Left Side Of Scrotum Research Articles

Unilateral Tb Epididymo-Orchitis with Scrotal Fistula- A Case Report

Tuberculosis is one of the most common worldwide diseases that remain almost unaltered in prevalence for the past few years. Genitourinary tract tuberculosis is common, but when associated with scrotal fistula it is a rare presentation. A 50 years old male came to the hospital with the complaints of pricking pain and swelling in the left side of scrotum for the past 2 months. He had history of smoking for past 40 years, on examination swelling of size approximately 6x5 cm present in left side of scrotum, globular in shape; penis pushed to right side was present, lower part of the swelling was firm to hard in consistency, left cord thickness was present and fixity to skin was also present. There was a small fistulous opening present in the left side of scrotum with no active discharge. Bilateral inguinal lymph nodes were palpable. This is a rare case presentation of tuberculous epididymo-orchitis with scrotal fistula leading to testis removal. Initially emperical treatment was started for TB epididymoorchitis which turned unresponsive, so he was then proceeded for surgery to avoid further disease progression. This case was managed radiologically, clinically and pathologically. This case report shows how the case was managed and followed up.Since symptoms of TB epididymo-orchitis are milder when compared to the symptoms of pyogenic epididymo-orchitis, they appear to physicians in later advanced stages. Tuberculosis should be considered in Patients with mild symptoms of epididymo-orchitis, mainly in those with HIV, immunosuppressive conditions and endemic areas.

Leiomyoma of scrotum

Leiomyoma is a benign tumor of smooth muscle. Leiomyoma originating from the scrotum is rare. We report here a case of 50-year-old male who presented with a lump in the left side of scrotum. Clinically, it was diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia. The final diagnosis of solitary scrotal leiomyoma was given.

A Case of Extramammary Paget's Disease Resistant to Photodynamic Therapy and Surgery Successfully Treated with Radiotherapy.

Dear Editor: Although surgery is widely accepted as the first-line treatment for extramammary Paget's disease (EMPD), it cannot always be accomplished due to its frequent involvement of areas with important function1. Nonsurgical treatments including radiotherapy (RTx) and photodynamic therapy (PDT) are considered in such cases. We report a case of EMPD refractory to PDT and surgery that was successfully treated with RTx. A 68-year-old man presented with a well-defined erythematous patch with ulceration on the left side of scrotum, which enlarged during the last 7 months (Fig. 1A). Skin biopsy revealed numerous Paget cells (Fig. 2). Possible accompanying internal neoplasms were discounted through multiple means, ranging from physical examination to positron emission tomography/computed tomography. Diagnosed as localized EMPD, the patient was primarily treated with PDT because he strongly requested preservation of his genitourinary functions. Methyl aminolevulinate cream (Metvix; Galderma, Fortworth, TX, USA) was applied occlusively and was maintained for 3 h. The lesion was then irradiated with a 630-nm light-emitting diode (Aktilite CL128; Photocure, Oslo, Norway). After two sessions, the patient showed a partial response and underwent local excision. He was treated with 15 sessions of PDT for possible remnants. As Paget cells were still seen on follow-up biopsy of the surgical margin, he underwent a three-stage Mohs surgery and received 11 additional sessions of PDT. Nonetheless, the lesion persisted clinically. We referred him to the radiation-oncology clinic. Radiation was administered by using an electron beam of 6 MeV, at 200~250 cGy per day, 4 days a week, until a total dose of 37 Gy was reached. He received subsequent RTx with a total dose of 30 Gy in same manner. The lesion disappeared completely. After 18 months, the patient revisited our clinic with an erythematous patch on the scrotum (Fig. 1B). Biopsy only revealed telangiectatic dermal vessels. Fig. 1 (A) Patient image at initial visit. (B) The patient revisited our clinic suspecting of recurrence. The biopsy of skin lesion did not show any tumor cells. Fig. 2 Skin biopsy showing acanthotic epidermis with numerous Paget cells of large nucleus and eosinophilic cytoplasm (H&E, ×200). A systematic review of clinical studies examining the use of PDT for EMPD showed that of 133 EMPD lesions, 77 exhibited complete response and 52 exhibited partial response with satisfactory cosmetic outcome in all patients2. However, the durability of this response remains unclear, as the follow-up periods were typically less than a year2. In a long-term follow-up study of EMPD in situ for 24 months, the recurrence rate was 50%. The authors stated that PDT should be recommended only for cases of scrotal lesions <4 cm in diameter3. Larger lesions showed an unfavorable response presumably because of the denser infiltration of Paget cells and more adnexal involvement, followed by disproportionate protoporphyrin IX accumulation in the glands resulting in photodynamic oxygen depletion. In the present case, the lesion was much larger than 4 cm, which may have been responsible for the ineffectiveness of PDT. The optimal RTx dose is not standardized; however, a total of 40~50 Gy has been considered suitable for primary treatment4. The lesion of our case was refractory to other therapies; hence, a higher dose of 67 Gy was chosen. In conclusion, EMPD lesions resistant to PDT and surgery may be significantly resolved with RTx; thus, it should be considered a treatment option in cases of repeatedly unsuccessful PDT and surgery.

Ventilatory response to high inspired carbon dioxide concentrations in anesthetized dogs

Background:The ventilation ( ) response to inspired CO2 has been extensively studied, but rarely with concentrations >10%.Aims:These experiments were performed to determine whether would increase correspondingly to higher concentrations and according to conventional chemoreceptor time delays.Materials and Methods:We exposed anesthetized dogs acutely, with and without vagotomy and electrical stimulation of the right vagus, to 20-100% CO2-balance O2 and to 0 and 10% O2-balance N2.Results:The time delays decreased and response magnitude increased with increasing concentrations (p<0.01), but at higher concentrations the time delays were shorter than expected, i.e., 0.5 s to double at 100% CO2, with the response to 0% O2 being ~3 s slower. Right vagotomy significantly reduced baseline breathing frequency (fR), increased tidal volume (VT) and increased the time delay by ~3 s. Bilateral vagotomy further reduced baseline fR and , and reduced the response to CO2 and increased the time delay by ~12 s. Electro-stimulation of the peripheral right vagus while inspiring CO2 caused a 13 s asystole and further reduced and delayed the response, especially after bilateral vagotomy, shifting the mode from VT to fR.Conclusions:Results indicate that airway or lung receptors responded to the rapid increase in lung H+ and that vagal afferents and unimpaired circulation seem necessary for the initial rapid response to high CO2 concentrations by receptors upstream from the aortic bodies.

Leiomyoma of scrotum

Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.