Tongue cleaner,an unusual foreign body in the urethra: A case report

Introduction

Various cases of self-inflicted foreign body insertion into the urethra have been reported in adult males. The most common motive for such acts has been postulated as autoerotic stimulation, psychiatric illness or intoxication.

Case presentation

A 40-year-old male presented with a partially inserted tongue cleaner in his urethra with one end projecting from the urethral meatus and with a history of bleeding and pain. After a gentle attempt of removal using local anaesthetic gel the patient was scheduled for its surgical removal under anaesthesia.

Conclusion

Large complex foreign bodies may be not amenable to endoscopic removal and may warrant open surgical procedure. Urethral stricture should be suspected in such patients. A psychiatric visit should be recommended for all adult males with self-inflicted foreign body in the urethra.     

尿道综合征的误诊与尿道口成形术治疗

目的: 分析尿道综合征的误诊原因及手术方法。方法: 对322例尿道综合征患者(包括术前误诊的112例)均行尿道外口成形术治疗,并对其临床资料进行回顾性分析。结果: 术后随访6~12个月,痊愈241例,好转51例,无效30例,总有效率90.7%。结论: 泌尿外科专科体格检查不可忽视,尿道外口成形术是尿道综合征的有效治疗方法。     

拉莫三嗪致儿童药物超敏反应综合征1例

Drug induced hypersensitivity syndrome (DIHS) is often manifested as severe systemic drug trans-reactions characterized by acute and extensive skin lesions (mostly measles-like rash), fever, enlargement of lymph nodes, multiple organ involvement (hepatitis, nephritis, and pneumonia), eosinophilia and mononucleosis,within 2-6 weeks of the application of sensitizing drugs. In the early stage of the lesion, macular papules or erythema multiforme were common, and in severe cases, exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis were also common. Most of them deve-loped after taking allergic drugs for 2-6 weeks (average: 3 weeks). Symptoms persisted after discontinuation of allergic drugs. It takes more than one month to alleviate, which may endanger life in severe cases. Documents report that the most common drugs causing DIHS are phenytoin sodium, carbamazepine and phenobarbital aromatic drugs. However, it was reported that phenobarbital sodium was the most common anticonvulsant among allergenic drugs in children, followed by antipyretics, analgesics and antibio-tics, which may be related to the spectrum of childhood diseases and the particularity of the drug. Lamotrigine has been reported to cause DIHS in adults in China, but less in children. In order to improve the understanding of clinical diagnosis and treatment of DIHS in children, reduce misdiagnosis, missed diagnosis, and untimely treatment, and prevent the aggravation of the disease, we studied the case of a 4-year-old 7-month-old girl who presented with systemic erythematous papules, fever, hepatosplenomegaly, marked increase of white blood cells, marked decrease of anemia and platelets, abnormal liver function and coagulation routine after taking lamotrigine for one month due to epilepsy seizures. Now, accor-ding to the DIHS diagnostic criteria established by Registration of Severe Cutaneous Adverse Reactions Drug Review Group in 2007, plasma exchange was immediately given to replace the toxic metabolites in hemorrhagic plasma, and methylprednisolone was given intravenously for three days. At the same time, after symptomatic supportive treatments, such as loratadine and albumin, the condition gradually improved without recurrence. Through a case report of Drug reaction with eosinophilia and systemic symptoms in a child caused by lamotrigine, we can strengthen our understanding and improve the level of diagnosis and treatment of drug hypersensitivity syndrome in children. Lamotrigine can cause DIHS in children, which is very dangerous. Early diagnosis and early withdrawal of allergenic drugs, plasma exchange and glucocorticoid therapy are the key to treatment.     

Laparoscopic repair of urinary bladder perforated during laparoscopic subtotal hysterectomy: case report

Bladder injury with subsequent intra-operative laparoscopic repair during a laparoscopic subtotal hysterectomy is reported. The injury was recognised intra-operatively. A successful laparoscopic repair was undertaken using intra-corporeal sutures. The case is highlighted to report potential complications of laparoscopic surgery and their management options. The possible mechanisms of injury, prevention and the principles of management are discussed.     

