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PubMed1989

[Bladder carcinoma in situ which harbored human papilloma virus. A case report].

Last year, we reported that human papilloma virus type 16 genome (HPV 16 genome) was detected in a case (S.Y.) of bladder carcinoma in situ (bladder CIS) (Cancer Res., 1988). Since then, a number of bladder tumors other than CIS were searched for HPV genome. However, no HPV genome was detected in the bladder tumors. From the results, we consider that HPV may not have a relation with all types of bladder tumor but with only a part of it. In the current report, the case (S.Y.) is presented more precisely than before, in particular on the characteristic bladder lesion. The patient was a 40-year-old female with immunodeficiency and anemia who was referred from a hospital with a complaint of asymptomatic pyuria. Cystoscopic examination revealed a bladder tumor, well-demarcated, white and velvety lesion with slight elevation. On November 25, 1987, she underwent total cystectomy, resection of the anterior vaginal wall and of a part of vulval skin, and ileal conduit formation. Postoperative course was stormy because of bleeding from the wounds and thrombophlebitis in the right femoral vein. In spite of the episodes, she eventually recovered and was discharged 2 months later. However she was readmitted 9 months later due to severe anemia which was ascribed to acute myelogenous leukemia. She is now on cancer chemotherapy for leukemia.

Adult↗
PubMed1989

[Investigation of factors affecting the progression of polycystic kidney disease and effects of percutaneous reduction of cystic size].

Factors affecting the progression of autosomal dominant adult type polycystic kidney disease were analysed in 27 cases. The patients ages ranged from 10 to 74 (mean 44) years old and the serum creatinine values were within the normal limits except two cases, in which the values were 2.4 mg/dl and 2.1. They were followed for from 2 years to 12 years (mean 5.6 years). During the followup period, 6 cases showed elevation of the serum creatinine values and hemodialysis was necessary in 4 cases. There was a tendency of higher morbidity rate of hypertension, proteinuria, hematuria and pyuria in the cases with decreased renal function. These factors may have participated in the progression of polycystic kidney disease. Cystic fluid analysis was performed by percutaneous puncture of more than hundred cysts in 27 cases. The results showed that the cystic fluid components of most cysts of the well functioning kidneys were similar to those of serum values: so-called proximal cysts. On the other hand, in the cases with decreased renal function, there were many cysts with lower sodium concentration and higher creatinine values: so-called distal cysts. The results suggest that the existence of so-called distal cysts may indicate poorer prognosis. DMSA renoscintigraphy was useful for followup polycystic kidney patients because of the uptake of the radionuclide was decreased before rising the serum creatinine value. In 6 cases, the cysts were instilled with 95% ethanol. Followup ultrasonography and DMSA renoscintigraphy revealed a marked reduction of the cystic size and an improvement of DMSA uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[The clinical efficacy of outpatient extracorporeal shock wave lithotripsy].

From March 1989 through December 1989, 123 patients, 9 to 78 years old, were treated by extracorporeal shock wave lithotripsy (ESWL) with the Wolf Piezolith device. Outpatient treatment was performed routinely. Anesthesia was not required in all of the patients. No analgesia or sedation was given routinely. When pyuria had been found before treatment, a course of prophylactic oral antibiotics was given. Treatment consisted of 2000 to 6000 shocks in adults. The need for re-treatment was decided on the basis of the follow up X-rays. Fragmentation into particles 5 mm in size or less occurred in 144 of the 149 renoureteral units (96.6%). Unfragmented stones were treated successfully by the combination therapy of ESWL and fiberoptic transurethral nephroureterolithotripsy (f-TUL). Of 144 renoureteral units, 3-month follow-up data are available for 96. Among the 96 units, the rate of being free of stones was 67 per cent for renal stones and 96 per cent for ureteral stones treated in situ. The over-all rate of being free of stones was 80.2 per cent. There were no significant complications. Ultrasound imaging has proved to be as effective as X-ray imaging. Outpatient ESWL with the Wolf Piezolith device is considered to be safe and efficient for the initial treatment of urinary stones. On the other hand, ESWL monotherapy is not sufficient for the treatment of complete staghorn calculi or long-term impacted ureteral calculi. We think that the combination use of ESWL and f-TUL is the most effective procedure for treatment of complicated stones.

