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[Atypical forms of primary acute pyelonephritis].

In acute "primary" pyelonephritis (APP), kidney infection occurs despite normal urinary tract morphology. Typical features of APP are spiking fever and chills, loin pain, pyuria, bacteriuria, isolation of uropathogenic strains of E. coli, and specific renal CT scan images. APP may be atypical when lacking pain, or fever, or when urine cultures are negative, or when urinary bacteria do not exhibit characters of uropathogenicity, or when CT scan examination is negative. Such atypical features entail loss of time in diagnosis, and thereby delayed treatment and increased risk of cortical scar formation. However, they are virtually never observed simultaneously in a given patient.

Acute Disease↗

[Diagnosis of prostatitis in the light of current knowledge].

Authors review the up-to-date questions of the prostatitis diagnostics on the basis of data of nearly 2,000 patients. In case of symptoms indicative of chr. prostatitis it is essential to localise the inflammation to the prostate with laboratory methods and in case of negative finding to identify the organic and functional diseases hidden behind the nonspecific clinical picture. A modified variation of the bacterial localisation culture (4 glasses test) has been applied by the authors in addition to previous methods. Among the potential etiological factors the hypertrophy of prostate stands first above 45 years of age. In the majority of cases etiological factor cannot be proved under 45 years. Among the subjective symptoms the cystitis syndrome, the low back and scrotal pain predominate, whereas among the objective symptoms above 45 years the microscopic pyuria, under 45 years of age the concomittant urethritis. Among Drach's prostatitis prevails (61%) whereas in the older patients prostetodynia, chr. nonbacterial and bacterial prostatitis have similar prevalence. In acute and subacute prostatitis the cystitis and the epididymitis, in chr. prostatis the pathozoospermia (44%) and the neurosis are the most frequent complications. Prostatitis presents a common differential diagnostic problem not only for the urology, but also for the abdominal diagnostics, rheumatology, proctology etc.

Bacterial Infections↗

[Acute cystourethritis during pregnancy].

A prospective study was carried out in 103/863 obstetric patients with cystitis characterized by urinary urgency and frequency, dysuria, pyuria and suprapubic discomfort in the absence of systemic symptoms such as fever and costovertebral angle tenderness. The association of symptomatic lower urinary tract infection with low-count bacteriuria (10(2)-10(5) UFC/mL of urine) was present in all the patients. The incidence of cystourethritis was about 12%, most of the infections occurred at the first trimester. To learn whether a multiple-dose of nitrofurantoin or ampicillin is safe and effective therapy for acute uncomplicated urinary tract infections, 103 symptomatic pregnant women were randomly grouped to receive oral nitrofurantoin (100 mg t.i.d.) or ampicillin (500 mg t.i.d.) for five days. Seventeen patient were excluded since they did not return for follow-up. Escherichia coli was isolated in 67% of infections. Overall cure varied from 87% to 89%, without any great differences between the regimens. Nine patients had asymptomatic bacteriuria in the course of pregnancy, four developed acute pyelonephritis and one of them had abnormal intravenous pyelogram.

Acute Disease↗

[Clinical effects of intravesical instillation of polymyxin B in patients with acute cystitis].

The effectiveness of intravesical instillation of Polymyxin B was studied in 17 patients suffering from acute cystitis. The 17 patients, all female, had an average age of 42 years. The average duration between the onset of symptoms and the initial visit to the hospital was 4.6 days. The causative organisms were 15 strains of E. coli and 1 each of P. rettegeri and K. pneumonia, respectively. Improvement of symptoms was observed in 76% of the cases but pyuria was cleared in only 47% of the cases. Clinical results were excellent in 8 cases (47%), good in 6 cases (35%) and poor in 3 cases (18%). The overall effectiveness rate was 82%. No appreciable amount o Polymyxin B, was detected in the serum of 4 patients examined.

Acute Disease↗

[Klippel-Trenaunay-Weber syndrome with papillary cystadenoma of the epididymis: a case report].

A case of Klippel-Trenaunay-Weber syndrome with papillary cystadenoma of the right epididymis is reported. A 7-year-old boy visited our clinic on October 19, 1985 with a tender right intra-scrotal mass (35 X 15 m) and pyuria. In spite of the initial treatment with antibiotics, the tumor grew larger in December, 1987. The patient underwent right orchiectomy on December 23, 1987. Macroscopically, the specimen measured 40 X 23 X 20 mm and weighed 17 g. Histological examinations demonstrated that the tumor was papillary cystadenoma of the right epididymis. The patient lacked the signs of von Hippel-Lindau disease since there were no abnormal findings on brain and abdominal computer tomographic scan, and retinae were normal on fundoscopic examinations.

