1993;92;44PediatricsA. Bodian and Ian R. Holzman

Gertrud S. Berkowitz, Robert H. Lapinski, Jacqueline G. Gazella, Stephen E. Dolgin, CarolPrevalence and Natural History of Cryptorchidism

  

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Prevalence and Natural History of Cryptorchidism

44 PEDIATRICS Vol. 92 No. I July 1993

Gertnud S. Berkowitz, PhD*�; Robert H. Lapinski, PhD*; Stephen E. Dolgin, MD�;Jacqueline C. Gazella, RN, MS*; Carol A. Bodian, DrPH(I; and Ian R. Holzman, MD�IJ

ABSTRACT. Objective. A prospective hospital-basedcohort study was conducted to determine the prevalencerates of cryptorchidism at birth, 3 months, and 1 year ofage.

Design. A total of 6935 consecutive male neonates de-livered at Mount Sinai Hospital in New York City be-tween October 1987 and October 1990 were examined atbirth for cryptorchidism. Standardized examination andclassification criteria were used. Infants classified ascryptorchid at birth were reexamined at 3 months and 1year after the expected date of delivery.

Results. Of 6935 neonates assessed at birth, 255(3.7%)were found to be cryptorchid at birth. The rates weresignificantly elevated for low birth weight, preterm,small-for-gestational age, and twin neonates. The overallrate had declined to 1.0% by the 3-month assessment and1.1% at the 1-year assessment. Although the rates at the1-year assessment tended to be higher for low birthweight and preterm infants, no significant group differ-ences were observed.

Conclusions. Since the prevalence rates in this studyare similar to those reported several decades ago, thesedata provide no evidence that the rate of cryptorchidismhas increased either at birth or by 1 year of age. Further-more, most testes that descend spontaneously do sowithin the first 3 months after the expected date of de-livery� Pediatrics 1993;92:44-49; cryptorchism, prevalence,birth weight, gestational age.

ABBREVIATIONS. SGA, small for gestational age; LGA, large forgestational age; AGA, appropriate for gestational age.

Cnyptonchidism represents the most common dis-order of sexual differentiation in males.’ In additionto its potentially adverse effect on subsequent fertil-ity,2 cryptorchidism is the major known risk factorfor testicular cancer.29

Scorer,’#{176}on the basis of a cohort study of some3600 infants in London in the late 1950s, found thatthe prevalence rate of undescended testis was 0.8% atthe age of I year. However, a recent report from GreatBritain concluded that the orchidopexy rate mayhave doubled during the past couple of decades.’1 Inaddition, a study by the John Radcliffe HospitalCryptorchidism Study Group’2’13 of some 7400 in-fants born in Oxford between November 1984 andNovember 1988 indicates an increase in the fre-quency of undescended testes compared with that

From the Departments of wObstetrics, Gynecology and Reproductive Sri-ence; �Community Medicine; §Surgery; IlBiomathematical Sciences; and#{182}Pediatrics, The Mount Sinai School of Medicine, New York, NY.

Received for publication Nov 25, 1992; accepted Feb 1, 1993.

PEDIATRICS (ISSN 0031 4005). Copyright © 1993 by the American Acad-

emy of Pediatrics.

found by Sconer. The incidence rate of testicular can-cer has also risen in northern Europe and amongwhites in the United States,6”4 and the age-specificincidence curve for testicular cancer has shifteddownward so that the peak is now among the 25-through 34-year age group.6 While it is not knownwhether cryptorchidism represents an independentrisk factor for testicular cancer or whether both dis-orders have a common cause, the reported increasesin both conditions are of concern.

Since there are no recent data on the prevalencerate of cryptorchidism in the United States, this studywas undertaken to provide current estimates of theprevalence rates and to evaluate potential risk factorsfor this condition. In addition, information on theapproximate timing of spontaneous descent wassought in light of the recent trend toward performingonchidopexies at younger ages. In this report wepresent the prevalence rates of cryptorchidism atbirth, 3 months, and I year of age from a hospital-based cohort study conducted in New York City.

