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Testicular Self-Exam

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81. Breast Implants, Silicone: Safety and Efficacy

that the mammographer can minimize the amount of breast that is hidden by an implant. Approximately 9% to more than 20% of breast cancers in all women are invisible on radiographs. Despite the increasing use of mammography, most breast cancers still are discovered by self-examination or physician examination. Many clinicians believe that the presence of an implant can increase the ease of palpation. To date, no cases have been documented in the medical literature in which a diagnosis of breast cancer was delayed (...) with the medication depending on the lipid characteristics of the drug used. Because insulin binds to silicone, extrapolative calculations suggest that patients with type I diabetes may inject as much as 25-30 g of silicone over a lifetime. In its solid form, silicone elastomers are used for pacemaker coatings, tubing, prosthetic joints, hydrocephalus shunts, and penile implants, and as the envelope for Norplant and other implanted drug-delivery systems. Some testicular and chin implants are similar to breast

2014 eMedicine Surgery

82. Late Effects of Childhood Cancer and Treatment (Overview)

capabilities. Chemotherapy agents, specifically alkylating agents can affect ovarian and testicular function as well. [ ] The hypothalamus tends to be more sensitive to effects of radiation than the pituitary gland. Growth hormone (GH) is the first hormone to be affected, followed by gonadotropins and then adrenocorticotropic hormone (ACTH) secretion. This effect is related to the total dose and fraction size of radiation received. Age at the time of treatment is also a factor; younger patients are more (...) implications for patient education and family planning. [ ] Fertility Irradiation of the gonads can also affect fertility.{ref1556-INVALID REFERENCE} Delivery of as little as 2-3 Gy to the testes causes 100% aspermia with no recovery after as many as 40 months of follow-up. This is an important consideration for boys undergoing testicular irradiation for testicular germ cell tumors or testicular disease from ALL, abdominal irradiation for advanced Hodgkin disease, or total-body irradiation with bone marrow

2014 eMedicine Pediatrics

83. Cryptorchidism (Overview)

children, as opposed to only 33-65% with bilateral undescended testes. [ , ] Facilitation of testicular self-examination for testicular cancer Males with undescended testis are 40 times as likely to develop as males without undescended testis. [ ] Ten percent of testicular cancer cases involve patients with undescended testis. [ , ] Prepubertal orchiopexy reduces this risk. [ , ] The ability for patients to perform testicular self-examination with the testes in the scrotum is a clear benefit of surgery (...) in 1820 by Rosenmerkal. However, it was not until 1877 that Annandale performed the first successful orchiopexy. [ ] Previous Next: Problem Normal testicular development begins at conception. The testis-determining factor is now identified as the SRY gene (sex-determining region on Y chromosome). The presence of this gene and an intact downstream pathway generally result in testicular formation. At 3-5 weeks' gestation, the gonadal ridge or indifferent gonad develops, and, at 6 weeks' gestation

2014 eMedicine.com

85. Spermatocele (Overview)

. They are often incidental findings on testicular self-examination or routine physical examination. As they usually arise from the head of the epididymis, they are found superior to the testicle. They are smooth and spherical and transilluminate on examination. Failure to transilluminate suggests a solid lesion, which warrants further evaluation, including scrotal ultrasonography and possible inguinal exploration. [ , , ] Previous Next: Indications Surgical intervention is not indicated for the incidental (...) recognized for more than 100 years. Treatment for spermatoceles is with sclerotherapy or surgical excision. [ ] In the former, aspiration of the fluid from the spermatocele is followed by injection of a sclerosing agent (eg, polidocanol, 99.5% alcohol, 5% ethanolamine oleate, phenol, tetracycline) to reduce recurrences. [ , , , , ] Surgery consists of spermatocelectomy; microsurgical spermatocelectomy may reduce the risk of epididymal injury, testicular atrophy, and recurrence. [ , ] Pathological

