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1.
Objective
To determine the role of ultrasonography in diagnosis of scrotal disorders.Materials and methods
This study was carried out after institutional review board approval was granted, and informed consent was waived. Between January 2005 and January 2007, 144 patients aged 12 years and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analysed. The presentation symptoms were divided into three groups including scrotal pain, painless scrotal mass or swelling, and others. Surgery was performed in 32 patients.Results
Of 144 patients, 110 had clinical follow-up and constituted the material of this study. The patients ranged in age from 13 to 82 years (mean 38.6 years). Of 110 patients, 84 (76.4%) presented with scrotal pain, 21 (19%) had painless scrotal mass or swelling and 5 (4.5%) had other symptoms. Of the 84 patients with scrotal pain, 52 had infection, 4 had testicular torsion, 7 had testicular trauma, 10 had varicocele, 4 had hydrocele, 1 had epididymal cyst, 1 had scrotal sac and groin metastases, and 5 had unremarkable results. Of the 21 patients who presented with painless scrotal mass or swelling, 18 had extratesticular lesions and 3 had intratesticular lesions. All the extratesticular lesions were benign. Of the 3 intratesticular lesions, one was due to tuberculous epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcoma. Of the 5 patients who presented with other symptoms, 4 had undescended testes, and 1 had gynaecomastia. US gave incorrect diagnosis in only one patient with scrotal pain.Conclusion
The most common cause of scrotal pain was infection. The most common cause of scrotal mass or swelling was extratesticular lesion. US plays an important role in the diagnosis of scrotal disorders and in planning for proper management. 相似文献2.
3.
Won Hee Park Tae Young Shin Sang Min Yoon Soo-Hwan Park Yong Jin Kang Do Kyung Kim Jee-Young Han Do Hwan Seong 《Journal of Korean medical science》2014,29(7):1018-1020
Sparganosis is a parasitic infestation of human by plerocercoid larvae. Sparganum is usually reported to be found in the subcutaneous tissues as well as other organs, including scrotum. However, testicular sparganosis is extremely rare, because of strong capsule of tunica albuginea. An urban-living 54-yr-old Korean man presented with left scrotal pain for 6 yr. Both testes look normal physically. Ultrasonography revealed poorly defined, heterogeneous mass with increased echogenicity in the left testis. This case was misdiagnosed as testicular tumor and underwent orchiectomy, but was diagnosed as testicular sparganosis by histopathology. Sparganosis should be included for differential diagnosis of testis tumor in countries where sparganosis is prevalent.
Graphical Abstract
相似文献4.
Background
Solitary lateral cervical cystic mass is an uncommon presentation of papillary thyroid carcinoma.Objectives
To report our recent experience in the diagnosis and management of papillary thyroid carcinoma presenting as a lateral neck cyst.Methods
Patients who had papillary thyroid carcinoma and presented as a painless lateral neck cyst at the Department of Surgery, Al-Ain Hospital, from April 2005 to June 2009 were retrospectively studied. Their clinical presentation, diagnosis and management were reviewed.Results
Five patients were studied. No thyroid nodules were clinically palpable in all patients. Fine needle aspiration cytology from the cyst was positive for papillary thyroid carcinoma in three patients (60 percent). Two patients were diagnosed after excisional biopsy. Three patients had total thyroidectomy with modified radical neck dissection and postoperative radioactive iodine ablation. Two patients preferred to travel overseas for treatment. Thyroid histopathological examination has shown papillary thyroid carcinoma in all operated patients with multiple microscopic foci in two of them. This was associated with multiple bilateral cervical lymph node involvement.Conclusions
Metastatic papillary thyroid carcinoma presenting as a neck cyst is a diagnostic challenge. Excisional biopsy is indicated if fine needle aspiration cytology was inconclusive so as to rule out malignancy. 相似文献5.