Primary localised amyloidosis of the urinary bladder: A case report

Primary localised amyloidosis of the urinary bladder is a rare condition, of unknown aetiology, which can be successfully treated surgically. It has an excellent prognosis and a very low recurrence rate.     

泼尼松龙联合氯己定对口腔溃疡大鼠黏膜活性氧水平的影响

目的探讨泼尼松龙联合氯己定对口腔溃疡大鼠症状的改善作用及黏膜活性氧水平的影响。方法口腔溃疡大鼠模型通过石碳酸烧灼口腔黏膜制备,并随机分为对照组和研究组,两组均给予氯己定治疗,仅研究组加用泼尼松龙,分析两组治疗后2周的症状改善情况并检测治疗1 d、3 d、7 d及14 d的黏膜活性氧水平。结果①研究组的治疗总有效率高于对照组(P<0.05),显效例数多于对照组(P<0.01),无效例数少于对照组(P<0.05);②研究组的进食量、体重多于对照组,红肿和溃疡消失时间均低于对照组;③研究组在治疗后7 d和14 d黏膜的活性氧水平低于对照组(P<0.01)。结论泼尼松龙联合氯己定对口腔溃疡大鼠症状的改善作用较好,同时可降低黏膜的活性氧水平。     

膀胱憩室内鳞状上皮癌——附1例报告

[背景 ]膀胱憩室内鳞状上皮癌病例罕见 ,临床上因无特殊症状 ,容易误诊 .[病例报告 ]病人以下腹部肿块、排尿困难待查入院 ,经B型超声波、CT和膀胱镜等检查 ,确诊为膀胱憩室内癌 ,因肿瘤已浸润转移 ,没能做根治性手术 .[讨论 ]膀胱憩室内癌多继发下尿路梗阻性疾病 ,易浸润转移 ,因此应对下尿路梗阻病人作必要的影像学检查 ,尽量进行早期诊断和治疗     

超声在急性尿潴留插管导尿术中对导尿管的监测意义

目的探讨超声在急性尿潴留插管导尿术中对导尿管监测的意义。方法回顾性分析了超声监测下行插管导尿术的34例急性尿潴留患者资料。结果（1）超声可显示导尿术中导尿管体内段特征性的双线状或粗线状稍强回声,并可判断后尿道的走行;（2）超声可通过对导尿管前端回声观察准确判断导尿管前端到达的位置和提高后尿道结石的诊断率;（3）超声可通过在膀胱内显示气囊已扩张,导尿管呈特征性的单个穿葫芦状的声像图表现来作为导尿术成功的依据。结论 超声对急性尿潴留插管导尿术的监测能显示导尿管前端,体内段以及气囊的位置和形态,为临床操作提供一个可视的手段,提高插管导尿术的成功率,是一种简单易操作的方法。     

双膀胱镜下尿道会师术治疗男性尿道损伤18例

目的探讨双膀胱镜下尿道会师治疗男性尿道损伤的疗效。方法回顾性分析18例经双膀胱镜下尿道会师术治疗的男性尿道损伤患者的临床资料。结果球部损伤患者10例会师成功,后尿道损伤患者5例会师成功,3例失败。平均手术时间33min（20～45min）。手术成功的15例患者术后均获随访1年,3例患者随访期内接受了尿道扩张治疗,随访结束时行尿流率检测,最大尿流率13.6～18.8ml/s,平均16.2ml/s。结论双膀胱镜腔内尿道会师术,具有手术方式简单,手术时间短,微创,并发症少的优点,可有效用于男性闭合性尿道损伤的治疗。     

经尿道膀胱壁内嗜铬细胞瘤激光切除手术的麻醉管理（2例报告）

目的探讨经尿道膀胱嗜铬细胞瘤激光切除手术的麻醉与管理。方法通过回顾2例膀胱嗜铬细胞瘤的临床资料,分析经尿道膀胱嗜铬细胞瘤切除手术的麻醉特点。结果 2例术前诊断明确,充分准备。切除肿瘤时有创动脉监测血压、心率明显波动,适时采用血管活性药物调整血压和心率,手术过程顺利。结论术前需充分准备,术中有创血压监测可帮助外科医生确定病灶部位。     

