Ivana Štula

Incarcerated Inguinal Hernia Mesh Repair: Effect on Testicular Blood Flow and Sperm Autoimmunity

Background The aim of our study was to determine an influence of incarcerated inguinal hernia mesh repair on testicular circulation and to investigate consequent sperm autoimmunity as a possible reason for infertility. Material/Methods This prospective study was performed over a 3-year period, and 50 male patients were included; 25 of these patients underwent elective open mesh hernia repair (Group I). Group II consisted of 25 patients who had surgery for incarcerated inguinal hernia. Doppler ultrasound evaluation of the testicular blood flow and blood samplings for antisperm antibodies (ASA) was performed in all patients before the surgery, on the second day, and 5 months after. Main outcome ultrasound measures were resistive index (RI) and pulsative index (PI), as their values are inversely proportional to testicular blood flow. Results In Group I, RI, and PI temporarily increased after surgery and then returned to basal values in the late postoperative period. Friedman analysis showed a significant difference in RI and PI for all measurements in Group II (p<0.05), with a significant decrease between the preoperative, early, and late postoperative periods. All final values were within reference range, including ASA, despite significant increase of ASA in the late postoperative period. Conclusions Although statistically significant differences in values of testicular flow parameters and immunologic sensitization in observed time, final values remained within the reference ranges in all patients. Our results suggest that the polypropylene mesh probably does not cause any clinically significant effect on testicular flow and immunologic response in both groups of patients.

CASTLEMAN'S DISEASE PRESENTING AS A TUMOROUS PARACARDIAC FORMATION.

Castlemans disease (in the literature also known as angiofollicular hyperplasia) is a rare benign lymphoproliferative disease. Clinically, it can manifest as unicentric or multicentric disease. Unicentric disease is most often diagnosed by accident or by symptomatology resulting from compression upon the adjoining anatomical structures. Considering its lymphatic origin, tumor mass can theoretically occur in any body region. We present a case of paracardiac localization of unicentric Castlemans disease in a previously healthy 24-year-old woman. In such clinical cases, the specific localization of the tumor and its radiological properties can pose a differential diagnostic dilemma. Correct diagnosis is only possible after complete surgical excision and histopathologic analysis, which is the optimal therapeutic approach in this disease.

Duplication of Posterior Cerebral Artery

A case report of a forty-six-year old female patient with the duplication of the posterior cerebral artery (PCA) and concomitant vascular malformation. We try to explain the development of this variant and diagnostic approach in this particular case.

Castelman’s disease presenting as tumorous paracardial formation

pRIKAz sLUČAJA: Prikazujemo slučaj od ranije zdrave 24-godišnje žene koja se javila na Hitni kirurški prijam Kliničkog bolničkog centra Split zbog protrahiranih bolova u leđima koji su nastali dva dana ranije kada je doživjela prometnu nezgodu. U sklopu dijagnostičke obrade urađena je rendgenska snimka torakalnih organa kojom se postavi sumnja na tumorsku tvorbu prednjeg medijastinuma. Žurna obrada se nadopuni MSCT-om prsišta i transtorakalnom ehokardiografijom koje su ukazale na postojanje moguće pseudoaneurizme lijeve klijetke (slika 1). Daljnjim dijagnostičkim postupcima (MSCT angiografija) odbaci se INTROdUCTION: Castelman’s disease is a rare benign lymphoprolipherative disease. Clinically it can manifest as unicentric or multicentric.