Lesser vestibular periurethral gland-like inflammation associated with lower urinary tract signs in a female dog

CASE DESCRIPTION

A 4-year-old female spayed mixed breed dog presented with a 2-year history of painful urination and recurrent hematuria.

CLINICAL FINDINGS

The dog had a large sensitive bladder, palpation of which was followed by painful urination. Pollakiuria accompanied by vocalization were noted during observation of voiding.

DIAGNOSTICS

Cystoscopy identified a focal, rounded expansion of epithelial tissue in the right lateral aspect of the urethral papilla containing purulent material consistent with an abscess. A sample submitted for culture yielded growth of Staphylococcus pseudintermedius and Proteus mirabilis.

TREATMENT AND OUTCOME

Purulent material was expelled by manual pressure during cystourethroscopy. Enrofloxacin (10 mg/kg PO q24h for 42 days) and carprofen (4.4 mg/kg PO q24h for 14 days) were initiated. Clinical signs resolved within 2 days.

CLINICAL RELEVANCE

Inflammation in the region of the lesser vestibular paraurethral glands should be considered as a differential for female dogs presenting with chronic dysuria.

Adeno-associated virus-vectored erythropoietin gene therapy for anemia in cats with chronic kidney disease

BACKGROUND

A treatment of chronic kidney disease (CKD)-associated anemia in cats is needed. SB-001 is an adeno-associated virus-vectored (AAV)-based gene therapeutic agent that is administered intramuscularly, causing the expression of feline erythropoietin.

HYPOTHESIS/OBJECTIVE

We hypothesized that SB-001 injection would lead to a sustained increase in PCV in cats with CKD-associated anemia.

ANIMALS

Twenty-three cats with International Renal Interest Society (IRIS) Stage 2 to 4 CKD-associated anemia were enrolled at 4 veterinary clinics.

METHODS

In a prospective clinical trial, cats were treated with 1 of 3 regimens of SB-001 (Lo 1.2 × 109 genome copies [GCs] on Day 0; Lo ± Hi [supplemental 2nd dose of 3.65 × 109 GC on Day 42]; Hi 3.65 × 109 GC IM on Day 0) and followed for 70 days.

RESULTS

A response to SB-001 at any time between Day 28 and Day 70 was seen in 86% (95% confidence interval 65, 97%) of all cats. There was a significant (P < .003) increase in PCV from Day 0 to Day 28 (mean increase 6 ± 6 percentage points [pp]; n = 21), Day 42 (8 ± 9 pp; n = 21), Day 56 (10 ± 11 pp; n = 17), and Day 70 (13 ± 14 pp, n = 14). Twelve cats were hypertensive at baseline, 4 of which developed encephalopathy during the study. An additional 6 cats became hypertensive during the study.

CONCLUSIONS AND CLINICAL IMPORTANCE

Results of this study suggest that SB-001 therapy represents a suitable single injection treatment that can address nonregenerative anemia in cats with CKD. It was generally well tolerated; however, hypertension and encephalopathy developed in some cats as previously described in association with erythropoiesis-stimulating agent therapy.

Reversible myelosuppression suspected to be secondary to linezolid in a cat with infected subcutaneous ureteral bypass systems

CASE SUMMARY

A 5-year-old castrated male domestic shorthair cat was presented for a multidrug-resistant Enterococcus faecium urinary tract infection within its bilateral subcutaneous ureteral bypass systems. After considerable consultation, the cat was treated with oral linezolid (10 mg/kg q12h) for two separate 2-week courses over 5 weeks. Over this time period, the cat became progressively neutropenic and thrombocytopenic, but was otherwise clinically stable. Upon cessation of the linezolid, the bicytopenia resolved within 12 days.

RELEVANCE AND NOVEL INFORMATION

The reversible myelosuppression in this case is suspected to be secondary to linezolid administration. While previously reported in people, this effect has not been reported at therapeutic doses in veterinary species. This report demonstrates the potential for adverse drug reaction development in cats treated with prolonged linezolid therapy and highlights the need for extreme caution when utilizing linezolid in patients with renal insufficiency. Linezolid is the only drug currently approved by the Food and Drug Administration to treat vancomycin-resistant enterococci infections in people; however, resistance to this antibiotic appears to be increasing. Multidrug-resistant organisms continue to be a real global public health threat in both human and veterinary medicine. Third-tier antibiotics should only be considered under extreme circumstances and after considerable consultation with a specialist. Please note that the authors of this manuscript followed American Veterinary Medical Association policies on stewardship and International Society for Companion Animal Infectious Diseases guidelines, and do not promote or encourage the use in daily practice.

