Scrotal calcinosis in a patient treated with isotretinoin: a rare entity.

Scrotal calcinosis is a rare disorder characterized by multiple papules or nodules of calcification in the scrotal skin. The pathogenesis of this disease is poorly understood. The condition presents as several brown to yellowish asymptomatic nodules on the scrotum. Excision followed by scrotal reconstruction is the treatment of choice. It leaves a good cosmetic result with low chances of recurrence. Newer treatments, such as ablative lasers, have been proposed with very good results. We describe the case of a 28-year-old patient with a history of severe acne treated with oral isotretinoin that presented for scrotal nodules. On laboratory examination, hypercalcemia was found with normal phosphorus, parathyroid hormone, and vitamin D hormone levels. Hypercalcemia was linked to his isotretinoin therapy. Serum calcium concentrations normalized after cessation of isotretinoin and hydration. Because the patient refused surgery, a biopsy of the lesion confirmed the diagnosis of scrotal calcinosis. Then the patient was referred to a cosmetic laser center to treat his condition.

Protective Effects of Fisetin in the Mice Induced by Long-Term Scrotal Hyperthermia.

Exposure to heat in the male reproductive system can lead to transient periods of partial or complete infertility. The current study aimed to examine the beneficial effects of  Fisetin against spermatogenic disorders in mice affected by long-term scrotal hyperthermia. For this purpose, hyperthermia was induced daily by exposure to the temperature of 43 °C for 20 min for 5 weeks. Except for the Healthy group, six other groups were exposed to heat stress: two treated groups including Preventive and Curative which received oral administration of fisetin (10 mg/kg/day) starting immediately before heat exposure and 15 consecutive days after the end of the heat exposure, respectively. And for each treated group, two groups including Positive Control (Pre/Cur+PC group) and vehicle (Pre/Cur+DMSO group) were considered. Our results showed that the testicular volume; the density of spermatogonia, primary spermatocyte, round spermatid, and Sertoli and Leydig cells; and sperm parameters, as well biochemical properties of the testis tissue, were remarkably higher in both Preventive and Curative groups compared to the other hyperthermia-induced groups and were highest in Preventive ones. Unlike the c-kit gene transcript which was significantly increased in the  Fisetin treatment groups (specially the Preventive group), the expression of HSP72 and NF-kß genes, Caspase3 protein, and DFI in sperm cells were significantly more decreased in Preventive and Curative groups compared to other hyperthermia-induced groups and were lowest in Preventive ones. Overall,  Fisetin exerts preventive and curative effects against spermatogenic disorders induced by long-term scrotal hyperthermia.

Photobiomodulation restores spermatogenesis in the transient scrotal hyperthermia-induced mice.

OBJECTIVE: Heat stress shock affects the generation of free radicals and can have a harmful effect on spermatogenesis. Photobiomodulation (PBM) is very effective in andrology for treating male infertility. This research aimed at the evaluation of the impacts of PBM on spermatogenesis on the transient scrotal hyperthermia-induced oligospermia mouse model. MATERIALS AND METHODS: This experimental research divided 24 mice into the following four groups: (1) Control, (2) Scrotal hyperthermia, (3) Scrotal hyperthermia receiving laser 0.03 J/cm2 for 30 s for each testis, 35 days after induction of scrotal hyperthermia every other day for 35 days, and (4) Scrotal hyperthermia receiving laser 0.03 J/cm2 for 30 s for each testis, immediately after induction of scrotal hyperthermia every other day for 35 days. Scrotal hyperthermia was induced by water bath with 43 °C for 30 min. Then, the mice were euthanized, and their sperm samples were collected for sperm parameters analysis. Then, we took the testis samples for histopathological experimentations, serum testosterone level, reactive oxygen species (ROS), RNA extraction for the examination of IL1-α, IL6 and TNF-α genes expression as well as production and glutathione disulfide (GSH) activity. KEY FINDINGS: Our outputs indicated that PBM could largely improve the sperms parameters and stereological parameters, like spermatogonia, primary spermatocyte, round spermatid and Leydig cells together with an increasing level of the serum testosterone and GSH activity compared to the scrotal hyperthermia induced mice. In addition, it was found that the diameter of seminiferous tubules, ROS production, as well as the expression of IL1-α, IL6, and TNF-α genes significantly decreased in the treatment groups by PBM compared to the scrotal hyperthermia induced mice, but there was not a significant difference in terms of testis weight and Sertoli cells between the studied groups. SIGNIFICANCE: It could be concluded that PBM may be regarded as an alternative treatment for improving the spermatogenesis process in the scrotal hyperthermia induced mice.

