Scrotal Edema Research Articles

Laparoscopic management of infantile hydrocele in pediatric age group

PurposeTo evaluate laparoscopic management of hydroceles in pediatrics, with evaluation of the internal inguinal ring (IIR) and the PPV (patent processus vaginalis) in different types of hydroceles, and the incidence of the contralateral PPV.MethodsThe IIR and the type of hydrocele on the same side of 93 patients with 106 infantile hydroceles were evaluated and managed, in addition to contralateral side.ResultsThe IIR on same side was closed in 8.5% (Type I) and patent in 91.5% (Type II and III) with different shapes. Contralateral IIR was open in 88.7% of cases. The operative time was 30.99 ± 7.23 min, with no intra-operative complication. The vas deferens and testicular vessels were secured and there were no injuries or bleeding. The conversion rate was zero, and all procedures (Type II and II) were completed totally laparoscopic. No post-operative complications except a case of tense hydrocele developed scrotal edema that managed conservatively.ConclusionLaparoscopic hydrocelectomy is safe, applicable and feasible for management of different types of hydroceles in pediatrics. The IIR is patent in nearly all cases with/out communication to the hydrocele. The contralateral IIR can be managed in the same session. Laparoscopic hydrocelectomy with/out hydrocelectomy and IIR closure is essential in preventing recurrence.

Temsirolimus (T) in patients (pts) with colorectal cancer (CRC) with PIK3CA mutation: Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study.

106 Background: TAPUR is a phase II basket study evaluating anti-tumor activity of commercially available targeted agents in pts with advanced cancers with genomic alterations. Results in a cohort of CRC pts with PIK3CA mutation treated with T are reported. Methods: Eligible pts had advanced CRC with PIK3CA mutation reported by a genomic test performed in a CLIA-certified, CAP-accredited site selected lab, no standard treatment options, measurable disease, ECOG performance status (PS) 0-2, and adequate organ function. Use of T was approved by the TAPUR Molecular Tumor Board in each case. After antihistamine pre-treatment, T was administered at 25 mg IV over 30-60 minutes weekly until disease progression. Primary endpoint was disease control (DC), defined as complete (CR) or partial (PR) response per RECIST v. 1.1, or stable disease at 16+ weeks (SD 16+). Simon 2-stage design tested the null DC rate of 15% vs. 35% (power = 0.85; α = 0.10). If ≥2 of 10 pts in stage 1 has DC, 18 more pts are enrolled; otherwise, the study stops for futility. If ≥7 of 28 pts has DC, the null DC rate is rejected. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and safety. Results: 10 pts (60% male) with CRC with PIK3CA mutation were enrolled from November 2017 to May 2020. All were eligible for efficacy and toxicity. Demographics and outcomes are summarized in Table. No objective responses (OR) were observed. 1 pt had SD of 16.1 wks duration for a DC rate of 10% (95% CI: 0%, 45%); the null DC rate of 15% was not rejected (p=0.80). 6 pts had at least one grade 3-4 adverse or serious adverse event (AE/SAE) at least possibly related to T, including acute kidney injury, dehydration, decreased platelet count hypertriglyceridemia, mucositis, neutropenia, and scrotal and penile edema. Conclusions: Monotherapy T does not have sufficient clinical activity in CRC pts with PIK3CA mutation for continued evaluation in this pt population. Other treatments should be considered for these pts, including treatments offered in clinical trials. Clinical trial information: NCT02693535. [Table: see text]

Elizabethkingia miricola Recovered from a Peritoneal Fluid Sample – A Clinical Case Report with Diagnostic Challenges

Background: Elizabethkingia spp. are Gram-negative, non-spore-forming bacteria that used to be rarely encountered but now they are of growing clinical significance. Furthermore, the diagnostic challenges to identification impede the complete elucidation of their epidemiology and association with human diseases. Case report: A 64-year-old man with liver cirrhosis due to alcohol abuse presented with fatigue, abdominal swelling, and bilateral scrotal edema. A peritoneal fluid sample was cultured and subject to a number of identification methods – API 20 NE (bioMerieux), automated Vitek-2 Compact (bioMerieux), MALDI-TOF MS (Vitek-MS, bioMerieux), and 16S rRNA gene sequencing. A final diagnosis of bacterascites was made on the basis of clinical, laboratory, and microbiological findings. Conclusion: To the best of our knowledge this is the first report of Elizabethkingia miricola being cultured from a peritoneal fluid sample in an immune-compromised host thus pointing to the emerging pathogenic role of the bacterium in patients with liver cirrhosis and ascites.

