Prospective Study of Routine Scrotal Ultrasonography in Urological Practice

London, N. J. M.; Smart, J. G.; Kinder, R. B.; Watkin, E. M.; McDermott, Yvonne; Haley, Patrick D.

doi:10.1111/j.1464-410x.1989.tb05229.x

Cited by 24 publications

(13 citation statements)

References 21 publications

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“…Ultrasound is the mainstay for imaging of the testis and has a sensitivity of 80–98% 1. One of its limitations is that non-neoplastic lesions may mimic tumours.…”

Section: Discussionmentioning

confidence: 99%

A lesson in the management of testicular cancer in a patient with a solitary testis

Sawyer

Oliver

Tobias

et al. 1999

Postgraduate Medical Journal

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SummaryFive per cent of patients with germ cell tumours of the testis will develop a further tumour in the contralateral testis. Standard treatment in such cases is a second orchidectomy, resulting in infertility, hormone replacement, and psychological morbidity. In this case report we explore the role of testis conservation in these patients and also show that there is a risk of removing a potentially normal testis if a histological diagnosis is not sought prior to orchidectomy.Keywords: testicular germ cell tumours; carcinoma-insitu; orchidectomy With the current preference for orchidectomy in patients with suspicious testicular masses there is the risk of removing a potentially normal testis. Experience of a patient with a suspicious mass in a solitary testis which was subsequently found to have benign histology after testis-conserving surgery, prompted us to report the present case. Case historyA 39-year-old man presented with a 6-week history of pain in the left groin and suprapubic area with increasing tenderness in the right testis. Fourteen years earlier he had undergone a left orchidectomy and chemotherapy (four cycles of bleomycin, etoposide and cisplatin) for stage 2C teratoma. Since that time he had been well apart from azospermia which had been detected prior to starting chemotherapy.Examination on this occasion revealed a tender solitary right testis with no palpable nodule. Doppler ultrasound revealed a 4-mm lesion with normal blood flow within the right testis. Serum -human chorionic gonadotropin ( -hCG) and -fetoprotein were not raised but on the basis of the ultrasound findings it was felt that the lesion probably represented a tumour and he was advised to undergo an orchidectomy.He was concerned about having to take long-term testosterone replacement, and although he was aware that the most likely diagnosis was a second malignancy, was keen if possible to pursue testis conservation. He underwent exploration of the right testis through a groin incision. Intra-operative ultrasound using a 7.5 mH ultrasound probe was used to identify the lesion (figure 1), which was excised with a rim of surrounding normal tissue. A separate testicular biopsy was also performed. Despite the clinical prediction of a new primary malignancy, histology of the nodule revealed seminiferous tubules lined only by Sertoli cells and marked proliferation and hyperplasia of Leydig cells. The separate biopsy showed atrophic testis. DiscussionThis case highlights the problems of diagnosis of testicular masses. Ultrasound is the mainstay for imaging of the testis and has a sensitivity of 80-98%. 1One of its limitations is that non-neoplastic lesions may mimic tumours. Magnetic resonance imaging (MRI) has no proven diagnostic benefit over ultrasound, but provides better localisation when partial orchidectomy is being considered (figure 2).2 If this surgical approach is followed, then intraoperative ultrasound can be used, as in this case, to delimit the lesion and thus remove as little of the normal testis as possible.Fine needl...

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“…Ultrasound is the mainstay for imaging of the testis and has a sensitivity of 80–98% 1. One of its limitations is that non-neoplastic lesions may mimic tumours.…”

Section: Discussionmentioning

confidence: 99%

A lesson in the management of testicular cancer in a patient with a solitary testis

Sawyer

Oliver

Tobias

et al. 1999

Postgraduate Medical Journal

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“…1 This reflects the incidence of Salmonella infection in the community, 2 the fact that 3-8% of Salmonella infections result in bacteraemia, 3 4 and the predilection of Salmonellae to infect damaged tissues such as atherosclerotic vascular endothelium. 5 Patients are usually male, over 50 years old and may present in a variety of ways ranging from the typical features of a rupturing aortic aneurysm to pyrexia of unknown origin.…”

