Clinical Case Studies

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

  1. BBC3

    BBC3 Member

    Is that what happens if ya dont POP-EM..?:eek::rolleyes:[:eek:)]

    I think really the big point you guys are missing is that there are no ingrowns. I think this guy has been shaving and even manicuring his nutz for some time...:eek:

    But I really don't get it. If I had just one of something like that pop up, I'd be down at the doc advising him that if he did not get it off - I would be performing surgery on myself by the end of the day....!
    Michael Scally MD likes this.
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine


    Attached Files:

  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [Syphilis] Pulsatile Chest Swelling
    MMS: Error

    A 45-year-old man presented with swelling on the right side of the chest that he had had for the previous 3 [ONLY THREE!!!] months. Examination revealed pulsatile swelling in the right infraclavicular area (Panels A and B, and Video at Link).

    Cardiac examination was normal. Radiography of the chest showed mediastinal widening. An echocardiogram revealed mild aortic regurgitation with an aneurysm of the ascending aorta. Computed tomography of the chest with the use of contrast material showed a large saccular aneurysm (Panel C, asterisks in images) arising from the right anterolateral wall of the distal ascending aorta.

    The aneurysm was eroding the right half of the manubrium of sternum and the adjacent first and second costochondral junctions. Compression of the trachea, pulmonary artery, superior vena cava, and esophagus was noted.

    The patient had a history of untreated syphilis. Tertiary syphilis was confirmed by means of a positive Venereal Disease Research Laboratory test and Treponema pallidum hemagglutination assay.

    The patient underwent successful valve-sparing resection after penicillin G therapy. Pathological findings were consistent with syphilitic aortitis, an infrequent condition in which spirochetal invasion of the adventitia causes an obliterative endarteritis of the vasa vasorum. Impaired blood supply to the aortic wall results in the weakening of the tunica media and in aneurysm formation.


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  4. The compression of the "trachea, pulmonary artery, superior vena cava, and esophagus" must have been causing physical symptoms. Regardless, any "sane" person would have sought medical attention long before the size of the swelling reached baseball status. If neurosyphilis isn't responsible, he's certainly a candidate for the Darwin award.
  5. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Trichomycosis Axillaris

    Ma D-L, Vano-Galvan S. Trichomycosis Axillaris. New England Journal of Medicine 2013;369(18):1735. MMS: Error

    A 40-year-old man presented with axillary odor and reported having had dirty axillary hair for 4 years. The condition worsened in the summer, staining his clothing. His medical history was notable only for obesity.

    On examination, creamy yellow concretions were observed along several hair shafts (Panels A and B).

    The concretions took on a soft fluorescence when examined under a Woods lamp, but the skin of the axilla showed no coral red fluorescence, ruling out erythrasma. Microscopical examination after topical administration of potassium hydroxide showed an opaque material surrounding the involved hair, without invasion of the hair cortex (Panel C).

    The patient received a diagnosis of trichomycosis axillaris. Treatment consisted of shaving the affected hair and administering topical 15% aluminum chloride and topical erythromycin. The odor resolved within several weeks.

    Trichomycosis axillaris is a superficial bacterial infection that is typically caused by Corynebacterium tenuis. The adherent concretions on the hair shaft may be yellow, black, or red, and there is typically an associated rancid, acidic odor, which is due in part to the bacterial metabolism of testosterone in the apocrine sweat into malodorous compounds.

    Obesity, hyperhidrosis, poor local hygiene, and warm, moist environments are common predisposing factors.


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  6. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Green Sweat: An Atypical Finding in Drug-Induced Liver Disease

    Narciso-Schiavon JL, Giunta GD, Andre MH, et al. Green Sweat: An Atypical Finding in Drug-Induced Liver Disease. Liver Int. Green Sweat: An Atypical Finding in Drug-Induced Liver Disease - Narciso-Schiavon - Liver International - Wiley Online Library

    A 36-year-old man was admitted to the gastroenterology ward for jaundice and a history of drug abuse. He had been using fluconazole 150 mg/day for 6 months, cyclobenzaprine and meloxicam irregularly for 60 days, and finally, Stanozolol and testosterone for muscle mass gain for 45 days.

    The following laboratory results were obtained: Total bilirubin 43.4 mg/dL, direct bilirubin 36.3 mg/dL, aspartate aminotransferase 50 U/L, alanine aminotransferase 67 U/L, alkaline phosphatase 276 U/L, gamma glutamyltransferase 72 U/L, creatinine 1.7 mg/dL, and international normalized ratio 0.92.

