Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume: using the prader orchidometer versus ultrasonography

INTRODUCTION: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. PATIENTS AND METHODS: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. RESULTS: The mean age of the boys was 13.5 +/- 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). CONCLUSIONS: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.     

A comparison of four different alpha1-blockers in benign prostatic hyperplasia patients with and without diabetes

OBJECTIVE: The aim of this study was to evaluate the intensity of lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) with and without diabetes. We also determined whether alpha1-blockers improve subjective and objective symptoms similarly in these patients. MATERIAL AND METHODS: The study subjects comprised 281 patients (60 with diabetes and 221 non-diabetics with clinically diagnosed BPH) who were treated with alpha1-blockers (doxazosin, terazosin, alfuzosin and tamsulosin). The international prostate symptom score (IPSS), bother score, maximum flow rate (Q(max)) and post-void residual urine volume (PVR) were determined at baseline and after treatment for a minimum of 6 months. RESULTS: Diabetic patients had a lower baseline Q(max) than non-diabetics (p < 0.001), while the IPSS, bother score and PVR did not differ significantly between the two groups. After treatment with alpha1-blockers, lower urinary tract symptoms improved significantly. The improvement rates of the IPSS and bother score were significantly higher in the diabetic patients than in the non-diabetics (p < 0.01). The relationship between the duration of diabetes and the effect of alpha1-blockers on IPSS, bother score, Q(max) and PVR was not statistically significant (p > 0.05). CONCLUSIONS: The voiding function of the bladder may be more affected by diabetes than the storage function in patients with BPH. Treatment with alpha1-blockers appears to be useful for diabetic patients with BPH and its effectiveness is not altered by the duration of diabetes.     

Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus Open Lichtenstein technique

Laparoscopic hernia repair has all the advantages of a tension free repair. This study compares the laparoscopic transabdominal preperitoneal (TAPP) approach with tension-free open hernia repair in terms of operative time, postoperative pain, hospital stay, complications, and cost. Open and TAPP repairs using polypropylene mesh were performed in two groups of 25 male patients. The difference in operative times between the groups was not significant. Mean pain scores (0-100) for the open group were 54.12 +/- 13.06 at 12 hours and 37.24 +/- 11.38 at 24 hours, significantly higher than the corresponding scores of 38.36 +/- 8.21 at 12 hours and 20.92 +/- 8.73 at 24 hours for the TAPP group (P < 0.05). The mean postoperative analgesic dose was 6.72 +/- 2.72 in the TAPP group, which was insignificantly lower than 7.52 +/- 2.00 in the open group. Mean hospital stay was 2.24 +/- 0.97 days in the open group and 1.52 +/- 0.51 in the TAPP group, which was significant (P < 0.05). Twenty patients (80%) in the TAPP group rated themselves highly satisfied with the surgery as compared to 11 patients (44%) in the open group (P < 0.05). There was no recurrence in either group during a mean followup period of 13.5 months (range, 8-28 months). Laparoscopic hernia repair was significantly more expensive than open (1100 US dollars versus 629 US dollars). TAPP repair is superior to open repair in terms of shorter hospital stay, lower postoperative pain, and better patient satisfaction. It is also safe, with no recurrence in a short-term period. This technique will be the operation of choice for the treatment of groin hernia after long-term results have been established in our center.     

Asthma and cost of illness

The basic aim of the activities concerning health is to implement the initiatives for people to attain the best health status and sustain it. That's why these initiatives have to be chosen from the ones that consume minimum resource and affect life quality and duration in most beneficial way. Asthma is one of the most prevalent chronic disorders. Asthma brings significant direct and indirect costs to societies. To decrease the burden of asthma, it is necessary to emphasize its effects related to morbidity, mortality and material losses. Therefore, countries should give priority to cost of illness studies.     

How reliable are bladder perceptions during cystometry?

AIMS: Sensory input is important for bladder control in daily life. It has been reported that perceptions during cystometry are subjective. To help refine this subjectivity, objective and semi-objective tests (e.g., sensory thresholds of electrical stimulation) have been recommended by The International Continence Society. However, the reliability of such studies has not been established. This study was designed to evaluate the reliability of bladder perceptions during cystometry. METHODS: The study included 59 patients with urologic complaints. The average age of 40 male and 19 female patients was 58.1 years (range: 14-83). After insertion of an 8F double lumen catheter, patients were blinded to the pump and screen process. During Phase I nothing was infused. In Phase II, filling cystometry was performed with 50 ml/min pump speed and then the bladder was emptied. Phase III was performed with the same method used in Phase I. The time that each sensation was perceived, in seconds, was used to compare sensations. The bladder volume, at which sensations were perceived, was recorded at Phase II. RESULTS: Except for strong desire, there were no statistically significant differences between the mean times in seconds elapsed till sensations in Phases I and III, but they were different from those in Phase II. The time elapsed until strong desire was not different in each of the three phases. However, there was strong a correlation in the ratios of sensations to strong desire between Phase I and II (r = 1, P = 0.01), Phase I and III (r = 0.99, P = 0.01), and Phase II and III (r = 0.98, P = 0.01). CONCLUSIONS: Proprioception of the bladder filling during cystometry is subjective. This data shows that sensations noticed by the patient during filling cystometry may be related to stimuli other than bladder filling.     

