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[Present status on bladder replacement--colon bladder replacement].

Bladder replacement using a detubularized right colonic segment was successfully performed on 22 male patients with bladder cancer after radical cystectomy. There were 10 early postoperative complications and one of them required reoperation. Urodynamic studies, performed on 16 patients, showed a low pressure reservoir at a large capacity without any involuntary spikes in every case. Of the 16 patients, 4 were nocturnally enuretic and 1 was partially continent. The other 11 patients (68.8%) were totally continent and voiding well, except one who was on intermittent self-catheterization. The incidence of urinary reservoir infections in patients treated with colon bladder replacement was investigated in 18 patients. The incidence rate of bacteriuria was 5.6% and the positive rate of pyuria was 27.8%. The detection rate of bacteriuria and pyuria was significantly low in patients after colon bladder replacement. These findings indicate that colon bladder replacement can be an ideal option for selected patients with bladder cancer.

Adult

[Comparative study of cefpirome and ceftazidime in complicated urinary tract infections].

We carried out a randomized multi-center study comparing cefpirome (CPR) 0.5 g b.i.d. (1 g group), 1.0 g b.i.d. (2 g group) and ceftazidime (CAZ) 1.0 g b.i.d. (CAZ group) in the treatment of complicated urinary tract infections. Patients who were over 16 years old and had underlying urinary tract disease, with bacteriuria of more than 10(4) cells ml or more and pyuria of more than 5 WBCs/hpf (x 400) or more were randomly allocated to receive either 0.5 g of CPR, 1.0 g of CPR or 1.0 g of CAZ twice a day for 5 days by intravenous drip infusion. The overall clinical efficacy of the treatment was evaluated by the criteria of the Japanese UTI Committee as excellent, moderate or poor, on the basis of the changes in pyuria and bacteriuria. A total of 530 patients were treated. Of these, 141 patients in the 1 g group, 136 in the 2 g group, and 140 in the CAZ group were evaluable for clinical efficacy. No significant differences in background characteristics were observed among the treatment groups. The overall clinical efficacy rate of the 1 g group, the 2 g group and the CAZ group was 80.1%, 76.5% and 71.4%, respectively. The differences were not statistically significant. The overall bacteriological eradication rate of the 1 g group, the 2 g group and the CAZ group was 81.0%, 88.1% and 83.8%. The differences were not statistically significant either. Against the enterococcus group, however, eradication rates were higher significantly in the 1 g and 2 g groups than in the CAZ group. The incidence of adverse reactions was 2.2% in the 1 g group, 0.6% in the 2 g group and 2.9% in the CAZ group. Abnormal laboratory data after medication were observed in 10.8% of the 1 g group, 12.1% of the 2 g group and 10.2% of the CAZ group, the difference not being statistically significant. There were no serious untoward reactions to medication. From the results obtained in this study, we consider that CPR is at least as useful as CAZ in the treatment of complicated urinary tract infections.

Adolescent

Sultamicillin in the treatment of urinary tract infections.

An open multicenter study was carried out to evaluate the efficacy and safety of sultamicillin in patients with urinary tract infections or gonococcal urethritis. 1) Sultamicillin (750-2250 mg/day) was administered for 3 d to 196 patients with acute uncomplicated cystitis. The most common dosage regimen was 375 mg three times daily. The results of treatment based on the combination of changes in symptoms, pyuria and bacteriuria were excellent in 66.8%, moderate in 30.6% and poor in 2.6% of cases. Of 203 strains isolated before treatment, 185 (91.1%) were eradicated. The eradication rate for E. coli, the most common pathogen (167 strains), was 92.2%. 2) In total, 368 patients with complicated urinary tract infections were treated with 750-2250 mg/d of sultamicillin for 5 d. The most common dosage regimens were 375 mg three times daily and 750 mg twice daily. The clinical results based on the combination of changes in pyuria and bacteriuria were excellent in 30.4%, moderate in 35.6% and poor in 34.0% of cases. Of 470 strains isolated before treatment, 352 (74.9%) were eradicated. The eradication rate achieved with high beta-lactamase-producing organisms (64.1%) was not significantly different from that achieved with low or non-producers (75.6%). 3) Sultamicillin (750-3000 mg/d) was administered to 367 male patients with gonococcal urethritis for 3 to 7 d. The eradication rate ranged from 92.3% with 750 mg/d to 100% with greater than or equal to 1500 mg/d. The effect of dose was particularly evident with the 27 strains of gonococci that had penicillinase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[A comparative study on lomefloxacin and norfloxacin in the treatment of acute uncomplicated cystitis].

