In comparison with the CT scan, there was trend in favor of EUS/EUS-FNA for the superior diagnostic accuracy. EUS was distinctly superior to the CT scan in detecting the number of metastatic lesions. EUS-FNA was also useful to identify the nature of lesions that were too small to be characterized on the CT scan.

Introduction:Diabetes mellitus has been associated with an earlier onset and increased severity of urologic diseases that often result in debilitating urologic complications. Diabetic bladder dysfunction refers to a group of bladder symptoms occurring in patients with diabetes mellitus ranging from bladder over activity to impaired bladder contractility.Aim:Bladder dysfunction is an under evaluated issue in women with diabetes. Aim of our study was to investigate prevalence of bladder dysfunction and its relation with other chronic complications of diabetes in women with type 2 diabetes.Materials and Methods:In a hospital-based cross sectional study, a cohort of women with type 2 diabetes mellitus who had lower urinary tract symptoms (LUTS) were enrolled. We used the American Urological Association Symptom Index (AUA-SI) to assess the severity of LUTS and the Indevus Urgency Severity Scale (IUSS) to assess presence of overactive bladder (OAB). Age-BMI- matched controls that did not have diabetes but had lower urinary tract symptoms were also studied and compared with women with type 2 diabetes. Urodynamic evaluation was done in willing patients.Results:LUTS attributable to bladder dysfunction were reported in 67% of women with type 2 diabetes after exclusion of other causes. Out of them, 36% had moderate to severe LUTS (total AUA-SI score >7). Prevalence of OAB was 53%. Urodynamic evaluation revealed presence of stress urinary incontinence in 48% patients and changes of detrusor over activity and detrusor under activity in 23% and 11% patients, respectively. Among the chronic complications of diabetes, peripheral neuropathy, nephropathy, and presence of metabolic syndrome were significantly associated with moderate to severe LUTS and OAB.Conclusion:Bladder dysfunction is a highly prevalent complication in women with diabetes. Chronic complications of diabetes especially neuropathy, nephropathy, and presence of metabolic syndrome are important predictors of bladder dysfunction.

EUS-FNA as a first test (after CT) has high diagnostic yield and accuracy for detecting lung cancer metastases to the mediastinum and distant sites. Metastasis to the CLNs is associated with poor prognosis. EUS-FNA is able to detect occult metastasis to the CLNs and thus avoids thoracotomy.

RESULTSThere was a significant difference in genotype and allelic distribution of VDR (Fok-I) polymorphism in the patients ( P = 0.033 and = 0.017, respectively). The FF genotype was associated with twice the risk for bladder cancer (odds ratio 2.042, 95% confidence interval, CI,). There was no significant difference in genotypic distribution or allelic frequencies of the VDR (Taq-I) polymorphism ( P = 0.477 and 0.230) when compared with the controls. The stage and grade of the bladder tumours had no association with VDR (Fok-I and Taq-I) genotypes. There was a significant difference in the frequency distribution of the haplotypes FT and fT ( P < 0.001); these haplotypes had a protective effect in the control group (odds ratio 0.167, 95% CI 0.096-0.291, and 0.079, 0.038-0.164). CONCLUSIONThese data suggest that VDR (Fok-I) polymorphism is associated with the risk of bladder cancer. Further, the results for the haplotype FT and fT indicate that patients with this haplotype have a lower risk of developing bladder cancer than those with other haplotypes.

BACKGROUND AND OBJECTIVEChyluria can be confused with nephrotic syndrome when massive proteinuria is present on urine examination during evaluation of a milky/white urine. Our objective was to attempt to resolve diagnosis in the case of nephrotic range proteinuria when there is no clear evidence of a significant kidney lesion.DESIGN AND SETTINGRetrospective review of the medical records of all patients referred the nephrology department at a single institution.PATIENTS AND METHODSWe identified a subgroup of patients misdiagnosed with nephrotic syndrome and treated aggressively with immunosupression with no benefit and who were later diagnosed as having chyluria.RESULTSTwelve patients were identified (8 men, 4 women) with a median age of 34.5 years. Chyle was positive in the urine in eight while chyle was positive on oral ingestion of butterfat in another 4. Six had undergone kidney biopsy and were treated as having minimal change disease. Eight had massive proteinuria and a history of treatment with prednisone, but none of these patients had shown improvement in their clinical presentation. Two patients showed excellent results with diethylcarbamazine with angiotensin-converting enzyme inhibitors in while eight required betadine instillation in the fistulous connection with success in six. Surgical correction was successfully tried in two of these resistant cases.CONCLUSIONIn individuals with nephrotic range proteinuria with a normal or low lipid profile status along with normal serum albumin levels, urine color and nature, frequency, and checking the urine for chyle can help identify the large subgroup who unnecessarily have to undergo kidney biopsy and at times are treated with immunosuppression, which is not only life threatening but useless in these patients.

Internal hernia is a rare cause of small bowel obstruction. It may account for 0.2 to 0.9 % of cases of intestinal obstruction. Intestinal obstruction due to internal hernia is very dangerous and lethal because it may be silent or may present as severe acute abdominal pain. We describe a case of acute intestinal obstruction which presented in our emergency department.

BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with lactulose and probiotics has shown some benefit. We compared lactulose and a combination of lactulose plus probiotics in the treatment of MHE. PATIENTS AND METHODS: Fifty cirrhotic patients without overt encephalopathy were evaluated by psychometry (Number connection tests, Block design test and Digit symbol test). MHE was diagnosed by abnormal psychometry. Patients were randomized to receive lactulose [group 1 (n = 25): dose 30-60 ml/day], and probiotics plus lactulose [group 2 (n = 25) same dose of lactulose plus probiotic one capsule three times/ day, each capsule contained Streptococcus faecalis 60 million, Clostridium butyricum 4 million, Bacillus mesentricus 2 million, lactic acid bacillus 100 million]. Response was defined by normalization of the abnormal test parameters at six weeks treatment. RESULTS: MHE was diagnosed in 50 patients. Of the 50 patients, all had abnormal psychometry tests. Significant improvement was seen in abnormal psychometry tests in lactulose alone and lactulose plus probiotics groups after treatment. Normalization of abnormal psychometry was seen in 63%, and 60% of patients treated with lactulose alone and lactulose plus probiotics groups, respectively. CONCLUSION: All the patients with cirrhosis had MHE. Lactulose alone or combinations of both lactulose plus probiotic are equally effective in the treatment of MHE.

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