一例膀胱壁内嗜铬细胞瘤的诊断与治疗并文献复习

目的 探讨膀胱壁内嗜铬细胞瘤的诊断与治疗特点.方法 回顾性分析我院诊断与治疗的1例膀胱壁内嗜铬细胞瘤患者的临床资料,并结合相关文献进行探讨.结果 患者行膀胱嗜铬细胞瘤切除术,术后病理提示为膀胱嗜铬细胞瘤,恢复良好,血压降至正常,痊愈出院,随访18个月未见肿瘤复发及远处转移.结论 膀胱壁内嗜铬细胞瘤临床罕见,预后良好,虽其症状比较典型,但临床上少见,术前极易漏诊,需提高对此病的认识.     

间歇导尿在脊髓损伤患者泌尿系管理中的应用

目的：应用间歇导尿探讨对脊髓损伤患者进行泌尿系管理的价值。方法：将252例脊髓损伤患者随机分为干预组和对照组。干预组126例患者根据残余尿量实施间歇导尿,刺激低级反射中枢,逐渐形成排尿反射,恢复自主排尿。对照组126例患者行常规导尿。对两组患者的临床疗效进行统计学分析和对比。结果：干预组痊愈71例,显效32例．有效14例,无效9例,有效率为92．86％;对照组痊愈59例,显效30例,有效11例,无效26例,有效率为79．37％。干预组疗效明显高于对照组（P〈O．05）。结论：间歇导尿在脊髓损伤患者泌尿系管理中能促进逼尿肌恢复,减轻植物神经功能和心理功能障碍等,具有重要的临床意义。     

妊娠合并感染性心内膜炎1例

Infective endocarditis in pregnancy is extremely rare in clinical practice. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. Due to increased blood volume and hemodynamic changes in late pregnancy, endocardial neoplasms are easy to fall off and cause systemic or pulmonary embolism, respiratory, cardiac arrest and sudden death may occur in pregnant women, the fetus can suffer from intrauterine distress and stillbirth at any time, leading to adverse outcomes for pregnant women and fetuses. The disease is dangerous and difficult to treat, which seriously threatens the lives of mothers and babies. Early diagnosis and reasonable treatment can effectively improve the prognosis of patients. The most important method for the treatment of infective endocarditis requires early, adequate, long-term and combined antibiotic therapy. Moreover, surgical controversies regarding indication and timing of treatment exist, especially in pregnancy. In terms of the timing of termination of pregnancy, the timing of cardiac surgery, and the method of surgery, individualized programs must be adopted. A pregnant woman with 30⁺⁵ weeks of gestation is reported. She was admitted to hospital due to intermittent chest tightness, suffocation and fever, with grade Ⅲ cardiac insufficiency. Imaging revealed large mitral valve vegetation, 22.0 mm×4.1 mm and 22.0 mm×5.1 mm, respectively, and severe valve regurgitation. Mitral valve perforation was more likely, blood culture suggested Staphylococcus epidermidis infection, after antibiotic conservative treatment, the effect was poor. After the joint consultation including cardiology, neonatology, interventional vascular surgery, anesthesiology, and obstetrics, the combined operation of obstetrics and cardiac surgery was performed in time. The heart was blocked for 60 minutes, the bleeding was 1 200 mL, the newborn was mildly asphyxiated after birth, and the birth weight was 1 890 g. Nine days after the operation, the patient was discharged from the hospital, and the newborn was discharged with the weight of 2 020 g. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child. An optimal outcome in a challenging case like this greatly depends on effective interdisciplinary communication, informed consent of the patient, and concerted action among the specialists involved.     

