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PubMed1983

Localized amyloid of the ureter--case report and review of the literature.

An unusual case of localized amyloidosis of the ureter is described and a review of the 12 previously reported cases is presented. No case had been diagnosed prior to surgery. Loin pain, with or without haematuria, associated with a sterile pyuria and an abnormal pyelogram were the commonest clinical signs. In the case reported an incidental small renal cell carcinoma was also present and the association of amyloidosis and neoplasia is discussed.

Adenocarcinoma↗
PubMed1980

Interstitial deletion of the long arm of chromosome 1, del(1)(q21 leads to q25) in a profoundly retarded 8-year-old girl with multiple anomalies.

An 8-year-old revealed the karyotype 46,XX,del(1)(q21 leads to q25). Both parents had normal chromosomes. The patient showed the following findings: underweight at birth, severe growth deficiency (at 7 9/12 years, length, weight and head circumference were at the levels of 24, 18 and 6 months, respectively), delayed bone age; bilateral cleft lip and cleft palate; a pattern of facial dysmorphic stigmata including a short, bulbous nose, exotropia, anisocoria, absence of some teeth, poorly modeled auricles; very small hands and feet with short fingers and toes, and broad thumbs and big toes exhibiting dysplastic, hyperconvex nails; in radiographs multiple phalangeal cone-shaped epiphyses, bifid terminal phalanges of the thumbs and half-moon shaped terminal phalanges of the big toes and absence of the 12th ribs. The patient suffered from seizures and from recurrent otitis and pyuria. Motor and mental development were profoundly delayed: at 8 years she was unable to sit up, had no speech and barely responded to her environment. As the proband and her parents were Fya/Fyb, location of the Duffy locus on segment 1q22 leads to 1q24 can be excluded.

Abnormalities, Multiple↗
PubMed2005

Diagnosing symptomatic urinary tract infections in infants by catheter urine culture.

BACKGROUND: Diagnosing infantile urinary tract infection (UTI) is difficult due to contamination during urine collection. Catheterization is convenient but diagnostic criteria (colony-forming units per millilitre (CFU/mL)) is controversial, especially in uncircumcised males. OBJECTIVES: To study the value of catheter urine cultures in terms of likelihood ratios (LRs), sensitivity, specificity, positive and negative predictive values of different CFU/mL in uncircumcised boys and girls. METHODS: Infants aged 1-18 months who had catheter urine cultures from July 1999 to June 2002 were reviewed to decide if they had symptomatic UTI (group A) or not (group B). Urinary tract infection was confirmed if patients had a positive urine culture plus acute fever, pyuria, positive leucocyte esterase and nitrite tests and good response to antibiotics, with pyelonephritic evidence on early dimercaptosuccinic acid (DMSA) scans in doubtful cases. Group B included infants with negative urine culture results, and those with positive results but were asymptomatic and admitted for micturating cystourethrogram. RESULTS: Nine hundred and fifty-two patients were studied (492 boys, 460 girls; 212 in group A, 740 in group B). No single cut-off CFU/mL has high sensitivity and specificity to simultaneously diagnose and exclude UTI. The CFU counts of 100-10(3), 10(3)-10(4), 10(4)-10(5) and >10(5) were associated with LRs of 0.11, 0.45, 1.52 and 20.5, respectively in uncircumcised boys, and with LRs of 1.39, 2.49, 8.95 and 18.8, respectively in girls. The LR for mixed growths was 0.21. CONCLUSION: Unlike suprapubic tap urine, catheter urine culture has to be interpreted against the clinical context or pretest probability and in terms of probability. In the scenario of a febrile infant where the pretest probability of UTI was about 5%, UTI was highly likely if counts exceeded 10(5)/mL, and unlikely if counts were below 10(4)/mL in uncircumcised boys. In female infants, UTI was highly likely if counts were >10(4) CFU/mL, but lower counts could not exclude UTI.

