Lester Karafin

Necrotic testicle with increased blood flow on doppler ultrasonic examination

A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.

Scrotal imaging in the Henoch-Schönlein syndrome.

Testicular involvement in patients with Henoch-Schönlein syndrome may occur in as high as 15 per cent of the cases. Scrotal imaging is extremely accurate in differentiating hyperemia (vasculitis) from impairment of blood flow encountered in torsion of the spermatic cord, the most common cause of acute scrotal swelling in children.

Fluorescence of testicle: An indication of viability of spermatic cord after torsion

We present an objective measure of testicular viability intended to aid the surgeon in salvaging the testicle at the time of operation for torsion of the spermatic cord. Following the intravenous administration of 5 to 10 cc. of sodium fluorescein, the viability of the untwisted testicle can be determined by its fluorescence when exposed to a portable long wavelength Wood ultraviolet light source.

Paget's disease of scrotum Need for early biopsy

Abstract A case of Pagets disease of the scrotum is presented. The results of previously reported cases and the pathology are reviewed. A program of management and therapy is suggested.

CONGENITAL CYSTIC DISEASE OF KIDNEY Classification and Manifestations

Abstract A simplified, easy to recall classification of congenital renal cystic disease, based on location of the cysts, is presented. Adherence to this nomenclature should clarify existing semantics and eradicate much of the confusion which has developed throughout the years.

Preoperative localization of pheochromocytoma

Several tests are available which indicate pheochromocytoma as a probable cause of hypertension. Measures for localization of the tumor(s) are, however, less effective. Preoperative localization is relatively more important in children than in adults since there is a higher incidence of multiple tumors in the younger age group and such tumors are often located at some distance from the adrenal glands. A previously described technique for localizing tumors in which plasma samples obtained by catheterization of several veins are analyzed for catecholamine has been modified. Seven previously undetected pheochromocytomas were localized by this modified method in a boy from whom 5 tumors had been surgically removed at an earlier date.

Urachal Diverticulum in a 3-Year-Old Boy

A case of a urachal diverticulum that presented as a right lower quadrant mass in a 3-year-old boy is reported. There was no urinary tract infection or obstructive uropathy in this patient. Classification of urachal anomalies is reviewed.

Electrocoaptive Closure of Linear Incisions in the Ureter

High-frequency electric currents were intro-· cluced into medical practice at the close of the last century. The practical irnplications of highfrequency currents were soon noted with the observation that frequencies of more than 10,000 per second produced heat without nrnscular contraction. This fact led to the development of electrocoagulation as a substitute for actual coagulation of blood vessels. Electrocoagulation of blood vessels may be accomplished by either obliterative or coaptive closure. In the obliterative closure the electrode is directly applied to the vessel causing coagulation of the blood vessel and the surrounding tissues. This produces shrinkage of the vessel wall and obliteration of the lumen by coagulated tissue and thrombosis. In the coaptive closure the edges of the vessel are mechanically opposed with a forceps and then sealed coagulation. In 1963 Sigel and Acevedo first described electrocoaptive closure for repair of linear incisions in arteries and veins and the construction of venous anastomoses.1 The application of this technique to blood vessels .suggested that it might also be used in ureteral closure. The usual method for blood vessel and ureteral anastomoses has been a direct suture technique which is both practical and reliable. However, the possibility of compromising the lumen or producing excessive periureteral fibrosis has always been present. This report describes our ,vork in closing ureterotomy incisions eleetrocoaptation. Essentially, the ureteral walls were coapted by a limited, heat-formed coagulum produced by a high-frequency electric current passed through the tissues to be joined. Not much information is available on the exact action of high-frequency electric currents 011 particularly on the ureter. Several questions needed to be answered. 1) Could a.

Postprostatectomy incontinence: Possible etiology

Abstract Destruction of the membranous urethra at the time of prostatectomy can be expected to result in some degree of urinary incontinence. It is postulated that excessive circumferential fibrosis of the remaining prostatic urethra following transurethral resection may in some way result in incontinence despite an intact membranous urethra. Further studies are underway to investigate the effects of nonsclerosing solutions.