Background
Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting.
Case presentation
Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion.
Conclusion
This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.
Testicular size is an important parameter to investigate male reproductive and sexual functions. However, diagnosis and treatments are hindered by the lack of country‐specific standard values for testicular volume. We conducted the present retrospective chart review study on 24,440 men who sought consultation at Andrology and Sexual Medicine—Hanoi Medical University Hospital to provide a reference range of testicular volume and to determine the correlations between testicular volume, age and hormonal profiles. These men were classified into groups being healthy fathers, hypogonadal men, unexplained infertile men, men with unknown fertility, testicular pathologies and other andrological condition groups. Hypogonadal men and unexplained infertile men had significantly smaller testicular sizes compared with healthy fathers. The mean value of testicular volume of healthy subjects was 13.64 ± 3.44 ml (left testis: 13.94 ± 3.72 ml; right testis: 13.34 ± 3.61 ml; p < 0.001). Testicular size of Vietnamese men was negatively correlated with LH and FSH (Rho = −0.16 and −0.33, p < 0.001) and positively correlated with testosterone after adjusting for confounding factors. Testicular volume was independent of the subject's age and smoking habits.
We examined 501 patients with non - obstructive azoospermia to evaluate clinical, subclinical, and genetic characteristics. The results show that the average age of patients in the study was 29.8 ± 5.5 years. Primary infertility accounts for the majority, with a rate of 90.3%. There was 38.6% of patients had a history of mumps orchitis. The average levels of FSH, LH, testosterone were 31.6 ± 16.5 mIU/mL, 15.5 ± 10 mIU/mL and 12.8 ± 7.13 nmol/L, respectively. The prevalence of chromosomal abnormalities was 30.7%. Of these, the sex chromosome aneuploidy with 47,XXY karyotype (Klinefelter syndrome) accounted for 27.3%. The incidence of AZF microdeletion was 13.8%. Of these, AZFc deletion was the most common at the rate of 42.1%, AZFa deletion, which accounted for 2.6%, were the least prevalent, and the frequency of AZFd deletion was 5.3%. However, there was no solitary AZFb deletion, which combined with other AZF deletions with 34.2%. Our research shows that mumps orchitis and chromosomal abnormalities are the leading causes of azoospermia. Screening for genetic abnormalities plays an important role in infertile patients with non - obstructive azoospermia.
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