2014 eMedicine.com

87. Spermatocele (Diagnosis)

. They are often incidental findings on testicular self-examination or routine physical examination. As they usually arise from the head of the epididymis, they are found superior to the testicle. They are smooth and spherical and transilluminate on examination. Failure to transilluminate suggests a solid lesion, which warrants further evaluation, including scrotal ultrasonography and possible inguinal exploration. [ , , ] Previous Next: Indications Surgical intervention is not indicated for the incidental (...) recognized for more than 100 years. Treatment for spermatoceles is with sclerotherapy or surgical excision. [ ] In the former, aspiration of the fluid from the spermatocele is followed by injection of a sclerosing agent (eg, polidocanol, 99.5% alcohol, 5% ethanolamine oleate, phenol, tetracycline) to reduce recurrences. [ , , , , ] Surgery consists of spermatocelectomy; microsurgical spermatocelectomy may reduce the risk of epididymal injury, testicular atrophy, and recurrence. [ , ] Pathological

2014 eMedicine.com

88. Cryptorchidism (Follow-up)

provider or surgeon should evaluate the child at 2-3 weeks and 6-12 months following surgery to determine testis location, size, and viability. When the child reaches puberty, the physician should readdress the potential issues of fertility and testicular cancer and give instructions concerning the boy's monthly testicular self-examination. Previous Next: Complications Complications of orchiopexy are as follows: Inadequate testis position occurs in up to 10% of patients and is due to incomplete (...) androgens. The exact mechanism of action of the increased androgens in testicular descent is not known but may involve effects on the testicular cord or cremaster muscle. hCG is administered via intramuscular injection. Multiple series on the efficacy of hCG have been published; however, because of differences in patient age, treatment schedules, and possible inclusion of retractile testes, very divergent results have been reported. A meta-analysis of hCG treatment of cryptorchidism concluded that hCG

2014 eMedicine.com

89. Infertility (Follow-up)

with hyperthyroidism. The presence of epicanthus, lower implantation of the ears and hairline, and webbed neck can be associated with chromosomic abnormalities. Carefully evaluate the thyroid gland to exclude gland enlargement or thyroid nodules. Perform a breast examination to evaluate breast development and to seek abnormal masses or secretions, especially galactorrhea. Take the opportunity to educate patients about breast self-examination during the early days of their menstrual cycles. The abdominal (...) that affect fertility include the following categories: Pretesticular: Congenital or acquired diseases of the hypothalamus, pituitary, or peripheral organs that alter the hypothalamic-pituitary axis Testicular: Genetic or nongenetic Posttesticular: Congenital or acquired factors that disrupt normal transport of sperm through the ductal system Factors that affect the fertility of both sexes include the following: Environmental/occupational factors Toxic effects related to tobacco, marijuana, or other drugs

2014 eMedicine.com

90. Ichthyosis, X-Linked (Diagnosis)

of an annoyance than a serious medical problem. Previous Next: Patient Education Instruct patients in techniques for regular self-examination to detect testicular carcinoma. Previous References Wells RS, Kerr CB. Genetic classification of ichthyosis. Arch Dermatol . 1965 Jul. 92(1):1-6. . Elias PM, Crumrine D, Rassner U, et al. Basis for abnormal desquamation and permeability barrier dysfunction in RXLI. J Invest Dermatol . 2004 Feb. 122(2):314-9. . Ramesh R, Bouloux P, Dorkins HR, Ellis R, Buch M, Batta K

2014 eMedicine.com

91. Infertility (Diagnosis)

with hyperthyroidism. The presence of epicanthus, lower implantation of the ears and hairline, and webbed neck can be associated with chromosomic abnormalities. Carefully evaluate the thyroid gland to exclude gland enlargement or thyroid nodules. Perform a breast examination to evaluate breast development and to seek abnormal masses or secretions, especially galactorrhea. Take the opportunity to educate patients about breast self-examination during the early days of their menstrual cycles. The abdominal (...) that affect fertility include the following categories: Pretesticular: Congenital or acquired diseases of the hypothalamus, pituitary, or peripheral organs that alter the hypothalamic-pituitary axis Testicular: Genetic or nongenetic Posttesticular: Congenital or acquired factors that disrupt normal transport of sperm through the ductal system Factors that affect the fertility of both sexes include the following: Environmental/occupational factors Toxic effects related to tobacco, marijuana, or other drugs

