Cremaster muscle thickening: the anatomic difference in men with testicular retraction due to hyperactive cremaster muscle reflex

The objective was to assess whether men suffering from testicular retraction secondary to hyperactive cremaster muscle reflex havean anatomic difference in the thickness of the cremaster muscle in comparison to men who do not have retraction. From March2021 to December 2021, 21 men underwent microsurgical subinguinal cremaster muscle release (MSCMR) on 33 spermatic cordunits, as 12 of them had bilateral surgery, at Surgicare of South Austin Ambulatory Surgery Center in Austin, TX, USA. Duringthat same time frame, 36 men underwent subinguinal microsurgical varicocele repair on 41 spermatic cord units, as 5 werebilateral for infertility. The thickness of cremaster muscles was measured by the operating surgeon in men undergoing MSCMRand varicocele repair. Comparison was made between the cremaster muscle thickness in men with testicular retraction due toa hyperactive cremaster muscle reflex undergoing MSCMR and the cremaster muscle thickness in men undergoing varicocelerepair for infertility with no history of testicular retraction, which served as an anatomic control. The mean cremaster musclethickness in men who underwent MSCMR was significantly greater than those undergoing varicocele repair for infertility, witha mean cremaster muscle thickness of 3.9 (standard deviation [s.d.]: 1.2) mm vs 1.0 (s.d.: 0.4) mm, respectively. Men withtesticular retraction secondary to a hyperactive cremaster muscle reflex demonstrate thicker cremaster muscles than controls,those undergoing varicocele repair. An anatomic difference may be a beginning to understanding the pathology in men whostruggle with testicular retraction.

Abdominal-B regulates structure and development of the Harmonia axyridis cremaster

The ladybird Harmonia axyridis is an insect that exhibits pupal attachment to plants,which facilitates development and environmental adaptation.The cremaster is highly specialized for this behavior.However,the underlying molecular regulation of the cremaster remains unclear;therefore,we performed experiments to investigate the transcriptional regulation of cremaster development.First,we examined the morphological structure of the cremaster to reveal its function in pupal attachment of H.axyridis.Next,we analyzed the Hox gene Ha-Abd-B using RNA interference(RNAi)to determine its function in regulating cremaster formation;Ha-Abd-B up-regulation promoted effective pupal attachment,whereas successful RNAi caused severe down-regulation of this gene,and pupae were unable to attach.Furthermore,successful RNAi and subsequent Ha-Abd-B down-regulation caused phenotypic changes in cremaster structure,including its complete disappearance from some individuals.Finally,we observed unique development of the cremaster and dynamic expression of Ha-Abd-B during pre-pupal development;consequently,we hypothesized that there was specific pre-pupal development of the cremaster.Overall,based on these results,the specialized cremasteric structure located on the posterior side of H.axyridis was determined to be a key organ for pupal attachment.Cremaster identification in H.axyridis is regulated by Ha-Abd-B and exhibits preferential development.Pupal attachment of H.axyridis reveals an environmental adaptation of this species;thus,this study and future molecular studies will help determine the role of Hox genes in regulation of insect attachment and further our understanding of the multiple functions of Hox genes.

睾丸扭转误诊分析并文献复习

目的提高临床医师睾丸扭转的诊治水平,减少误诊。方法报道2例因延迟就诊的睾丸扭转患者的诊治资料,结合文献对其病因、临床表现、超声诊断及误诊原因进行复习与分析。结果对2例患者均行手术探查,1例睾丸坏死者行睾丸切除,1例行复位及同侧睾丸固定术,术后睾丸萎缩失去功能。结论发病后及时就诊、准确诊断和及时正确的治疗是避免睾丸丢失的关键,彩色多普勒超声为睾丸扭转的首选检查方法,及时的手术探查可以提高睾丸的挽救率。

睾丸扭转反复误诊致坏死1例并文献复习

目的:提高临床医生对睾丸扭转的诊断能力。方法:报道1例睾丸扭转因延迟就诊和2次误诊致坏死。结合文献,对其解剖、临床表现、超声诊断及误诊原因进行复习与分析。结果:1例表现为下腹痛的睾丸扭转患者,2次分别被误诊为肠痉挛和输尿管结石。术中探查证实睾丸扭转,睾丸已经坏死并切除。术后病理证实为睾丸坏死并弥漫性出血。结论:发病后及时就诊、准确诊断和正确治疗是避免睾丸丢失的关键。彩色多普勒超声检查为明确本病的一种理想影像学检查方法,并对手术有指导作用。

小儿隐睾提睾肌自主神经支配缺陷的超微结构研究

目的了解小儿先天性隐睾提睾肌的超微结构与腹股沟斜疝患儿提睾肌之间的差异,希望能阐明小儿隐睾的发病机制。方法分别于手术时取研究组(小儿隐睾8例)及对照组(腹股沟斜疝患儿8例,年龄与研究组相似)提睾肌各一小块,编号后常规送电子显微镜检查。结果与对照组相比,研究组中的提睾肌可见:无髓鞘纤维减少,有髓鞘纤维的数量多于无髓鞘纤维、肌纤维排列紊乱、肌膜过多、基底层空虚、肌原纤维排列散乱、肌丝厚实、Z线缺失、肌质网扩大、线粒体形状不规则、卫星细胞不活动等。结论无髓鞘纤维数量的减少代表自主神经纤维的减少,肌纤维的改变提示其自主神经支配的缺陷,这可能导致隐睾的发生。

开放腹股沟疝修补术中精索游离术式探讨（附78例报告）

目的探讨在开放腹股沟疝修补手术中游离精索新术式的可行性。方法 2009年12月至2011年5月,南方医科大学附属南海医院普外三科在择期78例(双侧疝19例)Lichtenstein疝修补术中采用新术式游离精索(游离精索的解剖平面在提睾肌筋膜浅层与腹横筋膜之间),观察有无出血和神经损伤,记录所需时间,随访术后并发症。结果 78例手术中修补斜疝82侧,直疝17侧;游离精索的时间为4～11min,平均6.9min;无一例发生1mL以上的出血;游离过程中损伤髂腹股沟神经1例;术后切口脂肪液化3例,术后耻骨上区疼痛1例,随访3个月以上无慢性疼痛病例。结论在开放腹股沟疝修补术中,采用新术式游离精索的方法简单可行。

提睾反射消失及手术探查在睾丸扭转早期诊疗中的临床意义(附22例报告)

目的提高睾丸扭转的早期诊断水平及睾丸挽救成功率。方法对22例睾丸扭转确诊病例的临床表现及诊治情况进行回顾分析。结果 22例患者中提睾反射消失者22例（100%）。22例患者中,2例发病2 h就诊者行手法复位成功,经观察,未予手术;20例均行手术探查确诊为睾丸扭转,6例患者发病4~6 h行患侧睾丸复位固定及对侧睾丸固定术,14例患者发病8~18 h因睾丸坏死行患侧睾丸切除加对侧睾丸固定术。随访3月至6年,2例手法复位患者再次发生同侧睾丸扭转。结论提睾反射消失是睾丸扭转患者最敏感的体征之一,在睾丸扭转早期诊断中具有重要的临床意义;对于提睾反射消失患者,尽早行手术探查,可以大大提高睾丸扭转的挽救成功率。