MATERIALS AND METHODS

The study population was drawn from all male singleton andtwin neonates delivered at Mount Sinai Hospital in New York Cityduring the period October 2, 1987, through October 1, 1990. Ap-

proximately 67% of the patients are delivered on the private ser-vice and 33% on the clinic service. Our population is also racially

and ethnically heterogeneous, with approximately 52% of themothers classified as white, 23% as Hispanic, 18% as black, 6% asOriental, and 1% as belonging to another racial/ethnic group.

Excluded from the study were multiple gestations of triplets orhigher order births, but infants with congenital abnormalities wereincluded. This study was approved by the Institutional ReviewBoard of our institution, and informed consent was obtained from

the mothers.Of 7491 boys born during the study period, 6936 (92.6%) were

examined at birth. The remaining 555 were not examined becausethe mother refused to participate (n = 247), the mother was dis-

charged before she could be approached (n = 161), the infant diedduring the neonatal period (n = 37), or because of other reasons,such as the mother did not speak English or Spanish, the newbornwas placed for adoption, or the mother was very ill or mentallyunstable (n = 110). In addition, one infant who was classified ascryptorchid at birth was later found, at the time of surgery, to havean absent testis. This infant was excluded from the study. None ofthe infants had ambiguous genitalia. The final study population

comprised 6935 infants.Either of two specially trained nurses examined 91.0% of all the

neonates. The remaining 622 neonates were examined by anothermember of our study team who had received standardized train-

ing in performing the testicular measurements. The neonates ad-

mitted to the well-baby nursery were examined generally duringthe first 48 hours of life. Neonates admitted to the newborn specialcare unit were examined as soon after birth as their medical con-dition permitted.

We used the same examination technique and definition ofundescended testis as used by Scorer’#{176}and the John RadcliffeHospital Cryptorchidism Study Group.’2’#{176}3Specifically, a testis

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ARTICLES 45

was classified as undescended if the center of the testis was lessthan 4 cm below the pubic tubercle at the birth examination for a

neonate weighing 2500 g or more, and less than 2.5 cm for a babyweighing less than 2500 g. The measurement was made after

gently manipulating the testis into the lowest position along thepathway of normal descent. The location of the undescended testiswas classified as high scrotal, at the external ring, inguinal canal,

abdominal, ectopic, or nonpalpable. We defined a retractile testis

as one that could easily be manipulated into the scrotum and thatwould remain in the scrotum at least momentarily.

Follow-up examinations for infants found to be cryptorchid at

birth were scheduled for 3 months and I year after the expected

date of delivery to allow for the shorter gestational period ofpreterm infants. If the center of a testis was less than 4 cm belowthe pubic tubercle at follow-up, it was classified as undescended.Of the 255 infants diagnosed as cryptorchid at birth, 209 (82.0%)

were examined at approximately 3 months of age and 218 (85.5%)were examined at approximately 1 year of age. A total of 197infants were examined both at the 3-month and 1-year assess-

ments. Orchidopexies were performed on 6 infants before the

1-year assessment; all 6 cases were classified at the time of the

operation as undescended. The 3-month assessment could not becompleted on 46 infants for the following reasons: infant death

(n = 8); refused follow-up (n = 10); and could not be located

despite numerous attempts to trace the infant (n = 28). The 1-year

examination could not be completed on 37 infants for the follow-ing reasons: infant death (n = 8); refused follow-up (n = 12); and

could not be located (n = 17). If the family had left the New YorkCity area but could be located or our study team was unable toperform the follow-up assessment, the infant’s pediatrician was

asked to perform the measurements after having received detailedand graphic instructions on how to conduct the examination. As aresult, 30 infants were examined by their pediatrician at 3 monthsand 21 infants at I year of age.

Prevalence rates and 95% confidence intervals were calculatedat birth, 3 months, and I year of age for all infants combined aswell as by birth weight, gestational age, birth weight percentile forgestational age, and type of gestation (singleton vs twin). Birthweight was classified as less than 2500 g (low birth weight) and2500 g or more. Gestational age was categorized as less than 37weeks (preterm) and 37 or more completed weeks of gestation

(term). Gestational age was assigned according to menstrual his-

tory in conjunction with ultrasonographic assessment, if available.

