转移性附睾肿瘤误诊为附睾炎1例并文献复习

患者,男,62岁,主诉“右阴囊肿痛1周”,门诊行彩超提示右侧附睾肿大,可见丰富血流信号,双侧睾丸未见明显异常,考虑右侧附睾炎。门诊予抗感染治疗(头孢类抗生素,具体不详),症状缓解不明显,遂以“右侧附睾炎”于2016年5月24日收入院。查体：生命体征平稳,浅表淋巴结未及明显肿大,心肺未及明显异常,腹软,无压痛及反跳痛,双肾区无叩击痛,脊柱四肢活动正常,阴茎、阴囊发育正常,右侧阴囊较左侧稍肿大,右侧附睾明显肿大,触痛明显,与右睾丸分界不清,精索无明显增粗,指诊前列腺质地中等,未及明显结节。追问病史,患者半年前类似病史(右睾丸附睾炎)发作,在当地医院抗感染治疗后症状完全缓解。     

补肾祛湿中药联合多沙唑嗪治疗慢性附睾炎的临床研究

目的:了解补肾祛湿中药联合多沙唑嗪治疗慢性附睾炎的临床疗效。方法:64例慢性附睾炎患者随机均分为2组,每组32例。对照组仅服用多沙唑嗪,治疗组采用补肾祛湿中药联合多沙唑嗪治疗,每组患者接受药物治疗4周。使用慢性附睾炎症状指数评分表(CESI)、焦虑自评量表(SDS)、抑郁自评量表(SAS)等对治疗前后临床症状进行评估,并评价其疗效。结果:两组经治疗后,在CESI总均分、疼痛评分以及生活质量评分上皆有显著性改善(P<0.05);治疗组与对照组相比疗效更佳,差异有显著性(P<0.05)。治疗后两组患者在SAS及SDS评分上皆有显著性降低(P<0.05),但两组间比较无显著性差异(P>0.05)。结论:单独使用多沙唑嗪及补肾祛湿中药联合多沙唑嗪对慢性附睾炎皆有明显的临床疗效,但联合用药是一种更佳的治疗方法。     

醋酸泼尼松联合左氧氟沙星治疗Ⅲ型前列腺炎临床研究

目的:评价肾上腺皮质激素与抗生素联合用药治疗慢性非细菌性前列腺炎的有效性及耐受性。方法:采用随机、双盲、平行对照临床试验研究方法,通过Stamey试验、前列腺按摩液(EPS)常规及美国国立卫生研究院慢性前列腺炎症状评分(NIH-CPSI),筛选出160例慢性非细菌性前列腺炎患者,随机分为试验组(80例,脱落2例)和对照组(80例)。试验组前2周合用肾上腺皮质激素和左氧氟沙星,后2周单用左氧氟沙星,醋酸泼尼松片15mg/次,1次/d,口服,连续2周后停药;左氧氟沙星0.1mg/次,2次/d;对照组方法同上,仅将醋酸泼尼松片换为安慰剂。所有患者均行入组前、治疗第2周和第4周随访并行NIH-CPSI评分、EPS等检查及药物不良反应的评估。结果:治疗后2周和4周,试验组NIH-CPSI总分、疼痛评分、排尿评分和生活质量评分降低分别为(9.56±2.05)、(4.59±1.18)、(2.38±1.24)、(2.59±1.20)分和(11.72±2.41)、(5.51±1.42)、(2.92±1.17)、(3.33±1.08)分;对照组NIH-CPSI总分、疼痛评分、排尿评分和生活质量评分降低分别(6.53±2.70)、(3.20±1.30)、(1.40±1.05)、(1.80±1.15)分和(8.53±2.91)、(3.88±1.44)、(2.08±1.11)、(2.55±1.33)分。两组治疗前后的自身对比差异均有显著性(P<0.01);组间比较,试验组较对照组第2周和第4周NIH-CPSI总分、疼痛、排尿和生活质量评分差异均有显著性(P<0.01)。两组治疗前后EPS中WBC计数差异有显著性(P<0.01)。组间比较,试验组较对照组第2周和第4周WBC计数差异均有显著性(P<0.01)。对药物的耐受性差异无显著性(P>0.05),无严重不良反应事件发生。结论:泼尼松联合左氧氟沙星能更有效地缓解慢性非细菌性前列腺炎患者的疼痛不适症状和排尿症状、改善患者的生活质量和减少EPS中WBC,耐受性好,但长期疗效及耐受性尚待进一步的临床研究。     