2014 eMedicine.com

93. Bone Marrow Transplantation, Long-Term Effects (Overview)

exposure. Perform breast self-examination. Perform skin self-examination. Eat high-fiber foods and foods with vitamins A and C. Decrease fat in the diet. Have an annual professional dermatology exam. Endocrinopathies Obtain thyroid-stimulating hormone (TSH) and free T4 levels annually for those who received TBI. Measure annual growth velocity. (If abnormal, evaluate with provocative testing.) Monitor secondary sex characteristics (eg, menses and follicle-stimulating hormone [FSH] and luteinizing (...) was 2.1 and seemed to decrease over time. All of the second malignancies were solid tumors, and 9 of them were meningiomas. [ ] Overall, the risk of developing a second malignancy from growth hormone therapy remains unclear and should be weighed against the benefits in childhood cancer survivors. Gonadal dysfunction High-dose alkylator and radiation therapy used as conditioning for HSCT invariably affect ovarian and testicular function. When discussing gonadal dysfunction, 2 distinct aspects must

2014 eMedicine Pediatrics

94. Disorders of the Breast (Overview)

with a positive family history. [ ] Screening guidelines for patients with a history of atypia on breast biopsy findings are still evolving. In adults, current recommendations include yearly physician examinations and yearly mammography. [ ] Patients should be aware of the limitations and should be taught how to perform self-examinations on their breasts. No data indicate that the additive radiation from mammography increases the risk of breast cancer. These recommendations should be followed in children (...) . [ ] The differential diagnosis for gynecomastia includes the following: Testicular feminization Hormone-secreting tumors Drug use (eg, cimetidine, marijuana) Familial predisposition Previous Next: Malignant Breast Disease in Children and Adolescents Malignant breast disease is uncommon in children and in adolescents. Risk factors for breast malignancies include the following: History of familial breast cancer Previous benign disease associated with malignancy (ie, fibrocystic changes with atypia) Other

2014 eMedicine Pediatrics

95. Late Effects of Childhood Cancer and Treatment (Treatment)

capabilities. Chemotherapy agents, specifically alkylating agents can affect ovarian and testicular function as well. [ ] The hypothalamus tends to be more sensitive to effects of radiation than the pituitary gland. Growth hormone (GH) is the first hormone to be affected, followed by gonadotropins and then adrenocorticotropic hormone (ACTH) secretion. This effect is related to the total dose and fraction size of radiation received. Age at the time of treatment is also a factor; younger patients are more (...) implications for patient education and family planning. [ ] Fertility Irradiation of the gonads can also affect fertility.{ref1556-INVALID REFERENCE} Delivery of as little as 2-3 Gy to the testes causes 100% aspermia with no recovery after as many as 40 months of follow-up. This is an important consideration for boys undergoing testicular irradiation for testicular germ cell tumors or testicular disease from ALL, abdominal irradiation for advanced Hodgkin disease, or total-body irradiation with bone marrow

2014 eMedicine Pediatrics

96. Cryptorchidism (Treatment)

to seeing the patient again at the time of puberty. Discussions of fertility issues and the need for self-examination to detect cancer should be revisited. Previous References Braga LH, Lorenzo AJ. Cryptorchidism: A practical review for all community healthcare providers. Can Urol Assoc J . 2017 Jan-Feb. 11 (1-2Suppl1):S26-S32. . . Barthold JS, Redman JF. Association of epididymal anomalies with patent processus vaginalis in hernia, hydrocele and cryptorchidism. J Urol . 1996 Dec. 156(6):2054-6 (...) fertility and hormonal production To diagnose potential testicular malignancies Other putative benefits include correction of associated hernias and prevention of testicular torsion. The risk of trauma and possible psychological effects of having a missing testis must be taken into account. Orchiopexy should be considered after 4 months of life; the rate of descent diminishes considerably after this point. For postpubertal adolescents and men younger than 32 years who underwent unilateral orchiopexy

