scholarly journals Differential Diagnosis of Azoospermia in Men with Infertility

2021 ◽  
Vol 10 (14) ◽  
pp. 3144
Author(s):  
Danilo L. Andrade ◽  
Marina C. Viana ◽  
Sandro C. Esteves
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Detailed Analysis ◽  
Clinical Management ◽  
Semen Analysis ◽  
Testicular Biopsy ◽  
Nonobstructive Azoospermia ◽  
Sperm Cryopreservation ◽  
Imaging Studies ◽  
Detailed Medical History

The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.

scholarly journals Scleroderma with Acro-Osteolysis and Papular Mucinosis Resembling Multicentric Reticulohistiocytosis

2020 ◽  
Author(s):  
João Dantas ◽  
Isabela S de Oliveira ◽  
Emanuela P Fonseca ◽  
Mittermayer Barreto Santiago
Keyword(s):  
Differential Diagnosis ◽  
Systemic Sclerosis ◽  
Bone Resorption ◽  
Physical Examination ◽  
Skin Biopsy ◽  
Laboratory Tests ◽  
Skin Lesions ◽  
Imaging Studies ◽  
Plain Radiographs ◽  
Multicentric Reticulohistiocytosis

Objectives: We describe a case of systemic sclerosis (SS) with acro-osteolysis associated with cutaneous mucinosis, usually characterized by mucin deposition in the skin. The main differential diagnosis was multicentric reticulohistiocytosis due to the presentation of papulonodular skin lesions. Materials and methods: A physical examination, imaging studies and laboratory tests were performed. Results: Distal bone resorption was evident on plain radiographs, and skin biopsy confirmed mucinosis. The SS diagnosis was based on the clinical features, high levels of antinucleolar antibodies and typical nailfold capillaroscopy findings. Conclusion: To the best of our knowledge, this is the first description of cutaneous mucinosis accompanying SS with acro-osteolysis.

scholarly journals Difficult diagnosis of a neurogenic thoracic outlet syndrome and review of the current literature

2020 ◽  
Vol 6 (5) ◽  
pp. 1087
Author(s):  
Joao Maia Rosa ◽  
Arnaldo Sousa ◽  
Helder Fonte ◽  
Eva Pereira ◽  
Rita Sapage ◽  
...  
Keyword(s):  
Physical Examination ◽  
Brachial Plexus ◽  
Nerve Root ◽  
Clinical Management ◽  
Thoracic Outlet Syndrome ◽  
Clinical Presentation ◽  
Cervical Region ◽  
Imaging Studies ◽  
Difficult Diagnosis

<p>Thoracic outlet syndrome (TOS) is an uncommon disorder, without a clear clinical presentation or a fully accepted definition. The patients usually present a set of symptoms arising from compression of the brachial plexus or subclavian vessels during their passage through the thorax, between the base of the cervical region and the axilla. The authors present a case of a 20 years old woman with sporadic paresthesia in the territory of C7-T1 nerve root. At the physical examination she had a positive Wright's test. The imaging studies revealed the presence of a right cervical rib. A partial rib resection was performed with exploration of the braquial plexus and at the current follow up; 24 months after the surgery, the patient is asymptomatic. Our objective is to present a case of TOS and to highlight the clinical-management and treatment challenges of this pathology.</p>

scholarly journals Obstrução Congénita dos Canais Ejaculadores: Diagnóstico e Resolução em Dois Casos de Sucesso

2013 ◽  
Vol 26 (5) ◽  
pp. 616
Author(s):  
Rui Amorim ◽  
Vitor Oliveira ◽  
Jorge Dias ◽  
Rui Freitas ◽  
Luis Ferraz
Keyword(s):  
Surgical Treatment ◽  
Physical Examination ◽  
Transurethral Resection ◽  
Sperm Count ◽  
Semen Analysis ◽  
Clinical Suspicion ◽  
Imaging Studies ◽  
Male Factor ◽  
High Importance ◽  
Reproductive Techniques

The ejaculatory ducts obstruction is an uncommon finding in the study of infertility male factor. We present two cases referred to our department for conjugal infertility, with proven male factor (low ejaculate volume and azoospermia). On physical examination there was no abnormality in both patients. Imaging studies demonstrated intra-prostatic cystic structure, causing ejaculatory ducts dilation. We performed transurethral resection of the ejaculatory ducts. Semen analysis 3 months postoperatively showed 1 case of normalization and 1 case of improvement in sperm count parameters. The couple 1 couple has 2 children, without medical assisted reproductive techniques. The couple 2 had one pregnancy after Intracytoplasmic Sperm Injection, from the ejaculate. This diagnosis depends on a strong clinical suspicion and is of high importance, since this disease has effective surgical treatment. The authors aim to highlight the relevance of the assessment andrological when studying marital infertility.

