Torsion testis was diagnosed in a 14-year-old boy presenting with acute right scrotal pain. On examination, his right testicle was higher in the scrotum, exquisitely tender, and the cremasteric reflex was absent on that side. Doppler ultrasound showed no central testicular blood flow. The patient was taken to the operating room for exploration, detorsion, and fixation orchiopexy to save the testicle from necrosis due to twisting of the spermatic cord and testis. Other possible causes of acute scrotal pain include torsion of testicular appendages and acute epididymo-orchitis.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
Urology- Hematuria, Renal/Ureteric colic and Bladder Outlet ObstructionSelvaraj Balasubramani
In this PPT you can learn all important problems in Urology for undergraduate medical students. They are
1. Hematuria--> Renal cell carcinoma and Bladder carcinoma
2. Renal/Ureteric colic--> Urolithiasis
3. Bladder outlet obstruction--> Benign Prostatic Obstruction
you can also watch my YouTube channel playlist on Urology in the following link: https://www.youtube.com/playlist?list=PLxyHif1Z9-uXzZkDec1nDRwzPpW6V-G06
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
Urology- Hematuria, Renal/Ureteric colic and Bladder Outlet ObstructionSelvaraj Balasubramani
In this PPT you can learn all important problems in Urology for undergraduate medical students. They are
1. Hematuria--> Renal cell carcinoma and Bladder carcinoma
2. Renal/Ureteric colic--> Urolithiasis
3. Bladder outlet obstruction--> Benign Prostatic Obstruction
you can also watch my YouTube channel playlist on Urology in the following link: https://www.youtube.com/playlist?list=PLxyHif1Z9-uXzZkDec1nDRwzPpW6V-G06
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
In this playlist I discussed about groin swellings and the various causes for this problem. I discussed about Inguinal hernia, femoral hernia, ventral hernia and undescended testis. If you watch all these videos together you will become confident in managing groin swellings
Simple notes on definition of abdominal hernias in general, as well as clinical features and management of inguinal hernias.
Brief explanation of hernia repair methods (laparoscopic, open surgery)
This is the second presentation on Scrotal Swellings. I have included unique classical clinical vignette, mind map and a tabular column to clinch the correct diagnosis.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
In this playlist I discussed about groin swellings and the various causes for this problem. I discussed about Inguinal hernia, femoral hernia, ventral hernia and undescended testis. If you watch all these videos together you will become confident in managing groin swellings
Simple notes on definition of abdominal hernias in general, as well as clinical features and management of inguinal hernias.
Brief explanation of hernia repair methods (laparoscopic, open surgery)
This is the second presentation on Scrotal Swellings. I have included unique classical clinical vignette, mind map and a tabular column to clinch the correct diagnosis.
MECKEL’S DIVERTICULUM- Pediatric Surgery
Dear Viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on Meckel’s diverticulum. This is a great imitator because of its varied ways of presentation. It can present as bleeding per rectum, intestinal obstruction, pain abdomen and fecal umbilical discharge. I have discussed the epidemiology, etiology, embryology, clinical features, investigations, differential diagnosis and treatment of Meckel’s diverticulum in this video. Hope you will enjoy the video. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
this power point presentation is made ideally according to criteria of ppt. with opener , energizes , bibliography ans much more criteria are followed.thank you..
Chronic progressive sclerosing inflammatory dermatosis of unknown origin that results in white plaques with epidermal atrophy and scarring…… Lichen sclerosus. Penile Lichen sclerosus (LS) is the preferred term for Balanitis Xerotica Obliterans.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
● Abdominal Wall Hematoma
● Walled Off Necrosis Of The Pancreas
● Acute Aortic Thrombosis
In this presentation I am talking about the overview of So-Hum meditation- the universal mantra.
I have discussed the meaning, how to do it, it's advantages and an advanced visualisation technique.
This is a small handbook on individual surgical disease and its management . I have discussed about Acute Appendicitis and then step by step I explain both open and laparoscopic appendicectomy in this book.
The operative surgery part is very useful for surgical trainees.
POWER OF YOUTUBE IN MEDICAL EDUCATION- Surgical Educator Channel
#powerofyoutube #surgicaleducator #babysurgeon #usmle
Website Link: www.surgicaleducator.com
Dear viewers,
• Greetings from “Surgical Educator’
• In this episode, I am talking about the Power of YouTube in medical education
• I will be discussing the various benefits of using YouTube in medical education. YouTube is definitely revolutionize the way in which we are teaching our students.
• You can enjoy all my videos in the following links:
•
/ surgicaleducator surgicaleducator.com
• Thank you for watching the video.
All my videos are problem-based, because patients are coming to us with problems and not with a diagnosis.
• I have made modules for each surgical problem which consists of
many of my YouTube videos and my PPT slides
• I request you all to watch all the videos in a playlist together, so
that you will become confident in dealing with these problems.
• Links to the Playlists based on the Surgical Problems:
• Module 1: Scrotal Swellings:
https://www.youtube.com/playlist?list...
uXwt0JH0YG8m4JmzgAli9jj
https://www.slideshare.net/babysurgeo...
• Module 2: Groin Swellings:
https://www.youtube.com/playlist?list...
uVaDboG_ddw2S6xInNnB80D
https://www.slideshare.net/babysurgeo...