Effect of γ-oryzanol on testicular degeneration induced by scrotal insulation in rams.

The present study assessed the effects of daily supplementation with 33 mg/metabolic weight (MW) of γ-oryzanol on testicular degeneration induced by scrotal insulation in rams. Eight animals were divided into two groups: Control (subjected to scrotal insulation without treatment) and Gamma (subjected to scrotal insulation and γ-oryzanol treatment). The rams were subjected to scrotal insulation by covering the scrotum with a thermal bag for 72 h. Animals in the Gamma group received 33 mg/MW oral γ-oryzanol once-daily, beginning 7 days before insulation and continuing during insulation and for 20 days afterward, for a total treatment period of 30 days. Samples of semen and blood were collected during the experiment to perform biochemical evaluations of oxidative stress, seminal kinetics and morphology, and plasma testosterone concentrations. Ultrasound examinations of the testicular parenchyma and clinical evaluations of its consistency and the scrotal perimeter were also performed at weekly intervals. Testicular tissue was collected for biochemical analyses of oxidative stress parameters at the end of the experiment by orchiectomy. The results showed that testicular degeneration was induced by scrotal insulation, as was demonstrated by the reduced scrotal perimeter and increased in testicular flaccidity immediately after insulation. Moreover, a delayed increase in the number of hyperechoic points in the parenchyma and a delayed reduction in sperm motility were observed at 10 weeks after insulation by ultrasonography. Treatment with γ-oryzanol reduced levels of reactive oxygen species (ROS) levels in the testes, and increased the total antioxidant potential (assessed based on the ferric reducing ability (FRAP)) in week 10 and levels of lipid peroxidation (TBARS). It also increased the number of intact spermatozoa in week 3, but increased the total number of sperm defects from week 5 onwards. Although γ-oryzanol protected the semen and testes by reducing the levels of the parameters of oxidative stress evaluated herein, the other parameters studied were not improved by the treatment. In addition, supplementation with γ-oryzanol led to more morphological abnormalities in the sperm. This study presented new information on the oral administration of γ-oryzanol to rams with testicular degeneration, and described potential therapies for this pathology, which currently has no established treatment and has important impacts on reproductive health.

Lymphangioma Circumscriptum Post Radiotherapy for Penile Cancer Treated with CO2 Laser.

Lymphangioma circumscriptum (LC) is a rare, benign condition, predominantly characterized by the malformation of lymphatic skin vessels. Its onset may be congenital or due to secondary causes such as radiotherapy, infections, or surgical procedures. We present the case of a 55-year-old patient with a pathologic history of squamous cell carcinoma of the penis followed by radical penectomy. Due to metastasis to the locoregional lymph nodes, the entire affected area was subsequently treated with radiation therapy, receiving a total dose of 55.8 Gray. Eight years after this treatment, translucent vesicles filled with a clear liquid appeared on the scrotum. Histopathology confirmed the diagnosis of LC and therapy with CO2 laser was applied, resulting in a favorable outcome. LC of the scrotum may present a long-term radiotherapy-induced complication of this site. Our clinical experience showed that the CO2 laser was the therapy of choice as the vesicles entirely disappeared and healed as white scar-like lesions.

Protective effects of vitamin E on sodium arsenite-induced toxicity, testicular measurements and histopathological studies of testes in Teddy goat bucks.

