Acute scrotal pain with a twist

Intratesticular lesions identified on ultrasound are usually malignant. It presents a particular dilemma to the surgeon when conservative approach is considered. A 55-year-old smoker with peripheral vascular disease had attended the accident and emergency with acute left hemiscrotal pain of 24-h duration. Clinical examination revealed a swollen, tender hemiscrotum. Ultrasound had demonstrated a hypo-echoic lesion in the testis measuring 2 × 1.8 cm. This was reported as possible infarct and managed conservatively. On review after 4 weeks, the patient was still symptomatic with persistent dull pain. A repeat scan in 4 weeks showed persistence of the lesion raising the possibility of tumour. Tumour marker profile was not elevated. The patient had a radical orchidectomy and the histology showed segmental infarction of the testis with thrombosis of the segmental testicular vessels. Peripheral vascular disease can cause segmental infarction of the testis due to the end arterial blood supply; in these cases, magnetic resonance scan can be diagnostic. Once confirmed, segmental infarcts can be safely managed conservatively.     

睾旁胚胎型横纹肌肉瘤5例报告并文献复习

目的:提高睾旁胚胎型横纹肌肉瘤的诊治水平。方法:回顾性分析5例睾旁胚胎型横纹肌肉瘤患者的临床资料,结合文献复习进行讨论。结果:5例患者中精索胚胎型横纹肌肉瘤2例、附睾胚胎型横纹肌肉瘤2例、鞘膜横纹肌肉瘤1例,临床病理分期Ⅰ期2例,Ⅱ期1例,Ⅳ期2例。5例患者最终均行根治性睾丸切除术及肿块完整切除术。1例Ⅰb期和1例Ⅱ期患者术后采用异环磷酰胺、长春新碱、足叶乙甙、丝裂霉素、顺铂化疗并配合局部放疗,余3例未行进一步治疗。2例Ⅰ期、1例Ⅱ期患者随访28、18、12个月未见复发和转移,1例Ⅳ期患者随访6个月后死于多发转移,1例Ⅳ期随访6个月未见复发和转移,后失访。结论:早期诊断,根治性手术并辅助化疗、放疗是治疗睾旁胚胎型横纹肌肉瘤的有效手段。     

Case report: Traumatic unilateral testicular rupture

IntroductionTesticular trauma is classified aetiologically as blunt, penetrating or degloving. Blunt testicular trauma, caused by interpersonal violence, sporting injuries and RTAs account for the majority of cases, typically affecting males aged 15–40 [1]. Approximately 98.5% of blunt trauma resulted in unilateral testicular injury; about 12–15% involving cyclists or motorcyclists (Cass and Luxenberg, 1988) [2].Presentation of caseA 48-year-old male motorcyclist presented to the accident and emergency department with an acute scrotum following collision with an oncoming vehicle. On arrival, he was fully conscious, tachycardic and hypertensive. Examination of his genitalia revealed ecchymosis of the right hemi-scrotum and perineal bruising. The right hemi-scrotum was grossly swollen but the left testis was normal. Ultrasound revealed gross haematoma and ruptured capsule of the right testicle. Intraoperatively, emergency exploration of the right hemiscrotum revealed evidence of lower pole rupture. Clot evacuation and debridement of necrotic testicular tissue preceded closure of the tunica albuginea.DiscussionThe majority of all testicular ruptures are diagnosed secondary to sport-related injuries [3] and motor vehicle or motorbike accidents. However, analysis of the literature has revealed a total of five cases of rupture, which have been linked to testicular tumours, the most recent of which was reported in 2014 (Lunawat et al., 2014) [5]. In two out of these five cases, trivial trauma preceded the diagnosis. It raises the question whether the presence of malignancy decreases the threshold of suffering a blunt testicular injury hence increasing the likelihood of testicular rupture.ConclusionEmergency assessment and diagnosis as well as scrotal exploration are important components of the management of acute testicular rupture. Analysis of the literature proves that timely surgical intervention is crucial; early intervention results in higher rates of preservation and avoids the need for an orchidectomy.     