Angiomatosis↗

Urinary tract tuberculosis in a child with Henoch-Schönlein purpura: a case report.

A seven-year-old girl is presented, who was previously diagnosed as having Henoch-Schönlein vasculitis, and was further evaluated for hypertension. Urograms showed bilateral strictures of the ureter, causing obstruction on the left side. Tuberculosis, our preoperative diagnosis, evidenced by her sterile pyuria and PPD conversion was confirmed by the surgical specimen and treatment was begun.

Child↗

[Status epilepticus induced by prolonged immersion in hot herb bath: report of one case].

A 6-year-old girl with cerebral palsy developed conscious disturbance and generalized convulsion after one-hour hot herb drug bath. Physical examination on admission revealed rectal temperature 41 degrees C, hot skin, respiration 46/min, regular heart beat 98/min, BP 130/60 mmHg, Glascow coma scale 4 (E2M1V1), soft and flat abdomen, no hepatosplenomegaly, no skin rash, no focal neurological sign, increased generalized muscle ton. Laboratory data showed CBC: WBC 20400 cumm (Neutrophils 31%, Lymphocytes 69%), Hb 11.6gm%, ESR 11 mm/hr, arterial blood gas: PH 7.077, PO2 43mmHg, PCO2 57.1mmHg, HCO3- 16 mEq/L, BE-11.5mEq/L, serum sodium 143 mEq./L, potassium 5.2 mEq/L, chloride 101 mEq/L, free calcium ion 3.8mg%, GOT 63IU/L, GPT 263 IU/L, amylase 193 IU/L, alkaline phosphatase 388 IU/L, LDH 1245 IU/L, CPK 677 IU/L, total bilirubin 0.8 mg/dl, direct type 0.1 mg/dl, BUN 18 mg/dl, Glucose 35 mg/dl. Urinalysis revealed proteinuria( ) trace hematuria and pyuria, but no cast. Lumbar puncture is within normal limits. Bacteriology including blood and CSF are normal. Multiple organ failure was noted at that time. Intensive cooling methods were performed including central and peripheral cooling. We used luminal and valium to control the seizure. Condition didn't improve. Afterwards cardiopulmonary arrest developed. Patient expired 8 hours after admission despite of resuscitation. Heat stroke in infancy and childhood is different from that in adulthood. The predisposing factors are high ambient temperature, dehydration, very young baby, sweat gland dysfunction, or ectodermal dysplasia. Definition of heat stroke includes 1) rectal temperature above 41 degrees C, 2) behavioral change, 3) warm skin, wet or dry.(ABSTRACT TRUNCATED AT 250 WORDS)

Baths↗

Omnatax in acute urinary tract infection. A clinical study.

25 patients of acute urinary tract infection with E. coli received Omnatax, 1 gm. b.d. 80% patients had bacteriologic cure on second day and 96% on fourth day of treatment. When assessed in light of the disappearance or decrease in pyuria and bacteriuria, 72% patients showed excellent response and 28% moderate response at the end of treatment. Clinical cure was achieved in 84% of patients. Mean number of days required for the patients to become symptom-free was 3.5 and mean time to achieve complete bacterial elimination was 1.96 days.

Acute Disease↗

[Treatment of female acute cystitis with a single dose of cefminox].

Thirty six female patients with acute cystitis were treated with one shot intravenous injection of 1 g cefminox. Clinical efficacy was evaluated based on extent of subjective symptoms, pyuria and bacteriuria. Of 36 patients, an excellent efficacy was shown in 32 cases, moderate in 3 cases and poor in 1 case. This poor case was diagnosed as complicated urinary tract infection because of right vesicoureteral reflux. Therefore, the overall effectiveness rate of this treatment for acute uncomplicated cystitis in women was 100%. Single dose chemotherapy with an adequate antibiotic is considered a useful treatment for female acute cystitis.

Acute Disease↗

Kawasaki disease--the Singapore experience.

50 children with Kawasaki disease were seen between September 1983 to March 1988. Their ages ranged from 3 months to 10 years with a mean age of 25 months. Male to Female ratio was 2.3 to 1. The diagnosis of Kawasaki disease was made between the fourth to fifteenth day of illness. Marked thrombocytosis, raised erythrocyte sedimentation rate, leucocytosis, mild anemia and sterile pyuria were common features. All patients had a normal ECG and chest X-ray. 2D echocardiogram was done in the sub-acute phase of the illness in every patient. Sixteen patients (32%) had coronary artery dilatation. Thirteen of these had serial 2D echocardiograms done over a period of more than one year. Twelve had echocardiographic resolution of the coronary lesion within 18 months of follow up. Patients with coronary artery dilatation were significantly younger. All had full clinical recovery with aspirin therapy. Kawasaki disease afflicts mostly young children and can present as a diagnostic problem. Coronary artery involvement is common, and except for age, it is not predictable by any clinical or laboratory parameter. Serial echocardiographic examinations are necessary in the management of these patients.

