Zinner Syndrome—A Rare Cause of Recurrent Epididymitis and Infertility

Zinner syndrome (ZS) is a rare disorder that affects only men. It is characterized by a triad of abnormalities, including unilateral renal agenesis, ipsilateral seminal vesicle cysts, and atresia of the ejaculatory tract. Unfortunately, there is no consensus on the best treatment modality. We describe a case of a young male patient with recurrent epididymitis, dysuria, and frequent urination. In the diagnostic evaluation, we found an extended right seminal vesicle in the ultrasound with hyperechoic fluid inside and an absence of the right kidney. We performed magnetic resonance imaging, computed tomography, and semen analysis confirming Zinner syndrome and deteriorated semen parameters. Urethroscopic evaluation and ultrasound-guided puncture of the seminal vesicle were performed. An abscess was excluded. The cytologic evaluation showed hemosiderophages. Tamsulosin was introduced. We found no signs of relapse in a six-month observation, and the patient had no further symptoms. Therefore, minimally invasive treatment is a feasible option in young patients found with early-stage Zinner syndrome.

The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.

Ultrasound guided percutaneous catheterization of the brachiocephalic vein by small caliber catheter: An alternative to epicutaneo-caval catheter in newborn and premature infants

Background: Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, we developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV). Methods: Three years retrospective single center experience of ultrasound guided BCV insertion of silicon or polyurethane small caliber central catheter in a tertiary neonatal intensive care in case of insertion fail of ECC. Results: Twenty-one echo guided BCV-ECC insertions were performed in 20 newborns. Median age was 16 days (range: 0–110 days), median weight was 1700 g (range: 605–4960 g) at insertion. In most cases, insertion was on the left side (17/21). No failures were noted. Only one attempt was necessary in all cases. Insertion time, when noted, was always of <45 min. The median duration of use of these catheters was 11 days (range 3–35 days). No complication was noted during insertion or catheter use, including catheter-related infections and thrombosis. Conclusion: Echo guided percutaneous catheterization of the brachiocephalic vein with a long lasting silicone or polyurethane small caliber catheter is a safe alternative to the ECC if insertion has failed. However, it requires a mastery of ultrasound-guided insertion technique in term and premature neonates.

Subaortic left brachiocephalic vein and real-time ultrasound-guided puncture

We describe a subaortic left brachiocephalic vein, a congenital anomaly that can be suspected during the rapid central vein assessment before central venous catheterization. Since the vein descends vertically/obliquely rapidly from its origin, we suggest that the puncture should be made at a greater angle (50°–60°) than what is usually used to puncture this vein (20°–30°). Failure to identify this anomaly may cause a failed puncture or complications from the puncture of adjacent blood vessels.

Ultrasonographic detection of meningoencephalitis in a dog

The aim of this report is to disseminate ultrasound findings of meningoencephalitis in a dog, diagnosed by analysis of cerebrospinal fluid collected by guided-ultrasound puncture. The patient presented walking in circles, absence of bilateral threat reflex, decreased left eyelid reflex, divergent strabismus of the right eye, negative nasal sensation on the right side, and an increase in volume of skullcap with the presence of open fontanelle. The clinical suspicion was hydrocephalus and/or inflammatory/infectious disease. The distemper rapid test was negative. The hematological profile showed an increase in alanine aminotransferase enzyme. Ultrasound examination was performed with patient in sternal decubitus, using a linear transducer (9.0 MHz). Images were obtained in longitudinal and transverse sections through the temporal windows and bregmatic fontanelle. The presence of a marked anechogenic content with moderate amount of floating hyperechogenic spots was observed, with retraction and increased echogenicity of the brain. Cerebrospinal fluid was collected using the bregmatic fontanelle for ultrasound-guided puncture, under general anesthesia. Meningoencephalitis was indicated by mononucleated cells and red blood cells founded in cerebrospinal fluid analysis. However, the patient not return to start treatment and investigate the cause of the meningoencephalitis.

A Bladder Teratoma after Oocyte Retrievals

Oocyte recovery by means of transvaginal ultrasound-guided puncture was first described in 1985, and the procedure has gained widespread popularity. The literature consistently reports that complications related to oocyte retrievals are rare. Yet this report describes a woman with a long-term complication after egg retrievals.

Ultrasound-guided cannulation of the superficial femoral vein for central venous access

Background: In some clinical conditions, central venous access is preferably or necessarily achieved by threading the catheter into the inferior vena cava. This can be obtained not only by puncture of the common femoral vein at the groin, but also—as suggested by few recent studies—by puncture of the superficial femoral vein at mid-thigh. Methods: We have retrospectively reviewed our experience with central catheters inserted by ultrasound-guided puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and incidence of immediate/early complications. Results: From June 2020 to December 2020, we have inserted 98 non-tunneled central venous catheters (tip in inferior vena cava or right atrium) by ultrasound-guided puncture of the superficial femoral vein at mid-thigh or in the lower third of the thigh, all of them secured by subcutaneous anchorage. The success of the maneuver was 100% and immediate/early complications were negligible. Follow-up of hospitalized patients (72.5% of all cases) showed only one episode of catheter dislodgment, no episode of infection and no episode of catheter related thrombosis. Conclusions: The ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous access. In our experience, it was not associated with any risk of severe insertion-related complications, even in patients with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if compare to the exit site in the inguinal area.