Clinical findings, diagnostic test results, and treatment outcome in cats with hiatal hernia: 31 cases (1995-2018)

Background

Information regarding clinical signs, assessment, treatment, and outcome in cats with hiatal hernia (HH) is limited.

Objectives

To characterize the clinical presentation of HH and medical and surgical outcomes in a cohort of affected cats.

Animals

Thirty‐one client‐owned cats with HH.

Methods

Medical records of cats with HH were retrospectively reviewed for signalment, history, results of diagnostic tests, details of surgical and medical treatments, complications, and outcome. Long‐term follow‐up data were obtained by telephone communication. Relationships between clinical variables and outcome were evaluated by regression analysis.

Results

Type I HH was present in 85.7% (24/28) of cats, and 64.5% (20/31) were >3 years of age at diagnosis. Twenty‐one of 31 (67.7%) cats underwent surgical repair including phrenoplasty, esophagopexy, and left‐sided gastropexy, and 10 of 31 cats were treated medically without surgery. Concurrent illness was common, and 77.4% cats had comorbidities. All cats survived to discharge, and median time to death or follow‐up was 959 days (range, 3‐4015 days). Cats treated medically survived longer than cats treated surgically, with median time to death or follow‐up of 2559 and 771 days, respectively.

Conclusions and Clinical Importance

Type I HH is the most common type of HH in cats. A congenital etiology is possible, but many cats with HH were >3 years of age at diagnosis and suffered from comorbidities, including upper airway obstruction. Case selection and the presence of comorbidities likely influenced the outcome. Cats with HH may not be diagnosed until disease is advanced or concurrent illness draws attention to clinical signs.

Outcome following treatment of soft tissue and visceral extraskeletal osteosarcoma in 33 dogs: 2008-2013

Extraskeletal osteosarcoma (EOS) is a rare, highly malignant mesenchymal neoplasm arising from viscera or soft tissues characterised by the formation of osteoid in the absence of bone involvement. Owing to the rarity of these neoplasms very little information exists on treatment outcomes. The purpose of this study was to describe the outcome following surgical treatment of non-mammary and non-thyroidal soft tissue and visceral EOS in dogs. Thirty-three dogs were identified; the most common primary tumour site was the spleen. Dogs that had wide or radical tumour excision had longer survival times compared with dogs that had only marginal tumour excision performed [median survival time of 90 days (range: 0-458 days) versus median survival time of 13 days (range: 0-20 days)]. The use of surgery should be considered in the management of dogs with non-mammary and non-thyroidal soft tissue and visceral EOS.

Capturing the circadian rhythms of free-running blind people with 0.5 mg melatonin

We have recently shown that six of seven totally blind people (who had free-running circadian rhythms with periods longer than 24 h) could be entrained (synchronized) to a nightly dose of 10 mg melatonin. After treatment discontinuation and re-entrainment to the 10 mg dose, we further found in three of these subjects that the dose could be gradually reduced to 0.5 mg without loss of effect. The question then arose: can a de novo (starting) dose of 0.5 mg initially capture free-running rhythms? Following withdrawal of the stepped-down 0.5 mg dose and consequent release into a free-run, the same three individuals were given 0.5 mg of melatonin de novo. All entrained within a few weeks.

Effects of aging on the intrinsic circadian period of totally blind humans

Age-related changes in the intrinsic circadian period (tau) have been hypothesized to account for sleep symptoms in the elderly such as early morning awakening. The authors sought to determine whether the aging process produced quantifiable differences in the tau of totally blind men who had free-running circadian rhythms. The melatonin onset was used as the indicator of circadian phase. Melatonin rhythms had been characterized about a decade previously when the participants were 38 +/- 6 (SD) years old. Both previous and current assessments of tau were derived from at least 3 serial measurements of the 24-h melatonin profile from which the melatonin onset was determined. All 6 participants exhibited a longer tau in the 2nd assessment (mean increase +/- SD of 0.13 +/- 0.08 h; p < 0.01). Four participants exhibited differences in tau with nonoverlapping 95% confidence intervals. The results do not support the commonly held view that tau shortens during human aging. On the contrary, tau appears to slightly, but significantly, lengthen during at least 1 decade in midlife.