• Module 3: Abdominal Pain:
https://www.youtube.com/playlist?list...
uUcXb96A3tFpTrWOVa2F7j1
https://www.slideshare.net/babysurgeo...
case-based-learning-82091549
• Module 4: Abdominal Lumps:
https://youtube.com/playlist?list=PLx...
uWBKVnBkhdE4XkW-xEoiIwB
• Module 5: Obstructive Jaundice:
https://www.youtube.com/playlist?list...
uX6MsQnsCTGl8YDFN1TYiQm
https://www.slideshare.net/babysurgeo...
127314632
• Module 6: Upper GI Hemorrhage:
https://www.youtube.com/playlist?list...
uUtV67AdUQYEUKdhX9vL576
https://www.slideshare.net/babysurgeo...
227888333
• Module 7: Lower GI Hemorrhage:
https://www.youtube.com/playlist?list...
https://www.slideshare.net/babysurgeo...
• Module 8: Thyroid Pathologies:
https://www.youtube.com/playlist?list...
uWg55odQfB_7JT0NYIP8ELp
https://www.slideshare.net/babysurgeo...
benign-diseases-and-carcinoma-thyroid
• Module 9: Breast Pathologies:
https://www.youtube.com/playlist?list...
uVTLcGtam1kFBzjY4NAf7MZ
https://www.slideshare.net/babysurgeo...
diseases-and-carcinoma-breast
• Module 10: Peripheral Arterial Diseases:
https://www.youtube.com/playlist?list...
6VIbQR4g8MdOi0z
https://www.slideshare.net/babysurgeo...
106254612
• Module 11: Venous Diseases:
https://www.youtube.com/playlist?list...
uVf1aYodgILbxVpC-fkdqNo
https://www.slideshare.net/babysurgeo...
127314847
• Module 12: Dysphagia:
https://www.youtube.com/playlist?list...
4DlU1Lp
# Dear Viewers/Friends/Colleagues,
# Greetings from Surgical Educator YouTube channel
# I am sharing an E-book where you can find out the hyperlinks for all my surgery teaching videos and their PPTs
# In this E-book you will learn the purpose of my YouTube channel Surgical Educator, core clinical problems you should master, how to utilize the channel effectively, statistics and analytics for the channel, all the teaching modules with hyperlinks to all my teaching videos and their PPTs and other learning resources created by me like the android app for the channel and other E-books.
In this presentation, I discussed the various liver swellings- both cystic and solid swellings. Cystic lumps are Pyogenic liver abscess, Amebic liver abscess and hydatid cyst. Benign solid swellings are Hepatic adenoma, Focal nodular hyperplasia and Hemangioma. The malignant solid swelings are secondary carcinoma of the liver, primary Hepatocellular carcinoma and Hepatoblastoma.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
The surgical causes for jaundice in children- both in neonates and infants- are Biliary atresia, Choledochal cyst, Biliary hypoplasia, Inspissated bile syndrome, and spontaneous perforation of CBD. How to Diagnose & Treat all these causes.
I am sharing a 10 paged e-book that consists of the hyperlinks to all my surgery teaching videos and to all the PPTs used for these videos from SlideShare. You can watch these videos problem based and can become competent to deal with it. You can read this to cover the whole undergraduate curriculum.
In this presentation I discussed 5 scrotal swellings case scenarios with my MBBS students. I have shared these case scenarios prior to the PBL class and asked the students to come prepared to the class. In the class i tested the knowledge gaind by the students by watching my didactic YouTube videos on the subject by asking so many questions. So this online class was highly interactive based on flip class model.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
1. Surgical Teaching Video Cast
Introduction
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
3. Scheme for Problem oriented
Case based Teaching
Scrotal Swellings
Testicular
Carcinoma
Varicocele Hydrocele
Testicular
Torsion
Epididymal
Cyst
4. Scrotal Swellings-
Introduction
• Various causes( Differential diagnosis) of scrotal swellings
• Applied Anatomy & Physiology
• Algorithm to clinch the correct diagnosis
• Unique teaching video cast consisting powerful teaching tools
Classical clinical vignette with probable diagnosis
The diagnosis in detail- only one pathology in each episode
Mind map of the diagnosis
Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your
diagnosis
7. Scrotal contents
• Purse like arrangement for lodgement of Testis on either sides
with a midline septum separating.
• Contents are: Testis, Epididymis, Vas Deferens, Testicular artery,
Pampiniform plexus of veins, Artery to the Vas, Lymphatics,
Areolar tissue, & coverings.
• Coverings of Testis: Skin, Dartos, External Spermatic fascia,
Cremasteric fascia, Internal Spermatic fascia, Tunica Vaginalis
Testis – 2 layers
11. Thank You
To watch the video version go to
Channel
“ Surgical Educator” in You
Tube
https://www.youtube.com/watch?v=UAn0pL8qUvs
12. SCROTAL SWELLINGS
Case No:1
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
13. OVERVIEW
• Various causes( Differential diagnosis) of scrotal swellings
• Classical clinical vignette with probable diagnosis
• The diagnosis in detail- only one pathology in each episode
• Mindmap of the diagnosis
• Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your
diagnosis
• References and feedback
15. Classical Clinical Vignette
Vaginal Hydrocele
• A 35-year-old male patient presents with right sided scrotal swelling of
two years duration. It is a progressively increasing painless swelling.