Section: Discussionmentioning

confidence: 99%

“…1 The diagnosis can be diYcult and a high index of suspicion is required on the part of the physician. We describe a case of Salmonella aortitis in a patient with a pre-existing aortic aneurysm.…”

Section: Summary Pointsmentioning

confidence: 99%

Hypersensitivity pneumonitis associated with co-proxamol (paracetamol + dextropropoxyphene) therapy

Matusiewicz

Wallace

Crompton

1999

Postgraduate Medical Journal

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SummaryA 61-year-old man developed hypersensitivity pneumonitis and skin rash in close association with taking co-proxamol. These problems occurred in spite of being treated with prednisolone 40 mg daily (20 mg daily at the time of presentation) for assumed cranial arteritis. A therapeutic challenge with paracetamol was negative and the patient continues to take this drug. It seems likely that this patient's rash and hypersensitivity pneumonitis was caused by dextropropoxyphene. Dextropropoxyphene has not been reported previously as a cause of hypersensitivity pneumonitis.Keywords: adverse drug reaction; hypersensitivity pneumonitis; co-proxamol; dextropropoxyphene Hypersensitivity pneumonitis is known to be caused by a large number of drugs, although it is more often associated with inhaled protein antigens. Co-proxamol, a combined preparation containing paracetamol and dextropropoxyphene, is a widely used analgesic and is well tolerated in recommended doses. Skin rash has been associated with its use 1 and two cases of paracetamol pneumonitis have been reported 2 3 but pulmonary complications of dextropropoxyphene have not been reported either in the literature or to the Committee on Safety of Medicines. Case reportA 61-year-old man presented with a 2-month history of increasing breathlessness. He had stopped smoking 13 years previously because of cough, and for some years had been troubled with headache which had responded to corticosteroid therapy and a presumed diagnosis of cranial arteritis was made in 1988. Prednisolone therapy was withdrawn in 1992, but headaches recurred in early 1993. Prednisolone was restarted in a dose of 40 mg daily with only partial response and co-proxamol was taken as required to relieve headache. He then developed breathlessness which progressed steadily over a 2-month period. There was no exposure to any known causes of extrinsic allergic alveolitis and his only drug therapy was co-proxamol and prednisolone, the dose of which had been reduced to 20 mg daily. On examination there were bilateral lateinspiratory basal crackles audible. A chest X-ray had a vague shadowing in both lower zones suggesting an interstitial abnormality. An FEV 1 of 2.6 (predicted 3.4 ± 0.5 l) and an FVC of 4.1 (predicted 4.2 ± 0.7 l), together with the lung volumes and transfer coeYcient (see table), suggested a combined obstructive and restrictive defect. Electrocardiogram and echocardiography were normal. Haematological indices, urea, electrolytes and standard liver function tests were normal, but there was an elevation of lactate dehydrogenase (LDH) of 531 IU/l (normal range 92-395). Serum was negative for Aspergillus fumigatus and avian precipitins and autoantibodies. Arterial blood gas analysis revealed mild hypoxaemia: PaO 2 8.9 kPa, PaCO 2 5.9 kPa, hydrogen ion 36.8 nmol/l. A ventilation/perfusion scan was normal. Exercise induced O 2 desaturation to 88% at 1.5 min at 40 watts.It was concluded that this man had some form of interstitial lung disease which had developed while being treated with pre...

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“…SUS has been 100% accurate in detecting tumors in the patients in our series, and this agrees with the findings in other series. [6][7][8] SUS was also able to differentiate between seminoma and teratoma due to their characteristic macroscopic pathology. 3 Although SUS has been used to detect focal occult testicular tumors, 9 it may not be capable of diagnosing diffuse neoplastic involvement of the testis due to absence of an adjacent normal area for comparison.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Scanning in Scrotal Disorders: Correlation of Clinical and Operative Findings

et al. 1990

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Prospective Study of Routine Scrotal Ultrasonography in Urological Practice

Cited by 24 publications

References 21 publications

A lesson in the management of testicular cancer in a patient with a solitary testis

A lesson in the management of testicular cancer in a patient with a solitary testis

Hypersensitivity pneumonitis associated with co-proxamol (paracetamol + dextropropoxyphene) therapy

Ultrasound Scanning in Scrotal Disorders: Correlation of Clinical and Operative Findings

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