Entrainment of free-running circadian rhythms by melatonin in blind people

BACKGROUND

Most totally blind people have circadian rhythms that are "free-running" (i.e., that are not synchronized to environmental time cues and that oscillate on a cycle slightly longer than 24 hours). This condition causes recurrent insomnia and daytime sleepiness when the rhythms drift out of phase with the normal 24-hour cycle. We investigated whether a daily dose of melatonin could entrain their circadian rhythms to a normal 24-hour cycle.

METHODS

We performed a crossover study involving seven totally blind subjects who had free-running circadian rhythms. The subjects were given 10 mg of melatonin or placebo daily, one hour before their preferred bedtime, for three to nine weeks. They were then given the other treatment. The timing of the production of endogenous melatonin was measured as a marker of the circadian time (phase), and sleep was monitored by polysomnography.

RESULTS

At base line, the subjects had free-running circadian rhythms with distinct and predictable cycles averaging 24.5 hours (range, 24.2 to 24.9). These rhythms were unaffected by the administration of placebo. In six of the seven subjects the rhythm was entrained to a 24.0-hour cycle during melatonin treatment (P<0.001). After entrainment, the subjects spent less time awake after the initial onset of sleep (P=0.05) and the efficiency of sleep was higher (P=0.06). Three subjects subsequently participated in a trial in which a 10-mg dose of melatonin was given daily until entrainment was achieved. The dose was then reduced to 0.5 mg per day over a period of three months; the entrainment persisted, even at the lowest dose.

CONCLUSIONS

Administration of melatonin can entrain circadian rhythms in most blind people who have free-running rhythms.

Computer-assisted microfluorometric detection of individual malignant bladder cells

A prospective study was done comparing the use of computer-assisted fluorescence photomicroscopy (cytophotometry) with routine cytology for the detection of human bladder cancers. A total of 129 specimens were analyzed from 89 patients. The patients were divided into two groups: Group I, with cancer demonstrated cystoscopically (55 specimens) and Group II, with no demonstrable cancer (74 specimens). The false-negative rate for cytology in the Group I patients was 64 percent but only 7 percent for microfluorometry. The false-positive rate for cytology in Group II was 5 percent but 59 percent for microfluorometry because of the presence of "reactive" cells. The sequential measurement of both routine cytology and deoxyribonucleic acid (DNA) content can be performed on the same cells. When both modalities were employed, the false-negative and false-positive rates were only 4 percent and 5 percent, respectively. The technique and advantages of cytophotometry are discussed in detail, especially in relation to flow cytometry.

Renoduodenal fistula in a patient with chronic nephrostomy drainage: a case report

We describe the occurrence of a renoduodenal fistula related to a nephrostomy tube in a patient with xanthogranulomatous pyelonephritis and renal calculi. The patient was successfully treated by nephrectomy. Etiological, diagnostic and therapeutic aspects are discussed.

Segmental infarct of the testis due to hypersensitivity angiitis

We present a case of hypersensitivity angiitis causing a segmental infarction of the testis. The lesion presented as a discrete, palpable mass that led to orchiectomy. Hypersensitivity angiitis has not been reported previously to affect the testes or to produce a segmental infarct in any solid organ. A discussion is given of the vasculitides, especially periarteritis nodosa, that may involve the testes.

Congenital pelvic arteriovenous malformation with massive prostatic hemorrhage: a case report

Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.

Venous intravasation of barium into the inferior mesenteric vein mimicking a coloureteral fistula: a case report and literature review

Venous intravasation of barium following a barium enema is a rare event. We report a case of barium venous intravasation into the inferior mesenteric vein. Because of the close proximity to the course of the left ureter, this condition was interpreted initially as a coloureteral fistula. After further analysis of the original films, and left retrograde pyelography the true diagnosis was established. A literature review of barium intravasation is presented.

Spontaneous subcapsular renal hematoma: diagnosis and management

Spontaneous subcapsular or perinephric hematoma in the absence of anticoagulation, arteritis or trauma is most likely due to an underlying renal tumor. Eight such patients recently have been evaluated and after nephrectomy 5 had small tumors undetectable by imaging techniques, including computerized tomography or angiography. In 1 patient a tumor was demonstrated preoperatively by angiography and in only 2 was a tumor not found. In the absence of an apparent etiology, patients with spontaneous renal bleeding and a normal contralateral kidney should undergo radical nephrectomy because of the extremely high incidence of small undetectable occult tumors, often less than 2 cm. in size.

