scholarly journals Atypical presentation of testicular torsion: a case series

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Uzodimma Ejike Onwuasoanya
Keyword(s):  
Physical Examination ◽  
Testicular Torsion ◽  
Age Groups ◽  
Case Series ◽  
Atypical Presentation ◽  
Testicular Pain ◽  
Future Fertility ◽  
Urological Emergency ◽  
High Index Of Suspicion ◽  
Symptoms And Signs

Abstract Background Testicular torsion is a urological emergency and needs urgent intervention to prevent testicular loss and impaired future fertility. It is commonly seen in the neonatal and adolescent age groups. Testicular torsion can also present outside these common age groups with uncommon symptoms and signs. We report case series of patients managed at Lily Hospitals Limited, Warri, Delta State, Nigeria with atypical presentation of testicular torsion. Case Presentation The first patient was a 35-year-old male that presented with recurrent right testicular pain of 1-year duration, described as dull aching with no constitutional symptoms, physical examination findings were not pathognomonic of testicular torsion, he had scrotal exploration with right orchidectomy and left orchidopexy. The second patient was a 39-year-old male who presented with recurrent right testicular pain of 4-days duration, described as dull aching with no constitutional symptoms. Physical examination findings were not classical for testicular torsion, he had scrotal exploration with bilateral orchidopexy. Conclusion Testicular torsion although common in neonatal and adolescent age groups can also present outside these age groups with uncommon symptoms and signs, a high index of suspicion is thus invaluable in any patient presenting with testicular pain despite the age and severity to avoid missing the diagnosis as this can lead to testicular loss.

scholarly journals Incidence of mortality due to malaria with typical and atypical presentation

2018 ◽  
Vol 5 (4) ◽  
pp. 818
Author(s):  
Shital N. Rathod ◽  
Arvind Chavan ◽  
Shilpa Sharma ◽  
Tushar Rathod ◽  
Koustubh Bavdhankar
Keyword(s):  
Mortality Rate ◽  
Falciparum Malaria ◽  
Age Groups ◽  
Clinical Suspicion ◽  
Study Group ◽  
Atypical Presentation ◽  
Peripheral Smear ◽  
Atypical Presentations ◽  
High Index Of Suspicion ◽  
Mixed Infestation

Background: Malaria, despite intensive efforts to control, remains a leading cause of morbidity and mortality in humans. India contributes to 61 per cent of malaria cases and 41 per cent of malaria deaths in SEAR countries. The objective of the present study was to find out an incidence of mortality due to malaria with typical and atypical presentation.Methods: The present was conducted over a period of three years. During the study period 630 patients with clinical suspicion of malaria were tested for malaria using peripheral smear, QBC and RDT.Results: The mortality rate in this study group 161 (25.55%) out of which maximum mortality observed in patients with falciparum malaria either singly or with mixed infestation. There is no significant correlation between the typical and atypical presentations in the different age groups with mortality.Conclusions: For timely diagnosis and treatment a high index of suspicion for the disease should be maintained by treating physicians, especially in endemic areas. They should be aware of the varied manifestations to minimize the mortality due to malaria.

scholarly journals Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

2021 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Chukwubuike Kevin Emeka
Keyword(s):  
Pediatric Surgery ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Tertiary Hospital ◽  
Prior History ◽  
Testicular Pain ◽  
History Of ◽  
The Mean ◽  
Urological Emergency ◽  
The Right

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

Isolated tricuspid valve endocarditis in immunocompetent juvenile patients: a series of three cases

2021 ◽  
Vol 14 (8) ◽  
pp. e244312
Author(s):  
Atanu Chandra ◽  
Shrestha Ghosh ◽  
Uddalak Chakraborty ◽  
Debojyoti Ray
Keyword(s):  
Risk Factors ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Age Groups ◽  
Case Series ◽  
Venous Catheter ◽  
Diagnostic Challenge ◽  
Native Valve ◽  
Younger Age ◽  
High Index Of Suspicion

Right-sided native valve infective endocarditis is common in patients with congenital or valvular heart disease, intracardiac device, central venous catheter and intravenous drug abuse, usually manifesting in adulthood. However, in the absence of predisposing risk factors and in younger age groups, this disease may pose a diagnostic challenge. We report a case series of three juvenile patients with isolated tricuspid valve infective endocarditis without any risk factors and paucity of cardiovascular findings in two of them, in an attempt to highlight the importance of maintaining a high index of suspicion to arrive a timely diagnosis.