Age Factors↗

[Eosinophilic cystitis].

We report two cases of eosinophilic cystitis in children of 11 months and 11 and a half year of age respectively. The presenting symptoms were the emision of mucosanguinolent filaments in the urine in one case and with lower urinary tract symptoms and macroscopic hematuria in the other. Physical examination revealed in one of them a round, tough and painful mass in the hypogastric area. In one case we found peripheral blood eosinophilia. They both showed in the Urinalysis albuminuria, pyuria and hematuria, with the presence of eosinophils in one of them. Macroscopic examination presented in the two cases a tumoral, mamelonne mass in the wall of the bladded. The diagnosis was anatomopathologic due to the demonstration of an inflammatory infiltration, primarily of eosinophils. The clinical course was unfavourable in the case an hemicystectomy was practicated and self-limited in the one only symptomatic treatment was used.

Child↗

[Isolated proteinuria: practical approach].

Isolated proteinuria (i.e. without hematuria and/or pyuria) is a frequent finding. Simple methods exist which make it easy to classify into various subtypes. Guidelines are suggested mainly to avoid useless and potentially dangerous investigations.

Humans↗

[Urinary tract infection in children: clinical analysis and investigation].

The urinary tract is a common site for bacterial infection in childhood. The most important aspect of urinary tract infection in childhood is that it can lead to severe and progressive renal disease. From March 1983 to March 1987, 63 cases of suspected urinary tract infection were collected in Taichung VGH. Among them only 24 cases reached our diagnostic criteria. Eight cases were within 2 years old, which all are male. Sixteen cases were beyond 2 years old, which the ratio of male to female is 1:1. Eighteen cases presented pyuria. Ten cases had recurrent infections, among which eight cases had urinary abnormalities. The most common pathogenic organism was E. coli (44%), then Proteus (24%), Klebsiella (16%), Pseudomonas (12%). The antibiotics sensitivity test revealed 95.7% were sensitive to gentamicin and amikacin, 81% to cephalothin, 56. 5% to sulfamethoxazole-trimethoprim. Imaging studies revealed nine cases (37.5%) with urinary tract abnormalities, including vesicoureteral refluxes 6 cases, right multicystic kidney with left vesicoureteral reflux 1 case, horse-shoe kidney 1 case, atonic bladder 1 case. The ratio of male to female is 2:1. All seven cases of severe vesicoureteral refluxes received surgery. One case developed post-operative ureteral stricture. One case occurred unilateral chronic renal parenchymal disease one year later. Others were free of reflux and reinfection of urinary tract.

Anti-Bacterial Agents↗

Functional voiding disorders in women.

From July 1986 to Dec 1987, 78 women complaining of frequency, urgency, dysuria and suprapubic discomfort were evaluated at our clinic. Their ages ranged from 20 to 68 (mean age: 38.2). The patients who were noted to have evidence of pyuria, neurological or gynecological abnormalities were excluded from the study. Urodynamic examinations including uroflowmetry, cystometry (CMG), urethral pressure profiles (UPP) and electromyography (EMG) of the external urethral sphincter were performed. The results revealed low flow rates in 56 patients (71.8%), non-relaxation of the external sphincter during voiding in 55 patients (70.5%), unstable bladder in 6 patients (7.7%) and a high maximal urethral closure pressure (MUCP) (greater than 80 cmH2O) in 44 patients (56.4%). The average volume of the cystometric capacity (250 +/- 86 ml) was decreased. The association between the low flow rate, non-relaxation of the external sphincter and a high MUCP was statistically significant. Urethral hypersensitivity has been recognized as being the major cause of these symptoms.

Adult↗

Noninvasive renal diagnostic studies.