Adolescent↗
PubMed1990

[Clinical studies on thirty-two cases of childhood urolithiasis].

We evaluated 32 patients with urinary calculi under 16 years of age over the past 14 years since the founding of the Department of Urology, Kinki University School of Medicine. They comprised 0.8% of the total urolithiasis patients. They consisted of 18 boys and 14 girls with a male-to-female ratio of 1.29. The average age was 8.7 years for boys and 10.4 years for girls without any marked peak. The most frequently chief complaint was hematuria which was present in 15 cases (47%). Although pyuria was seen in seven cases (22%), urinary bacterial culture was positive only in 5. The underlying diseases could be diagnosed in 13 cases (41%), of which eight cases (62%) developed metabolic disorder. The sites of calculi were determined in 29 cases (91%), of which 28 had stones in the upper urinary tract. Surgical treatment was performed on 16 cases in 17 sessions. Ureterolithotomy was done in as many as five cases, followed by pyeloplasty in four cases. Nephrectomy was performed in only one case. There was only one case which had been treated with extracorporeal shock-wave lithotripsy (ESWL). The composition of calculi was found in 21 cases (66%), the majority or 13 cases (57%) of which had calcium-containing stones. Nevertheless, there was no case of hypercalciuria. When compared to the previous reports in Japan, it was worthy of note that calculi in the upper urinary tract and calcium-containing stones had higher incidences. It is expected that more patients will be treated with ESWL in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Clinical studies on medullary sponge kidney evaluated from urolithiasis].

Thirty eight patients with medullary sponge kidney (MSK) were detected (4.3%) in 881 patients with urolithiasis diagnosed by drip infusion pyelography in 12 years from January 1974 to December 1985. Those with MSK were studied clinically and as to metabolism of urolithiasis. The results obtained were as follows: 1) Age distribution of the patients with MSK was the same as that of general stone formers. 2) Hematuria was observed in 20 patients (52.6%) and pyuria in 7, in whom 4 were positive by urine culture (E. coli in 3 and P. mirabilis in 1) and 2 of them had infective stones. 3) Renal function of the patients examined by PSP test (20 patients) and creatinine clearance test (21 patients) was normal in all of the patients but three with ureteral caliculi. Concentration tests performed by Fishberg method (12 patients) were disturbed in half of them. 4) Affected lesions wer detected at more than three pyramides in each kidney and the bilaterals were found in 32 patients (84.2%) and at less than two pyramides in each kidney and the unilateral or the bilaterals were shown in the other 6. 5) When urinary levels of calcium, phosphate, uric acid and citrate using 24 hours urine were compared with 37 patients with MSK and 100 general stone formers, there was no difference in hypercalciuria and hyperuricosuria accounting for the frequency of the patients with MSK and the general stone formers, but there was a tendency of increased frequency about hyperphosphaturia and hypocitraturia in the patients with MSK.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Gram-positive cocci in the urinary tract. Do they influence the postoperative course of transurethral prostatectomy?].

The influence of gram-positive cocci on the postoperative course of transurethral prostatectomy was analysed on 463 patients. The half of isolated cocci was Enterococcus, followed by S. epidermidis and S. aureus. The rates of postoperative urinary infection by gram-negative bacilli were nearly the same for patients with preoperative gram-positive cocci infection and those without any of bacteria (3/79 vs. 9/310). Patients who developed new infection with gram-negative bacilli had fever, in contrast to patients with new gram-positive cocci infection. Gram-positive cocci prolonged the postoperative pyuria but not so long as gram-negative bacilli. All these findings suggest that infection caused by gram-positive cocci is not so severe as that caused by gram-negative bacilli.

Enterococcus↗
PubMed1992

[Vesical ultrasonography and internal examination of female patients with urethral syndrome].