Catheterization↗
PubMed1984

Renal actinomycosis associated with a duodenorenal fistula caused by foreign body.

We are reporting a case of a rare renal actinomycosis in a 12-year-old mentally-retarded girl. Proteinuria and hemopyuria were pointed out one year before the operation by an annual medical check-up and IVP subsequently performed showed foreign bodies at the upper pole of the right kidney. The patient continued to have pyuria and right nephrectomy was performed. There was a fistula between the duodenum and the upper portion of the right kidney. Foreign bodies (two bobby pins) were found in the kidney. Subsequent pathologic examination of the resected kidney revealed an actinomycotic lesion.

Actinomycosis↗
PubMed1995

Assessment of sextant biopsy of the prostate for detecting cancer prior to therapy in patients clinically diagnosed as benign prostatic hyperplasia.

Pathological results and perioperative morbidity were compared in 199 patients who had undergone prostatectomy and/or biopsy in order to determine the extent to which systematic biopsy is effective for detecting prostate cancer prior to therapy in patients clinically diagnosed as having benign prostatic hyperplasia. Seventeen (8.5%) cancers were detected in 199 patients following surgery and/or biopsy. Digitally-guided biopsy as a means of detecting prostate cancer was found to be just as effective as ultrasound-guided biopsy. Seven (12.5%) cancers were detected in 56 patients who had undergone biopsy and transurethral resection. Preprostatectomy biopsy detected only two of three patients with stage T1b disease. All four stage T1a and one stage T1b failed to be diagnosed. Of 90 patients who had biopsy prior to surgery other than TURP, seven (7.8%) cancers were found. Four of these were advanced. The incidence of postoperative fever > 38.0 degrees C and duration of postoperative pyuria did not differ significantly between groups with or without biopsy. Preoperative biopsy did not contribute to perioperative morbidity. Tumors detected by systematic biopsy are usually large and clinically significant. Positive biopsy results are often diagnostic, but the pathological features of a tumor together with clinical parameters should be considered to reduce the chance of overdiagnosing an insignificant tumor. Sextant biopsy would be most applicable to patients scheduled for any type of therapy other than TURP especially in those with markedly elevated serum PSA levels. This procedure may be beneficial particularly for younger patients with long life expectancy who will benefit from definitive therapy.

Aged↗
PubMed1995

Plasma endotoxin concentrations in patients with urinary tract infections.

BACKGROUND: Although endotoxin elicits a variety of pathophysiological activities in hosts with gram-negative bacterial infections, the clinical significance of plasma endotoxin levels have not been clearly defined in the patients with urinary tract infections. The purpose of the study was to measure plasma endotoxin concentrations in relation to the types of urinary tract infections and to examine their correlation with inflammatory parameters. METHODS: Using chromogenic Limulus-amebocyte lysate assay, plasma endotoxin concentrations were measured in a total of 63 patients with various types of nonspecific urinary tract infections. RESULTS: The mean plasma endotoxin concentrations in patients with sterile pyuria, chronic complicated cystitis, acute uncomplicated pyelonephritis or acute exacerbation of chronic complicated pyelonephritis, chronic complicated pyelonephritis, and acute bacterial prostatitis or epididymitis were significantly higher than those in healthy individuals and in patients with acute uncomplicated cystitis. The correlation coefficients between plasma endotoxin concentrations and body temperatures, white blood cell counts in peripheral blood, erythrocyte sedimentation rates, and C-reactive proteins were 0.678 (P < 0.01), 0.503 (P < 0.01), and 0.330 (P < 0.01), respectively. CONCLUSIONS: Patients with urinary tract infections may respond to endotoxin locally and generally depending on the sites of infection involved. However, endotoxin levels do not always correlate to clinical findings or inflammatory parameters.

Biomarkers↗
PubMed2004

Squamous cell carcinoma in the renal pelvis of a horseshoe kidney.

