Erosion of a penile prosthesis due to an indwelling urethral catheter as a late complication

A case of erosion of a penile prosthesis caused by indwelling of a catheter in the urethra is reported. A 73-year-old man had maintained sexual intercourse with penile prostheses (Jonas prosthesis, 19 cm) for 11 years without any complications until he developed cerebral infarction. One month after starting an indwelling urethral catheter in a neurosurgery clinic, the left-side penile prosthesis eroded from the area of the fossa navicularis, and was immediately removed. This type of complication is not unusual in patients with a neurogenic bladder. However, it is not well recognized in patients who suddenly develop a neurogenic bladder following a long-term uneventful period after the implantation of penile prostheses. Therefore, urologists should inform patients who receive this type of treatment that erosion of the prosthesis may develop when they need an indwelling urethral catheter as a late complication.     

Five Cases with Ectopic Esophageal Sebaceous Glands

Abstract: Sebaceous glands in the esophagus are considered to be rare and are of particular interest because of their as yet unknown origin. Six postmortem and 48 antemortem cases with this condition have been reported. We report herein five cases diagnosed by endoscopy and biopsy, with a review of the pertinent literature. The hypotheses that gastroesophageal reflux disease (GERD), alcohol consumption, smoking, and hyperlipidemia play roles in the pathogenesis of ectopic sebaceous glands of the esophagus are not supported by current evidence. Given the gradual increase in reports of adult cases with ectopic esophageal sebaceous glands, we suspect that these lesions may not be as rare as generally assumed.     

Significance of the progression of respiratory symptoms for predicting community‐acquired pneumonia in general practice

Background and objective: Early diagnosis improves outcomes in patients with community‐acquired pneumonia (CAP). However, prediction of CAP based on symptoms and signs is difficult. The present study investigated the evaluation of progression of symptoms as a factor for predicting the occurrence of CAP in general practice. Methods: Consecutive patients (n = 406) suspected of having CAP on routine clinical examination were studied retrospectively. Selection of patients with suspected CAP was based on progression of symptoms after 5 days, as well as published criteria. Diagnostic yields for the recommended criteria and our proposed criteria were then compared. Scoring systems for the prediction of CAP were designed, based on the results of multiple regression analysis. The diagnostic performance of these systems, including or excluding symptom progression, was compared using the areas under receiver operating characteristic curves. Results: The sensitivity and specificity of the recommended criteria and our proposed criteria were 0.75 and 0.44, and 0.93 and 0.38, respectively. Sputum production, dyspnoea, fever > 38°C, heart rate > 100 beats/min, decreased breath sounds, coarse crackles and progression of symptoms significantly increased the likelihood of CAP. Areas under receiver operating characteristic curves analysis showed that the diagnostic prediction of CAP was significantly improved when the scoring system included progression of symptoms. Conclusions: Progression of symptoms was a significant factor for predicting CAP and selecting patients who required CXR. Inclusion of progression of symptoms among the other recommended criteria, namely, dyspnoea, fever > 38°C, heart rate > 100 beats/min and abnormal chest findings, improved prediction of the incidence of CAP in general practice.