The objective of this study was to investigate the toxic effects of arsenic on testicular measurements and histology of adult Teddy goats bucks and to examine whether these toxic effects are scavenged by vitamin E. Twelve adult Teddy goat bucks were divided randomly into three groups, A, B and C. Group A was kept as control, the B was given sodium arsenite 5 mg/kg BW per day, and group C was fed with vitamin E 200 mg/kg BW per day + arsenic 5 mg/kg BW per day. This treatment was continued for 84 days. Analysis of data revealed that the testicular measurements (scrotal circumference, width, length and weight) were significantly reduced in arsenic-treated animals, whereas there were ameliorating effects of vitamin E on these parameters. The major histopathological changes were present in the form of loss of germinal epithelium, atrophy of Leydig cells and vacuolations. Vitamin E in combination with sodium arsenite increased the active spermatogenesis as well as restoration of germinal epithelium. It can be concluded from the present findings that sodium arsenite causes toxicity in the male reproductive system of Teddy goat bucks with major changes in parenchyma of testes. Supplementation of vitamin E has protective effects on the toxicity of sodium arsenite on the reproductive system of male Teddy goat bucks.

Alleviating effect of Mallotus roxburghianus in heat-induced testicular dysfunction in Wistar rats.

CONTEXT: Hyperthermia causes detrimental effects on the testes leading to fertility problems. Mallotus roxbhurghianus Muell. Arg. (Euphorbiaceae) is used in traditional medicine and possesses antioxidant property. However, the mechanisms remain unknown in the context of alleviative action of M. roxburghianus against heat stress. OBJECTIVE: The objective of this study was to demonstrate the alleviating activity of M. roxburghianus and its mechanism in scrotal hyperthermia. MATERIALS AND METHODS: Scrotal hyperthermia experiments were performed in three groups (n = 7 per group) consisting of (i) the control group (C) maintained at 22 °C for 30 min, (ii) the heat stress-induced group (HS), and (iii) the heat stress-induced M. roxburghianus-treated group (HSM - 400 mg/kg each) in a thermostatically controlled water bath at 43 °C for 30 min. Subsequent to the heat treatment HS group, rats were treated with saline p.o and methanol extract of M. roxburghianus was administered to the rats of HSM group along with their standard food for 14 d. Scrotal hyperthermic effects were evaluated. RESULTS: Scrotal hyperthermia significantly (p < 0.0001) elevated malondialdehyde levels while decreasing the body and testes weights, serum testosterone, and antioxidant enzyme levels due to oxidative stress. Disorganisation of seminiferous tubules and arrest of spermatogenesis were observed in the HS group. The administration of methanol extract of M. roxburghianus (400 mg/kg) for 14 d after heat treatment significantly suppressed the lipid peroxidation, restored the antioxidant enzyme and testosterone levels, revived the spermatogenesis, and increased the cell proliferation activity in the HSM group. DISCUSSION AND CONCLUSION: The methanol extract of M. roxburghianus accelerates testicular recovery from the damaging influence of hyperthermia.

Diagnosis of torture after 32 years: assessment of three alleged torture victims during the 1980 military coup in Turkey.

Torture is a crime against humanity and it is frequently encountered in countries that have a history of military intervention such as Turkey. Torture still exists despite absolute prohibition by human rights and humanitarian law. More than 1 million people were tortured in Turkey since 1980 coup d'état. Documentation of medical evidence is a prominent step for prevention of torture. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol) provides international standards for medical documentation of torture. A holistic approach to trauma stories together with physical and psychological findings has been the main frame of the Protocol. The aim of this study is to discuss physicians' responsibility for prevention of torture, and to emphasize the importance of holistic approach to the assessment of particularly chronic patients. A team of two forensic medicine experts and a psychiatrist examined three male patients, who allegedly had been tortured severely during the 1980 military coup. The team arranged necessary referrals and diagnostic examinations. After conducting a comprehensive medical examination, some physical and psychological findings of trauma were observed and documented even after 32 years. The medico-legal evaluation and documentation of these cases many years after torture under the guidance of Istanbul Protocol were presented and significance of psychological assessment was especially emphasized. Furthermore, possible evidence of torture after a long period and physicians' responsibility for prevention of torture is discussed.

