Cauda Equina Lesions Associated with Ankylosing Spondylitis

by different observers by slightly different symptomatic measures, as well as in some cases by different antibiotics in addition to cortisone or A.C.T.H. administered by different routes in varying doses for varying periods -came to the conclusion that cortisone was beneficial in diminishing pain in and swelling of the testicle, when compared with a group, not necessarily equivalent, treated symptomatically only. However, in their properly controlled trial Klemola and Somer (1956) found an absence of the effect of steroids on the symptoms of orchitis similar to that in our study, but in their cases the temperature did remain raised for a little longer. Mongan's (1959) findings were similar. The fact that cortisone appeared to have no effect on the later history of the affected testicles which may be related to the duration of the original swelling agrees with its absence of effect on the latter. It was of interest to observe changes in testes not affected to our knowledge at any time by an acute process, and it would have been of great interest to examine the testicles of all the men in the depot on arrival and follow them up at intervals throughout the epidemic and after, whether or not they had had clinical mumps. Abnormality of liver-function tests was mentioned by Petersdorf and Bennett (1957), and some possible disturbance was found in 6 of our 11 patients in whom it was sought. These patients were selected only in so far as they were among the last 13 patients in our series. Finally, although no testicular biopsies or sperm counts were performed on these patients, it is hoped that they may all be followed up for some years so that further testicular changes and their effect may be observed. Summary and Conclusion During an epidemic of mumps in an Army depot all the 35 cases of orchitis were admitted to hospital and treated with bed rest and simple analgesics. Half, selected at random, were also given a six-day course of cortisone as described above. One case was later excluded because of the absence of serological evidence of mumps, which was present in the other 34 cases. All the patients were examined daily, and observations were charted on a previously prepared form by one of two observers. All the patients were seen again approximately three, five, and seven months later by one or other of the observers. The following observations were made: (1) At the time of the acute illness cortisone in the dosage administered had no statistically significant effect on the duration of the swelling, the pain, or the tenderness of the affected testicle, even in cases treated within 48 hours of onset. (2) In the cortisone-treated group the duration of the pyrexia was slightly reduced from a mean of 2.6 days to one of 1.1 days; this reduction was found to be statistically significant (P<0.01); the mode of termination of the pyrexia had no relation to treatment or to the sequelae. (3) Testicular degeneration, as evidenced by a loss of consistency and a decrease in size leading in some to complete atrophy, was found to be progressive for at least five months after the acute attack; it did not appear to have been influenced by previous cortisone therapy. (4) The ultimate state of the testicle some seven months after the acute attack did not appear to be related to the duration of the pain, the tenderness, or the pyrexia, but may perhaps have been influenced by the duration of the swelling at the time of the attack. (5) Cortisone appeared to depress the formation of complement-fixing antibody, but the level of the latter did not seem to be related to the symptoms, signs, or sequelae of the attack. (6) The serum globulin and thymol turbidity were slightly raised in 6 of the 11 patients in whom they were determined. It is thought that neither the previously reported cases nor the present trial show any evidence of the efficacy of steroids in the treatment of mumps epididymo-orchitis.