Clinical Case Studies

Discussion in 'Men's Health Forum' started by Michael Scally MD, Aug 17, 2011.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Images Physicians Should Know
    NEJM | Classic Clinical Images, Images Physicians should know, NEJM Images

    This collection of images is selected from our “Images in Clinical Medicine” series. They are classic representations of common, visually appealing, and important medical conditions. Images play an important role in what we do and how we learn, and this feature is intended to capture the sense of visual discovery and variety that physicians experience. Click on the image to learn more.
     
  2. BBC3

    BBC3 Member

    Seems like there must be a laser therapy that would quickly know that out.

     
  3. BBC3

    BBC3 Member

    So then truely my hair IS moving to my Back - LOL and just needs to be put back up there... Now if I could just get that damn gremlin that comes round in the night to undo what he did for free.

    Or perhaps, its when a woman touches our scalps and then our backs and during sex. She is moving our essence... LOL

    The old transplant stuff is really bad and because we all wind up with the COURSE head hairs and no fine filler hairs. But worse, and CHARLES GRODIN ( I suspect) and Nick Cage (pretty sure) are the WORSE case examples as they have freakishly thinned the side and back head hairs to the point that they look like a hedge hog that go in a fight with a badger. And now one big scruff....

    On that note if you pay attention to cages biggest moving failures lately, and I am not sure, but I know the second one with the devil and car and all he was going with his natural look. HE SEEMS HELL BENT ON DESTROYING HIS CAREER over that fact that he wants to be a natural beaty still. If you look at him in flicks where he is wearing a weave or whatever, his acting shines through, cause you are not looking at that scalp... He really NEVER needs to take another role that he is not wearing a hair piece and he could still stand a chance as going down in history where his acting power deserves to be...

     
  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Fordyce's Angiokeratomas
    MMS: Error

    During a routine full-body skin examination, a 60-year-old man was incidentally found to have numerous firm purple papules measuring 1 to 2 mm in diameter and covering the scrotum. The patient reported that the lesions had been present for “many years” and were asymptomatic. Diagnosis of angiokeratomas of the scrotum (Fordyce's angiokeratomas) was made. Angiokeratomas of the scrotum often arise in the second or third decade but are most commonly diagnosed in elderly men. There have been reported associations with thrombophlebitis of the scrotum, varicoceles, and inguinal hernias. The lesions may also occur in women and involve the vulvar area. No treatment is necessary unless there is associated pinpoint bleeding, in which case simple electrofulguration of the symptomatic lesions is curative.

    s-Angiokeratomas.gif
     
  5. BBC3

    BBC3 Member

    I actually found one of those on my sak at 40 when performing a now less and less routine inventory LOL. I RIPPED IT OFF, DESTROYED IT, ANNHIALATED IT.....! They are def some kind of vericose or circulatory disorder associated with the capillaries or blood supply in the skin. SOLUTION/PREVENTION - increase extensive massage with hot oils by self and or mate... LOL

     
  6. BBC3

    BBC3 Member

    Since you have so much here with regard to genetalia, here goes...

    Ya Know Doc. I got one for ya. And this is a subject that is dealt with by MANY men starting around puberty, AND NO ONE SEEMS TO KNOW THE ANSWER. I actually had a doc tell me that "he did not know what they were, but he had them too".. LOL But to address this would be THE FIRST PUBLICATION IN HISTORY. And would help to ease the minds and consciences of MILLIONS of young men.....

    What I am referring to is the appearance of "White or Zit like Pimples" on the penis and scrotum. They typically occur around the Base of the penis, and on the scrotum I suspect in most. I also suspect they occur at areas where hair follicles are located, OR WILL BE ONE DAY. They are about the size of a pinhead, and comprised of a white semi-solid substance not really oily like a zit, but with similar texture. If one tries to "pop" it, or remove it, they can be very stubborn and require even mild trauma in order to express the deposit from within the skin. I HAVE NEVER MET A DOC TO ACKNOWLEDGE OR MAKE THIS CONNECTION. But you can clearly see them on porn stars from time to time, pehaps with no "white" but remaining raised and under the skin. Hell, I think the even mold some dildos with them there:eek:. I finally put it all together at some point in my life when I had something similar inside the mouth/cheek area. I asked an ENT what they were and he said cholesterol. He stated some folks mouths are just littered with them. So you can also imagine the horror to a younger male if he should be so unfortunate to find them below and in mouth at the same time as surely he must have some rare STD he will think. but mouth seems to come much later.