Traditional methods of noninvasively evaluating patients for renal injury do not accomplish the following tasks: reliably distinguish potentially treatable forms of acute renal failure from acute tubular necrosis; provide a sensitive indicator of early allograft rejection in renal transplant recipients, particularly those in the pediatric age group; provide an early warning of incipient drug-induced nephrotoxicity; or serve as an adequate screening test for renal injury due to exposure to occupational or environmental toxins, especially heavy metals. Because of this, considerable effort has been devoted to the development of assays to satisfy these needs. Three approaches include measurement in the urine of low-molecular-weight plasma proteins such as beta 2-microglobulin; a variety of kidney-derived enzymes, such as L-alanine aminopeptidase and N-acetyl-beta-D-glucosaminidase; and specific renal antigens using immunologic detection. The first two of these have not proved to be adequately sensitive or specific, complicated by the frequent loss of activity associated with the physicochemical characteristics of the urine or the presence of pyuria. Despite this, useful information has been obtained. In particular, assays of beta 2-microglobulin urinary excretion and retinol binding protein appear to have clinical utility that should be pursued. Recent experience with a monoclonal antibody-based assay for a unique proximal tubular antigen, the adenosine deaminase binding protein, suggests that a battery of such assays, each directed against an antigen localized to a particular segment of the nephron, may be particularly useful.

Acetylglucosaminidase↗

Hospital-acquired urinary tract infection.

From 16,534 admissions, 60 patients, 4 days to 15 years of age, with one or more hospital-acquired urinary tract infections were identified during a 5-year period by a prospective surveillance system. The patient charts were subsequently reviewed to characterize the population at risk for such infections and to describe the course and consequences of these infections. Infections in individual patients ranged from one to greater than 50. The hospital-acquired urinary tract infection rate for the study period was 14.2 infections per 1,000 admissions. In the patients in whom all urinary tract infections were well documented, the following characteristics were defined: (1) 92% (97 of 105) of the infections occurred in catheterized patients; (2) almost half (49 of 105) of the infections occurred in patients exposed to only intermittent catheterization; (3) 28% (29 of 105) of the infections were asymptomatic; (4) fever was the most frequent finding in the symptomatic patients and occurred in 66% (60 of 105); (5) pyuria was found in only 51% (35 of 69) of the urinalyses performed at diagnosis; (6) 85% (89 of 105) of the infections were single-organism infections; (7) 82% (101 of 123) of the causative organisms were Escherichia coli, Pseudomonas sp, coagulase-negative staphylococci, Enterococcus spp, Klebsiella spp, or Enterobacter sp. The urinary tract infections in the 60 patients were not complicated by bacteremia, and no direct relationship between the infections and the minimal mortality in our patients could be established.

Adolescent↗

[A case of vesicosigmoidal fistula].

The clinical course of a case of vesicosigmoidal fistula is presented. The patient, a 76-year-old woman, became aware of terminal micturition pain and pollakisuria in February, 1985. She was first treated under the diagnosis of cystitis to be relieved of her subjective symptoms, although there was no improvement of pyuria. She also began to feel lower abdominal pain on April 3, 1985. After various examinations including intravenous pyelography, enteroclysis and cystoscopy the diagnosis of vesicosigmoidal fistula originating from sigmoid diverticulitis was established. Careful observation at operation revealed remarkable adhesion among the sigmoid colon, bladder, uterus and left ovary. The sigmoid colon, was resected followed by end-to-end anastomosis. Because of considerably extensive inflammatory changes over the mucosal membrane of the bladder, the hole of fistula on the vesical wall was simply closed from outside of the bladder without performing partial cystectomy. Histological examination only demonstrated non-specific inflammatory changes without evidence of malignancy. She had a favorable progress postoperatively.

Aged↗

Protocol for diagnosis of urinary tract infection: reconsidering the criterion for significant bacteriuria.

The traditional criterion of 10(5) colony-forming units (CFU) per milliliter of urine to diagnose urinary tract infection was based on studies of pregnant and nonpregnant women with asymptomatic bacteriuria or acute pyelonephritis. Recent studies of symptomatic women revealed that urine cultures in approximately one third of those with confirmed urinary tract infections grew only 10(2) to 10(4) CFU/mL. The major causes of acute dysuria among such women are urinary tract infection, sexually transmitted disease, and vaginitis. In most instances, it is possible to make the diagnosis based on clinical features. The major features of urinary tract infection are internal dysuria; frequency, urgency, and voiding of small volumes; abrupt onset; suprapubic pain; presence of pyuria. Presence of hematuria which occurs in about 50 percent of patients strongly suggests bacterial cystitis. Three to seven days of empiric antimicrobial therapy is indicated for these patients, with selection of a first-line antimicrobial agent that offers efficacy against Escherichia coli or Staphylococcus saprophyticus; reasonable cost; few side effects. Ampicillin is not recommended. Indications for culture include uncertain clinical features; history of previous infection within the past three weeks; duration of symptoms of more than seven days; recent hospitalization or catheterization; pregnancy; diabetes. To maximize the sensitivity and specificity of the urine culture in acutely symptomatic women, it is necessary to request the laboratory to report 10(2) to 10(4) CFU/mL.

Bacterial Infections↗