Scrotal cavernous hemangioma presented with pruritus in a teenager: A case report.

Key Clinical Message: Ulcerated scrotal cavernous hemangioma is uncommon and rarely presents with pruritus. The surgeon should perform a complete scrotal examination, choose the best treatment option, and the diagnosis should be confirmed histopathologically. Abstract: Ulcerated scrotal hemangiomas are a rare disease that can pose a diagnostic challenge, particularly if there is simultaneous hemorrhage. We report the case of a 12-year-old child with an unusual presentation of scrotal cavernous hemangioma characterized by itching and bleeding. The mass was surgically removed, and the diagnosis was confirmed histopathologically.

Local Tranexamic Acid for Local Hemostasis in an Animal Liver Injury Model.

BACKGROUND: Hyperfibrinolysis is a state of increased clot resolution often seen in trauma patients with ongoing hemorrhage. Tranexamic acid (TXA) inhibits fibrinolysis preventing clot resolution affecting hemorrhage continuation and is used by intravenous administration. AIMS: The purpose of this study was to evaluate the local tranexamic acid application for hemostatic control in an experimental animal liver injury model. SETTINGS AND DESIGN: This study was an experimental prospective treatment study to check the local TXA effects on liver injury. This study was approved by the Ethics Committee. MATERIALS AND METHODS: Twenty adult male Sprague-Dawley white rats were equally randomized to two groups after a standardized liver injury was conducted under anesthesia. One group were "liver-packed" with gauze (TXA [-]) and the other group with gauze soaked in TXA (TXA [+]). Bleeding from the injured middle liver lobe was measured at 2 and 15 min, and at 48h second-look surgery, with euthanasia conducted at 14 days. The liver was sent for histopathological and stereological analysis. STATISTICAL ANALYSIS AND RESULTS: There was no difference in bleeding at 2 or 15 min after packing; however, larger amount of free blood at 48 h in the TXA (-) group was noticed. Five animals in the TXA (-) were alive at 14 days compared to eight animals in the TXA (+) group. Significantly larger volume density of fibrosis, granulation tissue, and amorphous tissue were seen in the TXA (+) group compared to the TXA (-) group at the stereological analysis. CONCLUSION: Local TXA application on the injured liver surface might offer better hemostatic control than packing alone. Further studies are mandated before the clinical application of our findings.

The impact of post-procedural ureteric stent duration on the outcome of retrograde endopyelotomy for management of failed open pyeloplasty in children: a preliminary report.

Background: To evaluate the outcome of retrograde endopyelotomy as a minimally invasive option for management of failed open pyeloplasty in children and assess how the duration of post-procedural stenting may affect the endopyelotomy outcome. Methods: A total of 15 patients with secondary UPJO (Ureteropelvic junction obstruction) underwent retrograde endopyelotomy. The procedure was done using low-energy monopolar electrocautery hook under direct vision of pediatric ureteroscope and control of fluoroscopy. Double J stent was placed after the operation in all cases. Stent was removed in another session, 8 weeks (Group A, n=7) vs. 12 weeks (Group B, n=8) after endopyelotomy. Patients in both Groups were followed one, six and twelve months after the stent removal, and the anteroposterior renal pelvis diameter (APD), renal cortical thickness (CT) and degree of hydronephrosis (HDN) were recorded using the repeated measure test. P-value less than 0.05 were significant. We analyzed the data using SPSS software, version 20. Results: The median interquartile range (IQR) age at time of surgery for group A and B were 24 (62) months and 12 (50) months respectively. Median (IQR) times between previous pyeloplasty and endopyelotomy were 6 (6) months and 12 (8.5) months in groups A and B, respectively. The success rate of endopyelotomy after 12 months was 57.1% in group A and 87.5% in group B. The resolution of HDN was more prominent in the 12 week stenting group compared to the 8 week group during the 12 months follow-up period (p=0.030). The APD and CT in group B compared to group A was improved during follow-up period. Conclusion: A higher one-year success rate of retrograde endopyelotomy in terms of improvements in the degree of HDN, APD and CT was observed when the double j stent was remained for 12-weeks rather than 8-weeks. This observation need to be validated in a large cohort study with a long term post procedural follow up.

Comparison Between Processus Vaginalis Sac Tightening Technique and the Conventional Technique in Orchiopexy Surgery Over 10 Years.

