Feminizing syndrome and gynecomastia in males

Gynecomastia is one of the common symptoms of feminizing syndrome in males. Causes of feminizing syndrome are considered the increase of serum level of estrogen, prolactin, LH and hCG and testosterone deficiency. The condition of gynecomastia was commonly silent. Gynecomastia is classified three groups those are physiological, pathological and ideopathic gynecomastia. Physiological gynecomastia was reported to break out healthy males. Ideopathic gynecomastia is the main cause in medicine. Characterization of pathological gynecomastia are known side effect of drugs, testosterone deficiency and increased estrogen production. Gynecomastia is making satisfactory progress by treatment of the causes, but long term of the history merely have need resection.     

Galactorrhea and gynecomastia as side effect of drugs

Galactorrhoea or gynaecomastia are common and innocent phenomena, especially in certain age groups. Sometimes, however, they are secondary to serious diseases such as hormone producing tumours. Furthermore, a wide variety of drugs may in different ways induce galactorrhoea or gynaecomastia. A good knowledge of these drugs may prevent unnecessary anxiety and investigations. In spite of an abundance of often anecdotal reports scattered in the literature, little information is available on the identity of the most important drugs causing galactorrhoea or gynaecomastia in medical practice. The country-wide network of regional centres for intensified adverse drug reactions reporting of the Netherlands Pharmacovigilance Foundation LAREB can provide useful information on these and other side effects.     

Evaluation and treatment of orthostatic hypotension

Orthostatic hypotension is defined as a decrease of at least 20 mm Hg in systolic blood pressure when an individual moves from a supine position to a standing position. Nonneurogenic causes of orthostatic hypotension are related to cardiac pump failure, reduced intravascular volume, venous pooling or a medication side effect. Neurogenic causes include both central and peripheral nervous system lesions. The diagnostic evaluation requires a systematic review of medications and coexisting medical conditions along with a neurologic examination to search for treatable factors that may be contributing to orthostatic hypotension. Specific testing of autonomic function is useful for detecting subclinical orthostatic hypotension or for monitoring autonomic function over a period of time. Treatment is directed at improving the patient's symptoms rather than achieving arbitrary blood pressure goals.     

Evaluation and treatment of postmenopausal osteoporosis

OBJECTIVES: To review the recent literature and develop a logical strategy with which to approach the diagnosis and treatment of osteoporosis, based on clinical evidence and accepted practices. METHODS: Published reports from 1983 through 1997 obtained by MEDLINE search were reviewed and analyzed by both authors. RESULTS: Osteoporosis is a widespread medical condition readily identifiable by current diagnostic modalities, including quantitative computed tomography, single and dual x-ray absorbtiometry, radio-absorbtiometry, and ultrasound. Properly implemented prevention and treatment strategies, such as calcium and vitamin D supplementation, exercises, hormone replacement therapy, alendronate, and calcitonin, may reduce the future fracture risk in many individuals. An algorithm is provided based on currently available clinical evidence for the evaluation and treatment of osteoporosis. CONCLUSIONS: Expanded use of currently available and emerging diagnostic and therapeutic modalities should lead to decreased fracture rates and a resultant increase in quality of life for patients with osteoporosis.     

Genital ulcers. Evaluation and treatment

Ulcerations may appear on the genitalia in a variety of both infectious and noninfectious conditions. The vast diversity of etiologies, coupled with the often overlapping morphological features, make the diagnosis of genital ulcerations a challenging endeavor. This article highlights the most important clinical manifestations and laboratory findings which aid in the proper diagnosis of genital ulcerations.     

Evaluation and determinants of outcome of tuberculosis treatment

We report a case of fat embolism following self injection of vegetable oil in the penis, to treat an impotence. The patient developed respiratory failure and neurological disorders as confusion. A chest roentgenogram revealed diffuse alveolar infiltrate. Initially, he presented an hemoconcentration, and fat globules in his urine. The outcome was favourable in 72 hours, with oxygen and hydration. The diagnosis of fat embolism was made after neurological improvement: the patient admitted to injection his penis with vegetable oil, in his corpus cavernosum.     

99mTc(V)-DMSA accumulation in gynecomastia

The accumulation of 99mTc(V)-DMSA in bilateral breasts was recognized in a 60-year-old male with drug-induced gynecomastia. There are some reports describing 99mTc(V)-DMSA accumulation in normal female breast, fibrous dysplasia of the breast and metastatic lesions of breast carcinoma, but to my knowledge, there have been no reports describing 99mTc(V)-DMSA accumulation in gynecomastia.     