Transabdominal ultrasonography of the bladder and internal examination were performed in 80 female patients without pyuria. They were divided into 3 groups: urethral syndrome with trigonitis (49 cases), asymptomatic trigonitis (16 cases) and normal bladder (15 cases) by cystoscopy. Ultrasonography of trigonitis with or without symptoms showed focal dilation of the submucosal low echo zone and mucosal irregularity around the bladder neck. On the sagittal view, the thicknesses from the surface of mucosa to that of muscle layer within 2 cm from the bladder neck were 4 +/- 1 mm (mean +/- standard deviation) in the group with urethral syndrome and in that with asymptomatic trigonitis, and 3 +/- 1 mm in the normal bladder group. Mucosa of the trigonitis with or without symptom is patients with significantly thicker than that of those with normal bladder (p less than 0.01). On internal examination, tenderness at the upper frontal wall of the vagina was present in 10 of 11 cases (91%) with urethral syndrome, in 2 of 8 cases (25%) with asymptomatic trigonitis and in one of 9 cases (11%) with normal bladder. There was a significant difference (p less than 0.005) between the degree of inflammation and the number of cases with tenderness at the frontal wall of the vagina. From these results, transabdominal ultrasonographic measurement of mucosal thickness around the bladder neck and internal examination for tenderness at the frontal wall of vagina are thought to be useful methods for diagnosis and follow-up of urethral syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Drug induced cystitis due to ketotifen fumarate--a case report].

Tranilast, an antiallergic drug, is well known as a causal drug of cystitis, and a report is made here of our experience of 1 case of drug-induced cystitis ascribable to ketotifen fumarate. A 13-year-old female had been taking anti-asthmatic drugs orally since the onset of athmatoid attacks, from age of 5. The attacks intensified from the age of 12, because of this she began to take various anti-asthmatic drugs orally. She visited another hospital, due to pollakisuria, in November, 1990, and received treatment for cystitis. However, the symptoms were not alleviated, and she visited our department on January 9, 1991. By urinalysis, large counts of leukocytes and erythrocytes were observed in a visual field of the sediment. Remarkable reddening was observed over the urinary bladder in the patient's cystoscopic findings. Treatment was given at our department, on an outpatient basis, with various antibacterial drugs for approximately one month, but her symptoms were not alleviated, pollakisuria and aseptic pyuria persisted. The patient had never taken tranilast; oral intake of ketotifen fumarate and saibokutou was discontinued on February 13, due to a suspicion of drug-induced cystitis, and her symptoms subsequently disappeared. On February 22, she took ketotifen fumarate orally again, on her own, due to asthmatoid attack, and her symptoms returned. The oral intake of ketotifen fumarate was again discontinued, and alleviation of the symptoms and normalization of the urinary findings were again observed. As a result, lymphocyte stimulation tests on all the drugs the patient had ever taken, only ketotifen fumarate turned out to be positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Clinical experience of local thermotherapy in the treatment of benign prostatic hyperplasia].

Thirty-five patients with benign prostatic hyperplasia (age range: 45-88 years; average: 67.5 years) underwent local thermotherapy with prostathermer. Clinical therapeutic effect was evaluated in 30 of the 35 patients: 2 patients interrupting from therapy and 3 receiving pretherapeutic indwelling catheters were not included. A total of 6 treatments (2 per week) were performed, each lasting for 60 minutes. As for subjective improvement, improvement of nocturia was noted in 70.0% of all patients and sense of residual urine in 70.7%. Post-therapeutic nocturnal and daytime decreases in urination frequency were statistically significant (p less than 0.01). Objective improvement in residual urine volume occurred in 19 of the 30 cases, and elevation in uroflowmetric maximal flow rate following therapy was statistically significant (p less than 0.05). Among complications ascribable to catheter insertion were urethral bleeding (3 cases), epididymitis (1 case) and pyuria (1 case). Therapeutic result based primarily on subjective symptoms and partly on objective findings was fairly good in 17 cases (about 57%), and slightly good in 25 cases (about 83%). In conclusion, this therapy seems to be useful in the treatment of benign prostatic hyperplasia.

Aged↗
PubMed1993

[A study of methicillin-resistant Staphylococcus aureus (MRSA) infection in urological field].