Pulmonary alveolar proteinosis in a patient with acute lymphoid leukemia regression after G-CSF therapy

Pulmonary alveolar proteinosis (PAP) is the intra-alveolar accumulation of periodic-acid schiff (PAS) positive material. PAP is one of the underrecognized causes of pulmonary infiltrates in patients with hematologic malignancies. Here, we present a patient with acute lymphoid leukemia (ALL) in first remission that developed fever and diffuse pulmonary infiltrates during the neutropenic stage of consolidation chemotherapy. The histopathologic examination of bronchoalveolar lavage (BAL) fluid and transbronchial biopsy specimen demonstrated the presence of PAS-positive eosinophilic material. Empirical antibiotherapy and granulocyte-colony stimulating factor (G-CSF) were given. After the correction of neutropenia with G-CSF, the patient's fever disappeared, acute phase reactants decreased, pulmonary infiltrates resolved. We present this case because it was the first patient in whom the correction of neutropenia with G-CSF was followed by resolution of PAP.     

Large volume donor plasmapheresis in inherited thrombophilia implicated in arterial thrombosis.

BACKGROUND: Life-threatening complications following apheresis are rare, and include venous thrombosis. Arterial thrombosis following apheresis has not been reported. CASE REPORT: A 48 year old donor had cerebral infarction following large volume plasma donation. The outcome was fatal. He was found to be heterozygous for both methylene tetrahydrofolate reductase (MTHFR) 677C-T mutation and Prothrombin 20210G-A allele. CONCLUSION: This case suggests that large volume plasma donation may trigger arterial thrombotic events in inherited thrombophilia. Therefore, the effects of plasmapheresis on coagulation system should be studied thoroughly.     

Breast and osteoarticular tuberculosis in a male patient

Breast tuberculosis is an uncommon illness. It is predominant in young women. To our knowledge, only 7 cases of tuberculous mastitis in men have been reported in the English literature since 1945. Furthermore, there are no male patients who have breast and osteoarticular tuberculosis in the literature. We presented a 41-year-old man who was admitted with a fixed tender mass in the right retromammary region and pain in the right hip. Mycobacterium tuberculosis colonies were isolated from the semisolid mass of breast. Histopathologic examination revealed caseous granulomatous infection in the right hip synovial tissue. He was treated successfully with only antituberculous drugs.     

Splenic infarction in a pregnant woman with systemic lupus erythematosus

Here we describe a 20-year-old pregnant woman with systemic lupus erythematosus who had high anticardiolipin antibodies and presented with splenic infarction.     

Increased plasma malondialdehyde and protein carbonyl levels and lymphocyte DNA damage in patients with angiographically defined coronary artery disease

We investigated the oxidative modifications of lipids, proteins and DNA, three potential molecular targets of oxidative stress, in 30 patients with angiographically defined coronary artery disease (CAD) and 30 healthy control subjects. In addition, we examined relationships between these oxidative modifications and the severity of vascular lesions in patients with CAD. Malondialdehyde (MDA) and protein carbonyl (PC) levels, as well as ferric reducing antioxidant power (FRAP), were measured in the plasma. DNA damage was evaluated as single strand breaks (SSBs), formamidopyrimidine glycosylase (Fpg) and endonuclease III (E-III)-sensitive sites by the comet assay in DNA isolated from lymphocytes. MDA and PC levels increased, but FRAP values decreased, in patients as compared to controls. However, these values did not vary with the number of affected coronary vessels and were not correlated with Duke score, a parameter of the severity of vascular lesions in patients with CAD. We also found that lymphocyte DNA damage (SSBs, Fpg and E-III sites) were increased in patients. Although there were no significant differences in SSBs values in patients grouped according to affected vessel number, Fpg and E-III sites increased. We also detected significant correlations between Duke scores and SSBs and Fpg sites. Serum cholesterol, triglyceride and LDL-cholesterol levels were found to increase, but HDL-cholesterol levels decreased in CAD patients, but these lipids were not correlated with Duke scores. The results of this study reinforce the presence of increased combined oxidative modifications in lipid, protein and DNA in patients with CAD. However, lymphocyte DNA damage seems to be a more reliable assay than MDA and PC determinations to detect the severity of vascular lesions in patients.