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This paper reports the results on 13 patients with mumps orchitis, with special consideration of 7 andrologically after-cared cases. The results with and without therapeutic use of corticosteroids are compared. Furthermore, we present the andrological outcome in these patients.
One hundred twenty-one patients with acute epididymitis or epididymo-orchitis were evaluated retrospectively according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The patients younger than 30 years of age usually showed less severity of symptoms than the patients older than 50 years of age. The latter often demonstrated evidence of outflow obstruction. Eighty-two percent of patients with demonstrated urographic abnormalities had lower tract abnormalities, mainly secondary to outflow obstruction. All of these patients were older than 50 years of age. An intravenous pyelogram is indicated only in patients over 50 years of age and in young adults with positive bacteriologic urine culture.
Acute epididymo-orchitis occasionally responds poorly to conservative measures. Testicular infarction may be one reason for this complication. Ultrasonography and radionuclide scanning can elucidate the cause. A patient with this complication is described.
We report on three patients (28, 55 and 87 years old) with autoimmune granulomatous orchitis (AGO). Of a total of 182 surgical specimens examined, AGO accounted 1.64%. Clinically, it can be misdiagnosed as tuberculosis or tumor of the testis since most patients have a previous history of trauma, respectively. With respect to its pathogenesis, the lipid fraction of spermatozoa may be responsible for its characteristic granulomatous pattern.
The clinical features of dracunculus orchitis as a definite clinical entity are summarized and a case reported.
In experimental allergic orchitis (EAO), a lesion characterized by mononuclear invasion of seminiferous tubules can be adoptively transferred within 1 to 4 days by testicular injection of peritoneal exudate cells (PEC) from syngeneic strain 13 guinea pigs (GP) immunized with homologous testicular antigens in complete Freund's adjuvant (CFA). This study examined the role of T lymphocytes, macrophages, and polymorphonuclear neutrophils (PMN) in the adoptive transfer. Guinea pig PEC contained 7% T lymphocytes, rare B lymphocytes, and over 90% of macrophages and PMN. After T lymphocytes were depleted by rabbit erythrocyte (E) rosette and Hypaque-Ficoll gradient centrifugation, cell preparations that contained 73% of original macrophages and 15% original T lymphocytes were obtained, and these cells did not transfer EAO (0 of 18 testes). In contrast, cell preparations enriched in T lymphocytes by nylon wool column or E rosette contained 1.5% of the original macrophages and 59% of the original T lymphocytes transferred EAO to 70% of the testes, starting at 1.5 x 10(6) T lymphocytes per testis. The number of T lymphocytes correlated with the incidence of adoptive transfer; the correlation existed regardless of the number of macrophages or PMN present. Finally, EAO was adoptively transferred to recipients that had total-body irradiation. The results indicate that (a) T lymphocytes are capable of transferring lesions of EAO, (b) in the transfer, the T lymphocytes did not function as helper T cells, since the transfer need not involve participation of host lymphoid cells, and (c) by inference, testis antigen-reactive T lymphocytes exist.
A 34-year-old man visited our clinic because of right testicular swelling, pain and scrotal erythema. At first he was diagnosed as having acute epididymitis and received medical treatment. Nevertheless, his course was poor and was hospitalized after 1 month. Incision to the scrotum was performed and about 30 ml of dark yellow pus was drained. Culture of the pus yielded E. coli which was susceptible to all kinds of antibiotics. The local symptoms subsided, but the right testicular pain still persisted. Right epididymectomy was attempted on the 22nd hospital day. At the operation an abscess formation in testis was found but no marked changes in the epididymis were found. Right orchiectomy was performed. Histology of testis showed extensive necrosis and severe infiltration of many inflammatory cells. We report this rare case of pyogenic orchitis with abscess formation.
It is reported on a premature infant who fell ill with an orchitis and epididymitis by Salmonella cholerae suis in the fourth week of life. The proof of the germs was carried out by means of two blood cultures as well as in the smear from the periorchium. The most important informations from literature concerning this subject are briefly reviewed.
