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J C Nickel

Publications and source records attributed to J C Nickel.

At least 19 recordsLinked to original sources
PubMed2003

Neuromuscular objectives of the human masticatory apparatus during static biting.

OBJECTIVE: The central nervous system controls the muscles of mastication and may dictate muscle outputs according to a biologically important objective. This study tested the hypotheses that (a) the effective sagittal TMJ eminence morphology, and (b) the outputs of the masticatory muscles during static biting, are consistent with minimisation of joint loads or minimisation of muscle effort. DESIGN: Numerical modelling predicted effective eminence morphology (from sagittal plane directions of TMJ force for centred loading over a range from molar to incisor biting) and TMJ and muscle forces during static unilateral biting in seven subjects. In vivo effective eminence morphology was measured from jaw tracking recorded from each subject. Muscle activities during biting tasks on first molar and incisor teeth were measured by electromyography using surface or indwelling electrodes. RESULTS: Subject-specific predicted effective eminence morphology correlated with in vivo data (0.85< or =R2< or =0.99). Mixed and random coefficient analysis of covariance indicated good agreement between predicted and measured muscle outputs for all muscles of mastication investigated. Individual linear regression analysis showed that modelled muscle outputs accurately predicted EMG data, with average errors of 8% for molar and 15% for incisor biting. CONCLUSIONS: Effective sagittal eminence morphology was consistent with minimisation of joint loads for all subjects. Masticatory muscle outputs during unilateral biting were consistent with minimisation of joint loads or minimisation of muscle effort, or both, depending on the subject. These results are believed to be the first to test model predictions of muscle output during biting for all muscles of mastication.

Adult↗
PubMed2003

Classification and diagnosis of prostatitis: a gold standard?

The National Institutes of Health Classification System for prostatitis has now been accepted by the North American and International urology community. This categorization system consists of category I (acute bacterial prostatitis), category II (chronic bacterial prostatitis), category III (chronic prostatitis/chronic pelvic pain syndrome - CP/CPPS) and category IV asymptomatic inflammatory prostatitis. The evaluation of a patient with category I and category II bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively. The clinical tests for the evaluation of CP/CPPS can be classified as mandatory, recommended and optional. Mandatory evaluations include history and physical examination, urinalysis and urine culture. Recommended evaluations include lower urinary tract localization tests, symptom index, flow rate, residual urine determination and urine cytology. Optional evaluations include semen analysis and culture, urethral swab, urodynamics, cystoscopy, imaging, and prostate specific antigen determination. The physician must individualize a rational diagnostic strategy for each patient. There is no 'gold standard' for the diagnosis and evaluation of patients presenting with prostatitis.

Bacterial Infections↗
PubMed2003

Prevalence, diagnosis and treatment of prostatitis in Italy: a prospective urology outpatient practice study.

OBJECTIVE: To report a prospective, multicentre descriptive study designed to determine the prevalence of the diagnosis of prostatitis in male outpatients examined by urologists in Italy, and to further examine the diagnostic evaluation and treatment of patients identified with a clinical diagnosis of prostatitis. PATIENTS AND METHODS: Between July 2001 and October 2001, 70 urologists, representing a cross-section of urological centres in Italy, counted and recorded the overall total of men reported in the clinic and that of patients diagnosed with prostatitis over a 5-week period. Data on demographics, previous diagnoses, symptoms, physical examination, laboratory data and therapy instituted were collected. Patients with a diagnosis of prostatitis completed questionnaires on symptom frequency and severity, and quality of life. RESULTS: In all, 8503 patients were included in the primary outcome analysis; 1148 were identified with prostatitis (12.8%; mean age 47.1 years, range 16-83) with all age ranges equally represented, and 68% had had their first symptom within the last year. The most common presenting symptoms were severe, bothersome urinary frequency, obstructive voiding symptoms, perineal, suprapubic and penile pain or discomfort. The self-administered questionnaire confirmed that the most frequently reported and most severe symptoms at the time of evaluation were irritative voiding symptoms, perineal and suprapubic pain and discomfort. Over three-quarters of the patients were dissatisfied with their quality of life. While 98% of the patients had a digital rectal examination and expressed prostatic secretion was successfully recovered in 44%, < 3% of the patients had the traditional Meares-Stamey four-glass test. The most common treatment prescribed was drug therapy (not antibiotic). CONCLUSION: The prevalence of a clinical diagnosis of prostatitis in urology outpatient practice in Italy was 12.8%. The prevalence, diagnosis, evaluation and treatment of prostatitis reported in this prospective study was very similar to that reported in other retrospective series from other countries.