    So I pieced the puzzle together and now speculate the ones on the penis were cholesterol. They can be unsightly and cause great distress to a young man who is considering sex with his girl or potential girl. They dont just wash off and cleanliness is not related. In fact, excessive cleaning of the skin surface may even "lock them" somewhat and encourage even more to replace if truely inherent. So they are a bit of a mainenance bitch in worst case, but cause MOUNTAINS of distress for young men I guarantee.

    Sadly, I suspect that when men stop having the issue is when they are starting to fade in life and genetically encoded health and longevity factors. As the diminishment of their occurence for me has been corrolated directly inversly with age, and the loss of "youth factors' of the skin....

    But to technically diagnose and explain when young men could have access - would be a first in history I think...!!
     
  7. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Ipilimumab - A Novel Immunomodulating Therapy Causing Autoimmune Hypophysitis

    Ipilimumab (Yervoy, Medarex and Bristol-Myers Squibb) is a human monoclonal antibody against cytotoxic T lymphocyte antigen-4 (CTLA-4), which enhances costimulation of cytotoxic T lymphocytes, resulting in their proliferation and an antitumour response. It is licensed for the treatment of unresectable or metastatic malignant melanoma, while multiple clinical trials using this medication in the treatment of other malignancies are ongoing. YERVOY (IPILIMUMAB) INJECTION [E.R. SQUIBB & SONS, L.L.C.]

    A 54 year-old man presented to the oncology clinic with a one week history of headaches and severe lethargy following his third course of ipilimumab for recurrent metastatic malignant melanoma. On direct questioning, he admitted to the recent onset of poor libido and erectile dysfunction, which he linked to stress related to his principal disease and chemotherapy. He denied nausea, vomiting, visual symptoms, polydipsia or polyuria. For his melanoma, he was initially treated surgically, then started on chemotherapy on developing pulmonary metastases. He had stable disease on chemotherapy based upon docetaxel, but relapsed soon after this was completed. He did not have other co-morbidities or family history of endocrine problems or malignancy.

    As metastatic brain disease or hypophysitis were suspected, a brain MRI scan was arranged: this showed a pituitary swelling consistent with hypophysitis (Fig. 2A-B). Hormonal investigations demonstrated anterior pan-hypopituitarism (random cortisol 10 nmol/L [reference range 180-620], testosterone <4nmol/L [8.4-28.7] with a low-normal LH and FSH, TSH < 0.01mU/L [0.35-5.5] and fT4 9.4pmol/L [10.5-20.5]). There was no diabetes insipidus, his prolactin was less the 7 mU/L [45- 375mU/L], and the serum igf-1 was normal [13.5nmol/L, normal range 10.5-35 nmol/L]. He was started on dexamethasone 8mg twice daily and three days later Lthyroxine 75mcg daily and testosterone replacement were added. These resulted in rapid resolution of his symptoms. The dose of dexamethasone was gradually decreased over 3 weeks and replaced with physiological hydrocortisone replacement of 10/5/5mg daily. A pituitary MRI scan performed 2 weeks after initiation of corticosteroid treatment did not show any significant change in the size of the pituitary. However, the pituitary swelling had resolved completely on MRI three months later (Fig. 2C-D).

    He currently remains stable on his hormonal replacement therapy, and this will be periodically reviewed. Since hormonal replacement was started, the patient has received his 4th course of ipilimumab. Follow-up CT scans have demonstrated a response to treatment, with shrinkage in his pulmonary disease.


