SUBDURAL EMPYEMA: A REVIEW OF 29 CASES.
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Adolescent↗
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STENDOMYCIN: A NEW ANTIFUNGAL ANTIBIOTIC.
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Animals↗
Management of infection stones: the Stanford experience.
In summary, 46 renal lithotomies were performed in 40 patients for struvite infection stones. All patients had documented urinary tract infections at the time of surgery; all stones were cultured, demonstrated to contain bacteria and proved crystallographically to be composed primarily of struvite with smaller amounts of apatite. The recurrence rate in a mean followup period of 7 years was 2.5% (one patient). The negligible recurrence rate emphasizes that struvite stones are caused by urea-splitting bacteria, rather than metabolic disorders, and that a comprehensive approach that emphasizes biochemical, bacteriologic, and roentgenographic techniques is more important than the type of surgical procedure used to remove the stones. We believe that our routine of leaving a small polyethylene nephrostomy tube in every patient, combined with postoperative plain-film tomograms regardless of the results of intraoperative radiography, and the liberal use of hemiacidrin irrigation to dissolve any residual struvite particles with their entrapped bacteria, accounts for the virtual absence of stone recurrences in our series.
Adolescent↗
[Risk of infection in instrumental and surgical urologic interventions with special reference to catheter drainage].
The risk of infection in instrumental and operative urological surgery is particularly high in the use of catheter drainage. Dependent on the duration of use of a fistula catheter or a transurethral catheter, infection of the urinary tract occurs in almost 100% of cases. The pathogens of hospital infection show a clearly increasing drug resistance. The occurrence of multiple resistances is remarkable. Furthermore, fluctuations in the range of pathogens can be detected. An increase of infection by Proteus and Klebsiella and a decrease of infections of the urinary tract with Escherichia coli and staphylococci have been observed. Prophylactic administration of chemotherapeutic agents cannot prevent the recurrence of iatrogenic infections of the urinary tract.
Adult↗
Proteus mirabilis flagella and MR/P fimbriae: isolation, purification, N-terminal analysis, and serum antibody response following experimental urinary tract infection.
Urinary tract infection with Proteus mirabilis may lead to serious complications, including cystitis, acute pyelonephritis, fever, bacteremia, and death. In addition to the production of hemolysin and the enzyme urease, fimbriae and flagellum-mediated motility have been postulated as virulence factors for this species. We purified mannose-resistant/proteuslike (MR/P) fimbriae and flagella from strains CFT322 and HU2450, respectively. Electron microscopy revealed highly concentrated preparations of fimbriae and flagella. Fimbrial and flagellar structural subunits were estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to be 18.5 and 41 kDa, respectively. N-terminal sequencing revealed that 10 of the first 20 amino acids of the major MR/P subunit matched the sequence of the P. mirabilis uroepithelial cell adhesin N terminus and 11 of 20 amino acids matched the predicted amino acid sequence of the Escherichia coli P fimbriae structural subunit, PapA. In addition, 90 and 80% homologies were found between the first 20 amino acids of P. mirabilis flagellin and those of Salmonella typhimurium phase-1 flagellin and the E. coli hag gene product, respectively. An enzyme-linked immunosorbent assay using purified antigens showed a strong reaction between the MR/P fimbriae or flagella and sera of CBA mice challenged transurethrally with P. mirabilis. A possible role for MR/P fimbriae in the pathogenesis of urinary tract infection is supported by (i) a strong immune response to the antigen in experimentally infected animals, (ii) amino acid sequence similarity to other enteric surface structure, and (iii) our previously reported observation that MR/P fimbriae are expressed preferentially as the sole fimbrial type in human pyelonephritis isolates.
Amino Acid Sequence↗
Infection of a ventricular aneurysm and cardiac mural thrombus. Survival after surgical resection.
Infections of cardiac mural thrombi are rare, and because antemortem diagnosis is difficult and antibiotic therapy alone ineffective, the associated mortality has been significant. A patient with gram-negative bacillary infection of a mural thrombus is described. Gallium 67 citrate isotope scanning and two-dimensional echocardiography were helpful adjuncts in establishing the diagnosis. Surgical resection of the infected myocardial tissue and prolonged antimicrobial therapy were necessary for cure.
