Abdominoscrotal hydrocele: its particular characteristics

Abdominoscrotal hydrocele (ASH) is an unusual condition characterized by a large scrotal hydrocele which communicates in an hourglass fashion with an abdominal component through the inguinal canal. Based on previous clinical observations, we believed that ASH is a condition that begins as a large scrotal hydrocele during the neonatal period and later expands first into the inguinal canal and finally into the abdominal cavity during the next few months of life. We report a case series of ASH and point out its distinctive characteristics.     

Sclerotherapy for lymphatic malformations in children: a scoping review

Purpose

This scoping review assesses the literature and summarizes the current evidence on sclerotherapy for the treatment of lymphatic malformations in pediatric patients.

Methods

A comprehensive search of published and unpublished literature was conducted using multiple databases. Title, abstract, and full-text screening was conducted by 2 independent clinicians. All discrepancies were resolved during consensus meetings.

Results

A total of 182 articles were retrieved. Forty-four articles were removed as duplicates, and 11 articles were added after reviewing prominent studies. After full-text abstraction, 44 articles and 2 conference proceedings (N = 882 patients) were included in the final results. Twelve articles were classified as level II and 34 articles as level IV evidence. Picibanil (OK-432) was the primary agent used in most included studies. Postinjection symptoms with OK-432 were primarily fever, swelling, and erythema at the site. Life-threatening complications were uncommon and involved postinjection swelling of cervical lesions causing airway compromise.

Conclusions

The literature regarding sclerotherapy for lymphatic malformations is of a low level of evidence and suffers from a lack of standardization. Randomized clinical trials focused on OK-432, bleomycin, or alcoholic solution of zein; standardized dosing protocols; and consistent and reliable outcome reporting will be necessary for further development of treatment guidelines.     

Conservative management of hemorrhoids: A comparison of venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy

Purpose To compare the results of the conservative management of hemorrhoids between venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy, in terms of the subjective and objective outcome of patients after a follow-up period of 2 years. Methods One hundred and twenty-six patients who suffered from 1st-and 2nd-degree hemorrhoids were divided into 2 groups. The first (n = 64) and second (n = 62) groups underwent venotonic flavonoid MPFF (VF) and sclerotherapy (SCL). The Average Symptoms Score (ASS), Average Anascopy Score (AAS) and the subjective scale were used to assess the success of the treatments. Results A total of 113 patients agreed to participate in the follow-up study. ASS and AAS decreased in both of the groups in the first three visits (P < 0.05). At the end of the second visit, ASS and AAS significantly declined in the VF group. In addition, ASS and AAS decreased to the nadir level in the groups at the end of the 26th week. During the remaining time of the follow-up period, ASS showed a significant rise pattern in the VF group in comparison to the SCL group. The resolved and improved rate was significantly higher in the SCL group at the end of the study (P < 0.05). Conclusions Sclerotherapy was a more efficient treatment modality than VF in the long-term follow-up. SCL also had an acceptable success rate in the short-term follow-up.     

Giant unilateral abdominoscrotal hydrocele in an adult: Case report

Abdominoscrotal hydrocele (ASH) is an apparently highly uncommon clinical entity especially in childhood. While hydrocele is among the commonest inguinal anomaly in adult, its extreme form ASH is infrequently reported form. ASH consists of two large sacs, both abdominal and scrotal, connecting with the inguinal canal. Surgical correction is mandatory. We present a 34-year-old man with giant ASH. He was treated with excision of hydrocele sac through an inguinal approach.     

Sclerotherapy for the management of rectal prolapse in children

Purpose

Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse.

Sequential treatment by polidocanol and radiofrequency ablation of large benign partially cystic thyroid nodules with solid components: Efficacy and safety

