Non-malignant bladder mass series one

“Dr. Zhang Yi”, the picture shows Bingmao’s urinary column. The year before last I saw a woman in her 40s from the northeast. She found a pelvic mass in the local area due to painful urination and blood in the urine. The CT re-examination after hospitalization showed a solid mass between the bladder wall and the uterus, protruding to the bladder, and a hemorrhagic bump was seen on the cystoscope. Because of the difference from the appearance of bladder cancer, I performed a transurethral bladder mass resection (TURBT) for her, and the bladder wall was cut open to reveal a blood infiltrating mass. Postoperative pathology showed inflammatory pseudotumor. Inflammatory pseudotumor of the bladder, also known as pseudosarcomatoid fibromyxoma, is mainly seen in adults. The average age of diagnosis is 38 years (15-74 years). There is only one case of newborn, mainly male (male: female = 11 : 6). It is manifested as ulcerative or hemorrhagic masses in the bladder, hematuria and urination discomfort symptoms, and may also be accompanied by fever and iron deficiency anemia. The literature of inflammatory pseudotumor of the bladder reports that the size of the tumor is between 2-8cm, the surface is edema or jelly, solid or cystic; the tumor protrudes into the bladder cavity, and is exophytic or lobulated, rarely located Triangle of bladder. Clinically, the internal bladder mass is aggressive, and there are manifestations of external bladder invasion, making it difficult to distinguish it from malignant tumors. However, it will not progress after resection. Under the microscope, there are non-tumor spindle-shaped myofibroblasts and inflammatory cells, accompanied by mucus components. The specific mechanism is not clear, and it is inferred to be a reactive result of infection or inflammation, but unlike bladder cancer, inflammatory pseudotumor has nothing to do with smoking. In CT and MRI, the inflammatory pseudotumor is heterogeneous, the central high signal peripheral low signal (MRIT2 image), and the peripheral enhancement is higher than the center. This is due to the necrosis in the center of the pseudotumor, and the cells are mainly concentrated on the outer surface. Called “ring”-like performance. Treatment includes surgery, high-dose hormones, radiotherapy, or conservative observation. Pathological diagnosis is essential to avoid total cystectomy caused by the mistaken belief that bladder rhabdomyosarcoma or myxoid leiomyosarcoma. Due to the aggressive appearance of inflammatory pseudotumor, it is easily confused with bladder urothelial carcinoma, bladder adenocarcinoma or other malignant tumors. In children, in addition to similar clinical manifestations, even pathological examinations overlap with the pathological analysis of rhabdomyosarcoma, and special histochemical staining or electron microscopy is needed for identification. Due to clinical rarity and no consensus on treatment, surgery is still the first choice. Both partial cystectomy and total cystectomy are used, but even transurethral resection of the tumor (TURBT) has not reported postoperative recurrence. The woman mentioned above had a CT scan for one and a half years after the operation, and the mass subsided completely. This is the first lecture of the introduction of non-neoplastic lesions of the bladder, which is a relatively rare inflammatory pseudotumor. From the name, you can appreciate the similarity with bladder tumors. The clinical manifestations can be cystic or solid masses, which seem to be characteristic in imaging, which is confirmed by pathology after surgical resection. Dr. Zhang Yi (WeChat public account: eric_zhang2001)

How to treat hydrosalpinx?

