A Case of Vesical and Scrotal Sparganosis Presenting as a Scrotal Mass

A 59-year-old Korean man complained of a painless scrotal hard nodule and weak urine stream. The ultrasound scan revealed a 2.2-cm sized round heteroechogenic nodule located in the extratesticular area. Microscopic hematuria was detected in routine laboratory examinations. On scrotal exploration, multiple spargana were incidentally found in the mass and along the left spermatic cord. On cystoscopy, a 10-mm sized mucosal elevation was found in the right side of the bladder dome. After transurethral resection of the covered mucosa, larval tapeworms were removed from inside of the nodule by forceps. Plerocercoids of Spirometra erinacei was confirmed morphologically and also by PCR-sequencing analysis from the extracted tissue of the urinary bladder. So far as the literature is concerned, this is the first worm (PCR)-proven case of sparganosis in the urinary bladder.     

A Case of Inguinal Sparganosis Mimicking Myeloid Sarcoma

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.     

Scrotal circumference of Australian beef bulls

Normal range for scrotal circumference in Australian beef bulls was established using more than 300,000 measurements of breed, management group, age, liveweight, and scrotal circumference. The data used were derived from Australian bull breeders and two large research projects in northern Australia. Most bulls were within 250 to 750 kg liveweight and 300 to 750 days of age. The differences between breeds and variances within breeds were higher when scrotal circumference was predicted from age rather than liveweight, because of variance in growth rates. The average standard deviation for predicted scrotal circumference from liveweight and age was 25 and 30 mm, respectively. Scrotal circumference by liveweight relationships have a similar pattern across all breeds, except in Waygu, with a 50 to 70 mm range in average scrotal circumference at liveweights between 250 and 750 kg. Temperate breed bulls tended to have higher scrotal circumference at the same liveweight than tropically adapted breeds. Five groupings of common beef breeds in Australian were identified, within which there were similar predictions of scrotal circumference from liveweight. It was concluded that liveweight and breed are required to identify whether scrotal circumference is within normal range for Australian beef bulls that experience a wide range of nutritional conditions.     

A case of human breast sparganosis diagnosed as Spirometra Type I by molecular analysis in Japan

A 92-year-old Japanese woman presented with a mass in the left breast, and sparganosis was suspected by biopsy of the mass. The mass disappeared once, but it reappeared at the same site one year later. For a definitive diagnosis, the mass was surgically removed, and a sparganum-like worm was detected. The causative agent was confirmed as Spirometra Type I (most probably Spirometra mansoni) by mitochondrial DNA analysis. The serological examination also proved the case as sparganosis. Considering the presence of two Spirometra species (Type I and II) in Asia, particularly Japan, molecular analysis of the causative agents is highly recommended to understand the epidemiology, infection sources, and pathogenicity in humans in both species, if the parasite specimens are available.     

A case of breast sparganosis

A 29-year-old Korean woman visited the Department of Surgery in MizMedi Hospital with a palpable itching mass on the right breast that had existed for the past 7 months. She had no history to eat either frogs or snakes, but had the history of drinking impure water. Sonography revealed a serpiginous hypoechoic tubular structure associated with partial fat necrosis in breast parenchymal layer and subcutaneous fat layer. It also revealed oval cystic lesions. At operation, an ivory white opaque ribbon-like worm that measured 16.5 cm in length and 0.5 cm in width was extracted. Anti-sparganum specific serum IgG level in the patient's serum (absorbance = 0.71), measured by ELISA, was found to be significantly higher than those of normal controls (cut off point = 0.21). Sonography and ELISA appear to be helpful to diagnose sparganosis. Breast sparganosis is rarely found throughout the world.     

Scrotal circumference measurements in 764 beef bulls.

