תוצאת חיפוש

¹מחלקת ילדים, ²היחידה למיקרוביולוגיה קלינית, מרכז רפואי בני ציון, והפקולטה לרפואה, הטכניון- מכון טכנולוגי לישראל, חיפה

כיבים בדרכי המין יכולים להיגרם עקב מחלה זיהומית או לא זיהומית. הזיהומים השכיחים ביותר במדינות המערב הם שלבקת פשוטה (הרפס סימפלקס) ועגבת. זיהומים אלה יכולים להיות משולבים עם מחוללים אחרים שעוברים במגע מיני. כמו כן, מחלה כיבית מעלה את הסיכון להדבקה ב-HIV. אבחנה המבוססת על אנמנזה ומימצאים קליניים בלבד לרוב אינה מדויקת דיה. לכן נדרש אבחון מעבדה לשלבקת פשוטה ועגבת הכולל: סרולוגיה מהדם, תרבית ו-(PCR) Polymerase Chain Reaction מהכיב לשלבקת פשוטה, ובדיקה ב-Dark field לעגבת בשלבים הראשונים של ההדבקה וסרולוגיה מהדם בהמשך. לאחרונה, במעבדות קליניות רבות הוחל בביצוע שיטת סקר הפוכה לאבחון עגבת (תבחין Treponema pallidum ראשון ולאחריו תבחין Non treponema pallidum), מה שעלול לגרום לטיפול אנטיביוטי מיותר לחולים עם מחלה שטופלה בעבר. במחלות הגורמות להתפתחות כיבים בדרכי המין, יש מקום להתחיל טיפול מוקדם על בסיס האבחנה הסבירה ביותר, בהסתמך על המימצאים הקליניים, הנתונים האפידמיולוגיים ותוצאות המעבדה, במטרה להפחית את הסיכון להמשך ההדבקה.

Congenital Syphilis: Need for Adequate Antenatal Care

Mark Friedberg

Pediatrics B Dept., Soroka Medical Center, Beer Sheba

Congenital syphilis is well-known and treatable with penicillin. Diagnosis in the neonate and young child may be difficult and consequently morbidity and mortality can be high. Prevention in children is of utmost importance and can be achieved by proper antenatal care and adequate follow-up of pregnant women. This includes identification of pregnant women at risk for contracting syphilis. The case presented demonstrates this need.

Acute, Painful, Swollen Testis

Dan Leibovici, Simon Strauss, Ahuva Sharon

Dept. of Urology, Ultrasound Unit, Institute of Diagnostic Imaging and Medical Dept., Assaf Harofeh Medical Center and Sackler Faculty of Medicine, Tel Aviv University

An acutely painful and swollen testis mandates urgent diagnostic and therapeutic measures since this symptom complex may indicate torsion of the testis. Prompt scrotal exploration is necessary if the testis is to be saved from ischemic necrosis.

Polyarteritis nodosa (PAN) is a vasculitis involving mainly medium and small sized arteries and may damage any organ. In PAN, the presentation of an acutely painful and swollen testis raises a perplexing diagnostic problem since the symptoms may be related to vasculitis involving the testis on the one hand, or represent primary testicular pathology unrelated to the underlying PAN. A 31-year-old man with PAN who presented with acute pain and swelling in a solitary testis is reported.

Are Testes in Oligo/Azoospermia Homogenous or Heterogenous?

David B. Weiss, Shoshana Gottschalk-Sabag, Elchanan Bar-On, Zvi Zukerman

Kupat Cholim Meuhedet, Jerusalem; Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; and Andrology Unit, Rabin (Beilinson) Medical Center, Petah Tikva

We determined whether a single testicular specimen is sufficient to represent qualitatively the spermatogenic process within the testes of azoospermic or severely oligospermic infertile men. In 191 testes of azoospermic patients and in 26 of those with severe oligospermia, fine needle aspirations at 3 different sites of each testis were performed. Aspirated material from each puncture was stained and in each smear all spermatogenic cells, as well as Sertoli cells, were identified. Testes were classified according to the most mature spermatogenic cell type present, or the presence of only Sertoli cells. The homogeneity of the testicular spermatogenic process was then evaluated. There was an overall intratesticular difference between aspirates in 14.1% of azoospermic testes and in 26.9% of severely oligospermic testes with regard to the most mature spermatogenic cell type. When spermatozoa were the most mature cell type, they were detected in all of the 3 aspirates in 71.4% of the testes. In 18.4% or 10.2% of this group of testes they were retrieved in only 1 or 2 of the aspirates, respectively. In testes in which spermatids or spermatocytes were the most mature spermatogenic stage, these cell types were detected in all 3 aspirates in only 36.4% and 68.0%, respectively. In azoospermic patients with full testicular spermatogenesis, the likelihood of retrieving spermatozoa from the testes was 84.3%, 92.7% and 100% in 1, 2 and 3 specimens, respectively. The following conclusions were drawn: There is a wide range of testicular heterogeneity in azoospermia or very severe oligospermia for diagnosing the testicular spermatogenic pattern. In azoospermia, specimens from several testicular sites are required. It is strongly recommended that no assisted fertilization be offered to azoospermic patients unless prior evaluation of the spermatogenic pattern in the seminiferous tubules is determined.