Hydrosalpinx is a common type of chronic inflammation of the oviduct. After salpingitis, the fimbriae of the fallopian tube is blocked by adhesions, the secretion of mucosal cells is accumulated in the lumen, or the isthmus and fimbriae adhesions occur due to inflammation of the fallopian tubes, and the fallopian tubes are formed after obstruction Empyema, when the pus cells in the tube cavity are absorbed, the serous fluid continues to seep out from the tube wall to fill the tube cavity, which can form hydrosalpinx. The stagnant water is brown or colorless, but even if it is colorless, it contains inflammatory factors harmful to the embryo. The cause of hydrosalpinx hydrosalpinx is mainly the consequence of chronic inflammation of the pelvic cavity. Or pelvic infections caused by pelvic surgery, tubal ectopic pregnancy (ectopic pregnancy), severe endometriosis, etc., are also hydrosalpinx An important factor in formation.  The hazards of hydrosalpinx on fertility  1, infertility  If hydrosalpinx occurs, sperm and egg cannot meet, and pregnancy cannot be achieved. 2. Under normal circumstances, the fallopian tube transports the fertilized egg to the uterine cavity through the swing of the cilia and the peristalsis of the smooth muscle of the fallopian tube. However, when the hydrosalpinx, the fertilized egg cannot reach the uterine cavity and stay in the fallopian tube to grow, forming an ectopic pregnancy. .  3. Increase the chance of miscarriage   Toxic substances from stagnant water can produce toxins on embryos entering the uterine cavity, affect embryo development, reduce embryo implantation and pregnancy rates, and increase miscarriage rates. How to check for hydrosalpinx 1. Ultrasound examination When the hydrosalpinx reaches a certain level, it can be manifested under ultrasound, but ultrasound can only indicate that there is a dark area of ​​fluid and cannot ultimately confirm whether there is hydrosalpinx. If there is a hydrosalpinx A medical history of a water-fumigation ostomy, a long strip of fluid near the ovary found by B-ultrasound can be diagnosed as a recurrence of hydrosalpinx.  2, salpingogram    tubal angiography is a simple and reliable method in the current examination methods for hydrosalpinx.  3, laparoscopic    laparoscopy can directly and clearly diagnose hydrosalpinx. Under laparoscopy, you can see the adhesion of the umbrella tip and surroundings to determine the function of the fallopian tube, and it is mostly used in treatment after angiography. How to treat hydrosalpinx?    When hydrosalpinx is wrapped with inflammatory effusion, because the fallopian tube is connected to the uterine cavity, these effusions may have some washing effect on the uterine cavity, and the inflammation in these inflammatory effusions Factors or some microorganisms will destroy the environment of the endometrium, which will seriously affect the next embryo implantation. Therefore, it is necessary to perform mechanical embolization, ligation or excision from the root of the fallopian tube, that is, fallopian tube occlusion under X-ray or laparoscopic truncation of the fallopian tube to reduce the impact of fluid accumulation on the uterine cavity and improve the success rate of transplantation.

Why is rigidity always painful at night, affecting sleep? Try these little tricks

The pain is endless at night, and every day I sleep, I will be awakened by the pain. This is the trouble of many strong friends. The patients and friends are sighing: This is the night, where are you sleeping and resting, you are obviously suffering! Why does the pain worsen at night? 01. Rest at night blood circulation slows down. When we sleep at night, the body is in a state of rest, in which the small blood vessel smooth muscle is relatively high, blood flow is less than during the day, blood circulation slows down, resulting in inflammatory substances can not be transported quickly Walking, diluting, and decomposing, as the concentration of inflammatory substances increases, the local swelling and stasis will become heavier, so at night, the pain at the lesion site will increase. 02. Keep a posture for a long time while sleeping. After going to sleep at night, we generally keep a posture for a long time, which leads to the inability of blood flow, which increases the concentration of local inflammatory substances and worsens the pain. During the day, we often walk around. It is rarely said that maintaining a posture for a long time will accelerate the blood flow and reduce the concentration of local inflammatory substances, so strong friends will feel that the pain during the day is reduced. 03. Pain sensitivity increases. During the day, our body is in a period of sympathetic nerve excitement, and pain tolerance is relatively increased. In addition, there are a lot of things during the day, the attention is easy to shift, and it is not easy to feel the pain, but at night, the patient’s sensitivity to pain will greatly increase, so the pain will increase. Tips to relieve pain before going to bed In order for patients with ankylosing spondylitis to have a good night’s sleep, today I recommend 3 small methods to strong friends: 1 Do some stretching exercises before going to bed Strong friends can do some exercise before going to bed , Move the joints, let the joints rotate, increase blood circulation, so that you can sleep better at night. Don’t reduce your activity because you are afraid of pain. This will speed up the stiffness of the spine, and instead aggravate the pain. 2 Take a hot bath to do some physical therapy based on hyperthermia, such as hot baths, hot spring baths, etc., to increase local blood circulation, relax muscles and relieve pain. Of course, soaking your feet before going to bed has the same effect, and the time for soaking your feet should be within half an hour. 3 When using props to help sleep, put a pillow between your legs if you sleep on your side, and put a pillow under your knees if you sleep on your back to keep your spine straight. What should I do if I cannot lie down? 1. See a doctor early and take medicine to control inflammation, which can avoid bone bridge formation and spinal deformity in the later stage; 2. Posture and gait are very important in the early stage of treatment. Make sure to stand upright and sit upright to avoid lordosis or scoliosis. Avoid being unable to lie flat; 3. In the middle and late stages of ankylosing spondylitis, spine stiffness has already appeared, and postural exercise is not necessary. Regardless of the stage of ankylosing spondylitis, postural exercises, joint, muscle, and ligament exercises are necessary to avoid further aggravation of scoliosis or lordosis; 4. Surgery is recommended for very severe patients. References: [1]How to relieve pain in patients with ankylosing spondylitis[N].Family Doctor Report,2015-08-24(004).[2]What are the manifestations of ankylosing spondylitis and how to treat it[J].Longevity, 2020(02):73. The picture comes from the Internet, please contact to delete the infringement, thank you!

