In 62 planned staged orchiorrhaphies for a "short" spermatic cord, satisfactory location of the testicle following the second operation was achieved in 90% of cases. The testicle was atrophic and had to be excised in only 3.2%. After a follow-up period of two to ten years, the testicle remained satisfactorily located in 77% of cases; adequate size and configuration of the testicle (compared to the contralateral side) was found in 64.5%. In 17%, a partial or complete atrophy developed. No correlation was found between the initial size of the testicle and the late results. It is advocated, therefore, that excision be avoided unless definite atrophy exists. Planned staged orchiorrhaphy is recommended for testicles in high locations that are difficult to bring down. The late preschool period (5 to 6 years) is suggested as the optimal age for the first attempt at orchiorrhaphy and the second stage two years later, if required.

Adolescent↗

PubMed1975

The use of metoclopramide in acute pyloric obstruction. A clinical trial.

Twelve patients with complete, or nearly complete, pyloric obstruction due to duodenal ulcer, were treated conservatively with metoclopramide. The purpose of this therapeutic trial was to avoid emergency operations in these patients and to enable a better radiological evaluation and clinical preparation before surgery. The treatment, in addition to the usual gastric decompression and fluid and electrolyte replacement therapy, was effective in 10 patients (83.4 percent). In eight of these patients the results of the trial was regarded as "very good". Six of them were operated upon electively later and two were not operated upon at all. In two patients the results were regarded as "good". These patients underwent early elective surgery. In the remaining two patients (16.6 percent) the trial failed and semiurgent operation could not be avoided. As no side-effects are evident following the administration of metoclopramide and no harm is done by delaying surgery for three days, it is suggested that this therapeutic trial should be undertaken in every case of pyloric stenosis or obstruction. This may markedly reduce the need for emergency operation and prevent many postoperative complications which not uncommonly follow emergency surgery for pyloric stenosis.

Adolescent↗

PubMed1975

Gamma-glutamyl transpeptidase as an aid in the diagnosis of liver metastases.

Serum gamma-glutamyl transpeptidase (GGTP) activity was examined in 79 patients. Of these, 49 had diverse malignant tumors, some of which had metastasized to the liver, and 18 had benign diseases of the liver, gallbladder and bile ducts. Enzyme activity increased significantly in all but two patients in whom liver metastases were found. All but one of the patients with malignant tumors, but without liver metastases, showed normal GGTP activity. GGTP activity was elevated in all cases of jaundice. In the absence of jaundice, elevated GGTP activity is suggestive of the presence of liver metastases.

Adult↗

PubMed1974