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JCCC 2016 Issue 6

Table of Contents

Undescended Testis

Teaser: 

Yvonne Y. Chan, MD, 1 Stanley A. Yap, MD, 1Jennifer H. Yang, MD1

1University of California Davis, Department of Urology, Sacramento, CA.

CLINICAL TOOLS

Abstract: Undescended testis is the most common genitourinary anomaly in boys and is found in 2-4% of those born full term and 20-30% of those born premature. Spontaneous descent occurs in 50-70% of cases. Physical exam is critical and sufficient in the diagnosis and characterization of testicular location. As such, imaging is not necessary prior to referral to pediatric urology as it will not affect management. Testicular maldescent impairs spermatogenesis and increases risk for testicular germ cell tumors, so timely diagnosis and intervention are key.
Key Words:undescended testis, cryptorchidism, orchiopexy.

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Pre-test CME Quiz Post-test CME Quiz
Undescended testis affects spermatogenesis and increases risk for testicular cancer and infertility.
Initiate workup for disorders of sexual development in cases of bilateral, undescended, and nonpalpable testes.
For cases of congenital undescended testis, refer to pediatric urology if the testis remains undescended by 6 months of age (corrected for gestational age).
Imaging is not necessary prior to referral to pediatric urology.
Patients with bilateral undescended and nonpalpable testicles require DSD workup.
Physical exam is sufficient for determining the location of an undescended testis, and ultrasound is not necessary prior to referral to pediatric urology.
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Related Terms: Men’s Health, undescended testis, cryptorchidism, orchiopexy

Referral Criteria for Non-Emergent Spinal Symptoms in the Neck and Low Back: A Survey of Canadian Spine Surgeons

Teaser: 

Yoga Raja Rampersaud, MD, FRCSC,1 Dr. Hamilton Hall, MD, FRCSC,2

1Associate Professor Department of Surgery, University of Toronto, Divisions of Orthopaedic and Neurosurgery University Health Network Medical Director, Back and Neck Specialty Program, Altum Health, Past President Canadian Spine Society.
2is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract: The majority of the patients referred for surgical consultation are not candidates for surgery. Appropriate operative candidates endure unnecessary and potentially detrimental delays in obtaining their surgery while the rest waste time waiting to be told that surgery is not the answer. The Canadian Spine Society surveyed its membership to establish a set of practical surgical referral recommendations for non-emergent spinal problems. The results support referrals of patients with leg or arm dominant pain but, in the absence of a significant structural abnormality, discourage referring patients with neck or back dominant symptoms.
Key Words: spine surgery, indications, referral, clinical presentations, non-emergent.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
There is no universally acceptable ideal candidate, absolute indication or unqualified contraindication for elective spinal surgery.
Referral is recommended most often for patients who have constant arm or leg dominant pain.
Patients who have untreated neck or back dominant pain are not appropriate surgical referrals.
Surgeons insistence on an image or refusal to see a suitable patient who rejects surgery reflect the excessive demand on their time, which can be relieved with proper referral.
The recommendation for referral is highest when the patient has had aappropriate non-operative treatment: well supervised physical therapy, suitable medication, effective education and successful lifestyle modification.
Spine related arm and leg dominant pain are usually the result of specific nerve root pathologies and therefore are more likely amenable to surgical intervention than back or neck pain which are generally multifactorial.
Patients with disabling or progressive neurological deficits should be referred early; patients with little or no pain and with no functional limitation related to the neurological deficit are not recommended for referral.
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Related Terms: Back Health, spine surgery, indications, referral, clinical presentation, non-emergent

A Case of a Large Sublingual Dermoid Removed Successfully Using a Sublingual Approach

Teaser: 

Dr. Pradeep Shenoy, MD, FRCS, FACS, DLO,1
Dr. Farah Tabassum, MD, FRCPC, FABP2

1ENT & Neck Surgeon, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
2Pathologist, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.

CLINICAL TOOLS

Abstract:Sublingual dermoid cysts are rare lesions in the oral cavity. Common oral lesions include: ranula; benign mucosal swelling; and sublingual salivary gland tumours. Uncommon types of lesions include: thyroglossal cysts, pilomatrixomas,12 pilomatrix carcinomas, and arteriovenous malformations.
The etiology, diagnostic problems, radiological findings, various treatment approaches, and histopathological findings are described in the following case study, which includes a literature review.
Key Words: epidermoid cyst, submental swelling, sublingual swelling, sialo adenitis, thyroglossal cyst, pilomatrixoma.
Sublingual dermoid cysts are asymptomatic unless they are big causing pressure symptoms causing sialoadnitis, difficulty in swallowing, choking or pain while moving the tongue.
Good examination and CT scan of the neck helps to plan for the surgery.
Once removed completely the recurrence is very rare.
Dermoid cyst in the oral cavity are rare entity depending on the histological picutres that are classified into dermoid, epidermoid, and teratomas.
Complete excision through intra oral and external approach is done, depending on its site in relation with geniohyoid muscles.
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Related Terms: Otolaryngology, epidermoid cyst, submental swelling, sublingual swelling, sialo adenitis, thyroglossal cyst, pilomatrixoma