A total of 764 breeding soundness examinations was conducted on beef bulls utilizing the method of examination and criteria for classifying bulls of the Society for Theriogenology. In addition to this examination each bull was subjected to scrotal circumference measurement and to weighing. Classification of the bulls according to breeding soundness potentials was as follows: 88% of the bulls were satisfactory potential breeders, 8% of the bulls were questionable potential breeders and 4% of the bulls were unsatisfactory potential breeders. The proportions of bulls in each classification; satisfactory, questionable, or unsatisfactory; were not different among the four breeds evaluated. The majority of bulls evaluated in this study were between 14 and 36 months of age and weighed between 900 and 1500 pounds. For the ages and weights evaluated, scrotal circumference measurement variances were not closely related to age and weight differences. There was a tendency shown for “Questionable” and “Unsatisfactory Potential Breeders” to have smaller scrotal circumference measurements. The study indicates that Angus, Charolais, Horned Hereford and Polled Hereford bulls of breeding ages and weights should have scrotal circumference measurements of at least 32 centimeters in order to be classified as “Satisfactory Potential Breeders”.     

Scrotal heating stimulates panting and reduces body temperature similarly in febrile and non-febrile rams (Ovis aries)

It is known that heating the ram scrotum stimulates heat loss resulting in a decrease in body temperature and that during fever core temperature increases, but local scrotal thermoeffectors operate to maintain normal scrotal temperature. We have investigated whether scrotal warming influences core body temperature and the panting effector during fever generation. We measured rectal temperature, intrascrotal temperature, scrotal skin temperature and respiratory frequency in four adult Merino rams following intravascular injection of saline or lipopolysaccharide at an ambient temperature of 18-20 degrees C while scrotal skin temperature was maintained at 33 degrees C or elevated to 41 degrees C. Compared to maintaining normal scrotal temperature, heating the scrotum increased respiratory frequency and reduced rectal temperature by a similar amount following LPS as following saline. Fever was associated with decreased respiratory frequency compared to saline at both 33 and 41 degrees C scrotal temperature, suggesting that the fever was generated mainly by decreasing respiratory heat loss. We conclude that scrotal thermal afferent stimulation resulted in an offset for the set-point of body temperature regulation in both normothermic and febrile rams.     

Scrotal size of yearling sires and early calving in beef herds: epidemiological investigation of possible causal pathways

Scrotal circumference has been recommended as a clinical test for predicting the fertility potential of yearling bulls. The objectives of this study were to determine if scrotal size of yearling bulls influences herd fertility and to investigate specific causal pathways. Calving records from 44 herds enrolled in the Beef Herd Improvement Plan were selected from the data base for 1984 to 1989. Logistic regression was used to model the event of calving within the first 3 wk of the calving season as a function of scrotal circumference, herd size, age and the interactions of scrotal circumference with age, scrotal circumference with herd size, and herd size with age and the random effects of herd. The odds of cows calving in the first 3 weeks of the calving season were lower in large herds (>30 vs 20 to 30 calves born per season) and with younger yearling bulls (12 to 15 vs. 16 to 18 months of age). Early calving was not associated with scrotal circumference, or the interactions scrotal circumference with herd size and scrotal circumference with age (p > 0.15). It was concluded that the female:male ratio and age of bull both affected the odds of a cow calving early, but neither of the associations was altered by selection for bulls with a larger scrotal circumference, and therefore scrotal circumference is not included in either of the 2 causal pathways.     

Testicular function and Scrotal coloration in patas monkeys

Patas monkeys ( Erythrocebus patas ) have aquamarine-coloured scrota, but data are unavailable regarding the potential connection between changes in scrotal coloration and testicular function. In the rhesus monkey ( Macaca mulatta ), seasonality of mating is accompanied by an intensification of red colour of the scrotum and a doubling of testicle size. A one-year study of male patas monkeys was undertaken in order to examine potential seasonal correlates of testicular function and scrotal colour. Increases in testosterone concentrations and testicular volume occurred during the mating season in adult males, but scrotal colour was fairly uniform throughout the year. Neither age, body weight, nor health influenced scrotal colour. These findings contradict the suggestion that the sex skin of seasonally breeding primates will become more intense during the mating season as a result of elevations in steroid hormone levels. Evidence from field studies in Africa suggest that the colour is part of a constellation of traits involved in male competition for mates.     

Traumatismes fermés des bourses: stratégie de prise en charge

Introduction

Blunt scrotal trauma is increasingly frequent, but surgical exploration of these cases of trauma remains controversial. The objectives of this study were to assess the diagnostic value of clinical examination and ultrasound in testicular trauma and to analyse the complications of the various treatments proposed (surgical and medical treatments), in order to more clearly define the place of medical or surgical treatment in this form of trauma in young adults.