Progression of peritoneal adenomucinosis to the scrotum: a rare occurrence treated with cytoreductive surgery and hyperthermic chemoperfusion of the scrotum in two patients.

INTRODUCTION: Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. METHODS: We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. RESULTS: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. CONCLUSION: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.

INTRODUCCIÓN: La Adenomucinosis Peritoneal Diseminada (DPAM, por el término en inglés) es una presentación no frecuente del cáncer de apéndice. Infrecuentemente, las hernias umbilicales o inguinales pueden ser la primera manifestación clínica de esta condición; la extensión al escroto puede ser anatómicamente viable. La cirugía citoreductiva (CRS, por el término en inglés) con quimioterapia hipertérmica intraperitoneal (HIPEC, por el término en inglés) es el tratamiento estándar para DPAM. Nuestra hipótesis es que los mismos principios terapéuticos, consistentes en CRS con quimioterapia hipertérmica del escroto (HCS), pueden ser aplicados para DPAM con extensión al escroto. MÉTODOS: Revisamos una base de datos prospectiva en nuestra Institución donde se identificaron dos casos de DPAM con extensión al escroto. Se examinaron sus historias clínicas, y se realizaron controles cercanos. La histopatología tumoral y la citoreducción fueron evaluados. La progresión tumoral fue monitorizada en los controles mediante examen físico, marcadores tumorales (CEA, CA 125, CA 19.9) y TAC abdomino-pélvico. RESULTADOS: Dos pacientes a quienes se les practicó previamente CRS/HIPEC por DPAM fueron exitosamente tratados con CRS/HSC. Ambos pacientes se encuentran vivos y sin evidencia de enfermedad 88 y 57 meses después de la CRS/HIPEC inicial y a 50 y 32 meses post CRS/HCS, respectivamente. CONCLUSIÓN: La precaución de los cirujanos sobre la coexistencia de hernias inguinales con neoplasias peritoneales y la necesidad de reparo quirúrgico debe ser incrementada. La CRS/HCS puede ser empleada en el tratamiento a pacientes con DPAM con extensión al escroto. Los resultados clínicos son dependientes de una citoreducción completa del tumor metastásico.

Fine needle aspiration of a metastatic germ cell tumor to supraclavicular lymph node.

OBJECTIVE: Germ cell tumors are the most common tumors in men in their second decade. According to the National Comprehensive Cancer Network, the management of germ cell tumors depends on whether the tumor is diagnosed as a seminoma or a nonseminoma. Fine needle aspiration biopsy, compared to incisional biopsy, is relatively safe and facilitates rapid assessment of these tumors. METHODS: An ultrasound guided FNA biopsy was performed, and air-dried slides and alcohol-fixed slides were made for Diff-Quik staining and Papanicolaou staining, respectively. The syringes were rinsed and cell block was prepared. The resected specimen was fixed in 10% formalin and processed by routine histology techniques. RESULTS: We report a case of a 22-year-old male with an enlarged scrotal mass and a supraclavicular nodule. A superficial fine needle aspiration biopsy was performed on the nodule and the correct diagnosis was made via cytomorphology and immunohistochemistry. The cytologic diagnosis was correlated with the incisional biopsy results. CONCLUSION: Fine needle aspiration biopsy is very helpful in the initial triage of germ cell tumors. When the aspirate contains sufficient diagnostic material, a specific diagnosis may be reached. Likewise, as different germ cell tumors have characteristic immunohistochemical profiles, a cell block from an aspirate may be critical for correct diagnosis. However, because germ cell tumors often contain mixed elements, cytologic diagnosis may not be entirely representative due to incomplete sampling. Thus, it is important to correlate cytologic diagnosis with the excisional tissue biopsy results.

Progression of peritoneal adenomucinosis to the scrotum: a rare occurrence treated with cytoreductive surgery and hyperthermic chemoperfusion of the scrotum in two patients / Progresión de adenomucinosis peritoneal en el escroto de dos pacientes y tratamiento con cirugía citorreductora y quimioperfusión hipertérmica

Introduction: Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. Methods: We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. Results: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. Conclusion: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.