    Juszczak A, Gupta A, Karavitaki N, Middleton MR, Grossman A. IPILIMUMAB - A NOVEL IMMUNOMODULATING THERAPY CAUSING AUTOIMMUNE HYPOPHYSITIS: A CASE REPORT AND REVIEW. European Journal of Endocrinology. http://www.eje-online.org/content/early/2012/04/10/EJE-12-0167.full.pdf

    Ipilimumab (Yervoy, Medarex and Bristol-Myers Squibb) is a human monoclonal antibody against cytotoxic T lymphocyte antigen-4 (CTLA-4), which enhances co-stimulation of cytotoxic T lymphocytes, resulting in their proliferation and an anti-tumour response. It is licensed for the treatment of unresectable or metastatic malignant melanoma, while multiple clinical trials using this medication in the treatment of other malignancies are ongoing.

    As a clinical response to ipilimumab results from immunostimulation, predictably it generates autoimmunity as well, causing immune-related adverse events in the majority of patients. Of those, endocrinopathies are frequently seen, and in particular autoimmune lymphocytic hypophysitis with anterior panhypopituitarism has been reported a number of times in North America.

    We present a case of a male referred to our department with manifestations of anterior panhypopituitarism after his 3rd dose of ipilimumab for metastatic malignant melanoma, and we discuss the management of his case in the light of previous reports. We also review the published literature on the presenting symptoms, time to presentation, investigations, imaging, treatment and follow-up of ipilimumab-induced autoimmune lymphocytic hypophysitis.
     
  8. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Unilateral Dermatoheliosis
    Gordon JR, Brieva JC. N Engl J Med 2012;366:e25
    MMS: Error

    Unilateral-Dermatoheliosis.gif

    A 69-year-old man presented with a 25-year history of gradual, asymptomatic thickening and wrinkling of the skin on the left side of his face. The physical examination showed hyperkeratosis with accentuated ridging, multiple open comedones, and areas of nodular elastosis. Histopathological analysis showed an accumulation of elastolytic material in the dermis and the formation of milia within the vellus hair follicles. Findings were consistent with the Favre–Racouchot syndrome of photodamaged skin, known as dermatoheliosis. The patient reported that he had driven a delivery truck for 28 years. Ultraviolet A (UVA) rays transmit through window glass, penetrating the epidermis and upper layers of dermis. Chronic UVA exposure can result in thickening of the epidermis and stratum corneum, as well as destruction of elastic fibers. This photoaging effect of UVA is contrasted with photocarcinogenesis. Although exposure to ultraviolet B (UVB) rays is linked to a higher rate of photocarcinogenesis, UVA has also been shown to induce substantial DNA mutations and direct toxicity, leading to the formation of skin cancer. The use of sun protection and topical retinoids and periodic monitoring for skin cancer were recommended for the patient.
     
  9. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Torsion of Undescended Testis

    Torsion-of-Undescended-Test.gif

    A 22-year-old man with a history of uncorrected left cryptorchidism presented after 7 days of left groin pain. A genitourinary examination was performed, which revealed that his left inguinal region was swollen because of a palpable, tender mass that was 5 cm in greatest dimension. No testicle was palpable in the ipsilateral hemiscrotum (Panel A). An ultrasound examination of the inguinal area revealed a heterogeneous testicle, with no blood flow on Doppler examination. Surgical exploration confirmed torsion of the undescended testis (Panel B). Torsion of a cryptorchid testicle is an uncommon condition but is reported to occur more frequently than torsion of a normally descended testis. In a patient presenting with pain and uncorrected cryptorchidism, a testicular tumor must also be considered in the differential diagnosis. In this patient, final pathological examination revealed a diffusely ischemic, necrotic testicle with no malignant tumor.


    Hajji F, Janane A. Torsion of Undescended Testis. New England Journal of Medicine 2012;366(17):1625-. MMS: Error
     
  10. BBC3

    BBC3 Member

    You are BREAKING MINDS here.....:eek: The ONE injury that may be unrecoverable.....:p
     
  11. Structure

    Structure Member

    I can't seem to get a straight answer out of anybody. Do I have gyno?

