Noel L. Smith

Successful fibrinolytic therapy for superior vena cava thrombosis secondary to long-term total parenteral nutrition.

Thrombosis of the superior vena cava and other major central veins is an unusual and infrequent complication of total parenteral nutrition. When it does occur, it may be life threatening and prompt therapy is indicated. A case of superior vena cava thrombosis secondary to an indwelling Broviac catheter for long-term parenteral nutrition is presented, which was successfully treated with Streptokinase with reestablishment of flow through the catheter and veins.

Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management.

Genitourinary syndrome of menopause, a new term for a condition more renowned as atrophic vaginitis, is a hypoestrogenic condition with external genital, urological, and sexual implications that affects >50% of postmenopausal women. Due to sexual embarrassment and the sensitive nature of discussing symptoms, genitourinary syndrome of menopause is greatly underdiagnosed. The most up-to-date literature pertaining to clinical manifestations, pathophysiology, etiology, evaluation, and management of genitourinary syndrome of menopause is comprehensively reviewed. Early detection and individually tailored pharmacologic (eg, estrogen therapy, selective estrogen receptor modulator, synthetic steroid, oxytocin, and dehydroepiandrosterone) and/or nonpharmacologic (eg, laser therapies, moisturizers and lubricants, homeopathic remedies, and lifestyle modifications) treatment is paramount for not only improving quality of life but also for preventing exacerbation of symptoms in women with this condition.

Gangrene of male external genitalia in a patient with colorectal disease

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.

Impaired hypothalamic-pituitary-testicular axis activity, spermatogenesis, and sperm function promote infertility in males with lead poisoning.

Lead poisoning is a stealthy threat to human physiological systems as chronic exposure can remain asymptomatic for long periods of time before symptoms manifest. We presently review the biophysical mechanisms of lead poisoning that contribute to male infertility. Environmental and occupational exposure of lead may adversely affect the hypothalamic-pituitary-testicular axis, impairing the induction of spermatogenesis. Dysfunction at the reproductive axis, namely testosterone suppression, is most susceptible and irreversible during pubertal development. Lead poisoning also appears to directly impair the process of spermatogenesis itself as well as sperm function. Spermatogenesis issues may manifest as low sperm count and stem from reproductive axis dysfunction or testicular degeneration. Generation of excessive reactive oxygen species due to lead-associated oxidative stress can potentially affect sperm viability, motility, DNA fragmentation, membrane lipid peroxidation, capacitation, hyperactivation, acrosome reaction, and chemotaxis for sperm-oocyte fusion, all of which can contribute to deter fertilization. Reproductive toxicity has been tested through cross-sectional analysis studies in humans as well as in vivo and in vitro studies in animals.

Hemorrhoidal bleeding following transrectal prostatic biopsy

Three cases of rectal bleeding within a series of 120 transrectal prostatic biopsies are reported. The precipitating factor was the presence of hemorrhoids which were unsuspected prior to prostatic biopsy. Rectal bleeding in these patients was arrested by ballon tamponade with a 24 French Foley catheter.In situ monitoring of the rectal Foley catheter was discontinued when no further rectal bleeding was ascertained. There were no complications due to this simple, safe, and effective technique. When hemorrhoids are suspected, preliminary proctoscopy aids and alerts surgeons to choose alternative routes to the prostatic bed.

Urinoma – A Rare Presentation of Carcinoma of the Bladder

Urinoma as a presenting sign of carcinoma of the bladder, as occurred in this case, is rare. Aspiration of the cystic mass under sonography and chemistry of the fluid confirmed the diagnosis. The inferior extension of the urinoma on CT scan confirmed the gradual fading of Gerotas fascia into the retroperitoneum. Abdominal mass in the form of a urinoma is an uncommon presentation and only a few documented cases are reported in the literature. This case illustrates that the Gerotas fascia fades inferiorly into the retroperitoneum.

Volvulus of Cecum Following Simple Nephrectomy

We report a case of intestinal obstruction secondary to cecal volvulus following a palliative nephrectomy. Cecal volvulus and other causes of acute abdomen should be considered in postoperative patients who develop adynamic ileus undergoing retroperitoneal surgery.

The impact and management of sexual dysfunction secondary to pharmacological therapy of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common genitourinary complications in men over 50 years of age and typically presents with lower urinary tract symptoms (LUTS). Classes of medications include α1-adrenoceptor blockers, 5α-reductase inhibitors, and phosphodiesterase 5 inhibitors. Today, α1-adrenoceptor blockers and 5α-reductase inhibitors are often combined to give a synergistic effect. A review of the current literature identified several adverse sexual side effects, including erectile dysfunction (ED), decreased libido, orgasmic disorders, and ejaculatory disorders. We believe it is important to know the extent of these side effects, as the clinician and patient will need to decide the cost of improved voiding symptoms. The chief adverse effect is ejaculatory disorders, including the absence of ejaculation. Clinical consideration for BPH should include the elements of male sexual function, patients’ age, and the characteristics and comprehensive effects of each group of drugs. Methodological bias in clinical studies, such as the subjective evaluation of the sexual side effect, makes it difficult to determine the ideal drug for treatment.

Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management

Introduction: A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression. Materials and Methods: A MEDLINE® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management. Results: Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options. Conclusion: Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.

Advantage of lowsley tractor in studying prostatic lesions

Cet instrument facilite le diagnostic et la biopsie des lesions localisees a la base de la prostate ou dans la zone seminovesiculaire