Introducción: La Adenomucinosis Peritoneal Diseminada (DPAM, por el término en inglés) es una presentación no frecuente del cáncer de apéndice. Infrecuentemente, las hernias umbilicales o inguinales pueden ser la primera manifestación clínica de esta condición; la extensión al escroto puede ser anatómicamente viable. La cirugía citoreductiva (CRS, por el término en inglés) con quimioterapia hipertérmica intraperitoneal (HIPEC, por el término en inglés) es el tratamiento estándar para DPAM. Nuestra hipótesis es que los mismos principios terapéuticos, consistentes en CRS con quimioterapia hipertérmica del escroto (HCS, por el término en inglés), pueden ser aplicados para DPAM con extensión al escroto. Métodos: Revisamos una base de datos prospectiva en nuestra Institución donde se identificaron dos casos de DPAM con extensión al escroto. Se examinaron sus historias clínicas, y se realizaron controles cercanos. La histopatología tumoral y la citoreducción fueron evaluados. La progresión tumoral fue monitorizada en los controles mediante examen físico, marcadores tumorales (CEA, CA 125, CA 19.9) y TAC abdomino-pélvico. Resultados: Dos pacientes a quienes se les practicó previamente CRS/HIPEC por DPAM fueron exitosamente tratados con CRS/HSC. Ambos pacientes se encuentran vivos y sin evidencia de enfermedad 88 y 57 meses después de la CRS/HIPEC inicial y a 50 y 32 meses post CRS/HCS, respectivamente. Conclusión: La precaución de los cirujanos sobre la coexistencia de hernias inguinales con neoplasias peritoneales y la necesidad de reparo quirúrgico debe ser incrementada. La CRS/HCS puede ser empleada en el tratamiento a pacientes con DPAM con extensión al escroto. Los resultados clínicos son dependientes de una citoreducción completa del tumor metastásico.

Gangrena de Fournier. Perspectivas actuales / Fournier´s gangrene. Current perspectives

La Gangrena de Fournier (GF) es una fascitis necrotizante sinérgica, multimicrobiana, de origen infeccioso, que produce gangrena de piel de región genital, perineal, o perianal. Su mayor frecuencia se observa en pacientes de 20 a 50 años, los varones se afectan más que las hembras en proporción 10:1 y la tasa de mortalidad aún es alta. El manejo clínico debe ser rápido y oportuno, con aplicación intravenosa de líquidos, electrolitos y antibióticos de amplio espectro; a fin de lograr la estabilización hemodinámica del paciente antes de la intervención quirúrgica. La cirugía precoz con debridamiento extenso de tejidos desvitalizados, constituye la base principal del mismo

The Fournier Gangrene (FG) is a synergistic, polymicrobial, necrotizing fasciitis with infectious origin that produces gangrene of the perineal, genital or perianal skin. The number bigger than cases happens between 20 at 50 years, the males are affected more than the females in proportion 10:1 and the mortality rate is high yet. The clinical manage of the GF must be fast and opportune with intravenous application of fluids, electrolytes and systemic broad-spectrum antibiotic therapy; and avoid the hemodynamic stabilization of the patient before the surgery. The precocious surgery with debridament of the necrotizing tissues constitutes the main objective of the treatment

Treatment of angiokeratoma of Fordyce with pulsed dye laser.

BACKGROUND: Angiokeratomas of Fordyce are typically asymptomatic vascular lesions characterized by blue-to-red papules with a scale surface, most often located on the scrotum. Although considered benign, the lesions may bleed, either spontaneously or secondary to rupture, leading to patient anxiety and social embarrassment. OBJECTIVE: The objective was to determine the safety and effectiveness of 585-nm pulsed dye laser for the treatment of angiokeratomas of Fordyce. METHODS: Twelve patients with Fitzpatrick skin type II to IV were treated for angiokeratomas of Fordyce with pulsed dye laser (5.5-8.0 J/cm(2)) in two to six sessions. Lesion clearance was evaluated by two specialists on the basis of digital photographs taken before the first treatment and 2 months after the last treatment. RESULTS: Seven patients had an excellent response (clearance rating 75%-100%) and five patients had a good response (clearance rating 50%-75%). Transient purpura and pain were present in all patients. Bleeding during treatment occurred in five patients. There were no permanent side effects. CONCLUSION: Pulsed dye laser is effective and safe for the treatment of angiokeratoma of Fordyce, with minimum side effects, providing an additional nonablative therapeutic option.