High‐Resolution Sonography of the Normal Extrapelvic Vas Deferens

Objective. The purpose of this study was to determine the reliability of sonographic visualization of the normal extrapelvic vas deferens and to analyze its appearance and dimensions. Methods. Scans of the scrotum and spermatic cords were obtained in 25 fertile volunteers. Identification of the vas deferens was attempted bilaterally in the scrotal, suprascrotal, and prepubic segments in all volunteers. When possible, the total thickness and the diameter of the lumen were measured. Visualization and dimensions were correlated with the body mass index (BMI) and abstinence interval. Results. All segments of the vas deferens were identified bilaterally in all volunteers. In all cases, it appeared as an anechoic or very hypoechoic tubular structure that was noncompressible and contained no detectable blood flow. It was convoluted inferiorly and became straight as it progressed from the scrotum to the suprascrotal and prepubic segments. The lumen was seen in the suprascrotal segment in all of the volunteers except the one with the highest BMI. The total thickness of the vas ranged from 1.5 to 2.7 mm (mean, 1.89 mm). The lumen of the vas ranged from 0.2 to 0.7 mm (mean, 0.43 mm). There was no correlation between the luminal diameter and the abstinence interval. Conclusions. The extrapelvic portion of the vas deferens is reliably visualized sonographically. Its appearance is characteristic and reproducible. The lumen can be measured in almost all cases.     

New syndrome: Mother and son with hypertelorism,downslanting palpebral fissures,malar hypoplasia,and apparently low-set ears associated with joint and scrotal anomalies

We report on a mother and son with a similar syndrome of hypertelorism and telecanthus, epicanthal folds, downslanting palpebral fissures, ptosis, broad nasal bridge, malar hypoplasia, thin upper lip, smooth philtrum, and apparently low-set prominent ears. The son also has a hypoplastic shawl scrotum, cryptorchidism, and genu valgum. His language development was delayed at 18 months, but subsequently improved and was normal at age 3. The mother has the additional findings of marked cubitus valgus, hyperextensible joints, dull normal intelligence and a bleeding diathesis. This pattern of multiple congenital anomalies may represent a new syndrome.     

阴囊皮瓣修复后局部温度变化对生精细胞凋亡的影响

目的：探讨采用皮瓣重建阴囊后局部温度变化及其对生精细胞凋亡和生育能力的影响.方法：24只健康雄性新西兰大白兔随机分成重建组（皮瓣重建阴囊组）和对照组,每组12只.雌性12只用于配对试验.重建组建立皮瓣重建阴囊模型前采集精液进行计数,埋藏法测量阴囊内睾丸表面的温度,然后建立皮瓣重建阴囊模型.于重建阴囊第8周,重建组再次采集精液及测量阴囊内睾丸表面的温度,并随机取重建组及对照组各6只动物进行睾丸活检.应用原位末端标记（TUNEL）法检测生精细胞凋亡.将两组未行睾丸活检的各6只雄兔分别与雌兔配对喂养观察生育情况.结果：皮瓣重建阴囊后第8周睾丸表面温度明显高于皮瓣重建阴囊前的温度,精子计数明显低于阴囊重建前的精子计数（P〈0.05）.与对照组相比,重建组睾丸生精细胞凋亡指数显著升高（P〈0.05）.配对喂养结果显示,重建组没有生育,而对照组平均生育幼兔（6.0±1.3）只（P〈0.05）.结论：皮瓣重建阴囊后兔睾丸局部温度升高,睾丸的生精细胞过度凋亡,导致雄兔不育.皮瓣不宜被临床继续选用于重建阴囊.     

超声诊断在男性不育症中阴囊疾病的临床价值

目的：探讨高频彩色超声诊断在男性不育症中阴囊疾病的临床价值。方法通过高频多普勒超声观察男性不育患者的睾丸、附睾、精索,了解睾丸、附睾及精索静脉的血流情况,并根据实验室检查精子质量情况,研究超声声像图特征与睾丸生精功能、阴囊附件对精子的影响等进行相关分析。结果256例男性不育症患者中超声声像图表现为阳性的有195例,占76.2％。结论超声检查对男性不育症病因筛查有重要价值,为临床诊断与治疗方案的选择提供极有价值的信息,有效地提高内外科治疗的成功率。     

二维及彩色多普勒超声诊断阴囊肿块的研究

探讨二维及彩色多普勒超声对阴囊肿块的诊断价值。方法 报告１９５例经病理证实的阴囊肿块的超声检测结果。描述二维图像特征，探讨ＣＤＩ及ＰＤ的应用。结果超声诊断阴囊肿块总符合率为８９．２％，阴囊恶性肿瘤ＲＩ升高，结论西方主为二维超声＋ＣＤＩ＋ＲＩ有助于做出正确诊断。