Aged↗
TREATMENT OF INFECTIONS WITH COLISTIMETHATE SODIUM (COLY-MYCIN).
Colistimethate sodium (Coly-Mycin) was used in the treatment of 17 patients: 13 had urinary tract infections (two of these had positive blood cultures), three had respiratory tract infections, and one patient had both urinary and respiratory tract infections. In nine of the 17 a foreign body-either a carcinoma, a catheter, or a stone-complicated the infection.The dosage used was 1.1-2.3 mg./lb./day with a maximum in one case of 2.4 g. given over an eight-day period. The organisms so treated included Pseudomonas, six; Aerobacter, six and E. coli, two. Both Pseudomonas and Aerobacter were encountered in three cases.On bacteriological grounds, six patients were cured, eight relapsed, and in three the infecting agent was replaced by another organism. The best responses were obtained in those patients with Pseudomonas infection. Side effects included nausea, vomiting, vertigo, paresthesias, and pain at the site of injection.Colistimethate sodium has a place in the treatment of Gram-negative infections excluding Proteus organisms.
Colistin↗
The treatment of infection stones with penicillin.
The use of oral penicillin therapy is important in the management of renal stones secondary to Proteus mirabilis urinary tract infections. In 16 of 20 patients (80 per cent) with struvite renal calculi infected with Proteus mirabilis a sterile urine was achieved with appropriate penicillin therapy and diminution in stone size occurred in at least 2 cases. The rationale, supporting data and therapeutic uses are discussed.
Adolescent↗
[Septic pulmonary embolism, bacterial endocarditis and endocavitary pacemaker].
The number of patients carrying an endocavitary pacemaker is increasing every day. The presence of a foreign body in right cavities predisposes to the formation of thrombi that can be over infected from distal septic focci usually silent. When a pulmonary embolism is diagnosed in these patients, the initial study must include an echocardiographic exam in order to rule out the presence of an intracardiac thrombosis as the origin of the emboli. We present the case of a patient with and endocardiac pacemaker who was admitted with fever and repeated episodes of pulmonary embolism. Hemocultures were positive for proteus mirabilis and a electrocatheter thrombosis was demonstrated in bidimensional echocardiography. Proteus mirabilis was positive in cultures from the material obtained by cardiothomy and clinical evolution after surgery was satisfactory.
Aged↗
[Emphysematous pyelonephritis].
Pyelonephritis is a frequent infection of variable severity. Mortality is low since the era of antibiotics. Emphysematous pyelonephritis is however a rare but life threatening form of kidney infection, which affect more frequently diabetic subjects, characterized by gas producing bacteria. These gaseous lesions can be localized in the renal parenchyma or in the perirenal or retroperitoneal space. Diagnosis became easier with the advent of CT scan. Treatment usually requires surgery and antibiotics. We report a case of emphysematous pyelonephritis in a diabetic patient. The CT scan strongly suggested the diagnosis which was confirmed per-operatively. Proteus mirabilis is exceptionally described in emphysematous pyelonephritis.
Aged↗
[The effect of gentamycin on immunity in immunodeficiency and the action of immunomodulators].
The effect of 3 and 6 mg/kg gentamicin on the immunity of intact mice and cyclophosphan- and azathioprine-induced immunodeficiency was studied. Gentamicin deepens the severe suppression of antibody genesis against the background of cyclophosphan and azathioprine, inhibits the reaction of GZT in intact mice. The antibiotic does not prevent stimulation of AOK production by methyluracil and prodigiosan, and does not change the effect of immunostimulators on GZT in immunosuppression. Gentamicin has no effect on the phagocytic activity of neutrophils and macrophages in intact animals. The character of the effect of the antibiotic on phagocytosis depends on the genesis of immunosuppression. The effectiveness of gentamicin in experimental infection is maintained in immunosuppression also.
Adjuvants, Immunologic↗
Serum immunoglobulin response and protection from homologous challenge by Proteus mirabilis in a mouse model of ascending urinary tract infection.