舍尼通~和抗生素联合用药治疗慢性非细菌性前列腺炎临床研究

目的:评价舍尼通与抗生素联合用药治疗慢性非细菌性前列腺炎的有效性及耐受性。方法:采用双盲、平行对照、多中心临床试验研究方法,通过Stam ey试验、前列腺按摩液(EPS)常规及美国国立卫生院慢性前列腺炎症状评分(NIH-CPSI),筛选出160例慢性非细菌性前列腺炎患者,随机分为试验组(80例,脱落1例)和对照组(80例)。试验组前4周合用舍尼通和左氧氟沙星,后4周单用舍尼通,服用剂量为舍尼通2次/d,1片/次,左氧氟沙星2次/d,0.1 g/次;对照组方法同上,仅将舍尼通换为安慰剂。所有患者均行入组前、治疗第4周和第8周随访并行NIH-CPSI评分、EPS等检查及药物不良反应的评估。结果:治疗后4周和8周,试验组疼痛评分降低分别为3.34±2.45,4.33±3.13,排尿评分降低分别为2.22±1.79,2.77±2.04;对照组疼痛评分降低分别为2.28±2.42,3.30±3.29,排尿评分降低分别为1.24±1.67,1.83±2.25。两组治疗前后的自身对比均差异有显著性(P<0.01),生活质量影响评分差异也有显著性(P<0.05)。组间比较,试验组较对照组第4周和第8周疼痛和排尿评分差异均有显著性(P<0.01或P<0.05)。两组治疗前后白细胞、卵磷脂小体差异无显著性(P>0.05),对药物的耐受性差异无显著性(P>0.05),无严重不良反应事件发生。结论:舍尼通与抗生素联合用药方案能更有效地缓解慢性非细菌性前列腺炎患者的疼痛不适症状和排尿症状,耐受性好,值得在临床上推广应用。     

药物联合局部热疗治疗慢性前列腺炎疼痛症状的疗效(附76例报告)

目的:比较药物联合局部热疗和单一局部热疗治疗慢性前列腺炎疼痛症状的疗效。方法:慢性前列腺炎NIH-CPSI疼痛评分≥14分的患者76例,年龄18～48岁,平均(29.2±3.8)岁,病程3.5～180个月,平均(8.0±1.2)个月,随机分为治疗组(药物联合局部热疗组)和对照组(单一局部热疗组),每组38例。联合治疗为体外短波电容场热疗系统前列腺热疗仪隔日1次,60min/次,共7次,加每晚睡前服用多沙唑嗪控释片4mg,前列安栓肛塞1枚,共2周;对照组仅进行前列腺热疗仪治疗。两组患者治疗前后进行NIH-CPSI评分,比较两种治疗的疗效。结果:治疗前、后NIH-CPSI总评分在治疗组为(23.9±3.8)分和(5.2±3.1)分(P<0.01),在对照组为(24.5±4.3)分和(11.6±3.4)分(P<0.01);治疗前、后NIH-CPSI疼痛症状评分两组分别为(16.5±1.9)分和(3.1±2.2)分(P<0.001),(15.9±1.7)分和(8.2±2.0)分(P<0.01),且治疗组治疗前、后NIH-CPSI总分和疼痛评分改善均更为显著(P<0.01)。治疗组中初发患者比采用过其他方法治疗的患者疼痛症状评分改善更显著(P<0.01)。两组患者均未报告不良事件。结论:药物联合局部热疗或单一局部热疗治疗慢性前列腺炎疼痛症状疗效满意,有良好的安全性和耐受性。联合治疗疗效优于单一局部热疗,且初发患者疗效更为显著。     