Primary sweat gland carcinosarcoma of the scrotal skin.

BACKGROUND: Carcinosarcoma is a biphasic tumor composed of malignant epithelial and mesenchymal elements. Although the tumors have been reported in different locations, they rarely occur in the skin and have not been reported in the skin of external genitalia. CASE REPORT: We present such a case in a 71-year-old Taiwanese man. He had had a long-term indolent nodule on scrotal skin, but it enlarged rapidly in 2 weeks. Wide excision of the tumor was performed. RESULTS AND DISCUSSION: The pathologic examination revealed a sweat gland carcinosarcoma consisting of admixed mucin-producing adenocarcinoma and solid spindle cell sarcoma. The two components exhibited contrasting immunohistochemical profiles with the epithelial component diffusely positive for epithelial markers and S-100 protein, while the sarcomatous component positive for vimentin and smooth muscle actin but negative for epithelial markers and S-100 protein. The immunoreactivity for S-100 protein in the epithelial component supports sweat gland origin. The tumor behaved aggressively. Local recurrence and distant metastases to lungs and brain occurred 6 months and 18 months later. The patient died of the disease 20 months after the initial diagnosis.

Squamous cell carcinoma of the scrotum.

A patient with psoriasis was found to have a large skin tumor on his scrotum. He had received psoralen and ultraviolet A radiation therapy to control psoriasis. Histopathologic study revealed that the tumor was a well-differentiated squamous cell carcinoma. We present this rare case and suggest that the genitalia be shielded during ultraviolet therapy.

[A simple alternative method in the treatment of idiopathic hydrocele in adults: vaginal "fenestration"]. / Une alternative technique simple dans le traitement de l'hydrocèle idiopathique de l'adulte: la "fenestration" vaginale.

The author describes a new, simple technique for the treatment of idiopathic hydrocele according to a "fenestration" procedure designed to correct the imbalance of intravaginal hydrostatic exchanges. The operation consists of initially hemming separately the deep fibrous layer and the parietal leaflet of the tunica vaginalis to form the margins of the "window", which is then applied by its fibrous layer to the dartos, continuous with the subcutaneous connective tissue, a site of rich lymphatic drainage. In a series of 108 patients treated by this technique since September 1982, with a follow-up of 6 years, the anatomical and functional results were excellent in 98 cases (90.7%), moderate in 6 cases (5.5%) and poor in 4 cases (3.7%). Compared to classical techniques, the fenestrated opening of the tunica vaginalis with preservation of the tunica vaginalis and limited opening of the serosa, preserves the testicular support and the protective role of the serosa on the testis. Lastly, suture of the margins of the window to the dartos, by facilitating deep lymphatic drainage towards the superficial connective tissue, reconstitutes a physiological equilibrium in the constant exchanges of intravaginal serous fluids. Experience has demonstrated the anatomical and functional efficacy and reliability of this extremely simple procedure, which is essentially indicated in adult patients with idiopathic hydrocele and a healthy tunica vaginalis.

Verruciform xanthoma in a psoriatic patient under PUVA therapy.

A patient with psoriasis vulgaris developed verruciform xanthoma (VX) on the scrotum during psoralen photochemotherapy (PUVA). Although it is uncertain whether VX was induced by PUVA therapy, we report the first case of VX which appeared in a patient with psoriasis during PUVA therapy. We speculate that UV light may be one of the etiologic factors triggering VX in this case.

Treatment of Fournier's gangrene with adjunctive hyperbaric oxygen therapy.

Fournier's gangrene is a devastating infection and often is associated with a high morbidity and mortality. Surgical debridement and antibiotics are the cornerstones of therapy. This case describes the use of hyperbaric oxygen as an adjunct in the treatment of Fournier's gangrene.