Antibodies interacting with spermatid structures in the testis sections and with acrosome and caudal regions of spermatozoa in the smears of sperm were determined in the sera of guinea pigs and mice with experimental autoimmune orchitis by the indirect immunofluorescent method. The antibodies were found in mice from the 14th to the 30th day and in guinea pigs from the 14th to the 60th day after immunization. Circulation time and the level of the fluorescent antibodies were significantly decreased in immunized female guinea pigs and mice. Fluorescent antibodies did not show cytotoxic effect and belonged to the IgG fraction. The fluorescent antibodies of guinea pigs did not react with the mouse testicular antigens in cross reaction. The analogous results were seen in the cross reaction of the mouse antibodies with the guinea pig antigens.
Groups of male and female guinea-pigs were immunized with homologous sperm derived from testis (TS) or epididyimis (ES) in Freund's complete adjuvant (FCA). In vivo investigations included skin tests at 2 weeks and development of aspermatogenesis (testis weight) at 4 weeks; in vitro assays were inhibition of migration of peritoneal exudate cells (PEC) and culture of blood leucocytes (lymphocyte transformation) at weekly intervals after immunization. Antigens used were heat-treated extracts of sperm used for immunization (BTS, BES); cells were also cultured simultaneously with PPD. Skin tests revealed anergy in males as compared with females: a larger quantity of antigen which caused partial unresponsiveness in females, caused profound unresponsiveness in males although the aspermatogenesis was less severe. In vitro tests also showed anergy during the active stages of the orchitis. This was non-specific for PEC (specific unresponsiveness was not excluded), but blood leucocytes showed only specific unresponsiveness (to BES). These and previous studies suggest that the unresponsiveness results from a desensitisation by sperm antigens released during the development of aspermatogenesis.
An aspermatogenic polypeptide (AP3) capable of inducing experimental allergic orchitis (EAO) in the guinea pig (GP) was purified from GP testes by sequential delipidation, acid extraction, pH precipitation, ammonium sulfate fractionation, trichloroacetic acid precipitation, gel filtration on Sephadex G-75, preparative isoelectric focusing from pH 3-10 followed by isoelectric focusing from pH 7-10, gel filtration on Sephadex G-75 Superfine under reducing conditions, and reduced acid urea gel electrophoresis. Approximately 250 micrograms (BSA equivalents) of AP3 were obtained from 500 g wet weight of GP testes. On 15% reduced acid urea polyacrylamide gels, AP3 appeared as a single band with an Rf of 0.19. SDS-PAGE showed a single band with a mobility corresponding to a m.w. of 12,500 +/- 1500. The isoelectric point, determined during purification, was 9.90 +/- 0.50. Amino acid analysis of AP3 indicates it is a protein. Gas liquid chromatographic analysis failed to reveal the presence of either hexose or hexosamine, indicating that AP3 is probably not a glycopeptide. Two to 5.0 micrograms (BSA equivalents) of AP3 are capable of inducing severe EAO in 100% of GP tested; 1 to 2.0 micrograms (BSA equivalents) induced EAO in 60% of GP tested. Because AP3 appears to be nonglycosylated and the aspermatogenic activity of AP3 is highly resistant to various denaturing conditions including reduction and alkylation, the primary sequence of the polypeptide rather than higher ordered structure may be more important in defining the determinant(s) responsible for its aspermatogenic activity.
Three cases of granulomatous orchitis are presented; they were observed during a period of 30 years among 44 testicular tumors. The testis was always uniformly enlarged. The aspect of granulomatous inflammation predominated with nodules or large zones formed from histiocytes, epithelioid cells and more rarely giant, multinucleated cells, and surrounded or intersperced by lymphocytes, plasma cells, fibrocytes and collagen fibers. The epithelial testis component was more or less damaged. The differential diagnosis has to be performed with tuberculosis, sarcoidosis, syphilis, malignant lymphoma and malacoplasia; the clinical data are very important for diagnosis. The traumatic, ischemic, infectious, fungal and autoimmune nature of these lesions is discussed.
This article reports the case of an adult suffering from orchitis due to Haemophilus influenzae. The difficulties encountered in isolating this bacteria when the correct techniques are not used may explain the apparent rarity of Haemophilus influenzae infections of the genital tract. The physiopathological mechanisms of this infection are discussed in relation to the characteristics of the strain isolated.