PurposeThe purpose of this study was to retrospectively evaluate the efficacy and safety of a sequential treatment including percutaneous polidocanol sclerotherapy and radiofrequency ablation (RFA) in terms of volume reduction and complication rate in large, benign, partially cystic thyroid nodules with solid components.Materials and methodFrom April 2017 to April 2019, 46 patients with 47 large benign partially cystic thyroid nodules underwent sequential treatment. There were 14 men and 32 women with a mean age of 49.9 ± 11.5 (SD) years (range: 18–75 years). The volume of initial nodules was 12.7 ± 12.3 (SD) mL (range: 2.16–75.62 mL). Volume reduction after percutaneous polidocanol sclerotherapy and further RFA was evaluated respectively. Patients had clinical and ultrasound evaluations at a follow-up time of 12.1 ± 5.3 (SD) months (range: 1.5–23.9 months). Technical success and complications were accessed retrospectively.ResultsAfter unsatisfying results with polidocanol sclerotherapy alone the 46 patients with 47 large benign partially cystic thyroid nodules had further RFA. Mean volume reduction of 47 nodules was 90.5 ± 11.3 (SD) % (range: 43.9–99.3%) one month after RFA, 94.9 ± 6.2 (SD) % (range: 66.9–99.5%) three months after RFA, and 95.8 ± 5.5 (SD) % (range: 71.0–99.8%) six months after RFA. No recurrence or nodule enlargement after RFA was observed at the last follow-up. The complication rate of RFA was 12.5% (8/46 patients), with minor complications only.ConclusionsThe sequential treatment regimen, including percutaneous polidocanol sclerotherapy and RFA, is an appropriate and safe treatment strategy for large benign partially cystic thyroid nodules with solid components.     

Treatment of hydrocele: randomised prospective study of simple aspiration and sclerotherapy with tetracycline.

Following reports in the literature on the efficacy of tetracycline sclerotherapy in the treatment of hydroceles, we carried out a randomised prospective study of 45 patients (50 hydroceles), comparing simple evacuation with tetracycline sclerotherapy. The results revealed no statistically significant difference in the percentage of success between the 2 groups, but complications were more common in the patients treated with tetracycline. The good results reported by other authors in non-randomised studies are, therefore, not confirmed.     

Sclerotherapy: it is back and better

With the recent US Food and Drug Administration (FDA) approval of polidocanol in the United States, there has been a resurgence of interest in sclerotherapy. Despite the popularity of laser therapy, sclerotherapy remains the gold standard for treating spider and reticular veins. Although this traditional method of treatment has been around for more than 100 years, better sclerosing agents and newer techniques have made sclerotherapy safer and more efficacious than ever before. This article is a primer for physicians interested in updating their skills in sclerotherapy. It reviews common sclerosants, sclerotherapy techniques, patient evaluation, complications, and recent advancements in sclerotherapy.     

单孔腹腔镜单次双线法治疗复杂性鞘膜积液的研究

目的探讨单孔腹腔镜单次双线法治疗复杂性鞘膜积液的临床疗效。 方法回顾性分析2013年2月至2016年9月我科行单孔腹腔镜单次双线法治疗的80例复杂性鞘膜积液患儿临床资料,脐上作一个5 mm切口,建立气腹并置入腹腔镜,鞘状突体表投影处做一个1 mm切口,将2-0肌腱线对折穿过自制钩针,腹腔镜直视下将针刺至鞘状突腹膜前,分别行内外半周荷包缝合,带出线结扎内环口。 结果所有患儿手术均顺利完成,无中转开放手术者,手术时间8~25 min,平均（19±4）min,均无切口及阴囊感染、水肿等并发症发生,术后住院时间（1.6±0.2）d,术后随访6~48个月,均未见复发及并发症,创口愈合完好,无明显瘢痕。 结论单孔腹腔镜单次双线法治疗复杂性小儿鞘膜积液安全可行,疗效确切,患儿创伤小,恢复快,值得临床推广应用。     

微型腹腔镜套线法治疗小儿斜疝及鞘膜积液(附747例报告)

目的：探讨微型腹腔镜套线法治疗小儿腹股沟斜疝及鞘膜积液的临床效果。方法：2001年8月至2007年3月用微型腹腔镜下操作钳配合自制带线雪橇针作腹膜外潜行缝合高位结扎疝囊治疗小儿腹股沟斜疝及鞘膜积液747例,共898侧。结果：手术切口创伤小,疝囊高位结扎确切,操作简单,手术时间短,并发症少,复发率低（0.9%）,康复快,术后不留疤痕。结论：此手术安全,疗效确切,复发率低,值得临床推广应用。     

