Cas D’une Fausse Fracture De La Verge Par Rupture De La Veine Dorsale Profonde Au Centre Hospitalo-Universitaire Departemental -Oueme Plateau De Porto Novo, Benin

Introduction : Les traumatismes du pénis intéressant le réseau vasculaire sont rarement rapportés dans la littérature. La rupture de la veine profonde du pénis est une urgence urologique dont la clinique peut simuler une fracture de la verge.Nous rapportons un cas de rupture de la veine profonde du pénis survenue lors d’un faux pas de coït.Patient et Méthodes : Il s’est agi d’un patient âgé de 26 ans présentant une tuméfaction de tout le pénis précédée d’une douleur minime et d’une détumescence progressive survenue au décours d’un coït. L’exploration chirurgicale a mis en évidence une lésion incomplète de la veine dorsale profonde et qui a été réparée.Conclusion : La rupture de la veine dorsale profonde est rare et peut simuler une fracture des corps érectiles. . L’exploration chirurgicale reste un moyen diagnostique et thérapeutique accessible. Introduction: Penile trauma involving the vascular network is rarely reported in this paper. The rupture of the deep vein of the penis is a urological emergency which can simulate a fracture of the penis. A case of rupture of the deep vein of the penis is reported, which occurred during a false coitus.Patient and Methods: The case study was a 26-year-old patient with swelling of the entire penis. This was preceded by minimal pain and progressive detumescence during coitus. Surgical exploration revealed an incomplete lesion of the deep dorsal vein, which was repaired.Conclusion: Rupture of the deep dorsal vein is rare and may simulate a fracture of the erectile bodies. Surgical exploration remains an accessible diagnostic and therapeutic means.

Comparative flower morphology of Agapanthus africanus and A. praecox (Amaryllidaceae)

The structure of Agapanthus africanus and A. praecox flowers was studied on permanent cross-sectional and longitudinal sections using a light microscope. The genus Agapanthus belongs to the subfamily Agapanthoideae, the family Amaryllidaceae, which is characterized by the presence of the upper ovary, septal nectaries and fruit – fleshy capsule. Micromorphological studies of the flower are considered as a way for detection of unknown plant features, adjustment of plants to specialized ways of pollination and determining the first stages of morphogenesis of fruit, and further use these features in taxonomy. 10 flowers of A. africanus and A. praecox were sectioned using standard methods of Paraplast embedding and serial sectioning at 20 micron thickness. Sections were stained with Safranin and Astra Blau and mounted in Eukitt. It was found that in the studied species the tepals have single-bundle traces. The vascular system of the superior ovary consists of a three bundle dorsal vein, of the ventral roots complex, which are reorganized into paired ventral bundles of the carpel, which form traces to ovules. For the first time, the following gynoecium zones were detected in A. africanus: a synascidiate structural zone with a height of about 560 μm and a fertile symplicate structural zone with a height of about 380 μm and a hemisymplicate zone of 2580 μm. In A. praecox gynoecium, there is a synascidiate structural zone with a height of 200 μm and a symplicate structural zone of 600 μm and a hemisymplicate zone of 620 μm. Septal nectaries appear in the hemisymplicate zone and open with nectar fissures at the base of the column, with a total septal nectar height of 2880 μm in A. africanus and 820 μm in A. praecox. The ovary roof is 300 µm in A. africanus and 200 µm in A. praecox. Triple dorsal bundles of carpels in A. africanus have been identified, which could be considered as adaptation of different stages of morphogenesis of fruit to dehiscence. The new data obtained by the vascular anatomy of the flower and the presence of different ovary zones significantly add to the information about anatomical and morphological features of the studied species, which can be further used in the taxonomy of the family Amaryllidaceae.

Mondor’s disease of the penis due to asymptomatic infective prostatitis provoking episodes of secondary sclerotizing lymphangitis

Mondor’s disease of the penis is an under-reported condition caused by superficial thrombophlebitis of the dorsal vein or thrombosis of the deep venous network of the penis. This is a benign, self-limiting condition, characterized by a sudden, indurated swelling of the aforementioned veins. The possible causes comprise traumatism, neoplasms, excessive sexual activity, or coagulation inherited deficit. An accompanied lymphangitis is discussed, eventually as a distinct variety. The differential diagnosis must be established by the means of ultrasound, which is the imaging diagnostic technique of choice. We describe the case of Mondor’s sclerotizing lymphangitis secondary to recurrent episodes of genitourinary infection previously diagnosed as recurrent superficial Mondor thrombophlebitis of the penis.

Penile Mondor’s in a Covid-19 patient on prophylactic anti-thrombosis with rivaroxaban: a case report

Background Penile Mondor’s disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment. Case Presentation A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD’s onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week. Conclusion Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.