• O/E: the right side of the scrotum shows a swelling of 15 × 10 cm size
which is confined to the scrotum (can get above the swelling). The
surface of the swelling is smooth and borders are well-defined. There is
no local rise of temperature. The swelling is fluctuant and
transilluminant. It is not reducible.There is no cough impulse. The
right testis is not felt separately. On percussion it is dull.
• The spermatic cord is felt above the swelling and is tender.
• The contralateral testis and genitalia are normal. There is no evidence
of any mass or lymph nodes in the abdomen
16. Hydrocele- Etiopathogenesis
• A hydrocele is an abnormal collection of serous fluid in a part of
the processus vaginalis, usually the tunica vaginalis.
• A hydrocele can be produced in four different ways
• 1. By excessive production of fluid within the sac in secondary
hydrocele
• 2. By defective absorption of fluid in primary hydrocele
• 3. By interference with lymphatic drainage of scrotal structures
in filariasis
• 4. By connection with the peritoneal cavity via a patent processus
vaginalis in congenital hydrocele
17. Primary Vs Secondary Hydrocele
Primary Hydrocele
• Defective absorption of fluid
• Ex: Vaginal & infantile
hydroceles
• Attain moderate to big size
• Difficult to palpate testis
• Transillumination positive
• Consistency tensely cystic
• Tx: Jaboulay’s & Lord’s
operations
Secondary Hydrocele
• Excessive production of fluid
• Ex: Filariasis, tumor, trauma &
epididymo-orchitis
• Attain small size
• Testis easily palpable
• Transillumination negative
• Consistency Lax cystic
• Tx: Treat underlying causes
18. Composition of Hydrocele Fluid
• Color—Straw or amber colored.
• Composition—Water, fibrinogen, inorganic salts, albumin
and cholesterol crystals
• Hydrocele fluid normally won’t clot if it is drained into a
container but will clot immediately even if it comes into
contact with a drop of blood
• Following swellings contain cholesterol crystals viz.
hydrocele, branchial cyst, and dental and dentigerous cyst
19. Primary Hydrocele- Types
• 1.Congenital hydrocele
• 2. Funicular hydrocele
• 3. Infantile hydrocele
• 4. Encysted hydrocele of the
cord
• 5. Vaginal hydrocele-
commonest type
• 6. Bilocular hydrocele
• 7. Hydrocele of the hernial sac
20. Primary Hydrocele- Clinical features
• Moderate to big size swelling
• Cough impulse negative
• Get above the swelling positive
• Not reducible
• Consistency tensely cystic
• Transillumination positive
• Testis not felt separately
• Congenital hydrocele Diurnal
variation +
• Bilocular hydrocele Cross
fluctuation +
• Encysted hydrocele Traction test+
• Get above the swelling negative in
Infantile and Bilocular hydroceles
• Transillumination negative in
Hematocele, Pyocele, Chylocele and
thick sac
21. Hydrocele of Canal of Nuck
• Hydrocele of the canal of Nuck
is a condition in females.
• The cyst lies in relation to the
round ligament and is always
at least partially within the
inguinal canal.
24. Primary Hydrocele- Treatment
• Congenital hydrocele- Inguinal herniotomy
• Adult vaginal hydrocele
Small sizeLord’s plication
Large sizeJaboulay’s operation Incision and eversion of sac
After evacuation, the sac with the testis is placed in a newly
created pocket between the fascial layers of the scrotum
Sharma and Jhawer’s technique.
• Encysted hydroceleInguinal herniotomy + incision and
drainage of the encysted hydrocele
29. Scrotal Swellings Ex & Px Hx Sx Dx Tx
1. Hydrocele Primary-Idiopathic
Secondary- under
lying pathology
Painless big
swelling; not
reducible
No cough impulse
Get above swelling+
Transilluminant+
Clinical
In doubt- USG of
scrotum
Lord’s operation
Jaboulay’s
operation
2. Epididymal
cyst &
Spermatocele
Degenaration of
epididymis, occlusion
of pathway
Swelling in
scrotum resembles
3rd testis
Testis palpable
separately; Chinese
lantern appearance
Clinical
USG of scrotum
Conservative
Excision
3. Varicocele Idiopathic
Absence of valves in
testicular veins
Worm like in upper
scrotum; infertility
Disappears on lying
down; Bag of worms
appearance
Clinical
USG color doppler
Varicocelectomy
Inguinal or
Retroperitoneal
4. Testicular
torsion &
Epididymo-
orchitis
Abnormal fixation and
lie of testis
UTI & trauma
Severe pain&
swelling scrotum
Nausea & vomiting
Tender hemi scrotum;
cremasteric reflex
absent
Clinical
USG color doppler
Explore,detorse,
orchiopexy or
orchidectomy
Conservative
5. Testicular
carcinoma
UDT, Kieinfelter’s
Germ cell- Seminoma
& Non seminoma
Non germ cell tumor
Painless heavy
swelling
Not reducible
Hard in consistency
Testis felt separately
Clinical; No FNAC
USG OF scrotum
High orcidectomy
with or without
RPLND+ RT+CT
D/D for Scrotal Swellings (Compare & Contrast)
(Vertical Reading)
30. References
• Hunt & Marshall’s clinical problems
in surgery 2nd edition
• Clinical surgery made easy- a
companion to PBL by Mohan De
silva 1st edition
• 100 cases in surgery 2nd edition
• Case files surgery 4th edition
• Clinical scenarios in surgery-
decision making 1st edition
• Surgery- a case based clinical
review 1st edition
• Surgery Review by Carlos Pestana
• Clinical surgery pearls by
Dr Dayananda Babu 2nd edition
• NMS casebook surgery 2nd edition
• General Surgery- Correlations &
clinical scenarios 1st edition
• Surgery review by Makary 3rd edition
• Surgery- Clinical cases uncovered by
Harold Ellis 1st edition
• Self- Life Surgery 1st edition
32. ThankYouSubscribe to get notified
regarding my new uploads
https://www.youtube.com/watch?v=Sv5tfeHpGxM
33. SCROTAL SWELLINGS
Case No:2
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
34. OVERVIEW
• Various causes(Differential diagnosis) of scrotal swellings
• Classical clinical vignette with probable diagnosis
• The diagnosis in detail- only one pathology in each episode
• Mind map of the diagnosis
• Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your
diagnosis
• References and feedback
36. Classical Clinical vignette
Torsion Testis
• A 14-year-old boy presents with acute onset of right scrotal and
RLQ pain for the past 4 hours. He additionally reports nausea and
one episode of vomiting. He denies any similar past pain and
reports no history of trauma.