BACKGROUND: Undescended testis (UDT) is a common congenital urogenital anomaly that is treated by orchiopexy. We aimed to introduce patent processus vaginalis (PPV) sac tightening (PVST) technique and compare it to the conventional technique. METHODS: We retrospectively studied all the operated UDT patients during 10 years. In the conventional technique, it was necessary to ligate PPV sac after being peeled off from the spermatic cord. PVST was dissected longitudinally from the two sides of where the PPV sac wall was attached to the spermatic cord till the proximal part, and only a narrow thin layer sticking to the spermatic cord was left and the proximal PVV sac opening was tightened as much as possible with vicryl suture at the internal inguinal ring level. The significance level was <0.05. RESULTS: Of 821 orchiopexy (mean age 24.5±24.2 months), 36.3% were done by conventional and 63.7% by PVST technique. Hematoma, edema, hydrocele, and wound infection were lower in the PVST technique, but it was not significant (p>0.05). Testicular atrophy and operation time were significantly lower in the PVST than the conventional technique (p<0.001). CONCLUSION: The orchiopexy PVST technique has lower complications and seems to be easier, faster and safer than the conventional technique.

The effect of silicone gel versus contractubex gel on the upper-extremity postsurgical scars: A randomized, double-blinded, controlled trial.

Background: Wound healing is a process that has three overlapping inflammatory, proliferative, and reconstruction phases. Silicone gel and Contractubex (onion extract gel) are two main topical agents used for the prevention and treatment of hypertrophic scars. This clinical trial study aimed to evaluate the efficacy and safety of onion extract and silicone gel on hypertrophic scars of the upper extremity and compare it to non-treated patients. Methods: This randomized, double-blind, parallel, clinical trial was done on 120 male patients who had undergone upper extremity sharp injury repair. Patients were assigned to three groups, i.e., Silicone gel (Kelo-cortTM; WA, USA) (group 1; 40 patients), Onion extract (ContractubexTM, Merz Pharma, Frankfurt, Germany) gel (group 2; 40 patients), and No Intervention (group 3; 40 patients), using drawing sealed envelopes and a computer-based table of randomization. Data were recorded using the Vancouver scale in each visit by two surgeons who were blinded to the study groups. IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp). Data were compared using the ANOVA test. A P-value of less than 0.05 was considered statistically significant. Results: Vascularity (p=0.200), pliability (p=0.058), pigmentation (p=0.701), and height (p=0.438) as subjective scar parameters were approximately similar in post-upper extremity sharp injury wound hypertrophic scar among the three groups. Conclusion: Vascularity, pliability, pigmentation and height, as subjective scar parameters, were not statistically different in post-upper extremity sharp injury wound hypertrophic scar among the groups. Even though onion extract gel and Silicone gel show preventive effects in the literature, especially in burns wounds, further studies are recommended to be conducted to prove the topical effects of above-mentioned gels in patients.

Efficacy Of Silicone Gel In Reducing Scar Formation After Hypospadias Repair: A Randomized Placebo-Controlled Trial.

BACKGROUND: Hypospadias is one of the most common congenital disorders of the urogenital system that is repaired by surgical method. Literature review shows that silicone gel is effective in preventing and improving hypertrophic scars after surgery. Thus, we conducted this study to evaluate the effect of silicone gel on scar reduction after surgical repair of hypospadias. MATERIALS AND METHODS: In this randomized double-blind clinical trial, 64 patients who had undergone surgical repair of hypospadias were divided into two groups: 32 patients in the intervention group (silicone gel) and 32 in the control group (placebo). Then, the patients in the silicone gel treatment group were treated twice per day for two months on the site of surgical wound, and the patients in the control group were treated with Vaseline twice per day for two months on the site of surgical wound, too. Scar characteristics (pigmentation, vascularity, pliability, and height) were recorded based on Vancouver's scars scale. Finally, the results of the two treatments on reduction of scars after surgical repair were compared between the two groups. Data were analyzed using SPSS-24. RESULTS: There were significant differences between the two groups in scar characteristics after surgical repair of hypospadias, such as vascularity, pliability, and height (P˂0.05); however, there was no significant difference in pigmentation (P>0.05). CONCLUSION: The results of this study showed that silicone gel had considerable effects on reduction of scars after surgical repair of hypospadias. However, further studies with larger sample size are recommended to confirm our conclusion.

Constipation, the sole presentation of primary renal carcinoid tumor: A case report.

Primary renal carcinoid tumors are quite rare. The pathogenesis of these tumors is unknown due to lack of enterochromaffin cells in the kidney. Because of nonspecific clinical manifestations and radiologic features, they are commonly misdiagnosed. Hence, Primary renal carcinoid tumors should be considered in differential diagnosis of any renal mass. In the present case, a 26-year-old woman was presented with a renal mass and constipation. After partial nephrectomy, diagnosis of carcinoid tumor was confirmed.

A review of the application of cellulose hemostatic agent on trauma injuries.

INTRODUCTION: Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries. METHODS: We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles. RESULTS: Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients. CONCLUSION: Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.