What should I do with closed mouth acne?

The horny content of open acne is sometimes removed by acupuncture. Especially for deep, concentrated and long-lasting acne, topical medicine combined with acupuncture can obtain better curative effect. However, if the needle clears the inflammatory acne or pus, it is likely to leave scars. At present, the treatment of acne mainly relies on topical and oral medications, and the effect is basically satisfactory. The operation of acne extrusion has become less and less practiced in medical institutions. The reasons why it is not recommended to squeeze acne at home are: First of all, squeezing acne by yourself cannot distinguish which can be squeezed and which can not be squeezed. Therefore, it is easy to squeeze into inflammatory acne and leave scars. Secondly, the disinfection of instruments and skin by self-operation is often inadequate, which increases the risk of infection, and local skin infections further increase the risk of leaving scars. Almost luck, if the squeezed inflammatory acne is located in the dangerous triangle of the face, it may spread the infection to the skull and cause cavernous sinus thrombophlebitis, which may be life-threatening. Therefore, it is unwise to squeeze acne yourself. For redness, swelling and acne, try not to touch it without touching it. It is recommended to apply antibacterial agents such as benzoyl peroxide to control it.

Wang Hongxia: Can the use of immunosuppressants cure kidney disease? Did you use the right method?

There are currently three types of immunosuppressive agents in clinical use. 1. Cytotoxic preparations are mainly used to kill lymphocytes, reduce lymphocyte activity, and inhibit rejection after organ transplantation. Representative drugs include cyclophosphamide and methotrexate. 2. Glucocorticoids are mainly used to suppress the immune response, reduce the exudation of inflammatory secretions, and acute rejection after organ transplantation. Representative drugs are: dexamethasone, prednisolone, etc. 3. New immunosuppressant: It can inhibit the activity of T lymphocytes, inhibit the production of various lymphokines, and inhibit immune expression. Used for rejection after organ transplantation. Representative drugs are: cyclosporine, mycophenolate mofetil, tacrolimus, sirolimus, etc. Immunosuppressant-hormones The pharmacological effect of hormones is to inhibit the production of inflammatory secretions. Therefore, when immune complexes deposit on the glomeruli and cause inflammatory immune responses, they inhibit the inflammatory response, thereby inhibiting the secretion of inflammatory secretions, thereby reducing Urine protein. Because hormones reduce immunity, it suppresses the immune inflammatory response caused by immune complexes, and does not decompose and discharge immune complexes. Therefore, during the process of using hormones, the disease will easily rebound and relapse when the dose is reduced. The side effects of hormones are: 1. Inhibit the activity of immune cells, interfere with immune function, and cause a decline in immunity. It also induces new infections, and the infection forms new immune complexes, which aggravates kidney disease. 2. Inhibit calcium absorption, leading to osteoporosis and causing femoral head necrosis. 3. Causing water and sodium retention, causing high blood pressure; causing circulatory disturbances, leading to non-pitting edema, forming facial, back acne, full moon face 4. Destroying pancreatic function, inhibiting glycogen synthesis, promoting glycogen decomposition, causing blood sugar to rise High, the formation of steroid-type diabetes. 5. Destroy thyroid function, interfere with the secretion of thyroxine, cause lower body temperature and lower immunity. 6. Stimulate the secretion of gastric acid and cause gastric ulcer. 7. Causes cataracts, glaucoma, and induces seizures. Therefore, hormones should not be used in the treatment of kidney disease. If hormones are used, antihypertensive drugs, diuretics, gastro-protective drugs, calcium supplements, blood circulation should be improved, and hypoglycemic drugs should be used when blood sugar rises, and immunity should be strengthened. medicine. -Wang Hongxia

Are bone spurs related to heel pain? What should be done to treat?

