OBJECTIVE To describe our experience of inguinal exploration in patients who had a reasonable chance of having a benign testicular lesion. PATIENTS AND METHODS From 1995 to 2002, 11 patients (mean age 43 years, range 27–63) with testicular masses that were suspected to be benign underwent inguinal exploration. RESULTS In nine of the 11 patients, frozen‐section analysis and the final pathological results were similar, and two underwent inguinal orchidectomy. In seven patients the testicle was spared. Finally, because of an uncertain pathological diagnosis and patient age, two patients underwent orchidectomy. CONCLUSIONS Inguinal exploration and testicular‐sparing surgery are reasonable options in patients with peripheral intratesticular lesions, on the basis of preoperative ultrasonographic characteristics, and if there is a possibility of the mass being benign because of age, race, physical examination and tumour markers.

Portopulmonary hypertension is a common condition in patients who have portal hypertension. This article reviews the definition and clinical presentation of this disorder and outlines our current understanding of its pathophysiology. A diagnostic approach is provided , and novel medical therapies that are being investigated to treat this condition are discussed. Finally, the safety of liver transplantation in patients who have portopulmonary hypertension is reviewed.

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A 35-year-old male with no prior medical history presented for evaluation of multi-year history of dysphagia to both solids and liquids. He underwent esophagogastroduodenoscopy revealing linear furrows with ring-like esophagus. Pathology of biopsies showed findings consistent with eosinophilic esophagitis (EoE). This is a newly recognized disease entity with a rapidly increasing prevalence that cannot be entirely accounted for by the increasing awareness in medicine. All patients with clinical suspicion of EoE should undergo esophageal biopsies regardless of endoscopic findings, as normal endoscopy can be seen in up to 17% of cases. Numerous non-specific endoscopic findings have been described, including trachealization, felinization, linear furrows, crepe paper mucosa, and longitudinal shearing. We present a unique and neverbefore seen image of EoE that accentuates the findings that may be seen endoscopically. Case ReportA 35-year-old male with no prior medical history presented for evaluation of multi-year history of dysphagia to both solids and liquids. Laboratory data and modified barium swallow study were unrevealing of a cause of his dysphagia. After failure of an empiric eight-week trial of proton pump inhibitor therapy, he underwent esophagogastroduodenoscopy revealing linear furrows with ring-like esophagus. After biopsies were taken, mild bleeding accentuated the linear furrows, creating a watermelon esophagus appearance (Figure 1). Pathology of biopsies showed findings consistent with eosinophilic esophagitis. Discussion and ConclusionsEosinophilic esophagitis (EoE) is a primary clinico-pathologic disorder of the esophagus that is defined by clinical symptoms of esophageal dysfunction in addition to ≥15 eosinopils/high-power field on esophageal mucuosal biopsy specimens. 1 EoE is a newly recognized disease entity with a rapidly increasing prevalence that cannot be entirely accounted for by the increasing awareness in medicine. 1 A high clinical suspicion is needed to make a diagnosis given the non-specific presenting symptoms, which may include dysphagia, food impaction, food aversion, heartburn, and chest pain. 2 All patients with clinical suspicion of EoE should undergo esophageal biopsies regardless of endoscopic findings, as normal endoscopy can be seen in up to 17% of cases. 3 Numerous non-specific endoscopic findings have been described, including trachealization, felinization, linear furrows, crepe paper mucosa, and longitudinal shearing. 1 We present a unique and never-before seen image of EoE that accentuates the findings that may be seen endoscopically. References