Conus medullaris intramedullary arachnoid cyst- case report and review of the literature

Background: Spinal intramedullary cysts present a radiological dilemma. We present a rare case of a conus intramedullary arachnoid cyst and report on its differentiating features and management. Case Description: We report a case of a 30-month-old child who presented with decreased gluteal sensation and urinary dribbling for 6 months. Apart from some slowness in walking, the power was normal in all four limbs. Imaging showed a non-enhancing, T2-weighted hyperintense 12 × 8 mm conus intramedullary cyst without any edema. A T12-L1 laminotomy followed by marsupialization of the cyst was done. Histopathology was suggestive of an arachnoid cyst. The postoperative course was uneventful with improvement in muscle strength and achievement of regular milestones. We also present the pertinent review of the literature to date. Conclusion: Intramedullary arachnoid cysts are a rare entity and should form the differential diagnosis for cysts presenting in the conus medullaris. Simple decompressive options may suffice for symptomatic cases and radical excision may be avoided. A high index of suspicion is essential considering the subtle nature of presenting symptoms.

AN UNUSUAL CASE OF LARGE PENILE URETHRAL CALCULUS WITH URETHROCUTANEOUS FISTULA IN AN ELDERLY MAN.

Impacted penile urethral calculus complicated with urethrocutaneous stula is a rare condition. Such calculi can form as a result of urethral strictures, meatal stenosis, urethral diverticulum, and migration of stones from the proximal urinary tract. A 65 year old male presented to our emergency department with complaints of fever and urinary dribbling since 2-3 weeks and obstructive lower urinary tract symptoms since 6 months. He showed features of sepsis and a palpable bladder on examination. Xray KUB and penile USG was suggestive of a 2x1.5cm distal penile urethral calculus. In this paper we present our approach to such case.

Geriatric Health Problems in a Rural Community of Bangladesh

This cross sectional descriptive study was conducted in some rural communities of Sreepur Thana during the month of April 2007. The study population included those aged 50 years or more and residing in the study areas. A total of 226 respondents were selected purposively and were interviewed using a pre-tested questionnaire. The objective of this study was to assess their socio economic condition and identify their health problems. The mean age of the respondents was found to be 62 years. Mean family size and monthly family income was estimated to be 5.31 and Taka 5857.52 respectively. More than half (64.2%) of the respondents were illiterate. Fifty eight percent of them were unemployed and 67.3% were found to be dependent on their family members. Most of them (65.5%) were found to be suffering from joint pains. Some cardio-respiratory problems like palpitation, dyspnea and chest pain was found to be significantly higher among the female respondents (p<0.03). ECG was done on 22 of them. Left ventricular hypertrophy was detected in 22.7% and ischemic heart disease in 27.27% of them. Systolic hypertension was significantly higher in the females (p<0.01). Majority of the respondents (64.5%) were found to have a normal fasting blood sugar level. Symptoms of prostatic enlargement like frequency, urgency, hesitation and post void dribbling of urine was respectively found to be present among 15.9, 62.8, 10.7 and 24.8% of the male respondents. In 11.4% of the female respondents, urinary dribbling was found. The mean age of menopause was estimated to be 48.46 years. Ibrahim Med. Coll. J. 2007; 1(2): 17-20 Key Words: Geriatric problems, old age, community health, RFST. doi: 10.3329/imcj.v1i2.2900

CONCEALED DIVERTICULUM OF THE MALE URETHRA AS A CAUSE OF URINARY OBSTRUCTION

In infancy and childhood there are many causes for obstruction to the flow of urine through the urethra. These include preputial adhesions,meatal narrowing, urethral stricture, posterior urethral valves, and contracted bladder neck. It has been known also that congenital diverticula of the urethra can give rise to urinary obstruction. These have been studied by Watts1 in 1906, by Lowsley and Gutierrez2 in 1928, by Kretschmer3 in 1936, and by Campbell4 in 1937. Such diverticula have been detected heretofore by the presence of a swelling on the ventral surface of the penis, in the peno-scrotal angle, or in the perineum. It is the purpose of this paper to present three cases of concealed diverticula of the urethra in each of which there was urinary obstruction; in none of these was there any swelling on the external surface of the penis. In two of these children the cause of obstruction was not recognized during life;death ensued as a result of urinary tract infection and the urethral abnormalities were found at autopsy. In the third child the cause of obstruction was found by roentgenologic visualization of the urethra, and surgical relief of the obstruction was prompdy instituted. CASE REPORTS Case 1 Children's Hospital #153,603. This 5-year-old boy was admitted to the Surgical Service on October 3, 1931, with a history of urinary dribbling,intermittent fever, and pyuria. The mother stated that until 1½ years of age, the child had had no urinary stream, the urine coming away only in a slow