Adolescent↗
PubMed2003

Human masticatory muscle forces during static biting.

Muscle forces determine joint loads, but the objectives governing the mix of muscle forces involved are unknown. This study tested the hypothesis that masticatory muscle forces exerted during static biting are consistent with objectives of minimization of joint loads (MJL) or muscle effort (MME). To do this, we compared numerical model predictions with data measured from six subjects. Biting tasks which produced moments on molar and incisor teeth were modeled based on MJL or MME. The slope of predicted vs. electromyographic (EMG) data for an individual was compared with a perfect match slope of 1.00. Predictions based on MME matched best with EMG activity for molar biting (slopes, 0.89-1.16). Predictions from either or both models matched EMG results for incisor biting (best-match slopes, 0.95-1.07). Muscle forces during isometric biting appear to be consistent with objectives of MJL or MME, depending on the individual, biting location, and moment.

Adult↗
PubMed2002

The urologist view of BPH progression: results of an international survey.

OBJECTIVES: To assess the opinion amongst the international urological community on whether benign prostatic hyperplasia (BPH) is a progressive disease. METHODS: A 15-item questionnaire was distributed to the mailing list of the publication European Urology Today as well as being accessed through the website of the European Association of Urology (EAU). The survey included questions on: whether BPH was a progressive disorder; what evidence there was to support this, including clinical parameters that could be identified; risk factors for progression; and prevention of progression. RESULTS: A total of 472 completed questionnaires from 47 countries were evaluated. Overall, the urologists surveyed agreed that BPH was a progressive disease, and that some patients were more prone to this than others. Increased post-void residual urine, reduced flow rate, increased urinary symptoms and urodynamic evidence of obstruction were considered to be the most significant risk factors for progression. Half of the urologists surveyed considered that current medical therapies could prevent progression of BPH, while a significant proportion thought that surgery was an effective preventative measure. CONCLUSIONS: BPH, although a benign disease, has a considerable impact on the patient's quality of life. Its progressive nature and the identification of risk factors for progression warrant further investigation. In the future, there is likely to be a shift in the paradigm from treatment of BPH complications to include the prevention of BPH progression.

Adult↗
PubMed2002

Prostatitis-like symptoms: one year later.

OBJECTIVES: To re-survey (after 1 year) men identified in 1999 as having perineal and/or ejaculatory pain/discomfort severe enough to suggest a clinical diagnosis of chronic prostatitis (using the National Institutes of Health-Chronic Prostatitis Symptom Index, NIH-CPSI), and to compare them with an age-matched population of men who had no prostatitis-like symptoms in the initial survey, to determine the effect of time on specific symptoms associated with the diagnosis of chronic prostatitis. SUBJECTS AND METHODS: A comprehensive questionnaire incorporating the pain and voiding domains of the NIH-CPSI, and data on demographics, medical history, socio-economic status, health-seeking behaviour and a quality of life assessment, was sent to 67 men who had reported prostatitis-like symptoms in the 1999 survey, and to 202 age-matched controls (1 : 3) who reported no prostatitis-like symptoms in the same survey. RESULTS: Forty men (60%) with previous prostatitis-like symptoms, i.e. a mean (sd) 1999 NIH-CPSI pain score of 8.8 (0.4), and 119 (59%) of the control population completed and returned the survey. There was no difference in the 1999 demographics (P = 0.82) or NIH-CPSI pain score (P = 0.49) between patients who returned the recent questionnaire and those who could not be located or declined to complete the survey. Fifteen men (38%) identified with prostatitis in 1999 did not report similar symptoms in 2000. The initial mean NIH-CPSI pain score (0-21) for the men who had resolution of their prostatitis-like symptoms was 7.5 (0.6); 1 year later it was 0.73 (0.3). Their mean age was 51.1 (3.9) years and mean duration of symptoms 1.1 (0.3) years. Those with persistent symptoms had an initial NIH-CPSI pain score of 9.6 (0.5); 1 year later it was 8.68 (0.4), at mean age of 51.4 (2.5) years and duration of symptoms 2.2 (0.3) years. Four men (3%) in the control group who had no symptoms in 1999 reported prostatitis-like symptoms in 2000; these men had a mean age of 52.5 (5.9) and NIH-CPSI pain score of 7.0 (0.9). CONCLUSION: About a third of men reporting prostatitis-like symptoms in the general population had resolution of their symptoms (usually those with a shorter duration and less severe symptoms) 1 year later. The severity of symptoms of men with persistent chronic prostatitis remained relatively unchanged over the year.