Microsurgical Testicular Denervation for the Treatment of Chronic Testicular Pain �C Initial Results
Rafael Garcia de Oliveira Cesar Camara Jo?o de Magalh?es Avancini Ferreira Alves Rafael Ferreira Coelho Antonio Marmo Lucon Miguel Srougi 《Clinics (S?o Paulo, Brazil)》2009,64(5):393-396
INTRODUCTION:
Chronic testicular pain remains an important challenge for urologists. Currently, the treatment plan is primarily empirical, with the first approach consisting of clinical measures. However, some patients remain in pain despite a conservative treatment protocol and, for them, it is possible to perform a surgical procedure that involves severing the scrotal and spermatic branches of the genitofemoral and ilioinguinal nerve fibers.METHODS:
In our institution, 60 patients were evaluated and treated for idiopathic chronic testicular pain between January 2003 and July 2007. Priority was give to clinical treatment, which evolved from simple to more complex measures. Microsurgical treatment was performed on those who experienced no considerable pain relief (10 individuals in our study).RESULTS:
Over a twenty-four-month follow-up period, 70% of patients showed complete remission and 20% exhibited partial relief from pain. 相似文献6.
Belson Rugwizangoga Theresia Mwabili Trishia Scanlan Peter Meyer James Kitinya 《African health sciences》2014,14(3):763-768
Background
Coats'' disease is an exudative retinal detachment with vascular telangiectasis occurring mostly in male children, the age group most affected by retinoblastoma.Objectives
Compare the differential diagnoses of Coats'' diseaseEstablish recommendation to early disease detection.Materials and Methods
A 3-year-old female child was referred to Muhimbili National Hospital (MNH), Tanzania, in September 2011. She had presented at the peripheral hospital with gradual onset of left eye leukocoria for 1 year and pain for 2 months. B-scan showed a mass in the left eye. A clinical diagnosis of retinoblastoma was made. Left eye enucleation was performed; the patient was referred to MNH, with the enucleated specimen.Results
Brain and orbits scan revealed no residual tumour. The globe measured 2x1.8 cm, the optic nerve stump measured 3 mm. A whitish mass filled the vitreous, with complete retinal detachment. Microscopy showed retinal gliosis, detachment with sub retinal PAS positive exudates, vacuolation and cholesterol clefts. Foreign body giant cells were present; telangiectatic thin-walled blood vessels were identified. Clinico-pathological findings were of stage 4 Coats'' disease.Conclusion
Coats'' disease is an important differential diagnosis of retinoblastoma. Delay to detect Coats'' disease leads to vision loss which necessitates eye enucleation as was in this child. 相似文献7.
Context:
Type I superior labrum anterior-posterior (SLAP) lesions involve degenerative fraying and probably are not the cause of shoulder pain. Type II to IV SLAP lesions are tears of the labrum.Objective:
To determine the diagnostic accuracy of patient history and the active compression, anterior slide, and crank tests for type I and type II to IV SLAP lesions.Design:
Cohort study.Setting:
Clinic.Patients or Other Participants:
Fifty-five patients (47 men, 8 women; age = 40.6 ± 15.1 years) presenting with shoulder pain.Intervention(s):
For each patient, an orthopaedic surgeon conducted a clinical examination of history of trauma; sudden onset of symptoms; history of popping, clicking, or catching; age; and active compression, crank, and anterior slide tests. The reference standard was the intraoperative diagnosis. The operating surgeon was blinded to the results of the clinical examination.Main Outcome Measure(s):
Diagnostic utility was calculated using the receiver operating characteristic curve and area under the curve (AUC), sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (−LR). Forward stepwise binary regression was used to determine a combination of tests for diagnosis.Results:
No history item or physical examination test had diagnostic accuracy for type I SLAP lesions (n = 13). The anterior slide test had utility (AUC = 0.70, +LR = 2.25, −LR = 0.44) to confirm and exclude type II to IV SLAP lesions (n = 10). The combination of a history of popping, clicking, or catching and the anterior slide test demonstrated diagnostic utility for confirming type II to IV SLAP lesions (+LR = 6.00).Conclusions:
The anterior slide test had limited diagnostic utility for confirming and excluding type II to IV SLAP lesions; diagnostic values indicated only small shifts in probability. However, the combination of the anterior slide test with a history of popping, clicking, or catching had moderate diagnostic utility for confirming type II to IV SLAP lesions. No single item or combination of history items and physical examination tests had diagnostic utility for type I SLAP lesions. 相似文献8.