苍龟探穴针法对肩关节炎患者肩功能及生活质量的影响

目的：探讨苍龟探穴针法对肩关节炎患者肩功能及生活质量的影响。方法：选取 2015 年 6 月—2017 年 6 月我院收治的肩关节炎患者 100 例,依据治疗方法分为苍龟组和对照组,每组 50 例,对照组给予常规关节松动及针法治疗,苍龟组给予常规关节松动及苍龟探穴针法治疗,比较两组疼痛视觉模拟评分法（VAS）、Constant-Murley 肩功能评分法（CM）中的肩关节功能项（ROM）和日常生活能力项（ADL）、治疗疗效。结果：苍龟组和对照组治疗后 VAS 评分 （[ 0.63±0.10）分、（1.01±0.16）分 ] 明显低于治疗前 [（3.20±0.44）分、（3.17±0.42）分 ],苍龟组治疗后 VAS 评分明显低于对照组,苍龟组和对照组 ROM、ADL 评分 [（32.47±3.43）分、（16.04±1.61）分和（27.67±3.01）分、（13.72±1.43）分 ] 明显高于治疗前 [（12.14±4.73）分、（5.68±0.60）分和（12.27±4.81）分、（5.74±0.61）分 ],苍龟组治疗后 ROM、ADL评分明显高于对照组,差异有统计学显著差异（P<0.05）;苍龟组治疗有效率为 94.00%,明显高于对照组的 80.00%,差异有统计学显著差异（P<0.05）。结论：苍龟探穴针法治疗可有效改善肩关节炎患者的疼痛症状及肩功能,有利于提高患者的治疗疗效及生活质量,值得临床推广。     

附睾肿物的超声诊断与鉴别诊断

目的:通过分析附睾肿物的超声特征,提高对附睾肿物的超声诊断及鉴别诊断水平。方法:回顾性分析1990年1月~2004年12月在我院接受手术治疗的179例附睾肿物患者,对病理诊断和超声特征进行分析。结果:179例患者,年龄(51.4±14.7)岁。附睾肿物包括附睾囊性肿物98例,非特异性附睾炎症27例,附睾结核33例,附睾肿瘤21例。附睾疾病中囊性肿物超声诊断率93.8%;附睾结核与附睾炎不易鉴别,两者主要区别在于附睾结核常同时合并肾、输尿管、膀胱、前列腺和睾丸等多脏器结核,在出现寒性脓疡、钙化灶,与皮肤形成窦道时易诊断;附睾肿瘤多为良性,恶性少见,应结合病史、体格检查和超声特征综合鉴别。结论:超声检查对附睾肿物的诊断和鉴别具有重要临床价值,是附睾疾病的首选影像学检查方法。     

103例附睾结节临床分析

目的 探讨附睾结节的诊断、治疗方法及病理特点.方法 对103例附睾结节进行回顾性分析.结果 103例均行手术治疗,术后恢复顺利.病理检查示:附睾结核46例,精子肉芽肿17例,腺瘤样瘤13例,慢性非特异性附睾炎12例,精液性囊肿5例,浆液性囊腺瘤4例,化脓性附睾炎3例,纤维瘤2例和平滑肌肉瘤1例.结论 附睾结节诊断依赖病史、体征和病理检查.手术是有效治疗方法.附睾结节大部份为良性病变.     

慢性前列腺炎患者前列腺液中尿酸检测及临床意义

目的:检测慢性前列腺炎患者EPS中的尿酸(UA)水平并探讨其临床意义。方法:按NIH诊断标准确诊的91例慢性前列腺炎患者分为2组,ⅢA组(n=48)和ⅢB组(n=43)。对照组(n=22)为无慢性前列腺炎的健康志愿者。分别进行CPSI评分,EPS中WBC计数、pH值及UA浓度测定。结果:ⅢB组的EPS中UA浓度[(257.02±144.84)μmol/L]显著高于ⅢA组[(159.73±121.49)μmol/L,P<0.01]和对照组[(78.55±44.53)μmol/L,P<0.01]。EPS中UA水平与pH值之间呈负显著相关(r=-0.398,P<0.01),而与CPSI疼痛症状评分(CPSI-P)、排尿症状评分(CPSI-U)以及CPSI总分(CPSI-T)之间均呈显著正相关(r分别为0.436、0.316、0.403,P均<0.01)。结论:前列腺内的UA浓度升高可能会导致化学性炎症反应。EPS中的UA水平与慢性前列腺炎的症状相关。检测EPS中的UA水平对慢性前列腺炎的诊断和治疗具有重要意义。     

