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PubMed1987

[Clinical study of ofloxacin (OFLX) on urinary tract infections].

Fifty-three patients with urinary tract infections (UTI) were treated with Ofloxacin, a new oral synthetic antimicrobial agent, and its clinical efficacy was studied. Ofloxacin (600 mg/day) was administered to 35 patients with acute simple cystitis for more than three days, and to 17 patients with complicated UTI for more than five days except a case in which the treatment was interrupted for side effects. Acute simple cystitis: In ten cases meeting the criteria of UTI committee, overall effectiveness rate was 100%. All of the 26 strains isolated from 26 patients disappeared after the treatment. In all of acute simple cystitis cases, 94.3% were evaluated as excellent or as moderate by attending doctors. Complicated UTI: In 11 cases treated during five or seven days, 63.6% of patients showed improvement on pyuria. Seven out of nine strains isolated from seven patients disappeared. However, two strains of P. aeruginosa and P. cepacia persisted after the treatment. In all of the complicated UTI cases, 38.9% of patients were evaluated as excellent or as moderate by attending doctors. Some slight side effects were observed in four out of 53 cases. This study showed that Ofloxacin is effective against urinary tract infections.

Acute Disease↗
PubMed1986

Accuracy of standard urinalysis in predicting culture results.

Single and multiple test combinations were studied to determine the accuracy of the standard urinalysis method in predicting sterile or contaminated cultures and cultures with significant bacteriuria from gram negative rods (GNR). The results demonstrated a significant incidence of microscopic bacteriuria and pyuria in GNR culture (P < .001) and an association between large numbers of epithelial cells and culture contamination. A discriminate analysis of multiple test combinations was done to identify the order in which urinalysis tests significantly improved the ability to discriminate between culture groups. Results indicated that multiple test combinations were more predictive than single tests. Based on study results, a cost-effective scheme for ordering urine cultures is proposed.

Bacteriological Techniques↗
PubMed1986

Relationship of abnormal Tamm-Horsfall glycoprotein localization to renal morphology and function.

Tamm-Horsfall glycoprotein (TH) distribution was studied using a biotin-avidin immunoperoxidase technique in renal biopsies from 166 consecutive patients and 8 normal kidneys. Tubulointerstitial damage was independently assessed and graded. In 109 patients TH antibodies were measured by ELISA and in 30 of these urinary TH and beta 2-microglobulin excretions were measured by radioimmunoassay. In 124 biopsies only distal tubular epithelium and casts were stained. Glomerular space (8) or interstitial (34) deposits were seen in 42 biopsies; 16/68 with glomerulonephritis, 4/14 with systemic vasculitis, 12/33 with chronic interstitial nephritis, 1/8 with acute interstitial nephritis, 9/43 with other nephropathies. There was no correlation between TH distribution and the degree of tubulointerstitial damage (p greater than 0.5), urinary TH excretion (p greater than 0.05), urinary beta 2-microglobulin excretion (p greater than 0.05), glomerular filtration rate, urinary concentrating ability, or the incidence of pyuria. TH antibodies did not correlate with TH distribution (p greater than 0.5) or the degree of tubulointerstitial damage. Abnormal TH distribution showed no statistical relationship to the degree of tubulointerstitial damage, changes in renal function or levels of TH antibodies.

Animals↗
PubMed1987

[On the history of kidney disease].

Except for infections (pyelonephritis, abscess of the kidney), which cause symptoms such as pyuria, pain and fever, most diseases of the renal parenchyma were unknown in Greek and Roman antiquity. Even in the Renaissance they were not yet properly identified. Edema was generally thought to be related to liver disease. Proteinuria was discovered at the end of the 18th century. In 1827 Bright provided the first, almost complete clinical description of the various forms of acute and chronic glomerulonephritis and showed that they were accompanied by macroscopic changes in the kidneys. Between 1850 and 1885, Frerichs, Klebs and Langhans described the primary glomerular lesions. The amount of new knowledge acquired during the 20th century has been tremendous, and covers the mechanism of urine formation, the role of sodium retention in edematous states, the physiology and physiopathology of the renin-angiotensin-aldosterone system, the glomerular origin of the nephrotic syndrome, new methods of investigation, progress in histology and immunology, the discovery of many tubular syndromes, the introduction of antibiotics and antihypertensive drugs, and the development of dialysis and transplantation.