We tested the hypothesis that experimental Proteus mirabilis urinary tract infection in mice would protect against homologous bladder rechallenge. Despite production of serum immunoglobulin G (IgG) and IgM (median titers of 1:320 and 1:80, respectively), vaccinated (infected and antibiotic-cured) mice did not show a decrease in mortality upon rechallenge; the survivors experienced only modest protection from infection (mean log(10) number of CFU of P. mirabilis Nal(r) HI4320 per milliliter or gram in vaccinated mice versus sham-vaccinated mice: urine, 100-fold less [3.5 versus 5.5; P = 0.13]; bladder, 100-fold less [3.1 versus 5.1; P = 0.066]; kidneys, 40-fold less [2.7 versus 4.3; P = 0.016]). Western blots using protein from the wild-type strain and isogenic mutants demonstrated antibody responses to MR/P and PMF fimbriae and flagella. There was no correlation between serum IgG or IgM levels and protection from mortality or infection. There was a trend toward elevated serum IgA titers and protection from subsequent challenge (P >/= 0.09), although only a few mice developed significant serum IgA levels. We conclude that prior infection with P. mirabilis does not protect significantly against homologous challenge.
Animals↗
[Emphysematous pyelonephritis].
OBJECTIVES: The etiopathogenic and therapeutic aspects of emphysematous pyelonephritis, an uncommon disease entity, are discussed. METHODS/RESULTS: We describe the clinical history of a diabetic with intercurrent gas-forming infection in the form of emphysematous pyelonephritis that was successfully treated. CONCLUSIONS: This disease entity, which is almost exclusive to diabetic patients, is unique. It produces a type of organism that warrants early and aggressive treatment.
Chronic Disease↗
Recurrent and residual renal calculi in children.
One hundred and thirteen children with non-metabolic urinary tract calculi were operated on between 1960 and 1983. One hundred were followed up for 3 to 17 years (mean 8.2). Seventeen children (15%) developed recurrent calculi after complete clearance at the initial operation and in 13 of these the stones recurred within 5 years. Proteus urinary infection was a constant feature of stone recurrence. Five patients required re-operation for removal of the recurrent calculus. Small residual caliceal fragments were left behind in 17 children but only 3 required surgical removal.
Adolescent↗
Infection of a renal cyst, a rare complication of bronchopneumonia.
The authors report a rare case of abscess developed in a solitary renal cyst and observed just after the resolution of a bronchopneumonia. The modern imaging techniques, sonography and computed tomography, permitted an exact diagnosis, and subsequent surgical treatment brought to a complete recovery.
Abscess↗
Infected false aneurysm following carotid endarterectomy with vein patch angioplasty.
The authors report a case of infected false aneurysm that developed after carotid endarterectomy with vein patch angioplasty. This complication is extremely rare and occurs most commonly when a Dacron patch graft has been employed. Various clinical presentations are described and the etiology of infection is discussed. Surgical management consisted of the resection of the pseudoaneurysm and segmental replacement with vein. Parenteral antibiotic therapy was given for three weeks and topical irrigation with an antiseptic solution performed for two weeks.
Aneurysm↗
[The immunotropic properties of rifampicin and their correction].
The effect of rifampicin on antibody genesis depends on the dose, duration, and time of its administration in relation to the antigen, as well as on the character of immunosuppression. The antibiotic has no effect on delayed hypersensitivity and stimulates the activity of phagocytes, predominantly that of neutrophils. The effectiveness of rifampicin in experimental infection is maintained in treatment with cyclophosphane and azathioprine. When administered in combination with rifampicin and cytostatics methyluracil possesses a broader spectrum of immunostimulating activity than that of prodigiosin and levamisole.
Adjuvants, Immunologic↗
Reduction of infection stones in rats by combined antibiotic and phosphocitrate therapy.
The potential of phosphocitrate to inhibit infection stones in rats when combined with an antibiotic was studied. A significant reduction occurred in both the number and weight of recovered stones from rats receiving combined treatment with amoxycillin (50 mg./kg. body wt./day and phosphocitrate (112 mumol./kg. body wt./day) for four weeks. The inhibitory responses were attributed to the intact phosphocitrate molecule as administration of citrate in equimolar concentrations did not mimic the observed effects of phosphocitrate. In comparison with non-infected controls, antibiotic treatment alone failed to eliminate total stone growth. However, composition of the stone reverted from predominantly struvite to a mixture of struvite and newberyite as urinary parameters normalized. The studies highlight the usefulness of phosphocitrate to restrict magnesium salt deposition in vivo.
Amoxicillin↗