Rupture of Dorsal Vein Mimicking Penile Fracture: a Case Series Report and Literature Review

Penile fracture is a rare and traumatic emergency in andrology. Immediate surgical repair is widely accepted as the therapy of choice in penile fracture. But some situations mimic penile fracture such as superficial dorsal vein rupture. There are few cases reported in the literature. Aim: To present a case series of injuries of the penile dorsal vein that occurred during sexual intercourse. Methods: A 48-year-old and 45-year-old patients both received in emergency for suspected penile fracture after one hour of vigorous sexual intercourse, the clinical examination and ultrasound were performed and the penile fracture was suspected. Surgical management in an emergency was indicated. Results: Per-operative diagnosis was a dorsal vein injury. The surgical management which consisted of early exploration, evacuation of hematoma, and ligation of the bleeding vessel in this case was good with preserving erectile function after surgery, without abnormal curvature erection. Conclusions: Vascular injuries of the penis can mimic perfectly penile fractures. The medical history and clinical examination can lead to prompted exploration for suspected penile fracture. The ultrasound exploration can be limited for detection of penile vascular injury and final surgical exploration offers final diagnosis and repairment of the trauma. Clinical evolution is favorable, without painful nocturnal erections or deviation of the penis or hypoesthesia of the glans.

Presentation of Psychosis Subsequent to Penile Injection of MDMA in a 60-year-old Patient-A Case Report

The street drug Molly, the crystal or powder form of MDMA (3,4-methylenedioxymethylamphetamine) is commonly ingested via oral or pulmonary routes. Intravenous administration of MDMA is rare and here we report a case of penile dorsal vein injection of Molly, development of penile abscess, and subsequent psychotic symptoms in a patient with a history of polysubstance use. A 60-year-old Caucasian male was presented to the psychiatric hospital with a chief complaint of hallucinations and homicidal and suicidal ideation following reported use of MDMA. Three days into his hospitalization, he began to experience sever penile pain and upon interviewing disclosed penile injection of MDMA prior to admission. Examination revealed a 1.5 X 0.7 cm abscess with minimal drainage and surrounding erythema on the body of the penis. The treatment course consisted of three days of intramuscular ceftriaxone and six days of oral Minocycline. In this case report, we discuss the challenges and importance of obtaining a thorough history for patients presenting with IV drug use as well as considering uncommon routes of administration.

Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery

Purpose To evaluate the impact of modifications to anatomical apical dissection including a puboprostatic open-collar technique, which visualizes the lateral aspect of the apex and dorsal vein complex (DVC) covering the rhabdosphincter while preserving the puboprostatic collar, on positive surgical margin (PSM) and continence recovery. Methods One-hundred-and-sixty-seven patients underwent gasless single-port retroperitoneoscopic radical prostatectomy using a three-dimensional head-mounted display system. Sequentially modified surgical techniques comprised puboprostatic open-collar technique, sutureless transection of the DVC, retrograde urethral dissection, and anterior reconstruction. The associations of these modifications with PSM and continence recovery were assessed. Results The puboprostatic open-collar technique, sutureless DVC transection, and retrograde urethral dissection were significantly associated with lower apical PSM (P = 0.003, 0.003, and 0.010, respectively). The former two also showed similar associations in 84 patients with anterior apical tumor (P = 0.021 and 0.030, respectively). Among 92 patients undergoing all of these three procedures, overall and apical PSM rates were 13.0% and 3.3%, respectively. Retrograde urethral dissection (odds ratio [OR] 2.73, P = 0.004) together with nerve sparing (OR 2.77, P = 0.003) and anterior apical tumor (OR 0.45, P = 0.017) were independently associated with immediate continence recovery. A multivariable model for 3-month continence recovery included anterior apical tumor (OR 0.28, P = 0.003) and puboprostatic open-collar technique (OR 3.42, P = 0.062). Immediate and 3-month continence recovery rates were 56.3% and 85.4%, respectively, in 103 patients undergoing both the puboprostatic open-collar technique and retrograde urethral dissection. Conclusion Novel anatomical apical dissection utilizing a puboprostatic open-collar technique may favorably impact on both apical surgical margin and continence recovery.

Peripheral Intravenous Line Access

A peripheral intravenous catheter is used to access a peripheral vein. To start a peripheral intravenous line, identify the site, place a tourniquet, clean the skin, stabilize the vein, and insert the catheter. When a “flash” is obtained, thread off the catheter, connect it to the tubing, and secure. This chapter describes tips for finding common intravenous access sites in children, which are the metacarpal, saphenous, cephalic, median, and scalp veins. These veins vary in size, depth, and difficulty. Metacarpal/dorsal hand veins are on the dorsal aspect of the hand and typically arise from adjacent digital veins and form a network that usually provides several targets for access, although there is significant variation. These veins form the cephalic vein (radial side) and basilic vein (ulnar side) as they converge. The cephalic vein arises from the lateral (radial) side of the dorsal venous network before curving around the wrist to run along the anterolateral forearm, where it is frequently easily accessed. It continues on this course up the arm, but more proximally it is less superficial. The median cubital vein runs from the cephalic vein medially toward the basilic vein diagonally across the antecubital fossa and is reliably present if not always visible. The greater saphenous vein is formed on the foot from the dorsal vein of the great toe and the dorsal venous arch of the foot. It ascends anteriorly to the medial malleolus and superiorly up the medial calf.