• O/E: the skin overlying the right side of the scrotum appears to be
slightly erythematous and edematous. The right testicle appears to
be lying significantly higher in the scrotum as compared to the left
testicle.
• The entire right testicle is exquisitely tender to palpation, whereas
the left one is nontender
• He has an absent cremasteric reflex on the right.
37. Torsion Testis- Etiopathogenesis
• Twisting of testis along with spermatic cordStrangulationNecrosis
• Common in neonates and in puberty
• Inversion of testis
• Strong muscular exertion or blunt trauma can trigger it
• Undescended testis undergo torsion frequently
• High insertion of tunica vaginalis- bell clapper deformity-predisposes
• There are 3 types of torsion- Extravaginal, intravaginal and mesorchial
• Extravaginal in neonates, intravaginal in adolescents
39. Torsion Testis- Clinical Features
• Sudden severe pain in hemiscrotum or both sides
• Nausea & vomiting
• Scrotal skin edematous and erythematous
• Testis exquisitively tender
• Affected testis at higher level because of twisting Deming’s sign
• Normal testis lying horizontally Angel’s sign
• Pain not relieved on elevation of scrotum Prehn’s sign
• Cremastric reflex absent in affected side
45. Torsion Testis- Doppler USG
Central testicular blood flow Normal
Testis
No Central testicular blood flow but
excessive peripheral blood flow
46. • Ipsilateral side Exploration, detorsion and fixation orchiopexy
Detorsion is away from median raphae of scrotum like opening a
book
• Contralateral side Exploration and fixation orchiopexy
• In doubtful cases and nonavailability of Doppler USG Better to
explore rather than unduly delay the treatment
• Testicular salvage rate is 100% if surgery is done within 6 hrs
and it is 20% if surgery is delayed > 24 hrs
Torsion Testis- Treatment
47. • Hydatid of testis & epididymis Remnant of obliterated
Mullerian ducts
• Sudden Swelling and redness of hemiscrotum
• Tender Testis
• ‘Bluedot sign’ +ve
• Cremastric reflex intact
Torsion of Testicular appendages
49. • Explore & Excise torsed appendages in early cases
• In delayed cases >48 hrs conservative treatment with
antibiotics & anti inflammatory drugs
Torsion of Testicular appendages
Treatment
50. • Inflammation of epididymis & Testis due to infection or
trauma
• Sudden onset of pain in a hemiscrotum
• Commonly associated with UTI or trauma
• Thickened & Tender epididymis
• Pain relief by elevation of hemiscrotum Prehn’s sign
• Can be treated conservatively with antibiotics and
antiinflammatory drugs
Acute epididymo-orchitis
54. Scrotal Swellings Ex & Px Hx Sx Dx Tx
1. Hydrocele Primary-Idiopathic
Secondary- under
lying pathology
Painless big
swelling; not
reducible
No cough impulse
Get above swelling+
Transilluminant+
Clinical
In doubt- USG of
scrotum
Lord’s operation
Jaboulay’s
operation
2. Epididymal
cyst &
Spermatocele
Degenaration of
epididymis, occlusion
of pathway
Swelling in
scrotum resembles
3rd testis
Testis palpable
separately; Chinese
lantern appearance
Clinical
USG of scrotum
Conservative
Excision
3. Varicocele Idiopathic
Absence of valves in
testicular vein
Worm like in upper
scrotum; infertility
Disappears on lying
down; Bag of worms
appearance
Clinical
USG color doppler
Varicocelectomy
Inguinal or
Retroperitoneal
4. Testicular
torsion &
Epididymo-
orchitis
Abnormal fixation and
lie of testis
UTI & trauma
Severe pain&
swelling scrotum
Nausea & vomiting
Tender hemi scrotum;
cremasteric reflex
absent
Clinical
USG color doppler
Explore,detorse,
orchiopexy or
orchidectomy
Conservative
5. Testicular
carcinoma
UDT, Kieinfelter’s
Germ cell- Seminoma
& Non seminoma
Non germ cell tumor
Painless heavy
swelling
Not reducible
Hard in consistency
Testis felt separately
Clinical; No FNAC
USG OF scrotum
High orcidectomy
with or without
RPLND+ RT+CT
D/D for Scrotal Swellings (Compare & Contrast)
(Vertical Reading)
55. References
• Hunt & Marshall’s clinical problems
in surgery 2nd edition
• Clinical surgery made easy- a
companion to PBL by Mohan De
silva 1st edition
• 100 cases in surgery 2nd edition
• Case files surgery 4th edition
• Clinical scenarios in surgery-
decision making 1st edition
• Surgery- a case based clinical
review 1st edition
• Surgery Review by Carlos Pestana
• Clinical surgery pearls by
Dr Dayananda Babu 2nd edition
• NMS casebook surgery 2nd edition
• General Surgery- Correlations &
clinical scenarios 1st edition
• Surgery review by Makary 3rd edition
• Short practice of surgery by Bailey
and Love 26th edition
• Shelf life surgery 1st edition
57. ThankYou
To watch the video version go to
Channel
Surgical Educator in You Tube
https://www.youtube.com/watch?v=HqHEf0krIng
58. SCROTAL SWELLINGS
Case No:3
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
59. OVERVIEW
• Various causes(Differential diagnosis) of scrotal swellings
• Classical clinical vignette with probable diagnosis
• The diagnosis in detail- only one pathology in each episode
• Mind map of the diagnosis
• Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your
diagnosis
• References and feedback
