RESUMO
PURPOSE: Retrospective studies were carried out to clarify the incidence of contralateral occurrence after unilateral repair of hydrocele in children and the role of ultrasonography in preoperative recognition of asymptomatic hydrocele. MATERIALS AND METHODS: 452 patients of under 14 years old who underwent unilateral hydrocele repairs between January, 1990 and December, 1997 were reviewed. Patients with contralateral occurrence were defined as those who had previous unilateral hydrocele repairs and no clinical or historical evidence of contralateral hydrocele at the time of the initial repair Patients with simultaneous presence of bilateral hydrocele on their initial visit were excluded from this study. 36 patients who visited lately underwent ultrasonographic examination of both side of the groin and scrotum prior to surgery to identify asymptomatic contralateral hydrocele. RESULTS: The incidence of contralateral occurrence after unilateral hydrocele repairs was 5.4%(24 patients). When the left side was repaired initially, 13(7.4%) patients showed contralateral occurrence and when the right side was repaired initially, 11 (4.0%) patients showed contralateral occurrence. In the 36 patients who underwent ultrasonography, 2 patients(5.6%) had asymptomatic contralateral hydrocele and exploration revealed the presence of a patent processus vaginalis. On the other hand, 2 patients(5.6%) with negative ultrasonographic findings had contralateral repairs 1 month after clinically apparent hydrocele repair. CONCLUSIONS: Although the incidence was low, contralateral occurrence after unilateral repair of hydrocele in children was noted. Therefore, preoperative thorough history taking and physical examination in unilateral hydrocele patients should be performed. Also, in suspicious cases, inguinal or scrotal ultrasonography is helpful for the detection of the clinically occult contralateral hydrocele in children.
Assuntos
Adolescente , Criança , Humanos , Virilha , Mãos , Incidência , Exame Físico , Estudos Retrospectivos , Escroto , UltrassonografiaRESUMO
Wegener`s granulomatosis (WG) is a multisystem disorder of unknown origin characterized by necrotizing granulomatous vasculitis. WG usually affects the upper respiratory tract, lungs, and kidneys with focal glomerulonephritis, but almost any organ can be affected. The ureter is primarily an unusual location for lesions of WG. A 30-year-old woman presented with intermittent right flank pain and hematuria. A renal ultrasound demonstrated unilateral hydronephrosis and a retrograde pyelography revealed a filling defect at right mid ureter and a computed tomography displayed marked concentric thickening of the right ureteral wall which was mimicking ureteral tumor. At nephroureterectomy, the right ureter was found to be obstructed by dense, intramural fibroinflammatory reaction. There was a necrotizing granulomatous vasculitis in the muscle layer of the ureter. Our case represents the rare occurrence of WG presenting ureteral bstruction.
Assuntos
Adulto , Feminino , Humanos , Dor no Flanco , Glomerulonefrite , Hematúria , Hidronefrose , Rim , Pulmão , Sistema Respiratório , Ultrassonografia , Ureter , Urografia , VasculiteRESUMO
Early diagnosis and prompt surgical exploration in blunt scrotal trauma is mandatory to save the affected testis and decrease the morbidity. We reviewed 25 cases of blunt scrotal trauma evaluated with ultrasonography as a result of violence, sports, traffic accident from March, 1989 to February, 1997. The right side was affected slightly more often than the left side. Sonography identified scrotal hematocele in 21 out of 25 cases and 4 cases had no evidence of scrotal hematocele. In 7 out of 21 cases with scrotal hematocele, ultrasonography showed rupture sites of the tunica albuginea (5) and intratesticular radiolucency displacing the normal echogenicity of the testicular parenchyina (2). In the other 14 cases ultrasonography showed no evidence of rupture. In 4 cases without scrotal hematocele, one was diagnosed as traumatic orchitis due to testicular enlargement and two had focal intratesticular hematoma so that these cases didn't undergo explorations. And 1 case had rupture of the tonics albuginea combined with testicular torsion at the time of exploration. Surgical explorations were performed in 19 (76.0%) out of 25 cases, who showed definitive rupture sites of the tunica albiginea (8), large hematoma and/or persistent severe pain without being seen rupture sites of the tunica albuginea (11) on ultrasonography and their operative methods were orchiectomy in 9 (36.0%), evacuation of the hematocele in 6 (24%), partial orchiectomy in 2 (8.0%) and simple closure of the tunica in 2 cases (8.0%). There was a direct relationship between salvageability and early surgery. In 13 out of 19 cases who underwent explorations within 3 days after trauma, the surgical managements comprised evacuation of the hematocele in 5 (38.5%), orchiectomy in 4 (30.8%), partial orchiectomy in 2 (15.4%), and simple closure of the tunica in 2 cases (IS.4%). However, in 6 cases who underwent explorations 4 days later after trauma, the surgical managements comprised orchiectomy in 5 (83.3%) and evacuation of the hematoma in 1 case (16.7%). In comparison with operative findings, 5 of the 14 cases, in which ultrasonography showed large hematocele without rupture of the tunica, had rupture of the tunica. Also, 7 cases, in which ultrasonography showed rupture of the tunica, all had rupture of the tonics. All patients with a history of blunt scrotal trauma, followed by a large hematocele without lure of the tunica or severely distorted testis on ultrasonography should have early surgical exploration to exclude injury to the testicle. A delayed treatment decreases the salvage rate due complications, such as ischemic necrosis and severe inflammatory reaction.