Patients and Methods

130 cases of blunt scrotal trauma were managed between 1993 and 2004. In the absence of clinical and ultrasound criteria of severity (haematocele, very large intratesticular haematoma, rupture of the tunica albuginea), medical treatment consisting of rest, anti-inflammatory drugs, and testicular support was instituted. Surgical exploration was performed when serious lesions of the testis were suspected. Scrotal ultrasound was performed in 68 patients and 46 of them underwent scrotal exploration. The sensitivity and specificity of scrotal ultrasound were determined by comparing radiological findings with definitive intraoperative findings. The immediate morbidity and long-term sequelae were analysed.

Results

The mean age of the patients was 24 years (range: 4 to 73 years). The clinical features were dominated by pain (73.8%) and scrotal swelling (89.2%). The sensitivity of testicular ultrasound was 34.7% for testicular rupture, 100% for testicular contusions, 33.3% for intratesticular hematoma and 76.9% for haematocele. Medical and surgical treatments were instituted in 29.2% and 70.7% of cases, respectively. With a mean follow-up of 8 months, chronic pain and testicular atrophy were observed in 18% and 5.5% of cases, respectively.

Conclusion

In the absence of signs of severity, medical treatment with regular surveillance remains justified. However, in the presence of doubtful clinical or ultrasound findings, surgical exploration must be performed as soon as possible     

Splenogonadal fusion diagnosed by Doppler ultrasonography

Splenogonadal fusion usually presents as a left scrotal mass but rarely is the diagnosis suspected preoperatively. Herein, we present the first report of a left splenogonadal fusion which was suspected preoperatively by doppler ultrasonography in a 2 year old boy.     

A seroepidemiologic survey for human sparganosis in Gangweon-do

Gangweon-do is known to be highly endemic area of sparganosis more than other provinces in Korea. A seroepidmiologic examination for the detection of anti-Spirometra erinacei plerocercoid IgG in serum was carried out in normal inhabitants in Hongcheon-gun, Gangweon-do. Sere were tested by enzyme-linked immunosrobent assay (ELISA) for the anti-sparganum antibodies. Positive rate for anti-sparganum antibody in 719 adults was 3.3%. Data of the questionnaire for 24 ELISA positive inhabitants revealed that 20 had a history of eating raw meat of snakes, 24 had a history of eating frogs, and 24 had a history of drinking stream water. Two positive cases had a past history of sparganosis. Two positive cases showed current symptoms of sparganosis. The data revealed that ELISA would be useful to find infected cases among normal inhabitants at sparganosis-endemic areas.     

Scrotal circumference does not accurately predict degree of germinal epithelial loss or semen quality in yearling Hereford and Simmental bulls

The accuracy of scrotal circumference as a predictor of specific pathologic changes within testicular parenchyma was assessed by scoring 121 Hereford and Simmental bulls for scrotal circumference, degree of germinal epithelial loss and semen quality. Scrotal circumference was not linearly related to the degree of germinal epithelial loss or to the percentage of tubules (Grade 4+ or higher, no germinal epithelium) for either breed (P > 0.1). Thirty-two centimeters was the minimal acceptable scrotal circumference to ensure both a low prevalence of tubules with irreversible loss of germinal epithelium and acceptable semen quality. Scrotal circumference had a positive predictive value (the proportion of test-positive animals truly diseased) of 0.07 (95% confidence interval [CI] of 0 to 0.29) and a specificity (the proportion of test postive individuals that are diseased) of 0.89 (95% CI of 0.83 to 0.95) for 25% Grade 4 + tubules. For acceptable semen morphology (>/= 75% morphologically normal spermatozoa), scrotal circumference had a positive predictive value of 0.08 (95% CI of 0 to 0.34), a sensitivity (the proportion of diseased individuals testing positively) of 0.06 (95% CI of 0 to 0.24), and a specificity of 0.88 (95% CI of 0.80 to 0.95). For acceptable sperm motility (>/= 30% progressively motile spermatozoa) scrotal circumference had a positive predictive value of 0.0 (95% CI of 0 to 0.22), a sensitivity of 0.0 (95% CI of 0 to 0.15), and a specificity of 0.87 (95% CI of 0.80 to 0.94). Although scrotal circumference is widely accepted as a useful test, its accuracy should be recognized as low when 32 cm is used as the minimal acceptable scrotal circumference in predicting unacceptable testicular histology or unacceptable semen quality in a healthy population of yearling bulls.     