灵芝孢子粉对2型糖尿病大鼠附睾细胞线粒体Ca~(2+)细胞色素C的影响

目的:研究灵芝孢子粉对2型糖尿病大鼠附睾组织中细胞色素C(Cyt-C)、线粒体Ca2+的影响。方法:青春期Wistar大鼠50只,大鼠尾静脉一次性注射2%链脲佐菌素(STZ)或柠檬酸-柠檬酸钠缓冲液制备2型糖尿病大鼠模型和对照组模型。糖尿病大鼠模型随机分模型组和灵芝组,每组20只,分别给以高脂高糖饮食、高脂高糖+灵芝孢子粉[250mg/(kg.d)],对照组10只,正常饮食。10周后,取双侧附睾,检测附睾细胞线粒体Ca2+、Cyt-C含量。结果:2型糖尿病模型制备成功,模型组附睾细胞线粒体Ca2+含量[(3.279±0.502)mg/L]明显高于对照组[(2.606±0.048)mg/L,P<0.01],灵芝组[(2.693±0.196)mg/L]明显低于模型组(P<0.05),与对照组差异无显著性(P>0.05)。模型组线粒体Cyt-C含量[(3.213±1.511)μmol/L]明显少于对照组[(5.688±1.679)μmol/L,P<0.05],胞质Cyt-C含量[(2.484±0.661)μmol/L]明显高于对照组[(1.574±0.329)μmol/L,P<0.01];灵芝组线粒体Cyt-C含量[(5.258±1.560)μmol/L]高于模型组,但差异无显著性(P>0.05),胞质Cyt-C含量[(1.727±0.396μmol/L]明显低于模型组(P<0.05),与对照组差异无显著性(P>0.05)。结论:2型糖尿病大鼠附睾细胞钙稳态失衡、线粒体有损伤,附睾细胞可能存在细胞凋亡过度。灵芝孢子粉在糖尿病状态下,对附睾组织有保护作用或有对抗细胞凋亡作用。     

PLASMA ENDOTOXIN CONCENTRATIONS IN PATIENTS WITH URINARY TRACT INFECTIONS

Background:
Although endotoxin elicits a variety of pathophysiological activities in hosts with gram-negative bacterial infections, the clinical significance of plasma endotoxin levels have not been clearly defined in the patients with urinary tract infections. The purpose of the study was to measure plasma endotoxin concentrations in relation to the types of urinary tract infections and to examine their correlation with inflammatory parameters.
Methods:
Using chromogenic Limulus-amebocyte lysate assay, plasma endotoxin concentrations were measured in a total of 63 patients with various types of nonspecific urinary tract infections. Results: The mean plasma endotoxin concentrations in patients with sterile pyuria, chronic complicated cystitis, acute uncomplicated pyelonephritis or acute exacerbation of chronic complicated pyelonephritis, chronic complicated pyelonephritis, and acute bacterial prostatitis or epididymitis were significantly higher than those in healthy individuals and in patients with acute uncomplicated cystitis. The correlation coefficients between plasma endotoxin concentrations and body temperatures, white blood cell counts in peripheral blood, erythrocyte sedimentation rates, and C-reactive proteins were 0.678 ( P 0.01), 0.503 ( P 0.01), 0.416 ( P 0.01), and 0.330 ( P 0.01), respectively. Conclusions: Patients with urinary tract infections may respond to endotoxin locally and generally depending on the sites of infection involved. However, endotoxin levels do not always correlate to clinical findings or inflammatory parameters.     