    [​IMG]

    :) Just kidding. The image above is of a woman with hypertrichosis and bilateral nipple retraction:

    Acquired eyelash trichomegaly and generalized hypertrichosis associated with breast anomaly. Shahin Aghaei MD, Ladan Dastgheib MD. Dermatology Online Journal 12 (2): 19. Acquired eyelash trichomegaly and generalized hypertrichosis associated with breast anomaly

    Abstract

    Acquired eyelash trichomegaly is a rare condition. We present a 23-year-old woman with acquired trichomegaly and generalized hypertrichosis from childhood. The patient also exhibited bilateral nipple retraction and unilateral left-sided accessory nipple. According to our knowledge the association between trichomegaly, hypertrichosis, and breast anomaly has not been reported.
     
  12. beav7

    beav7 Junior Member

    Do I need to be concerned if this pic turns me on? [no homo]
     
  13. BBC3

    BBC3 Member

    Sweet God Above. And to think that some folks have the nerve to act sihtty about being normal...

    But you are running a close second to Scally now in causing irrepairable psychological harm.. This is no way to treat a man trying to back off the alcohol. There should be further warning in the title, "Read at own risk, OR No Psychologist on Duty" LOL

     
  14. beav7

    beav7 Junior Member

    There are much worse things a person can have than some hair on the body.
    You can simply shave it off or laser it off. Big deal.
     
  15. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Yes!!!
     
  16. beav7

    beav7 Junior Member

    What does this mean? That I'm into hairy women or hairy men with boobs? :eek:
    I hope it's just hairy women.
     
  17. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Eschar Formation from testosterone Patch
    MMS: Error

    Eschar-Formation-from-Testo.gif

    A 78-year-old man presented for his yearly skin examination and was noted to have a 4-cm by 2.5-cm, oval-shaped, green-black eschar on his midback. A 3-cm, pink, atrophic scar was located nearby, in addition to a medicated patch of similar size. The patient had started using this transdermal testosterone patch (Androderm [Watson], 5 mg) for hypogonadism 5 years ago. The patch was changed daily, and he occasionally had skin irritation at the site. An eschar subsequently developed. The atrophic scar corresponded to irritation from a prior patch. Repeated, burnlike lesions are a rare but reported adverse reaction to testosterone-patch use. The cause is not clear but may relate to the testosterone, the alcohol-based compounding gel, or the polyethylene base. The patient was prescribed a hydrocolloid dressing to promote wound healing. The eschar eventually healed, leaving a 3-cm pink scar similar in appearance to that shown at left in the photo. Given his repeated sensitivity to the patch and risk of secondary infection, the patient was instructed to discontinue its use.
     
  18. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Compulsive Masturbation And Chronic Penile Lymphedema

    A 40-year-old man, affected by intellectual disability, was referred to our Institute for behavioral disturbance, including compulsive masturbation. The patient had been masturbating for more than 5 hours almost everyday for many years.

    To the best of their knowledge, this is the first report on Chronic Penile Lymphedema (CPL) entirely due to compulsive masturbation in a neuropsychiatric patient. Only one other similar case has been described so far, but the patient had chlamydial oculogenital infection, which may have also exacerbated the effect of the chronic masturbation on the penile lymphatic system.

    Masturbation is the deliberate stimulation of one’s own genitals to achieve sexual arousal and pleasure and it is done at least occasionally by a majority of both men and women. Compulsive masturbation, like all other compulsive behaviors, may be included in the spectrum of anxiety disorders since it is characterized by intrusive thoughts (obsessions) that produce uneasiness, apprehension, fear or worry, and by repetitive behaviors, i.e., masturbation, aimed at reducing anxiety (compulsions). Persons with compulsive disorders frequently display an inability to inhibit behaviors once they become maladaptive, despite adverse consequences of their behavior. Compulsive masturbation is more frequent in patients with psychiatric illness, such as autism, schizophrenia, and personality disorders, and in those affected by neurological diseases, such as dementia and Parkinson disease.


