Urological manifestations of Chikungunya fever: a single centre experience

Chikungunya is a viral infection often associated with lower urinary tract dysfunction. This study evaluates the urological squeal of Chikungunya fever in a single centre after an epidemic in 2006-2007 in India. Retrospective analysis of medical records of 13 patients with lower urinary tract symptoms after Chikungunya fever was evaluated and outcome following intervention assessed. A total of 13 patients [M:F=9:4], with age ranging from 30 to 72 years, were included in the study. They presented with chronic urinary retention [n=9, 69.23%] of which two had paraparesis, voiding symptoms alone [n=7, 53.8%], storage symptoms alone [n=3, 23%], and acute urinary retention [n=1, 7.6%]. Presentation with lower urinary tract symptoms after an episode of Chikungunya fever was after a mean period of 163 days [range 30-360 days]. Mean serum creatinine on presentation was 1.8 mg/dl [0.6-6.5 mg/dl]. Evaluation revealed dilated upper tract in four [30.7%] patients. Cystometrography showed acontractile detrusor [n=3, 37.5%], hypocontractile detrusor [n=3, 37.5%], overactive detrusor [n=1, 12.5%] and normal study [n=1, 12.5%]. At the mean follow up of 11 months, 11 patients [84.6%] had satisfactory functional outcome after intervention, namely supra pubic diversion and bladder training [n=5, 38.4%], alpha blocker [n=3, 23%], timed frequent voiding [n=2, 15.3%], clean intermittent catheterization [n=2, 15.3%], trial void with alpha blocker [n=1, 7.6%] while two are on continuing supra pubic diversion due to persistent neurological deficit. Chikungunya fever is an uncommon entity in urological practice, often associated with urinary symptoms. An accurate assessment of the symptoms and timely intervention prevents upper tract deterioration and improves the quality of life

Neonatal priapism associated with spontaneous bilateral pyocavernositis

<p><b>INTRODUCTION</b>Neonatal priapism is known to be associated with a wide range of aetiologies, but an association with spontaneous purulent cavernositis has not been reported in the paediatric literature. We report the first of such case.</p><p><b>CLINICAL PICTURE</b>A 24-day-old neonate was brought with the history of persistent erection of penis since day 4 of life and swollen penis of 4 days' duration, which revealed frank pus on cavernosal aspiration bilaterally.</p><p><b>TREATMENT</b>The child was treated with closed aspiration drainage; cross-irrigation with antibiotic solution under systemic antibiotic cover helped in achieving complete detumescence.</p><p><b>OUTCOME</b>On follow-up, child demonstrated normal full bladder tumescence and colour doppler revealed bilateral normal corporo-cavernosal appearance and blood flow, indicating good functional and anatomical recovery.</p><p><b>CONCLUSION</b>This case report describes the presentation, successful management and excellent functional and anatomical outcome, on follow-up, of this rare association of neonatal priapism with spontaneous bilateral pyocavernositis. An attempt has been made to describe the underlying pathophysiology.</p>

Perimalleolar ulcers in hydroxyurea treated patients with concomitant chronic venous disease: diagnostic pitfalls

We report three male patients, with duplex confirmed chronic venous disease, who were on treatment with hydroxyurea for chronic myelogenous leukaemia [CML] and polycythemia vera [PV], referred to us for the management of non-healing perimalleolar ulcers of varying durations. Treatment of the ulcers, based on standard venous ulcer treatment protocols, proved futile, and one patient actually underwent surgery for varicose veins. The ulcers healed only after the discontinuation of hydroxyurea. In another patient, the ulcer continued to progress along with emergence of ankle oedema, venous eczema and lipodermatosclerosis, even after discontinuation of hydroxyurea. The short duration of treatment with the drug before the onset of ulcer and characteristic skin changes of chronic venous disease [CVD], in this patient, made us reconsider our diagnosis and this patient ultimately benefited from varicose veins surgery. Based on our experience with these cases, we have made an attempt to differentiate between the chronic venous ulcer and the drug-induced ulcer on clinical grounds

Adult colonic rhabdomyosarcoma: a case report with review of literature

We report a 62-year-old male who presented with altered bowel habit, right hypochondriac pain, anorexia, vomiting and significant weight loss. A hard mass was palpable in the right lumbar region and iliac fossa on clinical examination. Colonoscopic biopsy revealed a malignant neoplasm of ascending colon. The patient underwent right radical hemicolectomy and histopathological examination of the resected specimen revealed alveolar rhabdomyosarcoma which is extremely rare in adults and very uncommon in the gastrointestinal tract