Testicular biopsies from 30 patients with fertility disorders were investigated by peroxidase-labeled antibodies against IgG and C3 at an ultrastructural level. Three types of abnormal basement membrane structures (ABMS) proved to be positive. Immune-type deposits (ABMS type 2), ABMS with vesicular particles (ABMS type 4), and those with membranous structures (ABMS type 5) stained positively for IgG and C3. In 21 cases ABMS were positive for at least one of the antisera. Two additional cases showed a linear reaction for IgG and C3 in the basement membrane. According to the number and size of positive ABMS, the cases were divided into three groups. Group I contained 10 cases with extensive ABMS types 2, 4, and 5 positive for IgG and C3 and two cases with linear positivity. At light microscopy, the changes varied from light to severe tubular atrophy. In these latter cases ABMS types 4 and 5 predominated, whereas in the light and focal tubular lesions ABMS type 2 did. In group II, eight cases revealed few and small ABMS positive by immunoelectron microscopy and no more than slight tubular changes at light microscopy. In group III, minimal or no ABMS were present, but in three cases mast cells were numerous in the interstitial tissue. The demonstration of immune deposits in the basement membrane of seminiferous tubules is interpreted to be the result of an antibody-mediated damage to the germinal epithelium leading to tubular atrophy. In one case obstruction of the sperm ducts and in another torsion of the testis are incriminated as events triggering the autoimmune process. Linear staining of the basement membrane for IgG and C3 in two cases suggests the development of antibasement membrane orchitis.
Inoculation of 1 X 10(3) viable Listeria monocytogenes into unilateral testis induced pathological changes in the contralateral testis and epididymis in guinea-pigs. Because L. Monocytogenes was not detected in the contralateral testis, liver or spleen during the period of the experiment, that is, bacterial growth was limited to the inoculated site, the pathological changes in the contralateral testis may be due to autoimmune mechanisms, but not due to bacterial inflammation. The pathological changes in our system were similar to those observed after the injection of testicular antigen in Freund's complete adjuvant. Delayed-in-onset erythematous skin reaction against testicular antigen and antisperm antibody in sera were detected in the guinea-pigs. The animal model in our system is a new one in which experimental autoimmune orchitis is induced by bacterial infection.
Experimental allergic orchitis (EAO) was induced in rats following the injection of homologous testicular homogenate (THr) emulsified in Freund's complete adjuvant. Immune RNA (iRNA) was extracted from the spleen and lymph nodes. Normal guinea-pig peritoneal exudate cells (GP-PEC), when incubated in vitro with iRNA, were able to specifically recognise and respond to the immunising antigens (THr and PPD) as assessed by the direct migration inhibition reaction (MIR). Positive MIR's were also observed when incubated peritoneal exudate cells were tested against testicular homogenates from mice and guinea-pigs. This would confirm the presence of a common testicular antigen(s) in the three species studied. The reaction would appear to be organ-specific, kidney homogenate being unable to cause migration inhibition. GP-PEC incubated with iRNA which had been pretreated with RNAse did not show antigen-specific migration inhibition. Similarly, GP-PEC treated with RNA extracted from non-immunised donor rats did not respond.
The ultrastructural distribution of Treponema pallidum and the host inflammatory response during experimental testicular infection of rabbits have been examined. During the inductive phase of experimental orchitis both organisms and inflammatory cells, primarily lymphocytes, are coated by amorphous material not seen in other cellular inflammatory reactions. Phagocytosis of organisms by macrophages occurs during the reactive phase. Phagocytic vesicles contain T. pallidum and are frequently lined by amorphous material. T. pallidum do not appear structurally abnormal prior to phagocytosis; destruction of T. pallidum, manifested by swelling and lysis of the organisms, occurs within phagocytic vacuoles. We conclude that removal of organisms during the reactive stage of experimental syphilis is accomplished by phagocytosis and digestion of organisms by macrophages, resulting from a delayed hypersensitivity reaction initiated by specifically sensitized T cells. The presence of amorphous "ground substance" material does not block the inflammatory response and inhibits neither phagocytosis nor digestion by macrophages.
A rare disease of orchitis granulomatosa is presented. The patient was 38 years of age, which is below the average age. The classification into an acute or chronic and the clinical features for an acute course. The differential diagnosis of tumour of the testis or tuberculosis must be considered. Orchiectomy is the therapy of choice. The etiology is not clear. Urinary tract infections, caused by bacteria or fungis, and immunological causes are discussed.