Is the thorn related to heel pain? What should be done to treat? —-Wang Ting, Department of Orthopedics, Haikou Orthopedics and Diabetes Hospital Many people think that heel pain is due to bone spurs on the heel. “You think, when you stand up, the weight of your whole body presses the bone spurs and stabs them into the flesh. It’s hard to think of whether it hurts!” Indeed, long bone spurs may cause pain, but the heel pain caused by it only accounts for a very small part. But not all bone spurs cause pain. On the contrary, its appearance can help the foot better support and balance. What is going on, what are the causes of heel pain, and how to relieve the pain, let me explain in detail. “Bone spurs” are also called bone hyperplasia and osteophytes. It is the bone that the human body actively and compensatively proliferates to compensate for aging, wear, and overwhelmed joints. It can play the role of auxiliary fixation and support. It often occurs in the elderly and post-menopausal women with severe bone loss. The aforementioned spontaneous hyperplasia of the human body is a good thing in most cases. Its appearance just happened to indicate that “the organization needs it.” For example, some patients have long-term lumbar disc herniation and low back pain. After a few years, the low back pain has spontaneously improved. As a result, the film showed that the lumbar spine had osteophytes, which increased the stability of the lumbar spine. Although bone spurs that do not grow well may cause heel pain, heel pain caused by plantar fasciitis accounts for about 80% of patients and is the primary cause. The heel pain caused by it has the following characteristics: 1. After getting out of bed in the morning or standing still for a period of time, I feel heel pain when standing on the heel; 2. The pain aggravates during the first step, and it is relieved after a few steps; 3. As the walking distance or standing time increases, the pain will increase again. For normal people, the calcaneus is not easy to fracture. However, if you fall from a height, or people with severe bone loss, the calcaneus is indeed easy to fracture. If the heel pain is accompanied by swelling, bruising of the skin or even unable to walk, this is very likely. At this time, go to the orthopedics department immediately. The doctor will check whether there is a fracture through X-rays, etc. If there is a fracture, plaster fixation or surgical treatment is required. In addition to the above reasons, flat feet, high arches, bone tumors, Achilles tendon rupture, Achilles tendinitis and other diseases can all cause heel pain. Some diseases can be dealt with first if they are not critical, but diseases such as bone tumors and Achilles tendon rupture must not be delayed. See a doctor in time. What should I do if my heel hurts? If you suddenly experience heel pain after a fall, fall, etc., please go to the hospital for examination immediately. If the heel pain that gradually appears and slowly worsens, first take the following measures to relieve: 1. Rest and reduce weight-bearing exercise. I believe many people have this experience. After shopping for a long time, the feet will hurt badly, just want to find a stool to sit on. . This is the long-term weight-bearing of the foot fascia, and the inflammatory factors that can cause pain are produced after strain. A pair of suitable shoes or insoles 2. Change to a suitable pair of shoes or insoles or insoles. What kind of shoes are worn for a long time and the feet hurt most? The answer is flat shoes! That’s right, the soles of this kind of shoes cannot provide enough support for the soles of the feet, especially the foot sockets. This will concentrate all the weight on the toes and heels. The toe and heel are connected by the plantar fascia. Excessive force on these two ends will pull the plantar fascia excessively and cause pain. It is recommended to wear sports shoes or buy a special heel pad. 3) Skillful use of cold and hot compresses 3. The root cause of pain caused by clever use of cold and hot compresses is inflammatory factors. Cold compresses can prevent the release of inflammatory factors, while hot compresses can accelerate the absorption of inflammatory factors. Usually, cold compresses are used when the pain first appears, and appropriate warm compresses after 48 hours of pain can effectively relieve heel pain. 4. Stretching training and walking for a long time may cause cramps and stiffness in the relevant foot muscles. Stretching can protect ligaments, reduce muscle tension, relax tightened muscles, promote blood circulation, and relieve pain. If your heel hurts, it is recommended to perform towel stretching, stepping on steps, and massage stretching as shown in the figure below. Note that when doing the above stretching exercises, don’t be too greedy. Choose one action at a time to practice 3 groups, and do 10 reps for each group. Find a doctor! Plantar fasciitis, Achilles tendinitis and other diseases are aseptic inflammations, but if they are not good for a long time, they can seriously affect life. At this time, you can take some non-steroidal drugs, such as celecoxib, fenbid, etc. However, these drugs have certain side effects, so it is recommended to consult a doctor before taking them. In addition, if the long-term inflammation does not heal, you may need to go to the hospital for surgery.