61. Classical Clinical vignette
Epididymal Cyst
• A 45 years old male patient presented with a swelling in right side
of the scrotum for last 3 years which is increasing very slowly in
size. There is no pain over the swelling.
• O/E: There is a soft cystic swelling in relation to the head of the
right epididymis. The swelling has a lobulated surface and feels
like a bunch of grapes.
• Testis can be felt separately from the swelling
• The swelling is brilliantly transilluminant and has Chinese
lantern pattern appearance
62. Epididymal Cyst- Etiopathogenesis
• These are cysts in connection with the epididymis divided into the
following types:
• 1. Degeneration cysts occur due to cystic degeneration of the
epididymis Epididymal cyst
• 2. Retention cysts due to obstruction of the sperm conducting
mechanism Spermatocele Ex: after vasectomy
63. Epididymal Cyst- Clinical Features
• Most epididymal cysts occur in males over the age of 40 years
• An epididymal cyst usually contains clear fluid
• The variety that contains slightly grey, opaque, ‘barleywater’-like fluid
and few spermatozoa is sometimes termed a Spermatocele
• They are often multiple or multilocular and are frequently bilateral
and feels like bunch of grapes
• Brilliantly transilluminant “Chinese lantern pattern”
• Testis palpable separately
• Cysts are connected to the head of the epididymis, so lie above the
testis 3rd testis
67. Epididymal Cyst - Treatment
• Single large cyst Excision of cyst
• Recurrent or multilocular cyst Excision + partial or total
epididymectomy
• No role for aspiration because cysts are multilocular
• Spermatocele if big aspiration or excision; If small no
intervention
70. Scrotal Swellings Ex & Px Hx Sx Dx Tx
1. Hydrocele Primary-Idiopathic
Secondary- under
lying pathology
Painless big
swelling; not
reducible
No cough impulse
Get above swelling+
Transilluminant+
Clinical
In doubt- USG of
scrotum
Lord’s operation
Jaboulay’s
operation
2. Epididymal
cyst &
Spermatocele
Degenaration of
epididymis, occlusion
of pathway
Swelling in
scrotum resembles
3rd testis
Testis palpable
separately; Chinese
lantern appearance
Clinical
USG of scrotum
Conservative
Excision
3. Varicocele Idiopathic
Absence of valves in
testicular vein
Worm like in upper
scrotum; infertility
Disappears on lying
down; Bag of worms
appearance
Clinical
USG color doppler
Varicocelectomy
Inguinal or
Retroperitoneal
4. Testicular
torsion &
Epididymo-
orchitis
Abnormal fixation and
lie of testis
UTI & trauma
Severe pain&
swelling scrotum
Nausea & vomiting
Tender hemi scrotum;
cremasteric reflex
absent
Clinical
USG color doppler
Explore,detorse,
orchiopexy or
orchidectomy
Conservative
5. Testicular
carcinoma
UDT, Kieinfelter’s
Germ cell- Seminoma
& Non seminoma
Non germ cell tumor
Painless heavy
swelling
Not reducible
Hard in consistency
Testis felt separately
Clinical; No FNAC
USG OF scrotum
High orcidectomy
with or without
RPLND+ RT+CT
D/D for Scrotal Swellings (Compare & Contrast)
(Vertical Reading)
71. References
• Hunt & Marshall’s clinical problems
in surgery 2nd edition
• Clinical surgery made easy- a
companion to PBL by Mohan De
silva 1st edition
• 100 cases in surgery 2nd edition
• Case files surgery 4th edition
• Clinical scenarios in surgery-
decision making 1st edition
• Surgery- a case based clinical
review 1st edition
• Surgery Review by Carlos Pestana
• Clinical surgery pearls by
Dr Dayananda Babu 2nd edition
• NMS casebook surgery 2nd edition
• General Surgery- Correlations &
clinical scenarios 1st edition
• Surgery review by Makary 3rd edition
• Surgery- Clinical cases uncovered by
Harold Ellis 1st edition
• Shelf life surgery 1st edition
74. SCROTAL SWELLINGS
Case No:4
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
75. OVERVIEW
• Various causes(Differential diagnosis) of scrotal swellings
• Classical clinical vignette with probable diagnosis
• The diagnosis in detail- only one pathology in each episode
• Mind map of the diagnosis
• Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your
diagnosis
• References and feedback
77. Classical Clinical Vignette
• 30 years male patient presented with a swelling in the left side of
the scrotum for last 4years. The swelling started in the lower part
of the scrotum and subsequently the swelling is slowly increasing
in size and grown up to the root of the scrotum. The swelling
disappears on lying down position and reappears on standing and
walking
• Patient complains of dull aching pain in the left side of the scrotum
for last 6 months, the pain is more towards the evening when the
swelling enlarges in size
• There is no pain abdomen, no urinary complaints
78. Classical Clinical Vignette
Varicocele
• O/E: A mass of dilated vein feeling like a bag of worms is palpable
on the left side of the scrotum along the left spermatic cord
extending from the upper pole of the testis up to the superficial
inguinal ring
• No expansile impulse on cough is palpable, instead a thrill is
palpable. On lying down and on elevation of the scrotum the
swelling disappears
• On asking the patient to stand up the dilated veins reappeared.
