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Key Clinical Message : The scrotum hematoma following femoral artery puncture is a rare complication. The bleeding from the puncture site drained through the inguinal canal into the scrotum. The present case may indicate the importance of quick observation of the scrotum, when the puncture of femoral artery was performed. The scrotum hematoma following femoral artery puncture is a rare complication. The bleeding from the puncture site drained through the inguinal canal into the scrotum. The present case may indicate the importance of quick observation of the scrotum, when the puncture of femoral artery was performed. [ABSTRACT FROM AUTHOR]

A 12-year-old donkey and a 6-year-old Connemara pony, both sexually intact males, were admitted for surgical removal of urinary calculi. Both underwent a laparoscopic-assisted cystotomy technique to exteriorise the bladder and remove uroliths via the inguinal canal after hemi-castration. Both surgeries were successful and no complications occurred. This modified technique, which is minimally invasive, may be a safe and efficient way to remove bladder stones from adult stallions. [ABSTRACT FROM AUTHOR]

We describe a huge abdominal gastrointestinal stromal tumor (GIST) extending through the right inguinal canal. The reported case illustrates that the scrotum might be a place of initial presentation of a GIST growing along preformed anatomical structures. Urologists should be aware of this condition that might be mistaken for a primarily testicular malignancy. [ABSTRACT FROM AUTHOR]

Inguinal lymph nodes are often excised in dermatological surgery, because they are the most common of the lymphatic basin involved in metastasis of malignant skin tumor on the lower extremities or genital region. Herein, we describe a case of cutaneous malignant melanoma on the buttock of a 78-year-old woman. Under the huge metastasized inguinal lymph node, there was tumor invasion into the femoral vein with intraluminal tumor thrombus formation. Careful preoperative radiological assessment enabled successful resection on surgery. A review of the published work revealed that tumor thrombus due to direct invasion of melanoma may be rare. The possibility of intravenous tumor thrombus should be considered in the settings of surgery of inguinal metastasis of melanoma, especially when a large-sized node is located near the great veins., (© 2014 Japanese Dermatological Association.)

Background: Three different sites of needle insertion have been proposed for ilioinguinal-iliohypogastric (ILIH) nerve block. This double-blind study was designed to assess the quality of analgesia produced from these different sites., Methods: One hundred and thirty-two children of ASA grade I and II were randomly allocated into four groups to receive no nerve block (control group, n = 30) or ILIH block at 1 cm inferio-medial to the anterior superior iliac spine (ASIS) in group IM (n = 34), 1-2 cm medial to the ASIS in group M (n = 34) and 2 cm superio-medial to the ASIS in group SM (n = 34) with 0.25 ml/kg of 0.25% bupivacaine after induction of anaesthesia. Pain was assessed using the All India Institute of Medical Sciences (AIIMS) pain discomfort scale (APDS) score. The amount and pattern of fentanyl consumed over the ensuing 24-h period was noted., Results: APDS score and fentanyl requirement were similar in all the study groups but significantly higher until 8 h after surgery in the control group, P < 0.05. Twenty-two out of 102 children in the study groups and all patients in the control group received additional fentanyl during the post-operative period. Only 6 out of 22 children required additional fentanyl supplementation beyond the 30-min interval. Overall failure rate of ILIH nerve block was 6%., Conclusion: ILIH block can be successfully accomplished from any point if the needle bevel lies between the two muscle planes above and below the internal oblique.

Background: By choosing spinal anaesthesia instead of general anaesthesia, and by infiltrating the wound area with local anaesthetic the need for postoperative analgesics may be reduced. An ilioinguinal and iliohypogastric nerve block (IINB) in inguinal herniorrhaphy was, therefore, studied in a day surgery setting in combination with a spinal block., Methods: One hundred ASA I-II adult patients scheduled for inguinal herniorrhaphy were given spinal anaesthesia with hyperbaric 0.5% bupivacaine. In a randomized and blinded fashion half of them received an IINB 5 min before the surgical incision with 10 ml of 0.5% bupivacaine (B-IINB) and the other half with saline (S-IINB). All patients received ketoprofen 100 mg i.v. during surgery and another 100 mg 2-3 h postoperatively. The patients were observed for about 6 h in the day surgery unit before discharge., Results: The results showed that in comparison with the S-IINB group, significantly fewer patients in the B-IINB group needed analgesics (P<0.01) and the amount required was also significantly less postoperatively, before discharge (about 6 h postoperatively) (P<0.05). The latency to the need for the first postoperative analgesic was shorter in the S-IINB patients (P<0.01). At home the VAS scores and the need for analgesics (oral ketoprofen 100 mg) were low with no differences between the groups. No complications occurred., Conclusion: It is concluded that no long-term analgesia could be demonstrated by a preincisional IINB performed during spinal anaesthesia in day-surgery inguinal herniorrhaphy patients. Thus, reduced analgesic requirement was seen only for about 6 h postoperatively.