Europe↗
PubMed1987

[A clinical study of urological examinations in uterus malignant tumors before treatment].

Sixty six cases of uterus malignant tumors examined urologically before gynecologic treatment between 1980 and 1984 are reviewed retrospectively. The uterus lesion excluding 1 malignant mixed mesodermal tumor was cervical carcinoma in 55 cases and corpus carcinoma in 10 cases. Pathologically, 46 cases were squamous cell carcinoma, 10 were adenocarcinoma, 3 were squamous adenocarcinoma and 6 were unknown. Clinical staging according to classification of FIGO, was stage 0 in 3 cases, stage I in 23 cases, stage II in 28 cases, stage III in 3 cases, stage IV in 7 cases, and unknown in 2 cases. Only 4 cases (6.1%) had urological symptoms with no special relationship to the uterus lesion. Abnormal findings of urine tests were seen in 15 cases (22.7%). The incidence of hematuria and pyuria, which were seen in 12 and 10 cases, respectively, was high. Cystoscopic abnormality was revealed in 32 (51.6%) out of 62 cases. Protrusion of vesical wall was found in 11 cases (34.3%) and it was an important finding which showed a significant incidence. Edema was seen in 11 cases (34.3%). This was a sign of progression, and the observation on spread of lesion was important. Redness was seen in 3 cases (4.8%). It was considered to be the result of circulatory disturbance. At the same time observations on vascular change, edematous change etc. should be done in detail. Bleeding was seen in 1 case (1.6%), microscopic bleeding was seen more frequently than macroscopic bleeding. Abnormalities of ureteral orifice were significant only after other examinations were reviewed in addition to these signs. IVU was performed in 58 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1987

The Ames Clinitek 200/Multistix 9 urinalysis method compared with manual and microscopic methods.

We assayed 315 urine specimens by the Ames Clinitek 200/Multistix 9 semi-automated method and by corresponding standard methods (listed in parentheses) for the following analytes: protein (sulfosalicylic acid precipitation), glucose (Lilly Tes-Tape), ketones (Boehringer Mannheim Chemstrip K), leukocyte esterase (microscopic examination for leukocytes), blood (microscopic examination for erythrocytes), nitrite (microscopic examination for bacteria, Gram stain, or culture), and pH (pH meter). The Clinitek and standard methods agreed well at all concentrations for protein, ketones, and glucose. The Clinitek leukocyte esterase, nitrite, and blood methods were less sensitive than microscopic methods for detection of pyuria, bacteriuria, and hematuria, respectively. The Clinitek pH method produced falsely low pH values for urines with true pH less than 6.5, and falsely high values for urines with true pH greater than 6.5.

Autoanalysis↗
PubMed1987

[Study of clinical efficacy and safety of long-term cinoxacin therapy of chronic urogenital organ infection].

Thirty-five patients with chronic simple and complicated urogenital organ infections were treated with 400 mg/day Cinoxacin for 60 to 284 days. The effects were judged according to improvements of subjective symptoms, bacteriuria and pyuria before and after the complete administration. Overall clinical efficacy in 35 cases with urogenital organ infections was estimated as excellent: 54%, good: 26%, poor: 17%, and effectiveness rate: 80%. The clinical effectiveness rate in 12 cases of chronic simple urinary tract infection was 100%, and in 14 cases of chronic complicated urinary tract infections was 64%, and in 6 cases of chronic prostatitis the rate of effectiveness was 83%. No recurrence was observed during the treatment. No side-effects or toxicity were seen. Accordingly long-term Cinoxacin therapy seems to be useful in preventing recurrence in chronic infections encountered in the department of urology.

Adult↗
PubMed1986

[Renal papillary necrosis cured with endourological treatment].