    Calabro RS, Gali A, Marino S, Bramanti P. Compulsive masturbation and chronic penile lymphedema. Arch Sex Behav 2012;41(3):737-9. Archives of Sexual Behavior, Volume 41, Number 3 - SpringerLink

    Chronic penile lymphedema arises from the abnormal retention of lymphatic fluid in the subcutaneous tissues and may be secondary to local and systemic medical conditions such as sexually transmitted diseases, filariasis, malignancy, local radiotherapy, and surgery. This case report aims to consider compulsive masturbation as a possible cause of chronic penile edema. A 40-year-old man was referred to our institute for behavioral disturbance, including compulsive masturbation. Neuropsychiatric evaluation showed moderate mental retardation, mild dysarthria and limb incoordination, anxiety, depressed mood, and impulse dyscontrol. Brain MRI pointed out diffuse white matter lesions. Urogenital examination revealed an uncircumcised penis with non-tender edema of the shaft and prepuce with areas of lichenification. Since the most common local and systemic causes of edema were excluded, chronic penile edema due to compulsive masturbation was diagnosed and the compulsive behavior treated with an antidepressant and low-dose neuroleptics. Compulsive masturbation should be taken into account when counselling patients with penile edema.
     
  19. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Nadeau S, Nguyen F, Guigou S. [Serous central chorioretinopathy and tadalafil: a case report]. J Fr Ophtalmol 2012;35(2):121 e1-5. Choriorétinite séreuse centrale et tadalafil, à propos d’un cas - EM|consulte

    We report a case of central serous chorioretinopathy in a 46-year-old man with no risk factors except for erectile dysfunction agent use: Tadalafil (cialis((R))). An association between tadalafil and central serous chorioretinopathy could involve phosphodiesterase type 5 inhibitors and be a risk factor of central serous chorioretinopathy.
     
  20. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Cardiac Arrest Associated With sildenafil

    A 59-year-old caucasian man was found by his wife collapsed in the bathroom after sexual intercourse. On arrival, the rescue team found an unconscious patient with ventricular fibrillation. After single defibrillation and 15 minutes of cardiopulmonary resuscitation spontaneous circulation was restored. His wife reported that the patient has ingested Sildenafil (50 mg) 30 minutes before the cardiac arrest for the first time. Except from a vascular-type erectile dysfunction he had no previous medical history and no familial history of cardiovascular disease or sudden death. The patient did not take a regular medication. Here, investigators report a case of cardiac arrest associated with Sildenafil ingestion in a patient with a Coronary Artery Anomaly (CAA).


    Huber BC, von Ziegler F, Bamberg F, Franz WM, Becker A. Cardiac arrest associated with sildenafil ingestion in a patient with an abnormal origin of the left coronary artery: case report. BMC Cardiovasc Disord 2012;11:49. BMC Cardiovascular Disorders | Full text | Cardiac arrest associated with Sildenafil ingestion in a patient with an abnormal origin of the left coronary artery: Case report

    BACKGROUND: Left coronary artery arising from the right sinus of Valsalva is an uncommon congenital coronary anomaly that seems to be associated with sudden death in young patients.

    CASE PRESENTATION: We report a case of cardiac arrest in a 59-year-old patient after sexual intercourse and Sildenafil ingestion. A coronary arteriography and an angiographic computed tomography scan subsequently revealed a LCA origin from the right aortic sinus along with an intramural course of the left main stem. In addition a distal stenosis of the right coronary artery was detected. After successful resuscitation without neurological deficits coronary artery bypass surgery was performed.

    CONCLUSION: To our knowledge, this is the first report demonstrating sudden cardiac arrest associated with Sildenafil ingestion in a patient with this type of coronary anomaly. The question arises, whether a cardiac screening is necessary before a Sildenafil therapy is initiated.