US of the tunica vaginalis testis: anatomic relationships and pathologic conditions.

Extratesticular lesions are common incidental findings at ultrasonography (US) among men and boys. Most lesions originate from or depend on the tunica vaginalis, a mesothelium-lined sac with a visceral layer and a parietal layer. The tunica vaginalis is formed when the superior portion of the processus vaginalis closes during embryologic development. Abnormal closure of the processus vaginalis leads to congenital anomalies of the tunica vaginalis, such as complete or partial patency of the processus vaginalis, spermatic cord hydrocele, and inguinoscrotal hernia. The proximity of the visceral layer to the testis explains the reactive involvement seen in epididymo-orchitis, with resultant pyocele or abscess formation. The tunica vaginalis also may be affected by inflammatory and traumatic disorders such as scrotal calculi, fibrous pseudotumor, or hematocele. These lesions manifest as solid or heterogeneous tumorlike masses. Lesions of mesothelial origin, such as adenomatoid tumor, tunica cyst, and mesothelioma, may involve the tunica vaginalis. Entrapped mesenchymal cells can lead to lipoma, leiomyoma, or sarcoma, although these tumors are uncommon in the tunica vaginalis. US is not useful for differentiating between benign and malignant tumors; however, some characteristic findings may help in planning the best surgical approach. Knowledge of the embryologic development, anatomic relationships, and pathologic disorders of the tunica vaginalis is essential to narrow the differential diagnosis of an extratesticular lesion. In most cases, US findings in combination with clinical assessment can indicate whether nonsurgical management or testis-sparing surgery is warranted.

Oral sodium phosphates solution versus polyethylene glycol for colon cleansing prior to radiological assessment.

A clean bowel environment is essential prior to radiological assessment of the colon. The objectives were to determine patient compliance and acceptability, physician satisfaction, overall clinical effectiveness and tolerability with the use of oral sodium phosphates (Fosfosoda) and polyethylene glycol solutions as bowel cleansing agents in a relatively large cohort of Spanish patients requiring radiologic examination of the colon. This was an observational survey involving 592 patients (> or =18 years and approximately 60% women) who received Fosfosoda or polyethylene glycol solutions according to data sheet instructions. Parameters measured included mucosal cleansing (presence of solid residues), patient acceptability (including any adverse effects to treatment) and compliance with the treatment regimen, and physician-rated satisfaction with the procedure. The date from the study demonstrated that Fosfosoda and polyethylene glycol solutions were found to be equally well tolerated in this study, although patients receiving Fosfosoda found it easier to complete the treatment regimen. Fosfosoda was significantly superior to polyethylene glycol solutions with regards to mucosal cleansing with 52% achieving an 'excellent' result compared with only 36% of the polyethylene glycol group (relative risk:1.43; 95% confidence interval: 1.12-1.82). Physician-rated assessment of the bowel cleansing procedure also significantly favored Fosfosoda (p = 0.014). In conclusion, while Fosfosoda and polyethylene glycol solutions were equally well tolerated when given to patients prior to radiologic examination of the colon, Fosfosoda was shown to be significantly more effective in terms of bowel cleansing. Based upon the available evidence this could provide significant cost benefit for Fosfosoda.

Sonographic findings of mesenteric panniculitis: correlation with CT and literature review.

PURPOSE: To evaluate the sonographic findings of mesenteric panniculitis (MP) and correlate them with CT findings. METHODS: We retrospectively evaluated the clinical, CT, and sonographic findings in 26 cases of MP in our hospital between January 1997 and July 2003. We also reviewed the sonographic features of MP previously described in the literature. RESULTS: The sonographic findings were well correlated to CT in 24 of 26 patients (92%). In these 24 cases, abdominal sonographic examination revealed a hyperechogenic, well-defined fatty mass (corresponding to the pseudocapsule CT sign) in the root of the mesentery, displacing the bowel loops. We found a clear interface between MP and normal intra abdominal fat. Examination with color Doppler sonography revealed the nondeviated mesenteric vessels within the mass. The persence of MP improved sonographic transmission in 9 obese patients and enabled the retroperitoneal vessels to be clearly visualized. Sonography was unable to demonstrate the preservation of the fat nearest the mesenteric vessels corresponding to the "fatty halo" sign on CT. CONCLUSIONS: Sonography is useful in the diagnostic workup for MP. The characteristic sonographic features of MP (well-defined mass, homogeneous hyperechogenicity of the mass, nondeviated vessels within the mass, and displaced bowel loops) correlate well with CT findings.

[Quick and early diagnostic outpatient unit: an effective and efficient assistential model. Five years experience]. / Unidad de diagnóstico rápido: un modelo asistencial eficaz y eficiente. Experiencia de 5 años.

BACKGROUND AND OBJECTIVE: To analyze the applicability of an out-patient Quick and Early Diagnostic Unit (QEDU) to evaluate patients with a potential life-threatening disorder on an out-patient basis. PATIENTS AND METHOD: We analyzed prospectively all patients attended in the unit for five years (1997-2001). We compared patients with lung cancer and colorectal cancer admitted to hospital for conventional study versus patients studied at the unit. RESULTS: We attended 2,748 patients in total Main reasons for consultation were abdominal pain, asthenia-anorexia, neurologic symptoms, anemia and palpable tumors. The most frequent diagnostic category corresponded to gastroenterological diseases and neoplastic diseases. The mean interval (standard error) for the first visit was 4.9 (3.4) days and for diagnosis it was 5.7 (6.5) days. Some 95% patients displayed a high degree of satisfaction by the questionnaire. In patients with cancer of the colon studied at the QEDU, we observed a reduction in the average interval for diagnosis which was highly significant (p = 0.03). The overall costs of final diagnosis were also lower for the QEDU model. CONCLUSIONS: The QEDU unit represents an alternative to in hospital admission for diagnostic workouts, which is fully feasible in our setting. It can result in the same efficacy and a higher efficiency than hospital admission.

Morpho-functional evaluation of osteomeatal complex in chronic sinusitis by coronal CT.

The objective was to determine whether or not there exists a clinical-radiological correlation in chronic sinusitis of anterior paranasal sinus and to quantitatively evaluate the importance of osteomeatal complex structures and anatomic variants in chronic sinusitis etiopathology. We analyzed 208 nasal fossae with high-resolution and low-irradiation coronal computed tomography. The following inclusion criteria we established: one case control and one control group. We considered any chronic thickness of sinusal mucosal as a radiological indicator of chronic sinusitis. We evaluated the mucosal thickness of internal, external, superior and inferior maxillary walls, the addition of four maxillary walls and the maximal mucosal thickness in frontal sinus and anterior ethmoidal cells. We also obtained 15 parameters of osteomeatal complex structures and anatomical variants in each nasal fossa, and we correlated them statistically with chronic sinusitis radiological indicators. Uncinate process length is the only anatomic element from which we have been able to obtain a statistically significant cut point between case and control groups, but only with a sensitivity of 51.6%, specificity of 71.2%, positive predictive value of 74.2%, and negative predictive value of 47.9%. No association of radiological parameters exists that can explain chronic sinusitis.