ABSTRACT
El hemangioma cavernoso intraescrotal es una enfermedad muy rara que debe tenerse en cuenta cuando se realiza el diagnóstico diferencial de las masas vasculares. Un paciente de 26 años de edad fue remitido al Servicio de Urología para la evaluación de malestar y una sensación de masa en el hemiescroto derecho. La ecografía doppler mostró una malformación vascular y el paciente fue sometido a resección de la masa por vía inguinal derecha. El examen anatomopatológico reveló el diagnóstico de hemangioma cavernoso. No hubo complicaciones durante la cirugía y no se ha producido recurrencia de la misma. A pesar de su baja incidencia, es importante tenerlo en cuenta al realizar el diagnóstico diferencial de masas vasculares. Para su diagnóstico, el examen físico y el uso de técnicas de ultrasonido doppler son esenciales (AU)
Intrascrotal cavernous hemangioma is a very rare disease which should be taken into account when making a differential diagnosis of vascular masses. A 26-year-old male patient was referred to the Urology Department for evaluation of discomfort and sensation of having a mass in his right hemiscrotum. Doppler ultrasound imaging showed a vascular malformation and the patient underwent excision of the mass through an inguinal incision. Anatomical and pathologic examination revealed cavernous hemangioma. There were no complications during the surgery and no recurrence afterwards. Despite its low incidence, it is important to keep this in mind when making differential diagnoses of vascular masses. Physical examinations and the use of doppler ultrasound techniques are essential for its diagnosis (AU)
Subject(s)
Humans , Male , Hemangioma, Cavernous/pathology , Scrotum/pathology , Testicular Neoplasms/pathology , Vascular Malformations/diagnosis , Vascular Neoplasms/pathology , Diagnosis, DifferentialABSTRACT
OBJECTIVES: To compare low versus high frequency for lithotripsy in the management of distal ureteral calculi. METHODS: A total of 154 patients with radio-opaque calculi (0.5-1 cm diameter) in the distal ureter were randomized to be given either lithotripsy at 80 or 60 pulses per min (high frequency or low frequency groups, respectively). The number of waves and sessions received, and time to total resolution were measured. A Dornier Compact Delta lithotripter was used. RESULTS: A total of 72 patients were assigned to the high frequency group and 78 to the low frequency group. Four patients were excluded from the study because of intolerance of the procedure. The size was slightly lower in low frequency group, whereby an analysis of covariance was carried out to eliminate the size factor, with the limit established as 0.7 cm. The low frequency group received 2980 ± 1211 waves, and the high frequency group received 5752 ± 3121 (P<0.001). The success rate was higher in the low frequency group (100%) than in the high frequency group (92.9%; P=0.02). If adjusted to the size of the calculus with a threshold of 0.7 cm, there was a difference, although it was not statistically significant. The time to elimination of the fragments was higher in the high frequency group (17.68 days) than in the low frequency group (7.15 days; P<0.001). The number of sessions necessary for resolution was higher in the high frequency group (1.56) than in the low frequency group (1.14; P<0.001). CONCLUSIONS: Lithotripsy at 60 pulses provides better outcomes than lithotripsy at 80 pulses for the treatment of distal ureteral calculi.
Subject(s)
Lithotripsy/methods , Ureteral Calculi/diagnosis , Ureteral Calculi/therapy , Adult , Female , Follow-Up Studies , Humans , Lithotripsy/adverse effects , Male , Middle Aged , Pain Measurement , Pain, Postoperative/physiopathology , Prospective Studies , Radio Waves , Reference Values , Risk Assessment , Severity of Illness Index , Treatment Outcome , Young AdultABSTRACT
Objetivo: Establecer a qué nivel se produce la fragmentación del ácido desoxirribonucleico (FADN), intratesticular o en la vía seminal, en varones infértiles con varicocele. Material y métodos: Análisis preliminar sobre 15 sujetos en estudio por infertilidad de un año de evolución con varicocele como causa más probable de su alteración. Realizamos FADN en semen previo a la varicocelectomía quirúrgica. Durante la intervención, se obtuvo una muestra testicular mediante biopsia (TESE), para la medición de FADN en espermatozoides intratesticulares, con el objetivo de establecer sus valores y si había diferencias respecto al semen. Resultados: Quince pacientes fueron intervenidos de varicocele izquierdo. En el seminograma, la alteración más frecuente fue la oligoastenozoospermia. Presentaron ADN fragmentado en semen 9 pacientes con una media de 47,8% (rango 38,8-59,2%), y en 6 fueron normales (media 27,4%; rango 12,7-35,3%). La FADN en testículo presentó valores más elevados que en el semen, estando alterados en 14 de los 15 pacientes (media 62,3%, rango 39,0-83,3%). Conclusiones: La FADN parece tener un papel importante en la fisiopatología actual del varicocele y aumenta en el semen de varones infértiles con esta alteración. Derivado de nuestros resultados, podríamos deducir que el mecanismo más importante de fragmentación se situaría a nivel intratesticular, en contra de lo que actualmente se postula. Confirmar esta hipótesis con mayor número de casos supondría un avance significativo en el conocimiento y aplicaciones clínicas en cuanto a esta patología (AU)
Objective: To establish the site at which intratesticular or seminal DNA fragmentation (DNAF) occurs in infertile men with varicocele. Material and Methods: A preliminary analysis was performed in a 1-year study of 15 patients in whom the suspected cause of infertility was varicocele. Analysis of DNAF was performed in semen prior to surgical varicocelectomy. To measure DNAF in intratesticular sperm, testicular samples were obtained by biopsy during the intervention. Results: Fifteen patients had left varicocele surgery. The most frequent abnormality observed in the semen was oligoasthenozoospermia. Nine patients had DNAF (average: 47.8%, range: 38.8-59.2%), and six were normal (average; 27.4%, range: 12.7-35.3%). DNAF levels were higher in testicular tissue samples than in semen (average: 62.3%, range: 39.0-83.3%). Only one of these patient samples did not reveal DNAF. Conclusions: DNAF seems to be related to the physiopathology of varicocele and is present at higher levels in the semen of infertile men with this alteration. In view of these results, we deduce that DNA fragmentation will primarily occur in the testes, which is contrary to current understanding. Testing this hypothesis in studies that include more patients would allow important advances to be made in the knowledge and treatment of this alteration (AU)