Case-Control Studies↗
PubMed2001

Strain rate dependent orthotropic properties of pristine and impulsively loaded porcine temporomandibular joint disk.

The purpose of this study was to characterize the tensile stress-strain behavior of the porcine temporomandibular joint (TMJ) disk with respect to collagen orientation and strain rate dependency. The apparent elastic modulus, ultimate tensile strength, and strain at maximum stress were measured at three elongation rates (0.5, 50, and 500 mm/min) for dumbbell-shaped samples oriented along either anteroposterior or mediolateral axes of the disks. In order to study the effects of impact-induced fissuring on the mechanical behavior, the same properties were measured along each orientation at an elongation rate of 500 mm/min for disks subjected to impulsive loads of 0.5 N. s. The results suggested a strongly orthotropic nature to the healthy pristine disk. The values for the apparent modulus and ultimate strength were 10-fold higher along the anteroposterior axis (p < or = 0.01), which represented the primary orientation of the collagen fibers. Strain rate dependency was evident for loading along the anteroposterior axis but not along the mediolateral axis. No significant differences in any property were noted between pristine and impulsively loaded disks for either orientation (p > 0.05). The results demonstrated the importance of choosing an orthotropic model for the TMJ disk to conduct finite element modeling, to develop failure criteria, and to construct tissue-engineered replacements. Impact-induced fissuring requires further study to determine if the TMJ disk is orthotropic with respect to fatigue.

Animals↗
PubMed2001

Human interleukin-1 beta and interleukin-1 receptor antagonist secretion and velocity of tooth movement.

The cytokines interleukin-1 beta (IL-1 beta) and IL-1 receptor antagonist (IL-1RA) probably play a part in orthodontic tooth movement. Here, the force magnitudes and the area of force application in the compressed periodontal ligament (PDL) were controlled and the velocity of tooth movement correlated with concentrations of IL-1 beta and IL-1RA in the gingival crevicular fluid (GCF). Seven individuals undergoing orthodontic treatment involving maxillary first premolar extractions and distal movement (bodily retraction) of the maxillary canines participated in the 84-day study. For each participant, continuous retraction forces were applied so that they received equivalent PDL stresses of 13 kPa for one canine and 4 kPa for the other. GCF cytokine concentrations from experimental and control teeth were expressed relative to total protein in the GCF and compared using an 'Activity Index' (AI)=Experimental (IL-1 beta/IL-1RA)/Control (IL-1 beta/IL-1RA). The results showed that the velocity of tooth movement in an individual was related to their AI. The correlation between AI and tooth movement was stronger from the distal (R(d)=0.78) than from the mesial (R(m)=0.65) of retracted teeth. The results demonstrate that equivalent force systems produce individual differences in cytokine production, which correlate with interindividual differences in the velocity of canine retraction.

Cuspid↗
PubMed2001

The effect of disc thickness and trauma on disc surface friction in the porcine temporomandibular joint.

The pathomechanics of osteoarthritis in the human temporomandibular joint (TMJ) are unknown. Compromised lubrication is a potential factor, but, lubrication within even the normal TMJ is not understood completely. Weeping lubrication is a concept that may be applicable to the TMJ. A characteristic of weeping lubrication is a slow increase in friction during static loading. The rate of increase in friction is related to the rate of lateral movement of synovial fluid away from the loading area. The TMJ disc is expected to be the main source of TMJ lubrication. This study tested two variables, disc thickness and magnitude of trauma to the disc, as factors that can affect the rate of flow of synovial fluid and thus alter lubrication of the disc surfaces. To test these variables, TMJ disc surface friction was measured before and after an impulse load. Before the impulse load, all discs demonstrated a gradual increase in friction during light static loading. The rate of increase in friction was inversely related to the disc thickness (R(2)=0.75). After an impulse load of known magnitude and peak force, disc surface friction was higher. The magnitude of this surface friction was correlated with the magnitude of the impulsive blow (R(2)=0.89) and the area of surface damage (R(2)=0.85). Disc thickness was a significant factor in determining the minimal impulse needed to produce higher surface friction (R(2)=0.99). These results confirm that disc thickness and trauma to the disc affect surface friction in the TMJ, and therefore may be important factors in compromised lubrication and the development of osteoarthritis.

