A prospective study was carried out to elucidate the clinical, epidemiological and laboratory features of human brucellosis. A total of 26 948 blood samples (from adults aged 15 years and above) were screened for serological evidence of brucellosis over a period of 16 years. The slide agglutination/Rose Bengal plate agglutination test gave positive results in 517 patients, of which 509 had detectable titres by the standard tube agglutination test (SAT). The diagnosis of brucellosis was documented in 495 (1?8 %) patients based on diagnostic titres (¢1 : 160, 490 cases) and rising titres from insignificant titres (four cases) by serology and for one case by blood-culture isolation alone. Blood cultures were carried out in 345 cases, of which 191 cases (55?3 %) yielded Brucella melitensis. In 77/79 cases undertaken for follow up, there was a steady fall in 2-mercaptoethanol (2ME) agglutination titres along with clinical improvement (P <0?01). SAT titres remained detectable in most cases for a longer period in spite of an effective antimicrobial therapy and clinical recovery. A substantial number of patients (84?2 %) presented with fever, this being the only complaint in 51?1 % of the cases. Complications were present in 8?8 % of the patients (arthritis excluded): this included the unusual complications of hydrocele (two cases), Stevens-Johnson syndrome (one case) and urinary tract infection (one case). Brucella agglutinins were demonstrated in synovial, testicular, hydrocele and cerebrospinal fluids. There was no clinical suspicion of brucellosis in 439 cases (88?7 %) and the diagnosis was made only by routine serology. A two-drug regimen for 42-84 days with a follow-up 2ME test resulted in lower levels of relapse. These results suggest that, in endemic areas of the world, it should be mandatory to screen routinely for brucellosis due to protean clinical manifestations. INTRODUCTIONBrucellosis is a worldwide zoonotic disease caused by Brucella spp. The genus Brucella comprises Gram-negative, facultative, intracellular pathogens (Alton et al., 1975). Currently, there are six recognized species of Brucella based on phenotypic characteristics, antigenic variation and prevalence of infection in different animal hosts: Brucella abortus (cattle), Brucella canis (dogs), Brucella melitensis (goats, sheep), Brucella neotomae (desert wood rats), Brucella ovis (sheep) and Brucella suis (pigs, reindeer and hares) (Corbel, 1997;Moreno et al., 2002). Recently, two Brucella strains from marine mammals have been reported (Bricker et al., 2000;Cloeckaert et al., 2000) and the names Brucella pinnipediae (seal/otter) and Brucella cetaceae (porpoise/ whale) have been proposed (Cloeckaert et al., 2003). There has also been a report of human infection with marine brucellae (Sohn et al., 2003). Although each species of Brucella has a preferred host, all can infect a wide range of animals, including humans. Brucellosis is a worldwide reemerging zoonosis causing high economic losses and severe human disease. It has areas of high endemicity...

No abstract

Xanthogranulomatous pyelonephritis (XGPN) is a rare clinicopathological syndrome that is unique among the various inflammatory conditions of the kidney, and it closely mimics renal cell carcinoma, both clinically and radiologically. Approximately one third of XGPN cases have associated complications, such as abscess and fistulas, although the latter is much less common. Spontaneous renocolic fistulas of non-tubercular origin are also rare, especially in Asia. Fistula or deep sinus formation as a complication of XGPN is a rare clinical condition. Currently, only approximately 10 such cases (including our case) have been reported in the literature. We present one such case of spontaneous nephrocolic fistula complicating XGPN. Ultrasonography, an intravenous urogram, retrograde pyelogram, and computerized tomography aided in diagnosing the presence of a renocolic fistula. The treatment regimen of total nephrectomy with primary closure of the rent in the colon was adequate.

Prostatectomy and Transurethral resection of prostate TURP have been the surgical options for men with obstructive symptoms due to benign prostatic hyperplasia. Various clinical manifestations produced due to the absorption of large volumes of irrigating fluid during TURP are referred to as TURP syndrome. In this study we have analyzed the changes in serum electrolytes while using irrigating fluids such as 1.5 glycine and Normal saline while performing TURP using Monopolar and Bipolar procedures respectively. A prospective randomized study was conducted on 88 male patients belonging to the age group of 50 to 86 years over a period of 19 months. 1.5 glycine was used in 46 cases and Normal saline in 42 cases for irrigation. The weight of the prostate gland ranged from 25 gms to 90 gms. The duration of the TURP surgery ranged from 10 min to 90 min. The volume of 1.5 glycine used ranged from 5l litres to 21 l and the volume of normal saline ranged from 5l to 36l. The changes in serum electrolytes that occurred during the procedure were correlated with duration of the procedure volume of 1.5 glycine and Normal saline used and weight of prostate gland resected. The electrolyte changes during Monopolar and Bipolar TURP were same. Use of Normal Saline did not have any advantages over glycine in patients undergoing TURP.

Vesical diverticula occur in the setting of bladder outlet obstruction (BOO) and neurogenic vesicourethral dysfunction. Vesical diverticular calculi are rare, especially for minimally invasive endoscopic lithotripsy treatment. A male patient of around 80 years presented with complaints of urinary intermittency and dribbling for 3 to 4 days. On investigation, the patient was found to have a calculus within a diverticulum in the urinary bladder. After counselling, cystolithotripsy + transurethral resection (CLT+TURP) of the prostate under spinal anaesthesia was performed.  Usually, open surgery is recommended for the management of vesical diverticular calculi. However, CLT+TURP was the best option, in this case, keeping in mind the patient’s age and comorbidities. Simultaneous endoscopic resection of the prostate gland would help to treat the cause.