Diverticular abscess of colon: irritative bladder symptoms

Diverticular disease can affect the bladder in subtle ways. Presented herein is a case of a chronic abscess secondary to diverticulitis presenting as irritable vesical symptoms overlooked for several years. The value of pelvic computerized tomography in the diagnosis is stressed.

Benign prostatic hyperplasia. Evaluation, management, and operative indications

Although signs and symptoms of benign prostatic hyperplasia are found in an estimated 90% of men by the age of 70, less than 10% are likely to require surgery. If symptoms are mild and findings on urinalysis negative, nothing further need be done except follow-up evaluation in six months. Many patients stabilize without any progression of disease. When treatment is necessary, there is at present no alternative to surgery. Transurethral resection is the preferred procedure. Reoperation is seldom necessary.

Percutaneous management of a pyelocaliceal diverticular abscess

A renal abscess secondary to obstruction and infection of a pyelocaliceal diverticulum was managed successfully percutaneously. The diverticulum spontaneously re-established communication with the renal collecting system. No surgery was required and the patient was well 2 years later.

The use of the Nd:YAG laser in urology

The use of the neodymium:YAG(Nd:YAG) laser in urology in still in its infancy. To date, the most widely published application of this laser is in the treatment of bladder carcinoma. We have utilized the Nd:YAG laser in 23 treatments for superficial bladder tumors. The laser has both advantages and shortcomings, which are thoroughly addressed. In our hands the laser has been a safe instrument for the treatment of these lesions, although we do not recommend its use for tumors greater than 3 cm. We have treated two patients with invasive disease one week prior to planned cystectomy. In one case, no residual tumor was found at cystectomy, while the second patient had viable tumor only in an untreated area. Two patients were successfully treated with the laser for intractable bladder bleeding, one each with primary and secondary bladder tumor. Seven patients with condylomata acuminata were treated with laser therapy. All had excellent results without complication. One patient with urethral bleeding secondary to trauma was treated without success, while one patient with a urethral hemangioma was well treated with the Nd:YAG laser. Thus the Nd:YAG laser would appear to have a place in the urologic armamentarium, but whether it is cost-effective for widespread use remains to be seen.

Lasers in urology. I. Laser physics and safety

Interest in the use of the laser in urology is increasing. A thorough understanding of the physical principles governing the laser will aid greatly in the choice of the proper laser for each indication. The tenets of laser safety are stressed, along with the current federal guidelines.

Lasers in urology. II. Laser therapy

To date four laser wavelengths are commercially available which have urologic applications. The experience with all of these lasers is reviewed. The major urologic lesions treatable by the laser are: condylomata acuminata, superficial penile carcinoma, and bladder carcinoma. The carbon dioxide (CO2) laser is most applicable for external genital lesions while the Nd:YAG laser is better suited for the endoscopic treatment of bladder tumors. Due to its preferential absorption by hemoglobin, the argon laser is useful in treating vascular lesions. The tunable dye laser with hematoporphyrin-derivative therapy has exciting potential, but is too new to evaluate its therapeutic efficacy.

The association of inverted papilloma and transitional cell carcinoma of the urothelium

Inverted papilloma generally is considered a benign lesion, with recurrence documented in only 1 case. However, the association of typical transitional cell carcinoma and inverted papilloma in a single lesion has been reported rarely. We present 1 such case and review the literature. Treatment recommendations are included.

Inclusion cyst of the tunica albuginea: demonstration by ultrasound

A 35-year-old man discovered a 1-cm nodule at the upper pole of the left testicle after blunt focal trauma. While the pain, tenderness, and location suggested hematoma or appendiceal torsion, the demonstration by ultrasound of the size, cystic nature, and extraparenchymal location was consistent with the rarely documented cyst of the tunica albuginea.

Practical approach to stress urinary incontinence

Stress urinary incontinence (SUI) in women is more frequent in the multiparous patient, especially in those postmenopausal after withdrawal of hormonal stimulation of the pelvic supportive tissues. With loss of support of the vesical neck and urethra, sphincter incompetence may result. A patient whose symptoms are purely irritative (urinary frequency, nocturia, urgency, or urge incontinence), without a significant degree of stress incontinence, should not benefit from any operation.

