Bilateral testicular tuberculomas: a case detection

Genitourinary tuberculosis (TB) is the most frequent manifestation of extrapulmonary TB, where the epididymides, seminal vesicles and prostate are the commonly infected sites, followed by the testes. We report a 29‐year‐old man who presented with primary infertility since 2 years. He had a history of bilateral painful scrotal swelling with fever since 4 years, diagnosed as pyogenic scrotal abscess, which was managed by incision and drainage. At presentation, fever, weight loss and night sweats were absent. On examination, he had ovoid slightly tender, firm to hard irregular masses in the lower poles of both testes with no line of separation encroaching on both epididymes. Both testes were not felt distinctly and the overlying scrotal skin showed no signs of inflammation. Semen analysis revealed azoospermia. Scrotal colour coded duplex ultrasonography demonstrated moderately enlarged testes having well defined hypoechoic masses with foci of calcifications. Magnetic resonance imaging confirmed these findings. Biopsy and histopathology detected the presence of caseating granuloma and Ziehl–Neelsen staining of paraffin sections demonstrated acid‐fast bacilli. The patient was treated with combination therapy. Tracing of the condition is discussed.     

Flow through a defective mechanical heart valve: a steady flow analysis

Approximately 250,000 valve replacement operations occur annually around the world and more than two thirds of these operations use mechanical heart valves (MHV). These valves are subject to complications such: pannus and/or thrombus formation. Another potential complication is a malfunction in one of the valve leaflets. Although the occurrence of such malfunctions is low, they are life-threatening events that require emergency surgery. It is, therefore, important to develop parameters that will allow an early non-invasive diagnosis of such valve malfunction. In the present study, we performed numerical simulations of the flow through a defective mechanical valve under several flow and malfunction severity conditions. Our results show that the flow upstream and downstream of the defective valve is highly influenced by malfunction severity and this resulted in a misleading improvement in the correlation between simulated Doppler echocardiographic and catheter transvalvular pressure gradients. In this study, we were also able to propose and test two potential non-invasive parameters, using Doppler echocardiography and phase contrast magnetic resonance imaging, for an early detection of mechanical heart valve malfunction. Finally, we showed that valve malfunction has a significant impact on platelet activation and therefore on thrombus formation.     

Long-term Functional and Quality of Life Outcomes of Patients After Repair of Large Perianal Skin Defects for Paget’s and Bowen’s Disease

Introduction  

The assessment of long- term functional and quality of life outcomes of these patients following repair of large defects after surgical excision has not been reported.     

Does posttransplant anemia at 6 months affect long-term outcome of live-donor kidney transplantation? A single-center experience

Background/Aims  Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia at 6 months of transplantation in patients under different protocols of immunosuppression, and to determine the impact of anemia on long-term patient and graft survival. Methods  We included 832 renal transplant recipients who were categorized at 6 months according to hemoglobin (Hb) level into two groups: the first group, with Hb >13 g/dl in males and >12 g/dl in females (group I, 385 cases); and the second group, with Hb <13 g/dl in males and <12 g/dl in females (group II, 447 cases). We compared the two groups regarding posttransplant complications as well as patient and graft survival. Results  Although there was no significant difference between the two groups regarding acute rejection episodes, chronic allograft nephropathy was significantly higher in the anemic group. Other posttransplant medical complications were comparable in both groups. Graft survival was significantly higher in the nonanemic group. However, no difference in patient survival was detected. Conclusion  From this study, we can conclude that prevalence of PTA is high, especially in females and those receiving calcineurine inhibitors (CNI) and mycophenolate mofetil (MMF), and that it was associated with poorer graft outcome but with no effect on patient survival.     

Comparison between a serous‐lined extramural tunnel and T‐limb ileal procedure as an antireflux technique in orthotopic ileal substitutes: a prospective randomized trial

OBJECTIVE

To compare the functional results from a prospective randomized trial of two different reflux‐prevention techniques for ileal bladder substitution.

PATIENTS AND METHODS

In all, 60 patients with invasive bladder cancer were randomized to receive either a serous‐lined extramural tunnel (group 1) or T‐limb ileal procedure (group 2) as an antireflux technique for the ileal substitute. The preoperative evaluation included intravenous urography, radioisotope renography to evaluate glomerular filtration rates (GFRs) and renal cortical imaging with ^99mTc‐ dimercaptosuccinic acid to assess parenchymal scarring. Evaluable patients were re‐assessed by the same imaging, and by ascending studies.

RESULTS

The follow‐up included 27 patients (49 units) in group 1 and 23 (45 units) in group 2, with a mean (sd ) follow‐up of 6.3 (0.5) and 7.4 (1.9), respectively. Uretero‐ileal strictures were diagnosed in one renal unit in each group (P = 0.5). Ascending studies showed no reflux in any patients in group 1, while 13 renal units (29%) in group 2 were refluxing (P < 0.01). There was progressive cortical scarring with or with no significant reduction in GFR (>25%) in three and four renal units in groups 1 and 2, respectively. Among the 13 refluxing units in group 2, three showed a significant deterioration in GFR and one renal unit was diagnosed with progressive cortical scarring.

CONCLUSION

Both procedures provided a low rate of anastomotic stricture, with acceptable preservation of renal function. The serous‐lined extramural tunnel provided a more effective antireflux mechanism.     

Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation

Background contextPolyetheretherketone (PEEK) has been increasingly used as a biomaterial for spinal implants. PEEK lumbar fusion rods have recently become available for use in posterior lumbar fusion procedures.PurposeTo compare Polyetheretherketone Rod System to traditional titanium rod fixation in a cadaveric model and provide mechanical test data for the PEEK system.Study designBiomechanical testing.MethodsCadaveric biomechanical testing was conducted to compare Expedium 5.5 mm PEEK rods to titanium rods of equivalent diameter. Biomaterials testing was performed to determine static and dynamic performance of Expedium 5.5 mm PEEK rods with 6% BaSo4 in compressive bending and torsion.ResultsCadaveric testing demonstrated that PEEK rods can significantly reduce the range of motion of a destabilized segment. The testing showed no significant difference in the stability provided by PEEK and titanium rods in posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) constructs. PEEK static compressive bending tests showed 67 degrees displacement without fracture of the rod. Torsion testing showed 30 degrees of rotation without yield or plastic deformation. Dynamic compression testing revealed two fatigue runouts at 23 degrees.ConclusionsPEEK rods provide comparable stability to titanium rods of equivalent diameter in cadaveric testing. Mechanical testing suggests PEEK rods can withstand far beyond the angular displacements suggested by cadaveric testing and that of normal physiologic range of motion. Potential advantages to PEEK rods include better anterior column load sharing, reduced stress at bone-to-screw interface, and reduced computed tomography and magnetic resonance imaging scatter and artifact.