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.     

Transcranial duplex in the differential diagnosis of parkinsonian syndromes

Background   Transcranial duplex scanning (TCD) of the substantia nigra (SN) is increasingly used to diagnose Idiopathic Parkinson’s Disease (IPD). Up until now 70 diagnostic studies have been published, not only on investigation of the SN, but also of the lenticular nucleus (LN) and the Raphe nuclei (RN). Method   We systematically reviewed all diagnostic TCD studies in parkinsonian patients up to June 2008. Results   We found 35 eligible studies. Of the 1534 IPD patients investigated in the 35 studies 200 (13 %) had an inconclusive SN-TCD. An increased echo-intensity of the SN was seen in 1167 (87 %) of the 1334 IPD patients, 276 (12 %) of the 2340 healthy controls and in 41 (30 %) of the 138 patients with an atypical parkinsonian syndrome (APS). On the contrary, a pathological LNTCD was found more often in APS patients (79 %) than in IPD patients (23 %) and healthy controls (6 %). A decreased echo-intensity of the RN was found more often in depressed (46 %) than in non-depressed IPD patients (16 %). Conclusions   SN-TCD accurately differentiates between patients with IPD and healthy controls, but not between patients with IPD and APS. LN-TCD is only moderate accurate to delineate IPD from APS, but combinations of SN- and LN-TCD may be more promising. RN-TCD has only marginal diagnostic accuracy in diagnosing depression in IPD and non-IPD patients. Before TCD can be implicated, more research is needed to standardize the TCD technique, to investigate the TCD in non-research settings and to determine the additional value of TCD compared with currently used clinical techniques like SPECT imaging.     

Endobronchial ultrasound for detection of tracheomalacia from chronic compression by vascular ring

A 67-year-old female chronic smoker was evaluated for an asymptomatic right paratracheal mass and the diagnosis of double-arch aorta was made. She returned 2 years later with dyspnoea on exertion, productive cough and wheeze on lying supine. Flow volume curve showed variable intrathoracic airway obstruction, and bronchoscopy revealed extrinsic compression of the trachea by double-arch aorta with destruction of the cartilaginous layer visualized on endobronchial ultrasonography. Endobronchial ultrasonography may be a useful adjunctive tool for the identification of adults at risk of postoperative tracheomalacia where tracheopexy or airway stenting can be performed concurrently or sequentially if surgery is contemplated.     

Ultrasonographic evaluation of the diaphragm in patients with amyotrophic lateral sclerosis

Real-time diaphragmatic movement was evaluated with ultrasonography in three patients with amyotrophic lateral sclerosis (ALS). The initial complaint of two patients was weakness of the extremities followed by dyspnoea later in the disease course, while the third patient had dyspnoea as the initial symptom. Ultrasonographic analyses revealed that the contractile function of the diaphragm was not maintained during maximum inspiratory effort, with unsatisfactory diaphragmatic excursion and no change in diaphragmatic thickness during respiration, indicating diaphragmatic paralysis. Ultrasonography may be useful for the diagnosis and follow up of diaphragmatic involvement with amyotrophic lateral sclerosis and other motor-neuron diseases.     

Meralgia paresthetica caused by hip-huggers in a patient with aberrant course of the lateral femoral cutaneous nerve

"Hip-huggers" may be a precipitating factor for meralgia paresthetica (MP), especially in thin persons with an aberrant pathway of the lateral femoral cutaneous nerve (LFCN). We describe a 25-year-old woman with a long-standing history of MP caused by an abnormal course of the LFCN and tight trousers, specifically hip-huggers. Ultrasonography was useful for detecting the lesion site and the abnormal pathway of the LFCN. After neurectomy of the LFCN, most of the symptoms of MP were relieved, but mild hypesthesia remained in the lateral thigh.     

Dynamic cerebral autoregulation: should intracranial pressure be taken into account?