Specific red cell adherence testing and radiotherapy

The presence or absence of measurable blood group antigens on the surface of a bladder carcinoma has aided in the prediction of the biologic potential of that patient's transitional cell carcinoma. Confusing data has arisen as to the reliability of the determination of specific red cell adherence testing following radiotherapy. The authors of this report have examined the presence of red cell antigens on the bladder tumor and adjacent uninvolved epithelium in patients before and after radiotherapy. Two groups of patients were studied: those receiving 2000 rad of radiation prior to radical cystectomy and those receiving 6000 rad as definitive therapy. In neither group did radiation therapy alone affect the measurement of blood-group antigens on the bladder carcinoma. In some cases the uninvolved mucosa does show alteration in the measurement of the blood-group antigens before and after radiotherapy, and thiotepa instilled intravesically after radiotherapy may affect the measurement of the uninvolved mucosa as well as the bladder tumor itself.

Complications in patient with triple penile prosthesis

A case report of a man with three poorly functional prosthetic implants in his penis is presented. Complications resulting from the insertion of penile implants are reviewed and suggestions are made on evaluating a patient who had previous prosthetic surgery.

Blood group antigens and bladder carcinoma: a perspective

A review of the current literature relative to the measurement of blood group antigens on bladder epithelium is presented. The determination of the presence or absence of such antigens on bladder tumors has enabled us to separate patients into two predictive groups at a time when their routine histologic patterns are identical. Group I consists of those patients with detectable blood group antigens by specific red cell adherence testing (SRCA). Regardless of the grade of their lesion, these patients have a low incidence (0-19%) of the ultimate development of invasive disease. Group II consists of those patients without demonstrable blood group antigens on their bladder carcinomas. These patients have a 60 to 93 per cent change of invasive disease developing within five years. Treatment thus can be predicated not only on the grade and stage, but also on a prediction of future behavior. Studies mapping cystectomy specimens, as well as those studying random mucosal biopsies, have shown that when the primary tumor lacks demonstrable blood group antigens, other areas of the bladder are also SRCA negative. These findings may help explain the frequent recurrences and ultimate development of invasive lesions in some of these patients. The role of the measurments of blood group antigens in urine cytology is reviewed, as well as those situations in which red cell adherence may be less definitive, i.e., those patients with carcinoma in situ, after radiotherapy, or thiotepa, and in those patients with blood group O. Future areas of usefulness of blood group antigens are discussed including other organs, i.e., kidney, renal pelvis, testes, and prostate.

Immunoperoxidase localization of prostate-specific antigen

In instances of metastatic tumor from an unknown primary site, it is important to isolate those cases which are attributable to prostatic carcinoma. Immunoperoxidase localization of human prostate-specific antigen (PSA) would be useful in this regard if it were reliably detectable in prostatic carcinoma. We have studied 15 specimens from 14 patients with carcinoma of the prostate by immunoperoxidase techniques. The presence of PSA correlates with the Gleason grade. All cases of Gleason grade 9 or less demonstrated strong staining for PSA. Of the seven specimens with a Gleason grade 10, only four (57%) demonstrated significant staining, while two were entirely devoid of PSA. PSA is thus useful when it is present, but the absence of PSA in a poorly differentiated tumor of undetermined origin does not unequivocally rule out the possibility of a prostatic carcinoma.

Specific red cell adherence: immunologic evaluation of random mucosal biopsies in carcinoma of the bladder

We studied 103 random biopsies from patients with overt transitional cell carcinoma of the bladder for specific red cell adherence. We evaluated 62 random biopsies from patients whose primary tumors were positive for specific red cell adherence and 100 per cent of the biopsies in these patients also were positive for specific red cell adherence regardless of the pathologic finding in the random biopsy. We evaluated 41 random biopsies from patients whose primary bladder tumors were negative for specific red cell adherence and only 27 per cent of all biopsies in this group of patients were positive for specific red cell adherence. Thus, we found that in 92 of the 103 random biopsies (89 per cent) and specific red cell adherence of the biopsy agreed with that of the primary tumor. The loss of red cell antigens in random biopsies that are histologically normal may prove to be the earliest measureable changes of the malignant potential of the urothelium.

Specific red cell adherence testing and benign prostatic hyperplasia

Specific red cell adherence testing has established itself as a valuable means of predicting the behavior of non-invasive bladder carcinoma. In an attempt to determine whether specific red cell adherence testing could have a similar role in low grade, low stage prostatic carcinoma we first attempted to detect its presence in benign prostatic diseases. We tested 36 consecutive prostatectomy specimens of benign disease for the presence of specific red cell adherence in the prostatic acini. We were able to detect the presence of specific red cell adherence in only 36 per cent of the cases with benign prostatic hyperplasia. Thus, we believe that specific red cell adherence testing is not present in a sufficient percentage of patients with benign disease to allow its usefulness in determining the aggressive behavior of prostatic cancer.