Coccidioidomycosis of the male genital tract

PURPOSE: Symptomatic genital tract infection is a rare manifestation of disseminated coccidioidomycosis. We characterized the clinical presentation, diagnosis, management and outcome in male patients with genitourinary coccidioidomycosis. MATERIALS AND METHODS: We reviewed all cases of genital tract coccidioidomycosis involving testes, epididymis or prostate at our institution between 1990 and 2000, and searched the medical literature for all reports since the first reported case in 1943. RESULTS: A total of 30 male patients with a median age of 58 years who had coccidioidomycosis of the genital tract were identified, including 6 at our institution. Four patients (13%) had a simultaneous pulmonary infection and 63% (19) had a remote history of primary pulmonary coccidioidomycosis. The most commonly involved genital tract sites were the epididymis in 18 cases, prostate in 14 and testes in 6. Patients with prostatitis presented with urinary obstruction, prostatic enlargement, tenderness and palpable nodules. Most patients with epididymal infection presented with scrotal swelling, tenderness and induration. All 30 patients (100%) had histopathological evidence of granulomatous inflammation with fungal spherules. Urine fungal cultures were positive in 19 cases (63%). A total of 12 patients received combined medical and surgical treatment, and 18 underwent surgical excision only. Most immunocompetent patients with isolated genital coccidioidomycosis did well with surgical resection alone. Six deaths occurred in patients with multifocal, extragenital, disseminated disease. CONCLUSIONS: Male genitourinary coccidioidomycosis is rare but it should be considered in the differential diagnosis of patients with exposure to the endemic area who present with prostatitis or epididymitis.     

Epididymitis: aspects concerning etiology and treatment

Extended microbiological studies were performed on 49 patients with acute or chronic epididymitis, including bacteriology of epididymal specimens in cases of scrotal surgery. In no patient had instrumentation or catheterization resulted in epididymitis. The microbiological data showed a prevalence of Chlamydia trachomatis epididymal infections in men less than 40 years old, whereas common urinary tract pathogens prevailed in older patients. Cultures of urethral swabs and midstream urine provided reliable information on the type of microorganism that caused epididymitis. Ofloxacin, an antibiotic of the new quinolone group, was proved to be highly effective in the treatment of acute and chronic bacterial as well as chlamydial epididymitis.     

Acute and Chronic Epididymitis

Epididymitis is a relatively common clinical condition presenting as acute or chronic forms. Acute epididymitis is the inflammation of epididymitis accompanied by pain and swelling, while chronic epididymitis may present only with pain. Etiological factors may be infectious or noninfectious, for example urinary obstruction, drug induced, or idiopathic. Bacterial ascent through the urogenital tract is the most common etiology in acute epididymitis, with Chlamydia trachomatis being isolated in all adult age groups. Diagnosis is generally based on patient history, symptoms, and clinical findings. Recent data indicate that sexually active patients with acute epididymitis should be screened for sexually-transmitted diseases, regardless of their age. Additional laboratory investigations and imaging may be required for differential diagnosis with other intrascrotal conditions, particularly with testicular torsion. Although no evidence-based recommendations can be given for the antimicrobial treatment of acute epididymitis, >85% of bacterial strains causing acute epididymitis are susceptible to fluoroquinoles and third-generation cephalosporins. Chronic epididymitis has not been investigated as thorough as acute epididymitis; however, the development and use of a symptom index is promising in terms of achieving a widely-accepted standardization of diagnosis and evaluation. A conservative approach may be beneficial; medical treatment employing antibiotics, anti-inflammatory agents, pain medication, and others are also being utilized without any evidence-based data. Spermatic cord block with short-term and long-term acting agents as well as surgical treatment including epididymectomy microdenervation of the spermatic cord are other treatment alternatives in patients with chronic epididymitis.Patient summaryIn this article, we provide an update on the definition, epidemiology, etiology, diagnostics, and therapy in terms of acute and chronic epididymitis.     

DO URINARY TRACT INFECTIONS TRIGGER CHRONIC KIDNEY TRANSPLANT REJECTION IN MAN?

Purpose

Urinary tract infections are frequent after kidney transplantation but little is known about the impact on long-term survival. As chronic rejection is the major cause of graft loss in the long term, we retrospectively analyzed the role of urinary tract infections in this process.

