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A varicocele is a widening of the veins along the cord that holds up a man's testicles (spermatic cord).

Causes, incidence, and risk factors A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.) Varicoceles usually develop slowly. They are more common in men ages 15 - 25 and are most often seen on the left side of the scrotum. The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right. Symptoms

Enlarged, twisted veins in the scrotum Painless testicle lump, scrotal swelling, or bulge in the scrotum

There may not be symptoms. Signs and tests The health care provider will examine the groin area, including the scrotum and testicles. The health care provider may feel a twisted growth along the spermatic cord. (It feels like a bag of worms.) However, the growth may not be able to be seen or felt, especially when you are lying down. The testicle on the side of the varicocele may be smaller than the one on the other side. Treatment A jock strap (scrotal support) or snug underwear may help relieve the pain or discomfort. If pain continues or other symptoms occur, you may need further treatment. Surgery to correct a varicocele is called varicocelectomy. You will leave the hospital on the same day as your surgery. During this procedure, you will receive some type of numbing medication (anesthesia). The urologist will make a cut, usually in the lower abdomen, and tie off the abnormal veins. Blood will now flow around the area into normal veins. Keep an ice pack on the area for the first 24 hours after surgery to reduce swelling. An alternative to surgery is varicocele embolization. This method is also done without an overnight hospital stay. It uses a much smaller cut than surgery, so you will heal faster. A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area. Using x-rays as a guide, the health care provider moves the tube into the varicocele. A tiny coil passes through the tube into the varicocele. The coil blocks blood flow to the bad vein, and sends it to normal veins. After the procedure, you will be told to place ice on the area and wear a scrotal support for a little while. Expectations (prognosis) A varicocele is usually harmless and often does not need to be treated. If you have surgery, your sperm count will likely increase but it will not improve your chances of getting a woman pregnant. In most cases, testicular wasting (atrophy) does not improve unless surgery is done early in adolescence.

Complications Infertility is a complication of varicocele. Complications from treatment may include:

Atrophic testis Blood clot formation Infection Injury to the scrotum or nearby blood vessel

Signs and symptoms Symptoms of a varicocele may include:


Dragging-like or aching pain within scrotum. Feeling of heaviness in the testicle(s) Atrophy (shrinking) of the testicle(s) Low testosterone. [1] Visible or palpable (able to be felt) enlarged vein

The idiopathic varicocele occurs when the valves within the veins along the spermatic cord do not work properly. This is essentially the same process as varicose veins, which are common in the legs. This results in backflow of blood into the pampiniform plexus and causes increased pressures, ultimately leading to permanent damage to the testicular tissue due to disruption of normal supply of oxygenated blood via the testicular artery. Varicoceles develop slowly and may not have any symptoms. They are most frequently diagnosed when a patient is 1530 years of age, and rarely develop after the age of 40. They occur in 15-20% of all males, and it is the main cause of male infertility. 98% of idiopathic varicoceles occur on the left side, apparently because the left testicular vein connects to the renal vein (and does so at a 90-degree angle), while the right testicular vein drains at less than 90-degrees directly into the significantly larger inferior vena cava. Isolated right sided varicoceles are rare. A secondary varicocele is due to compression of the venous drainage of the testicle. A pelvic or abdominal malignancy is a definite concern when a right-sided varicocele is newly diagnosed in a patient older than 40 years of age. One non-malignant cause of a secondary varicocele is the so-called "Nutcracker syndrome", a condition in which the superior mesenteric artery compresses the left renal vein, causing increased pressures there to be [2] transmitted retrograde into the left pampiniform plexus. The most common cause is renal cell carcinoma (a.k.a. hypernephroma) followed by retroperitoneal fibrosis or adhesions. Pathophysiology The term varicocele specifically refers to dilatation and tortuosity of the pampiniform plexus, which is the network of veins that drain the testicle. This plexus travels along the posterior portion of the testicle with the epididymis and vas deferens, and then into the spermatic cord. This network of veins coalesces into the gonadal, or testicular, vein. The right gonadal vein drains into the inferior vena cava, while the left gonadal vein drains into the left renal vein at right angle to the renal vein, which then drains into the inferior vena cava. one of the main function of the plexus is to lower the temp to the testicles, during vericocele this function is lost, hence the most common complication of untreated vericocele is higher temp to testes resulting in testicular atrophy causing infertility. The small vessels of the pampiniform plexus normally range from 0.5 1.5 mm in diameter. Dilatation of these vessels greater than 2 mm is called a varicocele.

Recent studies have shown that the detrimental effect of varicocele on the sperm production is progressive and due to reduction in supply of oxygenated blood and nutrient material to the sperm production sites, which persistently reduces the quality and the quantity of the sperms, leading to reduction in their fertility capacity with time. Neurocirculatory asthenia: A clinical syndrome characterized by palpitation, SHORTNESS OF BREATH, labored breathing, subjective complaints of effort and discomfort, all following slight EXERTION. Other symptoms may be DIZZINESS, tremulousness, SWEATING, and INSOMNIA. Neurocirculatory asthenia is most typically seen as a form of anxiety disorder. neurocirculatory asthenia a syndrome of breathlessness, fear of effort, a sense of fatigue, precordial pain, and palpitation, generally considered to be a particular presentation of an anxiety disorder. Advertisement (Bad banner? Please let us know) Ads by Google Help for Lichen Sclerosis Natural Ointment has Reduced Lichen Sclerosis Symptoms asthenia /asthenia/ (as-thene-ah) lack or loss of strength and energy; weakness. neurocirculatory asthenia a syndrome of breathlessness, fear of effort, a sense of fatigue, precordial pain, and palpitation, generally considered to be a particular presentation of an anxiety disorder. tropical anhidrotic asthenia a condition due to generalized anhidrosis in conditions of high temperature, characterized by a tendency to overfatigability, irritability, anorexia, inability to concentrate, and drowsiness, with headache and vertigo.