2014 eMedicine Pediatrics

97. Disorders of the Breast (Treatment)

with a positive family history. [ ] Screening guidelines for patients with a history of atypia on breast biopsy findings are still evolving. In adults, current recommendations include yearly physician examinations and yearly mammography. [ ] Patients should be aware of the limitations and should be taught how to perform self-examinations on their breasts. No data indicate that the additive radiation from mammography increases the risk of breast cancer. These recommendations should be followed in children (...) . [ ] The differential diagnosis for gynecomastia includes the following: Testicular feminization Hormone-secreting tumors Drug use (eg, cimetidine, marijuana) Familial predisposition Previous Next: Malignant Breast Disease in Children and Adolescents Malignant breast disease is uncommon in children and in adolescents. Risk factors for breast malignancies include the following: History of familial breast cancer Previous benign disease associated with malignancy (ie, fibrocystic changes with atypia) Other

2014 eMedicine Pediatrics

98. Cryptorchidism (Diagnosis)

children, as opposed to only 33-65% with bilateral undescended testes. [ , ] Facilitation of testicular self-examination for testicular cancer Males with undescended testis are 40 times as likely to develop as males without undescended testis. [ ] Ten percent of testicular cancer cases involve patients with undescended testis. [ , ] Prepubertal orchiopexy reduces this risk. [ , ] The ability for patients to perform testicular self-examination with the testes in the scrotum is a clear benefit of surgery (...) in 1820 by Rosenmerkal. However, it was not until 1877 that Annandale performed the first successful orchiopexy. [ ] Previous Next: Problem Normal testicular development begins at conception. The testis-determining factor is now identified as the SRY gene (sex-determining region on Y chromosome). The presence of this gene and an intact downstream pathway generally result in testicular formation. At 3-5 weeks' gestation, the gonadal ridge or indifferent gonad develops, and, at 6 weeks' gestation

2014 eMedicine.com

99. Bone Marrow Transplantation, Long-Term Effects (Treatment)

exposure. Perform breast self-examination. Perform skin self-examination. Eat high-fiber foods and foods with vitamins A and C. Decrease fat in the diet. Have an annual professional dermatology exam. Endocrinopathies Obtain thyroid-stimulating hormone (TSH) and free T4 levels annually for those who received TBI. Measure annual growth velocity. (If abnormal, evaluate with provocative testing.) Monitor secondary sex characteristics (eg, menses and follicle-stimulating hormone [FSH] and luteinizing (...) was 2.1 and seemed to decrease over time. All of the second malignancies were solid tumors, and 9 of them were meningiomas. [ ] Overall, the risk of developing a second malignancy from growth hormone therapy remains unclear and should be weighed against the benefits in childhood cancer survivors. Gonadal dysfunction High-dose alkylator and radiation therapy used as conditioning for HSCT invariably affect ovarian and testicular function. When discussing gonadal dysfunction, 2 distinct aspects must

2014 eMedicine Pediatrics

100. Late Effects of Childhood Cancer and Treatment (Follow-up)

capabilities. Chemotherapy agents, specifically alkylating agents can affect ovarian and testicular function as well. [ ] The hypothalamus tends to be more sensitive to effects of radiation than the pituitary gland. Growth hormone (GH) is the first hormone to be affected, followed by gonadotropins and then adrenocorticotropic hormone (ACTH) secretion. This effect is related to the total dose and fraction size of radiation received. Age at the time of treatment is also a factor; younger patients are more (...) implications for patient education and family planning. [ ] Fertility Irradiation of the gonads can also affect fertility.{ref1556-INVALID REFERENCE} Delivery of as little as 2-3 Gy to the testes causes 100% aspermia with no recovery after as many as 40 months of follow-up. This is an important consideration for boys undergoing testicular irradiation for testicular germ cell tumors or testicular disease from ALL, abdominal irradiation for advanced Hodgkin disease, or total-body irradiation with bone marrow

2014 eMedicine Pediatrics

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