P16 Endoloop ligatures in the retrieval of urethral foreign bodies: a narrative review

Introduction

Self-insertion of foreign bodies into the urethra has been described previously in patients presenting to hospital emergency services. Treatment typically involves procedural retrieval under local anaesthesia using basket or forceps, cystoscopy, or open surgery. An Endoloop is a device designed to snare colonic polyps during endoscopy with nylon loops. It is not traditionally used for retrieval of urethral foreign bodies. Our objective was to determine the incidence, safety and efficacy of this approach.

Methods

A narrative review was performed. Primary outcomes were technical success, defined as uncomplicated retrieval of foreign body, and adverse events related to pain, bleeding, infection, and damage to structures. Electronic searches were performed using PubMed, Embase and Google Scholar. Reference lists of selected studies were searched manually.

Results

2 case studies met inclusion criteria for analysis, both describing self-insertion of urethral foreign bodies for purposes of sexual arousal. These comprised a 30-year-old male (magnets) and a 29- year-old female (metal urethral sound). Both patients underwent successful retrieval of foreign body using an Endoloop ligature. There were no symptoms post-operatively and no procedural complications were reported.

Conclusion

An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval. Follow-up is mandatory to monitor for complications due to foreign body insertion such as urethritis, incontinence, fistula and diverticulum formation. Referral to psychological services is encouraged to reduce the risk of recurrence. Further studies are required to validate the efficacy and safety of this technique.

Take-home message

An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval of urethral foreign bodies.

E-cigarettes: a need to broaden the debate

The unregulated market for e-cigarettes continues to grow, with debates on their efficacy and impact on global public health. E-cigarettes, or electronic nicotine delivery systems (ENDs), are marketed as a 'safe' alternative to tobacco products and a tool for 'harm reduction'. Some public health experts are calling it a 'game changer' and favour the 'harm reduction' strategy, while others dispute this claim. In our opinion, the debate needs to be broadened to encompass other related concerns and effects on non-users and affected stakeholders. As with tobacco control, a holistic approach is needed to build a raft of policies that effectively address the issue from all angles and look beyond the direct health implications of e-cigarette use to explore the social, economic, political and environmental aspects of this debate, putting 'harm reduction' in context.

Use of uterine artery embolization to prevent peripartum hemorrhage of placental abruption with fetal demise & severe DIC

Uterine artery embolization (UAE) is typically not indicated in the pre-operative management of pregnancies with a live fetus, because risk of fetal death from reduced uteroplacental blood flow. However, pre-operative UAE in pregnancies with a fetal demise poses no fetal risk, and may offer maternal benefits. Patients with placental abruption resulting in fetal demise are at high-risk for developing disseminated intravascular coagulation (DIC), which could have devastating complications such as peri-operative hemorrhage and death. This case report describes the first successful execution of a pre-operative UAE that effectively prevented antepartum and postpartum hemorrhage in a patient with DIC secondary to a placental abruption and recent fetal demise.

Anemia as One of Presenting Symptoms in an Adult with Cyst and Torsion of the Omentum - A Case Report

BACKGROUND

Torsion is an uncommon disorder of the omentum and cysts are one of the rarest causes of omental torsion. To our knowledge, this is the first report of a case of an omental cyst presenting with both omental torsion and anemia.

CASE PRESENTATION

We herein present a case report of a 41 year old indian female patient who presented with anemia (hemoglobin concentration 6.5 g/dL) and intermittent abdominal pain caused by torsion of a hemorrhagic omental cyst. A computed tomography scan, showed an omental cyst with free fluid in the abdominal cavity. At abdominal exploration, 1.5 L of hemorrhagic fluid was confirmed in the abdominal cavity. The cyst and twisted omentum were removed en bloc. The patient had an uneventful postoperative course and was discharged on day 8. At her 2-month follow-up, she was no longer anemic (hemoglobin concentration 10.7 g/dL).

CONCLUSION

Cases of anemia associated with omental torsion have been reported in children; however, to the best of our knowledge, this is the first reported case of such a presentation in an adult. In such patients, surgical removal is the treatment of choice. Persons with recurrent abdominal pain and anemia must be assessed carefully and their differential diagnosis should include omental torsion. Appropriate diagnosis and treatment help avoid complications.

Strengthening government tobacco control in low- and middle-income countries: a 'must do' for lung health progress

Tobacco control in low- and middle-income countries (LMICs) must gather pace in the coming decade to reverse the increasing prevalence of tobacco use and counter the intensive development of LMIC markets by the tobacco industry. If unchecked, this could undermine wider developments and gains in lung health, for example for people with tuberculosis (TB), TB and human immunodeficiency virus co-infection, asthma and chronic obstructive pulmonary disease. The issue of sustainability for tobacco control in LMICs is also pressing. This perspective article proposes that greater engagement with governments at the national and sub-national levels to strengthen their capacity for effective tobacco control, scale up action and sustain tobacco control is critical. There is also considerable scope to widen effort and impact by building tobacco control into broader initiatives, particularly into those relating to lung health. This paper draws on examples from the tobacco control technical support and capacity building in LMICs of the International Union Against Tuberculosis and Lung Disease, outlines the rationale for such an approach and addresses perceived disadvantages, limitations and barriers. Priority actions and suggestions for how these can best be applied in practice are proposed.

Secrets to psychological success: why older doctors might have lower psychological distress and burnout than younger doctors

BACKGROUND

Doctors have long been exposed to situations that can induce psychological distress. Long hours, little acknowledgement, poor sleep and high-stress work environments all contribute to making doctors prone to psychological distress and burnout, which have been much studied in younger doctors, but less so in older doctors. Little is known about whether there are differences in psychological distress among different age groups of doctors.

METHODS

Doctors (n = 158) were recruited from in and around the St George Hospital, a major teaching hospital in Sydney, Australia. Participants completed a self-report questionnaire, comprising the Maslach Burnout Inventory (MBI), and Kessler 10 Psychological Distress Scale. Demographic details were collected. A subsample (n = 51) completed a semi-structured interview about issues related to burnout. These data were subjected to qualitative analysis.

RESULTS

Older doctors and doctors with more years of experience had significantly lower scores on MBI subscales of Depersonalization and Emotional exhaustion, and K-10 measured psychological distress. Aspects of working conditions such as being in private practice were associated with increased scores on MBI subscales of Personal accomplishment, and lower scores on MBI subscales of Emotional exhaustion and Depersonalization, and K-10 measured psychological distress. Older doctors more frequently worked in private practice. These quantitative findings were supported by the qualitative data that suggested that older doctors perceived that they experienced less psychological distress compared with earlier in their careers, which they attributed to the development of protective defences in their relationship with patients and the liberation afforded by accumulation of experience and changed work conditions.

CONCLUSIONS

Findings from this study suggest that older, more experienced doctors report lower psychological distress and burnout than younger doctors which the older doctors attributed to lessons learned over their years of training and practice. It may be of considerable value to find ways to more efficiently pass on these lessons to younger doctors to aid them in dealing with this challenging profession. By soliciting older doctors to aid in this transfer of knowledge, this approach may also have the added benefit of assisting older doctors in transitioning from an active clinical practice to a role of mentoring the new physician cohort.