肾癌与血管平滑肌脂肪瘤的谐波超声造影研究

目的 分析肾癌与血管平滑肌脂肪瘤谐波超声造影的强化形式和时间一强度曲线参数特征. 方法 前瞻性分析.肾癌47例(47个)、血管平滑肌脂肪瘤10例(11个)的谐波超声造影表现及时间强度曲线参数,比较2组强化形式及强化参数差异. 结果 ①27例(57.4%)肾癌高回声,39例(83.0%)彩色多普勒超声显示周边环绕血流或周边向内穿入血流与环绕血流混合;血管平滑肌脂肪瘤为高回声6例(54.5%),3例(27.3%)显示周边环绕血流或周边向内穿入血流与环绕血流混合.②39例(83.0%)肾癌谐波超声造影为高或等增强;血管半滑肌脂肪瘤9例(81.8%))为低增强,2组比较差异有统计学意义(P<0.01).③肾癌峰值强化时间(PT)、廓清时间(WT)、强化程度(△A,峰值强化与基础回声强度之差)、相对强化倍数(△AT/R,肿瘤强化程度与肾皮质强化程度之比)、时间一强度曲线的斜率(k)、相对血流最(△A·k,强化程度与斜率的乘积)分别为(22.65±8.78)s,(206.16±65.94)s,(14.94±6.14)dB,(1.28±0.64)dB,0.29±0.14,4.36±2.62;血管平滑肌脂肪瘤分别为(35.87±16.16)s,(150.03±61.08)s,(8.94±7.87)dB,(0.61±0.37)dB,0.17±0.07,2.06±1.02.2组参数比较差异均有统计学意义,P值均<0.05. 结论 谐波超声造影对肾癌与血管平滑肌脂肪瘤的鉴别有临床应用价值,前者以高或等增强为主,后者以低增强为主;时间一强度曲线参数也有助于二者的鉴别.     

Testicular torsion: a review

Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion is an acute vascular event causing the rotation of the vascular pedicle of the testis, thereby impeding the blood flow to the testis and the scrotal contents. It could be either within or outside the tunica vaginalis. Testicular torsion causes immediate circulatory changes and long-term sequelae such as testicular function and fertility. It is considered a surgical emergency, as a delay causes irreversible testicular damage. The diagnosis and treatment of testicular torsion are discussed in this review, which also illustrates an algorithm and a scoring system for the diagnosis and management of this condition based on current literature.     

Testicular torsion: Nigerian experience

The records of 80 patients at this institution diagnosed as having testicular torsion during a 5-year period were examined to establish the characteristics and peculiarities, if any, of the disease in Nigeria. There were 74 suitable cases. Similar symptoms and physical signs were identified in Nigeria as have occurred elsewhere. However, contrary to reports from Europe and America the majority (57 per cent) of the patients with testicular torsion in this study were 20 or more years old. Also, torsion occurred significantly more often (9 per cent) in men 30 or more years old than has been reported in other areas. Only 5 per cent of the patients were less than 10 years old. There is no ready explanation why testicular torsion becomes manifest during adulthood in Nigeria. The testes were explored in 73 cases. Of the testes 25 per cent could not be salvaged because of infarction with acute torsion. However, the immediate testicular salvage rate of 75 per cent does not necessarily ensure long-term normal exocrine and endocrine testicular function.     

Testicular torsion after orchiopexy

We report 2 cases of testicular torsion after orchiopexy, which is rare but potentially catastrophic. A review of the literature revealed that absorbable suture was used in 15 of 16 cases of recurrent torsion. We conclude that the tunica albuginea should be secured to the scrotal wall with several nonabsorbable sutures to pex the testes permanently.     

Testicular function after torsion

A group of 20 patients with torsion was investigated. The study indicated that immediate surgical intervention with a period of torsion of the testis of less than 6 h will prevent impairment of testicle function. The histology of testicular biopsies taken from such patients revealed only interstitial oedema and, at the most, partial necrosis. If torsion time exceeded 6 h testicular histology revealed severe alterations, and surgical correction could not prevent atrophy of the testis. Patients with pathological spermiograms showed FSH values over or at the upper limit of the normal range. As far as can be concluded from one single basal hormone determination, the testosterone secretion remained unaltered. Libido, potency and virilization remained normal.     