scholarly journals The Effect of Single and Triple Testicular Biopsy Using Biopty Gun on Spermatogenesis in Pubertal Rats

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1569
Author(s):  
Tomislav Šušnjar ◽  
Ivana Kuzmić Prusac ◽  
Ivan Švagelj ◽  
Anđela Jurišić ◽  
Tomislav Šušnjar ◽  
...  
Keyword(s):  
Sperm Count ◽  
Semen Analysis ◽  
Study Groups ◽  
Testicular Biopsy ◽  
Male Rats ◽  
Lower Percentage ◽  
Control Group ◽  
Sprague Dawley ◽  
Left Testis ◽  
Significant Difference

Background: The aim of this study was to compare consequences in single and triple testicular biopsy by biopty gun in pubertal rats using histological and immunohistochemical analysis. Methods: Thirty-two Sprague-Dawley male rats were used as the experimental model. The rats were randomly divided into three study groups. The rats from the first group (n = 12) received a single-biopsy of upper pole of the left testis, while the rats from the second group (n = 10) received triple-biopsy of upper and lower poles and lateral surface of left testis. The third group (n = 10) was a control group. On the eightieth day after the biopsy in all rats bilateral orchiectomy and funiculectomy were performed to obtain testicular tissue and sperm for analysis. The consequences of the puncture were observed by pathohistology, immunohistochemistry and semen analysis. Results: The results of the study showed lower percentage of sperm count (14.5 mill/mL vs. 16 mill/mL, p = 0.130), sperm motility (24.6% vs. 32.7%, p > 0.05), abnormal sperm (30% vs. 27%, p > 0.05), atrophic tubules (21% vs. 6%, p < 0.001), volume (1.7 mL vs. 2.28 mL, p < 0.01) and apoptotic index (1.56 vs. 1.19, p = 0.650) in the testes with a triple-biopsy compared to the testes with a single-biopsy. Semen analysis showed a borderline significant difference between the group with triple-biopsy where sperm count was lower than it in the control group (14.5 mill/mL vs. 17.5 mill/mL, p = 0.05). A single-biopsy has little effect on the testis, especially on overall fertility. A triple-biopsy showed higher degree of the testicular damage but without a significant impact on overall fertility. Semen analysis showed that single- and triple-biopsies did not have a significant effect on sperm count, motility and morphology. Conclusion: Biopty gun procedure is a cheap, simple and reliable method for testicular biopsy in rats without a significant effect on sperm count, motility and morphology.

Approach To The Pediatric Patient: Central Diabetes Insipidus

2022 ◽  
Author(s):  
Giuseppa Patti ◽  
Flavia Napoli ◽  
Daniela Fava ◽  
Emilio Casalini ◽  
Natascia Di Iorgi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Pituitary Stalk ◽  
Central Nervous System Damage ◽  
Gold Standard Method ◽  
Underlying Condition ◽  
Detailed Medical History ◽  
Over Time

Abstract Central diabetes insipidus (CDI) is a complex disorder in which large volumes of dilute urine are excreted due to arginine-vasopressin deficiency, and it is caused by a variety of disorders affecting the hypothalamic-posterior pituitary network. The differential diagnosis is challenging and requires a detailed medical history, physical examination, biochemical approach, imaging studies and, in some cases, histological confirmation. Magnetic resonance imaging is the gold standard method for evaluating congenital or acquired cerebral and pituitary stalk lesions. Pituitary stalk size at presentation could be normal, but it may change over time, depending on the underlying condition, while other brain areas or organs may become involved during follow up. Early diagnosis and treatment are crucial in order to avoid central nervous system damage, germ cell tumor dissemination, and to minimize complications of multiple pituitary hormone defects. We provide a practical update on the diagnosis and management of patients with CDI and highlight several pitfalls that may complicate the differential diagnosis of conditions presenting with polyuria and polydipsia. The need for a careful and close follow-up of patients with “apparently” idiopathic CDI is particularly emphasized, because the underlying condition may be recognized over time. The clinical scenario that we outline at the beginning of this article represents the basis for the discussion about how the etiological diagnosis of CDI can be overlooked, and demonstrates how a water intake and urine output improvement can be a sign of progressive damage of both hypothalamus and anterior pituitary gland with associated pituitary hormonal deficiencies.

Physical Examination of Patients With Cerebrospinal Fluid Shunts: Is There Useful Information in Pumping the Shunt?