If these estimates differed by 2 weeks or less, the gestational age bythe last menstrual period was assumed to be correct. If the lastmenstrual period was unreliable or the discrepancy between men-

strual and ultrasonographic gestational age was greater than 2

weeks, the gestational age was based on the ultrasonographic

assessment. Small for gestational age (SGA) was defined as a birth

weight less than 10th percentile and large for gestational age

(LGA) as a birth weight greater than 90th percentile for gestationalage based on the nomogram by Brenner et al.’5

To adjust for the infants lost to follow-up, the 3-month and

I -year prevalence rates were corrected for the number of infants

assessed at the follow-up examinations. The variance of the fol-low-up prevalence rates was estimated by the method of statisticaldifferentials in a manner similar to the derivation of Greenwood’s

formula for the variance of a survival probability.’6 The equationsfor calculating the follow-up prevalence rates and 95% confidence

intervals are available from the authors. All prevalence rates areexpressed as percentages. The prevalence rates at follow-up arebased on the assumption that testes classified as descended atbirth would remain descended.

The �‘ test or Fisher’s Exact Test was used to assess the statis-tical significance of binomial proportions in 2 X 2 tables. Differ-

ences between prevalence rates at follow-up were evaluated by az test constructed the same way as the test for comparing twoindependent life-table survival estimates.’7 Mantel-Haenszel x�was used to assess trends for proportions.’8 Logistic regression

analysis was used to control for birth weight or gestational age in

assessing the risk of cryptorchidism for singleton and twin gesta-tions. A P value < .05 was considered significant.

RESULTS

At birth 255 (3.68%) of the 6935 neonates examinedwere cryptorchid. Of these, 115 had bilateral unde-scended testes and 140 had a unilateral undescendedtestis. Among the unilateral cases, the undescendedtestis was on the left side in 72 neonates and on theright side in 68 neonates. There were 11 neonateswith hypospadias, two of which were cryptorchid.

Table 1 presents the prevalence rates of cnyp-torchidism at birth according to birth weight, gesta-tional age, birth weight percentile according togestational age, and singleton vs twin gestations.The prevalence rate for low birth weight newborns(19.83%) was significantly higher than for thoseweighing 2500 g or more (2.22%, P < .001). Similarly,the rate was higher for preterm deliveries (17.24%) asopposed to term deliveries (2.08%, P < .001). Whenbirth weight and gestational age were analyzed as

TABLE 1. Prevalence Rates of Cryptorchidis m at Birth and 95% Co nfidence Intervals Acc ording to Selected Perinata 1 Characteristics*

Characteristic No. No. Prevalence 95% Confidence P ValueExamined Cryptorchid Rate, % Interval

Birth weight<2500 g 575 114 19.83 16.57-23.08

<.001

�2500 g 6360 141 2.22 1.86-2.58

Gestational age<37.0 wk 731 126 17.24 14.50-19.97

<.001

�37.0 wk 6204 129 2.08 1.72-2.43

SGA 439 33 7.52 5.05-9.98

AGA 5621 207 3.68 3.19-4.17 <.OOlt

LGA 875 15 1.71 0.85-2.57

Singleton 6699 231 3.45 3.01-3.89<.001

Twin 236 24 10.17 6.31-14.03

Total 6935 255 3.68 3.23-4.12

* SCA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age.

t Mantel-Haenszel x�test for trend.

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46 CRYVTORCHIDISM

continuous variables, there was also a significant in-crease in the frequency of cryptorchidism with eitherdecreasing birth weight (P = .0001) or decreasing

gestational age (P = .0001). The rate was higher forSGA neonates (7.52%) compared with appropriate-for-gestational-age (AGA) neonates (3.68%) and LGAneonates (1 .71 %, test for trend, P < .001). Neonates

born of twin gestations had an elevated rate com-pared with singleton neonates (10.17% vs 3.45%, P <

.001). However, the higher rate for the twins couldlargely be explained by their lower birth weight aslogistic regression analysis controlling for birthweight showed no significant increase in the risk ofcryptorchidism for twin compared with singletongestations (adjusted odds ratio = 1 .38; 95% confi-dence interval, 0.84, 2.26). A similar result was ob-tamed when adjustment was made for gestationalage.