Background
The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the diagnosis of tuberculosis and drug resistant-tuberculosis. In resource-limited settings, GeneXpert has been used predominantly for research and there is little experience with its use in day-to-day management of patients.Case summary
We describe a case of a 46 year old HIV-infected male with smear-negative pulmonary tuberculosis, who had several visits to various lower level health centres and two admissions in a tertiary care hospital; however, the diagnosis of tuberculosis was only made several months later on GeneXpert testing that was performed under a research project.Conclusion
GeneXpert facilitated identification of tuberculosis in an HIV positive patient in whom the diagnosis had been delayed when more widely available tests were used. Operational and cost-effectiveness studies are needed to provide evidence to policy makers in order to improve access to GeneXpert. 相似文献9.
10.
Background
The increase in tuberculosis and HIV/AIDS patients in many countries in Africa including Tanzania, is outstripping the ability of public health services to cope. This calls for a closer collaboration between tuberculosis programmes and other stakeholders involved in HIV/AIDS care.Objective
To determine the feasibility of establishing collaboration between the tuberculosis programme and an NGO in TB/HIV care at a district level in Tanzania.Methods
Quantitative and qualitative study designs involving TB as well as HIV suspects and patients together with health workers, were conducted between December, 2001 and September, 2002.Results
A total of 72 patients and 28 key informants were involved. The collaboration was in the following areas; voluntary counselling and testing for HIV, diagnosis and treatment of TB, referral and follow up of patients and suspects, home based care, psychological support and training. . Both the tuberculosis programme and NGO benefited from the collaboration. TB case detection among PLWA increased more than three folds and TB treatment was integrated in home based care of NGO. The main barriers identified in this study were; poor communication, poor referral system and lack of knowledge and skills among health staff.Conclusion
The study has shown that it is possible for a tuberculosis programme and a non governmental organisation to collaborate in TB/HIV care. The study has also identified potential areas of collaboration and barriers that needed to be overcome in order to provide such comprehensive services at a district level. 相似文献11.
Background
The duration of gastro-esophageal reflux disease (GERD), the frequency of reflux, the pH and type of acid, and the quality and quantity of saliva affect the severity of dental erosion due to GERD.Objective
To summarize the diagnostic protocol and treatment of dental erosion due to GERD.Methods
A Medline literature search was performed to identify articles associated with a dental approach to GERD.Results
The dental professional must carry out a diagnostic protocol, which includes collecting data on the patient''s medical and dietary history, occupational/recreational history, dental history, and oral hygiene methods. Intraoral, head and neck, and salivary function examinations should be performed to expose the dental implications of GERD symptoms.Conclusion
Diagnosing the cause of erosive tooth wear can help prevent further damage. Patients must be informed about how to prevent GERD. 相似文献12.
Background
There is growing evidence that emotional distress expressed in terms of anxiety and depression is very high among tuberculosis (TB) patients.Objectives
This study aims to determine levels of anxiety, depression and emotional distress in patients with several types of TB and to determine the association between social-demographic and economical factors, clinical variables and anxiety, depression and emotional distress.Methods
A cross-sectional study was performed in a sample of 81 TB patients. A social-demographic and economical questionnaire was used, followed by the hospital anxiety and depression scale.Results
38.3% and 49.4% of our sample presented significant levels of anxiety and depression. 44.4% of patients had significant levels of emotional distress.Married subjects, a diagnosis of extra-pulmonary TB and multidrug resistant TB were related to higher risk for anxiety. Gender, extra-pulmonary and multidrug resistant TB were associated to depression. Female gender and cases of extra-pulmonary TB presented a 1.5 times risk for emotional distress.Conclusions
Our study found high rates of anxiety, depression and emotional distress among TB patients. Marital status, gender, type and treatment of TB were related to higher levels of emotional disorder. Mental health services should be an integral part of programs against tuberculosis. 相似文献13.