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 470-473
Author(s):  
Joseph H. Piatt
Keyword(s):  
Cerebrospinal Fluid ◽  
Physical Examination ◽  
Predictive Value ◽  
Pumping Test ◽  
Study Group ◽  
Cerebrospinal Fluid Shunts ◽  
Imaging Studies ◽  
Shunt Valve ◽  
The Status ◽  
Shunt Obstruction

To assess the value of the information derived from pumping the shunt valve in hydrocephalic patients with cerebrospinal fluid shunts, the findings on examination of 200 consecutive patients were recorded prospectively. The status of each shunt was determined on the basis of all available clinical data, and the results of the shunt pumping test were compared to the final status of each shunt for various subsets of the study group. In the most clinically pertinent subsets, the sensitivity of the shunt pumping test in the detection of shunt obstruction was 18% to 20%, and the predictive value of a negative shunt pumping test, indicating shunt patency, was only 65% to 81%. For the hydrocephalic patient with symptoms of shunt malfunction, definitive imaging studies must not be deferred because of reassuring findings on examination of the shunt valve.

scholarly journals Blake's Pouch Cyst: A Case Report

2017 ◽  
Vol 06 (02) ◽  
pp. 122-125
Author(s):  
Saurabh Verma ◽  
M. Sridhar ◽  
S. Shashivadhanan ◽  
Manish Garg
Keyword(s):  
Genetic Counseling ◽  
Case Report ◽  
Literature Review ◽  
Posterior Fossa ◽  
Clinical Management ◽  
In Utero ◽  
Prenatal Ultrasound ◽  
Male Child ◽  
Imaging Studies ◽  
Initial Imaging

AbstractIt is a rare and underdiagnosed entity. The adagium “one only sees what one knows” is certainly true in cases of Blake's pouch cyst, as all types of posterior fossa cysts and cyst-like malformations may present nearly identical on initial imaging studies. Only one case of Blake's pouch cyst has been reported from this country, except for a case in utero, in which a diagnosis of Blake's pouch cyst was made on prenatal ultrasound and later confirmed by MRI. In this report we describe a case of Blake's pouch cyst in a 9-month-old male child along with the principles of diagnosis of Blake's pouch cyst, in combination with literature review. Differentiating Blake's pouch cyst from other posterior fossa cysts and cyst-like malformations and recognizing the accompanying hydrocephalus that are essentially noncommunicating have important implications not only on clinical management but also on genetic counseling, which is unnecessary in case of Blake's pouch cyst.

scholarly journals Differential Diagnosis between the Varieties of Vasculitis Forms

2018 ◽  
Vol 6 (2) ◽  
pp. 1-8
Author(s):  
Joana Hankollari ◽  
Marsida Duli ◽  
Qamil Dika ◽  
Xhenila Duli ◽  
Indrit Bimi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Blood Vessel ◽  
Specific Form ◽  
The Body ◽  
Imaging Studies ◽  
Patient Assessment ◽  
Diagnostic Difficulties ◽  
History Of ◽  
Specific Symptoms

Vasculitis is an inflammation of the blood vessels. It can affect any blood vessel in the body by manifesting a variety of systemic, non-specific symptoms that make difficult the diagnosis of this pathology and especially its specific form. In front of any patient suspected of being affected by vasculitis, some questions are asked: Is the vasculitis or other pathology that camouflages, whether it is primary or secondary vasculitis, in which vessels this pathology extends, how can the diagnosis be confirmed and how can it be determined the type of vasculitis?The purpose of this study is to inform about the protocols to be followed to perform differential diagnosis of vasculitis types.This study is a review based on the research of world studies and literature regarding the recommendations for performing differential diagnosis among the variety of vasculitis forms.Primary patient assessment involves taking the history of the medications it uses, risk factors for infectious pathology, history of cardiac valve pathologies, and autoimmune pathologies. Then laboratory and imaging studies are carried out, aiming at setting the diagnosis, determining the affected organ and the degree of disease activity. And recently we refer to algorithms to make differential diagnosis between the varieties of vasculitis forms.Despite the diagnostic difficulties of vasculitis, the variety of its forms, the separation of responsibilities among many specialities, there are protocols that need to be followed rigorously to arrive at a safe diagnosis as well as auxiliary algorithms to distinguish the type of vasculitis.

scholarly journals TESTICULAR TORSION OF UNDESCENDED TESTIS IN A CHILD

2011 ◽  
Vol 18 (03) ◽  
pp. 535-537
Author(s):  
MAQSOOD AHMAD ◽  
MUMTAZ AHMAD ◽  
MUHAMMAD SAQIB
Keyword(s):  
Differential Diagnosis ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Blood Supply ◽  
Spermatic Cord ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Accurate Diagnosis ◽  
Acute Scrotum ◽  
Prompt Treatment

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children.

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