Bronchogenic carcinoma accompanied with gynecomastia. A case report

A case of bronchogenic carcinoma accompanied with gynecomastia was reported. The enlargement of bilateral breasts was discovered for 3 months before admission with continuous low grade fever, dyspnea and weight loss. The patient was a heavy smoker and had chronic bronchitis. Physical examination revealed bilateral enlargement of breasts, the diameter of each breast was 12 cm and the height was 6 cm. Serum human chorionic gonadotropin (HCG) was > 2000 miu/ml, prolactin (PRL) 41.5 ng/ml, luteinizing hormone (LH) > 200 miu/ml. The chest X-ray film showed scattered nodular shadows in both lung fields. Tumor cells were found in the lung tissue obtained by biopsy after death suggesting of adenocarcinoma. The pathogenesis of gynecomastia was discussed.     

Evaluation and treatment of uncompensated unilateral vestibular disease

Polar auxin transport plays a key role in the regulation of plant growth and development. To identify genes involved in this process, we have developed a genetic procedure to screen for mutants of Arabidopsis that are altered in their response to auxin transport inhibitors. We recovered a total of 16 independent mutants that defined seven genes, called TRANSPORT INHIBITOR RESPONSE (TIR) genes. Recessive mutations in one of these genes, TIR3, result in altered responses to transport inhibitors, a reduction in polar auxin transport, and a variety of morphological defects that can be ascribed to changes in indole-3-acetic acid distribution. Most dramatically, tir3 seedlings are strongly deficient in lateral root production, a process that is known to depend on polar auxin transport from the shoot into the root. In addition, tir3 plants display a reduction in apical dominance as well as decreased elongation of siliques, pedicels, roots, and the inflorescence. Biochemical studies indicate that tir3 plants have a reduced number of N-1-naphthylphthalamic (NPA) binding sites, suggesting that the TIR3 gene is required for expression, localization, or stabilization of the NPA binding protein (NBP). Alternatively, the TIR3 gene may encode the NBP. Because the tir3 mutants have a substantial defect in NPA binding, their phenotype provides genetic evidence for a role for the NBP in plant growth and development.     

Evaluation and treatment of posterior cruciate ligament injuries

Twenty-eight low median nerve injuries and 23 low ulnar nerve injuries were repaired using intraneural fascicular dissection and electrical fascicular orientation. Eleven freshly lacerated nerves were seen within 48 hours after injury; 40 nerve lacerations were chronic. Fascicular orientation between sensory and motor fascicles at the proximal nerve end could be accurately differentiated in 47 nerves (92%) independent of whether it was acute or chronic. At the distal nerve end in fresh lacerations, the motor fascicles could be determined conclusively by muscle contraction with sequential electrical stimulation of the fascicles. In chronic nerve lacerations, the distal fascicles could be estimated anatomically after internal neurolysis. After fascicular orientation, nerves were repaired with end-to-end group fascicular suture or interfascicular sural nerve grafting. Twenty-four nerves repaired with end-to-end suture and 13 nerves repaired with nerve grafting were monitored more than 25 months. Satisfactory sensory results (i.e., S3+ or S4 functions) were obtained in 29 nerves (78%) and M4 or M5 motor functions were achieved in 29 nerves (78%). There were no patients who needed additional tendon transfers to reconstruct thumb opposition or to correct claw finger deformity. These results suggest that low median or ulnar nerve lacerations, whether acute or chronic, partial or complete, may be successfully repaired with the aid of electrical fascicular orientation with or without intraneural fascicular dissection.     

Evaluation and treatment of urinary tract infections in children

Urinary tract infections (UTIs) are among the most common bacterial infections encountered by primary care physicians. Although UTIs do not occur with as great a frequency in children as in adults, they can be a source of significant morbidity in children. For reasons that are not yet completely understood, a minority of UTIs in children progress to renal scarring, hypertension and renal insufficiency. Clinical presentation of UTI in children may be nonspecific, and the appropriateness of certain diagnostic tests remains controversial. The diagnostic work-up should be tailored to uncover functional and structural abnormalities such as dysfunctional voiding, vesicoureteral reflux and obstructive uropathy. A more aggressive work-up, including renal cortical scintigraphy, ultrasound and voiding cystourethrography, is recommended for patients at greater risk for pyelonephritis and renal scarring, including infants less than one year of age and all children who have systemic signs of infection concomitant with a UTI. Antibiotic prophylaxis is used in patients with reflux or recurrent UTI who are at greater risk for subsequent infections and complications.     

Evaluation and treatment of head and neck venous vascular malformations

Congenital venous vascular malformations of the head and neck are low-flow, nonproliferative lesions that should be distinguished from hemangiomas. The characteristic history and clinical findings can establish the diagnosis. Direct percutaneous puncture and contrast injection at the time of treatment delineate the lesion and its drainage pattern. Treatment must be individualized according to lesion extent, patient tolerance and physician experience. Sclerotherapy with ethanol has proved to be a successful treatment modality for these lesions, as demonstrated in this study of 57 patients. Surgery is used for treatment of clinically significant residual disease. A multidisciplinary approach to evaluation and treatment is key to successful management.