarly, testicular cancer is found more commonly in patients with testicular dysgenesis, infertility, and Kleinfelter's syndrome (with expression of an XXY chromosome). Additional epidemiologic associations include reduced body muscle mass and a lower prevalence of male pattern baldness, which may imply lower circulating testosterone levels, as either a cause or an effect of testicular cancer.86 Although testicular trauma and mumps orchitis have largely been discounted as antecedents of GCTs,87 88 earlier studies suggested that both could have mechanisms of oncogenesis predicated on testicular atrophy and the consequent evolution of atypical germ cells. Similar mechanisms have been...
The lymphatic drainage of the testis is to the retroperitoneum. The region of lymphatics draining the testicles includes that area bordered by the crus of the diaphragm superiorly, the bifurcation of the iliac arteries inferiorly, and the ureters laterally. The lymphatic drainage of the testicles is usually very predictable, and metastatic disease reliably involves the area described above. However, exceptions do occur when metastatic disease is found in the retroperitoneum of patients with low-stage disease, it is located in an aberrant drainage area approximately 5 of the time.
Remarks Comparative palpation with the orchidometer of Prader is a quick and fairly accurate way to estimate testicular size (Fig. 10.9). The volume in milliliters is clearly printed on each of the elliptical models. At young ages, intermediate volume size models can be obtained (0.5, 1.5, and 2.5 mL size), and very large volume size models have also been developed for macro-orchidism.
Milne-Edwards's sifakas live in monogamous pairs, harems, multi-male, multi-female groups and in polyandrous groups. Breeding is seasonal, and males' testicles begin to expand three months before the mating in December to January. During estrus the female's vulva becomes swollen and pink. Milne-Edwards' sifakas mate 3-4 times within a 10-hour period with the male mounting the female from the back. Females may mate with one or more males in the group. The gestation period is six months, and infants are born in May or June. One infant is born per mother on average every second year. Newborn infants weigh about 4.4 oz (125 g) and are 0.2 of the weight of the mother. The infant clings ventrally to the mother for the first four weeks and then rides on her back for five months. Males help transport older infants about 10 of the time, and defend the group against attacks by large raptors. Females are dominant in feeding and social situations. Infant mortality is high (over 50 ).
The female constructs a den on the bank of a river or stream where she builds a nest with vegetation. The young are born very undeveloped after a short gestation. The female keeps the young in a well-developed pouch that closes hermetically when she swims. The male also has a marsupium to protect the testicles.
In rats, mice, guinea pigs, and hamsters exposed to inorganic mercury (mercuric chloride, intraperitoneally, 1, 2, or 5 mg kg day for 1 month), the highest dosage caused testicular degeneration and cellular deformation of the seminiferous tubules and the Leydig cells in all species, whereas the lowest dosage caused testicu-lar degeneration only in the hamster partial degeneration was observed in the rat and mouse, and no change was noted in the guinea pig (Chowdhury and Arora, 1982). In rats orally exposed to mercuric chloride (9 mg kg day, for 60-180 days), testicular morphological changes and decreased testosterone levels were found (Agrawal and Chansouria, 1989). In mice exposed to inorganic mercury through drinking water (4 ppm mercuric chloride, for 12 weeks), degenerative testicular changes, decreased absolute and relative testicular weight, and decreased epididymal sperm count were found a protective effect of zinc was reported (Orisakwe et al., 2001). Vitamin E, administered...
A number of studies have explored the effects of hormones whose levels rise in puberty. In some of the studies, levels of testosterone, LH, and follicle-stimulating hormone (FSH) were measured. In others, factors that can be interpreted as proxies for androgens and gonadotropins were measured instead. In a study conducted among men with diagnosed unilateral testicular cancer, investigators examined the contralateral testicle for the presence of carcinoma in situ (CIS). Men with both testicular cancer and CIS at the time of diagnosis tended to have lower levels of testosterone and higher levels of both LH and FSH76 than men with only testicular cancer. However, the implications of this result are not clear. One possibility is that this hormone profile confers greater susceptibility to disease, indicated by carcinogenic processes that are under way in both testicles of men with CIS. Alternatively, this hormone profile may result from disease processes that are occurring in both...
Regardless of age, depression is the most common factor in suicide (Carson & Butcher, 1992). However, it is not the only factor. Despite the fact that depression is significantly more prevalent among females than males, the suicide rate is substantially lower for females than males-whiteor black. Contributing to the higher rate for males is the fact that males who attempt suicide employ more lethal methods, such as firearms. Another factor contributing to the sex difference in suicide rate is that the more assertive, achievement-oriented, middle-aged man has greater difficulty than the more passive, nurturant, middle-aged woman adapting to role changes in later life. Women also tend to have more extensive social supports, which can act as a buffer against despair. Many older men, especially the less affluent, are unable to attain satisfaction in their new roles while retaining the macho myth that they can only maintain their dignity or manliness by keeping quiet about their problems...
Unlike in adults, the incidence of extragonadal tumors exceeds that of gonadal tumors in children less than 15 years of age. However, in the population aged 15 to 19 years, the testicles and ovaries are the most common sites of tumor origin. Several large pediatric series show that approximately 59 of these tumors originate in extragonadal sites and that 41 originate in the gonads.3
Sometimes the obvious can stare you in the face. Until 1955, it was agreed that human beings had twenty-four pairs of chromosomes. It was just one of those facts that everybody knew was right. They knew it was right because in 1921 a Texan named Theophilus Painter had sliced thin sections off the testicles of two black men and one white man castrated for insanity and 'self-abuse', fixed the slices in chemicals and examined them under the microscope. Painter tried to count the tangled mass of unpaired chromosomes he could see in the spermatocytes of the unfortunate men, and arrived at the figure of twenty-four. 'I feel confident that this is correct,' he said. Others later repeated his experiment in other ways. All agreed the number was twenty-four.
History of the Present Illness Severe, colicky, intermittent,, lower abdominal pain flank pain, hematuria, fever, dysuria prior history of renal stones. Abdominal pain may radiate laterally around abdomen to groin, testicles or labia. History of low fluid intake, urinary tract infection, parenteral nutrition. Excessive calcium administration, immobilization, furosemide.
A high single dose of manganese (160 mg MnO2 kg by intratracheal instillation) caused degenerative testicu-lar changes and sterility in rabbits (Chandra et al., 1973 Seth et al., 1973). Chronic dietary exposure of young rats to manganese Mn3O4for 224 days resulted in no effect on male fertility at manganese doses
Little as 6 Gy will induce ovarian failure in women between 40 and 50 years.41 Male testicles are even more sensitive to radiation. Spermatogenesis will be affected with doses as low as 0.2 Gy, and may be permanent above 1.2 Gy.42 Gonadal shielding can be somewhat effective but cannot be relied upon to preserve fertility.
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