Is neck and shoulder pain the cervical spondylosis?

Neck and shoulder pain is not an independent disease, but a syndrome, either unilateral or bilateral. It is a general term for neck or shoulder pain and discomfort caused by various reasons. In other words, neck and shoulder pain is not necessarily cervical spondylosis. Neck and shoulder pain is a group of clinical syndromes that can be caused by many reasons, and cervical spondylosis is just one of the most common causes. So what are the causes of neck and shoulder pain? 1. Overfatigue of the neck muscles: working in front of the computer for a long time, playing games or doing other work with the head down. 2. Trauma: Acute sprains are not treated in time, or neck fatigue or heavy workload for a long time after injury. 3. Bone hyperplasia, cervical disc herniation or degeneration, facet joint dislocation, vertebral body displacement or spondylolisthesis caused by long-term acute and chronic injury of the cervical spine. It is easy to find that people with neck and shoulder pain have one thing in common, which is to maintain a posture for a long time. Maintaining a posture for a long time, the load on the neck muscles may exceed the physiological limit, causing aseptic inflammation. The accumulation of inflammatory substances in the muscle fascia causes edema, and the pain factors in the inflammatory substances stimulate the nerve endings, thereby causing pain.

Skin care basic science 丨 Will you not squeeze acne?

Probably, the symptoms that may not be acne from light to heavy are whiteheads and blackheads, inflammatory papules and pustules, cysts and nodules. Light, superficial black and white acne may resolve on its own without crushing, and deeper ones will not resolve on their own. The inflammatory papules are also divided into shallow and deep layers, the same reason. If it develops into a pustular cyst type acne, it is not recommended to squeeze, and topical medication is required. Once nodules, scars, and normal skin tissue have undergone pathological changes, it is useless to squeeze, and it is difficult to recover by themselves without medical means. Finally, it is not recommended that you “squeeze acne” by yourself, especially in the face of yellow, red, white spots, pimples with pus, don’t squeeze. #Acne

Can such an anal fistula be operated? Without surgery, what should I do?