The left testicular volume is smaller than the right one. Abdominal
examination is normal
79. Varicocele-Anatomy
• Surgical Anatomy: Pampiniform plexus of veins (15 – 20) draining the
testis and epididymis makes the major bulk of the spermatic cord. As
they ascend, the number is reduced to 12 and on reaching the
superficial inguinal ring they unite to form 4 veins. At the level of deep
ring they are 2 in number and in retroperitoneum, it forms single
testicular vein.
• Left testicular vein drains into left renal vein and right testicular vein
into inferior vena cava
81. Varicocele
• Dilatation and tortuosity of the pampiniform plexus of veins
• Seen commonly in men aged 15-30yrs and rarely after 40yrs.
• Occur in 15-20% of all males and 40% of all infertile males.
• Normal vein diameter of vessels of plexus- 0.5-1.5mm. Diameter
greater than 2mm- Varicocele.
82. Varicocele
• It is common on the left side5 reasons.
Left testicular vein is longer than right testicular vein
Left testicular vein enters at right angle to the left renal vein
Left testicular artery is arching over left testicular vein
A loaded sigmoid colon compressing left testicular vein
Left renal vein is compressed b/w the Aorta and SMA
83. Varicocele- Etiology
• 1.Idiopathic/Primary – due to incompetency of valves. 98% occur on
the left side
• 2.Secondary
Pelvic or abdominal mass.
Lt renal cell carcinoma with tumor thrombus in left renal vein.
Nutcracker syndrome- SMA compressing left renal vein. Other
conditions- Retroperitoneal fibrosis or adhesions
85. Varicocele- Clinical Features
• The patient may have aching or dragging pain particularly after
prolonged standing.
• It can be differentiated from an omentocele by the peculiar feel of the
bag of worms.
• Many varicoceles are asymptomatic and found incidentally
• It is more common on the left side for reasons stated above
• Infertility: Varicocele is often associated with infertility. The scrotal
temperature is usually higher in the presence of varicocele and this
may impair spermatogenesis
86. Varicocele- Clinical Features
• Bow sign- hold varicocele b/w thumb and fingers, patient is asked to
bow- reduced in size
• On lying down it gets reduced; On standing up it reappears
• Long standing cases- affected side testis is reduced in size and softer.
Testis size can be measured by Prader orchidometer
• No expansile cough impulse present, but thrill present while coughing
87. Varicocele- Grading
• Grade I: Small varicocele which is palpable only when patient performs
Valsalva maneuver (expiration against a closed glottis).
• Grade II: Moderate sized. Easily palpable varicocele without Valsalva’s
maneuver
• Grade III: Large varicocele visible through the scrotal skin.
• Grade IV : Very much dilated and tortuous veins
88. Varicocele- Investigations
• Venous color doppler of the scrotum and groin-
-standing/ valsalva’s manoeuvre
• USG abdomen to look for kidney tumours.
• Seminal analysis Oligospermia or azospermia
90. Varicocele- Indications for Surgery
• American Urological Society recommends that varicocele treatment
should be offered to the male partner of a couple attempting to conceive
when all of the following are present.
• A varicocele is palpable.
• The couple has documented infertility.
• The female has normal fertility or potentially correctable infertility
• The male partner has one or more abnormal semen parameters or sperm
function test results.
• The indications in adolescents- presence of significant testicular
asymmetry (>20%) demonstrated on serial examinations, testicular pain,
and abnormal semen analysis results.
91. Varicocele- Treatment
• Asymptomatic varicocele—No treatment is required, only scrotal support
and reassurance
• Symptomatic varicocele—Excision of the pampiniform plexus in the
inguinal canal after ligating them. Testis still has venous drainage via the
cremasteric veins
• VARICOCELECTOMY- The most common approaches are
• Inguinal (groin)-easier and safer.
• Retroperitoneal (abdominal)
• Suprainguinal extraperitonial( Palomo’s operation)Open & Laparoscopic
• Scrotal approach- For Gr 4
93. Varicocele-
• Non-surgical procedure.
