The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort.

INTRODUCTION: Recent studies in other European countries suggest that the prevalence of congenital cryptorchidism continues to increase. This study aimed to explore the prevalence and natural history of congenital cryptorchidism in a UK centre. METHODS: Between October 2001 and July 2008, 784 male infants were born in the prospective Cambridge Baby Growth Study. 742 infants were examined by trained research nurses at birth; testicular position was assessed using standard techniques. Follow-up assessments were completed at ages 3, 12, 18 and 24 months in 615, 462, 393 and 326 infants, respectively. RESULTS: The prevalence of cryptorchidism at birth was 5.9% (95% CI 4.4% to 7.9%). Congenital cryptorchidism was associated with earlier gestational age (p<0.001), lower birth weight (p<0.001), birth length (p<0.001) and shorter penile length at birth (p<0.0001) compared with other infants, but normal size after age 3 months. The prevalence of cryptorchidism declined to 2.4% at 3 months, but unexpectedly rose again to 6.7% at 12 months as a result of new cases. The cumulative incidence of "acquired cryptorchidism" by age 24 months was 7.0% and these cases had shorter penile length during infancy than other infants (p = 0.003). CONCLUSIONS: The prevalence of congenital cryptorchidism was higher than earlier estimates in UK populations. Furthermore, this study for the first time describes acquired cryptorchidism or "ascending testis" as a common entity in male infants, which is possibly associated with reduced early postnatal androgen activity.

FATIGUE CRACK GROWTH - THE COMPLICATIONS.

A vast body of experimental data has been accumulated on the constant amplitude crack growth response of structural metals in moist laboratory air. Usually the data is presented as plots of crack growth rate, da/dN, against stress intensity range, DELTA K. In order to extrapolate this data to fatigue crack growth in more active or more inert environments, to crack growth under variable amplitude loading, or to crack growth under multi-axial or mixed mode loading, the mechanisms of crack advance and crack closure should be considered. This paper briefly reviews the crack closure phenomenon and discusses the dominant causes of accelerated and retarded growth under changes in environment or type of loading. It is argued that simple constant amplitude data is often surprisingly accurate when used to predict crack growth in more complex situations. However, there are some cases where constant amplitude data lead to dangerously non-conservative predictions of fatigue life.