Animals↗
PubMed2001

Impact of medical therapy on transurethral resection of the prostate: a decade of change.

OBJECTIVES: To assess whether medical therapy has delayed the need for eventual transurethral prostatectomy (TURP), causing a shift in the population characteristics of men undergoing TURP (ie, older, more comorbidities, more advanced disease), resulting in more complications and poorer outcomes. The introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) during the past decade may have changed the indications for TURP. METHODS: All patients who underwent TURP for symptomatic BPH at our institution in 1988 (before general introduction of medical therapy for BPH) and 1998 (medical therapy the primary initial therapy for BPH) were reviewed. We compared the two groups with respect to the total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and preoperative and postoperative complications. RESULTS: Despite a 16% increase in men at risk of BPH-related events, a 60% decrease in the total number of TURPs performed for symptomatic BPH occurred in 1998 (n = 64) compared with 10 years earlier (n = 157). No significant difference was found in age between the two groups, and no increase in comorbid status was observed. Previous medical management had failed in 36% of men who required TURP in 1998. A significantly higher percentage of patients presented in acute urinary retention (55%) and upper tract obstructive uropathy (12.5%) in 1998 compared with 1988 (23% acute urinary retention and 1.3% obstructive uropathy). Patients in 1998 were healthier, underwent smaller resections, had their catheters removed earlier, and were discharged home earlier. Although they were more likely to be discharged home with a catheter in situ, no significant difference was observed in the incidence of postoperative complications. CONCLUSIONS: There has been a dramatic decrease in the number of TURPs performed for symptomatic BPH at our institution since the advent of medical therapy. The proportion of TURP patients presenting with urinary retention and hydronephrosis increased, but the average age, medical comorbidities, operative parameters, and postoperative complications have not significantly changed.

Age Factors↗
PubMed2001

The information required by patients with early-stage prostate cancer in choosing their treatment.

OBJECTIVE: To determine the information that men diagnosed with early-stage prostate cancer think is necessary to choose their treatment (surgery, radiotherapy or 'watchful waiting'). PATIENTS AND METHODS: All men diagnosed with early-stage prostate cancer in a regional urology practice in an 18-month period were surveyed. Respondents considered the treatment decision for a specific hypothetical case and judged whether each of 59 specific information items would be 'necessary' to know to make the treatment decision. Respondents provided basic demographic information (age, education and marital status). RESULTS: Of 89 patients, 71 (80%) responded; the mean (SD, range) number of items that individual respondents identified as necessary was 32 (12, 9-58). Each item was considered necessary by 54 (18, 20-93)% of respondents. Of the 59 items, only five were necessary to > or = 80% of respondents; 23 were necessary to > or = 67% of respondents and five were not necessary to > or = 67% of respondents. Patients were divided about the remaining 31 items. There were no strong correlations (none accounted for > 20% of the variance) between the responses and demographic characteristics. CONCLUSIONS: There appears to be large variation among patients with early-stage prostate cancer in the number of information items deemed necessary to make a treatment decision, and little agreement on the need for most individual items. Demographic characteristics were not useful as predictors of the information needs of each patient. The process of informing patients with early-stage prostate cancer (and their decision aids) needs to be flexible and able to accommodate a wide range of patients' information needs.

Aged↗
PubMed2001

Consensus development of a histopathological classification system for chronic prostatic inflammation.

