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A national survey of practice for the emergency fixation of testis. Ann R Coll Surg Engl 2024. [PMID: 38362750 DOI: 10.1308/rcsann.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Scrotal exploration for suspected testicular torsion is a common emergency procedure in the United Kingdom (UK). There is no universally agreed practice for how the testis should be fixed, or whether a nontorted testis should receive fixation. This survey aims to describe the methods used for emergency scrotal exploration and testicular fixation in the UK. METHODS An online survey was distributed to urologists, general surgeons and specialist paediatric surgeons in approved NHS trusts, and via the email lists of collaborating organisations. The survey questioned surgeons on their operative management of a variety of common diagnoses encountered during scrotal exploration using multiple choice and free-text answers. RESULTS A total of 340 responses were received from 83 institutions. Respondents included urologists (consultants, 33%; trainees, 24%), paediatric surgeons (consultants, 12%; trainees, 16%) and general surgeons. In cases of torsion, respondents predominantly perform sutured fixation (74%); however, sutureless dartos pouch fixation was used frequently (37%) by paediatric surgeons. The finding of 'bell-clapper' anatomy without torsion prompts 69% of respondents to undertake sutured fixation, but alternative nontorsion diagnoses frequently prompt use of sutureless methods (53-66%). CONCLUSION This study is the largest survey of methods for emergency scrotal exploration and describes current UK practice. The majority of surgeons prefer sutured fixation in cases of torsion and/or bell-clapper anomalies, and sutureless methods in the absence of it.
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Ruaux E, VanBuren WM, Nougaret S, Gavrel M, Charlot M, Grangeon F, Bolze PA, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T2-hypointense lesions. Insights Imaging 2024; 15:20. [PMID: 38267633 PMCID: PMC10808434 DOI: 10.1186/s13244-023-01588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/27/2023] [Indexed: 01/26/2024] Open
Abstract
Endometriosis is a common crippling disease in women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While its sensitivity, especially in deep infiltrating endometriosis, is superior to that of ultrasonography, many sources of false-positive results exist, leading to a lack of specificity. Hypointense lesions or pseudo-lesions on T2-weighted images include anatomical variants, fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post treatment scars which may mimic deep pelvic infiltrating endometriosis. False positives can have a major impact on patient management, from diagnosis to medical or surgical treatment. This educational review aims to help the radiologist acknowledge MRI criteria, pitfalls, and the differential diagnosis of deep pelvic infiltrating endometriosis to reduce false-positive results. Critical relevance statement MRI in deep infiltrating endometriosis has a 23% false-positive rate, leading to misdiagnosis. T2-hypointense lesions primarily result from anatomical variations, fibrous connective tissue, benign and malignant tumors, feces, surgical material, and post-treatment scars. Key points • MRI in DIE has a 23% false-positive rate, leading to potential misdiagnosis.• Anatomical variations, fibrous connective tissues, neoplasms, and surgical alterations are the main sources of T2-hypointense mimickers.• Multisequence interpretation, morphologic assessment, and precise anatomic localization are crucial to prevent overdiagnosis.• Gadolinium injection is beneficial for assessing endometriosis differential diagnosis only in specific conditions.
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Affiliation(s)
- Edouard Ruaux
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | | | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, 34295, Montpellier, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mathilde Charlot
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Flavia Grangeon
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Pierre-Adrien Bolze
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, 69495, Pierre Bénite, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Service Imageries Radiologiques Et Interventionnelles Spécialisées, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France.