We recently experienced a case of renal papillary necrosis which we removed by endourological treatment. A 58-year-old female diabetic patient complaining of left flank pain, fever and chills was admitted to our clinic. She had no past history of analgesic abuse or atypical vasculitis. Physical examination revealed a body temperature of 38 degrees C and tenderness in the left costovertebral angle. Pyuria was noted, and urine cultures grew more than 100,000 colonies of Escherichia coli per cubic millimeter. DIP revealed a diminished renal function, hydronephrosis, distorted middle and lower calyces and filling defect in the dilated ureter. However, there was no evidence of obstruction or ureteral reflux. Retrograde pyelography confirmed distortion and irregularity of the calyces and hydronephrosis due to a shadow defect which was movable during radiographic examinations. Laboratory studies revealed anemia, leucocytosis and hyperglycemia, but no elevation of BUN. Therefore, the patient was diagnosed as renal papillary necrosis. We succeeded in its endourological removal through nephrostomy with a choledochoscope (Olympus Co.) under epidural anesthesia. After surgery, the patient made a satisfactory recovery.

Diabetes Complications↗
PubMed1986

Drug-induced acute interstitial nephritis: report of 10 cases.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.

Acute Disease↗
PubMed1987

Factors associated with a poor outcome in tularemia.

To identify the factors associated with a poor outcome, we reviewed the records of 28 patients with tularemia diagnosed between 1974 and 1984. Most of the patients were men between the ages of 35 and 45 years, who presented with ulceroglandular tularemia. Twelve patients had the anticipated rapid response to therapy, with resolution of their presenting symptoms within one week (group A). Surprisingly, the majority (16 [58%] of 28) had a more prolonged or fatal illness (group B). Group B patients more often had a serious underlying medical disorder, and waited longer before seeking medical attention. Only patients in group B presented with electrolyte or renal function abnormalities (31%), pneumonia and pleural effusions (25%), elevated serum creatine phosphokinase levels (25%), and Francisella tularensis bacteremia (12.5%). Sterile pyuria, however, was an unexpectedly frequent finding in both groups. Group B patients more often experienced a prolonged delay from the time of physician contact to therapy, and were not treated with an aminoglycoside; relapse (12.5%) and death (6.2%) occurred only in group B. Thus, earlier and more appropriate intervention by the physician may have prevented some of the increased morbidity in our patients. These findings suggest that rapid presumptive aminoglycoside therapy (gentamicin sulfate or streptomycin sulfate) should be considered soon after tularemia is suspected, especially for patients with serious underlying medical disorders.

Adult↗
PubMed1985

[Vesico-ureteral reflux in adults. Apropos of 103 cases].

Case reports of 103 adult patients operated upon for vesicorenal reflux are reviewed. The majority of the patients (94%) were women, and clinical signs appeared initially after puberty in half of these, mainly as fever, abdominal pains and pyuria. Twelve of the 25 women known to have children had had serious septic accidents during pregnancy. Only 11% had two normal kidneys, 50% having bilateral and 39% unilateral kidney lesions. Of the total studied, 70% of kidneys had corticopapillary lesions, while 35% were smaller than normal. The average length of the submucous trajectory of a refluxing ureter was 3.5 mm, 95.5% of kidneys with corticopapillary lesions having a ureter ending in a short submucous trajectory (average: 3.7 mm). Of the 156 ureters operated upon by antireflux advancement, stenosis developed in 2 and residual reflux in 9, 7 of these latter corresponding to exclusively transvesical ureteral dissections. Global efficacy was 73% for this type of surgery, with 7.5% poor and 19.5% doubtful results. Conclusions drawn from this analysis were: the adverse effects of reflux during pregnancy (one out of 2 cases), the frequency of renal lesions in adults (35% of small kidneys and 70.4% of kidneys with corticopapillary lesions), the short submucous portion of these ureters--its length did not exceed that found in children with reflux--perhaps there had not been intramural ureteral growth, and the efficacy of the antireflux operation if a wide extravesical dissection is performed before the antireflux advancement procedure itself.

Adolescent↗
PubMed1985

[The duration of antibacterial treatment following transurethral prostatectomy].

Forty-three cases were studied to determine the most optimal timing to discontinue an oral antibacterial agent for preventing urinary tract infection after transurethral prostatectomy. On the 5th postoperative day intravenous antibiotic treatment was replaced by oral medication of 1.5 g talampicillin hydrochloride (TAPC, Yamacillin), which was tapered and discontinued depending on the urinary findings. Nine out of 15 cases who discontinued the medication within 2 weeks failed to keep the urine sterile. It may be advisable to continue the medication at least 3 weeks and to discontinue thereafter when pyuria has vanished. All 24 cases who followed this principle became sterile within 8 weeks. Medication continued over 8 weeks seemed to have no additional benefit. Four cases dropped out from this treatment mainly because of gastrointestinal symptoms.