Primary renal pelvis and ureter squamous cell carcinoma (SCC): a rare case report and review of literature.

Primary renal squamous cell carcinoma (SCC) is a very rare upper urinary tract neoplasm. Renal SCC has a poor prognosis because it usually presents in advanced stages. We report a 64-year-old woman with a right paravertebral mass; after right radical nephroureterectomy and salpingo-oophorectomy, pathologic examination revealed primary SCC.

Relationship of glucose-6-phosphate dehydrogenase deficiency and neonatal sepsis: a single-center investigation on the major cause of neonatal morbidity and mortality.

Introduction: Neonatal sepsis is a serious disease with distinct clinical and laboratory findings. G6PD deficiency is known as the most common human erythrocyte-enzyme deficiency. This study was designed to investigate the relationship between G6PD deficiency and neonatal sepsis, since it is a major cause of neonatal morbidity and mortality. Methods: A cross-sectional case-control study was designed and performed on 50 neonates who had been admitted to the neonatal intensive-care unit and diagnosed with sepsis and 50 normal neonate controls. Quantitative G6PD-enzyme activity was assessed in the case and control groups. Results: Quantitative G6PD-level assessment showed that five (5%) subjects in the case group vs one (1%) of the control group were severely deficient and nine (9%) cases vs one (1%) control were moderately deficient. Enzyme-level differences were statistically significant (P=0.003). Conclusion: Our study showed higher incidence of G6PD deficiency in neonates who had been admitted due to sepsis. We suggest quantitative G6PD-level assessment instead of the routine qualitative methods in prevalent G6PD deficiency. It is also recommended that neonates with G6PD deficiency be under close supervision during the first month of life, especially those with other risks of neonatal sepsis, such as prematurity or low birth weight.

A giant ureteral stone in a 32-year-old man: a case report.

Giant ureteral calculi are defined as stones greater than 5 cm in length or circumference. These giant calculi can cause blockage of the ureter, dilation of the kidney and also decreased kidney function if not treated in time. The patient in this report presented with complaints of bilateral episodic pain of the bilateral lumbar region. Kidney, ureter and bladder (KUB) X-ray test showed a large bilateral ureteral stone about 14 cm in length and 106 g weight in the left ureter and 3 cm longitudinal diameter in the right ureter and also a staghorn stone in the left upper collecting system. Thereafter, the ureteric calculi were managed successfully using the combination of open and endoscopic techniques.

Stereological Comparison of Imbibed Fibrinogen Gauze versus Simple Gauze in External Packing of Grade IV Liver Injury in Rats.

OBJECTIVE: To evaluate the effect of imbibed fibrinogen gauze on survival, bleeding and healing in liver trauma. METHODS: This animal experimental study was conducted on 20 adult male Sprague-Dawley rats; with a mean weight of 300±50 gram; divided into two groups. Grade IV injury was induced to the subjects' liver. Then, the bleeding site was packed with simple gauze in the control group, and imbibed fibrinogen gauze in the experimental group. All animals were re-evaluated for liver hemostasis 48 hours after the initial injury. Bleeding in the intra peritoneal cavity was measured using Tuberculosis Syringe in the first and second operations. Subjects were followed-up for 14 days. Eventually, the rats were sacrificed and their livers were sent to a lab for stereological assessment. Statistical comparisons were performed via Mann-Whitney U-test using SPSS. P-Values less than 0.05 were considered to be statistically significant. RESULTS: Half of the rats in the control group died, while all the rats in the imbibed fibrinogen gauze group survived after two weeks (p= 0.032). Bleeding in the imbibed fibrinogen gauze was significantly less than control group, 48 hours' post-surgery (p<0.001). According to the stereological results, granulation tissue in the imbibed fibrinogen gauze group were more than the control group (P= 0.032). Also, fibrosis in the imbibed fibrinogen gauze group were more than the control group (P= 0.014). CONCLUSION: Our study indicated that imbibed fibrinogen gauze can potentially control liver bleeding and improve survival through increasing granulation tissue and fibrosis in injured liver.

Effects of Azelnidipine-Carboxymethylcellulose Gel on Healing of Full-Thickness Skin Wounds in Streptozotocin Induced Diabetic Rats.