At 3 months of age, 57 (27.3%) of the 209 infantsexamined remained cryptorchid, yielding an overallprevalence rate of I .0% (Table 2). The rate declined toI .94% for infants weighing less than 2500 g at birthand to 0.91% for those weighing 2500 g or more.Although the rate remained higher for the formerinfants, the difference was not significant. The3-month rate for preterm infants was 2.03%, com-pared with 0.87% for term deliveries. This differencewas of borderline significance (P .05). The rate wasalso higher for SGA infants (1 .50%) than for AGA(1.01%) and LGA infants (0.66%), but none of thecomparisons were significant. None of the twin in-fants who were examined at 3 months of age hadremained cryptorchid.

At I year of age, 63 (28.9%) of the 218 infantsexamined were classified as cryptorchid (Table 3).The overall prevalence rate at I year (1 .06%) wasvery similar to that at 3 months of age (1.00%).

Among the 197 infants who had been examined both

at 3 months and I year of age, the testes were de-scended at both follow-up assessments in 134 infants,one or both testes remained undescended in 49 in-fants, 7 infants had an undescended testis at 3months of age that had descended by I year of age,

and another 7 infants were classified as having de-scended testes at 3 months of age but had an unde-scended testis at I year of age.

Spontaneous descent between 3 months and I yearwas significantly more common among preterm thanterm infants (P = .03). Spontaneous descent alsotended to be more common among low birth weightinfants (P = .07) and among SGA infants (P = .11).All five LGA infants who were cryptorchid at the3-month assessment remained cryptorchid at the1-year assessment.

It may be seen that the rate at I year of age tendedto be higher for infants weighing less than 2500 g(1.94%) than for those weighing 2500 g or more(0.95%), but this difference was not significant. How-ever, the test for trend with birth weight as a contin-uous variable was significant (P = .038). Similarly,the rates tended to be higher for infants deliveredbefore 37 weeks (1.86%) than for those delivered at 37weeks of gestation or later (0.93%). Those who wereclassified as SGA also had a higher rate (1 .5%) thanthose who were AGA (1.08%) or LGA (0.66%), butthese differences were not significant. As was true forthe 3-month assessment, none of the twin infants hadan undescended testis at 1-year of age.

Of the 63 infants classified as cryptorchid at I yearof age, 32 had a unilateral left undescended testis, 25had a unilateral right undescended testis, and 6 hadbilateral undescended testes. With regard to the lo-cation of the unilateral cryptorchid testis, 4 were clas-sified as high scrotal, 7 were at the external ring, 20

TABLE 2. Prevalence Rates of Cryptorchidism at 3 Months of Age and 95% Confidence Intervals According to Selected PerinatalCharacteristics*

Characteristic Follow-up at 3 Months of Age

No. No. Prevalence 95% Confidence

Examined Cryptorchid Rate, % , Interval P Value

Birth weight

<2500 g 92 9 1.94 0.69-3.18

.11�2500 g 117 48 0.91 0.66-1.16

Gestational age

<37.0 wk 102 12 2.03 0.90-3.15

.05

�37.0 wk 107 45 0.87 0.63-1.12

SGA 25 5 1.50 0.23-2.78 .46t

AGA 171 47 1.01 0.73-1.29 .271

LGA 13 5 0.66 0.10-1.22.

Singleton 191 57 1.03 0.77-1.29

Twin 18 0 0.00 ...

Total 209 57 1.00 0.75-1.26

* SGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age.

t P value based on the comparison between SCA and AGA infants.

I P value based on the comparison between AGA and LGA infants.

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ARTICLES 47

TABLE 3. Prevalence Rates of Cryptorchidism at I Year of Age and 95% Confidence Intervals AccordingCharacteristics*

to Selected Perinatal

Characteristic Follow-up at 1 Year of Age

No. No. Prevalence 95% Confidence

Examined Cryptorchid Rate, % Interval P Value

Birth weight<2500 g 92 9 1.94 0.69-3.18

.13

�2500 g 126 54 0.95 0.70-1.20

Gestational age

<37.0 wk 102 11 1.86 0.78-2.94

.10�37.0 wk 116 52 0.93 0.69-1.18

SGA 25 5 1 .50 0.23-2.78 .53+

AGA 180 53 1.08 0.80-1.37 .191

LGA 13 5 0.66 0.10-1.22

Singleton 202 63 1 .08 0.82-1.33

Twin 16 0 0.00 ...

