TMI Friday: Vacuum Cleaners Suck

When you look at a vacuum cleaner, what do you see ? A tool perhaps, to help you deal with the crisps trodden into the carpet from a party the night before. A way to keep armies of dust from taking over your house and to frighten your pet dog. 

But there are some people (Who am I kidding, It's men.) who look at vacuum cleaners in a different way. Who observe the coquettish expression on a Henry vacuum cleaner and contemplate a universe of intimacy. Not much is known about these people. Are they a real sub-culture ? Do they compare notes on Rule 34 ?

What we do know is that these individuals tend to end up in an emergency room, crossing their legs out of embarrassment and to stem the flow of blood.

Dr Ralph Benson, in his article "Vacuum Cleaner Injury: A Common Urologic Problem ?", he examines  five cases where men had attempted intimacy with these household implements... and suffered the consequences.  All of these cases occurred when  men attempted to use vacuum cleaners as masturbatory aids. I don't want to get into the details of the injuries, but the words "laceration" and "penis" should give you an idea of what happened. If you don't know what the terms "avulsion" and "degloving" mean, then don't worry, the paper comes with helpful photographs. Why not download the paper and look at them ?

Dr Benson notes in the paper that the cases he describes are not isolated incidents. Reports of vacuum cleaner injury go right back to the 1960's. But the interesting thing that Dr Benson notes is that even though he lived in a relatively small town,  he encountered a cluster of these vacuum cleaner cases. In the absence of a tangible connection between these people, he came to a somewhat incredible conclusion. 

His conclusion was that this was not an isolated cluster of vacuum abusers. Instead , he suggests that vacuum cleaner abuse may be far more common than is generally recognised. He notes that often, people will lie about the causes for the injury, and will only reveal the truth if the doctor subjects them to more intense questioning. He proposes that in busier emergency rooms, medics don't have the time or the inclination to probe into these lies, and just get on with repairing the injury.

Nevertheless, there is an important lesson in here, that I never would have thought needed to be iterated, but nonetheless here it is- Do not stick any part of your body into a hole that contains whirling blades.

C. Benson R. (1985). Vacuum cleaner injury to penis: A common urologic problem?, Urology, 25 (1) 41-44. DOI: 10.1016/0090-4295(85)90561-8

TMI Friday: A Vexacious Consequence of a Vasectomy

It was an emergency. The patient was 51 years of age, running a high fever, and pain and swelling in a particularly sensitive area, in which an operation had been performed a week previous. Gentlemen of delicate dispositions may wish to avoid reading further, for that operation was a vasectomy.

The purpose of a vasectomy is contraception, to make sure that a man cannot impregnate a woman with his sperm. A vasectomy works through preventing sperm from escaping from your testicles, where they are manufactured. It does this by cutting the vas deferens, the tube through which the sperm travel out of the testicles. This procedure has become relatively advanced in recent years.

The gentleman in question had a "No scalpel" incision vasectomy. This has a number of benefits , not least that it doesn't involve a scalpel being wielded near to a "gentleman's dangling region". It its quicker, leaves a tiny operation scar, which means less bleeding pain and infection, and more importantly, a quicker return to sexual activity. 

The 51 year old gentleman however had clearly acquired some form of infection after the operation. Infection after a vasectomy is generally uncommon. They then found the identity of the bacterium causing this infection. It was Streptococcus pyogenes, the bacterium that commonly causes sore throats. Long time readers of this blog probably have some idea of where this is going...

His wife had been looking after their children who were suffering from sore throats. And unbeknownst to anyone, the Streptococcus pyogenes had been passed to her, and was settling on her tonsils. The night before the fateful emergency visit, she and her husband had an intimate moment. During this process, the bacteria on the wife's tonsils somehow ended up on the husbands genitals. The paper describing this clinical case describes the infectious process that followed:

It is reasonable to assume that the vasectomy incision was only superficially healed, and therefore, violated and impregnated during the “trauma” of oral intercourse.

This is one of those cases where a series of events coincide, which results in a bizarre disease complication.

That was my TMI Friday, I hope you endured it as well as I did.

Ramaswamy K. &; Kaminetsky J. (2011). Unique Infective Complication after Routine Vasectomy: A Case Report, The Journal of Sexual Medicine, 8 (9) 2655-2658. DOI: 10.1111/j.1743-6109.2011.02345.x

TMI Friday: Taking a Bite out of Love

Love isn't commonly encountered within the medical literature. The romantic lives of two people in love is a subject that rarely requires the attention of a doctor.

But occasionally in the violent throes of a passionate embrace, there is an emphasis on the violence. With this in mind, let us consider the Hickey.

Once when I was in school, I met up with my friend and the first thing I said to him was "What the f**k happened to your neck ? Did you get attacked ?" at which point I realised the girl next to him started to giggle.
I later learned that during the violent throes of passion, that occasional nibble may occur, leaving a bruise, or just a red mark. But on occasion, some couples go a little bit too far. This is where medical professionals get involved.
In a set of case reports published by the British Journal of Surgery in 1990, 7 cases of what are described as "Traumatic" love bites are reported. I shall summarise them below

1. Patient 1, a 35 year old man, came into hospital complaining of a hard lump in his shoulder that had been bothering him for long time. It was a worrying lump, and the doctors initially suggested that it was some sort of cyst. When they removed the cyst, they were dismayed to find... a plastic tooth. It turned out that he had engaged in intimate relations with a lady who was not only dressed as a vampire, but possessed an incredible commitment to the lifestyle.
2. Patient 2 arrived at the hospital with an abscess in his neck that was swollen with bacteria, caused by a particularly violent love bite that had happened 3 weeks previously
3. Patient 3 arrived at the emergency room, bleeding from the jugular vein that was caused by deep bite marks that had been inflicted 2 hours earlier under undisclosed circumstances.
4. Patient 4, a 26 year old woman had been suffering from cellulitis in the neck for about 3 days before she went to hospital, and later confessed it was due to "ferocious love biting" by her boyfriend, and in response, the surgeons gave her a course of antibiotics and also a tetanus shot.
5. Patient 5 appeared to accept some form of responsibility for the infected wound on his neck, as the wounds were inflicted after he had returned from a long holiday by his "frustrated" girlfriend.
6. I feel sorry for Patient 6, who had to cut off her honeymoon early after her drunken husband accidentally bit off her left nipple. The doctors don't mention the fate of this relationship, but I would be very surprised if "Divorce" was not a key feature of it.
7. Patient 7 suggested that the primary reason for the infected injury in the left breast was due to the short stature of her paramour.

Only in two of these cases is the injury in itself severe enough to merit an immediate visit to hospital. The majority of the problems caused by these human bites come from infection. The human mouth is generally full to the brim with bacteria, that could potentially become hazardous if introduced into a wound.

When one attempts a lovebite, always remember to take a sensible nibble, if you end up with a mouthful of blood then you are probably doing it wrong. Unless you are a vampire, in which case, check that you still have all of your teeth at the end of it.

Al Fallouji M. (1990). Traumatic love bites, British Journal of Surgery, 77 (1) 100-101. DOI: 10.1002/bjs.1800770134

The Early Emergence of Antibiotic Resistance

The development of resistance to the antibiotics is a phenomenon of great theoretic interest to a bacteriologist, and it may some day become a matter of major concern to the clinician.

This is the opening line in C. Phillip Miller's paper on the development of resistance to antibiotics, which he published in 1947. Penicillin had only just been in production for five years. It was saving countless lives. It was emerging as a miracle drug. But even in this relatively optimistic era, a number of scientists were getting a taste of things to come.