OBJECTIVE: To evaluate the effects of azelnidipine-carboxyl methyl cellulose (AZL-CMC) gel and carboxyl methyl cellulose 2% gel (CMC) on the healing of full-thickness skin wounds of diabetic rats. METHODS: Fifteen Sprague Dawley male rats were studied. The rats were divided into three groups: AZL-CMC gel-treated, CMC 2% gel-treated, and control group. Wounds were assessed by wound area measurement every 3 days and histopathology samples were collected at 4, 7 and 12 days post wounding to evaluate the healing process using stereological study. Mann-Whitney U-test repeated measurement and non-parametric one-way analysis of variance (ANOVA) were used to analyze the data using SPSS, version 18. RESULTS: Numerical density of the fibroblasts of the AZL-CMC gel treated group was 59.17±2.69 (×104/mm3) and higher than the control 22.64±1.34 (×104/mm3) and CMC 2%-treated groups 40.80±5.27 (×104/mm3), respectively, P<0.001. The volume density of the collagen bundles and LV of the vessels were 83.1±4.46 and 42.16±5.78, respectively, in the AZL-CMC treated group, and higher compared to the control (53.96±5.07, 9.9±2.49) and the CMC 2%-treated (65.88±2.13, 18.1±2.20) groups (P <0.001). CONCLUSION: The healing of AZL-CMC gel-treated wound was better than the control wounds, grossly. Wound healing processes and wound closure in the intervention group began sooner and was completed more quickly. The quantitative and qualitative parameters showed the significant wound healing effect of the AZL-CMC gel-treated group.

The role of ultrasonography in detecting urinary tract calculi compared to CT scan.

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) in measuring the urinary tract stone using non-contrast computed tomography (NCCT) as the standard reference. PATIENTS AND METHODS: A total of 184 patients suspected with urolithiasis who had undergone NCCT and US radiologic investigation from 2015 to 2017 were enrolled in this study. The sensitivity, specificity, and stone size measured in US were validated by NCCT. Data of the stone size in US were classified into four groups (0-3.5, 3.6-5, 5.1-10, >10 mm) and then compared with NCCT data. RESULTS: In 184 patients, NCCT detected 276 (97.2%) stones, while US could identify 213 (75.5%) stones. Overall sensitivity and specificity of US were 75.4% and 16.7%, respectively. Detection rate of mid and distal ureteral stone was lower than that at other locations. The detection rate increased with the stone size. About 73% concordance was obtained for the stone size measured by US and NCCT (Pearson's correlation coefficient was 0.841). Factors such as the stone size, amount of hydronephrosis, and weight affected the detection rate of the urinary tract stone using US (P<0.001, P=0.02, and P=0.01, respectively). CONCLUSION: The stone size obtained by US was almost the same as that detected by NCCT; however, US is a limited imaging modality in detecting urinary tract stone, especially when used by an inexperienced radiologist, and in the case of smaller stone size, increased weight, and low grade of hydronephrosis.

Spontaneous Rupture of Renal Cell Carcinoma in Pregnancy, Surgical Management With Fetal Preservation:A Case Report.

Spontaneous Retroperitoneal hemorrhage in pregnancy is a rare condition. Renal angiomyolipoma (RA) is the most common cause of this hemorrhage. To the best of our knowledge, this is the first reported case of Wunderlich syndrome (WS) due to renal cell carcinoma (RCC) diagnosed in the second trimester of pregnancy.

Serological investigation for hepatitis E virus infection in the patients with chronic maintenance hemodialysis from southwest of Iran.

BACKGROUND AND OBJECTIVES: A global distribution has been shown for hepatitis E virus (HEV) infection. Although the fecal-oral was considered as the primary infection route, there is controversial evidence for increased risk of the infection and consequent problems in patients on maintenance hemodialysis (HD) with suppressed immunity. The aim is to find if the prevalence of anti-HEV IgG, in patients with maintenance HD is higher than normal population in southwest of Iran. MATERIALS AND METHODS: During November and December 2010, in a cross-sectional study we compared the seroprevalence of HEV among 80 patients with maintenance HD and 276 healthy individuals from Jahrom and Shiraz, Southwest of Iran. In addition to the clinical and laboratory records, serum samples were tested for the presence of IgG anti-HEV antibody by enzyme immunoassay (ELISA) test. The Chi-square, the Student's 't' and Fisher's exact tests were used for the statistical analysis. RESULTS: ELISA tests detected anti-HEV antibody in five males of the patients (6.3%) and in eight of the healthy controls (2.9%, 6 males and 2 female) which statistically were not different. The mean levels of the aspartate aminotransferase and the alanine aminotransferase in the sera of the patients were 19.96±11.08U/L and 23.93±14.26 IU/L, respectively. However, no one of the individuals with positive anti-HEV antibody showed elevated liver enzymes. Moreover, there was not a significant association between positive anti-HEV antibody result, age and the history of the hemodialysis. CONCLUSIONS: We did not observe statistically significant higher anti-HEV prevalence among patients with chronic HD; however, more safety precaution is needed to keep HD patients from the risk of possible exposure to HEV infection.