Diagnosis of multiple myeloma by demonstration of M protein in bone marrow aspirate by agar gel electrophoresis: A case report

A number of laboratory tests are used to confirm the diagnosis of multiple myeloma, including M protein in the serum. Since M protein in the serum originate from tumour cells in the bone marrow before circulating in the serum, demonstration of M protein in bone marrow aspirate can be added to the batteries of diagnostic parameters. Keywords: Multiple myeloma, Bone marrow aspirate, M band, Agar gel electrophoresis.     

盆腔放疗后继发性膀胱海绵状血管瘤1例报告

1病例资料患者,男性,63岁,吸烟30年,20支/d,因"尿频3个月"检查发现血清前列腺特异抗原(TPSA)升高为6.88ng/mL,游离前列腺特异抗原(fPSA)1.4ng/mL,fPSA/TPSA 0.20,B超显示前列腺大小5.2cm×4.2cm。于2006年7月11日在我科门诊行     

DRESS,the maverick among SCARS: A case series-based review of literature

DRESS is a potentially life-threatening severe cutaneous adverse reaction (SCAR). Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome; however, it was later found to be caused by various other medications, with the commonest been aromatic anticonvulsants, allopurinol and sulfonamides. The severity of this entity is related to systemic involvement, which can result in multiorgan failure and death. The diagnosis of DRESS, especially in the early stages, remains challenging and elusive due to its heterogeneous clinical presentation and the complex course of the disease with different patterns depending on the causal drug. The most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug along with oral steroids or immunosuppressants to control the disease. We describe the varying presentation and management of six adults with DRESS from a tertiary care hospital, observed over a two-year period with a brief review of the literature.     

急性白血病14年中二次复发化疗仍缓解一例报告

临床资料　患者 ,女 ,6 0岁 ,1988年 2月起反复皮下、牙龈出血伴月经量增多 ,于 1988年 4月 2 8日入院 ,经骨髓检查确诊为急性粒细胞性白血病 (M2 a) ,经 HATP方案化疗 1个疗程后完全缓解 ,又先后 13次予强化、巩固、维持治疗 ,方案分别为 HOTP、HOAM、HAT、HTP、HATP等 ,至 1989年7月 18日中断化疗。 1996年 4月患者因面色苍白十余天再次入院 ,查骨髓象示 :急性粒细胞性白血病 (M2 a)复发。于AA(阿霉素 +阿糖胞苷 )方案化疗 3个疗程后达完全缓解。后先后 2 4次予 HAE、NA、HA、VA、CAM、AE方案化疗 ,多次复查骨髓象均示完…     

帕珠沙星治疗尿路感染32例分析

目的: 评价帕珠沙星治疗细菌性尿路感染的安全性、有效性。方法: 以左氧氟沙星为对照药物,在62例受试者中进行随机对照试验。治疗组32例,每日给予帕珠沙星每次300 mg,静脉滴注,每天2次;对照组30例,每日给予左氧氟沙星每次200 mg,静脉滴注,每天2次。疗程7~10天。结果: 治疗组、对照组有效率分别为90.6%和90.0%;痊愈率分别为84.4%和83.3%,细菌清除率分别为93.3%和92.9%;不良反应发生率分别为6.3%和6.7%。两组间差异均无显著性(P>0.05)。结论: 帕珠沙星治疗尿路感染有效、安全,与左氧氟沙星疗效相当。     

Osteosarcoma of the patella: A case report

We present a rare case of osteosarcoma involving the patella. A 30-year-old Japanese woman first consulted our out-patient clinic with a 2-year history of knee pain. Radiographs showed an enlargement of the patella with irregular distribution of both osteolytic and sclerotic lesions. Computed tomography and magnetic resonance imaging demonstrated soft tissue extension at the anterior part of the patella. Incisional biopsy showed abundant osteoid formation by spindle-shaped malignant cells, and the histological diagnosis was conventional osteosarcoma. The patient underwent preoperative chemotherapy, but there was no response. Furthermore, she developed a pathological fracture during chemotherapy. She underwent above-the-knee amputation with postoperative chemotherapy. She developed multiple metastases in the thoracic vertebrae 20 months after the surgery. At the most recent examination, she remains alive with multiple spinal metastases without paralysis 4 years after the surgery.