Case Series: Organophosphate Contamination of Camel’s Mammary Glands Affects Human Health

In this case series, we present 2 cases of previously healthy farmers, who presented with symptoms of a cholinergic crisis that developed several hours after ingestion of camel milk. The initial case was treated with supportive medical care without using antidote as no history of direct exposure to pesticides was available.The second case presented with symptoms of cholinergic crisis that developed several hours after the ingestion of camel milk. Clinical features included slurred speech, headache, vomiting, diarrhea, frequent ­micturition, muscle fasciculation, chest discomfort, and atrial fibrillation. The patient developed bradycardia that responded to intravenous atropine. Routine investigations were unremarkable, but acetylcholinesterase and pseudocholinesterase levels were both low. The patient was managed with intravenous fluids, analgesia, atropine, and pralidoxime, which were administered when he developed respiratory symptoms secondary to excessive secretions. The following day, the patient was asymptomatic and discharged. On the medical history, the patient denied any other ingestion including food and drink or potential organophosphate exposure on the day of symptom onset. Application of organophosphate pesticides to the mammary glands of camels has been used for many decades against <i>Sarcoptes scabei cameli</i>, a mite that causes a dermal infestation in camels similar to human scabies infections.

Severe emphysematous cystitis complicated with perforation, bilateral renal cortical atrophy and sepsis: a case report

Emphysematous cystitis (EC) is a rare bladder infection characterized by the presence of gas in the wall or cavity of the bladder. Most patients with EC will present with the typical symptoms of cystitis (e.g. frequent micturition, urgent micturition and dysuria), but other signs include distension and pain in the lower abdomen, drum sounds on percussion and a large amount of gas in the bladder. There can also be other complications such as sepsis. However, it is usually characterized by the typical symptoms of infection combined with pneumatinuria, the passage of gas mixed with urine. The early stage of EC is mostly limited to the submucosa and the symptoms of infection can be mild. Some patients may have no obvious clinical symptoms. If the infection becomes severe, it may result in difficulty urinating and kidney dysfunction. Therefore, timely treatment of these rare bladder infections is essential. This current case report describes an 80-year-old female patient with severe EC complicated by significant bilateral ureteral dilatation, bilateral renal cortical atrophy and sepsis. The patient was successfully treated with antibiotics and surgery. This report provides clinical data, test results and treatment experience that might be useful for clinicians that are involved in the treatment of EC.

The prostatic utricle cyst with huge calculus and hypospadias: A case report and a review of the literature

Prostatic utricle cysts with calculus and hypospadias are rare in clinical practice. According to our literature review, only few cases have been reported. Recently, we experienced a case of prostatic utricle cyst with huge calculus in a 25-year-old male patient. He had a history of left cryptorchidism and surgery for penoscrotal hypospadias in his infancy. He was referred for frequent micturition, urgency of urination, urine pain, terminal hematuria and dysuria. Computed tomography (CT) revealed a retrovesical cystic lesion of low density, in which a 5×5 cm calcification was shown. Retrograde urethrocystography showed a 5×5 cm high-density shadow in the posterior urethra. The cyst was incised by transperineal approach and the stone was clearly observed and removed. Urethral stricture repair was performed simultaneously. The patient recovered smoothly after operation.

Ganglioneuroma with leiomyomatosis of the urinary bladder: A rare tumor causing frequent micturition and dysuria

We present the case of a 34-year-old female, complaining of frequent micturition and progressive dysuria. By cystoscopy and computerized tomography, we found that she had multiple submucosal protuberant lesions in the entire bladder. After surgical excision, she has thus far showed no further signs of the disease. The postoperative histopathologic examination revealed a ganglioneuroma and leiomyomatosis. Urinary bladder paraganglioma is an unusual tumour; when it is combined with leiomyomatosis, it is extremely rare. We describe the main clinical presentation, diagnostic procedures, and pathologic features. We also review the English literature.

Case of Eosinophilic Cystitis Treated with Suplatast Tosilate as Maintenance Therapy

Eosinophilic cystitis is a rare inflammatory lesion of the bladder, characterized by massive eosinophilic infiltration of the bladder wall. Its cause is not known definitely. A 49-year-old man consulted our department with a miction pain, gross hematuria, and frequent micturition. Urinalysis showed combined hematuria and pyuria, but urine culture was sterile. Abnormal findings of laboratory examination included an elevated white blood cell (WBC) count (15,700/μL) and the proportion of eosinophils in the peripheral blood was 12% of the WBCs (normal 0–5%). Cystoscopy revealed a solid mass with severe edematous mucosa. Magnetic resonance imaging (MRI) also indicated marked bladder wall thickening, which was suspected for invasive bladder cancer. Transurethral biopsy of the bladder mass was performed with pathological examination revealing features of eosinophilic cystitis. After administration of a combination of prednisolone and suplatast tosilate, followed by monotherapy with suplatast tosilate, regression of the bladder mass, and normalization of the count of peripheral eosinophils were achieved. Fourteen months after steroid therapy, under treatment with suplatast tosilate, there was no relapse of urinary symptoms and the bladder mass.

Safety and efficacy of a new imidazole fungicide, Sertaconazole, in the treatment of fungal vulvo-vaginitis: a comparative study using Fluconazole and Clotrimazole

Background: Sertaconazole is a new imidazole fungicide introduced for vulvo-vaginal candidiasis. It has an azole group with benzothiophene that inhibits biosynthesis of ergosterol and brings about a massive leak of cytoplasm with consequent fungal cell death. Objective: Assess the safety and efficacy of Sertaconazole in the treatment of fungal vulvo-vaginitis for comparison with Fluconazole and Clotrimazole. Subjects and methods: One-hundred eighty-eight outpatients with fungal vulvo-vaginitis were recruited at Siriraj Hospital, Thailand between August 31, 2004 and January 30, 2006. The patients were given Sertaconazole, Fluconazole, or Clotrimazole, and received vaginal swab and culture for fungus at seventh and 28th days after treatment. Results: Out of 188 cases, 177 cases were followed-up completely. Sertaconazole group included 66 cases where 35 cure, 20 fail, and 7 recurrent cases. Fluconazole group included 60 cases and had 37 cure, six fail, and 20 recurrence cases. Clotrimazole group included 55 cases and had 32 cure, nine fail and 11 recurrent cases. There were risk factors of fungal vulvo-vaginitis, including frequent micturition and small toilet shower flushing. Conclusion: Sertaconazole had similar effectiveness and less side-effect as compared with Fluconazole and Clotrimazole. It appeared to work well with lowest recurrence.

Experimental colitis in mice and sensitization of converging visceral and somatic afferent pathways

Chronic pain syndromes affecting different organs often coexist. We hypothesized that sensitization of one afferent pathway may affect converging input from other areas of the body. We induced colitis in mice with 2,4,6-trinitrobenzenesulfonic acid (TNBS); control animals were treated with equal volumes of vehicle (50% ethanol) only. Visceromotor responses to graded colorectal distension, cystometrograms, and response thresholds to mechanical and thermal stimulation of both hind paws were determined on days 7 and 14. Inflammation of colon and bladder was assessed with validated histological markers and scores. TNBS caused significant colitis on day 7 that resolved by day 14; there was no evidence of bladder inflammation. There was a significant hypersensitivity to colorectal distension on day 7, which returned to normal on day 14. This was associated with bladder overactivity, as demonstrated by early onset of micturition and more frequent micturition on day 7 after TNBS administration. Colitis also significantly altered responses to mechanical and thermal stimulation of both hind paws on day 7 but not day 14. We conclude that cross talk between afferent visceral and somatic pathways may contribute to the coexistence of pain syndromes.