To objectively evaluate the efficacy, safety and utility of lomefloxacin (NY-198), a new quinolone antibacterial agent, in the treatment of acute uncomplicated cystitis, a comparative double blind trial was performed using norfloxacin (NFLX) as the control drug. In both groups, the drug was orally administered after meals for 3 days in a dose of 100 mg t.i.d. and clinical efficacies were assessed on the 3rd day (the 1st assessment) according to the criteria by the UTI Committee in Japan. Subsequently, either the active drug (NY-198 or NFLX) or placebo was administered for 4 days and the 2nd assessment was performed on the 7th day. Further, in patients who showed excellent responses at the 2nd assessment, recurrence was examined on the 14th day (the 3rd assessment) and on around the 21st day (the 4th assessment) following a subsequent 7-day placebo treatment. 1. A total of 258 patients was treated, and among them clinical efficacies were evaluable in 207 patients (NY-198: 106, NFLX: 101) at the 1st assessment, and in 176 patients (NY-198-NY-198 which was the combination of the 1st and 2nd administrations: 47, NY-198-placebo: 43, NFLX-NFLX: 44, NFLX-placebo: 42). 2. In the evaluation of overall clinical efficacy by the committee at the 1st assessment, the overall efficacy rates in the NY-198 group and the NFLX group were 76.4% and 64.4% (excellent), respectively, or 100% and 99.0% (excellent and good), respectively. There was no statistically significant difference between the 2 groups. In the 1st assessment on effects of drugs on pain at micturition, pyuria and bacteriuria and on bacteriological response, no significant differences were observed between the 2 groups. 3. In the 2nd assessment by the committee, there were statistically significant differences among the 4 groups in the overall clinical efficacies and the effects on bacteriuria (P less than 0.05). No difference was observed between NY-198 group and NFLX group, but the groups administered with active drug for 7 days, i.e. NY-198-NY-198 group and NFLX-NFLX group were significantly superior to the groups administered with active drug for 3 days and placebo for subsequent 4 days, i.e. NY-198-placebo group and NFLX-placebo group (P less than 0.05). There were no differences in the effects on pain at micturition and pyuria among the 4 groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease

[Clinical study of norfloxacin in the treatment of acute epididymitis].

The efficacy and safety of Norfloxacin were studied in the treatment of 20 patients with acute epididymitis. Norfloxacin was orally administered at a dose of 200 mg 3 times a day for 14 days. Clinical efficacy rate on the 7th day was 95% (19/20), excellent in 9 cases, moderate in 10 cases and poor in 1 case, and on the 14th day was 95% (18/19), excellent in 12 cases, moderate in 9 cases and poor in 1 case. On the 14th day, fever, pain and swelling had disappeared in 8 cases (in 2 cases on the 7th day). The efficacy on the 14th day was further investigated compared to that on the 7th day. Before treatment with Norfloxacin, in 13 of the 20 patients, pyuria was observed. Cultivating the bacteria was isolated in 4 of the 13 patients. Norfloxacin remarkably affected the treatment of these patients with pyuria and bacteriuria. In the treatment with Norfloxacin, the count of leukocytes, erythrocyte sedimentation rate and CRP were obviously improved. Side effects and abnormal clinical laboratory findings were not observed. From these results, Norfloxacin 600 mg/day, t.i.d was considered useful and safe in the treatment of acute epididymitis.