Administration, Oral↗
PubMed1985

[Clinical experience with cefmenoxime (CMX) in complicated urinary tract infections].

Cefmenoxime (CMX) was intravenously administered to 106 patients with complicated urinary tract infection at a daily dose of 2-4 g for 5 days. An excellent response in overall clinical efficacy was seen in 15 cases (18.3%), a moderate response in 46 cases (56.1%) and poor response in 21 cases (25.6%). Pyuria was cleared in 20 cases (24.4%), decreased in 22 cases (26.8%) and unchanged in 40 cases (48.8%). Bacteriuria was eliminated in 41 cases (50.0%), decreased in 17 cases (20.7%), relapsed in 7 cases (8.5%) and unchanged in 17 cases (20.7%). Bacteriologically, 74 (76.8%) of the 95 strains isolated were eradicated by CMX, and 22 (23.2%) persisted. Side effects were observed in 3 (abdominal pain, diarrhea and elevation of trans amylase) of the 106 cases. Judging from the above results, CMX is considered to be a useful drug in the treatment of complicated urinary tract infections.

Adolescent↗
PubMed1985

Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program.

Data describing the 5,485 participants in the stepped-care group of the Hypertension Detection and Follow-up Program were reviewed to determine the apparent prevalence of renal parenchymal and reversible, secondary hypertension. The investigation was limited and was not designed to identify all cases of secondary hypertension. Baseline prevalence of proteinuria was 3.6%, pyuria 7.1%, hematuria 5.1%, and elevated serum creatinine level (greater than or equal to 1.7 mg/dL) 2.7%. The combined occurrence of an elevated serum creatinine level plus one or more urinary abnormalities was noted in 0.95%. Initial review of case reports revealed six participants with hypertension secondary to use of birth control pills and three participants with hypertension that was proved to be secondary to renovascular disease. Specific laboratory or historical criteria were used as indications for more intensive investigation in an additional 65 participants. Among these individuals, one participant with renovascular disease and three with possible primary hyperaldosteronism were identified. A rapid-sequence intravenous urogram or radionuclide scan was performed on another subgroup of 62 participants whose hypertension was "poorly" controlled (diastolic BP, greater than or equal to 95 mm Hg). Fifty-nine studies were negative, one was positive, and two were equivocal. These results suggest that the frequency of clinically relevant cases of reversible, secondary hypertension, at least among individuals with mild to moderate elevation of blood pressure, is low.

Adult↗
PubMed1985

[Effectiveness of tiaprofenic acid on clinical symptoms of acute simple cystitis in women].

Acute simple cystitis is very easily cured by the proper use of an antibiotic. However, at times, such irritation symptoms in the bladder as micturition pain, pollakisuria and pyuria disappear. Consequently, medication to remove these irritation symptoms in the bladder at the earliest possible date, is required. However, there are no established standards for treatment in terms of the administration method and the administration period, etc. We gave a new non-steroid anti-inflammatory drug, tiaprofenic acid (SURGAM) to women suffering from acute simple cystitis who strongly complained of bladder irritation symptoms especially of micturition pain. The administration was carried out concurrently with an antibiotic, and its effectiveness was studied. As a result, micturition pain showed 86% improvement on the 1st day after starting administration, and it is thought that the concurrent use of this product with an antibiotic can probably remove the patients' complaints quickly and prevent the meaningless administration of antibiotics due to the persistence of symptoms and, subsequently, there is the possibility of shortening the period of administration.

Acute Disease↗
PubMed1985

Legionnaires' disease associated with acute renal failure: a report of two cases and review of the literature.