    Tests for the viral markers anti-HAV IgM, HBsAg, anti-HBc, and anti-HCV were negative. Liver biopsy showed cholestatic hepatitis with confluent necrosis.

    One month later, at the outpatient clinic, he presented greenish skin lesions on hands and feet that were biopsied. Liver tests normalized and skin lesions disappeared one year after the acute event.

    Chromhidrosis is a rare idiopathic disorder characterized by the secretion of colored sweat by apocrine or eccrine glands. Color varies with the degree of oxidation and has been reported to be yellow, blue, green, brown, or black.

    It has been hypothesized that direct bilirubin is secreted under the stratum corneum through the eccrine glands, and the green color is attributable to the switch from brown-colored bilirubin to green-colored biliverdin by oxidative processes. Cutaneous bilirubin excretion via eccrine sweat glands could be considered an exceptional variant of eccrine chromhidrosis.

    To our knowledge, bile pigment sweat has been previously described in only five cases reported in the English language. Two presented acute hepatitis of unknown etiology and history of parenteral exposure, while the remainder showed obstructive jaundice due to choledocholithiasis and adenocarcinoma of gallblader. All cases were males and presented high levels of total bilirubin (higher than 12 mg/dL). Ours is the first case of acute drug-induced liver disease with green sweat.

    Since hyperbilirubinemia is very common in liver disorders, other unknown factors likely play a key role in determining excretion of bilirubin via eccrine sweat glands, and males could be more predisposed to such presentation.

    In conclusion, this rare variant of eccrine chromhidrosis is a cutaneous sign of cholestasis with jaundice and may be present in individuals with high levels of direct bilirubin (more than 7 mg/dL), irrespective of the etiology.

    Greenish Skin Lesions


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  7. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Splenogonadal Fusion: A Rare Etiology Of Solid Testicular Mass

    A 35-year-old man presented with a painless left scrotal mass. Scrotal ultrasonography confirmed a 5.5-cm, hypoechoic, left intratesticular mass and the findings from a metastatic evaluation were normal. The tumor marker (a-fetoprotein, lactate dehydrogenase, b-human chorionic gonadotropin) levels were likewise unremarkable, and the patient had no history of cryptorchidism. After left inguinal orchiectomy, the pathologic examination revealed a 4-cm mass containing ectopic splenic tissue without evidence of testicular malignancy.

    Splenogonadal fusion (SGF) is a rare congenital anomaly that results from an abnormal association between primitive gonadal and splenic elements during gestation. Of the patients with continuous SGF, 50% will have additional congenital abnormalities (most commonly cryptorchidism). SGF occurs nearly exclusively on the left side.

    SGF is a diagnostic challenge preoperatively; however, a technetium-99m sulfur colloid scan can be performed to detect accessory splenic tissue. Concurrent testicular neoplasms have been reported in select cases. The present case is the largest identified discontinuous-type SGF mass reported.

    It is important for urologic surgeons to consider SGF in the differential diagnosis of a testicular mass, especially in patients who report a long-standing history of stable left scrotal mass or when a left scrotal mass has been found incidentally during an infertility evaluation.

    Kocher NJ, Tomaszewski JJ, Parsons RB, Cronson BR, Altman H, Kutikov A. Splenogonadal fusion: a rare etiology of solid testicular mass. Urology 2014;83(1):e1-2. Elsevier
    Last edited: Jan 6, 2014
  8. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    A 55-year-old housewife, educated up to fifth standard, from rural India, presented with the symptoms of nandrolone decanoate use for the past 10 years.

    She had history of frequent altercations with her family members, followed by episodes of dissociative stupor, convulsions, paraesthesia, multiple body aches and weakness. Symptoms would fluctuate over time and were related to psychosocial stressors in life. These symptoms were present since adolescence and lead to strained interpersonal relationships.

    The family consulted locally available doctors, mostly general practitioners or unqualified medical practitioners during exacerbations of symptoms, treatment would reduce her symptoms temporarily. An unqualified local practitioner prescribed her nandrolone decanoate injections (100 mg), intramuscular, when she reported extreme physical weakness and unspecified somatic symptoms during a consultation.

    The patient reported transient improvement in her physical as well as dissociative symptoms with nandrolone injections. Therefore injections were repeated for symptomatic relief on her demand.

    Gradually, the patient’s demand for injection increased from once a month to almost once a day over a period of 2–3 years. She would report improvement in somatic symptoms and weakness subsequent to nandrolone decanoate injections.

    She would also report intense craving, irritability, episodes of anxiety and dissociative stupor on stopping or delaying the injections. Gradually she developed long-term adverse effects of AAS like facial hair, male pattern baldness, increased muscularity and hoarsening of voice and skin rash over a period of 7–8 years.