Tension-Free Inguinal Hernia Repair in Local Anaesthesia versus Spinal Anaesthesia

Abstract Background: Inguinal hernia is a common presentation in surgical clinics. In the past, the hernia surgeries were done under general and spinal anesthesia. Recently local anesthesia is being increasingly used due to the increased efficacy of local anesthetics and economic reasons. We in the current study tried to evaluate the effectiveness of Lichtenstein repair under local anesthesia and spinal anesthesia and the overall outcomes of both methods. Methods: This cross-sectional study was conducted in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Successive cases of uncomplicated inguinal hernia were selected for the study. A total of n=60 cases randomly allotted in two groups The LA group and SA group were taken and studied. Post-operatively VAS scale was used to evaluate pain, other postoperative complications such as testicular swelling and pain, urinary retention, nausea/vomiting, postural hypotension, and wound infections were recorded. Results : The age of the patient varied from 20 to 80 years with the highest prevalence noted in the age group of 41 to 60 years. The Mean age of presentation is 51.3 years. The anatomical location and type of hernia are given in table 1. 60.9% of inguinal hernia in this study was an indirect type, 30.4% was direct, 6.5% was pantaloons type and 2.2% was Ogilvie's hernia. Out of 74 patients, 62.1% had a right-sided inguinal hernia compared to the left side which accounted for 37.8%. Complication records showed N=9(23.7%) of the SA group and n=8(22.2%) LA group developed scrotal edema and in total n=17(23%) developed scrotal edema. N=7(18.4%) patients in the SA group and n=7(19.4%) in the LA group developed seroma and in total patients, n=14(18.9%) developed seroma. Conclusion: Lichtenstein tension-free hernioplasty done under local anesthesia is with less immediate postoperative complications, also the best suitable for patients with medical comorbidities and those who are on antiplatelet therapy where spinal anesthesia is contraindicated.

Minimal dissection technique vs Jaboulay’s procedure for small to moderate size hydrocele – A retrospective study

Abstract: Hydrocele is one of the most common disease of the male, with incidence of 1 in 1000 cases. Primary hydrocele is of idiopathic origin and secondary hydrocele are caused by infection or tumours. Surgery is the gold standard treatment. This retrospective study was conducted to determine the advantages of minimal dissection technique vs. Jaboulay’s procedure in small and moderate size hydrocele. Methods and Materials: In this study 86 cases of hydrocele were included and divided in two groups. In group I, minimal dissection technique was done and in group II, conventional Jaboulay’s procedure was done. The two groups were compared with regard to operation time, hospital stay, return to work, recurrence and other results. Post-operative complications noted. Categorical data were statistically analyzed. Results: The study showed better results in respect of operative time, hospital stay, return to work, patient satisfaction in patients in minimal dissection group when compared with patients in the conventional Jaboulay’s procedure. Conclusion: Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally dissection technique provide the best operative outcomes regarding scrotal edema and hardening and patient’s satisfaction when compared to conventional eversion-excision hydrocelectomy.

A Fatal Case of Febrile Ulceronecrotic Mucha-Habermann Disease in a 10-Year-Old Boy.

A Fatal Case of Febrile Ulceronecrotic Mucha-Habermann Disease in a 10-Year-Old Boy.

