No abstract

Diabetic cystopathy was initially described as a complication of diabetes, characterized by an increase in bladder capacity and in post voiding residual volumes, accompanied by a decreased in bladder contraction and vesical sensation. Today, the term includes symptoms of overactive bladder.The main of this study is to evaluate the prevalence of urinary symptoms in the diabetic population, to compare it with the general population and to understand the impact that these symptoms have on this population.Methods: An inquiry of urinary symptoms was done to the diabetic patients followed in our hospital, being excluded patients with other comorbidities eventually responsible for cystopathy. We also evaluated the impact of symptoms on the daily basis. From a number of 400 patients, 151 were included in our study. A similar number of a control healthy population was inquired, respecting the same protocol. The statistically study was made with nonparametric test. Results:From the 151 patients evaluated, 76 were female. Our population included 52 DM1 and 99 DM2 patients, with an average of HbA1c: 8.14% and of 15years of diabetes duration. 64/151(42%) had more than one diabetes chronic complication and 35/151(23%) had symptoms of stress urinary incontinence. 114/151(75%) patients had more than one symptom of bladder dysfunction on the storage phase and 53/151(35%) had symptoms of voiding dysfunction, with only 28 patients with no symptoms of urinary dysfunction. Comparing to our healthy population we can attribute the bladder dysfunction symptoms to diabetes mellitus.The impact of the urinary symptoms on their daily basis was, on average, seven on a scale of 0-10. Conclusion:Diabetic cystopathy is a highly prevalent complication. For a correct evaluation other causes must be ruled out; a good clinical history with an inquiry of urinary symptoms help to characterize the disease stage, which is decisive for the choice of therapeutic strategy.

A 62-year-old woman with chronic obstructive pulmonary disease (COPD) attended emergency room because of a two-month history of progressive dyspnea, cough and thick sputum. Within the previous week she had dyspnea with minimal efforts and hoarseness. On admission her blood pressure was 120/65 mmHg, heart rate 70 bpm, respiratory rate 30 cpm with prolonged expiratory time, peripheral oxygen saturation of 94% (room air), and tympanic temperature of 39.3 ºC. Chest auscultation revealed rhonchi and crackles bilaterally. Usual COPD exacerbation therapies were administrated, but the patient had no response to them. Blood tests revealed neutrophilic leukocytosis and high serum C-reactive protein (369.9 mg/L). Chest X-ray (A) revealed enlarged mediastinum with an air-fluid level. Computed tomography scan (B, C) showed a bulky diverticulum at upper esophagus -Zenker´s diverticulum (ZD). She was admitted for ZD abscess. She was on antibiotic treatment with cefotaxime and clindamycin for seven days and got surgery (diverticulostomy). Patient became asymptomatic after that. Zenker´s diverticulum is a posterior pharyngoesophageal pouch that develops in an area of relative hypopharyngeal wall weakness. It occurs most frequently in elderly (seventh and eighth decades), predominately in males 1,2 . This is a rare condition with a reported prevalence (mostly symptomatic cases) of 0.01-0.11% in the general population 1-3 . Among symptomatic ZD patients, 80-90% complains of dysphagia 1,4 . Typical symptoms also include regurgitation of undigested food, choking, chronic cough and halitosis. The duration of symptoms at presentation may vary from weeks to several years. Hoarseness, cough and aspiration pneumonia may be present in 30-40% of patients 1,3 . In this case ZD might have caused this clinical picture by airflow restriction, reactive airways edema and eventually food microaspiration.Here we illustrate how the diagnosis may go unnoticed and be easily mistaken for commoner conditions if not enough attention is paid to certain details both in clinical history/ physical examination and diagnostic tests.

No abstract