Out of 110 strains of Staphylococcus aureus isolated from 1985 to 1990, isolation rate of methicillin-resistant S. aureus (MRSA) was investigated. Nineteen strains of 59 S. aureus from outpatients and 20 strains of 51 S. aureus from inpatients were determined as MRSA. Isolation frequency of MRSA from inpatients was increasing in the recent two years. Coagulase type, enterotoxin type and production of toxic shock syndrome toxin-1 (TSST-1) were examined in 22 strains of MRSA. Coagulase type II (86%), enterotoxin type C (68%) and TSST-1 positive strain was most dominant. Susceptibility of MRSA to 4 antimicrobial agents were measured, MRSA were sensitive to vancomycin (VCM), arbekacin (ABK) and minocycline, but resistant to flomoxef. Thirty-four patients from whom MRSA was isolated including 20 patients from urine, 13 from pus and 1 from blood, were analyzed clinically. Pyuria was not recognized in some cases in whom MRSA was isolated from their urine. Concomitant polymicrobial infection was frequently noted in those patients with MRSA in their urinary tract. These facts show that the pathogenic role of MRSA in the urinary tract infection was not significant. On the other hand, when MRSA was isolated from pus or blood, serious infections could be caused by MRSA, especially in compromised host. Regarding the treatment in these cases, administration of VCM or ABK was though to be necessary.

Aminoglycosides↗
PubMed1994

[Clinical study of bladder replacement--multilateral evaluation of the neobladder in patients with colon bladder replacement].

Following radical cystoprostatectomy, 32 male patients with bladder cancers underwent total bladder replacement using the detubularized right colonic or ileocolonic segment. Early postoperative complications related to the urinary reservoir occurred in 10 patients, in one of these patients, an additional other urinary diversion was required. In follow-up study with excretory urography, no upper urinary tract obstruction was detected, other than in one patient with unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphic studies detected no reflux into the upper urinary tract in any patients. Renal function, serum electrolytes and arterial blood pH were all within normal limits during the follow-up period (6-68 months). All patients were able to void well, except one who was performing intermittent self-catheterization. Of the 23 patients, day and night continence was preserved in 73.9% (17/23). Urodynamic evaluation showed the neobladder to be a low-pressure reservoir with a capacity of 300 ml or greater. Mean maximum flow rate was 15.3 ml/sec. Maximum urethral closure pressure was almost normal (mean, 62.8 cmH2O) in 12 patients. The incidences of pyuria and bacteriuria were 17.4% and 8.7%, respectively. We evaluated the postoperative life in 21 patients by scoring its condition. The scores concerning working condition and sexual life postoperatively reduced to 59.9%, and 39.2%, respectively. 14.3% of patients suffered insomnia. Other postoperative scores were not significantly different from those obtained preoperatively. These findings demonstrated that Colon Bladder Replacement is in appropriate patients an acceptable form of urinary diversion following radical cystoprostatectomy.

Adult↗
PubMed1998

[Antimicrobial prophylaxis in transurethral resection of the prostate].

OBJECTIVE: A prospective trial was performed to propose a suitable antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate (TUR-P). SUBJECTS AND METHODS: Patients who underwent TUR-P due to symptomatic prostatic hyperplasia between April 1995 and February 1996 were included. Based on the results of urinalysis obtained within preoperative 3 days, the patients were classified into Group I (less than 5 WBC/hpf and bacterial count of less than 10(4) CFU/ml in urine specimen), and Group II (5 or more WBC/hpf or bacterial count of 10(4) or more CFU/ml in urine specimen). Furthermore, each group was randomly subdivided into Group A and Group B according to the period of antimicrobial administration. As prophylactic antimicrobials, cefazolin (CEZ) was used in Group I and CEZ or cefotiam (CTM) in Group II. The antimicrobial was administered only on the day of operation in Group IA (n = 92), for 3 days in Group IB (n = 96), 2 days in Group IIA (n = 37), and 4 days in Group IIB (n = 30). On the day of operation, the antimicrobial was infused immediately before the operation. The presence or absence of pyuria, bacteriuria and febrile infection, and the period required for normalization of the urinalysis were the major points evaluated here. RESULTS: No significant differences were observed in any parameters with respect to the period of administration of antimicrobial between the groups, but in both Group I and Group II, the incidence of febrile infection was higher in the groups with shorter antimicrobial administration periods. The mean period for normalization of the urinalysis required 68.4, 68.6, 65.2 and 58.2 days in Group IA, Group IB, Group IIA and Group IIB, respectively. CONCLUSION: It is concluded that 3 or 4-day administration of first or second generation parenteral cephems is generally acceptable regimen for antimicrobial prophylaxis in patients undergoing TUR-P.