A Human Case of Lumbosacral Canal Sparganosis in China

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People’s Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1–S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1–S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study.     

Sorafenib-induced Scrotal Eczema

Sorafenib is an orally active, small-molecule multikinase inhibitor that blocks tumor cell proliferation and angiogenesis. Studies have shown that it is a highly potent, selective inhibitor of vascular endothelial growth factor receptors 2 and 3, platelet-derived growth factor-β, RAF, FLT-3, and c-Kit. This drug was recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. We report a case of a patient treated with sorafenib for metastatic renal cell carcinoma who developed scrotal eczema.Key words: Sorafenib, Scrotal eczema, Hand-foot skin reactionSorafenib is approved by the US Food and Drug Administration for use in metastatic renal cell carcinoma.¹ It is a multikinase inhibitor that blocks both tumor cell proliferation and angiogenesis. ² Up to 90% of patients receiving sorafenib have reported dermatologic symptoms, including handfoot skin reaction, facial erythema, subungual hemorrhage, alopecia, pruritus, and xerosis.³ Here we report on a patient on sorafenib who presents with the uncommon adverse effect of scrotal eczema.     

Proteomic and Immunological Identification of Diagnostic Antigens from Spirometra erinaceieuropaei Plerocercoid

Human sparganosis is a food-borne parasitic disease caused by the plerocercoids of Spirometra species. Clinical diagnosis of sparganosis is crucial for effective treatment, thus it is important to identify sensitive and specific antigens of plerocercoids. The aim of the current study was to identify and characterize the immunogenic proteins of Spirometra erinaceieuropaei plerocercoids that were recognized by patient sera. Crude soluble extract of the plerocercoids were separated using 2-dimensional gel electrophoresis coupled with immunoblot and mass spectrometry analysis. Based on immunoblotting patterns and mass spectrometry results, 8 antigenic proteins were identified from the plerocercoid. Among the proteins, cysteine protease protein might be developed as an antigen for diagnosis of sparganosis.     

<Emphasis Type="Italic">Paracoccidioides brasiliensis</Emphasis> Infection Mimicking Recurrent Hodgkin Lymphoma: A Case Report and Review of the Literature

Paracoccidioides infection is a rare entity in the USA. This dimorphic fungus is found in Central and South America and is thought to be acquired by inhalation through the soil. We report a case of Paracoccidioides brasiliensis infection presenting as a clavicular bone lesion, peripancreatic mass, and various skin lesions. A 35-year-old man with a history significant for Hodgkin lymphoma presented with a left clavicular mass that was suspected clinically and radiologically as recurrent Hodgkin lymphoma. He was not experiencing any associated symptoms and was undergoing chemotherapy treatment for his known Hodgkin disease. On CT imaging, the mass was seen as a lytic bone lesion with an overlying soft tissue mass. This was biopsied and histologically diagnosed as a Paracoccidioides brasiliensis infection with associated necrotizing granulomatous inflammation. Also found on the CT scan was an enlarging peripancreatic mass which on endoscopic biopsy had similar histologic findings. In conclusion, this report presents a rare case of Paracoccidioides brasiliensis infection mimicking recurrent Hodgkin lymphoma.     

Molecular identification of a causative parasite species using formalin-fixed paraffin embedded (FFPE) tissues of a complicated human pulmonary sparganosis case without decisive clinical diagnosis

PCR-based molecular diagnosis was made for the identification of causative agents of the clinically suspected pulmonary proliferative sparganosis case found in Thailand using formalin-fixed paraffin-embedded (FFPE) biopsy specimens. As a reference, FFPE biopsy specimen from a typical cutaneous sparganosis case was examined together. DNA samples were extracted from tissues and two partial fragments of cytochrome c oxidase subunit 1 (cox1) gene were amplified for the detection of Spirometra DNA. Two cox1 fragments were amplified successfully for both specimens. After alignment of nucleotide sequences of the PCR-amplicons, the causative agents of both cases were identified as Spirometra erinaceieuropaei.     