INGUINOSCROTAL SWELLINGS IN CHILDHOOD: A CLINICO-DIAGNOSTIC APPROACH TO DIFFERENTIAL DIAGNOSIS

BACKGROUNDS: Inguinoscrotal illnesses are one of the commonest gathering of problems seen in clinical careful practice. A wide scope of swellings are found around here in youngsters and incorporates hydrocele, twist testis, ectopic testis, lymphadenopathy, inguinal hernias, sores, epididymitis, orchitis, cancers and so on Careful clinical and radiological assessment of inguinoscrotum for changing infections helps in appropriate determination and careful administration of its differential analysis. METHOD: The current review was directed as an observational review over a time of 10 months and enlisted a sum of 50 patients. RESULTS: In this review, 31 cases had hydrocele, 14 cases had inguinal hernia, 2 cases had epididymorchitis, 2 cases had lymphadenopathy and one case had idiopathic scrotal edema. Individual sicknesses had changing introductions, clinical discoveries and post-usable discoveries. CONCLUSIONS: There is a shifting wide range of swellings in the inguinoscrotal area in youthful male kids. It was inferred that legitimate clinical and radiological assessment of the patient serves to opportune analyze the sickness and henceforth help in distinguishing right way to deal with the administration of the case.

Extended View Totally Extraperitoneal Technique and Its Advantages in Laparoscopic Inguinal Hernia Repair.

Objective: Endoscopic total extraperitoneal (TEP) is used increasingly in inguinal hernias. Perhaps the most fundamental difficulty of the classical TEP method is that the dissection plan it offers is overly limited, which is among the reasons why techniques other than TEP are preferred in large scrotal hernias. This study discusses our experience with the extended view totally extraperitoneal (e-TEP) method, which significantly expands the dissection plan compared to the classical method. Methods: Patients who had inguinal hernia surgery in 2018 and 2019 were retrospectively analyzed, and 21 male patients with L3 inguinal hernia by European Hernia Society classification, who underwent laparoscopic e-TEP surgery, were included in the study. Patient data were obtained from the hospital's electronic database and patient files. One year after the surgery, the patients were invited to the hospital by telephone and re-examined. Results: The median patient age was 47 years. The mean duration of surgery was 43.6 minutes, and the median postoperatively pain score in the first 24 hours was 1.975. Zig maneuver was performed in 85.7%, and drains were placed in 33.4% of patients. In 28.6% of patients, the peritoneal violation occurred. However, there was no conversion to another surgical technique. The mean length of stay was 1.33 days. Two patients had seroma, one had scrotal edema, and one had urinary retention. No recurrence was observed in any patient during the 1-year follow-up. Conclusions: According to our experience, the e-TEP technique can be safely performed in scrotal hernias as it offers a larger dissection plane. It also allows patients with large scrotal hernias to benefit from all the advantages of the TEP technique.

Minimal change disease following the Moderna COVID-19 vaccine: first case report

BackgroundThere have been cases of minimal change disease (MCD) reported following previous vaccines. During the COVID-19 era, only 3 cases of new-onset MCD and a case of MCD relapse were reported following the Pfizer-BioNTech COVID-19 vaccine. We herein report the first case of MCD after receiving the Moderna COVID-19 vaccine.Case presentationA 43-year-old man presented to hospital 3 weeks after receiving the first dose of the Moderna vaccine, with both bilateral lower extremities and scrotal edema. He initially developed a sudden-onset bilateral lower extremities swelling on day 7 post-vaccine. He, then, developed dyspnea and scrotal swelling over a time span of 2 weeks. On physical examination, his blood pressure was 150/92 mmHg. There was a decreased air entry at lung bases, bilateral lower extremities and scrotal edema. Labs revealed hypoalbuminemia, hyperlipidemia and 15 g of proteinuria. His immunologic and serologic work up was negative. Renal biopsy showed concomitant MCD and IgA nephropathy. Patient was treated with oral steroids and had a good response; his edema resolved, serum albumin improved, and proteinuria decreased to 1 g within 2 weeks of treatment.ConclusionsTo the best of our knowledge, MCD has not been previously reported after receiving the Moderna COVID-19 vaccine. It remains unclear whether the COVID-19 mRNA vaccines are associated with the development of MCD, or it coincided with the mass vaccination. Further studies are needed to determine the incidence of MCD post COVID-19 vaccines and the underlying pathophysiology of glomerular injury post vaccination.