Since he was diagnosed with anal fistula in Taiwan two months ago, he started taking cephalosporin antibiotics, but the para-anal mass did not shrink, and the rupture on the mass changed from one to three, and the rupture has been drained with pus. “Is it because I have become resistant to this antibiotic?” When he visited the doctor 2 weeks ago, he described the medical history and analyzed my illness. “I have a lot of bowel movements. It has been several months. I have a bowel movement of 5-6 a day. Second, it was not shaped or sparse, the cephalosporin was eaten for a long time, the lump became larger, and the pus was constant, but there was no time for surgery recently. “Specialist examination found that his anal skin was extensively reddened, and the surface of the lump was gray and floating Swollen, unclear boundaries, irregularly distributed three ulcers on the mass, the pus flowing out of the ulcers was thin and dark. -From the perianal mass, it is an anal fistula, but the appearance does not appear to be a “healthy” bacterial-infected anal fistula. Glandogenic anal fistula, perianal abscess during acute attack will be red, swollen and hot, and the range of the mass is basically limited. The pus will be thick and thick. Such an anal fistula with pus is either related to inflammatory bowel disease, such as an anal fistula with extraintestinal manifestation of Crohn’s disease, or a tuberculous anal fistula. Or the patient’s physique is weak, the fight between right and evil is not fierce, the inflammation of the perianal abscess is weak, and the pus is thin. In view of his frequent bowel movements, he needed to rule out inflammatory bowel disease, and helped him arrange a colonoscopy. While waiting for the colonoscopy, he prescribed 5-aminosalicylic acid for the treatment of inflammatory bowel disease and kidney yang to prevent diarrhea Of Chinese patent medicines. Reviewing today, he said that yesterday, with colonoscopy, there was more residual fecal water in the intestine, and no intestinal mucosal lesions of inflammatory bowel disease were found in the intestinal area, nor intestinal mucosal ulcers, but taking 5-amino salicylate After the acid and Chinese patent medicine, the number of stools decreased and the stools formed. The most important thing was that the lumps were significantly reduced. It was not as painful as before, and the outflow of pus was reduced. The specialist examination confirmed that the mass was obviously limited and hard, fibrotic tissue formed more, the mass tenderness was alleviated, two of the three ulcers had healed, and one of the ulcers had a thick yellow pus when it pressed around it. The anal fistula becomes “healthy”. According to the status of his anal fistula in the first clinic, he will not recommend immediate surgical treatment. If it is an anal fistula caused by inflammatory bowel disease, inflammatory bowel disease must be treated, otherwise the anal fistula will continue to occur in other parts, and the wound after the operation is difficult Healing. Inflammatory bowel disease, such as anal fistula of Crohn’s disease, can be treated with palliative care. A floating line is placed between the outer mouth and the inner mouth to drain the pus, so that the pus has a way out to avoid the closing of the outer mouth and the inner mouth. The state of the anal fistula is changed. Although it is not entirely certain that the anal fistula is improved by taking a drug for enteritis to improve enteritis, but it is certain that the change in stool situation reduces the impact of loose stools on the source of infection in the anus, thereby improving the anal fistula. Local symptoms. At this visit, such an anal fistula in a “healthy” state can be operated for anal fistula. After the operation, the wound surface can be restored to normal health. If the operation is postponed temporarily due to time problems and conservative treatment is required, it can be done in several ways-* & nbsp. Improve the stool condition, avoid diarrhea, avoid loose stools, and avoid constipation. * In terms of diet, nutrition is balanced, with meat and vegetables, avoid spicy food, reduce the intake of hot food. * Partial paraanal mass care, clean the perianal or sitting bath before going to bed, if there is still pus, keep the ulcer open, you can open the ulcer with a cotton swab, place a small gauze, and let the pus exit out until it flows out It is light yellow secretion or blood, otherwise the ulcer will heal, and the pus produced by the inflammatory tissue will have no way to escape, and the lumps will swell and pain soon. * Apply chlortetracycline eye ointment or Liushen Wan water-adjusting ointment to the swelling to reduce swelling and relieve pain.

What to do if the lung is nodular? Do you have surgery?

[Understand the general nature of the nodules] Therefore, the first task for people who have pulmonary nodules is to go to a regular hospital to find a specialist to determine the nature of the nodules, whether they are benign scar nodules or inflammatory hyperplastic nodules, which is tuberculous calcification Nodules are also nodules caused by tumors. All these nodules, malignant tumor nodules need attention and timely surgical treatment, tuberculous nodules need anti-tuberculosis treatment, and inflammatory nodules can be treated with anti-infection first. [Many nodules do not need treatment] Some nodules, such as scar tissue hyperplasia, such as organizing pneumonia, such as inflammatory granuloma, may remain unchanged for a long time, there is no need to worry, you can not deal with it. Nodules are different and treatment methods are different, so patients with lung nodules should first pay attention to seek medical advice, determine the possible nature of the nodules, and listen to the doctor’s opinion, follow-up or active treatment. [Mentality is even more important than the nodule itself] Pulmonary nodules are not a disease, but only an imaging manifestation. After excluding the possibility of malignant tumors, people with lung nodules can be the same as others, and there is no special need to pay attention to local. For those who have small nodules of unclear nature, they must relax their minds. In fact, the nodules themselves will not cause any symptoms, but some people are highly nervous and cause discomfort such as loss of appetite, insomnia, irritability, so pay attention to relax, 80 % Pulmonary nodules are benign nodules, no need to worry.