High-Frequency Ultrasound Imaging-Guided Wedge Resection: An Effective Treatment for Paraurethral Duct Dilatation Following Gonococcal Paraurethral Duct Infection in Men.

This study was performed to evaluate the therapeutic effects of wedge resection on male paraurethral duct dilatation following gonococcal paraurethral duct infection. Twenty-six men with paraurethral duct dilatation following gonococcal paraurethral duct infection were enrolled. Their lesions underwent wedge resection after examination using an ACUSON X300 ultrasound system. The anesthetic method, surgical duration, intraoperative blood loss, wound healing time, complications, sequelae, and curative effect were assessed. All 26 men received local infiltration anesthesia. The mean surgical duration was 18.65 ± 2.50 min (range, 14-23 min), the mean intraoperative blood loss was 10.50 ± 1.68 ml (range, 8-14 ml), and the mean wound healing time was 14.73 ± 1.31 days (range, 13-17 days). The lesions were cured in all patients (100%). The postoperative wounds healed in all patients. No complications or glans defects were observed in any patients. The study identifies that high-frequency ultrasound imaging-guided wedge resection is an effective and safe therapy for paraurethral duct dilatation following gonococcal paraurethral duct infection in men.

Dynamic Observation of the Morphological Changes in Paraurethral Ducts Infected with Gonococci in Men before and after Ceftriaxone Therapy Using High-Frequency Ultrasound.

OBJECTIVE: To observe the morphological changes in paraurethral ducts infected with gonococci in men before and after the administration of the ceftriaxone therapy using high-frequency ultrasound and determine its clinical significance. METHODS: Thirty-two male patients with gonococcal paraurethral duct infection were enrolled. Their lesions were examined using an ACUSON X300 ultrasound system before and after they were subjected to ceftriaxone therapy. RESULTS: The paraurethral duct was completely closed 3-4 days after ceftriaxone treatment in 30 patients. Paraurethral duct closure began from the blind end and proceeded gradually towards its orifice; during closure, the paraurethral duct diameter showed no apparent change. These 30 patients whose paraurethral ducts closed were considered cured. In the remaining 2 patients, the length and diameter of the paraurethral ducts showed no change before and after ceftriaxone treatment; one patient was unresponsive to ceftriaxone treatment, and the other had secondary dilatation of the paraurethral duct. These 2 patients were cured after surgery. CONCLUSION: High-frequency ultrasound enables dynamic observation of the morphological changes in paraurethral ducts infected with gonococci before and after ceftriaxone therapy. High-frequency ultrasound can provide valuable information for incision, drainage, and wedge resection of paraurethral ducts.

Is urethritis accompanied by seminal vesiculitis?

OBJECTIVE: To determine whether urethritis is accompanied by seminal vesiculitis using transrectal ultrasound (TRUS) imaging. METHODS: Fifty-six male patients (mean age 31.6 8.7 years) with urethritis were included in the study. As a control group,we also considered 34 healthy volunteers (mean age 21.3 1.8 years). The two groups were evaluated by the nucleic acid amplification test and imaging studies using TRUS. RESULTS: The nucleic acid amplification test could identify 15 patients (26.8%) with gonococcal urethritis (five had accompanying chlamydial urethritis), 32 (57.1%) with chlamydial urethritis, and nine (16.1%) with nongonococcal and nonchlamydial urethritis. The mean anteroposterior diameter of the bilateral seminal vesicles was significantly longer in the urethritis group than in the controls (12.9 3.3 mm vs 11.0 2.0 mm, P = 0.004). The incidence of dilatation or cystic changes of seminal vesicles was significantly higher in the urethritis group than in the controls (dilatation: 30% vs 9%, P = 0.019; cystic change: 39% vs 12%, P = 0.007). There was no significant difference in the incidence of dilatation or cystic changes of seminal vesicles between gonococcal urethritis and chlamydial urethritis. CONCLUSIONS: Patients with urethritis are likely to have accompanying seminal vesiculitis. This suggests a close interrelationship among urethritis, seminal vesiculitis and epididymitis.

[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases].

