In the second picture, there is a staghorn like stone. Different from the fist like stone, it has two forks, hard and sharp. Zhang Zimo has inexplicable urethral pain.
Again, a piece of sand like stone, broken like sand on the beach.
Pebbles, potatoes, eggs
One photo after another. Zhang Zimo still has some regrets. If only he could go and see it with his own eyes. However, there is an SCI saying that Wang Guiping should not be stingy.
After watching it for an hour, Wang Guiping sent out all the strange stones.
"Girl, send the picture of Massachusetts to Director Wang," said Wu Mian.
"OK." Chu Zhixi took out his mobile phone and began to look for it.
Zhang Zimo suddenly became energetic, and teacher Wu also had inventory! What strange stones are the photos that teacher Wu can keep?!
Soon, a photo was sent to the group.
If it weren''t for the particularity of this group, neither Zhang Zimo nor Wang Guiping on the mobile phone would think it was a urinary stone.
What appears in the photo is a "round" egg shell with light on the back. The egg shell seems to be transparent and carved from jade.
At first glance, no one will recognize that this is a medical specimen. At first glance, it looks like a work of art, or one carefully carved by a master craftsman.
"Miss Wu, what is this?" Zhang Zimo asked softly.
"Urinary catheter stones."
"..." Zhang Zimo was stunned. The urinary catheter... Can you still have stones?!
He works in the ICU. Almost every patient needs a urinary catheter. Some are disposable temporary catheterization, and some are long-term indwelling. But why does this stone appear?!
In the wechat group, Wang Guiping has the same question.
Chu Zhixi typed on the mobile phone keyboard with both hands, which was quite different from the slow action of Wang Guiping.
[the patient, a 57 year old man from ansa, was hospitalized in Massachusetts General Hospital because of poor urination for 3 months and aggravated for 3 days with hematuria.]
[after inquiring about the medical history, the patient had a long-term indwelling catheter for more than 5 months before August, and his urination was not smooth after extubation.]
[ultrasound findings: the bladder is well filled, and a slightly strip-shaped strong vocal cord can be seen in the cavity, about 5mm in size × 2mm, both ends are not smooth, and the rear is accompanied by sound shadow. It moves with the change of body position, and its head end looks like a bifurcation during the movement.]
A series of condition profiles appeared in the wechat group. Zhang Zimo looked carefully and had an estimate in his heart. It may be that the patient retained catheterization for a long time, resulting in the deposition of substances such as oxalic acid on the wall of catheterization tube.
[the X-ray film of posterior urinary bladder showed that it was negative. On the second day, cystoscopy was performed, and an arc-shaped eggshell stone with a length of about 20mm was found in the bladder. Holmium laser lithotripsy and bladder flushing were planned.]
[the patient refused, and then operated to remove the complete stone.]
"Teacher Wu, why does the patient refuse to use holmium laser lithotripsy?" Zhang Zimo asked in surprise.
"Andrew, the attending doctor at that time, told the patient that it was a rare shell stone. The patient was very excited. He refused to minimally invasive lithotripsy, and then discharged it naturally from the body. He thought it was a gift from the gods, which should be taken out completely and used as a souvenir."
"...." Zhang Zimo said nothing.
This hobby is really weird.
[teacher Wu, Professor Chu, is this a rare shell stone?]
Wang Guiping sent an information inquiry.
[shell stones are rare in bladder stones. Often, because the catheter is left for more than 4 weeks, the bacteria in the urinary tract grow biofilm on the surface of the catheter. Electrolytes, urinary salt crystals and matrix in the urine continuously deposit and condense on the membrane surface, and form in the side hole, cavity, tube body and ball of the catheter, also known as catheter crusting.]
Chu Zhixi didn''t want to. He typed a pile of words to explain the stone in more than ten seconds.
[I''ve been looking for a specimen of ureteral crusts!]
It''s a catheter
[sorry, I''m used to it. It''s a specimen of catheter crusting. Mr. Wu, do you have any kind on your side?]
[no, this specimen is collected by the patient. There is only one photo.]
Wang Guiping kept silent. He didn''t know whether he had regrets or appreciated the rare and complete urethral catheter crusting specimen.
It''s not that rare
Wu Mian typed a line.
【？？？】
Wang Guiping replied with three question marks.
[it is mainly because the sonogram of catheter crusting is rare, so we don''t know enough about this phenomenon. Through careful analysis of sonogram and comprehensive analysis of clinical long-term indwelling catheterization history, we can reduce unnecessary misdiagnosis.]
[Mr. Wu, please elaborate.]
[the sonogram of urinary catheter crusts shows arc-shaped strong echo, both ends are not smooth, and the head end can be forked during movement, which is very similar to foreign bodies, mainly because it is generated with the shape of urinary catheter, which is very different from the usual urinary calculi.]
[if you want to find a patient with catheter crusting, you are first recommended to learn B-ultrasound, or contact a doctor in the B-ultrasound room to find a doctor with high technical level to conduct B-ultrasound examination for slow diagnosis of urinary system. Especially for patients with long-term indwelling catheter and difficulty in pulling out, catheter crusting may occur.]
Zhang Zimo looked interesting. Unexpectedly, he turned into teacher Wu to give a lecture to Wang Guiping.
It''s really worthy of Mr. Wu''s name. As long as I have the opportunity, I will talk about some strange things that I don''t pay attention to at ordinary times, but often occur.
For example, this catheter crusting, according to logical analysis, patients in ICU should not be rare, but they have never paid attention to it. Zhang Zimo thought of this and secretly wrote down the diagnostic criteria of crusting. He was ready to go back and turn over the book in detail.
But do you want to learn B-ultrasound by yourself? He felt a little embarrassed.
At that time, he also laughed at Peng Peng. At an age, he had to change his profession, from anesthesia to pain to B-ultrasound. Unexpectedly, I have to learn B-ultrasound to see a broader world together with my curiosity.
Wu Mian and Wang Guiping talked for a while. The general manager of ICU came to him. "Teacher Wu, Xueyuan lover, the report of two hours'' observation is back."
Wu Mian put away his mobile phone, picked up the report and reviewed it one by one.
After symptomatic treatment, Xue Chunhe''s lover''s acute symptoms of ketoacidosis have been alleviated, acidosis has been neutralized, and disordered ions have been corrected. Although it has not returned to the normal value, it is much better than the value checked for the first time when I first came in.
Wu Mian came to the bedside and explained the test results in detail with Xue Chunhe''s lover, reassuring her.
After being busy, Wu Mian said, "director Zhang, you are busy. I''ll go back first."
"Miss Wu, I''ll send the report to your mobile phone in 4 hours?"
"OK." Wu Mian said, "Xue Yuan... Depending on the situation, it is estimated that he will be discharged soon. If it takes a long time, he will also be referred back and treated here together. Together, he will be less worried."