Long Term Risk of Pelvic Insufficiency Fractures and Lower Extremity Edema After Definitive Chemoradiation for Squamous Cell Carcinoma of the Anal Canal

Definitive chemoradiation is the standard of care of treatment of squamous cell carcinomas (SCC) of the anal canal. While this treatment is effective, definitive chemoradiation is associated with significant acute and late toxicities. In this study, we seek to evaluate the incidence and identify risk factors of radiotherapy (RT) induced pelvic insufficiency fractures and lower extremity (LE) edema.We performed a single-institution retrospective analysis of 185 patients treated with chemoradiation for anal SCC between 2007-2019. Median age was 61 (range: 15-92); 9.8% were metastatic and 34.1% were men. All patients received concurrent chemotherapy, including 160 patients treated with concurrent 5-fluorouracil /MMC, 12 treated with 5-fluorouracil /Cisplatin, 9 patients treated with 5FU alone, 2 treated with FOLFOX alone, and 2 treated with Carboplatin/Paclitaxel. Median dose to the pelvis was 54 Gy. RT modalities included IMRT/VMAT (N = 157), pencil beam proton beam (N = 17), 3D-CRT (N = 6), and multi-modalities (N = 5). Patient medical charts and imaging were reviewed for patient/treatment characteristics, and to determine incidence of development of post-RT related insufficiency fractures and LE. Pelvic insufficiency fractures were all confirmed radiographically with CT or MRI pelvis. Patients with baseline LE edema were excluded from the analysis of post-RT related LE edema. Cox univariate analysis was performed to identify predictors of pelvic fracture.Median follow-up was 59 months. Among 185 patients, 11 (6%) patients developed pelvic insufficiency fractures at a median time of 11 months (range: 2.7-60) since completion of RT treatment (range: 2-60). Treatment for pelvic insufficiency fractures included narcotics (n = 3), and no patient required sacroplasty. All but 1 of the patients who developed pelvic insufficiency fractures were women. However, gender (P = 0.12) and menopausal status (P = 0.87) were not significant on univariate analysis. On univariate analysis, only treatment with IMRT/VMAT (HR 2.33, P = 0.02) predicted for higher risk of development of pelvic insufficiency fracture. Among patients without baseline LE edema, 5.95% of patients developed LE or pelvic edema after completion of RT at a median of 3 months post-treatment (range: 0-42). Of these, 7 patients developed LE edema, 1 developed vulvar edema, and 1 patient developed scrotal edema. All patients had grade 1+ edema.RT related pelvic insufficiency fractures and LE edema are rare after chemoradiation to the pelvis, and often are incidental findings appreciated radiographically. IMRT/VMAT may be associated with higher risk of pelvic insufficiency fractures.

O08 A case of juvenile systemic lupus erythematosus with pyrexia of unknown origin