Acute Disease

[Treatment of nongonococcal urethritis--studies on clinical effects of ofloxacin].

Clinical effects of ofloxacin (OFLX) in the treatment of chlamydial urethritis was compared with those in the treatment of non-chlamydial urethritis. Chlamydia trachomatis was isolated from 33 (39.3%) out of 84 patients with nongonococcal urethritis. OFLX was administered at a dose of 100 mg, three times daily (300 mg) for 14 days. In 31 (93.3%) of the 33 patients with chlamydial urethritis, C. trachomatis was eliminated within 7 to 14 days after the start of administration, and, in two patients, inclusion bodies decreased in number but persisted. The subjective and objective clinical symptoms, urethral discharge, polymorphonuclear leucocyte (PMNL) in smears, and pyuria in VB1 of the patients with chlamydial urethritis, disappeared in 56.0, 57.6, and 63.0% of the cases, and improved in 24.0, 30.0 and 29.6% respectively, whereas those of the patients with non-chlamydial urethritis, urethral discharge, PMNL, and pyuria in VB1 disappeared in 57.6, 56.9 and 32.9%, and improved in 26.9, 13.7 and 37.9%, respectively. There was no significant difference in the clinical effects of OFLX between cases of chlamydial urethritis and those of non-chlamydial urethritis. Marked improvement in clinical symptoms were observed between day 7 and day 14 of medication in cases of both chlamydial and non-chlamydial urethritis. In nine out of 11 cases of non-chlamydial urethritis where OFLX was ineffective, no Ureaplasma nor aerobes, nor C. trachomatis, were isolated. In the remaining two cases where Ureaplasma and S. epidermidis were isolated respectively, these two bacteria were eradicated after medication, but urethral discharge and PMNL remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Renal manifestations in dermatomyositis and polymyositis].

Renal involvement is usually considered to be rare in dermatomyositis and polymyositis. The aim of this prospective study was to reevaluate the renal changes which may occur in these two conditions. Twenty patients, 12 with dermatomyositis and 8 with polymyositis of the adult type, were investigated to determine the incidence, the severity and course of renal disease. The 24 hour proteinuria was over 0.1 g in 14 cases and greater than 1 g/24 hours in 6 cases, including one patient with the nephrotic syndrome. Microscopic haematuria was noted in 3 cases and pyuria in 8 cases. Endogenous creatinine clearance was significantly decreased (p less than 0.001) in patients with dermatomyositis compared with a control group of subjects paired for age, sex, weight and serum creatinine concentration. Renal biopsy (5 cases) showed minimal glomerular lesions (2 cases), endocapillary proliferation and extramembranous glomerulonephritis (1 cases) and amyloid deposits (1 case). Although the proteinuria, haematuria and pyuria responded to steroid therapy (except in 1 case), the creatinine clearance remained decreased during the course of steroids.

Adult

[Encrustation and stone formation in double J ureteral stent: report of two cases].

We recently experienced two cases of encrustation and stone formation on double J ureteral stent which had been indwelt at pyeloplasty and at pyelolithotomy. In these patients, bacteriuria and pyuria had continued. Encrustation and stone formation were recognized by follow-up X-ray fairly soon after operation. Judging from our experience, encrustation and stone formation should be suspected in patients with persistent bacteriuria and/or pyuria and who have episodes of urolithiasis. To avoid encrustation and stone formation, the ureteral stent should be replaced more frequently.

Adolescent

Bedside urinalysis in untreated leprosy patients.

