Male genitourinary tuberculosis--13 years experience at a tertiary care center in India.

We conducted a retrospective study of genitourinary tuberculosis (TB) among males attending a hospital in the northern Himalayan region of India. Records from 1 January 1997 to 31 December 2009 were reviewed for clinical history, relevant radiological findings laboratory data, histopathology and treatment. Of the 1,113 male urogenital non-neoplastic specimens received at the histopathology laboratory of the hospital, tuberculosis was diagnosed in 25 cases (2.2%). Urinary bladder and prostate were the most common organs involved. Thirty-six percent of cases had a previous history of TB; 12% of cases presented with no symptoms. Ziehl-Neelsen staining was positive in 72% of cases. Cultures were positive for TB in 42.8% of cases and polymerase chain reaction was positive in two cases in which it was performed. Antituberculosis treatment was required for up to 12 months in some cases and surgery was required in 32% of cases. Genitourinary TB in this study had varying presentations. Cases having strong clinical and radiological findings and suggestive histopathology for tuberculosis, even without demonstration of mycobacteria may be considered for TB treatment, particularly in endemic areas. Patients living in more remote areas may have more specific and severe symptoms due to late presentation. Histopathology plays a crucial role in diagnosis due to lack of sophisticated techniques. The emphasis should be on early detection followed by prompt treatment to avoid further complications.

Effect of Vitamin E and selenium supplementation on concentrations of plasma cortisol and erythrocyte lipid peroxides and the incidence of retained fetal membranes in crossbred dairy cattle.

The objectives were to: (i) determine the effect of prepartum supplementation of Vitamin E (Vit E) and selenium (Se) on plasma cortisol, erythrocyte peroxidation and the incidence of retained fetal membranes (RFM); (ii) estimate myeloperoxidase (MPO), lysozyme, elastase, and acid phosphatase (ACP) enzyme activities in the cotyledons of cows with or without RFM; and (iii) determine the molecular weight (SDS-PAGE) of proteins present in the cotyledons of cows with or without RFM. Fifty dairy (Friesian x Sahiwal) cows were equally allocated to one of two treatments, given as an im injection 3 week before calving: 1100 IU of DL alpha-tocopherol acetate (Vit E) and 30 mg of sodium selenite (Se), or saline (control). Concentrations of plasma cortisol (20 cows) were determined on days 21, 7, 3, 2, 1, and 0 prepartum, and erythrocyte lipid peroxide (all cows) was determined on days 21 and 7 prepartum. Treatment with Vit E and Se did not affect (P = 0.23) the incidence of RFM (12% versus 0%, respectively) but decreased (P < 0.05) erythrocyte lipid peroxide concentrations on day 7 prepartum compared with day 21 prepartum. Plasma cortisol concentration increased (P < 0.05) from day 21 prepartum to the day of parturition in Vit E+Se and control cows. However, on day 0, plasma cortisol concentrations were lower (P<0.05) in cows given Vit E+Se than in control cows (with or without RFM). To investigate enzyme activity and peptides in cotyledons, cotyledons were collected (from cows that were not part of the principal experiment), homogenised with PBS, and the supernatant used for the estimation of cationic peptides. Cotyledons of cows with RFM (n = 8) had lower (P < 0.01) MPO and greater (P < 0.05) lysozyme and ACP enzyme activities than those from non-RFM cows (n = 6). A band at <10 kDa in the SDS-PAGE indicated the presence of cationic peptides. In conclusion, a single treatment of Vit E and Se at 3-week prepartum reduced concentrations of plasma cortisol and erythrocyte peroxide. Altered enzyme activities in the fetal membranes indicated the involvement of leukocytes and trauma at the fetomaternal junction and warrant further investigation.

Pelvic fracture-associated urethral injuries in girls: experience with primary repair.

OBJECTIVE: To present our experience with four urethral injuries in females accompanying a pelvic fracture, managed with primary repair or realignment of the urethra. PATIENTS AND METHODS: There were three teenage girls and one adult (22 years old). All the patients had complete urethral injuries associated with a pelvic fracture from accidents. They were managed by immediate suprapubic cystostomy followed by repair or realignment of the urethra over a catheter on the same day. The catheter was removed after 3 weeks and a voiding cysto-urethrogram taken. Thereafter they were followed with regular urethral calibration. RESULTS: All patients voided satisfactorily with a good stream; three were fully continent and the fourth had transient stress urinary incontinence. One patient needed dilatation at 2 months and another visual internal urethrotomy at 5 months. At a mean (range) follow-up of 33 (9-60) months all the patients had a normal voiding pattern and were continent; none developed vaginal stenosis. CONCLUSION: Primary repair of the urethra, and if that is impossible, simple urethral realignment over a catheter, is the procedure of choice for managing female urethral injury associated with a pelvic fracture. The procedure has the additional advantage of reducing the risk of vaginal stenosis.

Tubercular mass mimicking a tumour in a horseshoe kidney: a unique presentation.

Tuberculosis of the kidney is quite a common disease and various forms of presentation are described. In most cases the disease results in atrophy, calcification or necrosis of parenchyma. The kidney is not generally palpable except occasionally in case of hydronephrosis; caused by upper ureteral structure. Renal tuberculosis presenting as large solid mass has not yet been reported. We present a case of solid renal mass of tubercular etiology. Diagnosis and management are presented.