M Faizah A Zuhanis R Rahmah A Raja L Wu A Dayang M Zulfiqar 《Biomedical imaging and intervention journal》2012,8(1):e6-Mar;8(1):e6
Objectives:
This review was aimed at determining the imaging findings in patients with precocious puberty.Results:
Within a period of 8 years (from 2002 to 2010) there were 53 patients diagnosed with precocious puberty. Out of the 53 patients, 37 had undergone diagnostic imaging to detect the possible organic causes of precocious puberty. Imaging findings were positive in 31 patients and out of that, 3 patients had 2 findings each (34 abnormalities). Of the patients with positive imaging findings, central precocious puberty (gonadotrophin-dependent) was more common (81%; 25/31) and the causes included: tuber cinereum hamartoma (n = 10), glioma (n = 6), pineal gland tumour (n = 4), hydrocephalous (n = 3), arachnoid cyst (n = 2) and others (n = 3). Peripheral precocious puberty (gonadotrophin-independent) causes included: testicular adrenal rest tumour (n = 3), adrenal carcinoma (n = 1), ovarian granulosa thecal cell tumour (n = 1), and tuberous sclerosis (n = 1).Conclusion:
Positive imaging findings were observed in 84% (31/37) of the subjects. Hypothalamic hamartoma was the most common imaging finding in central precocious puberty while testicular adrenal rest tumour was the most common imaging finding in peripheral precocious puberty. 相似文献14.
15.
AC Ubesie OC Okafo NS Ibeziako VO Onukwuli NR Mbanefo JC Uzoigwe C Bede BC Ibe 《African health sciences》2013,13(2):518-521
Background
Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immune-compromised individuals such as those with acquired immuno-deficiency syndrome.Objective
To describe a case of disseminated histoplasmosis in an adolescent girl.Method
We report a case of disseminated histoplasmosis in a 13-year-old adolescent girl. She was admitted for 16 days because of neck masses of 3 years duration, generalized body swelling of 3 months and reduction in urinary output of 2 months. She tested negative for human immunodeficiency virus antibodies.Result
An autopsy was performed because a definitive diagnosis could not be made while the patient was still alive. The autopsy revealed central caseating areas in the lymph nodes and membranoproliferative glomerulonephritis. The periodic acid-Schiff staining technique for tissues showed viable yeast cells suggestive of histoplasmosis. Zeihl-Neelsen''s staining for mycobacteria tuberculosis was negative.Conclusion
Undiagnosed case of disseminated histoplasmosis while the patient was alive is being reported in a 13-year-old girl. Disseminated histoplasmosis should be considered as a differential diagnosis of childhood chronic infections and malignancies as in Nigeria. 相似文献16.
OI Alatise OA Oke OO Olaofe GO Omoniyi-Esan ARK Adesunkanmi 《African health sciences》2013,13(3):736-740
Introduction
Low-grade fibromyxoid sarcoma (LGFMS) is a rare non epithelial tumour. It usually arises from the smooth muscles of the extremities. It is, however, occasionally reported to arise from other regions of the body.Case report
We report the case of a 32 year old man who complained of a progressive abdominal swelling of 4 months duration. There was associated abdominal discomfort and weight loss. Abdominal examination revealed a non-tender intra abdominal mass filling the abdomen completely. Abdominal ultrasound suggested a massive splenomegaly. Abdomina Computerized Tomography (CT) scan was not done due to financial constraints. At laparotomy, a large, pearl-coloured mass was found within the mesentery of the proximal jejunum, with dilated, tortuous vessels. It was resected along with the overlying 60cm of jejunum. It weighed 7.5kg. Histology and immunohistochemistry confirmed the diagnosis of lowgrade fibromyxoid sarcoma. Post-operative period was uneventful and there were no features of recurrent after 2 year of follow up.Conclusion
LGFMS may cause a diagnostic dilemma, especially in a third world setting where preoperative diagnosis is hampered by lack of facilities and poverty. A high index of suspicion is needed for preoperative diagnosis, which is necessary for proper planning of the operation. 相似文献17.