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Kinberger M, Werner RN. [Current guidelines for the management of ano genital diseases]. Dermatologie (Heidelb) 2024; 75:7-14. [PMID: 37962648 DOI: 10.1007/s00105-023-05251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Anogenital disorders encompass a broad spectrum of conditions with diverse pathogenetic origins, often presenting with nonspecific symptoms and overlapping causative factors, thereby posing diagnostic and therapeutic challenges. Effective management requires interdisciplinary knowledge and the use of medical guidelines. Guidelines can play an important role in translating current knowledge into clinical practice and ensuring consistent care, minimizing complications, and optimizing patient outcomes. OBJECTIVE The dermatologically relevant guidelines for anogenital disorders, categorized by etiological groups, are reviewed. MATERIALS AND METHODS A selective literature review was conducted, incorporating data from the guideline repository of the Association of the Scientific Medical Societies in Germany (AWMF). RESULTS A broad range of current guidelines pertinent to the management of anogenital disorders with relevance for dermatologists is available. These encompass guidelines for the management of chronic inflammatory dermatoses with (potential) involvement of the anogenital region, such as anal eczema, psoriasis, lichen sclerosus, or lichen ruber, as well as sexually transmitted infections and associated conditions, involving a broad range of pathogens, including gonorrhea, chlamydia, syphilis, or human papillomaviruses (HPV)-associated disorders. In this article, we provide an overview of the available guidelines. CONCLUSION The present article does not claim to be exhaustive. The validity of the mentioned guidelines and the availability of updates needs to be verified in each case.
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Affiliation(s)
- Maria Kinberger
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Kitade Y, Tsukano K, Miyamoto Y, Suzuki K. Mastitis causes negative reproduction performance similar to genital diseases. Res Vet Sci 2022; 153:35-44. [PMID: 36308789 DOI: 10.1016/j.rvsc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/17/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
The economic efficiency of dairy farms is directly influenced by reproductive performance. Reproductive performance is affected by postpartum health; however, it is unknown which diseases reduce reproductive performance or how often these diseases occur in tie-stall dairy farms. In this study, the 15 most frequent diseases in tie-stalls and their impact on reproduction were determined by logistic analysis. Data from reproductive and veterinary records of 814 cows (473 Holstein) calving between April 2016 and March 2018 reared in 9 tie-stall commercial dairy farms were used. The 15 most frequent diseases were identified by medical records. The odds ratio (OR) of the diseases reducing reproductive performance (days open, number of artificial insemination, and first artificial insemination days in milk) was measured by logistic regression analysis. We focused on mastitis, and factors (inflammation grade, causative bacteria) having a negative effect on reproduction were measured similarly. Of the 15 most frequent diseases, endometritis (OR: 5.45, p < 0.001), ovarian quiescence (OR: 3.95, p < 0.001), mastitis (OR: 2.49, p < 0.001), and follicular cyst (OR: 2.33, p = 0.006) significantly prolonged days open after adjusting for environmental factors (farm, parity, and calving season). Focusing on mastitis, mastitis with mild inflammation significantly prolonged days open. Mastitis and genital diseases were frequent diseases that reduced reproductive performance. Strategies to reduce the incidence of these diseases are considered effective for the economics of tie-stall dairy farms.
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Affiliation(s)
- Yasuyuki Kitade
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan; Kitade Animal Clinic, 653 Sakae, Kitahiyama-ku setana-cho kudo-gun, Hokkaido 049-4751, Japan
| | - Kenji Tsukano
- Minami-Hokkaido Agricultural Mutual Relief Association, 74-2 Higashimae, Hokuto, Hokkaido 041-1214, Japan
| | - Yuichi Miyamoto
- Minami-Hokkaido Agricultural Mutual Relief Association, 74-2 Higashimae, Hokuto, Hokkaido 041-1214, Japan
| | - Kazuyuki Suzuki
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan.
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Suárez-Marquez E, Garcia-Rodriguez LF, Treviño-Rangel L, Guerrero-Putz MD. Labial Adhesion Secondary to Lichen Sclerosus Masked by Vulvar Hailey-Hailey Disease. J Menopausal Med 2022; 28:136-138. [PMID: 36647277 PMCID: PMC9843032 DOI: 10.6118/jmm.22020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Abstract
Labial adhesions in postmenopausal women are caused by various inflammatory processes in the context of estrogen deficiency. Lichen sclerosus (LS) is a chronic, progressive condition characterized by idiopathic epithelial thinning of the anogenital region with symptoms of significant pruritus, discomfort, and dyspareunia. Early diagnosis and treatment of LS can prevent disease progression, leading to labial adhesions and malignancy. We present an 84-year-old woman with long-standing vulvar Hailey-Hailey disease who developed labial adhesions. Clinical examination with vulvar biopsy revealed histopathological findings consistent with LS. Surgical separation of the labia by blunt dissection was then performed, and clobetasol ointment and vaginal dilatators were postoperatively prescribed. This resulted in a significant improvement in her symptoms. This is the first reported case of LS in a patient with Hailey-Hailey disease.