Sclerotherapy for the treatment of postmastectomy seroma

BACKGROUND: Seroma is a common complication after mastectomy. We review our experience with sclerotherapy for postmastectomy seroma management. METHODS: Patients who underwent outpatient sclerotherapy for postmastectomy seroma were reviewed. Ninety-five percent ethyl alcohol or povidone iodine, which was administered by way of percutaneous catheter, was the initial sclerosant, and dwell time was 20 to 30 minutes. Povidone iodine solution was instilled 2 to 3 times daily. Catheters were removed when output reached <30 mL/d or when cavity size was <20 ml by sinogram. RESULTS: Sixteen patients (18 seromas) had sclerotherapy initiated at median of 34 days after surgery. Mean number of treatment days was 3 (median duration 16). Seven patients (44%) developed infection during treatment, which was associated with increased duration. Three seromas recurred and were successfully treated with single aspiration. COMMENTS: Sclerotherapy is a feasible treatment for chronic seroma after mastectomy. Longer treatment duration was associated with infection; antibiotic prophylaxis should be considered. Research is necessary to determine optimal regimens and superiority over other approaches.     

聚桂醇硬化注射治疗内痔的临床疗效

为探讨聚桂醇硬化注射治疗内痔的临床疗效,将120例内痔患者随机分为治疗组和对照组,各60例,治疗组给予聚桂醇硬化注射,对照组给予消痔灵硬化注射,对比两组总体疗效和并发症。结果显示,两组总有效率比较差异无统计学意义,P〉0．05;但治疗组治疗后肛门坠胀感、肛门疼痛、肛门狭窄、黏膜坏死发生率明显低于对照组,P＜0．05。结果表明,聚桂醇硬化注射治疗内痔疗效肯定,并发症少,优于消痔灵。     

Resurfacing arthroplasty for hip dysplasia: a prospective randomised study

In this prospective study a total of 80 consecutive Chinese patients with Crowe type I or II developmental dysplasia of the hip were randomly assigned for hip resurfacing arthroplasty (HRA) or total hip replacement (THR). Three patients assigned to HRA were converted to THR, and three HRA patients and two THR patients were lost to follow-up. This left a total of 34 patients (37 hips) who underwent HRA and 38 (39 hips) who underwent THR. The mean follow-up was 59.4 months (52 to 70) in the HRA group and 60.6 months (50 to 72) in the THR group. There was no failure of the prosthesis in either group. Flexion of the hip was significantly better after HRA, but there was no difference in the mean post-operative Harris hip scores between the groups. The mean size of the acetabular component in the HRA group was significantly larger than in the THR group (49.5 mm vs 46.1 mm, p = 0.001). There was no difference in the mean abduction angle of the acetabular component between the two groups. Although the patients in this series had risk factors for failure after HRA, such as low body weight, small femoral heads and dysplasia, the clinical results of resurfacing in those with Crowe type I or II hip dysplasia were satisfactory. Patients in the HRA group had a better range of movement, although neck-cup impingement was observed. However, more acetabular bone was sacrificed in HRA patients, and it is unclear whether this will have an adverse effect in the long term.     

Laparoscopic diagnosis and treatment of a hydrocele of the canal of Nuck extending in the retroperitoneal space: A case report

INTRODUCTION

Hydrocele of the canal of Nuck is a rarely encountered entity. We report a case underwent laparoscopic totally extraperitoneal (TEP) treatment for a hydrocele of the canal of Nuck extending in the extraperitoneal space mainly.

PRESENTATION OF CASE

A 37-year-old woman complained of painless and reducible swelling in her left groin, and referred to our hospital for surgical management against left inguinal hernia with the incarcerated ovary. Ultrasonography and MR images revealed a cystic mass in the retroperitoneal space, and we diagnosed as an unusual type of hydrocele of the canal of Nuck. The patient was scheduled for laparoscopic treatment. Laparoscopic findings on pneumoperitoneum showed an extraperitoneal cystic tumor with no contact with the left ovary. The fascia and peritoneum of the port site were closed, and then an extraperitoneal space was created. The cystic tumor with the round ligament of the uterus was dissected and resected by the TEP technique. The extended deep inguinal ring was repaired with polypropylene mesh. Postoperative course was uneventful.

DISCUSSION

Hydrocele of the canal of Nuck in the adult female is a rare condition. The accurate diagnosis of an inguinal hydrocele in a female is seldom made. Laparoscopic examination provides surgeons with information of inguinal swelling accompanied with retroperitoneal cyst, and consecutive treatment by laparoscopic technique, especially TEP, is useful in regard to minimal damage of the peritoneum.

CONCLUSION

Laparoscopic diagnosis and TEP treatment offers a useful alternative in selected patients with hydrocele of the canal of Nuck.