Focal scrotal swelling would suggest a hernia, hydrocele, torsion of the testicle, abscesses, epididymitis, orchitis, varicoceles, and testicular tumors. The presence of diffuse edema of the scrotum with ascites or generalized edema would suggest congestive heart failure, nephrosis, uremia, or cirrhosis. The presence of painful scrotal swelling would suggest an incarcerated or strangulated inguinal hernia, torsion of the testicle, a hematoma, orchitis, epididymitis, furuncle, or abscess. If the mass transilluminates, it is very likely a hydrocele of the testicle or a spermatocele. If intestinal obstruction is suspected, a flat plate of the abdomen and lateral decubitus should be ordered. Ultrasonography or a radionuclide testicular scan with technetium-99m are useful in differentiating between testicular torsion and epididymitis. Scrotal ultrasound may be done to evaluate any kind of testicular or scrotal mass. This would suggest a viral, bacterial or autoimmune disorder somewhere in the body. It may also suggest multiple myeloma, neoplasm, or some myeloproliferative disorder. If there is significant lower abdominal pain, consider the possibility that the increased sedimentation rate is due to pelvic inflammation disease, appendicitis, or diverticulitis. If there is upper abdominal pain, consider the possibility of cholecystitis, pancreatitis, or a diaphragmatic abscess. In this case, the increased sedimentation rate may be due to polymyalgia rheumatica although dermatomyositis and other collagen disease need to be considered. If so, look for rheumatoid arthritis, lupus erythematosus, and multiple myeloma as well as septic arthritis or osteomyelitis. If none of these questions provide a positive answer, consider the possibility of leukemia, macroglobulinemia, metastatic carcinoma, or another collagen disease.
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Whereas preoperative radiotherapy and radical cystectomy should be restricted to patients under 65 yrs, radical radiotherapy with salvage cystectomy is good for patients above 65 yrs. In case of radical radiotherapy optimal dose is 6,000 rads given over a period of 6 weeks or more. If after irradiation viable tumour is still demonstrable, cystectomy, can be considered. In case of preoperative irradiation a dose of 2,000 to 4,000 rads are given followed by radical cystectomy and pelvic node dissection. The drugs used are 5- fluorouracil, methotrexate, adriamycin, cyclophosphamide, cis- platinum. Promising results have been achieved with parenteral cyclophosphamide, cis-platinum and doxorubicin. There has been several attempts to improve on the result of single agent chemotherapy using 2 or 3 drugs combination. Not many malignant tumours yield themselves to this operation, since many of them are situated near the trigone. If the tumour is situated on the superior surface, the peritoneum has to be opened. The surface of the tumour is first lightly coagulated to prevent possible implantation of tumour cells. The incision in the bladder wall is now extended with a diathermy to remove the tumour together with 1 cm of healthy bladder wall. As soon as the excision is carried out, tissue forceps are applied to the margins of the cut bladder, so that they are not retracted. If the surgeon is very confident that the haemorrhage has been well controlled, he can rely on simple transurethral drainage.
Joey, 28 years: Diagnosis can be established by the history that the patient gets respiratory difficulty during feeding.
Seruk, 27 years: The aim is to free all the intes- tine from the anterior and lateral abdominal wall, first on one side of the incision and then on the other, so the anterior and lateral layers of parietal peritoneum are completely free of intestinal attachments (Fig.
Jared, 51 years: Such adenomas may occur in any part of the cortex, although they are commonly seen close to the surface.
Hamlar, 58 years: The perineal surgeon, after a concentric dissection of anal sphincters, concentrates on dissecting anteriorly until the pouch of peritoneum in front of the rectum is opened.
Kamak, 49 years: To divide adhesions in these cases, many of the loops of Extensive damage requires bowel resection with anastomo- bowel can be separated by inserting the index finger between sis by sutures or stapling.
Nerusul, 22 years: Temporary decompression after colorectal surgery: randomized Peristomal sepsis is surprisingly uncommon.