Management of cryptorchidism: a survey of clinical practice in Italy

<p>Abstract</p> <p>Background</p> <p>An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.</p> <p>Methods</p> <p>Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from <it>Associazione Culturale Pediatri </it>(ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.</p> <p>Results</p> <p>Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.</p> <p>Conclusions</p> <p>Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.</p

Investigating the particularities of regionalization:contested state–federal relations and the politics of Alaska’s Arctic Policy

Abstract This paper focuses on the particularities of a regionalization process by investigating how a supranational region emerges as a context of, and tool for, political contestation regarding power relations between a sub-national and national government. This is done through an empirical case study of the Arctic Policy of the State of Alaska. The analysis shows how the contested relationship between state and federal governments became re-contextualized in relation to the Arctic due to a newfound federal attention on the region. This culminated in how the Arctic region is perceived within the ‘Alaskan’ and federal contexts. Additionally, the case study shows that by attempting to transform how the Arctic is perceived within, and enacted through, the policies of the federal government, state actors in Alaska have sought to utilize federal attention on the region and exert an influence on federal policies that affect Alaska. This, in turn, has potential implications for the overall regionalization process of the Arctic itself. The paper contends that rather than de-constructing regionalization processes as wholes, by focusing on the particularities of these processes we can better understand the politics at play. This concurrently helps to illuminate how such politics may affect the trajectory of regionalization itself