General « ThePclinic

Phimosis Giving Rise to Emergency Situations

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There have been several calls from hospital emergency staff in the recent past to alleviate retention of urine in elderly male and the associated pain. The urethral opening is completely closed by phimosed prepuce, the fore skin of penis. The common cause of retention of urine in elderly male is a prostatic enlargement. And in a situation where there is such type of phimosis remains associated, it gives rise to problem in introducing a silicon pipe through urethra to relieve the acute retention. Such type of peculiar situation probably is best encountered in India; where the people do not give attention to the phimosis they might be carrying from their childhood. Here, there is custom circumcision in Muslims and Hindus only go for it as a part of medical treatment. Perhaps there is no atheistic consideration, and people generally shy away from speaking about it. Even these people had enjoyed a good family life.

In this situation, first the prepuce is to be slit open to see the urethra, and glans is to be inspected for cancerous growths; as phimosis is associated with penile cancer in glans and prepuce. Many times there have been very much narrowing of urethral opening to obstruct the passage of urine. The urethra is to be dilated to allow the entry of a silastic pipe called catheter, and first of all the retention is to be relieved as it is a very painful condition, better known to a person who might had been compelled to postpone passing urine after the urge for it due to some reason. After that, a formal circumcision has to be performed. The stricture of urethral meatus may need a minor surgery to keep it open. All these can be performed under local anesthesia.

Though phimosis is apparently an innocent disease may a cause of grave concern.

Bleeding During Catheterization of Male Urethra (clinispot.blogspot.com)

Filed under: General — Tags: Add new tag, Catheter, Circumcision, Glans penis, Urethra — Dr.Prahallad @ February 6, 2010 5:50 am

Quarrel to Express Yourself

Some say a particular person is quarrelsome, angry and argumentative etc. But how those modes of expression came to existence? If those were not needed how come they have a place in our day to day life! Silent sufferers are more prone to heart attack as the bad feeling remains within and smokes inside. That creates stress followed by stress related hormone secretion. So, it is better ventilate the grievances or the bad feeling. One may quarrel even with the boss; of course, in a healthier way to express his stand on a particular issue. One may cry to relieve the tension. I support it.

Filed under: General — Tags: Add new tag, Cardiovascular Disorders — Dr.Prahallad @ January 11, 2010 6:55 am

Esophageal Ulcer

An accidentally ingested fish bone causing an ulcer in the esophagus was the cause of dysphagia, a painful agglutination; viewed in endoscopy.

Filed under: General — Dr.Prahallad @ December 11, 2009 5:56 am

Endoscopy

Filed under: General — Dr.Prahallad @ December 10, 2009 4:31 am

Unusual Presentations of Intestinal Worms

: Ascaria

Round worm, hook worm, tape worm, thread worm and whipworms are some of the common helminthes affecting human. These are transmitted through feco-oral route in the areas of poor sanitation. Common manifestations of the diseases caused by these groups of parasites include: pain abdomen, anemia, vomiting and poor health. Apart from these, some unusual complications from infestation of these worms are also seen.

Round worm (Ascariasis): These may lodge in the common bile duct, pancreatic duct and liver apart from their natural habitat; small intestine. That may cause obstruction to the free flow of bile resulting in obstructive jaundice, pancreatitis and liver abscess respectively. That may affect the liver function and cause inflammation of bile channel called cholangitis. Ascaria larva during the course of its development passes through the respiratory tract to come over to the alimentary tract once again, which causes night hawking cough and sometimes lungs infection by secondary bacterial invasion. A lot of adult round worms living or dead after administration of drugs or as such may cause obstruction of the alimentary tract which may arouse an emergency situation. These may become irritated during surgery by anesthetics and come up, to be aspirated to the respiratory tract causing the dangerous collapse of lungs.

Hook worm larva enters the body through the bare skin of foot, to find its way to the blood or lymphatic to reach the alimentary tract via respiratory tract. At the site of entry may evoke inflammation and intense pruritus called “Ground itch”. The route of its migration can be seen as an inflamed streak over the skin called the “Larva migrans”, which evokes pruritus. Finally they lodge themselves in the upper part of small intestine to cause the classical symptoms of the ankylostomiasis.

Thread worm egg are laid near the anal canal, hatch there and larva may migrate to the vagina in female to cause pruritus there. It may ascend upwards to the fallopian tubes, and even to the peritoneum to cause an infection there. Sometimes these may enter the appendix to cause appendicitis. These find their way again to the alimentary tract being carried by the nail to the mouth during intake of food.