Testicular Torsion

1994 ◽  
Vol 15 (11) ◽  
pp. 455-456
Keyword(s):  
Physical Examination ◽  
Testicular Torsion ◽  
Neonatal Period ◽  
Acute Onset ◽  
Nausea And Vomiting ◽  
Surgical Exploration ◽  
Urethral Discharge ◽  
Testicular Pain ◽  
Prompt Diagnosis ◽  
Careful History

Testicular torsion is a surgical emergency having an incidence that is probably underestimated at 1 in 4000 males. While torsion may occur at any age, its peak incidence is in adolescence (12 to 18 years) and the neonatal period. A prompt diagnosis is necessary to optimize the chance for testicular salvage by surgical exploration via detorsion and bilateral orchidopexy. A careful history and physical examination should lead to the diagnosis of testicular torsion. Adolescents often present having the acute onset of lateralized scrotal or testicular pain that is intense, unaffected by position, and associated with nausea and vomiting. There are no associated voiding complaints, urethral discharge, or fever.

scholarly journals Optic Neuritis in Pediatric Patients

2021 ◽  
Vol 8 (2) ◽  
pp. 102
Author(s):  
Atik Rahmawati ◽  
Dina Fatmawati
Keyword(s):  
Body Weight ◽  
Optic Nerve ◽  
Physical Examination ◽  
Optic Neuritis ◽  
Pediatric Patients ◽  
Vision Loss ◽  
Case Series ◽  
Atypical Symptoms ◽  
Ophthalmologic Examination ◽  
Symptoms And Signs

Optic neuritis denotes an inflammation of the optic nerve characterized by loss of vision progressing over a few hours to a few days. Based on the site involved, optic neuritis is classified as retrobulbar (2/3 cases), atypical, and typical optic neuritis. In some cases, pediatric patients with optic neuritis have atypical symptoms and signs and no comprehensive medical history leading to a challenging diagnosis. In this case series, we report cases of optic neuritis in pediatric patients at different ages and clinical features treated with methylprednisolone 1 mg/kg body weight and oral mecobalamin and respective management. With a poor initial vision at presentation, the patients recovered rapidly.  The diagno-sis of optic neuritis was based on anamnesis, ophthalmologic examination, and simple laboratory and physical examination. The administration of steroids at a dose of 1 mg/kg body weight followed by a taper of dose can improve vision loss.

scholarly journals Pancreatico‑pleural Fistula: Case Series

2018 ◽  
Vol 09 (01) ◽  
pp. 026-031 ◽  
Author(s):  
Manoj Munirathinam ◽  
Pugazhendhi Thangavelu ◽  
Ratnakar Kini
Keyword(s):  
Magnetic Resonance ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Case Series ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fluid Analysis ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis ◽  
Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

Preoperative Angiography for Free Fibula Flap Harvest: A Case Series: L’angiographie préopératoire pour prélever un lambeau libre de la fibula : une série de cas

2021 ◽  
pp. 229255032199696
Author(s):  
Noor Alolabi ◽  
Haley Augustine ◽  
Forough Farrokhyar ◽  
Carolyn Levis
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Perioperative Complications ◽  
Case Series ◽  
Vascular Anatomy ◽  
Limb Ischemia ◽  
Free Fibula Flap ◽  
Retrospective Case ◽  
Fibula Flap ◽  
Free Fibula

Purpose: To assess if preoperative angiography of the lower extremity is necessary to detect abnormalities that alter operative planning of a free fibula flap (FFF). The secondary objective is to determine whether abnormalities are identified on physical examination. Methods: A retrospective case series of patients receiving preoperative lower extremity angiography for FFF was performed. Between November 2004 and July 2016, patients assessed for FFF reconstruction by a single surgeon were reviewed. Outcomes analyzed were preoperative physical examination, angiography findings, changes in operative plan, and perioperative complications including flap failure and limb ischemia. Level of agreement between physical examination and angiography findings was analyzed. Results: A total of 132 consecutive patients were assessed for FFF, of which 70 met the inclusion criteria. Mean age was 60.9 (range: 22-88) years old. All patients underwent aortic angiogram runoff, except for 2 who received computed tomography angiography. The surgical plan was altered based on angiography findings in 9 (12.9%) patients, and 7 (77.8%) of these cases had a normal physical examination. A further 6 (8.6%) patients had physical examination findings precluding the use of FFF, whereas imaging demonstrated the contrary. Physical examination demonstrated low predictability of aberrant vascular anatomy, with a sensitivity of 22.2%. There were no limb ischemia complications. Conclusions: Routine preoperative angiography of the lower extremity for all patients being evaluated for FFF is important to ensure safety and success of the procedure. Physical examination alone is insufficient to detect vascular abnormalities that may result in limb or flap compromise.

scholarly journals POS0774 INFLUENZA INFECTION AS A TRIGGER FOR SYSTEMIC LUPUS ERYTHEMATOSUS FLARES RESULTING IN HOSPITALIZATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 641.1-641
Author(s):  
Y. B. Joo ◽  
Y. J. Park
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Influenza Infection ◽  
Age Groups ◽  
Case Series ◽  
Incidence Rates ◽  
Systemic Lupus ◽  
Control Interval ◽  
The Impact

