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INTRODUCTION: Urolithiasis is a common condition that affects approximately 5% to 10% of the population and the incidence of Urolithiasis is rising. Ureteric stones account for 20% of urinary tract stones and about 70% of them are found in the lower third of the ureter at presentation. Recent literatures show the efficacy of various drugs and minimally invasive procedures for the management of lower third ureteral stones. We performed a randomized, prospective study to assess and compare the efficacy of tamsulosin and silodosin as medical expulsive therapy for lower third ureteral stones. SETTING AND DURATION: Department of Surgery, Hassan Institute of Medical Sciences/ Teaching Hospital, Hassan. from August 2013 to August 2014. MATERIALS AND METHODS: The prospective data of 60 symptomatic patients with unilateral, lower third ureteral calculi of less than ≤10 mm were randomly allocated for out- patient treatment with tamsulosin and silodosin groups Patients aged ≥ 18 years with a single, unilateral, symptomatic, radio-opaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and vesico-ureteric junction were included. For Group I tamsulosin a daily single dose of 0.4 mg for 28days and for Group II a daily single dose of silodosin 8mg was given. Nonsteroidal anti-inflammatory drugs were used on demand for both the groups. All the patients were told to observe passage of stone by filtering urine stream. The primary end point was the expulsion of the stone and the secondary end points were expulsion time, analgesic use, socioeconomic status, need for hospitalization, endoscopic treatment and drug side effects were documented. RESULTS: The stone expulsion rates in patients treated with tamsulosin and silodosin were 83.3% and 86.6% respectively. Mean stone expulsion times in tamsulosin group and silodosin group were 6.8 and 6.2 days respectively. Mean number of pain episodes were 1.5 and 1.4 in the tamsulosin and silodosin group respectively. The mean number of analgesic requirement was 1.0 and 0.8 for the tamsulosin and silodosin group, respectively with no significant difference. Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced a higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Sub-group analysis shows, higher expulsion rates but lower mean expulsion time and pain episodes for stones ≤ 5 mm with both tamsulosin and silodosin groups. The total number of patients from lower socioeconomic status was more than 50% in this study and expulsion rates were better than with patients of higher socio-economic status with tamsulosin is 89 % and silodosin is 94%. There was higher expulsion rates in patients with stones ≤ 5 mm and this was true for both patients treated with tamsulosin 13(92.8%) and silodosin 14(93.3%). However the difference was not statistically significant. Most trials on MET for lower ureteric stones with tamsulosin demonstrated significant lower mean number of pain episodes with respect to placebo (1, 9, 21-23). Results from the present study in terms of mean number of pain episodes and need for

AIMS: To prospectively evaluate the efficacy of ultrasound and fluoroscopy for detection residual stones during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: We prospectively evaluated 49 patients (55 renal units) undergoing percutaneous nephrolithotomy for renal calculi greater than2cms, in 38 renal units or staghorn calculus in 17 renal units, from May 2011 to Sep 2011. In 35 renal units patients underwent standard fluoroscopic guided PCNL and in 20 renal units patients underwent standard fluoroscopic guided PCNL followed by ultrasound of kidney was done before concluding the procedure. The size and location of residual fragments determined fluoroscopically and identified by ultrasound were compared. RESULTS: Stone free status was achieved in 27 of the 35 renal units using fluoroscopy alone, of the 27 renal units significant residual fragment were detected postoperatively by CT kidney in 8 false negative rate of 29.6% renal units, 4(14.8%) of them required ESWL/ relook PCNL. Clinically insignificant residual fragments (≤4mm) not observed in 4 (14.8%) renal units by fluoroscopy were confirmed by post-operative CT scan. Stone free status was achieved in 14 of the 20 renal units and stone clearance was ensured by intra- operative ultrasound alone. Clinically significant residual stones were detected in 3 (21%) of 14 renal units by post-operative CT, managed conservatively. Clinically insignificant residual fragments (≤4mm) observed in 3 (21%) patients which were confirmed by post-operative CT scan. CONCLUSION: Routine intra-operative ultrasound after standard PCNL helps in detecting CIRF and significant residual calculi. There were significant false positive and false negative rate of detection of residual stones which can be overcome by further experience in use of intra-operative ultrasound.

BACKGROUND: Duodenal ulcer is a very common disease in the southern part of India and complication like perforation is still common and surgical intervention is considered the treatment of choice.(1) METHODS: A prospective study consisting of 70 patients of duodenal perforation presenting as acute abdomen to the casualty department of Victoria hospital and Bowring & Lady Curzon Hospital, Bangalore, between October 2009 to Aug 2011. RESULTS: In our study, presentation of duodenal perforation is common in males (91.4%) between 3rd to 6th decades. The incidence of the duodenal perforation is more in those consume spicy food, living in rural areas (59%) and with ‘0’ positive blood group (51%). Most of our patients presented after 48 hours and major post-operative complications observed in these patients (50%). CONCLUSION: Live omental patch closure with technical modifications is still the better operation in perforated duodenal ulcer and definitive procedure are reserved when suitable conditions are present.(2) Mortality rate in perforated duodenal ulcer is less when compared to other acute abdominal conditions and is directly related to duration of clinical symptoms, age, severity of dehydration, and peritoneal cavity contamination.

Tumor necrosis factor-alpha (TNF-alpha) has recently been implicated as a cause of insulin resistance (IR) in obesity and non-insulin dependent diabetes mellitus (NIDDM). To examine mechanisms involved, we induced IR induced IR in H-411 E cells with graded doses of TNF-alpha and measured the ability of insulin (INS) to stimulate both calmodulin (CaM) mRNA and glucose utilization. With TNF-alpha concentration at 1 ng/ml and 10(4) muU/ml INS, metformin 10 microM and pioglitazone 1.5 microM, reversed the IR induced by TNF-alpha restoring biologic response to 100% of INS effect alone. Furthermore, comparable results were obtained with glucose utilization/oxidation experiments in the H-411 E cells using glucose U-14C, trapping 14CO2 release in a hyamine filter and extracting 14C labelled lipids with Dole's reagent. In condusion, these data add scientific support for the use of both metformin and pioglitazone in treatment of IR in NIDDM patients and support a rationale for use of use of these drugs alone, and in conjuction with oral agents and/or INS treatment.

There is a need to obtain and make available preliminary subsurface investigation data applicable for light commercial and residential structures. Foremost among problems that this would alleviate are flooding, foundation failures due to adverse soil conditions, and improper location of absorption field disposal systems. This study investigates the feasibility of obtaining such preliminary soils data from available reports and maps and rates the suitability of soils in Fayette and Union counties, Indiana, for residential housing on the basis of published soil survey reports and maps and field laboratory study. The greater portion of' Fayette and Union counties is covered with glacial deposits, thinly capped with loess, mostly modified by weathering. Bedrock of the Ordovician system underlies soil mantle throughout the two counties, except in a small area west of Fayette County. Most of the soils fall into the great soil group “Gray Brown Podzolio soils". With a few exceptions, all the soils are fine-grained and contain a high percentage of silt. None of the soils are of a high-swelling type. The soils are grouped by terrain reconnaissance procedures and topography, and these groups or units are discussed in detail with reference to the problems of residential housing. Thie study reveals, neglecting frost action, that nearly 70 percent of Faye.tte and Union counties is suitable for residential housing. The ratings given may best be used primarily in planning more detailed investigations of soil nature and characteristics at the proposed housing project area. Master of Science