We report a rare case of squamous cell carcinoma in the renal pelvis of a horseshoe kidney. An 80-year-old woman was referred to the National Nagano Hospital for the examination of occult blood in her urine. Microscopic hematuria was found, but pyuria was not seen. Computed tomography and magnetic resonance imaging showed a mass in the left renal pelvis of the horseshoe kidney. No renal stone or hydronephrosis was found. Cytopathological examination in the voided urine specimen was positive. Left nephroureterectomy with the splitting of the isthmus of the horseshoe kidney was performed without renal pedicle clamping using a microwave tissue coagulator. No bleeding was encountered after separating the isthmus. A final pathological diagnosis of squamous cell carcinoma with a tumor thrombus was made. Lymph node metastasis had developed and rapidly progressed and the patient died of disseminated malignancy 4 months after the operation. We reviewed 24 cases of renal pelvic tumor in horseshoe kidneys previously reported in Japan. Seven cases (30%) included components of squamous cell carcinoma. The incidence is higher than that of renal pelvic tumors in the general population.

Aged↗
PubMed2006

Xanthogranulomatous pyelonephritis: our experience with review of published reports.

BACKGROUND: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. METHODS: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. RESULTS: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice.

Adolescent↗
PubMed1988

Genito-urinary complications of brucellosis.

Twelve cases of genito-urinary complications of brucellosis are presented. Ten patients had epididymo-orchitis, 1 presented with right hydronephrosis and 1 with haematuria and dysuria. The 10 cases of epididymo-orchitis were compared with 15 cases of acute non-specific epididymo-orchitis. The former were of longer duration and were not associated with lower urinary tract symptoms; almost all of these patients had ingested unpasteurised milk. Non-specific epididymo-orchitis had a more acute onset, shorter duration and was associated more frequently with pyuria, lower urinary tract symptoms, higher leucocyte counts and insignificant brucella titres. The distinction between these two types of epididymo-orchitis is essential, since the treatments are entirely different.

Adolescent↗
PubMed1989

Tuberculous epididymo-orchitis: clinical and ultrasound observations.

The clinical, radiological and ultrasound features of 3 patients presenting with tuberculous epididymo-orchitis are described and the relevant literature reviewed. Scrotal swelling, pain and sinuses are common features at presentation. The presence of a sterile pyuria is a useful sign, but intravenous urography may fail to identify active renal disease. Ultrasound examination revealed testicular involvement in 2 patients. Differentiation from tumour may not be possible, but the presence of epididymal involvement strongly suggests an infective cause. Early surgical biopsy may prove helpful if acid-fast bacilli are not initially identified in early morning urine samples.

Adult↗
PubMed1990

Histopathological effects and recovery rate of rat bladders following intravesical instillation of thiotepa, doxorubicin and mitomycin C.

A study was made of the local reactions and systemic effects induced by intravesical instillations of thiotepa, doxorubicin and mitomycin C in rats. The control group received normal saline. In the 1-dose short-term experiments, rats treated with doxorubicin and mitomycin C had a high incidence of chemical reactions, including congestion of the mucosa with methylene blue stain, increased bladder weight with oedematous changes either in the mucosa (doxorubian) or the muscle layer (mitomycin C), and infiltration of polymorphonuclear cells 3 days after instillation. These local changes disappeared within 10 days. In long-term experiments with weekly instillations of chemotherapeutic drugs, the rats showed no significant change in weight, methylene blue staining or mucosal congestion. A high percentage of pyuria and microscopic haematuria with submucosal/muscular fibrosis was noted in rats receiving doxorubicin or mitomycin C. A severe dysplastic change in the urothelium was noted in rats treated with mitomycin C. These results suggest that careful follow-up is required in patients receiving intravesical doxorubicin or mitomycin C because of possible severe side effects in the bladder.

Administration, Intravesical↗
PubMed1992

Screening for bacteriuria in urological patients using reagent strips.