The study included 53 patients of untreated leprosy attending University Hospital, Banaras Hindu University during study period of 1 1/2 years. The various types of leprosy included 9,14,16 and 14 cases of tuberculoid, borderline, lepromatous and leprosy with type II reaction respectively. Majority of the patients were below the age of 49 years with male preponderance. 66.04% of patients came from the rural area. Painful micturation (dysuria) (13.20%) was the commonest urinary complaint recorded on enquiry. Specific gravity of urine did not show any change. Abnormal proteinuria was noted in 16.98%, 11.32%, 7.54% and 3.77% of patients of leprosy with reaction, lepromatous, borderline and tuberculoid group respectively. Significant haematuria, pyuria and epithelial cells were noted in all the groups. Haematuria was recorded in focal segmental Glomerulonephritis (GN), mesangioproliferative and diffuse endocapillary Glomerulonephritis (GN) incidence of which was 7.89%, 7.89% and 5.26% respectively in the biopsy tissue. Significant pyuria was noticed in all the groups except minimal change GN.

Adult

[Twenty years of urology in a children's hospital (1954--1974). Together with an epicrisis of 101 children with bilateral anomalies of the urinary passages, operated on in the first year of life (author's transl)].

This work encompasses a 20-year period, during which a urologist spent an important part of his time in a children's hospital, because of his conviction that attemps at effective treatment of urinary passage anomalies in childhood have a chance only when treatment is begun as early as possible. A report is presented on 101 children with bilateral, severe urinary passage anomalies, who were operated on in the first year of life, with the goal of early, total correction. The following experiences are of general significance: 1. The earlier the symptoms -- in 90% of cases, pyuria -- the more severe are the findings. -- 2. Males are primarily affected, here at a ratio of 7:3. As a result, pyuria in infants must be explained urologically, particularly when it occurs in males. -- This report is a plea for early, total correction and against periodic urinary drainage. Results show a 50% decrease in infections, flow disturbances, and biochemical changes, as well as a postoperative burst of growth also in 50% of cases. Cinematographic examinations show normal peristalsis even after skeletization and drastic reduction of a megaureter. The mortality was 9%, in the first year of life, 6%. Surprisingly, the result was not influenced by the presence or absence of reflux, but rather by stigmas and inferior development. Reflux had probably already played its fateful part in this severe bilateral disease, so that antireflux plastic surgery loses its prophylactic value. Compared with reports of experiences with periodic urinary drainage, our aim is to disprove the argument that, in difficult cases, total correction is dangerous: on the contrary, our results are better and coincide with the experiences of Hendren. Although Bischoff did not live to see the results of this work, in retrospect, our results bear out his pioneering concepts and ideas.

Child

Value of a screening urinalysis in pregnancy.

In order to assess the value of a screening urinalysis in the detection of urinary tract infection, the results of routine urinalyses from 1,062 obstetric patients were compared to subsequent culture results. A positive urine culture was predicted by pyuria, bacteriuria and a positive nitrite test; the predictive values were 23%, 21% and 87%, respectively. If all the parameters were negative, 96% of the cultures were negative. These findings suggest that in the interest of cost effectiveness, the urine can be cultured only when the screening urinalysis shows pyuria, bacteriuria or a positive nitrite test.

Bacteriuria

Unsuspected urinary infection in general practice.

A SURVEY was undertaken to find the prevalence of asymptomatic bacteriuria in people in normal health who were patients of members of the North-west Faculty of the Royal College of General Practitioners. Midstream specimens were collected from 341 males and 456 females seen in visits to 19 practices in Lancashire and Cheshire. Three males and 45 females had > 10(5) bacteria/ml; three males and 26 females had > 50 pus cells/cu mm. Both significant bacteriuria and pyuria were found in three males and seven females. The percentage incidence varied in each practice from 0-24 per cent. About one third of the patients with significant bacteriuria or pyuria had urinary symptoms, but there were also 53 males and 104 females, who had urinary symptoms, whose urine was normal.The highest attendances were in those practices where the family doctor made the initial approach to the subjects.

Bacteriuria

[Double-blind comparison of cefotetan and cefmetazole in complex urinary tract infections].