OBJECTIVE: To develop a standardized histopathological classification system for chronic prostatitis (standardized description of prostatic inflammatory infiltrates) based on a literature review, extensive prospective evaluations in two recognized prostatitis research centres and widespread consensus of international urological centres identified as having major expertise or interest in chronic prostatitis. METHODS: Relevant articles for review were identified by a Medline search undertaken by the Cochrane Review Group in Prostate Diseases and Urologic Malignancies, and cross-checking bibliographies of retrieved studies, reviews, book chapters and abstracts of the American Urological Association and International Prostatitis Collaborative Network Annual Meetings. Initial drafts were based on classification systems independently developed by the Prostatitis Research Centers at Queen's University in Canada and University of Washington in the USA. A collaborative draft was distributed to 20 urological/pathological clinical centres who participated in the North American Chronic Prostatitis Collaborative Research Network and First International Prostatitis Collaborative Network. A consensus classification system was then distributed to the participating panel for acceptance. RESULTS: The literature review identified a reasonably consistent description of inflammatory infiltrate locations and patterns that were further incorporated into the draft based on the Queen's University and University of Washington proposals. Eighteen (90%) of the identified Prostatitis Centers participated in the revision of the draft and the final consensus process. The final consensus document classifies prostatic inflammation according to its extent and grade/severity in each tissue compartment (location). Conclusion The consensus of the expert panel was that this classification system can be used in the evaluation of prostatic inflammation in prostate biopsies, transurethral resected prostate chips or prostatectomy specimens. A standardized accepted framework to describe histopathological prostate inflammation will prove useful in evaluating prostate disease.

Chronic Disease↗
PubMed2001

Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia.

PURPOSE: Pharmacokinetic studies have shown that intravesical lidocaine is not sufficiently absorbed by human bladders to achieve significant serum levels and it only provides a superficial local anesthetic effect. We investigated the pharmacokinetics of alkalized intravesical lidocaine in healthy volunteers and patients with interstitial cystitis to determine a safe dose of buffered lidocaine, the effect of interstitial cystitis on lidocaine uptake and the acute local anesthetic effect on bladder pain in interstitial cystitis. MATERIALS AND METHODS: An initial dose finding study was done in 12 healthy volunteers using 4, 5 and 6 mg./kg. 5% lidocaine buffered with 8.4% sodium bicarbonate. Serial lidocaine levels were measured for 3 hours. Serum measurement was repeated in 12 patients with interstitial cystitis using 5 mg/kg. 5% lidocaine with sodium bicarbonate daily for 2 days. Patients rated pain before and during treatment. RESULTS: Healthy volunteers and patients with interstitial cystitis had similar lidocaine absorption profiles with a peak of 1.06 microg/ml. (range 0.66 to 1.71) and 1.3 (range 0.2 to 2.0) at about 30 minutes. Mean pain score in the interstitial cystitis group decreased from a baseline of 6.0 to 1.8 on day 1 and 0.6 on day 2. There were complaints of urethral discomfort after voiding the buffered lidocaine in each group. CONCLUSIONS: Alkalization provides safe and predictable lidocaine absorption into the bladder, as indicated by therapeutic systemic levels in healthy and inflamed bladders. Furthermore, the decrease in acute pain scores in the interstitial cystitis group indicated a concentration of local anesthetic within the bladder wall that was sufficient to block the sensory neurons within the submucosal plexus.

Absorption↗
PubMed2001

Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index.

PURPOSE: The National Institutes of Health (NIH) chronic prostatitis symptom index was used to determine the prevalence of prostatitis-like symptoms among men (age 20 to 74 years) at risk in a community based study. MATERIALS AND METHODS: The study was a cross-sectional postal survey of men age 20 to 74 years in Lennox and Addington counties, which included a large rural area, 1 major town and a suburban area with a stable population of men representative of Canadian demographics. The questionnaire collected information on 2 domains of chronic prostatitis identified in the NIH chronic prostatitis symptom index, including pain (location, severity and frequency), voiding function (irritative, obstructive), demographics, quality of life, general health and health seeking behavior. The self-reported pain score was used to identify prostatitis-like symptoms in the most discriminating domain. Based on analysis of the index final validation study comparing patients with prostatitis to normal controls and those with benign prostatic hyperplasia, the 2 questions most specific for prostatitis, including perineal and/or ejaculatory pain/discomfort, and a total pain score (0 to 21) 4 or greater were used to identify men with significant prostatitis-like symptoms. RESULTS: A total of 2,987 eligible men received the survey, and it was completed by 868 (29%). Of the men 84 (9.7%) were identified as having chronic prostatitis-like symptoms (mean NIH chronic prostatitis symptom index pain score 9.1 +/- 0.3). The average age of the prostatitis population was 50 years compared with 52 years for men without prostatitis-like symptoms. Prevalence was 11.5% in men younger than 50 years and 8.5% in men 50 years or older. Of the sampled population 57 (6.6%) men had prostatitis-like symptoms and an index pain score 8 or greater (moderate to severe). The index voiding score (0 to 10) was 4.1 +/- 0.5 in men younger than 50 years compared with 1.5 +/- 0.1 for normal controls, and 4.7 +/- 0.4 in those 50 years or older compared with 1.9 +/- 0.1 for normal controls. Of the prostatitis group 60% sought medical help for their symptoms. CONCLUSIONS: In our opinion this community based study using the new prostatitis symptom index confirms that chronic prostatitis-like symptoms are common.