Kyebambe PS 《African health sciences》2010,10(2):211-214
Background
Neurosyphilis is a common but often missed disease worldwide, mainly because it has many manifestations making its diagnosis difficult. It is often missed among HIV patients as the search for other co-infections such as toxoplasmosis often overshadows its consideration.Objectives
To describe one of our cases of neurosyphilis in HIV, raise awareness about the reality of neurosyphilis in Africa and share our experiences in diagnosis and management of the disease.Methods
A 40 year old, HIV positive female was admitted with a 2 month history of left sided facial and limb weakness followed by delirium, aphasia and Jacksonian epilepsy. She underwent clinical and laboratory evaluation.Results
On examination she had a maculo-papular rash and left sided paresis. Rapid Plasma Reagin(RPR) was reactive(titre 1:16). Treponema Pallidum Haemoaggluttination Assay(TPHA) was also reactive. Cerebrospinal fluid (CSF) analysis revealed: protein 56 mg per dl, glucose 71 mg per dl, cells 14 per high power field (predominantly lymphocytes). The VDRL on the CSF was positive. The CD4 cell count was 320 per ml. She was treated with intravenous penicillin G, 4 mega-units 6 hourly for 14 days, with a very good response.Conclusion
Neurosyphilis still occurs in Uganda. It should be considered in all patients with neurological/ophthalmic illness, including those with HIV. Most cases respond well to intravenous penicillin G. 相似文献18.
Stefan B?sner Annette Becker Maren Abu Hani Heidi Keller Andreas C S?nnichsen J?rg Haasenritter Konstantinos Karatolios Juergen R Schaefer Erika Baum Norbert Donner-Banzhoff 《The British journal of general practice》2010,60(575):e246-e257
Background
Diagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings.Aim
To evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain.Design of study
Cross-sectional diagnostic study with delayed-type reference standard.Setting
Seventy-four general practices in Germany.Method
The study included 1249 consecutive patients presenting with chest pain. Data were reviewed by an independent reference panel, with coronary heart disease (CHD) and an indication for urgent hospital admission as reference conditions. Main outcome measures were sensitivity, specificity, likelihood ratio, predictive value, and odds ratio (OR) for non-trauma patients with a reference diagnosis.Results
Several signs and symptoms showed strong associations with CHD, including known vascular disease (OR = 5.13; 95% confidence interval [CI] = 2.83 to 9.30), pain worse on exercise (OR = 4.27; 95% CI = 2.31 to 7.88), patient assumes cardiac origin of pain (OR = 3.20; 95% CI = 1.53 to 6.60), cough present (OR = 0.08; 95% CI = 0.01 to 0.77), and pain reproducible on palpation (OR = 0.27; 95% CI = 0.13 to 0.56). For urgent hospital admission, effective criteria included pain radiating to the left arm (OR = 8.81; 95% CI = 2.58 to 30.05), known clinical vascular disease (OR = 7.50; 95% CI = 2.88 to 19.55), home visit requested (OR = 7.31; 95% CI = 2.27 to 23.57), and known heart failure (OR = 3.53; 95% CI = 1.14 to 10.96).Conclusion
Although individual criteria were only moderately effective, in combination they can help to decide about further management of patients with chest pain in primary care. 相似文献19.
Abigail Moore Anthony Harnden Richard Mayon-White 《The British journal of general practice》2014,64(625):e477-e483
Background
Kawasaki disease is a rare childhood illness that can present non-specifically, making it a diagnostic challenge. The clinical presentation of Kawasaki disease has not been previously described in primary care.Aim
To describe how children with an eventual diagnosis of Kawasaki disease initially present to primary care in the UK.Design and setting
The Clinical Practice Research Datalink was used to find cases coded as Kawasaki disease. Hospital Episode Statistics, hospital admissions, and hospital outpatient attendances were used to identify the children with a convincing diagnosis of Kawasaki disease.Method
Questionnaires and a request for copies of relevant hospital summaries, discharge letters, and reports were sent to GPs of the 104 children with a diagnosis of Kawasaki disease between 2007 and 2011.Results
Most children presented with few clinical features typical of Kawasaki disease. Of those with just one feature, a fever or a polymorphous rash were the most common. By the time that most children were admitted to hospital they had a more recognisable syndrome, with three or more clinical features diagnostic of Kawasaki disease. Most GPs did not consider Kawasaki disease among their differential diagnoses, but some GPs did suspect that the child’s illness was unusual.Conclusion
The study highlighted the difficulty of early diagnosis, with most children having a non-specific presentation to primary care. GPs are encouraged to implement good safety netting, and to keep Kawasaki disease in mind when children present with fever and rashes. 相似文献20.
Nicolette Nabukeera-Barungi Jo Wilmshurst Muloiwa Rudzani James Nuttall 《African health sciences》2014,14(1):143-149