Aged↗
PubMed1999

[Psychogenic lower urinary tract dysfunction in women: patho-physiological investigation for psychogenic frequency-urgency syndrome and psychogenic urinary retention].

PURPOSE: Psychogenic lower urinary tract dysfunction (PLUTD) is composed of two syndromes; psychogenic frequency-urgency syndrome (PFUS) and psychogenic urinary retention (PUR). We evaluated the patho-physiology of PFUS and PUR, and explored the different pathogenesis in these syndromes. MATERIAL AND METHODS: Forty five patients with PLUTD, consisting of 23 patients with PFUS and 22 patients with PUR were investigated by using the psychological tests: CMI (Cornell Medical Index) and TEG (Todai's Egogram), a quantitative perspiration test in 45 females (23 patients with PFUS and 22 patients with PUR), and simultaneous measurements of voiding cysto-urethrography and urodynamic studies using the Life-Tech 6 channel polygraph in 35 patients (17 patients with PFUS and 18 patients with PUR). RESULTS: The prevalence in ages revealed two peaks, 20 years and 50 to 60 years. Over 25% of them had pyuria more than 10/hpf of WBC. Peak flow rate measured by uroflowmetry showed normal range in PFUS group and decreased in PUR group. The functional vesical volume was less than 100 ml in most patients with PFUS. Residual urine in PUR group was significantly greater. Capacity of the PFUS group were able to hold over 400 ml of contrast instilled through the urethral catheter, despite increased desire to void. Over 15% of the study group with PFUS showed uninhibited systolic contraction of detrusor (> 15 cm H2O) during filling phase. The measurement value of urodynamic parameters demonstrated that a periodic follow-up survey of the upper urinary tract should be performed because of the low compliance bladder in the patients with PLUTD. During voiding phase, the women with PFUS had a tendency to be divided into two groups, hypercontractile or acontractile detrusor. The voiding cysto-urethrography (VCUG) showed a tendency of bladder neck opening on patients with PFUS during filling phase. Most of PLUTD cases demonstrated a round to triangle shape on vesical configuration, which led to a spastic condition of detrusor muscle. We attempted to measure the quantitative perspiration using 3 kinds of loading tests; respiratory, arithmetic and psychological load. In the psychological loading test, we asked 98 questions about their daily lives including occupation, living condition, family relationship and sexual activities. Arithmetic loading test consisted of counting in reverse, subtraction and multiplication. The quantitative perspiration rate resulted in a "positive" in many patients with PFUS. Respiration loading test was performed to measure the respiration volume during 3 large inhales. Most patients with PUR tested within the normal range for respiration except for those patients with decreased or no perspiration during the psychiatric loading test. These results may reflect the psychological elements including suppression and subconscious defense mechanism. Neurosis which was diagnosed as having type III to type IV of the Cornell Medical Index was demonstrated in less than under 40% of patients with PFUS and more than 55% patients with PUR. There was no significant trend or difference between PFUS and PUR detected from Todai's Egogram. CONCLUSIONS: Due to the reflection of many psychological responses, it is necessary to investigate from various examinations including psychological, autonomical and classical urological studies for accurate diagnosis of PLUTD.

Adolescent↗
PubMed2002

[A case of transitional cell carcinoma of the bladder with active urinary tract tuberculosis].