Total 218 63 1 .06 0.81-1.32

* SGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age.

t P value based on the comparison between SCA and AGA infants.

I P value based on the comparison between AGA and LGA infants.

were inguinal, 4 were abdominal, and 14 were non-palpable. The location of the undescended testis wasnot noted in 8 infants.

Two cryptorchid infants had a known inheritablecondition. In one with Klinefelter syndrome, the tes-tes descended by 3 months of age while in the otherwith centnonuclear myopathy, the testes did not de-scend.

DISCUSSION

Our findings indicate that 3.7% of the infants werecryptorchid at birth but that only about I % wereclassified as cryptorchid at the 3-month and 1-yearassessments. Thus, approximately 70% of those cnyp-

tonchid at birth experienced spontaneous descent bythe age of 1. Furthermore, since only 7 infants expe-rienced descent between the 3-month and 1-year as-sessment, these data show that most spontaneousdescent occurs within 3 months of the expected dateof delivery.

TABLE 4. Comparison of Prevalence Rates of Cat Birth, 3 Months of Age, and I Year of Age

ryptorchidism

Birth Prevalence, %Weight, Scorer’#{176} John Radcliffe

g (n = 3612) Hospital’3Assessment (n = 7400)

Mount SinaiHospital

(n = 6935)

At birth <2500 21.00 22.83 19.83�2500 2.70 4.08 2.22

Overall 4.30 5.01 3.68At 3 mo <2500 1.71 5.16 1.94

�2500 0.91 1.61 0.91Overall 0.97 1.78 1.00

Atly <2500 1.67 #{149}#{149}#{149}*

�2500 0.69 . . .�

1.940.95

Overall 0.78 . . .� 1.06

* Rates not available.

At birth the prevalence rates were substantiallyelevated for low birth weight neonates, preterm ne-

onates, SGA neonates, and twins. By 3 months of age,only preterm as opposed to term infants had a mar-ginally elevated rate and by I year of age no signif-icant differences were observed, although there wassome suggestion that the rates were higher for pre-

term and low birth weight infants. While none of thetwin infants had an undescended testis at either the3-month or 1-year assessment, the number of twins

was small, and thus any estimate of the prevalencerate would be unstable.

Table 4 presents a comparison of our figures withthose of Scorer’#{176}and the Oxford study by the JohnRadcliffe Hospital Cryptorchidism Study Group,’3 aswe attempted to reproduce the study techniques andcase definition that were used in these two studies. Itmay be seen that our figures are very similar to thoseof Scorer but lower than those obtained in the recentJohn Radcliffe Hospital study. The discrepancy be-tween our study and that from the John Radcliffe

Hospital appears to be particularly marked at birthfor neonates weighing 2500 g or more, but at 3months the difference is more marked for the lowbirth weight infants. Our figures for the 1-year as-sessment are only slightly higher than those reportedby Scorer. Since there were a few cases of reascent inour study and since Scorer did not follow-up infantswho experienced spontaneous descent after the de-

scent had occurred, this may explain the slight dif-fenences in our rates. Similar to our findings, Scorernoted that two thirds of the cryptorchid testes ininfants weighing 2500 g or more at birth had de-scended within 3 months and only a few descendedbetween 3 months and 9 months of age. Among in-fants weighing less than 2500 g at birth in Scorer’s

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48 CRYPTORCHIDISM

study, all testes that descended spontaneously did sowithin the first 3 months. In our investigation, threeinfants whose birth weight was less than 2500 g hada spontaneous descent between 3 months and I yearof age. No published information is available on therates of cryptorchidism at I year of age from the JohnRadcliffe Hospital study.