Case report - IntroductionAn 18-year-old young man with diagnosis of Juvenile SLE with lupus nephritis maintained in remission on Mycophenolate Mofetil (MMF), presented with high-grade fever without focus close to his 18th birthday. History or examination did not point to any focus of infection, but blood tests showed systemic inflammation. Extensive investigations, including extended infection screen and bone marrow aspiration, were negative. His blood tests were suggestive of macrophage activation syndrome with no clinical or laboratory evidence of flare of lupus. MRI scan revealed extensive para-aortic lymphadenopathy and a diagnosis of classical Hodgkin's lymphoma confirmed on lymph node biopsy.Case report - Case descriptionInterestingly he first presented with fever and cervical lymphadenopathy at 13 years of age to local hospital, when a biopsy had revealed lymphoma but the diagnosis was changed to SLE following review at tertiary hospital. He was started on steroids and low-dose methotrexate. He later developed facial swelling, abdominal distension and groin swelling, following which he was referred to tertiary renal centre. His examination revealed scarring malar rash, anaemia, ankle and scrotal oedema, ascites and pleural effusion. His investigations showed anaemia, thrombocytopaenia, ESR over 100mm/hour, hypoalbuminaemia, low complement levels, positive ANA and double-stranded DNA. He had nephrotic range proteinuria and renal biopsy showed Class V lupus nephritis. He was treated with intravenous and later weaning dose of oral steroids and started on MMF. He remained in remission on a stable dose of MMF, except for brief flare of proteinuria, which settled with short course of oral steroids.A few months before his eighteenth birthday, he presented to local hospital with recurrent episodes of high-grade fever with no clear focus. He was twice managed with broad spectrum antibiotics, despite negative septic screen and an extended infection screen including viral PCRs and IGRA for tuberculosis. He had no focal symptoms or symptoms to suggest flare of underlying lupus, but had loss of appetite and loss of weight. He developed splenomegaly with increasing inflammatory markers and fall in all cell lines of full blood count with deranged coagulation. He satisfied the clinical and laboratory criteria of the preliminary Diagnostic Guidelines for Macrophage Activation Syndrome in JSLE (2009), following which he was commenced on three days of IV methylprednisolone following normal bone marrow aspirate. However, fever recurred after initial response and MRI scan revealed mediastinal and para-aortic lymphadenopathy, and a diagnosis of classical Hodgkin's lymphoma was confirmed on lymph node biopsy.Case report - DiscussionThis young man initially presented with fever and cervical lymphadenopathy, when a diagnosis of lymphoma was made. Yet, following review of the biopsy at the local tertiary centre and the abnormal immunological profile, a diagnosis of lupus was made. He then developed nephrotic syndrome, when a diagnosis of lupus nephritis was confirmed on biopsy. Other clinical and laboratory profile (raised ESR, hypocomplementeamia, serositis and haematological parameters) corroborated the diagnosis. He responded well to steroids and immunosuppression, when he presented with fever again. He had no evidence of flare of underlying lupus or any infection, but blood tests and splenomegaly pointed to macrophage activation syndrome (MAS). A negative bone marrow examination suggested that pancytopaenia was unlikely to be due to bone marrow infiltration, which is why he was treated with steroids. Yet, when fever recurred, MRI was arranged to investigate further, which eventually led to revelation of lymphadenopathy and biopsy, which eventually led to the right diagnosis. Another dilemma was if his MAS was to respond to steroids, whether we should change his baseline immunosuppression which had worked well so far for him and if we chose to, what would be the best agent.Case report - Key learning points1. Although extremely uncommon, children and young people with rheumatic diseases can develop malignancy, which may be unrelated to the primary condition or the therapeutic agents used. Unexplained symptoms in the absence of flare of underlying condition and with infections ruled out, warrant extension of investigations to rule out an underlying malignancy.2. Diagnosis of secondary MAS in a rheumatological condition without any evidence of flare of the underlying condition should be viewed as suspicious and warrants more investigations to rule out other causes.3. In patients who develop MAS, there are very few agents which work for both lupus and MAS, choosing an agent which treats both conditions is challenging.

Generalized Scrotal Edema as the First Sign of Gastric Cancer: A Case Report

Generalized Scrotal Edema as the First Sign of Gastric Cancer: A Case Report

Mechanisms Governing Anaphylaxis: Inflammatory Cells, Mediators, Endothelial Gap Junctions and Beyond.

Anaphylaxis is a severe, acute, life-threatening multisystem allergic reaction resulting from the release of a plethora of mediators from mast cells culminating in serious respiratory, cardiovascular and mucocutaneous manifestations that can be fatal. Medications, foods, latex, exercise, hormones (progesterone), and clonal mast cell disorders may be responsible. More recently, novel syndromes such as delayed reactions to red meat and hereditary alpha tryptasemia have been described. Anaphylaxis manifests as sudden onset urticaria, pruritus, flushing, erythema, angioedema (lips, tongue, airways, periphery), myocardial dysfunction (hypovolemia, distributive or mixed shock and arrhythmias), rhinitis, wheezing and stridor. Vomiting, diarrhea, scrotal edema, uterine cramps, vaginal bleeding, urinary incontinence, dizziness, seizures, confusion, and syncope may occur. The traditional (or classical) pathway is mediated via T cells, Th2 cytokines (such as IL-4 and 5), B cell production of IgE and subsequent crosslinking of the high affinity IgE receptor (FcεRI) on mast cells and basophils by IgE-antigen complexes, culminating in mast cell and basophil degranulation. Degranulation results in the release of preformed mediators (histamine, heparin, tryptase, chymase, carboxypeptidase, cathepsin G and tumor necrosis factor alpha (TNF-α), and of de novo synthesized ones such as lipid mediators (cysteinyl leukotrienes), platelet activating factor (PAF), cytokines and growth factors such as vascular endothelial growth factor (VEGF). Of these, histamine, tryptase, cathepsin G, TNF-α, LTC4, PAF and VEGF can increase vascular permeability. Recent data suggest that mast cell-derived histamine and PAF can activate nitric oxide production from endothelium and set into motion a signaling cascade that leads to dilatation of blood vessels and dysfunction of the endothelial barrier. The latter, characterized by the opening of adherens junctions, leads to increased capillary permeability and fluid extravasation. These changes contribute to airway edema, hypovolemia, and distributive shock, with potentially fatal consequences. In this review, besides mechanisms (endotypes) underlying IgE-mediated anaphylaxis, we also provide a brief overview of IgG-, complement-, contact system-, cytokine- and mast cell-mediated reactions that can result in phenotypes resembling IgE-mediated anaphylaxis. Such classifications can lead the way to precision medicine approaches to the management of this complex disease.