A 63-year-old man was admitted to our hospital complaining of painful urination. Urinalysis demonstrated pyuria and microscopic hematuria. Cystoscopy revealed the bladder tumor and the reddish mucosa. Transurethral biopsy was performed and the pathological examination showed transitional cell carcinoma in the bladder tumor and epithelioid granuloma in the reddish mucosa. Acid-fast bacilli smeas of urine sample and urine culture of Mycobacterium tuberculosis were positive. Therefore the treatment of urinary tuberculosis was started and the patient received intra-arterial chemotherapy combined with radiation. After the therapy, radical cystectomy and bilateral cutaneous ureterostomies were performed. Pathological study revealed transitional cell carcinoma and epithelioid granuloma in the removed bladder. The reports of urinary epithelial carcinoma with urinary tract tuberculosis were rare and, including our case, the 10 cases in Japanese literature are reviewed.

Carcinoma, Transitional Cell↗
PubMed2005

[Long-term usefulness and safety of the contemporary balloon catheter].

OBJECTIVE: To evaluate usefulness and safety of an indwelling contemporary balloon catheter, we compared complication rates among five methods of urinary tract management. PATIENTS AND METHODS: History of febrile episode, bladder stones, pyuria and the miscellaneous urinary tract problems of 114 patients were retrospectively reviewed. The rates of complications were compared among five types of urinary tract management as clean intermittent catheterization dry (not incontinent) (CIC-dry: n = 33), clean intermittent catheterization with incontinence (CIC-wet: n = 16), clean intermittent catheterization with a contemporary balloon catheter indwelling at night (Contemporary catheter: n = 20), a suprapubic cystostomy catheter indwelling (Cystostomy: n = 22) and permanent urethral balloon catheter indwelling (Urethral catheter: n = 24). The contemporary balloon catheter used consisted of a reusable balloon catheter and a reservoir to inflate the balloon. The patients in the Contemporary catheter group self-inserted the catheter every night before sleeping, and then removed it in the next morning. After use, the catheter was washed with tap water, and stored in a special purpose case filled with disinfectant. RESULTS: The mean follow up period was 41 months. The incidence of febrile episode in CIC-wet was 3.36 times/100 months, Urethral catheter was 2.96, Cystostomy was 1.26, Contemporary catheter was 0.57, and CIC-dry was 0.42. The incidence of febrile episode in CIC-wet and Urethral catheter were significantly higher than in CIC-dry (p<0.05). The incidence of bladder stone in Urethral catheter was 1.11 times/100 months, Cystostomy was 1.05, Contemporary catheter was 0.96, CIC-wet was 0.61, and CIC-dry was 0.21. The Urethral catheter group had significantly higher incidence of bladder stone than CIC-dry (p<0.05). CONCLUSIONS: The indwelling contemporary balloon catheter is recommended for long-term use in CIC-wet group.

Adult↗
PubMed2006

[Novel NMP22 quick qualitative analysis (BladderChek NMP22) for the diagnosis of urothelial tumor].

PURPOSE: The BladderChek NMP22 test was studied to determine whether it could be a useful diagnostic tool for urothelial tumor. MATERIALS AND METHODS: During the period from April to May 2004, a total of 50 patients who visited Nagano Municipal Hospital were subjected to analysis with the BladderChek NMP22 test. They consisted of 25 patients with microscopic or gross hematuria and 25 patients with urothelial tumor who were being followed after surgery. The clinical diagnosis was made by cystoscopy, abdominal CT scanning, ultrasonography or intravenous urography. BladderChek NMP22 was used in all of the patients and the test was judged to be positive when a line appeared on the glass at 30 minutes after a drop of urine was added to the sample well. Cytological examination of the urine was also done. It was defined as negative if the result was I, II or III, while it was positive if the result was IV or V. RESULTS: Seven patients who were not eligible were excluded and the remaining 43 patients were studied. Eleven of the 43 patients were diagnosed as having urothelial tumor. The sensitivity, specificity, and accuracy of BladderChek NMP22 for making a correct diagnosis was 63.6%, 62.5%, and 62.7%, respectively (p = 0.1703). As for urine cytology, the sensitivity, specificity, and accuracy was 36.3%, 100%, and 83.7%, respectively (p = 0.0027). BladderChek NMP22 was positive in all the patients whose urine cytology was positive and in three patients with low-grade, low-stage, and small tumors, although urine cytology was negative. On the other hand, false-positive BladderChek NMP22 results were obtained in patients undergoing follow-up after removal of urothelial carcinoma and in patients with urinary stones. The sensitivity of BladderChek NMP22 was superior to that of urine cytology, but its specificity was inferior. CONCLUSION: The combined use of BladderChek NMP22 and cystoscopy may be useful for the diagnosis and follow-up of urothelial tumor. On the other hand, the results obtained with BladderChek NMP22 need to be interpreted carefully because the test can yield a false-positive outcome in the presence of marked hematuria, pyuria or cytolysis of normal urotherium. When the result of BladderChek NMP22 in the monitoring of recurrent urotherial tumor following surgery was positive in spite of negative findings of cystoscopy, it is necessary to consider the presence of a tumor in the upper urinary tract or a high tendency toward tumor recurrence. In such a case, careful followup may be necessary.