Objective: Anti-tumor necrosis factor alpha (anti-TNFalpha) therapy is very effective in rheumatoid arthritis (RA), whereas depleting anti-CD4 therapy is relatively ineffective. To explain the differences in efficacy between these 2 therapies, we used an animal model of RA to compare their effects on different aspects of the disease process., Methods: Mice with collagen-induced arthritis were treated with depleting anti-CD4 monoclonal antibodies (mAb), anti-TNFalpha mAb, or phosphate buffered saline. Another group was given a combination of anti-TNFalpha plus anti-CD4. The treatments were compared for their ability to down-regulate the expression of proinflammatory cytokines and adhesion molecules, reduce the cellularity of the joint, and inhibit Th1 activity., Results: Anti-TNFalpha significantly reduced the numbers of cells expressing TNFalpha, interleukin-1beta (IL-1beta), very late activation antigen 4 (VLA-4), vascular cell adhesion molecule 1 (VCAM-1), and numbers of CD4+ T cells and macrophages in the joint. Anti-CD4 treatment led to a small reduction in the expression of TNFalpha, IL-1beta, VLA-4, and VCAM-1, but this did not reach statistical significance. Depleting anti-CD4 was also surprisingly ineffective in eliminating CD4+ T cells from the joint. Anti-TNFalpha therapy was also more effective than anti-CD4 in reducing Thl activity, as assessed by the production of interferon-gamma in lymph node cell cultures. There was a synergistic relationship between anti-TNFalpha and anti-CD4 in the reduction of histologic score and inhibition of TNFalpha/IL-1beta expression in the joints., Conclusion: The efficacy of the 3 treatments correlated with their ability to modulate the expression of inflammatory cytokines and adhesion molecules in the joint, reduce the cellularity of the joint, and inhibit Th1 activity. This kind of analysis may prove useful in the testing of novel therapies for RA.

Background: Nonsteroidal antiinflammatory drugs (NSAIDs) have become a popular component of analgesia regimens, particularly in combination with narcotics. We questioned whether there might also be a place for their use in conjunction with regional anesthesia and whether there was a preferable route for NSAID administration., Methods: Ilioinguinal and field blocks were performed preoperatively on seventy patients undergoing outpatient inguinal hernia repair. Patients were divided into a control group who received no ketorolac and four study groups who received a preoperative dose of 30 mg ketorolac by one of the following routes: i.v., i.m., p.o., or intrawound (i.w.). The ketorolac in the i.w group was mixed in the syringe with the local anesthetic used for the field block. i.v. and i.m. groups also received ketorolac at the time of the preoperative regional anesthesia and the PO group received the dose at least one hour preoperatively. All patients received a similar general anesthetic intraoperatively., Results: Postoperative pain scores and analgesic requirements were lowest for the i.m., i.v., and i.w. groups. Pain scores and analgesic requirements for the PO group were less than for the control group but more than for the other three groups. Analgesic efficacy therefore ranked: i.m. = i.v. = i.w. > p.o. > control. Though no differences were found between groups in the time to discharge from the recovery room, the ease of nursing care paralleled the findings for pain scores and analgesia requirements., Conclusion: Beyond the analgesia provided by the regional anesthesia of the ilioinguinal and field blocks, the preoperative use of ketorolac further reduced postoperative pain scores and the need for additional postoperative analgesic medication. Comparable outcomes for the i.v., i.m. and i.w. groups indicate the lack of any benefit to concentrating the non-steroidal anti-inflammatory drug at the wound (i.w.) or to achieving high blood levels rapidly (i.v.). In conclusion, ketorolac is a useful supplement to ilioinguinal plus field block regional anesthesia for hernia surgery and is most effective administered parenterally.

This report described a case of scrofuloderma that developed in the bilateral inguinal regions during treatment of bullous pemphigoid with systemic corticosteroid. Analysis of the literature on scrofuloderma between 1978-1993 disclosed that the number of cases with extracervical involvement are increasing. Immunosuppression could disseminate tuberculous focuses, resulting in extracervical involvement of SD connected with the underlying extrapulmonary tuberculous lesions.

The stroma-vascular fraction (SVF) of inguinal and epididymal fat pads of 4 week-old rats was studied by electron microscopy. Among the various cell types, endothelial cells and preadipocytes were found in both SVF, while mesothelial cells were only detected in the epididymal SVF. The resulting heterogeneity of primary culture and the adipoconversion of the fat cell precursors were studied in a serum-supplemented medium enriched with insulin (14.5 nM) and exogenous triglycerides. Despite the heterogeneity of the inoculum, the primary cultures were rather homogeneous, fat cell precursors being the main cell type. Distinctive contaminant fibroblast-like cells were observed in both cultures, whereas epithelial-like cells, which correspond most probably to mesothelial cells, were only found in epididymal cultures. Differentiation of fat cell precursors was assessed by the appearance of lipoprotein lipase (LPL) and glycerol-3-phosphate dehydrogenase (GPDH). LPL activity was found in the same level in cells of both deposits while GPDH activity was elevated in inguinal vs epididymal derived stroma-vascular cells. The different adipose conversion pattern of both cultures was confirmed by morphological quantification: the maturation of epididymal fat cell precursors was faster but less extensive. These differences could be related mainly to regional localization rather than to different maturation of the two fat deposits.

Between April 1969 and December 1980, 329 patients with pathologically staged IA-IIB Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Twenty-five (7.6 per cent) of these patients presented with inguinal-femoral or superficial iliac adenopathy and had disease limited to below the diaphragm. In addition 11 patients presented with intra-abdominal masses and Hodgkin's disease was diagnosed on laparotomy. The median age, histologic subtypes, and actuarial relapse free and overall survival of patients with peripheral adenopathy limited to below the diaphragm were similar to patients with supradiaphragmatic Hodgkin's disease. Patients with disease limited to the pelvic or inguinal-femoral nodes were treated with pelvic and para-aortic irradiation alone. Staging laparotomy identified those patients with para-aortic or splenic involvement and these patients were treated with total nodal irradiation or combined modality treatment. The small group of patients who presented with intra-abdominal disease without peripheral adenopathy was older, had a predominance of lymphocyte depleted histology, and had a worse prognosis than the other patients described.