RESUMEN

A testicular varicocele is the result of the expansion of the venous pampiniform plexus of the scrotum. Often painless, a significant number of patients experience orchialgia, swelling, testicular atrophy, and abnormalities in spermatic parameters. Treatment of symptomatic varicocele involves a radiologic or surgical intervention to obstruct the reflux of venous drainage. Testicular anatomy, diagnostic evaluation and imaging, options for surgical intervention, and a step-by-step description of retrograde embolization and antegrade scrotal sclerotherapy are discussed. Furthermore, included is an overview of postprocedural management and patient outcomes for radiological interventions, and the most up-to-date evidence on the efficacy of varicocele treatments as well as how they compare to each other.

RESUMEN

Introduction: Within clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM. Methods: Guided by generalized and targeted needs assessments, we created a case-based curriculum to practice communication responses to address RDM. The communication framework, a 6Ds approach, was developed through adaptation and expansion of established and previously learned communication upstander frameworks. Cases were collected through volunteer submission and revised to maintain anonymity. Faculty and senior medical students cofacilitated the small-group sessions. During the sessions, students reviewed the communication framework, explored their natural response strategies, and practiced all response strategies. Results: Of 196 workshop participants, 152 (78%) completed the evaluation surveys. Pre- and postsession survey cohort comparison demonstrated a significant increase in students' awareness of instances of RDM (from 34% to 46%), knowledge of communication strategies to mitigate RDM (presession M = 3.4, postsession M = 4.6, p < .01), and confidence to address RDM (presession M = 3.0, postsession M = 4.4, p < .01). Discussion: Students gained valuable communication skills from interactive sessions addressing RDM using empathy, reflection, and relatability. The workshop empowered students to feel prepared to enter professional teams and effectively mitigate harmful discourse.

Asunto(s)

RESUMEN

INTRODUCTION: The advent of novel fetal interventions has increased interest in interventions for previously "lethal" anomalies such as bilateral renal agenesis or other congenital anomalies of the kidney and urinary tract (CAKUT) associated with in utero renal failure. While there have been rare reports of successful births following intervention in these cases, there is a paucity of data regarding the risks, benefits, and outcomes of intervention. To address this gap, this study presents our experience with fetal intervention for anatomic or functional renal agenesis. CASE PRESENTATION: A retrospective review was conducted for patients referred to the Colorado Fetal Care Center (CFCC) between 2013 and 2019 for evaluation of CAKUT anomalies. Eligibility was determined by a multidisciplinary team. Amnioinfusion was scheduled prior to 24 weeks gestation, with normal saline or lactated ringers infused as needed to obtain a "normal" amniotic fluid volume. During this time period, a total of 5 cases received fetal amnioinfusion for treatment of bilateral renal agenesis or bladder outlet obstruction. All 5 cases reached birth. 3/5 cases expired on day one of life. 1/2 of the remaining infants expired at 3 months secondary to peritoneal dialysis failure. The remaining infant is 4 years. Developmentally, she is on track with cognitive and language skills but is behind with general motor skills. We observed a 30-day mortality of 60% and 1-year mortality of 80%. CONCLUSIONS: Individuals carrying a pregnancy complicated by CAKUT anomalies face a difficult choice when considering intervention. Morbidity and mortality remain high at this stage of this evolving therapy, including difficulty with retaining infused intra-amniotic fluid >72 h and complications with peritoneal dialysis after birth. The surviving infant in this case series is 4 years. She currently awaits renal transplantation. These findings reinforce that treatment of these cases should remain experimental and large-scale multicenter trials are needed to determine the optimal indications for prenatal intervention.

Asunto(s)