Characterization of a novel transitional group Rickettsia species (Rickettsia tillamookensis sp. nov.) from the western black-legged tick, Ixodes pacificus.

A previously unrecognized Rickettsia species was isolated in 1976 from a pool of Ixodes pacificus ticks collected in 1967 from Tillamook County, Oregon, USA. The isolate produced low fever and mild scrotal oedema following intraperitoneal injection into male guinea pigs (Cavia porcellus). Subsequent serotyping characterized this isolate as distinct from recognized typhus and spotted fever group Rickettsia species; nonetheless, the isolate remained unevaluated by molecular techniques and was not identified to species level for the subsequent 30 years. Ixodes pacificus is the most frequently identified human-biting tick in the western United States, and as such, formal identification and characterization of this potentially pathogenic Rickettsia species is warranted. Whole-genome sequencing of the Tillamook isolate revealed a genome 1.43 Mbp in size with 32.4 mol% G+C content. Maximum-likelihood phylogeny of core proteins places it in the transitional group of Rickettsia basal to both Rickettsia felis and Rickettsia asembonensis. It is distinct from existing named species, with maximum average nucleotide identity of 95.1% to R. asembonensis and maximum digital DNA-DNA hybridization score similarity to R. felis at 80.1%. The closest similarity at the 16S rRNA gene (97.9%) and sca4 (97.5%/97.6% respectively) is to Candidatus 'Rickettsia senegalensis' and Rickettsia sp. cf9, both isolated from cat fleas (Ctenocephalides felis). We characterized growth at various temperatures and in multiple cell lines. The Tillamook isolate grows aerobically in Vero E6, RF/6A and DH82 cells, and growth is rapid at 28 °C and 32 °C. Using accepted genomic criteria, we propose the name Rickettsia tillamookensis sp. nov., with the type strain Tillamook 23. Strain Tillamook 23 is available from the Centers for Disease Control and Prevention Rickettsial Isolate Reference Collection (WDCM 1093), Atlanta, GA, USA (CRIRC accession number RTI001T) and the Collection de Souches de l'Unité des Rickettsies (WDCM 875), Marseille, France (CSUR accession number R5043). Using accepted genomic criteria, we propose the name Rickettsia tillamookensis sp. nov., with the type strain Tillamook 23 (=CRIRC RTI001=R5043).

Comparison between Single Mesh and Double Mesh Placement in Huge Inguinal Hernia

Background: Recurrence after surgical treatment of inguinal hernia is still a challenge facing surgeons during their daily practice. Aim of the Work: The current trial aims to compare single and double mesh placement in huge inguinal hernia repair. Patients and Methods: 40 cases were involved in the study. They were classified into two equal groups according to the operative technique [A for single mesh and B for double mesh]. The study's candidates were examined and investigated thoroughly regarding their complaint, the presence of a clinically detectable hernia in the inguinal region, its size, characters, onset, duration, and associated symptoms. Then, all were examined clinically and prepared for surgical intervention after lab investigations. Results: The mean ages were 56 and 56.9 years for groups A and B. Both groups were comparable to body mass index, risk factors, type of hernia, hernia side, and intraoperative blood loss. There was a significant decrease in operative time in group A when compared to group B [54.50 ± 8.256 vs. 61.25 ± 6.664 minutes, respectively]. The overall rate of complications was lower in group B when compared to group A [30.0% vs. 50.0%, respectively]. Complications in group A were seroma [10.0%], wound infection [5.0%], scrotal edema [25.0%], and chronic pain [10.0%]; while in group B, seroma [10.0%], scrotal edema [5.0%], chronic pain [15.0%]. Recurrence was confined to group A, and reported to three patients [15.0%]. However, the difference was statistically nonsignificant. Conclusion: Double mesh technique is a safe and efficacious approach for managing huge inguinal hernia. It is associated with lower rate of recurrence than the single mesh approach with comparable operative time, complications, and outcomes.

