Surgical management of massive penoscrotal lymphedema. Case report and literature review.

INTRODUCTION: Giant lymphedema of the penis and scrotum is a rare and peculiar condition that carries many challanges for both the patient and the physician. The etiology of the disease is often difficult to trace, especially in geographical areas where filariasis is not endemic. CASE PRESENTATION: We reported an advanced case of massive penoscrotal lymphedema presented to our plastic surgery department. Extensive physical examination and imaging investigations allowed for a wide surgical excision of the tumor with the preservation of the penile body and testicles. The reconstruction was performed with adjacent healthy skin flaps and a split-thickness skin graft for the penis. The outcome was a success and the follow-up revealed no recurrences. DISCUSSION: Although the onset of the disease was poorly established, we regarded it as a secondary lymhpedema resulting from chronic local infection. The particularity of this case was the exclusive involvement of the superficial structures, as seen in similar cases from the literature. The clinical presentation explained by the distinctive lymphatic drainage offered a guided and rather secure surgical approach. The reconstruction techniques are varied and should not pose recurrence risks as long as functional tissue is used. CONCLUSION: Massive penoscrotal lymphedema cases display unique evolution and features leading to great impairment. In most instances, surgery is the treatment of choice as the pathological changes are irreversible. Our technique was innovative and comprised similarities and differences compared to other research, nevertheless, the results were a success. KEY WORDS: Penoscrotal Lymphedema, Surgical Excision, Reconstruction Techniques.

In Vivo Effects of Quercetin in Association with Moderate Exercise Training in Improving Streptozotocin-Induced Aortic Tissue Injuries.

BACKGROUND: Diabetes mellitus (DM) is a chronic endocrine-metabolic disorder associated with endothelial dysfunction. Hyperglycemia, dyslipidemia and abnormal nitric oxide-mediated vasodilatation are the major causal factors in the development of endothelial dysfunction in DM. The prevention of endothelial dysfunction may be a first target against the appearance of atherosclerosis and cardiovascular diseases. We have investigated the synergistic protective effects of quercetin administration and moderate exercise training on thoracic aorta injuries induced by diabetes. METHODS: Diabetic rats that performed exercise training were subjected to a swimming training program (1 h/day, 5 days/week, 4 weeks). The diabetic rats received quercetin (30 mg/kg body weight/day) for 4 weeks. At the end of the study, the thoracic aorta was isolated and divided into two parts; one part was immersed in 10% formalin for histopathological evaluations and the other was frozen for the assessment of oxidative stress markers (malondialdehyde, MDA and protein carbonyls groups, PC), the activity of antioxidant enzymes (superoxide dismutase, SOD and catalase, CAT), nitrite plus nitrate (NOx) production and inducible nitric oxide synthase (iNOS) protein expression. RESULTS: Diabetic rats showed significantly increased MDA and PC levels, NOx production and iNOS expression and a reduction of SOD and CAT activity in aortic tissues. A decrease in the levels of oxidative stress markers, NOx production and iNOS expression associated with elevated activity of antioxidant enzymes in the aortic tissue were observed in quercetin-treated diabetic trained rats. CONCLUSIONS: These findings suggest that quercetin administration in association with moderate exercise training reduces vascular complications and tissue injuries induced by diabetes in rat aorta by decreasing oxidative stress and restoring NO bioavailability.