sᴘᴏᴛ ᴅɪᴀɢɴᴏsɪs

2022-02-07 21:20:34 #Urology:
Radical inguinal Orchidectomy.

#Value:
Prevent seeding of tumor to the scrotum.
If seeding happened hemiscrotectomy and Ipsilateral inguinal LNs radiation is a must.

#Reference:
https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410x.2009.08434.x Open / Comment

2022-02-07 21:06:41 #Testicular_Cancer:
Histologically divided into:

A-Germ Cell Tumor (GCT) 95% (#Commonest):
Seminoma GCT(Commones):
Slowly growing malignant tumor of germ cells.

Tumor markers:
B HCG in 5%-10%.
AFP: Reference range.

Non seminoma GCT:
More aggressive than Seminoma.

Tumor markers:
AFP, HCG.
#subtypes:
1)Choriocarcinoma (rare, most aggressive and Worst prognosis ).
2) Yolk sac carcinoma.
3)Teratoma.
4)Embyronal Carcinoma.

B-Stromal tumor (rare) ~5% :
Tumor arises from supportive tissue:
1)Leydig Cell Tumor.
2)Sertolli Cell Tumor.

#Presentation:
1)15-35 yrs old age group.
2)Painless non tender testicular mass.
3) Hydrocele.
4)Dragging sensation.
5)History of Cryptorchidism.
6)Family History.

#Diagnosis_&_Treatment:
Radical inguinal orchidectomy.

#Notes:
Testicular lymphatic drainage: Para aortic LNs.
Scrotal Exploration or transscrotal biobsy in a patient with testicular cancer spread the tumor to the scrotum and subsequently to the inguinal LNs.
#Reference:
1)Medscape.
2)UWORLD Open / Comment

2022-02-07 12:53:35 #Carbancle:
Multiple hair follicle infection. Common among diabetics.

#History:
Diabetic.
Constitutional symptoms: Fever, fatigue.
Painful swelling draining pus.

#Exammination:
Febrile, tachycardic and tachypnic.
Localized lump with multiple draining sinuses, #Commonest site Nape Of The Neck.

#Invx:
CBC:leucocytosis.
RBG: Hyperglycemia.
ABG: DKA.

#Managment:
Admission.
Iv Antibotic.
Surgical: drain pus (Cruciate inscion), daily Dressing and later excision with skin graft.

#Reference:
SRB'S manual of surgery 4th Ed page 47-48. Open / Comment

2022-02-07 12:40:23 #Skin_Lump:
Furnuculosis (boil):
Staphylcoccal infection of a #Single hair follicle, a common skin infection appear red papules with whitish center, usually heal by its own with no supporation. Frequent Furnuculosis rise the suspicion of diabetes mellitus.

#Notes:
Furncule in external auditory meatus is very painful ( Suspect DM).
Furncule and other skin infection within the #Danger_Triangle of the face carry the risk of #Cavernous_Sinus_Thrombosis.
Multiple hair follicles infection with multiple draining sinuses is known as carbancle.
Commonest site of Carbancle is ( nape of neck).
Carbancle is common among diabetic.
Diabetic with carbancle is #Toxic & #Ketotic.

#Managment:
Most of furnucules resolve spontaneously if not give a course of oral antibiotics #Rarely require surgical intervention.

#Reference:
1)UWORLD Surgery
2)SRB'S manual of surgery 4th ed page 46. Open / Comment

2022-02-06 23:31:08 #Psoas_Abscess:
Collection of pus within the Psoas muscle.

#Cause:
1 - Primary: hematogenous spread usually distant sources (Furnuculosis, Hideradenitis supprotica). In many cases the exact source are not identified.

#Example:
Diabetes mellitus.
Patients on immunosuppressive medications.
Frequent body piercing ( IV drug abusers).
HIV/AIDS.

2-Secondary: spread of an infection from and adjacent structures.
#Example:
GIT: most common ( IBD, Acute appendicitis, Divirticulitis).
Urological: pylonephritis and pyohydronephrosis.
Orthopedic and rheumatologic: Vertebral spondylitis and osteomyelitis.


#Diagnosis:
1-Fever
2- Risk factors: DM, IVDU, HIV/AIDS and use of immunosuppressive drugs.
3 - Flank pain.
4- Psoas sign: pain that increases with the extension of the hip and soothen with flexion.
5-Imaging: non contrast CT abdomen 80%-100% diagnostic.

#Managment:
1-Admission.
2- IV antibiotics.
3-image Guided derinage.

#Reference:
1)UWORLD Surgery.
2)https://Radiopedia.org psoas abcess. Open / Comment

2022-02-06 21:49:54 Open / Comment

2022-02-06 21:34:58 Open / Comment

2022-02-06 21:31:38 Open / Comment

2022-02-06 20:13:34 Open / Comment

2022-02-02 11:56:41 #Urology:

Peyronie's Disease (PD) :
Fibrous plaque (local area of #fibrosis) within the #Tunica_Albuginea of the penile shaft leading to limitation of erection and curvature. Think of it as Dupertyn contracture of the penis ( many studies postulated the coexistence of both disease).


#Causes:
Exact cause Unkown.

#Risk_Factors:
1- Injuries.
2- Male > 40 yrs old.
3- Systemic vascular disease : HTN and DM.
5- Smoking.

#Manifestation:
Triad of:
1- Penile pain.
2- Penile curvature: usually upward.
3- Palpable Hard mass over the shaft.
After erection.


#Managment:
Surgical if interfere with sexual intercourse.

#Reference:
1)UWORLD Surgery.
2) Jhon Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/peyronie-disease#:~:text=Peyronie's%20disease%20is%20a%20connective,erections%20and%20palpable%20penile%20plaque.
3)Medscape. Open / Comment