A rapid and accurate ward-based method of diagnosing urinary infection would be of value in determining the prescription of antibiotics in pre-operative urological patients. This study describes the sensitivity and specificity of a screening technique based on commercially available reagent strips in the diagnosis of urinary infection. A total of 222 pre-operative samples and 83 post-operative samples was studied to compare the results of formal urine culture and reagent strips. Using a definition of a positive nitrite or a positive leucocyte esterase on the reagent strips as being suggestive of infection, it was found that the strips had a sensitivity of 91% and a specificity of 85% compared with formal culture in pre-operative samples. The results from post-operative samples were less satisfactory, the strips having a sensitivity of only 71% and specificity of 55%. The strips were insensitive but specific in the identification of pyuria in pre-operative specimens. These results suggest that reagent strips can be used as a ward-based method to identify men at risk of infection before urological procedures, and may allow selectivity in the use of peri-operative antibiotics.

Adolescent↗
PubMed1985

Bacteriuria in pregnancy.

In a racially mixed community in Gisborne, New Zealand, the prevalence of asymptomatic (covert) bacteriuria of pregnancy was 9.6%. The prevalence in Maori women was 17.1% and in non-Maori women 4.7%. There was a higher prevalence of bacteriuria in the younger women. Escherichia coli was the infecting organism in 58 of the 72 women with bacteriuria. Twenty-five (44%) of the E. coli were resistant to ampicillin and amoxycillin. Fifty-eight (81%) of the women with bacteriuria also had pyuria. In 37 of the 44 women (84%) who received antimicrobial therapy, the infection was cured. Single dose therapy was just as effective as a course of treatment. In 14 of the 28 untreated women, the infection cleared spontaneously. Four of the 28 (14%) patients in the untreated bacteriuric group developed acute pyelonephritis. More patients with bacteriuria had anaemia and a low fetal birth-weight.

Adolescent↗
PubMed2004

All dysuria is local. A cost-effectiveness model for designing site-specific management algorithms.

OBJECTIVE: To determine the cost-effectiveness of management strategies for dysuria in different office settings. DESIGN: Decision and cost-effectiveness analyses, assuming the payer's perspective. Data on disease prevalence, test characteristics, treatment efficacy, and adverse effects were drawn from the English language literature using medline searches and bibliographies. SETTING: Hypothetical primary care practice. PATIENTS: Otherwise healthy, nonpregnant women with symptoms of dysuria, urgency, and frequency. INTERVENTIONS: All reasonable combinations of urinalysis, urine culture, pelvic examination, chlamydia and gonorrhea cultures, and empiric treatment with trimethoprim-sulfamethoxazole. RESULTS: The cost-effectiveness of strategies varied substantially among different patient settings. In all settings, empiric trimethoprim-sulfamethoxazole for all patients was least expensive and least effective. Most testing increased both cost and effectiveness. Compared to empiric antibiotics, performing pelvic examination and urine culture for women with normal urinalyses had a marginal cost-effectiveness ratio of $4 to $32 per symptom-day avoided (SDA). Adding urine culture for patients with pyuria had a marginal cost of $34 to $107 per SDA, which fell to $40/SDA when the prevalence of resistance to trimethoprim-sulfamethoxazole exceeded 40%. Pelvic examination and urine culture for all patients regardless of urinalysis results achieved the greatest benefit but at the highest cost (>$300 per SDA). CONCLUSIONS: In otherwise healthy women with symptoms of dysuria and no vaginal complaints, performing pelvic exam and urine culture based on urinalysis offers a reasonable alternative to empiric therapy. Other testing may be warranted, depending on antibiotic resistance and the value of avoiding a day of dysuria.

Acute Disease↗
PubMed2001

Acute interstitial nephritis due to omeprazole.