• Steel coil or silicone balloon catheter is introduced into a vein below
the groin through a nick in the skin.
• Passed under X-ray guidance.
• Tiny metal coils or other embolizing agents introduced through the
catheter.
• No stitches needed.
• Patient can go back in 24hrs.
• Lower rates of complications. Less effective, higher recurrence(5-11%),
danger that the coil could migrate to the heart and cause death
Coil Embolization,
98. Scrotal Swellings Ex & Px Hx Sx Dx Tx
1. Hydrocele Primary-Idiopathic
Secondary- under
lying pathology
Painless big
swelling; not
reducible
No cough impulse
Get above swelling+
Transilluminant+
Clinical
In doubt- USG of
scrotum
Lord’s operation
Jaboulay’s
operation
2. Epididymal
cyst &
Spermatocele
Degenaration of
epididymis, occlusion
of pathway
Swelling in
scrotum resembles
3rd testis
Testis palpable
separately; Chinese
lantern appearance
Clinical
USG of scrotum
Conservative
Excision
3. Varicocele Idiopathic
Absence of valves in
testicular vein
Worm like in upper
scrotum; infertility
Disappears on lying
down; Bag of worms
appearance
Clinical
USG color doppler
Varicocelectomy
Inguinal or
Retroperitoneal
4. Testicular
torsion &
Epididymo-
orchitis
Abnormal fixation and
lie of testis
UTI & trauma
Severe pain&
swelling scrotum
Nausea & vomiting
Tender hemi scrotum;
cremasteric reflex
absent
Clinical
USG color doppler
Explore,detorse,
orchiopexy or
orchidectomy
Conservative
5. Testicular
carcinoma
UDT, Kieinfelter’s
Germ cell- Seminoma
& Non seminoma
Non germ cell tumor
Painless heavy
swelling
Not reducible
Hard in consistency
Testis felt separately
Clinical; No FNAC
USG OF scrotum
High orcidectomy
with or without
RPLND+ RT+CT
D/D for Scrotal Swellings (Compare & Contrast)
(Vertical Reading)
99. References
• Hunt & Marshall’s clinical problems
in surgery 2nd edition
• Clinical surgery made easy- a
companion to PBL by Mohan De
silva 1st edition
• 100 cases in surgery 2nd edition
• Case files surgery 4th edition
• Clinical scenarios in surgery-
decision making 1st edition
• Surgery- a case based clinical
review 1st edition
• Surgery Review by Carlos Pestana
• Clinical surgery pearls by
Dr Dayananda Babu 2nd edition
• NMS casebook surgery 2nd edition
• General Surgery- Correlations &
clinical scenarios 1st edition
• Surgery review by Makary 3rd edition
• Surgery- Clinical cases uncovered by
Harold Ellis 1st edition
• Shelf life surgery 1st edition
102. SCROTAL SWELLINGS
Case No:5
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical college
Melaka Malaysia 75150
103. OVERVIEW
• Various causes(Differential diagnosis) of scrotal swellings
• Classical clinical vignette with probable diagnosis
• The diagnosis in detail- only one pathology in each episode
• Mind map of the diagnosis
• Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your
diagnosis
• References and feedback
105. Classical Clinical Vignette
• A 22-year-old male presents with a left scrotal mass. He notes that he
was playing soccer about 5 weeks ago and sustained mild trauma to
the left hemi scrotum at that time. The trauma prompted him to
palpate his testicle, at which time he noted the mass. The patient
states that he had mild pain initially that resolved on its own and
denies any hematoma.
• He denies any pain at this time. He states that the mass does not seem
to be increasing in size and that it is approximately the size of a large
almond. The mass, he notes, seems to be “in the middle” of his left
testis.
106. Classical Clinical Vignette
Testicular Carcinoma
• On review of symptoms he denies subjective fevers, chills, dysuria,
gross hematuria, or urethral discharge
• O/E:Physical examination reveals a firm 2 cm mass within the left
testis. There is no pain to palpation. There are no epididymal
masses bilaterally, and the right testis is normal to examination.
Abdominal exam reveals no masses and no hepatomegaly.
• There are no supraclavicular nodes and no gynecomastia
• Laboratory analysis reveals a normal urinalysis and complete
blood count.
107. Testicular Carcinoma-Epidemiology
• The most common malignancy to affect young men.
• There is a peak frequency in early childhood, and a larger peak
incidence between 20 and 35 years of age. Uncommon after age 40.
• Occurs in whites more than African-Americans.
• It is a curable cancer
108. Testicular Carcinoma-Risk Factors
• Men with cryptorchid (undescended) testes (intra-abdominal testes
with the highest risk). It is important to note that both testicles are at
risk.
• Surgical placement of the testis into the scrotum does not decrease
malignant risk, but facilitates surveillance.
• Testicular cancer in the contralateral testis
• Family H/O Testicular Cancer
• Klinefelter’s syndrome
109. Testicular Carcinoma
Clinical features
• Painless enlargement of the testicle
• Firmness of the testicle; Lax Secondary hydrocele
• Back or abdominal pain secondary to retroperitoneal (inter-aortocaval)
lymphadenopathy.
• Weight loss. Lt supraclavicular LN +
• Enlarged retro peritoneal LN; Hepatomegaly;
• Dyspnea secondary to pulmonary metastasis.
