[PDF] DiVuse swelling of the penis in a young adult Hypercalcaemia in a

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DiVuse swelling of the penis in a young adult

N Sarath Krishna, E S Glen

A 25 year old man presented to our hospital

with a seven day history of pain in the root of the penis and two day history of swelling of the penis. On questioning there was no history of prolonged intercourse, local trauma, insect bite, or infection. He had no relevant past medical history.General physical and abdomi- nal examination were unremarkable. On localexamination the penis was diVusely swollen- due to oedema. A long, thick, ®rm, and cord like structure was felt along the dorsal aspect of the penis. It was not tender. There was no evidence of venous thrombosis elsewhere.

Urine microscopy, full blood count, and

coagulation studies were all within normal limits. Colour Doppler ultrasonography of the penis showed a prominent super®cial dorsal vein of penis with no evidence of spontaneous

¯ow. A clinical photograph of penis and Dop-

pler ultrasound scan of the penis are shown in

®gs 1 and 2 respectively.

Questions

(1) What is the probable diagnosis? (2) What is the aetiology and pathology of this condition? (3) How can this condition be managed?

Hypercalcaemia in a 63 year old man

L Ranganath, M J Semple

A 63 year old man with IgG myeloma was

found to have hypercalcaemia; speci®c hypo- calcaemic measures such as intravenous ¯uids and pamidronate 60 mg followed by 1.6 g of oral sodium clodronate daily in addition to antimyeloma agents such as prednisolone,

Adriamycin,and carmustine were unsuccessful

in restoring eucalcaemia (®g 1).

Blood test results while on treatment with

clodronate are shown in table 1.Questions (1) What is the cause of the apparent resistance to bisphosphonates? (2) What further investigations for hypercalcaemia should be undertaken? (3) What are the causes of hypercalcaemia in myeloma?

Answers on p 312.

Figure 1 Photograph of swollen penis (reproduced with the patient's permission).

Figure 2 Doppler ultrasound scan.

Epsom General

Hospital, Epsom,

Surrey UK:

Department of

Chemical Pathology

L Ranganath

Department of

Haematology

M J Semple

Correspondence to:

Dr L Ranganath,

Department of Clinical

Chemistry, Royal Liverpool

University Hospital, Prescot

Street,Liverpool L7 8XP,UK

(e-mail: lrang@liverpool.ac.uk)

Submitted 1 June 1999

Accepted 12 July 1999

Answers on p 313.Self assessment questions309

Department of

Urology, Southern

General Hospital, 1345

Govan Road, Glasgow

G51 4TF, Scotland, UK

N Sarath Krishna

E S Glen

Correspondence to:

Mr Sarath Krishna Nalagatla

(e-mail: sarath@rohini25.freeserve. co.uk)

Submitted 1 June 1999

Accepted 5 July 1999

Subacute haemorrhage into the spinal cord

John J Craig, R S Cooke, J P McCann

A 27 year old previously well man developed

mid-back pain immediately after doing ªstar jumpsº. The pain was not relieved by rest and was associated with increasing weakness and sensory disturbance of the legs. On admission to hospital 72 hours later he had asymmetric

¯accid weakness of the legs, absent deep

tendon re¯exes, ¯exor plantar responses, and reduced sensation to T4 on the left and T8 on the right. Perineal sensation was preserved but he required the insertion of a urinary catheter because of urinary retention. Examination was otherwise unremarkable.

Questions

(1) What is the investigation and what does it show (®g 1)? (2) What should be done next? (3) Are any other investigations indicated? (4) What long term problems might this young man complain of and how should they be managed? 3.0 2.5 1.5 2.0 1.0 0.5 0.0

806040

Days after detection of hypercalcaemia

Serum calcium (mmol/l)

200

Upper reference limit

Lower reference limit

Figure 1 Pro®le of serumcorrected calcium beforeand after treatment.Table 1 Blood test results while on treatment withclodronate

Patient's resultReferencerange

Calcium (corrected) 3.03 mmol/l (2.2±2.6)

Phosphate 1.34 mmol/l (0.80±1.40)

Alkaline phosphatse 137 IU/l (35±230)

Albumin 35 g/l (35±53)

Total protein 103 g/l (63±79)

Urea 7.1 mmol/l (2.3±6.3)

Creatinine 106 μmol/l (50±130)

Intact parathyroid hormone 4.7 pmol/l (0.5±5.5)

25-Hydroxycholecalciferol 80 nmol/l (20±110)

1, 25-Dihydroxycholecalciferol 93 pmol/l (40±150)

Answers on p 314.

Figure 1

310Self assessment questions

Department of

Neurology, Royal

Victoria Hospital,

Belfast BT12 6BA, UK

J J Craig

R S Cooke

Spinal Injuries Unit,

Musgrave Park

Hospital, Belfast

J P McCann

Correspondence to:

Dr Craig

Submitted 11 January 1999

Accepted 18 August 1999

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