c Coxsackievirus A6 (CV-A6) caused hand, foot, and mouth disease (HFMD) with a unique manifestation of epididymitis. The patient underwent operation due to suspicion of testicular torsion. Epididymitis was diagnosed by ultrasound examination. Enterovirus was detected from epididymal fluid by PCR and typed by partial sequencing of viral protein 1 as CV-A6. CASE REPORT The case patient was a 17-year-old male who had previously been in good health. He was not on any regular medication. He sought medical care at the emergency department of the Oulu University Hospital due to an intense pain in his left testis. He was admitted to the surgical ward with suspicion of a testicular torsion. On admission, his general condition was good. He had mild fever and swelling in the left side of the scrotum, and that area was painful in palpation. Vesicular exanthema had appeared on his palms during the week before admission to the hospital.Due to the suspicion of testicular torsion, an ultrasound examination was performed, which revealed epididymo-orchitis. The right testicle was normal when examined by ultrasound. Because the possibility of torsion could not be excluded, an exploratory operation was performed. The left testis and epididymis were found to be swollen and irritated. There was no pus in the scrotal area, but under the tunica vaginalis there was a small amount of fluid, which was aspirated and sent for the microbiological analysis. Antimicrobial treatment was started with cefuroxime and ciprofloxacin. After the operation, the patient remained on the ward for 3 days, and on discharge, he was recovering; he was afebrile and did not have any pain or swollenness in the scrotal area.Laboratory analysis showed an increased blood C-reactive protein (CRP) level of 105 mg/ml (normal level, Ͻ10 mg/liter). On discharge, the CRP level was 30 mg/ml. The white blood cell count was normal (6.2 to 7.8 ϫ 10 9 /liter). A bacterial culture from the epididymal fluid gave a negative result, as did a urine culture. Chlamydia trachomatis and Neisseria gonorrhoeae PCR test results from epididymal fluid were negative.
Objective The aim of this study was to analyze the impact of introduction of robot-assisted prostate surgery and its quality measures in Finland from 2008 to 2012. Materials and methods Registry data were collected for time trends and national distribution of prostate cancer surgery in Finland, while preoperative, operative and follow-up data were collected for quality measures. Results The number and proportion of robot-assisted laparoscopic radical prostatectomies (RALPs) increased rapidly and they accounted for 68% of all radical prostatectomies in 2012. The number of centers performing prostatectomies diminished from 25 to 20 at the expense of low-volume centers. In total, 1996 patients were operated on in the four RALP centers in 2008-2012. As anticipated, the learning curve was uniform between the centers, as were mean blood loss (212 ml), hospitalization (1.8 days) and catheterization times (10.6 days). At 3 and 12 months, 49.4% and 71.2% of patients, respectively, were totally continent (no pads). After unilateral nerve-sparing surgery, 9.9% and 5.1% had partial or normal erection at 3 months postoperatively and 14.8% and 20.4% at 12 months, respectively. If bilateral nerve sparing was done, the figures were 13.0% and 13.5% at 3 months and 14.6% and 34.9% at 12 months. Clavien-Dindo grade 3, 4 or 5 complications were seen in 0.3%, 0.3% and 0.1% of patients, respectively. Limitations of the study include non-standardized collection of outcome parameters. Conclusions This report shows that the main impact of adoption of RALP on a national level was rapid spontaneous centralization of prostate cancer surgery. The main advantages of minimally invasive prostatectomy, i.e. low blood loss and short hospitalization, are easily achieved, while continuous effort is necessary for improvements in surgical outcomes.
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