• Gynecomastia secondary to hormonal secretions
115. Testicular Carcinoma- Workup
• Testicular self-examination(TSE) or by a clinician
• USG of Scrotum
• CT scan/magnetic resonance imaging (MRI) of abdomen and pelvis to
assess for metastasis and lymphadenopathy
• Tumor markers—α-fetoprotein (AFP), human chorionic gonadotropin
(HCG), and lactic dehydrogenase (LDH).
• Tissue diagnosis- high inguinal orchidectomy (diagnostic &
therapeutic) – Chevassu maneuver
• Trans-scrotal biopsy – contraindicated
117. Testicular Carcinoma-Tumor Markers
• AFP : Normal value < 16 ngm/ml; Half life 5 to 7 days; Raised in
Pure embryonal Ca
Terato Ca
Yolk sac tumor
Mixed tumor
REMEMBER: AFP Not raised is Pure Choriocarcinoma or Pure
Seminoma
118. Testicular Carcinoma-Tumor Markers
• HCG: Normal value < 5 IU/ml; Half life 24 to 36 hrs; Raised in
Chorio carcinoma 100%
Embryonal carcinoma 60%
Terato carcinoma 55%
Yolk sac tumor 25%
Seminomas 7%
• LDH: Normal value 105 to 333 IU/ L; Half life 1 day
-Not diagnostic
-prognostic marker
- correlates tumor burden
120. Testicular Carcinoma- Treatment
Goals
• Treatment should be aimed at one level higher then the clinical stage
• Seminomas- radiosensitive
• Non seminomas- radio-resisitant hence best treated with surgery
• Advanced disease or mets- chemotherapy
• Radical inguinal orchidectomy is the standard first line therapy
• Lymphatic spread first to the RETRO-PERITONEAL NODES
• Early hematogenous spread rare
• Bulky tumors or metastatic tumors initially down staged with
Neoadjuvant chemotherapy
121. Testicular Carcinoma- Treatment
• Surgical approach: High radical inguinal orchiectomy
• Trans-scrotal biopsy of the testis or a trans-scrotal orchiectomy
should not be performed
• Early seminoma: Orchiectomy + retroperitoneal x-ray therapy (XRT).
• Advanced seminoma: Orchiectomy, and combination chemotherapy
followed by restaging
• Stage I nonseminoma: Orchiectomy + retroperitoneal lymph node
dissection (RPLND) or surveillance
122. Testicular Carcinoma- Treatment
• Stage II Nonseminoma: The optimal management of this group of
patients is controversial. RPLND can be curative but have a high
relapse rate. If relapse occurs, chemotherapy can be given as
adjunctive therapy. Alternatively, chemotherapy can be given prior to
RPLND
• Advanced stage Nonseminoma: Orchiectomy + chemotherapy ± tumor
reductive surgery.
• The most commonly used chemotherapeutic regimen: EBP (etoposide,
bleomycin, cisplatin).The prognosis of seminomas is excellent due
to its exquisite sensitivity to radiation!
127. Scrotal Swellings Ex & Px Hx Sx Dx Tx
1. Hydrocele Primary-Idiopathic
Secondary- under
lying pathology
Painless big
swelling; not
reducible
No cough impulse
Get above swelling+
Transilluminant+
Clinical
In doubt- USG of
scrotum
Lord’s operation
Jaboulay’s
operation
2. Epididymal
cyst &
Spermatocele
Degenaration of
epididymis, occlusion
of pathway
Swelling in
scrotum resembles
3rd testis
Testis palpable
separately; Chinese
lantern appearance
Clinical
USG of scrotum
Conservative
Excision
3. Varicocele Idiopathic
Absence of valves in
testicular vein
Worm like in upper
scrotum; infertility
Disappears on lying
down; Bag of worms
appearance
Clinical
USG color doppler
Varicocelectomy
Inguinal or
Retroperitoneal
4. Testicular
torsion &
Epididymo-
orchitis
Abnormal fixation and
lie of testis
UTI & trauma
Severe pain&
swelling scrotum
Nausea & vomiting
Tender hemi scrotum;
cremasteric reflex
absent
Clinical
USG color doppler
Explore,detorse,
orchiopexy or
orchidectomy
Conservative
5. Testicular
carcinoma
UDT, Kieinfelter’s
Germ cell- Seminoma
& Non seminoma
Non germ cell tumor
Painless heavy
swelling
Not reducible
Hard in consistency
Testis felt separately
Clinical; No FNAC
USG OF scrotum
High orcidectomy
with or without
RPLND+ RT+CT
D/D for Scrotal Swellings (Compare & Contrast)
(Vertical Reading)
128. References
• Hunt & Marshall’s clinical problems
in surgery 2nd edition
• Clinical surgery made easy- a
companion to PBL by Mohan De
silva 1st edition
• 100 cases in surgery 2nd edition
• Case files surgery 4th edition
• Clinical scenarios in surgery-
decision making 1st edition
• Surgery- a case based clinical
review 1st edition
• Surgery Review by Carlos Pestana
• Clinical surgery pearls by
Dr Dayananda Babu 2nd edition
• NMS casebook surgery 2nd edition
• General Surgery- Correlations &
clinical scenarios 1st edition
• Surgery review by Makary 3rd edition
• Surgery- Clinical cases uncovered by
Harold Ellis 1st edition
• Shelf life surgery 1st edition