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184 Motaş C. et al.Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 210. Evoli A, Minisci C, Di Schino C, et al.Thymoma in patients with MG: characteristicsand long-term outcome. Neurology. 2002;59(12): 1844-1850.11. Ohta M, Itoh M, Hara H, et al. Anti-skeletalmuscle and anti-acetylcholine receptorantibodies in patients with thymoma withoutmyasthenia gravis: relation to the onset ofmyasthenia gravis. Clin Chim Acta. 1991;201(3): 201-205.12. Sun XG, Wang YL, Liu YH, et al. Myastheniagravis appearing after thymectomy. J ClinNeurosci. 2011; 18(1): 57-6013. Ito M, Fujimura S, Monden Y, et al. Aretrospective group study on post-thymectomymyasthenia gravis. Nihon Kyobu Geka GakkaiZasshi. 1992; 40(2): 189-193.14. Li J, Zhang DC, Wang LJ, Zhang DW, ZhangRG. Myasthenia gravis occurring afterresection of thymoma. Zhonghua Wai Ke ZaZhi. 2004; 42: 540-542.15. Shinkai T, Saijo N, Yoshioka S, et al.Recurrence of thymoma with appearance ofmyasthenia gravis 18 years after surgery. Jpn JClin Oncol. 1985; 15: 567-575.16. Kuwata T, Iwata T, Iwanami T. Postthymectomymyasthenia gravis with an episodeof Osserman stage III. JSCR. 2012; 5: 3.17. Denayer MA, Rao KR, Wirz D, McNally D.Hepatic metastatic thymoma and myastheniagravis twenty-two years after the apparent cureof an invasive thymoma. A case report andreview of the literature. J Neurol Sci. 1986;76: 23-30.18. Tseng YL, Chang JM, Shu IL, Wu MH.Myasthenia gravis developed 30 months afterresection of recurrent thymoma. Eur JCardiothorac Surg. 2006; 29(2): 268-269.19. Buckley C, Douek D, Newsom-Davis J,Vincent A, Willcox N. Mature, long-livedCD4+ and CD8+ T cells are generated by thethymoma in myasthenia gravis. Ann Neurol.2000; 50: 64-72.20. Hoffacker V, Schultz A, Tiesinga JJ, et al.Thymomas after the T-cell subset compositionin the blood: a potential mechanism forthymoma associated autoimmune disease.Blood. 2000; 96: 3872-3879.21. Masaoka A. Staging system of thymoma. JThorac Oncol. 2010; 5(10 Suppl 4): S304-S312.
CASE REPORT 185Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2A CASE OF PENILE ENTRAPMENT IN METAL RINGSTREATED BY ASPIRATION AND PUNCTURE TECHNIQUES. Kumar 1 , A. Gupta 21) Department of Surgery, Himalayan Institute Hospital Trust University, Dehradun, India2) University College of Medical Sciences, Delhi, IndiaA CASE OF PENILE ENTRAPMENT IN METAL RINGS TREATED BY ASPIRATIONAND PUNCTURE TECHNIQUE (Abstract): INTRODUCTION: Application of constrictionover penis by means of various objects for autoerotic purpose is a practice that may lead todangerous consequences. A large variety of objects have been used for this purpose leading to aspectrum of complications. Management of such cases poses a great challenge to the treatingsurgeon, as it often requires teamwork involving not only doctors but also technical experts fromengineering department. We report a case where a man presented with acute retention of urinewith two metallic rings over his penis. CASE REPORT: A 50 years old man presented to thesurgical emergency ward with complaint of acute retention of urine. He had pushed two metallicrings over his penis about two hours back in a bid to get sexual pleasure while he was underinfluence of alcohol. The rings later got impacted over the penis because of congestion of distalpart of penis. Soon the patient developed the complaint of mild pain and swelling of penis andinability to pass urine and was brought to the hospital. The physical exam revealed that the part ofpenis distal to the rings was congested, swollen and slightly discolored. We started with urinarybladder emptying by putting a wide bore needle suprapubically and connecting it to a urobagthrough a drip set. Penile block was given. Blood was then aspirated from both corpora cavernosadistal to the rings and the rings were manipulated after generous application of lubricant jelly.This way, rings could be moved almost up to corona glandis obstructed only by a band ofedematous skin. Now multiple needle punctures were given in this skin and the area was keptcompressed for a while using a tape-gauze wrapped tightly over it. On removing the gauze, ringscould be moved up to corona. Now the distal ring was placed with its wide stone bearing partagainst the ventral aspect of glans. Glans was then decongested by means of needle punctures anddigital compression. Ring was rotated with traction while glans was compressed to negotiatethrough it. The attempt was successful and both rings were removed in this fashion. The postoperative course was uneventful. CONCLUSIONS: Aspiration and puncture technique facilitatesthe removal of constricting objects from the penis. This technique is safe and does not requiresophisticated equipment.KEY WORDS: PENILE ENTRAPMENT; METAL RINGS; ASPIRATION AND PUNCTURETECHNIQUESHORT TITLE: Penile entrapment: aspiration techniqueHOW TO CITE: Kumar S, Gupta A. A case of penile entrapment in metal rings treated by aspiration and puncturetechnique. Jurnalul de chirurgie (Iaşi). 2013; 9(2): 185-188. DOI: 10.7438/1584-9341-9-2-11.INTRODUCTIONApplication of constriction over penisby means of various objects for autoeroticpurpose is a practice that may lead todangerous consequences. A large variety ofReceived date: 23.02.2013Accepted date: 15.03.2013Correspondance to: Saurabh Kumar, MS, Assistant Professor of SurgeryDepartment of Surgery, Himalayan Institute Hospital Trust (H.I.H.T.) UniversitySwami Ram NagarPO Doiwala, Dist. Dehradun 248140Uttarakhand, IndiaPhone.: 0091 (0) 81 93 97 87 35Fax: 0091 (0) 13 52 47 13 17E-mail: drsaurabhkumar@yahoo.co.inobjects have been used for this purposeleading to a spectrum of complications.Management of such cases poses a greatchallenge to the treating surgeon, as it oftenrequires teamwork involving not only
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