Biomedical subjects
Publications and source records attributed to R R Bailey.
Five patients in whom deterioration in renal function was associated with the use of the aldosterone antagonist, spironolactone, are reported. Care in the use of this drug is urged, especially in the elderly. Patients with known renal functional impairment should not receive this agent.
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Radionuclide micturating cystography (RMC) has been compared with the standard micturating cystourethrogram for detecting vesicoureteric reflux (VUR). Of 16 renal tracts with VUR radiologically classified as gross all had reflux demonstrated on RMC and in 15 of these the reflux reached the renal pelvis. Eight of the 12 renal tracts with moderate VUR and three of four with slight VUR were shown to reflux on RMC. RMC should prove valuable for following the course of patients with VUR treated surgically or conservatively because of the lower gonadal radiation dose resulting from this technique compared with the conventional radiological method.
A simple non-invasive ultrasonic technique which identifies gross vesico-ureteric reflux (VUR) in adults is described. It is based on the time position (TP)-mode (or M-mode) of ultrasound imaging. This method warrants assessment as a possible screening procedure for gross VUR in newborn children.
The mother and daughter in a family had homozygous cystinuria and were also heterozygous carriers of the oculo-cerebro-renal dystrophy of Lowe. The daughter was also epileptic. The son had Lowe's syndrome and the father an increased urinary excretion of cystine and lysine. This evidence together with other case reports suggests that the defect in cystinuria and that of Lowe's syndrome may be connected.
A study has been made to assess the incidence of hypertension in patients who have suffered an episode of renal trauma sufficiently severe to cause haematuria. Sixty-three patients were studied and 63 age- and sex-matched controls were also studied. At follow-up, 6-138 months after injury, 13 of the patients who had suffered renal trauma and 12 of the control subjects had a diastolic blood pressure above 99 mm Hg. Three patients showed significant reduction in the size and volume of the previously damaged kidney. In this group, renal trauma did not appear to be associated with an increased risk of permanent hypertension.
Renal disease and hypertension is a continuing challenge to the nephrologist. At present there are few effective methods of dealing with the common renal diseases such as glomerulonephritis, but fortunately there is now a wide selection of potent antihypertensive agents. Drug resistant hypertension should be a rarity in clinical practice. Malignant hypertension remains a therapeutic emergency. If a patient with hypertension has renal functional impairment it is essential to lower the blood pressure to normal. In the presence of renal failure this should be done with caution so as to avoid a further deterioration in the glomerular filtration rate. However, if the blood pressure is controlled and especially if the renal failure is a result of hypertension alone, renal function may stabilise or even improve, often dramatically.
Streptococcus faecalis, while the most common streptococcal serotype causing urinary tract infection, is not the only one. Lancefield group A, B, C and G serotypes are capable of invading the urinary tract. This finding is not generally appreciated. The reason for this anomaly is seen in the failure of most investigators to utilise a definitive procedure to group streptococcal isolates from urine. Streptococci are responsible for 8.5 percent of urinary tract infections in this hospital.
Microstix is a simple and convenient reagent strip for obtaining a semi-quantitative bacterial count on urine specimens. This method correctly predicted over 10(5) gram-negative organisms per ml in 84 percent of samples and over 10(5) gram-positive organisms per ml in 72 percent. Urine specimens containing 10(4) per ml or more of any organism should be recultured using fully quantitative methods. If this criterion had been used 89 percent of urine samples with over 10(5) organisms per ml would have been detected with Microstix and only 33 of the 393 remaining samples would need to have been repeated. The false positive rate was low. This method would be ideal for use in doctors' offices to culture the urine of patients presenting with urinary tract symptoms. It would also be very suitable for use in hospital clinics and for the screening of asymptomatic populations who are high risk of having urinary tract infections.
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Colony counts on 122 clean-catch mid-stream urine specimens were determined with Bacturcult and compared with those obtained using the quantitative pour plate method. The suggested criteria for using Bacturcult resulted in an unacceptably high number of false positive cultures. It has been shown that over 100 colonies in the proscribed area on the cellophane sleeve correlated well with pour plate colony counts of over 100 000/ml. Bacturcult was found to be a simple and convenient method for performing a quantitative colony count on a urine specimen. It could be recommended for use in domiciliary practice, out-patient clinics and in population screening programes.
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A single 150 mg oral dose of clindamycin was given to three healthy volunteers and 13 patients with varying degrees of renal functional impairment. The mean peak serum levels in the two groups were 2.55 +/- 0.92 mug/ml and 3.39 +/- 0.68 mug/ml respectively. In all patients the levels greatly exceeded the minimum inhibitory concentration for sensitive pathogens. The serum half-life was extremely variable in patients with renal failure and bore no relationship to the glomerular filtration rate. In the normal subjects 11.9% of the administered dose was excreted in the urine but in severe renal failure less than 1% of the bioactivity was detected in the urine in 24 hours. The drug was not removed by haemodialysis. In patients with mild to moderate impairment of renal function no dosage adjustment of clindamycin is necessary. However, in those with severe renal failure some modification to dosage would be prudent and this should be monitored by measuring serum levels of the antibiotic.
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Explore the source record for details and available documents.