超声引导下精索阻滞麻醉对阴囊急诊手术患者应激反应和并发症的影响

摘要 目的：探究超声引导下精索阻滞麻醉对阴囊急诊手术患者应激反应和并发症的影响。方法：选择2020年10月至2022年12月来我院行阴囊急诊手术的急诊患者60例,按照随机数表法,分为观察组（n=30）和对照组（n=30）。两组均行精索阻滞麻醉,其中对照组采用盲探穿刺法,观察组采用超声引导的方式。比较两组患者阻滞成功率、麻醉方式更改人数、麻醉药物追加人数及并发症发生人数,比较不同时间点两组的疼痛（VAS）评分,比较术前及术后两组的应激反应[皮质醇（Cor）]、抗氧化指标[超氧化物歧化酶（SOD）]、炎性因子[白细胞介素-6（IL-6）、白细胞介素-8（IL-8）]水平。结果：观察组患者阻滞成功率为90.00%,高于对照组的66.67%（P＜0.05）,观察组麻醉方式更改率为6.67%低于对照组的9例30.33%（P＜0.05）,两组麻醉药物追加人数比较,差异无统计学意义（P＞0.05）;手术开始5 min及术后4、8、12 h时,观察组患者的VAS评分均低于对照组的（P＜0.05）;两组患者术后24 h时的Cor、IL-6、IL-8水平均高于术前,但是观察组为低于对照组（P＜0.05）,两组术后24 h的SOD均低于术前,而观察组为高于对照组（P＜0.05）;观察组的血肿、刺破血管发生率分别为6.67%、10.00%,均低于对照组的30.00%、36.67%（P＜0.05）。结论：精索阻滞麻醉对阴囊急诊手术患者具有较好的阻滞效果,能够为患者带来更好的镇痛效果,降低术后应激及炎症反应。     

Relationship between semen quality and pixel-intensity of testicular ultrasonograms after scrotal insulation in beef bulls

The objective of this study was to determine the relationship between semen quality and testicular pixel-intensity derived from image analysis of ultrasonograms after scrotal insulation in bulls. In addition, the ability to predict semen quality based on testicular pixel-intensity was evaluated. Sixteen beef bulls were selected on the basis of satisfactory semen quality and normal testicular ultrasonogram appearance. Bulls were allocated into two groups for scrotal insulation for 4 days (group 1) or 8 days (group 2). Semen was collected and evaluated twice weekly and testicular ultrasonograms were evaluated once weekly for 8 weeks after removal of scrotal insulation. In general, the percentages of motile and morphologically normal spermatozoa decreased below pre-insulation levels from 1 to 5 weeks after scrotal insulation removal. Overall, group 1 had greater (P < 0.01) percentages of motile and normal spermatozoa than group 2. Mean testicular pixel-intensity (PI), and the number of pixels corresponding to the intensity that occurs most frequently (NP) decreased in the first 2-3 weeks after scrotal insulation, coincidently with the decrease in sperm motility and normal morphology. When the entire data set was evaluated, there was no association between testicular PI or NP with semen quality observed at the same week of ultrasound examinations. However, regression models indicated that testicular PI and NP accounted for 13-25% of the variation in sperm motility and morphology in ejaculates collected 2-4 weeks after ultrasound exam. Testicular PI and NP had moderate sensitivity and negative predictive values (64.5-82.6%), but low specificity and positive predictive values (33.3-61.2%) as predictors of satisfactory semen quality (> or = 60% motile spermatozoa and > or = 70% morphologically normal spermatozoa) for ejaculates collected 2-4 weeks after ultrasound exam. In conclusion, the deleterious effects of scrotal insulation on semen quality were dependent on the length of the period of insulation and were associated with changes in testicular ultrasonogram pixel-intensity. Testicular ultrasonogram pixel-intensity had a better association with future semen quality than with present semen quality and was a better predictor of unsatisfactory semen quality than satisfactory semen quality.