    She stopped attending social gatherings and meeting relatives due to the stigma of these physical changes. Her household work was also impaired and the family suffered significant financial burden.


    Tripathi A, Tekkalaki B, Saxena S, Dandu H. Iatrogenic dependence of anabolic-androgenic steroid in an Indian non-athletic woman. BMJ Case Rep. 2014.

    Anabolic-androgenic steroids (AAS) are increasingly being used by athletes and youngsters to become masculine and to loose body fat. Long-term consumption of AAS causes multiple physical and psychological morbidities. Research has also concluded that AAS have addictive potential and AAS abuse is commonly found with other substance abuse. Abuse of AAS is rare in eastern countries. Abuse among women is even rarer.

    Here is a case report of an Indian woman, who was prescribed nandrolone decanoate injections by an unqualified medical practitioner to treat multiple non-specific somatic pains and reported weakness, leading to dependence for nandrolone decanoate.

    This case report supports the research finding of abuse potential of AAS, raises concern about the need for spreading the awareness about AAS abuse among medical professionals, regulating medical practice by unqualified practitioners, and strict legal check against AAS availability in developing countries.
    Gunrunner likes this.
  9. Man, the BMJ are really scrapping the bottom of the barrel to make a case for AAS addiction, aren't they? Traveling all the way to India to find a mentally ill bearded lady with a penchant for needles is beyond weak. Ridiculous.
    Gunrunner and Michael Scally MD like this.
  10. BBC3

    BBC3 Member

    WTF are you talkin about ----- THATS A MANNNN BABY...!!!! LOL:D

    Gunrunner and Michael Scally MD like this.
  11. Gunrunner

    Gunrunner Member Supporter

    [ame=]DodgeBall Threw Up - YouTube[/ame]
    BBC3 likes this.
  12. Acta Med Iran. 2012;50(12):846-8.
    Multi organ failure following intravenous gasoline for suicide: a case report.

    Mahmoodpoor A1, Soleimanpour H, Hamishehkar H.


    Hydrocarbons are ubiquitous in daily life and include plant and animal fats, alcohols, solvents, natural gas, petroleum derivates. Majority of intoxication reports of hydrocarbons are due to inhalation or ingestion, but there is few reports about intravenous injection of gasoline. We report a 58 year-old man who injected gasoline intravenously for suicide. He developed soft tissue necrosis of forearm and bilateral pulmonary infiltration. He underwent fasciotomy and extensive debridement of necrotic tissues, at the operation room. He was intubated and mechanically ventilated because of acute lung injury. He developed acute kidney injury after 2 days. These symptoms seem to be due to extravasation of gasoline from vessels which lead to inflammation, cell damage and organ failure. The patient developed multi organ failure which unfortunately did not respond to our treatment and he died at day 21. Management of gasoline intoxication depends on the rout of exposure. Like other types of toxications, intravenous toxication has pulmonary involvement, however in this case we had multiple organ involvement. It seems that in such cases we should consider early end organ targeted therapy to stop the future organ failure.

    © 2012 Tehran University of Medical Sciences. All rights reserved.
  13. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Empty Sella

    In May 2012, a 29-year-old male patient, known case of depressive disorder under treatment, was referred to our department for erectile dysfunction. The patient reported to a psychiatrist initially in April 2011, with low mood, easy fatigability, and loss of interest in sexual activity.

    He was married 6 months before presentation and was unable to maintain a satisfactory sexual relationship with the wife. Other medical and psychiatric history was normal. Clinical examination revealed normal vital parameters and no loss of secondary sexual characteristics.

    In view of low mood, apathy, avolition, anhedonia and lack of libido he is diagnosed as a moderate depressive disorder and treated with Fluoxetine.

    In view of poor response, Trazodone was given along with adjunctive electroconvulsive therapy (ECT). He had partial response after six ECTs and in view of persisting low libido he was referred to us for evaluation.

    He denied the presence of spontaneous nocturnal erections and had no contributing medical illness in the past. Examination of the external genitalia revealed testicular volume of 15 mL bilaterally and subnormal secondary sexual characteristics. Visual fields by confrontation method and fundus examination were normal.

    His hematological and biochemical parameters were normal and semen analysis revealed azoospermia. Hormonal panel showed total testosterone 190 ng/dL (normal 300-1100), free testosterone 6.2 pg/mL (normal 9-25), LH 0.6 IU/L (normal 0-7) and FSH 1.1 IU/L (normal 2-10).