Adult↗
PubMed2001

Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial.

PURPOSE: To our knowledge antibiotics are the most popular choice of therapy for all categories of the chronic prostatitis/chronic pelvic pain syndrome. We determine if culture, leukocyte and/or antibody status of prostate specific specimens predicts patient response to antibiotic therapy. MATERIALS AND METHODS: Patients clinically diagnosed with the chronic prostatitis/chronic pelvic pain syndrome according to the National Institutes of Health (NIH) definition had a lower urinary tract evaluation that included standard microscopy and culture of prostate specific specimens, and determination of the ratio of voided bladder 3 and voided bladder 2 antibody levels against a panel of identified prostate pathogens (enzyme linked immunosorbent assay methodology). Symptom evaluation consisted of the NIH chronic prostatitis symptom index (derived) pain scale 0 to 21, symptom severity index scale 0 to 100, symptom frequency questionnaire scale 0 to 50 and quality of life scale 0 to 6. Patients were stratified according to microscopy, culture and immune status, were treated with 12 weeks of ofloxacin, and were assessed at 4, 12 and 24 weeks with symptom scores as well as global assessments. RESULTS: Based on leukocyte and culture results, 102 evaluable patients were stratified into categories II (14%), IIIA (48%) and IIIB (38%) of the chronic prostatitis/chronic pelvic pain syndrome. Of the cases 23% were categorized as antibody positive and 77% as antibody negative. Average age was 42 +/- 10 years and 92% of patients were white. Of the patients 57% believed that they had moderate to marked improvement. All categories of the chronic prostatitis/chronic pelvic pain syndrome and patients in whom antibody was positive or negative had significant improvement in the NIH chronic prostatitis symptom index, symptom severity index, symptom frequency questionnaire and quality of life scores compared with baseline (p <0.001). There was no significant difference in patient response to the stratification based on culture, leukocyte, that is categories II, IIIA and IIIB had same beneficial response, or antibody status. CONCLUSIONS: Culture, leukocyte and antibody status of prostate specific specimens does not predict antibiotic response in patients with the chronic prostatitis/chronic pelvic pain syndrome. The perceived beneficial effect of antibiotics needs to be evaluated in a randomized placebo controlled trial.

Anti-Infective Agents↗
PubMed2001

The management of acute pyelonephritis in adults.

Acute pyelonephritis should be classified clinically at the time of presentation into either uncomplicated or complicated categories. The diagnostic workup includes history, physical examination, urinalysis (including a Gram stain), and urine culture. Patients with suspected complicated pyelonephritis require the standard assessment plus blood cultures and urinary tract imaging, preferably a computed tomography (CT) scan. Patients with moderate, uncomplicated pyelonephritis can be managed as outpatients with either a fluoroquinolone (7-14 days) or trimethoprim/sulfamethoxazole (at least 14 days). Patients with severe, uncomplicated pyelonephritis can be considered for short-term hospitalization and initial administration of intravenous antibiotics. Therapy for patients with complicated pyelonephritis should include initial hospitalization, supportive therapies, administration of wide spectrum intravenous antibiotic therapy, and relief of aggravating conditions. Such maneuvers could consist of simple bladder catheterization, percutaneous nephrostomy drainage, or definitive surgery. Patients with complicated pyelonephritis require longer duration of culture-specific antibiotic dosing, careful monitoring, long-term follow-up, and possible definitive management of their underlying condition.

Acute Disease↗