For the purpose of carrying out an objective evaluation of the clinical efficacy and safety of cefotetan (CTT), a new cephamycin-type injectable antibiotic, in the treatment of complicated urinary tract infections, cefmetazole (CMZ) was employed as the control drug in a comparative study performed by the double-blind method. CTT was administered in a dose of 0.5 g or 1 g, while CMZ was used in a dose of 1 g; both of these drugs were administered by intravenous drip infusion twice a day for 5 days. The total number of treated cases was 393; 105 patients in the CTT 1 g group, 97 patients in the CTT 2 g group, and 96 patients in the CMZ 2 g group. The judgment of the clinical effects of these 3 therapeutic regimens was carried out in accordance with the criteria for evaluation of clinical efficacy of antimicrobial agents on UTI (2nd edition). The results are as follows. With regard to the overall efficacy of the drug treatments, the calculated efficacy rates were 54.3% in the CTT 1 g group, 63.9% in the CTT 2 g group and 52.1% in the CMZ 2 g group. The differences between these efficacy rates were not statistically significant. Regarding the efficacy of the treatments in terms of the bacteriuria, the bacterial cultures were seen to become negative in 40% of the cases in the CTT 1 g group, 54.6% of the CTT 2 g group and 42.7% of the CMZ 2 g group. Again, there were no statistically significant differences between the groups. Concerning the efficacy of the drugs against pyuria, by combining the cases found to be normalized and those seen to show improvement, the improvement rates were calculated to be 41.9% for the CTT 1 g group, 37.1% for the CTT 2 g group, and 37.5% for the CMZ 2 g group. These pyuria improvement rates show no statistically significant differences, respectively. The incidences of occurrence of side effects and laboratory test abnormalities thought to be caused by the drug therapy were as follows; 1.5% and 5.3% in the CTT 1 g group, 1.5% and 3.1% in the CTT 2 g group and 0% and 6.9% in the CMZ 2 g group. There were no significant differences between the groups. Based on the above clinical results, it can be concluded that, in the treatment of complicated urinary tract infections, we can expect CTT to provide the same therapeutic efficacy as CMZ when its dosage is the same or even half thereof. In addition, the safety of CTT is equal to that of CMZ. Therefore, CTT is concluded to be a useful drug.

Adolescent

[Comparative double-blind study of cefroxadine and cephalexin in the treatment of complicated urinary tract infection].

To evaluate the efficacy, safety, and utility of cefroxadine (CXD) for the treatment of complicated urinary tract infections, a double blind study comparing CXD with cephalexin (CEX) was carried out. Patient received either 1,500 mg/day of CXD 3 times a day, or 2,000 mg/day of CEX 4 times a day for 5 days by oral route, and the following results were obtained. Of the 305 patients, clinical efficacies were evaluated in 220 cases (CXD 105 cases, CEX 115 cases) except that excluded or dropped out. Side effect was evaluated in 301 cases (CXD 150 cases, CEX 151 cases). There was no statistically significant difference in the back ground characteristics between the 2 groups. Overall clinical assessment by the committee according to the "Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on Urinary Tract Infection" patients evaluated as better than "good" were 64 of 105 (61.0%) for CXD and 75 of 115 (65.2%) for CEX. The difference between the 2 groups was not statistically significant. In effect on pyuria, patients evaluated as better than "decreased" were 58 of 105 (55.2%) for CXD and 69 of 115 (60.0%) for CEX. The difference between the 2 groups was not statistically significant. In effect of bacteriuria, patients evaluated as better than "decreased" were 57 of 105 (54.3%) for CXD and 69 of 115 (60.0%) for CEX. The difference between the 2 groups was not statistically significant. Analyses were stratified according to classification by the type of infection, diagnosis, degree of pyuria before treatment, and bacterial count before treatment. There were no statistically significant differences between the 2 treatment groups as to any item. In evaluation by attending physician, patients evaluated as better than "good" were 81 of 140 (57.9%) for CXD, and 85 of 141 (60.3%) for CEX. Statistically significant difference was not observed between the 2 groups. In drug usefulness by attending physician, patients evaluated as better than "usefulness" were 106 of 140 (75.7%) for CXD, and 109 of 141 (77.3%) for CEX. The difference between the 2 groups was not statistically significant. In evaluation of the infections with sensitive species to both CXD and CEX by the committee according to "Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on Urinary Tract Infections, overall clinical efficacies were evaluated in 102 (CXD 48 cases, CEX 54 cases) which were infected with sensitive species. There was no statistically significant difference in the back ground characteristics between the 2 treatment groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult

[Clinical studies on recurrence of acute uncomplicated cystitis].