Adult↗
PubMed1990

Erythromycin for persistent or recurrent nongonococcal urethritis. A randomized, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy of a 3-week regimen of erythromycin for treatment of persistent or recurrent nongonococcal urethritis in men. DESIGN: A prospective, randomized, double-blind trial with follow-up at 2, 4, and 8 weeks after enrollment. PATIENTS: Seventy-seven evaluable men with objective evidence of nongonococcal urethritis (36 in the erythromycin group and 41 in the placebo group) with a mean age of 28 years, a median duration of urethritis of 3 months, and a median number of three previous antimicrobial regimens. INTERVENTION: Erythromycin, 500 mg, or placebo four times daily for 3 weeks. RESULTS: After 2 weeks of treatment, urethral symptoms resolved in 13 of 25 erythromycin-treated patients compared with 8 of 34 placebo-treated patients (P = 0.03). Erythromycin also resulted in more frequent resolution of urethral discharge and leukocytosis at all visits compared with placebo but these differences were not statistically significant. First-voided urine leukocyte counts decreased, however, by a median of 89% (95% CI, -96% to -67%) in the erythromycin group compared with 23% (CI, -73% to 83%) in the placebo group after treatment (P = 0.02 for the difference in changes). Further, in men with prostatic inflammation, urinary leukocyte counts decreased by a median of 94% (CI, -99% to -83%) after treatment in erythromycin-treated patients compared with a 46% increase (CI, -57% to 290%) in placebo-treated patients (P = 0.0003 for the difference in changes). CONCLUSION: A 3-week regimen of erythromycin was more effective than placebo in improving symptoms and in reducing pyuria in men with persistent or recurrent nongonococcal urethritis, especially among men with prostatic inflammation.

Adult↗
PubMed1993

Early undifferentiated connective tissue disease: III. Outcome and prognostic indicators in early scleroderma (systemic sclerosis).

OBJECTIVE: To characterize the course of early scleroderma and to delineate prognostic factors present within 1 year of disease onset that might identify patients at high risk. DESIGN: Inception cohort study. SETTING: Ten university-based rheumatology clinics participating in the Cooperative Systematic Studies of Rheumatic Diseases Program. PATIENTS: Forty-eight patients who had had scleroderma for less than 1 year. MEASUREMENTS: Fifteen patients with early scleroderma who died were compared with those still living during the initial study period (1982 to 1992). Kaplan-Meier survival estimation and Cox proportional hazards analysis were used to analyze baseline variables for their ability to predict survival duration. RESULTS: Eight of 15 deaths were due to cardiac or pulmonary system failure. The estimated 5-year survival rate was 68%. Baseline factors that were the most predictive of a poor outcome included the presence of abnormal cardiopulmonary signs and abnormal urine sediment (pyuria, hematuria). CONCLUSION: Evidence of early cardiopulmonary disease, renal disease, inflammation, or immune activation may identify a subset of patients with scleroderma who will experience rapidly progressive disease and early death.

Adult↗