Insertion of a slim fit tampon into the urethra. A case report.

BACKGROUND: A 14-year-old accidentally inserted a slim fit tampon into her urethra. Such a case could occur again in young teenagers who otherwise have never inserted a tampon and especially have yet to see a gynecologist for their first gynecologic examination. CASE: Accidental insertion of a slim fit tampon into the urethra by a 14-year-old necessitated cystoscopic resection of the engorged tampon. CONCLUSION: Although this is the only case reported of urethral tampon placement, one must include it as part of the differential diagnosis in assessing acute onset of pain or hematuria after the placement of a slim fit tampon.

Laparoscopic tubal sterilization. The potential for thermal bowel injury.

One of the most severe complications of laparoscopic tubal sterilization is bowel burns, although they often go undetected at the time of laparoscopy. Controversy remains over whether these injuries are caused directly by operator error or indirectly from a hot oviduct's or instrument's inadvertently touching and burning the intestine. A study was performed to determine the potential for direct or indirect bowel burns using bipolar electrocoagulation in rabbits. The results indicate that neither a hot tube nor hot (recently used) forceps could cause injuries to the serosal surface of the intestine. That was true both of immediate injury and after one to five days of recovery. It was observed that the hot uterine tube caused significant bowel adhesions by five days after the procedure. Direct electrocoagulation of the bowel using 40 W for three seconds caused a minor, noticeable blanch on the bowel that was not detectable with gross or histologic means after one day of recovery. A direct bowel injury did result when 80 W was used for three seconds; the bowel became perforated after one day. These findings indicate that it is unlikely that one can produce a bowel burn indirectly from a hot uterine tube or instrument and that only a direct insult to the bowel appears to cause an injury. However, adhesions could be a complication of the procedure and should be considered.

Hepatobiliary kinetics and excretion of ciprofloxacin.

The biliary excretion and metabolism of ciprofloxacin was studied in 25 hospitalized patients: 19 undergoing routine cholecystectomy and 6 with indwelling biliary drainage catheters. An intravenous dose of 200 mg of ciprofloxacin given 2.5 to 3.0 h prior to cholecystectomy resulted in concentrations in common duct bile, gallbladder bile, and gallbladder wall of 5.69 +/- 4.8, 5.43 +/- 3.34, and 2.52 +/- 1.30 micrograms/g, respectively, all at least fourfold greater than simultaneous concentrations in serum. Ciprofloxacin concentrations in common duct bile exceeded peak concentrations in serum in all but two patients with common duct obstruction. Multiple preoperative doses of ciprofloxacin prior to cholecystectomy increased concentrations in gallbladder bile by eightfold. Six patients with indwelling biliary drainage catheters also received 200 mg of ciprofloxacin intravenously. Less than 1% of the administered dose was excreted in bile as unchanged ciprofloxacin, and there was extensive metabolism. However, peak ciprofloxacin concentrations of 2.83 +/- 0.76 micrograms/ml in serum produced peak concentrations of 10.69 +/- 5.30 micrograms/ml in bile within 1.5 h after infusion and maintained concentrations of at least 0.5 microgram/ml in common duct bile for over 12 h in all patients. It appears that ciprofloxacin concentrations in bile will exceed the MICs for most susceptible biliary pathogens for a period of at least 12 h after a 200-mg intravenous dose.