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Most popular medical Questions
Which boys with gynecomastia warrant further evaluation?Prepubertal boys
Pubertal-age boys with little or no virilization and small testes
Hepatomegaly or abdominal mass palpated
Child with central nervous system complaints
Evaluations may include testing for hypothalamic or pituitary disease, feminizing tumors of the adrenal or testes, and genetic abnormalities (e.g., Klinefelter syndrome). Although breast cancer is nearly reportable if it occurs in boys and is extremely rare in men (0.2%), in patients with Klinefelter syndrome, the rate increases to 3-6%.
What treatment options are available for developmental gynecomastia?
Treatment usually depends on the amount of breast tissue present and the degree of psychological problems that this causes. There are three primary options. Reassurance: Explanation of the process and expected resolution usually suffices for most adolescents. They should be told that resolution can take up to 24 months. Medications: These may include antiestrogens (clomiphene citrate, tamoxifen), aromatase inhibitors (testolactone), nonaromatizable androgens (dihydrotestosterone), and weak androgens (danazol). Surgery: This should be done by a plastic surgeon who has experience in breast reduction.
What are the clinical manifestations of testicular torsion?
Testicular torsion in adolescents usually presents with acute-onset hemiscrotal pain that radiates to the groin and lower abdomen. Nausea and vomiting are common, but fever is rare. The testis is acutely tender and swollen, and it may be high riding. The cremasteric reflex is absent. Many patients report previous episodes of severe acute scrotal pain. Radionuclide imaging of the scrotum with Tc-99m pertechnetate and/or color Doppler ultrasound demonstrates low or absent blood flow and can be helpful in equivocal cases. However, testis salvage depends on the timely restoration of blood flow, and obtaining such studies should not delay a highly suspect case from surgical exploration. The spermatic cord sometimes can be untwisted manually; this will give temporary relief, but surgical exploration is still required for fixation to prevent recurrence. Both testes may be secured because the underlying suspension defect is often bilateral.
How does the Prehn sign help distinguish between epididymitis and testicular torsion?
Classically, relief of pain with elevation of the testis (negative Prehn sign) is associated with epididymitis, whereas persistent pain (positive Prehn sign) is more indicative of testicular torsion. However, there is considerable overlap, and this relatively nonspecific sign should be interpreted in the context of other signs and symptoms.
If complete testicular torsion has occurred, how long is it before irreversible changes develop?
Irreversible changes develop in 4-6 hours. However, it is clinically impossible to distinguish partial from complete torsion, and thus duration of symptoms should not be used as a gauge for determining viability. Duration of symptoms does correlate with abnormal testicles on follow-up examination, which underscores the need for prompt diagnosis. Two thirds of patients with testicles salvaged between 12 and 24 hours after the onset of symptoms have palpable evidence of testicular atrophy during later evaluation as compared with only 10% when the diagnosis is made in 6 hours.
What is the most frequent solid cancer in older adolescent males?
Testicular cancer. The most common type is a seminoma, which, if detected when confined to the testicle (stage I), has a cure rate of up to 97% with orchiectomy and radiation. Although its overall effectiveness is debated, most authorities recommend that all adolescent males be taught testicular self-examination so that irregularities or changes in size can be noted early.
On which side do varicoceles more commonly occur?
The left side. The left spermatic vein drains into the left renal vein, and the right spermatic vein drains into the inferior vena cava. These hemodynamics favor higher left-sided pressures, which predispose patients to left-sided varicoceles. Unilateral left-sided varicoceles are the most common types, occurring in 90% of patients; the remainder are bilateral. A unilateral right-sided lesion is rare, and many experts consider its finding a reason to search for other causes of venous obstruction, such as a renal or retroperitoneal tumor, using ultrasound, computed tomography, or magnetic resonance imaging.
An adolescent who boasts of his overpowering "hircismus" is likely in need of what?
Both a dictionary and a shower. Hircismus is offensive axillary odor.
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