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Affiliation(s)
- Elizabeth Suárez-Marquez
- Department of Gynaecology and Obstetrics, School of Medicine and Health Sciences, Tecnológico de Monterrey, Monterrey, Mexico
| | - Luis Fernando Garcia-Rodriguez
- Department of Gynaecology and Obstetrics, School of Medicine and Health Sciences, Tecnológico de Monterrey, Monterrey, Mexico
| | | | - María D. Guerrero-Putz
- Department of Dermatology, University Hospital “Dr. José Eleuterio González”, Monterrey, México
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Florim S, Oliveira V, Rocha D. Zinner syndrome presenting with intermittent scrotal pain in a young man. Radiol Case Rep 2018; 13:1224-1227. [PMID: 30258511 PMCID: PMC6148829 DOI: 10.1016/j.radcr.2018.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022] Open
Abstract
Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs during the first trimester of gestation, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. The mutual embryological origins of the seminal vesicle and ureteral bud from the mesonephric (Wolffian) duct result in association between ipsilateral renal agenesis and seminal vesical cysts. Zinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. This syndrome were first described by Zinner in 1914, and 200 cases have been reported in the literature. Most patients with this anomaly are asymptomatic until the second or third decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. In this paper, we present a uncommon case of a 21-year-old patient which the initial presentation of this condition was intermittent scrotal pain. A brief review of the literature is undertaken, regarding the main clinical, imaging implications, and the developmental anomalies that are involved in this congenital anomaly.
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Affiliation(s)
- Sofia Florim
- Department of Radiology, Centro Hospitalar de Vila Nova de Gaia, Rua Conceição Fernandes, 1079, 4400 Vila Nova de Gaia, Portugal
| | - Vitor Oliveira
- Department of Urology, Centro Hospitalar de Vila Nova de Gaia, Rua Conceição Fernandes, 1079, 4400 Vila Nova de Gaia, Portugal
| | - Diogo Rocha
- Department of Radiology, Centro Hospitalar de Vila Nova de Gaia, Rua Conceição Fernandes, 1079, 4400 Vila Nova de Gaia, Portugal
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Reda S, Gonçalves FA, Mazepa MM, De Carvalho NS. Women infected with HIV and the impact of associated sexually transmitted infections. Int J Gynaecol Obstet 2018; 142:143-147. [PMID: 29656416 DOI: 10.1002/ijgo.12507] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/27/2018] [Accepted: 04/06/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To review the relationship between concomitant sexually transmitted infections in women infected with HIV. METHODS PubMed and Scopus were searched for articles published in English and Portuguese between January 1, 1994, and December 31, 2015, using relevant keywords, including AIDS, HIV, female genital diseases, and sexually transmitted infections. Articles that associated sexually transmitted infections with HIV-infected women were selected for inclusion. Those that only investigated prevalence in pregnant women or focused on social or behavioral aspects were excluded. RESULTS Of 108 identified articles, 24 were included. When correlated with HIV, genital herpes demonstrated an increased recurrence rate and increased replication rate for HIV in the mucosa. In HIV-positive women, syphilis can cause more genital ulcers. Bacterial vaginosis provides a pool of microorganisms that can increase the viral copy levels of genital HIV. Chlamydia, gonorrhea, and candidiasis may be more severe and complicated in women infected with HIV. CONCLUSIONS Screening of HIV-positive patients who could have other sexually transmitted infections is important to protect women and decrease the risk of transmission.
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Affiliation(s)
- Somaia Reda
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil.,University Positivo, Curitiba, Paraná, Brazil
| | - Fernanda Aguiar Gonçalves
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Melissa Mello Mazepa
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Newton Sérgio De Carvalho
- Obstetrics and Gynecology Department, Sector of Infectious Diseases in Obstetrics and Gynecology, Clinical Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil.,Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Paraná, Brazil
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