neurocirculatory asthenia (n r -sr ky -l -tr ) n. A former designation for a syndrome characterized by increased susceptibility to fatigue, dyspnea, rapid pulse, precordial pain, and anxiety, observed especially in soldiers on active duty. Also called DaCosta's syndrome, effort syndrome, irritable heart, soldier's heart. neurocirculatory asthenia [-surkyltr] Etymology: Gk, neuron + L, circulare, to go around; Gk, a + sthenos, without strength a psychosomatic disorder characterized by nervous and circulatory irregularities, including dyspnea, palpitation, giddiness, vertigo, tremor, precordial pain, and increased susceptibility to fatigue. The symptoms often result from or are associated with psychologic stress.

an dated alternate name for post traumatic stress disorder or panic disorder..

In addition to psychotherapy and pharmacotherapy treatments, occupational therapy may be helpful. Supportive therapies such as expressive therapies (i.e., art, music, or dance therapy) or relaxation techniques may be helpful to certain individuals. Physical therapy that addresses relaxation through use of breathing relaxation techniques may also prove helpful. Mild exercises such as calisthenics incorporated and supervised by rehabilitation professionals can also be helpful in decreasing anxiety and promoting relaxation. Physical and occupational therapists often use biofeedback techniques to help reduce anxiety. Biofeedback machines allow individuals to be consciously aware of any changes in their heart rate with visual and/or audio stimulation. The therapist can then address specific exercises that help individuals control their heart rate and anxiety.

Since medication therapy is one of the primary treatments for individuals with neurocirculatory asthenia, rehabilitation may need to be modified in accordance to any side effects from medication. Neurocirculatory asthenia or DaCosta's syndrome is a condition characterized by shortness of breath (dyspnea), fatigue, rapid pulse, and irregular or pounding heartbeats (palpitations) and chest pain. It occurs mostly with exertion and is not due to physical disease of the heart, but is associated with exhaustion and emotional strain and may have a psychological basis. In psychiatry, there is a tendency to view neurocirculatory asthenia as a form of anxiety disorder or panic disorder, yet it does not appear in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental th Disorders, 4 Edition, Text Revision). It is often associated with hyperventilation and respiratory acidosis that is measurable by arterial blood gas. It has classically been described in soldiers exposed to combat and is now thought to overlap with post-traumatic stress disorder and/or chronic fatigue syndrome. Specific causes are not known, although stress appears to play a role. Symptoms usually start in adolescence or the early twenties but may also present in middle age. The condition tends to be chronic with recurrent acute exacerbations. The resulting weakness may produce isolation from social situations, similar to social anxiety disorder, and may be associated with agoraphobia. Risk: Risk factors are basically the same as for any chronic anxiety condition, and may be related to past or present stress. Symptoms are twice as common in women as in men.

Diagnosis History: Individuals may complain of the inability to take a deep breath, a smothering sensation upon taking a breath, a choking sensation, the feeling of being short of breath (dyspnea), the sensation of a racing heart (palpitations) and/or a pulse rate of over 100 beats per minute (tachycardia), chest pain or discomfort, undue fatigue or limitation of activities, excessive sweating, insomnia, irritability, and feelings of nervousness, dizziness, faintness, or discomfort in crowds. Physical exam: A psychiatric interview, mental status exam, and neurologic exam are needed for diagnosis of this disorder. Diagnosis is often difficult. On physical exam, an increased respiratory rate of greater than 24 breaths per minute, shallow respirations, or sighing respirations may be evident. Pulse may be irregular or rapid. Tests: Psychological tests such as the Minnesota Multiphasic Personality Inventory and their interpretation can be helpful. Cardiac evaluation is needed to exclude physical diseases with similar symptoms such as mitral valve prolapse. Often the individual will go through exhaustive medical workups to eliminate physical causes of symptoms. Measurement of blood oxygenation by arterial blood gas may reflect a respiratory acidosis.

Treatment The treatment of neurocirculatory asthenia is challenging since many individuals may receive secondary gain of attention and sympathy for their symptoms, and tend to seek help from medical specialists rather than psychiatrists. Psychotherapy may be useful to focus on feelings of anxiety and explores ways to decrease anxiety levels. Medication therapy (beta-blockers or anti-anxiety agents) may be used to control symptoms of anxiety. Fatigue may indicate a need for stimulants. Stimulants, however, may worsen symptoms of anxiety and should be avoided if possible.

Prognosis The expected outcome for neurocirculatory asthenia is guarded, particularly if it is chronic. Treatment is difficult, and the individual most often avoids psychiatric help insisting there is an organic reason for the symptoms. The outcome can be positive if the individual accepts treatment aimed toward relieving the symptoms of anxiety such as medication or psychotherapy.