Materials and Methods

We included in the study all adult patients who received kidney transplants at our unit between 1972 and 1991, which ensured followup of at least 5 years, and we focused on the relationship between urinary tract infections and the incidence of chronic rejection episodes. To analyze the influence of urinary tract infections on chronic rejection patients were separated into those in whom biopsy proved chronic rejection developed within the first 5 years after transplantation (chronic rejection group 225) and those without apparent signs of chronic rejection during that period (control group 351). The correlation between urinary tract infections per year and the incidence of chronic rejection was analyzed.

Results

Patients with chronic rejection had more urinary tract infections per year than controls. In the first year after transplantation both groups had the highest incidence of urinary tract infections but thereafter the rate of urinary tract infections per year declined. However, the incidence consistently remained higher in the chronic rejection group. This difference reached significance by year 3 after transplantation. Furthermore, a high rate of urinary tract infections correlated with an early onset of chronic rejection.

Conclusions

Urinary tract infections are an important risk factor for the onset of chronic rejection, and early and intense treatment is critical.     

Recurrent epididymitis in a child without genitourinary malformations: a case report

The patient was a 12-year-old boy, who was brought to our hospital with a chief complaint of swelling and pain in the right scrotum. Color Doppler ultrasonography showed blood flow in the right testis and increased blood flow at the right epididymis. Our diagnosis was right epididymitis, and the swelling of the scrotum was improved by antibiotics. Since there was recurrence, right epididymectomy was performed. Histological diagnosis was chronic epididymitis. Postoperative, screening for abnormalities in the urinary tract revealed no malformations. Recurrent epididymitis in a child without genitourinary malformations is a very rare pathology.     

Urinary N-acetyl-beta-D-glucosaminidase activity in acute pyelonephritis patients with spinal cord injuries

The urinary N-acetyl-beta-D-glucosaminidase (NAG) activities were determined in acute pyelonephritis patients with spinal cord injuries. The urinary NAG activity was significantly elevated in 23 of 31 cases (74%) compared with normal controls. Out of 7 acute pyelonephritis patients without spinal cord injuries, 4 patients (57%) showed significantly elevated urinary NAG activities. The urinary NAG activities were within normal range in 20 patients with acute simple cystitis and 11 patients with chronic complicated cystitis. Out of 6 patients with urethritis, only one case (17%) showed a significantly higher level of urinary NAG activity. Significantly higher levels in urinary NAG activities were observed in 6 of 9 patients (67%) with acute prostatitis and 5 of 9 patients (56%) with acute epididymitis. In patients with spinal cord injuries, having frequent urinary tract infections and complicated pathophysiological conditions, urinary NAG is one of the helpful laboratory findings for the diagnosis of acute pyelonephritis.     

Family history and behavioral abnormalities in girls with recurrent urinary tract infections: a controlled study

PURPOSE: We evaluated the role of family history, infrequent voiding, poor fluid intake, functional stool retention and inadequate anogenital hygiene or toilet habits in girls with recurrent urinary tract infections. MATERIALS AND METHODS: The possible occurrence of these risk factors was assessed in 90 Swiss girls with recurrent urinary tract infections and in a control group of 45 girls. RESULTS: Family history was positive in 42% of patients and in 11% of controls (p <0.001). Behavioral abnormalities were also more frequently noted in girls with recurrent urinary tract infections than in the control group (81% vs 56%, p <0.01). There were 137 abnormalities in 73 girls with recurrent urinary tract infections and 30 abnormalities in 25 controls. Two or more abnormalities each, that is 2 in 32 girls and 3 in 16, were noted in 48 girls with recurrent urinary tract infections and in 5 control girls. No controls presented with more than 2 abnormalities. Infrequent voiding (54% vs 24%, p <0.001), poor fluid intake (53% vs 16%, p <0.001) and functional stool retention (30% vs 13%, p <0.05) were more frequently disclosed in girls with recurrent urinary tract infections than in control girls. In contrast, the frequency of inadequate stool hygiene or toilet habits was similar in patients and controls (14% and 13%, respectively). CONCLUSIONS: The evaluation of girls with recurrent urinary tract infections should focus on identifying behavioral aspects, including infrequent voiding, poor fluid intake and functional stool retention.