A 27-year-old woman was admitted to a hospital due to intermittent fever for 20+ days and swelling pain in knee joint for 7 days.Patients was with persistent fever,the highest temperature to 40.1°C,the double knee joint swelling pain,a large number of scattered red needle-like rash were visible on bilateral hands and legs,lymph-adenectasis,splenectasis,bilateral hands interphalangeal joint and knee joint swelling pain,lymph nodes were con-fined to the bilateral axillary with soft texture,local tenderness,and good activity.Pathological results of left axil-lary lymph node showed the following finding:fragmental lymph node tissue with incomplete structure,lymphoid follicles existed,there were diffuse histocytes,immunoblasts,and a few small lymphocytes proliferation in the re-duced or disappeared area of follicular,caryokinesis could be easily seen,there were patches of necrosis foci with varied size,nucleus disintegrated,fibrinoid necrosis blood vessel with bleeding could be seen.Immunohistochemical detection showed the following results:CD3 (diffuse +);CD20 (follicular +);CD79α(follicular +);CD68 (+);EMA (-);ALK (-);CD15 (a small amount of cells +);CD30 (+),CD4 (-),CD5 (+);CD10 (-);bcl-2 (+);CD21 (+);telomerase B (-);TIA-1 (-);EBV(-)Ki-67 (+).Through a combination of clinical and immunohistochemical detection results,the diagnosis of histiocytic necrotizing lymphadenitis was made.Patient discontinued antimicrobial drugs,after she was treated with 5% glucose 100 mL + hydrocortisone sodium succinate 200 mg intravenous drip for 3 days,patients had no fever,axillary lymph node gradually dwindled.Then patients was treated with methylprednisolone 8 mg/d,twice a day,reduced 1 tablet every two weeks,and stopped eventual-ly.Patients was followed up for two years,repeated examination of blood routine,liver and kidney function were in the normal range,bilateral knee didn’t swell,could walk freely,there appeared no enlargement of lymph node.

Objective:To explore effects of different timing of extubation on catheter-related lower urinary tract symptoms and urinary control recovery after extubation in patients with indwelling catheter after general anesthesia.Methods:Using the stratified random selection method, a total of 198 patients who underwent indwelling catheter after general anesthesia in Beijing Friendship Hospital affiliated to Capital Medical University were selected from January 2018 to July 2019. Using the random number table method, they were randomly divided into the observation group (101 cases) and the control group (97 cases) . In both groups, the extubation method was established by evidence-based nursing demonstration and the water sac test results of the material and model of urinary duct in the hospital. In the control group, the timing of extubation was to remove the catheter when the bladder was empty and the patient had no urination intention, and then assist urination when the urination intention appeared. In the observation group, the time of extubation was when the bladder was in a full state and the patient had the intention to urinate, the urinary duct was naturally discharged with urine by abdominal pressure. The lower urinary tract symptoms associated with urinary tube and the recovery of urinary control after extubation were compared between the two groups.Results:The success rate of urination in the observation group was higher than that of the control group, the core lower urinary tract symptom score and incidences of frequency of urination, urgency and acute urinary retention were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The maximum bladder pressure measurement volume and residual urine volume in the observation group were lower than those in the control group, and the urine control rate and maximum urine flow rate at 72 h after extubation were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Extubation in patients with bladder filling and urination after general anesthesia can reduce the incidence and severity of lower urinary tract symptoms associated with the catheter, which help patients recover bladder function and improve urinary control ability.

Objective:To investigate the effect of different timing of urinary catheter removal on postoperative recovery of elderly patients undergoing transurethral resection of prostate (TURP) .Methods:A total of 159 elderly patients undergoing TURP from Beijing Friendship Hospital Affiliated to Capital Medical University from March 2021 to June 2022 were selected as research objects by convenience sampling method, and were divided into the urinary catheter removal within 48 h after surgery group ( n=47), urinary catheter removal within 48 to 72 h after surgery group, urinary catheter removal>72 h after surgery group. The degree of dysuria after catheter removal, incidence of urinary tract infection, secondary catheter insertion rate and postoperative hospital stay were compared among the three groups. Results:The proportion of patients with moderate or above dysuria of the urinary catheter removal within 48 to 72 h after surgery group was lower than those of the urinary catheter removal within 48 h after surgery group and the urinary catheter removal>72 h after surgery group, and the differences were statistically significant ( P<0.05). The incidence of urinary tract infection of the urinary catheter removal within 48 h after surgery group and the urinary catheter removal within 48 to 72 h after surgery group were lower than that of the urinary catheter removal>72 h after surgery group, and the differences were statistically significant ( P<0.05). The rate of secondary catheterization of the urinary catheter removal within 48 to 72 h after surgery group and the urinary catheter removal>72 h after surgery group were lower than that of the urinary catheter removal within 48 h after surgery group, and the differences were statistically significant ( P<0.05). The postoperative hospital stay of the curinary catheter removal within 48 to 72 h after surgery group was shorter than those of the urinary catheter removal within 48 h after surgery group and the urinary catheter removal>72 h after surgery group, and the differences were statistically significant ( P<0.05) . Conclusions:Removing urinary catheter within 48 to 72 h after surgery can effectively reduce the degree of urination difficulty in elderly patients undergoing TURP, the incidence of urinary tract infection and the rate of secondary catheterization, and shorten the postoperative hospital stay.

A 41-year-old male was presented with rapidly progression memory impairment for 2 months and episodic limb shaking for 2 weeks as the main manifestations.Physical examination showed verbal disadvantage with decreased memory,attention,comprehension,and orientation.Serum vitamin B12 levels decreased,serum anti gastric parietal cell antibodies and anti-intrinsic factor antibodies were positive.Blood analysis showed macrocytic anemia,neuropsychological scale showed functional impairment in multiple cognitive domains,electrophysiological examination showed peripheral nerve damage,cerebrospinal fluid and imaging examination showed no abnormalities.The patient was diagnosed as having vitamin B12 deficiency dementia,vitamin B12 deficiency related involuntary movement and pernicious anemia.Supplementing with B vitamins and folic acid significantly improved cognitive impairment and eliminated symptoms of limb shaking.The purpose of this case report is to enhance the understanding of clinical doctors about dementia and involunting movement caused by vitamin B12 deficiency,in order to diagnose and treat it early.