Comparison of the Inguinal and High Scrotal Approaches for the Treatment of Inguinal Hernias in Boys.

The conventional groin incision herniotomy is still being adhered to despite high success rate of high scrotal approach. Hence, the aim of this study was to compare the outcomes of high scrotal and conventional approaches for the treatment of inguinal hernia in boys. A prospective study of 100 boys with 108 inguinal hernias whose ages were less than 15 years. They were randomized into 2 groups; high scrotal and conventional approaches. Ninety-four patients with 101 hernias were analyzed. The operative time, conversion rate (high scrotal approach), and postoperative complications were reported. A total of 100 boys with 108 hernias were enrolled but 94 patients with 101 hernias were analyzed. They comprised of 48 patients with 51 hernias in the high scrotal group and 46 patients with 50 hernias in the conventional group. Their age range was between 2 months and 168 months with a mean of 47.9 ± 46.7 months. The conversion rate of high scrotal approach was 1.9%. The mean duration of operation in the high scrotal group was 37.1 ± 13.3 minutes compared with 37.2 ± 15.1 minutes in the conventional group, p = 0.982. Early postoperative scrotal edema was more in the high scrotal group compared to the conventional group, p = 0.018. The Hollander wound evaluation score was better in the high scrotal incision compared to the conventional approach, p = 0.003. The high scrotal approach may be an alternative to conventional herniotomy in boys.

MO718ROLE OF CT-PERITONEOGRAPHY IN THE PATIENT WITH GENITAL EDEMA AND PERITONEAL DIALYSIS

Abstract Background and Aims Genital edema is a frequent complication in those patients who are on peritoneal dialysis, generally secondary to the increase in intra-abdominal pressure that it entails. It occurs late after the implantation of the peritoneal catheter (after 30 days of implantation). The typical clinical manifestation of this condition is basically subcutaneous edema in the genital area, accompanied by pain and UF failure. The diagnosis must be made by using an imaging test, mainly CT-peritoneography. Method A series of clinical cases of PD patients who consulted for genital edema is reviewed, analyzing the role of peritoneography Results CASE 1 A 76-year-old male, 15 days after the start of the technique, consulted for right scrotal edema. It was decided to suspend CAPD and start hospital intermittent IPD with low volumes. A CT-peritoneography was requested, which revealed a right peritoneal-vaginal duct and a left inguino-scrotal leak. Surgical correction of the anatomical defect was performed without incident, with subsequent return of the patient to CAPD. CASE 2 A 78-year-old man, 15 days after the start of the technique, consulted for bilateral scrotal edema. A CT-peritoneography was performed, which showed that the leak of peritoneal fluid to the scrotum was due to bilateral inguinal hernia. Subsequently, inguinal hernioplasty of the surgical defect was performed without complications. Conclusion Genital edema, as a complication of patients with CAPD, appears in approximately 4-10% of them. CT-peritoneography is the diagnostic technique of choice. To do this, 150 ml of nonionic iodinated contrast, with a concentration of 300 mg/ml, are diluted in approximately 2 liters of dialysis solution, which are introduced into the peritoneal cavity of the patient 2 h before performing the CT. Subsequently, a CT scan of the abdomen and pelvis including the perineum is performed, in the supine position and craniocaudal direction.