BACKGROUND/AIMS: Fitz-Hugh-Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease (PID). We retrospectively analyzed clinical and laboratory manifestations as well as the therapeutic response in patients with clinically diagnosed Fitz-Hugh-Curtis syndrome. METHODS: A cohort of 25 patients with PID and perihepatitis (as diagnosed by dynamic abdominal computed tomography (CT)) was enrolled. The prognosis, clinical manifestations, and physical examination, laboratory, and CT findings were analyzed. RESULTS: The mean (+/-SD) age of the patients was 32(+/-8) years, and all of them were sexually active, premenopausal women, and presented with abdominal pain. Of these, 52% complained of vaginal discharge. On physical examination, right upper-quadrant tenderness was the most common finding (84%), with lower-abdominal tenderness being present in 20% of patients. On laboratory examination, erythrocyte sedimentation rate and C-reactive protein were increased in 76% and 92% of the patients, respectively. The white blood cell count was increased in 60% of them. Most patients had a normal liver function test. Using a specimen of the cervical discharge, the polymerase chain reaction to test for Chlamydia trachomatis were positive in 87% (13/15) of the patients, and Chlamydia antigen was found in 75% (9/12) of them. Dynamic abdominal CT revealed subcapsular enhancement of the liver in the arterial phase. All of the patients improved with antibiotic therapy. CONCLUSIONS: Symptoms and physical findings suggestive of PID are not present in many patients with Fitz-Hugh-Curtis syndrome. When a premenopausal woman complains of upper abdominal pain and shows CT findings compatible with perihepatitis, examination of cervical discharge would be recommended to assess the possibility of Fitz-Hugh-Curtis syndrome.

Sonographically guided intralesional antibiotic injection for treatment of a recalcitrant pelvic abscess: a case report.

A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it.

Gonococcal endocarditis: assessment by transesophageal echocardiography.

Gonococcal endocarditis is a rare but aggressive infection that has an alarming rate of perivalvular abscess and mortality. We present a case of gonococcal endocarditis with intracardiac abscess and fistula diagnosed by transesophageal echocardiography. Given the often acute nature of gonococcal endocarditis and its propensity toward abscess formation, transesophageal echocardiography should be considered early in the course of this infection.

Transrectal ultrasound in male urethritis.

OBJECTIVE: To assess the prevalence of prostatic abnormalities in men with gonococcal and non-gonococcal urethritis using trans-rectal ultrasonic markers. DESIGN: A case control study of patients attending a department of genitourinary medicine with symptoms of urethritis. SETTING: Department of Genitourinary Medicine and Department of Radiology in Manchester Royal Infirmary. RESULTS: A total of 42 patients were recruited to the study: 26 with urethritis and 16 controls. Of the 26 study patients, six were gonococcal, four chlamydial, two mixed gonococcal and chlamydia and nine non specific (no organisms detected). Of the 26 study patients, 16 had abnormal scans (61.5%), eight from the chlamydia group and eight from the non specific group. No abnormalities were found in the gonococcal and mixed group. Of the 16 control patients, five had abnormal scans (31.25%), three of these have had a past history of chlamydial urethritis. CONCLUSION: The prevalence of prostatic abnormalities in patients with non-gonococcal urethritis was significantly higher when compared with controls. The cause of these abnormalities is unclear, but is compatible with inflammatory changes within the gland.

Disseminated gonococcal infection involving the foot.

The patient had two features of N. gonorrhoeae infection, which were urogenital inflammation and pharyngitis. At first, the urogenital inflammation was denied and so delayed the correct diagnosis. The patient had been treated initially with oral penicillin for the pharyngitis, but without effect. The result was because of the increase in penicillin-resistant strains. This created DGI with initial migratory polyarthralgia from his left shoulder to the right midfoot. Acute arthritis formed in the midfoot. Once the correct diagnosis was made and appropriate antibiotics started, the infection responded rapidly and completely.

Computed tomography in the evaluation of tubo-ovarian abscesses in children.

There are many reports in the literature describing ultrasonic features of tubo-ovarian abscess. Computed tomography characteristics of these lesions are less frequently described. This presentation shares our experience with computed tomography findings in two girls, aged 6 and 14 years, with tubo-ovarian abscesses.

Radiologic findings in anorectal gonorrhea.

Gonorrhea is the most prevalent communicable disease in the United States and the incidence of anorectal involvement is high. Anorectal gonorrhea may be clinically elusive making the radiologic findings crucial in suggesting the diagnosis. Edematous rectal mucosa with limited distensibility and small ulcerations are the prominent radiologic findings.

Elbow fat pads with new signs and extended differential diagnosis.

Although fat pad signs are classically associated with fracture, there are many nontraumatic disease processes which lead to positive fat pad signs. Any intraarticular fluid or tissue accumulation may result in an abnormal posterior fat pad. A "paradoxical" positive posterior fat pad sign may occur in some instances of extraarticular disease. An extended differential diagnosis is presented.