    In view of hypogonadotropic hypogonadism, neuroimaging was done which revealed empty sella. Other hormonal panel revealed normal prolactin and thyroid hormones. Insulin induced hypoglycemia revealed normal stimulated adrenal and growth axes.

    He was diagnosed to be a case of hypogonadotropic hypogonadism secondary to primary empty sella and managed with a monthly testosterone injection. He had marked improvement in his mood, sexual performance and the couple were counselled regarding the alternate methods of fertility.

    Hari Kumar KV, Dhull P, Somasekharan M, Seshadri K. Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology. Indian J Med Sci 2014;66(5-6):144-7. Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology Hari kumar K, Dhull P, Somasekharan M, Seshadri K - Indian J Med Sci

    Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr's disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty.
  14. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Testicular Seminoma

    Qureshi B, Albany C. Posterior Mediastinal Mass. New England Journal of Medicine 2014;371(8):e10.

    A 30-year-old man presented with chest pressure, shortness of breath, severe dyspnea on exertion, dysphagia, odynophagia, and a weight loss of 30 lb (14 kg) over a 2-month period. He had undergone orchiectomy 3 years earlier for stage 1 testicular seminoma but had been lost to follow-up.

    Cardiac examination revealed normal sinus rhythm without murmurs or gallops, and the lungs were clear on auscultation. Radiography (Panel A) and computed tomography (CT) (Panel B) of the chest revealed a large, posterior mediastinal mass.

    On CT, the mass measured 19 cm by 15 cm by 8 cm, displaced adjacent structures, and circumscribed the descending thoracic aorta. A CT scan of the abdomen was unremarkable.

    Laboratory evaluation revealed a human chorionic gonadotropin level of 4 mIU per milliliter (normal value, <3), a lactate dehydrogenase level of 1400 U per liter (normal range, 140 to 270), and a normal alpha-fetoprotein level.

    Findings on biopsy were consistent with seminoma.

    The patient received three cycles of chemotherapy with bleomycin, etoposide, and cisplatin, with substantial improvement in his symptoms. A follow-up CT scan 3 months later (Panel C) revealed a marked decrease in the size of the mass.

    After 10 months of follow-up, the patient is asymptomatic and is doing well, with continued follow-up every 4 months.

  15. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Functioning Gonadotroph Adenomas (FGA)

    Ntali G, Capatina C, Grossman A, Karavitaki N. Functioning Gonadotroph Adenomas (FGA). The Journal of Clinical Endocrinology & Metabolism.

    Context: Functioning gonadotroph adenomas (FGA) are pituitary tumors secreting biologically active gonadotropins. The published literature includes only small case series or individual case reports. This review summarizes the published dataonthis rare entity and, based on them, suggests guidance on the follow-up of these patients.

    Evidence Acquisition: A review of articles in English retrieved from the PubMed up to December 2013 was conducted. The following terms were used for the search “functioning gonadotroph adenomas”, “FSH secreting adenomas”, “LH secreting adenomas”, “gonadotroph adenomas”, “ovarian hyperstimulation”, “macroorchidism”, “testicular enlargement”, “precocious puberty”.

    Evidence Synthesis: All reported cases of FGA were assessed and information on presenting manifestations, management approaches and long-term outcome were reviewed.

    Conclusions: FGA cause distinct manifestations and, based on the limited published literature, they are mostly macroadenomas. Their pathogenesis remains enigmatic. Systematic series on their optimal management are lacking, but the primary therapy remains surgical excision of the adenoma. Given the risk of recurrence, long-term clinical and imaging follow-up is needed, and radiotherapy may be required. There is little evidence that medical therapies are particularly helpful, certainly in terms of tumor control. Central registration would enhance our insight regarding their pathology and optimal management.

    Testicular Enlargement in a Patient with FGA

    Largest ellipsoid of Prader (25 ml) is shown for comparison; mean testicular volume is 108 ml. Testicular enlargement and elevated serum inhibin concentrations occur in patients with pituitary macroadenomas secreting follicle stimulating hormone.

  16. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [NO AAS] Report of a Recurrent Cerebral Venous Thrombosis in a Young Athlete

    Richard S, Lacour JC, Frotscher B, Enea A, Mione G, Ducrocq X. Report of a recurrent cerebral venous thrombosis in a young athlete. BMC Neurol 2014;14(1):182.

    Background - Reports of occurrence of deep vein thrombosis during intensive sport are scarce. While a few cases have been described in the cerebral territory, these are only in the context of traumatism or anabolic agent consumption. Thus, causality with exercise remains uncertain and the mechanisms hypothetic.

