In the second picture, there is a staghorn-shaped stone, which is different from the previous fist-like stone, it has two bifurcations, hard and sharp, and Zhang Zimo's urethra is inexplicably painful.

Again, a piece of silt-like stones, broken like sand on the seashore.

Pebbles, potatoes, eggs......

One by one, one by one, they were sent. Zhang Zimo still has some regrets, if only he could see it with his own eyes. However, there is an article on SCI, and Wang Guiping's goods should not be stingy anymore.

After watching for an hour, Wang Guiping finished sending all the weird stones.

"Girl, send that photo from Massachusetts to Director Wang. Wu Mian said.

"Okay. Chu Zhixi took out his mobile phone and began to search.

Zhang Zimo suddenly became energetic, Mr. Wu also has inventory! What kind of weird stones can Mr. Wu save the photo?!

Soon, a photo was posted to the group.

If it weren't for the particularity of this group, neither Zhang Zimo nor Wang Guiping on the other side of the mobile phone would think that it was a urinary stone.

Shown in the photo is a "rounded" eggshell with a light on the back, and the eggshell seems to be transparent, carved from jade.

At first glance, no one will recognize that it is a medical specimen, but at a cursory glance, it looks like a work of art, or the kind that has been carefully carved by a master craftsman.

"Teacher Wu, what is this?" Zhang Zimo asked softly.

"Urinary catheter stones. ”

"......" Zhang Zi was stunned, and the urinary catheter ...... Can you still get stones?!

He works in the ICU, and almost every patient has to get a urinary catheter, some are one-time temporary catheters, and some are long-term indwelling, but why do such stones occur?!

In the WeChat group, Wang Guiping also had the same question.

Chu Zhixi's hands were typing on the keyboard of his mobile phone like flying, which was completely different from Wang Guiping's slow motion like an old ox pulling a cart.

[The patient, a 57-year-old male from Angsa, was admitted to Massachusetts General Hospital due to poor urination for 3 months, which worsened for 3 days with hematuria. 】

[Follow-up medical history, the patient had long-term indwelling urinary catheter for more than 5 months after surgery 8 months ago, and the urination was not smooth after extubation. 】

[Ultrasound performance: the bladder is well filled, and a slightly strip-shaped strong echo band can be seen in the cavity, with a size of about 5mm×2mm, both ends are not neat, and the rear is accompanied by sound and shadow, which moves with the change of body position, and its head seems to be bifurcated during the movement. 】

A series of medical profiles appeared in the WeChat group, Zhang Zimo looked at it carefully, and had an estimate in his heart. It may be that the patient has been in the catheter for a long time, causing substances such as oxalic acid to deposit on the catheter wall.

[Posterior urethral x-ray of the bladder is negative.] On the second day, cystoscopy was performed, and an arc-shaped eggshell-like stone with a length of about 20 mm was found in the bladder. It is proposed to be given holmium laser lithotripsy and bladder irrigation. 】

[The patient refuses, and the intact stone is removed by surgery.] 】

"Mr. Wu, why would the patient refuse to use holmium laser lithotripsy?" Zhang Zimo asked in surprise.

Andrew, the attending physician at the time, said to the patient that it was a rare crustal stone, and the patient was particularly excited, and he refused to be minimally invasive lithotripsy, which was then naturally expelled from the body. He thought it was a gift from the gods, to be taken out in whole and kept as a souvenir. ”

"......" Zhang Zimo was speechless.

This fetish, it's really weird.

[Teacher Wu, Professor Chu, is this a rare shell-shaped stone?]

Wang Guiping sent a message to ask.

[Shell stones are relatively rare in bladder stones, often due to the catheter indwelling time of more than 4 weeks, the bacteria in the urinary tract grow biofilm on the surface of the urinary catheter, and the electrolytes, urine salt crystals and matrix in the urine continue to deposit and condense on the membrane surface, and form in the side holes, cavities, tube bodies and balls of the urinary catheter, also known as catheter shells. 】

Chu Zhixi didn't think about it, and typed a bunch of words to explain this stone in more than ten seconds.

[I've been looking for a specimen of ureteral crusts!]

[It's a urinary catheter.] 】

[I'm sorry, I'm used to it.] It's a specimen of a urinary catheter crust, Mr. Wu, do you have a real thing on that side?]

[No, this specimen is in the patient's collection, and there is only one photo. 】

Wang Guiping was silent, not knowing whether to regret it or to appreciate the particularly rare and complete urinary catheter crust specimen.

[Actually, it's not that rare.] 】

Wu Mian typed a line.

【？？？】

Wang Guiping replied with three question marks.

[Mainly because sonograms of urinary catheter crusts are rare, and this phenomenon is not well understood.] Unnecessary misdiagnosis can be reduced by careful analysis of sonographic findings, combined with a comprehensive analysis of the history of long-term indwelling catheterization in clinical practice. 】

[Mr. Wu, please tell me in detail. 】

[The sonogram of the urinary catheter crust shows an arc-shaped strong echo, the two ends are not neat, and the tip can be bifurcated during the movement, which is very similar to a foreign body, mainly because it is generated with the shape of the urinary catheter, which is very different from the urinary stones usually seen. 】

[If you want to find a patient with urinary catheter crust, it is recommended that you first learn B-ultrasound, or contact the doctor in the B-ultrasound room, and find a high-skilled doctor who specializes in B-ultrasound examination of the chronic urinary system. In particular, patients who have been indwelling for a long time and have difficulty extracting the catheter may have urinary catheter crusting. 】

Zhang Zimo watched it interestingly, but he didn't expect to teach, and finally became Teacher Wu giving a lecture to Wang Guiping.

It's really worthy of the name of Mr. Wu, as long as he has the opportunity, he will talk about some strange things that he usually doesn't pay attention to at all, but they often appear.

For example, this urinary catheter crust, according to the logical analysis, it should not be rare for patients in the ICU, but they have never paid attention to it. Zhang Zi meditated on this, secretly wrote down the diagnostic criteria for shelling, and prepared to look at the book in detail after going back.

But do you want to learn B-ultrasound on your own? He felt a little embarrassed.

At that time, he also laughed at Peng Peng, who was going to change careers at an age, from anesthesia to pain to B-ultrasound. I didn't expect that my curiosity was together, and I had to learn B ultrasound to see a broader world.

Wu Mian and Wang Guiping chatted for a while, and the ICU inpatient always came to his side, "Mr. Wu, the report of Xueyuan's lover who observed for 2 hours is back." ”

Wu Mian put away his mobile phone and picked up the report sheets to review them one by one.

After symptomatic treatment, the acute symptoms of ketoacidosis in Xue Chunhe's lover have been alleviated, the acidosis has been neutralized, and the disordered ions have also been corrected. It's not back to normal, but it's much better than the first time I checked when I first came in.

Wu Mian came to the bedside and explained the test results in detail to Xue Chunhe's lover to reassure her.

After all the work was done, Wu Mian said, "Director Zhang, you are busy, I'll go back first." ”

"Teacher Wu, will I send the report in 4 hours to your mobile phone?"

"Okay. Wu Mian said, "Xue Yuan...... It depends, it is estimated that he will be discharged from the hospital soon. If it takes a long time, I will also be referred and transferred back, and we will treat it together. Together, there is less worry. ”