Background:Infections have been associated with a higher risk of systemic lupus erythematosus (SLE) flares, but the impact of influenza infection on SLE flares has not been evaluated.Objectives:We evaluated the association between influenza infection and SLE flares resulting in hospitalization.Methods:SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014-2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model.Results:We identified 1,624 influenza infections among the 1,455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63 – 37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00 – 37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively).Conclusion:We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.References:[1]Kwong, J. C. et al. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018:378;345-353.Table 1.Incidence ratios for SLE flares resulting in hospitalization after influenza infectionRisk intervalIncidence ratio95% CIDuring risk interval for 7 days / control interval25.7517.63 – 37.59Days 1-3 / control interval21.8114.71 – 32.35Days 4-7 / control interval7.563.69 – 15.47SLE, systemic lupus erythematosus; CI, confidence intervalDisclosure of Interests:None declared

123 Supporting A Learning System in Paediatric Emergency Pathways; Using Organisational Comparisons, Serious Incidents and Near Miss Events To Improve The Diagnosis And Treatment Of Testicular Torsion

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Winters ◽  
A Mehmi ◽  
R Menzies-Wilson ◽  
S Folkard ◽  
K Ryan ◽  
...  
Keyword(s):  
Testicular Torsion ◽  
Statistical Significance ◽  
Lower Abdominal Pain ◽  
Learning System ◽  
Near Miss ◽  
Freedom Of Information ◽  
Atypical Presentation ◽  
Scrotal Pain ◽  
Paediatric Emergency ◽  
Qualitative Thematic Analysis

Abstract Introduction Scrotal pain is a common presentation to the emergency department requiring prompt investigation and management to identify testicular torsion. Using national data we aim to identify key suboptimal areas in the acute diagnosis and management of testicular torsion with a view to improving outcomes. Method A freedom of information request was made to all Trusts in England that manage testicular torsion. Serious Incidents (SI's) were analysed to see if those with Paediatric Emergency Departments fared better than those without. In addition, a qualitative thematic analysis of the NHS England Strategic Executive Information System database from 2007-2019 was undertaken, identifying common themes associated with orchidectomies and ‘near miss’ events in children. Results 304 serious incidents were returned with 62 Orchidectomies and 242 Near Miss Events. Misdiagnosis of symptomatic testicle was not significant when comparing ED to specialists (OR = 1.46, p = 0.3842). Atypical presentation resulting in orchidectomy was significant when comparing ED to specialists (OR = 6, p = 0.0355). Near miss events are due to a variety of factors. There was no statistical significance in incidents when comparing ED's caring for all ages with Paediatric EDs U = 807.5, z = -1.124, p = 0.261. Conclusions There's a need for education in ED about atypical presentation of testicular torsion and examination of scrotum in cases of lower abdominal pain. It's also vital that specialist teams are cognisant of the standard operating procedures relevant to scrotal pain. Finally, there should be a drive for annual audit in Urology and ED units with regards to testicular torsion as SI's may be under-reported.

scholarly journals Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study

2014 ◽  
Vol 133 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Daniel de Oliveira Gomes ◽  
Rafael Rocha Vidal ◽  
Bruno Figueiredo Foeppel ◽  
Danilo Fiorindo Faria ◽  
Minori Saito
Keyword(s):  
Retrospective Study ◽  
Symptom Onset ◽  
Testicular Torsion ◽  
Weather Conditions ◽  
Cold Weather ◽  
Predisposing Factor ◽  
Tropical Country ◽  
Etiologic Role ◽  
Urological Emergency

CONTEXT AND OBJECTIVE:Testicular torsion is a medical and urological emergency because it can lead to loss of the organ. The theory of seasonal testicular torsion occurrence is based on studies from institutions located in cold and temperate regions. The objective here was to determine whether cold weather is associated with higher incidence of testicular torsion in a tropical country, such as Brazil.DESIGN AND SETTING:Retrospective study, conducted in a tertiary and teaching hospital.METHODS:Patients with acute testicular torsion confirmed by surgery between April 2006 and March 2011 were studied. Information on weather conditions at the time of symptom onset was collected.RESULTS:A total of 64 testicular torsion cases were identified. The months with the highest incidences of testicular torsion were June (16%), July (19%) and August (11%), which had the lowest mean temperatures, of 17.6 °C, 16.4 °C and 18.2 °C, respectively. Eleven percent of cases occurred during spring (October to December), 16% occurred in summer (January to March), 34% occurred in fall (April to June) and 39% occurred in winter (July to September). There was a significant association between the incidence of testicular torsion and the season (fall and winter), P < 0.001.CONCLUSIONS:Testicular torsion follows a seasonal association even in a tropical country, and is more frequent in the colder months of the year, namely fall and winter, when almost three-quarters of the cases occurred. These observations add further evidence that cold weather has an etiologic role in testicular torsion occurrence.

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