Estimates of the prevalence rates of cryptorchidism

from other studies are less comparable. Matlai andBeral’9 have reported a rate of less than 0.2% for 1983for England and Wales, but this was based on a con-genital malformation registry. Hjertkvist et al,2#{176}us-ing a national birth registry in Sweden for the period1973 to 1982, estimated that 0.5% of 1-year-old boyswere cryptorchid. Since reporting of minor malfor-

mations is often inaccurate, these are undoubtedlyunderestimates. In a study by Buemann et al2’ dun-ing the 1950s in Sweden, the prevalence rate of un-descent at birth among neonates weighing more than2500 g was estimated to be somewhere between I %and 1.8%. Cour-Palais,22 who reexamined boys inwhom undescended testicles had been diagnosed ina survey in Middlesex, England, during the early1960s, found that a high proportion had retractiletestes and that the true rate of undescended testeswas 0.76% at age 5. Similarly, Baumrucker,23 whoinvestigated the position of the testis in 10 000 USarmy recruits between the ages of 18 and 37, reporteda rate of 0.8%. In contrast to these figures, a recentstudy from New Zealand24 reported that 4.1 % of 509boys examined at age 5 in school were cryptorchidand that 3.7% had had an orchidopexy by the age of9. An even higher estimate of undescended testicles

of 9.9% for infants weighing less than 1850 g at birthwas recently reported for 355 infants examined at 18months after the expected date of delivery in En-gland.25 However, it is not clear how an unde-

scended testicle was defined in most of these studies.The reason for the higher birth and 3-month rates

from the John Radcliffe Hospital CryptorchidismStudy Group’3 is not clear. Since the proportion oflow birth weight infants was actually higher in ourstudy, this would tend to inflate our overall figuresrelative to those in the Oxford study. While our studypopulation was racially and ethnically heteroge-neous, the Oxford study was limited to white infants.However, we observed no significant differences in

the race- or ethnicity-specific prevalence rates at 3months and I year of age (data not shown). Even ifwe were to make the unlikely assumption that allthose lost to follow-up at the 3 month assessmentwere cryptorchid, the overall rate at 3 months in ourstudy would increase only from 1.0% to 1.3%. Nor isthere any ready explanation for the report of a dou-bling in the orchidopexy rate in England and Walesfor the period 1962 through 1981.11 While the fre-quency of undescended testis at 3 months of age was1 .78% in the Oxford study, this is considerably lowerthan the estimated orchidopexy rate of 2.9% for the1977 birth cohort in England and Wales. The inves-tigators of the Oxford Study have suggested thatsurgery on boys who have retractile rather than trulyundescended testes may be one explanation for this

discrepancy or alternatively that the higher orchi-dopexy rates reflect late ascent of testes.12’13

The question why some testes may ascend afterspontaneous descent is still under debate. The inves-tigators of the John Radcliffe Hospital study’3 havereported that 71 of 187 infants with spontaneous de-scent during the first 3 months had testes that werenot fully descended (defined as well down in thescrotum) at 9 months. Atwell26 has described 10 pa-tients with ascent of the testis from the normal to anundescended position. Since nine of the patients hada complete hernial sac, Atwell has speculated thatascent may be due to partial absorption of the pro-cessus vaginalis into the parietal peritoneum. Atwellhas also suggested that alteration in the length of theinguinal canal with growth or measurement errormay represent alternative explanations. Robertson eta!27 have also reported that 3 of 10 boys in whom thetestis ascended were classified as having retractiletestes at the initial assessment. At the time of surgery�the testes were found to be held in a high positionbecause of surrounding adhesions. While we have nosurgical information on six of the seven patients in

our study whose testes ascended between the3-month and the 1-year assessment, four of the in-fants were observed to have retractile testes at the3-month assessment.

It should be noted that our prevalence rates aredrawn from a hospital-based cohort study and thusare not population-based. Furthermore, the estimatesat the follow-up assessments in our study as well asthose of Scorer1#{176}and the John Radcliffe HospitalCryptorchidism Study Group’3 are not true preva-lence rates, as only those infants who were cryp-torchid at birth received subsequent assessment.Nevertheless, since ascent of a testis that is de-scended at birth is rare, the estimates are probablyclose to the true prevalence rates. Infant deaths aswell as losses to follow-up, particularly in our study,may also affect the true rates. However, apart from aslightly lower follow-up rate for the SGA and thetwin infants, there was no evidence of differentialfollow-up according to the characteristics examinedin this study.