Experimental evidence of increased ipsilateral gentamicin nephrotoxicity after unilateral ureteral obstruction

This study describes an experimental model for the investigation of nephrotoxicity in which the aminoglycoside, gentamicin, is given after unilateral ureteral obstruction is produced. The preliminary findings indicate a significantly more severe loss of renal function in the obstructed kidney which receives gentamicin than in the obstructed kidney which does not.

Scrotal imaging in the Henoch-Schönlein syndrome

Testicular involvement in patients with Henoch-Schönlein syndrome may occur in as high as 15 per cent of the cases. Scrotal imaging is extremely accurate in differentiating hyperemia (vasculitis) from impairment of blood flow encountered in torsion of the spermatic cord, the most common cause of acute scrotal swelling in children.

Clinicopathological conference: incidentally found renal mass

Doctor Petersen confirmed our preoperative suspicion that this lesion might represent a benign proximal tubular adenoma. Tessler and associates found 5 such cases from July 1974 to January 1975 and reviewed all cases of renal carcinoma in their institution from 1952 through 1975. An additional 9 cases were discovered with none before 1964. One must ask if there is an increased incidence now occurring or are we just beginning to recognize this entity with increasing sophistication? The question also must arise whether with a high degree of suspicion a less radical operation is indicated. Certainly, the angiogram is the only possible preoperative tool that can arouse suspicion but this still is far from diagnostic. The spoke-wheel configuration of vessels, a homogeneous nephrogram similar to the normal parenchyma and sharp margination in the absence of marked increased vascular puddling may all be suggestive. In this older patient with a normal contralateral kidney total nephrectomy still is indicated because angiographic patterns are not pathognomonic. Conversely, in the rare younger individual with concomitant unrelated bilateral renal disease or in the solitary kidney with a polar lesion partial nephrectomy should be considered. Although some differential recognition may be possible by gross examination, such as the tan color, sharp demarcation, absence of hemorrhage or necrosis and so forth, it always has been our policy not to violate Gerota's fascia or to biopsy in the treatment of suspected renal carcinoma. Thus, until a specific preoperative diagnosis is possible nephrectomy continues to be the treatment of choice in the proximal tubular adenoma with so-called oncocytic features. Debate will continue in urologic, pathologic and radiologic circles on whether such an entity is universally benign and with increasing recognition only time will tell.

Negative cystography with bladder rupture: presentation of 2 cases and review of the literature

Cystography is commonly thought to be the sine qua non in the diagnosis of perforation or rupture of the bladder. Recently, we encountered 2 cases of bladder rupture discovered at subsequent exploration in which preoperative cystography had been negative. The reasons for these negative radiographic findings in light of a non-intact bladder are discussed and a technique for cystography is suggested that will reveal disruptions of the bladder with greater certainty.

Urachal diverticulum in a 3-year-old boy

A case of a urachal diverticulum that presented as a right lower quadrant mass in a 3-year-old boy is reported. There was no urinary tract infection or obstructive uropathy in this patient. Classification of urachal anomalies is reviewed.

An evaluation of the role of the Doppler stethoscope and the testicular scan in the diagnosis of torsion of the spermatic cord

The spermatic cord of five dogs were twisted 720 degrees. The animals then underwent both Doppler and isotope evaluations of their scrotums. Both modalities proved highly accurate in diagnosing acute testicular ischemia.

The Doppler stethoscope and the diagnosis of the acute scrotum

We evaluated 30 patients who had acute scrotal swelling with the Doppler stethoscope. Every case of epididymitis and torsion of the appendix testis demonstrated an increased testicular blood flow. The cases of spermatic cord torsion had no blood flow on ultrasound examination.

Necrotic testicle with increased blood flow on Doppler ultrasonic examination

A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.

Fluorescence of testicle. An indication of viability of spermatic cord after torsion

We present an objective measure of testicular viability intended to aid the surgeon in salvaging the testicle at the time of operation for torsion of the spermatic cord. Following the intravenous administration of 5 to 10 cc. of sodium fluorescein, the viability of the untwisted testicle can be determined by its fluorescence when exposed to a portable long wavelength Wood ultraviolet light source.