Recurrence rate and symptoms after chemotherapy against acute uncomplicated cystitis (AUC) were studied. Upon completion of a 7-day treatment with two regimens, one of CEX alone (Group C) and the other of a combination of CEX with Lysozyme (Neuzym) (Group L), at a dose of 1 g CEX daily, efficacy of the drugs was assessed according to the criteria established by the UTI Study Group. The forty one cases in Group C and 38 cases in Group L showing an excellent response were evaluated for recurrence. The rates of recurrence were 12.2% in Group C and 21.1% in Group L during the first 7 days after treatment. In recurrent cases, bacteriuria was seen in 84.6% (11/13), pyuria in 53.8% (7/13) and miction pain in 30.8% (4/13). Thus, bacteriuria and pyuria should be the items of the criteria for AUC recurrence.

Acute Disease

[A study on non-sterile intermittent self-catheterization for voiding dysfunction following radical uterine or rectal carcinoma surgery].

To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.

Adult

Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome.

In an assessment of the possible etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in the acute urethral syndrome (AUS) in women, 79 women with AUS, 35 women with acute bacterial cystitis, and 66 asymptomatic volunteers were studied. Evidence against an etiologic role for M. hominis in AUS included: (1) a similar prevalence of the organism among women with AUS (18%), women with cystitis (29%), and asymptomatic women (15%); (2) a lack of association of M. hominis with AUS cases for which no other infectious cause was found; (3) a lack of association of pyuria with cases of infection in which M. hominis was isolated; and (4) an absence of M. hominis from cultures of bladder urine obtained by suprapubic aspiration. A possible etiologic role for U. urealyticum in some cases of AUS was suggested by the association of counts of this organism of greater than or equal to 10(3)/ml with pyuria in women whose AUS had no other apparent etiology and by the isolation of the organism from suprapubic aspirates from four of 15 women with AUS of unknown etiology. Further studies, similar to those done in men with nongonococcal urethritis, are necessary for confirmation of the causative role of U. urealyticum in AUS.

Acute Disease

Chlamydia trachomatis in cervicitis and urethritis in women.

In the Scandinavian countries today, Chlamydia trachomatis seems to be the most important cause of sexually transmitted diseases. Although C. trachomatis is most prevalent in symptomatic women and in persons visiting venereal disease clinics, the asymptomatic carrier rate, particularly in young women, appears to be surprisingly high. In addition to young age and level of sexual activity, the use of oral contraceptives and the presence of cervical ectopy are important risk factors for chlamydial infection. Chlamydial cervicitis often is characterized by a hypertrophic follicular appearance, with severe edema, erythema, friability, and endocervical mucopurulent discharge. On colposcopy, an atypical transformation zone is frequently observed. Papanicolaou smears taken from C. trachomatis culture-positive patients often reveal benign atypias and dyskaryotic changes. C. trachomatis, therefore, being a venereally transmitted intracellular organism, may well play a role in the development of cervical intraepithelial neoplasia (CIN). Future studies on patients with cytological atypias, therefore, also should include tests for C. trachomatis. Prospective studies are needed to determine the natural history and outcome of C. trachomatis-associated atypias and their behavior after adequate therapy. A large proportion of C. trachomatis-infected women also are culture-positive from the urethra. The demonstration that C. trachomatis is a common causative agent of acute urethral syndrome (also called abacterial urethritis, dysuria-pyuria syndrome) in women has been a valuable contribution. The diagnosis of pyuria in a patient with abacterial dysuria is of critical importance, since it suggests a chlamydial etiology and thus is a potentially treatable condition.

Adolescent