Summary Background. Although the inclusion of cerebral perfusion pressure (CPP) is a standard feature in static testing of autoregulation after head injury, controversy surrounds the use of CPP versus arterial blood pressure (ABP) in dynamic tests. The aim of our project was to assess the discrepancies between methods of dynamic autoregulation testing based on CPP or ABP, and study possible differences in their prognostic value. Method. Intermittent recordings of intracranial pressure (ICP), ABP and middle cerebral artery blood flow velocity (FV) waveforms were made in 151 anaesthetised and ventilated adult head injured patients as part of their required care. Indices of dynamic autoregulation were calculated as a moving correlation coefficient of 60 samples (total time 3 min) of 6 s mean values of FV and ABP (Mxa) or FV and CPP (Mx). Values of Mx and Mxa were averaged over multiple recordings in each patient and correlated with outcome at 6 months post injury. Findings. Association between Mx and Mxa was moderately strong (r ² = 0.73). However, limit of 95% accordance between both indices was ±0.32. Mxa was significantly greater than Mx (0.22 ± 0.22 versus 0.062 ± 0.28; p < 0.000001). The difference between Mx and Mxa decreased with impairment of autoregulation (r = −0.39; p < 0.000001). Mean value of Mx showed a significant difference between dichotomized outcome groups (better autoregulation in patients with favourable than unfavourable outcome), while Mxa did not. Conclusions. Although relatively similar in a large group of patients, the differences between these two methods of assessment of dynamic autoregulation may be considerable in individual cases. When ICP is monitored, CPP rather than ABP should be included in the calculation of the autoregulatory index.     

Unnoticed post-void residual urine volume in people with moderate to severe intellectual disabilities: prevalence and risk factors

Background   Increased post-void residual urine volume (PVR) is often seen in geriatric populations. People with intellectual disabilities (ID) have risk factors in common with these populations.
Aims   To investigate in adults with ID:

• • 

  Feasibility of portable ultrasound bladder scanning;
• • 

  Prevalence of PVR; and
• • 

  Relations with proposed risk factors for PVR.

Methods   In a cross-sectional design, PVR was measured using ultrasound scanning in 346 adults with moderate to severe ID aged 18–82 years. Relationship between increased PVR and the following risk factors was assessed: age, level of ID, gender, ambulancy, medication, chronic illnesses, incontinence and profound multiple disabilities (PMD). Acceptation of scanning and manageability were noted.
Results   Feasibility: All participants were cooperatively undergoing the ultrasound scan and all outcomes were sufficiently interpretable. Prevalence: PVR ≥ 150 mL was newly identified in 30/346 persons (8.7%, 95% confidence interval 5.92–12.14). Associations: Higher age ( P  = 0.001), laxative use ( P  = 0.001), chronic illnesses other than epilepsy ( P  = 0.005), profound ID ( P  = 0.008), incontinence ( P  = 0.048) and immobility ( P  = 0.005) are determinants that were associated with urinary retention.
Conclusions   The bladder ultrasound scan is a feasible method to identify increased PVR in adults with more severe levels of ID. The prevalence of PVR in adults is similar to prevalences found in the geriatric general population.     

乳腺触觉成像系统的临床应用评估

目的:评估乳腺触觉成像系统在乳腺癌诊断中的临床应用价值.方法:"以乳腺肿块"收入院治疗,经手术病理论断明确的患者194例,经Sure Touch 触觉成像系统检查,与临床触诊,B超与X线钼靶检查结果进行对比,统计分析其临床应用价值.结果:Sure Touch诊断乳腺癌88例,76例与病理符合,敏感性83.02%,特异性...     

超声内镜在腹膜后占位性病变诊断中的应用

目的评价超声内镜(endoscopic ultrasonography)在腹膜后占位性病变定性诊断中的应用价值。方法回顾性分析26例因腹膜后占位病变在本院行超声内镜介导下细针穿刺抽吸活检术(endoscopic ultrasonography guided fine needle aspiration,EUS-FNA)患者的病理诊断情况。结果 26例患者中24例有明确病理结果,组织学诊断率为92.3%。本组患者均未发生出血、感染、腹腔内脏器损伤等并发症。病理诊断为良性肿瘤8例,占33.3%;恶性16例,占66.7%。2例因取材较少无明确病理学诊断,8例患者避免了手术治疗。结论对于腹膜后占位的定性诊断,EUS-FNA具有并发症少、诊断率高的优点,值得临床推广。