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The article presents a case of a 62-year-old female who was rushed to a hospital due to complaints of leucorrhea, burning micturition and hematuria to discuss an incidental detection of Strongyloides stercoralis in liquid-based cytology. Based on microscopic examination, she has abundant atrophic squamous epithelial cells, neutrophils and eosinophils. She was successfully treated with ivermectin.

AIM: With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre. MATERIALS AND METHODS: Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1), kidney (group 2) and renal collecting system/ureter (group 3). All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy) for comparative study. The operative details, hospital stay and complications were analysed. RESULTS: Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n = 34) followed by laparoscopic nephrectomy (n = 13). Group 1 patients had a prolonged operative time (P = 0.012) and hospital stay (P = 0.025) when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All procedures were completed using the laparoscopic approach, without any conversion. CONCLUSIONS: Simultaneous laparoscopic procedures can be done for urological diseases in selected patients with the advantages of single anaesthesia and hospital admission without increasing the morbidity. [ABSTRACT FROM AUTHOR]

Persistent hematuria is one of the most dreaded complications following percutanous nephrolithotomy (PCNL). Although invasive, a catheter-based angiogram is usually used to localize the bleeding vessel and subsequently embolize it. Advances in imaging technology have now made it possible to use a non invasive multi-detector computed tomography (MDCT) angiogram with 3-D reconstruction to establish the diagnosis. We report a case of post-PCNL hemorrhage due to a pseudo aneurysm that was missed by a conventional angiogram and subsequently detected on MDCT angiogram. [ABSTRACT FROM AUTHOR]

The occurrence of nephrotic syndrome following a bee sting is rarely reported in the literature. Hypersensitivity is believed to be the precipitating factor for the renal disease. We report a two-year-old boy, who developed generalized edema and decreased urine output, seven days after a bee sting. Physical examination and laboratory findings were consistent with nephrotic syndrome; and corticosteroid treatment induced prompt remission with resolution of clinical symptoms and normalization of laboratory findings. There was no relapse of the disease during a one-year follow up. [ABSTRACT FROM AUTHOR]

A response by Kamlesh Maurya, S. E. Sivanandam, Sudhir Sukumar, Sanjay Bhat, Ginil Kumar, and Balagopal Nair to a letter to the editor about their article on the impact of concomitant laparoscopic urological procedures is presented.

Introduction: The benefits of bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome and pheochromocytoma associated with multiple endocrine neoplasia (MEN) have been published only in very few articles. Our aim is to analyze the results in these patients. Materials and Methods: From May 2003 to Jul 2007 fourteen patients had undergone bilateral single stage laparoscopic adrenalectomy. Patient's demographics, indications, operative details, complications, hospital stay and convalescence were analyzed retrospectively. Results: The median age group was 34 years (11-65) including 9 women and 5 men. The indications for bilateral adrenalectomy were refractory Cushing.s disease (n = 6), Ectopic ACTH dependant cushings syndrome (n = 4), and bilateral pheochromocytoma (n = 4) including three patients with MEN syndrome. A mean of 53 months elapsed between onset of symptoms and adrenalectomy. All procedures were completed laparoscopic approach without any conversion. One patient needed terminal hand assist in view of large size of the tumour. The mean hospital stay was 7.7 days (range, 3-15 days). The mean operative time and blood loss were 193 min (range 90-270) and 71 ml (30-100) respectively. Mean size of the adrenal gland was 5.9 cm (range, 4-9 cm). Three procedures were done by retroperitoneoscopic approach and all were on the right side. Three patients (21%) experienced postoperative complications such as adrenal crisis, chyluria and pleural effusion. All the patients received postoperative steroid replacement and appropriate follow-up assessment with an endocrinologist. Hypertension resolved in 3 out of 4 pheochromocytoma patients. Conclusion: Laparoscopic bilateral adrenalectomy is safe and effective option with minimal morbidity for this subset of patients. Although patients should be monitored closely in the immediate postoperative period, most are discharged with glucocorticoid and mineralocorticoid replacement in long term follow up. [ABSTRACT FROM AUTHOR]