Clinicopathological and Microscopic Features of Trypanosoma brucei and Trypanosoma evansi Induced Infections in Sheep II

The present study elucidates further on clinical, gross, and microscopic pathologies induced by single or mixed infections with Trypanosoma evansi and Trypanosoma brucei in sheep. Briefly, the experimental animals were divided into four groups of three animals each. Animals in each group were either infected with T. brucei, T. evansi, mixed (T. brucei and T. evansi), or noninfected. Animals were observed for clinical, gross, and microscopic pathologies for 98 days (14 weeks). The clinical pathologies observed included loss of body condition, pale ocular mucus membrane, rough hair coat, scrotal oedema, scrotal degeneration, emaciation, and death. At necropsy, macroscopic or gross lesions included very pale and anaemic carcass composition, congested and pneumonic lungs with severe haemorrhages, serous atrophy of intestinal and body fats, lymphadenopathy, splenomegaly, and hepatomegaly. Microscopic lesions observed in the testes, spleen, liver, lungs, lymphoid, heart, and brain tissues of infected sheep were varied and included swollen kidney with renal tubular degeneration, the proliferation of lymphocytes at the germinal centers of the spleen, degeneration of the bronchioles, severe testicular degeneration with a reduction in the number of spermatogenic cell layers, degenerated Leydig and Sertoli cells with loss of sperm reserves in the seminiferous lumen, congested liver with sinusoidal spaces and the proliferation of monocytes and lymphocytes. The results indicate that trypanosomosis due to experimental T. brucei, T. evansi, or mixed infections may be an important cause of various grades of tissue and organ pathologies in sheep in trypanosome-endemic areas.
 Keywords: Trypanosomosis; Clinico-pathological and microscopic features; Trypanosoma brucei; Trypanosoma evansi; Mixed infections; Sheep

To Evaluate the Outcome of Epididymal Cystectomy at Liaquat Medical College Hospital Jamshoro Pakistan

Introduction: Epididymal cystectomy is the procedure in which removal of cyst attached to epididymis is done. The cyst contains cleat/straw colored fluid. It is excised because of its increasing size causing discomfort or pain to patient.
 Methodology: A Cross sectional observational study was conducted at Surgical Unit 1, Department of of Surgery LMC Hospital Jamshoro from January 2020 to January 2021. All the patients were admitted through Surgical OPD (SOPD) with cystic swellings in scrotum. History and clinical examination of inguino-scrotal region was done. Transillimination test was also done. Ultrasound was obtained to confirm the diagnosis, number of cysts, sizes and site of cyst. Hydrocele, spermatocele and testicular malignancies were ruled out through investigations. Surgery was planned after getting cardiac and anesthesia fitness. The surgery was done. Patients were shifted to ward and assessed for 3 to 5 days. Patient was called for follow up for 6 months. Results were analyzed using statistical package for social sciences (SPSS) version 23.
 Results: Total patients included in our study are 49.32 (65%) patients had solitary cyst and 17 (35%) had multiple cysts. 30 (61.2%) patients had left sided epididymal cysts and 19 (38.7%) had right sided cysts. Hematoma was developed by 6.1%, chronic pain by 12.2%, infection by 8.1%, scrotal edema by 10.2% and recurrence by 6.1% patients.
 Conclusion: Epididymal cystectomy is the procedure with better outcome and least complications rate.

A new self-made electric hook for laparoscopic inguinal hernia repair

Background: Current investigation was conducted to explore the clinical application of self-made electric hook in laparoscopic indirect inguinal hernia repair.Methods: Randomized controlled trial was conducted that compared two groups of patients who underwent laparoscopic inguinal hernia repair from 2013 to 2017 at our institution. A laparoscopic indirect inguinal hernia repair with beak-like electrocoagulation instrument as modified trans-abdominal preperitoneal prosthesis was performed on 42 patients. As a comparison, 40 patients with traditional TAPP were collected and analyzed. In the end, we compared the operation time, blood loss, complications, and recurrence of two groups.Results: 82 patients have successfully completed surgery without conversion to open inguinal hernia repair. Patients were follow-up visited for 18 to 78 months, and no recurrence was found. 1 case of scrotal edema occurred using a self-made electric hook in modified TAPP, and cured by conservative treatment. In traditional TAPP group, there was 1 case of postoperative seroma, which cured by conservative treatment. There was no significant difference between these 2 groups in terms of complications and recurrence (p>0. 05). However, the differences in operation time and blood loss were significant (p<0. 05).Conclusions: Self-made electrical hook showed in laparoscopic inguinal hernia repair of indirect inguinal hernia has the advantages of shortening operation time, reducing bleeding, easing the difficulty of operation, and improving the safety of surgery, it is worthy of further clinical application.