Renal involvement is a well described complication of Legionnaires' disease and is often manifested as mild, transient azotemia, hematuria, proteinuria, pyuria or cylinduria. Acute renal failure complicating Legionnaires' disease has also been described, and some patients have required hemodialysis. Renal morphology has only been described in a few cases. We report two cases of Legionnaires' disease who developed acute renal failure. The serotype of the Legionella pneumophilia isolated from one of the patients had never been isolated from humans before. This patient expired and at autopsy the kidney revealed acute tubular necrosis, but there was no evidence for interstitial or glomerular disease. Renal morphology in six previously reported cases revealed acute tubulointerstitial nephritis in three cases and acute tubular necrosis in the other three. We conclude that acute renal failure may accompany severe Legionnaires' disease, and the development of the renal failure is not related to hemodynamic factors, while nephrotoxic antibiotics may be a contributing factor.

Acute Kidney Injury↗
PubMed1985

[Study on the detection of bacterial infection in tubeless ureterocutaneostomy].

The presence of bacteria at the renal pelvis and the methods of their detection were studied in 11 patients with catheter-free cutaneous ureterostomy (tubeless ureterocutaneostomy). These patients had had total radical cystectomy due to bladder carcinoma. Of these, 5 patients had single-sided stoma with 9 kidney-ureter units and 6 patients had bilateral stoma with 10 units, excluding 2 ureters because of indwelling catheters. The urine obtained both from the renal pelvis with a single lumen catheter and from the pouch were used in the bacterial culture test and urinalysis. The aseptic swab after touching the skin around the stoma was also cultured for bacteria. Of 19 kidney-ureter units, 9 (47%) were found to have bacteria in urine obtained from catheterization. However, only 2 units (11%) were observed to be accompanied with pyuria. In this method, the rate of bacterial appearance was higher in single-sided stomas than in bilateral ones. There was no statistical correlation between the presence of hydronephrosis and the rate of bacterial appearance. In conclusion, the method of single lumen catheterization might be of great use for analysis of urinary tract infections in patients with such conditions.

Aged↗
PubMed1985

[Comparative studies of the efficacy, safety and usefulness of S6472, cefaclor and cephalexin on complicated urinary tract infection by the double-blind method].

To objectively evaluated the usefulness of the standard formulation of cefaclor (CCL) and the long-acting formulation of cefaclor (S6472) in noncatheterized complicated urinary tract infection (UTI), a double-blind comparison study was carried out using cephalexin (CEX) as a control. Patients were orally treated with either 500 mg of CCL 3 times/day, 750 mg of S6472 2 times/day, or 500 mg of CEX 4 times/day for 14 days. Overall clinical effect was evaluated on days 5 and 14 in accordance with the UTI therapeutic evaluation standard, with check for recurrence on day 21. There was no demographic difference between the groups. There was no difference in the effective rate on day 5 among the 3 treatment groups: 58.1% in S6472 group, 66.0% in CCL group and 61.9% in CEX group. Nor on day 14, was there any significant difference in the effective rate among the 3 groups: 70.8% in S6472 group, 63.4% in CCL group and 61.8% in CEX group. Stratification analyses (by UTI group, infection site, in- or out-patient, time of starting treatment, pretreatment severity of pyuria, total number of bacteria before treatment) revealed no significant difference among the 3 groups. Therapeutic effect evaluated by physicians in charge was not significantly different among the 3 groups on day 5 or day 14. In terms of overall therapeutic effect, all 3 products were very effective in patients infected with sensitive bacteria: On day 5, 85.4% in S6472 group, 84.4% in CCL group, and 83.7% in CEX group. There was no significant difference among the 3 groups on either day. The incidence of side effects was not significantly different among the 3 groups: 4 out of 129 patients treated with S6472 (3.1%), 2 of 131 treated with CCL (1.5%) and 2 of 128 with CEX (1.6%). Clinical laboratory tests revealed 4 abnormal findings in 4 patients treated with S6472, 6 findings in 4 treated with CCL, and 4 findings in 2 treated with CEX, showing no significant difference in incidence among the 3 groups. Both side effects and abnormal clinical laboratory findings were mild and reversible. Physicians in charge judged the usefulness of the 3 drugs on days 5 and 14, taking efficacy and safety into consideration. Significant difference was not observed. The presence of recurrence was examined 7 days after drug withdrawal in patients regarded as remarkable responders to 14-day treatment by overall therapeutic effect evaluation.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