Omeprazole is a proton pump inhibitor that is used commonly in the treatment of acid-peptic disorders. Although omeprazole is generally well tolerated, serious adverse effects such as renal failure have been reported. Thus far, 17 cases of acute interstitial nephritis (AIN) secondary to omeprazole have been described. Another case of AIN is described in a 36-yr-old woman presenting with nausea, vomiting, weight loss, and a rising serum creatinine concentration. Omeprazole therapy had ceased 2 wk before admission. AIN was diagnosed by renal biopsy and corticosteroid therapy was initiated. After 4 wk of therapy the serum creatinine concentration had normalized. Among the reported cases in the literature, AIN was diagnosed after an average of 2.7 months of therapy with 20-40 mg of omeprazole daily. Recurrence was universal on rechallenge. Common symptoms included fatigue, fever, anorexia, and nausea. The classic triad of fever, rash, and eosinophilia was uncommon. Typical laboratory features included hematuria, proteinuria, pyuria, eosinophilia, and anemia. Management consisted of withdrawal of omeprazole and corticosteroid therapy in some patients. All but one patient recovered normal renal function. Corticosteroid therapy was well tolerated and may have been beneficial.

Acute Disease↗
PubMed1975

The sex variable in childhood urinary-tract infection.

Sex differences in childhood urinary-tract infection have been looked for by reviewing the medical records of all patients who were admitted to one medical centre during a certain time period. There were 240 patients; 26 males and 214 females, all under 14 years of age. The disease in boys-as compared with that in girls-was found to be characterized by an earlier onset, a shorter delay in diagnosis, and a shorter duration; but a higher frequency of malformations, a greater number of rehospitalizations, and a greater need for surgical intervention. Proteus infection was found more frequently in boys, while Enterococcus and Staphylococcus were more frequent in girls. The initial symptomatology did not show any significant sex difference except in late childhood where the non-specific symptoms were more common in females. No sex difference was noted with respect to the frequency of vesico-ureteric reflux or of bacteriuria without pyuria. It seems that the sex variable in this disease is worth considering in dealing with individual patients as well as in presenting data on a series of patients.

Adolescent↗
PubMed1989

Urinary lactic dehydrogenase isoenzyme analysis in children with spinal lesions.

In 48 children with spinal lesions and micturition problems urinary lactic dehydrogenase (LDH) isoenzymes were analyzed. They had higher total LDH activities (716.8 +/- 1,050.2 nkat/I), isoenzymes V percents (22.2 +/- 13.0%) and isoenzyme V activities (203.4 +/- 308.4 nkat/I) than those of healthy children (150.0 +/- 83.4 nkat/I, 1.9 +/- 1.0%, 5.0 +/- 3.3 nkat/I). Many subjects had an isoenzyme V-dominant LDH isoenzyme pattern. Among 48 subjects the patients with pyuria, bacteriuria or abnormal pyelograms had markedly high total LDH activities, isoenzyme V percents and isoenzyme V activities. The rise in LDH isoenzyme V levels may reflect the renal damage in the patients with neurogenic bladders.

Adolescent↗
PubMed1989

Aerococcus-like organism--an unnoticed urinary tract pathogen.

Aerococci are only occasionally isolated from urinary tract specimens. A 4-month' survey revealed 29 patients suspected of urinary tract infection (UTI), from whom an Aerococcus-like organism (ALO) was isolated in significant numbers from urinary tract specimens and singly in 11 cases. Approximately 0.8% of all urinary tract specimens examined during the period yielded growth of ALO. The median age of patients was 75 years. Half of the patients were found to have conditions predisposing to UTI. 9 of 11 patients without indwelling catheter, having ALO isolated in pure culture from the urine, showed one or more typical signs of UTI (fever, dysuria and/or pollakisuria and pyuria). A phenotypic comparison was made between 29 strains of ALO and 6 related organisms, including Aerococcus viridans, Streptococcus faecium, Streptococcus sanguis, Streptococcus bovis, Streptococcus Group Q and Streptococcus Group R. ALO and A. viridans showed many similarities, but, owing to characteristic differences with regard to colony morphology, biochemical reactions and antibiotic susceptibility pattern, the strains were easily separated.

Catheterization↗