Testicular torsion in children

The observations of 40 children with testicle torsion have shown results of the surgical treatment to depend not only on duration of the postoperative period but also on the degree of torsion and anatomical peculiarities of the spermatic cord. The preserved during operation testicle where non-recognized irreversible lesions have already occurred due to torsion can in later period result in the appearance of antisperm antibodies and threat of a lesion of the contralateral testicle.     

Usefulness of power Doppler ultrasonography in evaluating erectile dysfunction

OBJECTIVE: To evaluate deep penile arterial flow after an intracavernosal injection with papaverine in patients with erectile dysfunction (ED). PATIENTS AND METHODS: Twenty patients with ED were evaluated using power Doppler ultrasonography with a linear probe (8 MHz). Diagnostic tests were undertaken after an intracavernosal injection with 40 mg papaverine. The peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) were analysed. RESULTS: After injecting papaverine, seven patients had a normal erection and appropriate waveform patterns; their mean PSV was 30.7 cm/s, the EDV 4.42 cm/s and the RI 0.85. There was tumescence and elongation of the penis with no rigidity in eight patients; their mean PSV was 23.9 cm/s, the EDV 7.34 cm/s and the RI 0.72. There was no erection in five patients. The abnormal flow values showed insufficient arterial vessels in a quarter of the men, venous leakage in 15% and mixed ED in 20%. CONCLUSION: The power Doppler technique allows the accurate location and evaluation of deep penile arteries. Vascular pathology may be differentiated after an intracavernosal injection with a vasomotor agent. Recognising the pathological pattern assists in choosing the best method of treatment.     

Testicular torsion: time is the enemy

BACKGROUND: The acute scrotum is a diagnostic dilemma, and testicular torsion is of primary interest because of its fertility problems for the patient and medico-legal issues for the surgeon. The present study aimed to correlate operative findings of patients with suspected testicular torsion with certain clinical variables and investigations to see if diagnosis and outcome could be improved. METHODS: A total of 99 patients underwent scrotal exploration for suspected testicular torsion at the Royal Brisbane Hospital between 1990 and 1995. Colour Doppler ultrasound, white blood count and urine microscopy results were documented, along with the patient's age and duration of testicular pain. RESULTS: Fifty-six patients were found to have torsion, and the testicular loss rate was 23%. Patients who experienced testicular pain for longer than 12 h had a testicular loss rate of 67%. A negative urine microscopy was suggestive of testicular torsion, but was not diagnostic. The white blood count did not aid in the diagnosis. Colour Doppler ultrasound of the scrotum was used on nine occasions with three false negative results and a sensitivity of only 57%. CONCLUSIONS: Time is the enemy when managing the acute scrotum. No investigation substantially improves clinical diagnosis enough to warrant any delay in definitive surgical intervention.     

Testicular torsion: Evaluation of contralateral testicular histology

Infertility may occur in patients with unilateral testicular torsion whose contralateral testis is intact. Depending on this observation, the physicians have begun to examine the contralateral testis. In the present prospective study we aimed to examine the histopathologic alterations occurring in the contralateral testicle with time. Sixty adult male albino rats were included in the programme, and following experimental torsion the histopathologic findings, especially those in the contralateral testis, were evaluated after 4–12 weeks. Long-term and high degree torsion of the testicle led to varying degrees of deterioration in the germinal epithelium and interstitial cells of the contralateral testicle. Histopathologic alterations were reversed in 12 weeks. Tubular diameter and testicular volume also decreased in accordance with the histopathologic alteration. In our opinion, orchiectomy following torsion of one testicle will limit potential histopathologic alterations in the contralateral testicle.     

Testicular salvage following spermatic cord torsion

There have been several reports indicating that men who have suffered from spermatic cord torsion are likely to have abnormal seminal analyses. It is now well recognized that unilateral spermatic cord torsion can result in contralateral testicular damage. This study was instituted to evaluate possible methods of preventing post-torsion contralateral testicular damage. Experimental torsion was produced in 250 g Wistar rats. The duration of torsion was either 3, 6, or 24 hours. The rats were then treated by one of three methods, namely, detorsion, immediate ipsilateral orchidectomy, or detorsion and adjuvant immunotherapy. Contralateral testicular damage was prevented by immediate ipsilateral orchidectomy and by detorsion with adjuvant immunotherapy. The immunotherapeutic agents administered were either hydrocortisone, azathioprine, or cyclosporin A. The results strongly support the premise that detorsion with adjuvant immunotherapy results in salvage of the ipsilateral testis while preventing contralateral testicular damage. Hydrocortisone is the immunotherapeutic agent of choice because its administration was associated with the fewest complications.