We conclude that the rate of cnyptorchidism at Iyear of age in our study population was approxi-mately I %, similar to estimates obtained several de-cades ago both in this country and in Europe.

ACKNOWLEDGMENTS

This study was supported by a research grant (CA 47053) from

the National Cancer Institute.This study would not have been possible without the help of

the mothers who allowed us to examine their babies and theped iatricians at Mount Sinai Hospital who gave us access to their

patients. We also acknowledge the invaluable contribution ofTheresa Sweeny, who conducted many of the testicular assess-ments.

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19. Matlai P, Beral V. Trends in congenital malformations of external geni-talia. Lancet. 1985;1:108

20. Hjertkvist M, Damber J-E, Bergh A. Cryptorchidism: a registry based

study in Sweden on some factors of possible aetiological importance. I

Epidemiol Community Health. 1989;43:324-32921. Buemann B, Henriksen H, Villumsen AL, Westh A, Zachau-Christiansen

B. Incidence of undescended testis in the newborn. Acta Chir Scand.

1%1;283(suppl):289-293

22. Cour-Palais IJ. Spontaneous descent of the testicle. Lancet. 1966;1:1403-

1405

23. Baumrucker GO. Incidence of testicular pathology. Bull US Army Med

Dept. 19465:312-314

24. Simpson AS, Laugesen M, Silva PA, Stewart C, WaltonJ. The prevalence

of retained testes in Dunedin. NZ Med J. 198598:758-760

25. Morley R, Lucas A. Undescended testes in low birthweight infants. Br

Med J. 1987;295:753

26. AtwellJD. Ascent of the testis: fact or fiction. BrJ Urol. 198557:474-477

27. Robertson JFR, Azmy AF, Cochran W. Assent to ascent of the testis. Br

I Urn!. 198861:146-147.

AIDS AND BLOOD TRANSFUSIONS

[Early in 19831, blood donated for transfusion or for the manufacture of otherblood products was subjected to two tests, one for syphilis and one for hepatitis B

surface antigen (HBsAg). Today, all blood is tested for antibodies to HIV-1 andHIV-2, antibodies to the hepatitis C virus (HCV, the causative agent for most

transfusion-transmitted hepatitis, formerly called non-A, non-B hepatitis), antibod-ies to human T cell lymphotropic viruses-types I and II (HTLV-I/II), antibodies tohepatitis B core antigen (HBcAg), and alanine aminotnansferase (ALT), as well as

syphilis and HBsAg. In addition, many units are tested for cytomegalovirus (CMV)antibodies. HBsAg, HTLV and CMV are spread in manners similar to HIV and thus

serve as potential markers for silent HIV infection. Syphilis testing may be used toindicate sexual promiscuity. In 1983, there were two tests; now, there are eight.

That the causative agent of AIDS could be transmitted by blood transfusions

gradually became recognized during 1982 when a transfusion in a pediatric patientwas implicated2 and AIDS emerged in hemophiiacs3...

.. .As of the end of 1991, only 18 adults and two pediatric cases ofAIDS acquired

from blood screened negative by the HIV-1-antibody test had been documented.’5

Since the introduction of the test in March 1985, more than 130,000,000 bloodcomponents have been transfused.

REFERENCES

2. Possible transfusion-acquired immune deficiency syndrome (AIDS)-California. MMWR. 198231:6523. Update on acquired immune deficiency syndrome (AIDS) among patients with hemophilia. MMWR. 198Z31:644

15. Cumming PD, Wallace EL, Schorr JB, Dodd RY. Exposure of patients to the human immunodeficiency virus

through the transfusion of blood components that test antibody-negative. N Engl J Med. 1989321:941

Zuck iT. The case of Arthur Ashe: that was then, this is now. The Journal ofNIH Research. 1992;4:99-101.

by J.F.L., MD

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1993;92;44PediatricsA. Bodian and Ian R. Holzman

Gertrud S. Berkowitz, Robert H. Lapinski, Jacqueline G. Gazella, Stephen E. Dolgin, CarolPrevalence and Natural History of Cryptorchidism

  

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