    We present the case of a young athlete who experienced two episodes of severe cerebral venous thromboses (CVT), both during intensive training, in the absence of any other known thrombogenic factor.

    Case Presentation - A healthy 26-year-old man presented a thrombosis of the superior sagittal sinus during recent intensive training for a triathlon.

    Investigation at the time found no drug or anabolic steroid consumption, or any hematologic or coagulation disturbance.

    Anticoagulation therapy was initiated for 10 months with good outcome. One year later, soon after returning to intensive exercise, mainly running, the patient presented a thrombosis of the straight sinus complicated by bithalamic hyperintensities observed on T2 magnetic resonance imaging sequences. Anticoagulation treatment was reinitiated and led to repermeabilization of the cerebral vein and reversibility of thalamic abnormalities.

    Four months later, the patient was free of headache and had no cognitive impairment. He continues to practice intensive sport with vitamin K antagonist as preventive treatment.

    Conclusion - This is the first case report of recurrent CVT in a context of intensive sport, without any other thrombogenic features, suggesting a causal link. Intensive exercise should be considered as a potential promoting factor of CVT and investigated during routine examination.
  17. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Ahn H, Son H. Successful removal of an intravesical electrical wire cable. World J Mens Health 2014;32(2):120-2.

    A few previous reports have described cases wherein electrical wire cables were inserted into the male urethra and bladder. Electrical wire cables are available at home and are easy to insert. However, after they coil in the patient's bladder, they are difficult to remove.

    In February 2013, a 30-year-old man presented to the emergency room of SMG-SNU Boramae Medical Center with a urethral foreign body. He had inserted an electrical wire cable into his urethra for the purpose of masturbation, despite having a regular sex partner and no underlying disease.

    A kidney-ureter-bladder radiography showed a tangled wire in his bladder and urethra. On the next day, we tried to remove the wire cystoscopically, but this proved to be impossible because of complex coiling and the slippery surface of the wire. A Pfannenstiel incision was made to remove the foreign body. No postoperative complications were noted.

    Kidney-Ureter-Bladder Abdominal Radiography: A Tangled Wire In The Bladder And Urethra Of A 30-Year-Old Man.

    Kidney-ureter-bladder abdominal radiography.jpg
    BBC3 likes this.
  18. BBC3

    BBC3 Member

    WOW - So we are talking about an individual who MAY have been involving with the practice of Sexual related E-STIM type activity, jammed so much wire down his urethra most likely looking for a more direct application of current to the prostate, and then the bladder most likely in contractions basically knotted the excess wire up into a ball in his bladder. And the bladder can shrink up pretty damn small when stimulated - so I am having visions of chicks that can tie knots in cherry stems with their mouths right about now. LOL This on no trick for the light hearted...

    (***AND I am NOT reading any attached detail if so/at this time, because ANY ANSWER given by the patient would most likely be fiction)

    What would be interesting would be to find that this person was simply getting sexual stimulation from the sensation the the wire alone, and perhaps via the continued manipulation as it moved PAST the prostate, or even as "quasi-sexual" simply as a sensation of the wire passing through his bladder sphincter..??!!

    OR perhaps even ingaging in the behavior and truly NON-Sexual and for some other purpose unknown??!!....?

    I wonder if the article addresses whether or not the wire was shielded with rubber/vinyl casing to what degree down the urethra/ IF At all. Because if the wire was perhaps shielded down to prostate per say, then he would have been gaining gratification from BLADDER related, electrical or possibly not, ONLY. Then AGAIN, if say the wire were shielded completely and all the way to the end/ it would be an indication that the simple sensation of the vinyl coated wire ALONE was gratuitous at the either the prostate, bladder, or both - but non electrical as primary and for the sake of the wire-"feel"...

    That one is kind of interesting because THIS THOUGH has occurred to me on an occasion and greatfully the potential was logic'd out as self protective to not do in my case..:D

    Can you imagine the look on this poor bastard's face when he started to figure out this wire was not pulling back out...!!!!:eek::eek::eek::eek::eek: ... :confused:
    Further, you have to wonder HOW LONG he walked around with it in their prior to breaking down and telling...!!! LOL:(:D

  19. BBC3

    BBC3 Member

    So then we are talking the article premises to defend that steroids are NOT the only cause of deep blood vessel blockades in healthy atheletes.. I will have to cyper on this one to debunk and possibly shed light as it premises that he truly tested negative for any AAS.. So then WHAT agent could have possibly been involved to contribute to this action. The mind of a high school or college age "atheletic" right??

    Hmmmm. Working.. Working.. I will have to let this one run a few days I think....


  20. Well, be careful. Wouldn't want to see anything happen to you. o_O