Testicular Asymmetry and Adolescent Varicoceles Managed Expectantly
ABSTRACT Adolescent varicocele is often associated with testicular asymmetry. Depending on the degree of asymmetry, some physicians will recommend surgery. However, given the possibility that asynchronous growth may be transient, others advocate for a period of observation. We reviewed our outcomes in such patients who were initially treated expectantly.
We retrospectively reviewed our pediatric varicocele database. We analyzed the outcomes of patients presenting for evaluation of varicocele who were followed with serial testicular volume measurements using scrotal ultrasound or ring orchidometry and who had at least a 6-month interval between measurements. Fisher's exact test was used to compare groups based on initial and final testicular asymmetry.
We identified 181 patients (median age 13.8 years) who were followed expectantly. Serial volume measurements had been obtained at a median interval of 12 months (interquartile range 8 to 21) between first and most recent visits. Mean percent asymmetry for the group did not change with time. Among patients who initially had less than 20% asymmetry 35% had 20% or greater asymmetry on followup, and among those with 20% or greater asymmetry initially 53% remained in that range (p = 0.007).
Asymmetry can be a transient phenomenon. Patients with initial asymmetry can end up with significant asymmetry, and many with significant asymmetry can have catch-up growth. However, when patients have a peak retrograde flow of 38 cm per second or greater on duplex Doppler ultrasound in association with 20% or greater asymmetry spontaneous catch-up growth is unlikely to occur.
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ABSTRACT: As part of its electricity reform and privatisation, Argentina developed a distinctive policy on transmission expansion. Market participants, rather than the transmission company or the regulator, would determine expansions. The implementation of this policy proved controversial, particularly the Area of Influence method. This paper explains why and how it was decided to adopt the policy. The aim was to avoid the inefficiencies and over-expansions of the state-owned era, caused partly by regulation. The solution was to introduce competition wherever possible and to minimise the role for regulation. The existing transmission system contained several separate but co-ordinated transmission networks, and new ones could be encouraged. Competition was viable for the construction and operation of transmission expansions. Users would have the incentive to propose and approve economic expansions. The Area of Influence method to allocate costs and votes was not only pragmatic, to take advantage of the existing program for system control. It was also designed to limit the scope for subjective and unpredictable regulatory judgements. The policy represents a practical way of dealing with governance problems in weak institutional systems.
Conference Paper: Impurities in IBAD processes[Show abstract] [Hide abstract]
ABSTRACT: Impurities in IBAD processes were discussed using radioactivation analysis with thermal neutrons. IBAD processes are useful for hard coatings. In this process, an ion source without a mass separator is normally used. So, contamination by filaments and electrodes is possible but had not been considered. We then studied impurities in Si films deposited with simultaneous Ar or N<sub>2</sub> ion beam irradiation. The samples were activated by thermal neutron irradiation in a reactor to detect γ-ray emission. It was revealed that the electrode contaminated the film but the filament did not. It was also revealed that the atmosphere in the process was contained in the film. Impurities with vapor pressure were reduced with an ion irradiationIon Implantation Technology Proceedings, 1998 International Conference on; 01/2000
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ABSTRACT: The management of adolescent varicocele has evolved over the last 30 years. This article briefly reviews some of the current issues regarding the adolescent varicocele, including (a) the progressive nature of the adolescent varicocele, (b) the degree of asymmetry that necessitates surgery, (c) the wide variability in percentage of repairs performed bilaterally in published adolescent series, and (d) the choice of surgical procedure to be performed.F1000 Medicine Reports 04/2010; 2(1, article 25). DOI:10.3410/M2-25