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[Asymptomatic microhematuria].

Microscopic haematuria is an urinary finding more and more frequently observed in routine analysis in childhood; the diagnostic problems, most of which unresolved, are yet the principal questions of concern. We have studied 123 patients during five years from 1975 to 1980, and followed them for 1-8 years (mean 4 years). Our experience allowed us to consider "normal" or without remarkable pathologic significance a urinary finding less than or equal to 5.000 RBC/m' at the Addis count. Such findings were pointed out in 55 cases (44%); 27 patients (22%) had 5-10.000 RBC/m', 34 cases (27,6%) presented 10-50.000 RBC/m' and 7 cases (5,7%) had more then 50.000 RBC/m'. The familiar background, the clinical, biological and immunological data, the roentgenographic investigations and the renal biopsy carried out in the 4 groups of patients, led us to the following conclusions: 1) 26% of the 123 cases had a "unexplained;; microscopic haematuria with complete lack of anamnestic data, symptomatology and with normal biological findings. 2) in 65,8% of the cases it was possible to discover frequent upper respiratory tract infections (and allergy in 5,6% of them). 3) in 26% of the patients we discovered a previous or actual genito-urinary (10,5% and 15,5% respectively) infection: 9,4% of 96 urography demonstrated a variable degree of nephro-urological abnormalities. 4) 23 children (18,7%) was selected for renal biopsy, primarily by the hypocomplementemia and positive anti-DNA ab. test, and secondly by elevated degree of microhematuria. The histological and immunohistochemical studies demonstrated the presence of mesangial proliferation glomerulonephritis with IgG-IgA-C3 deposits in 7 cases (30% of the cases biopsied and 5,6% of the total), 69,6% of the cases had only minimal charges with negative immunofluorescence. 5) A mean follow-up of 4 years in two groups of patients (less than or greater than 6 years of age) has demonstrated that microscopic haematuria remains unchanged in 18-19% of both groups. A more marked improvement or normalization has been documented in the children more than 6 years aged (p less than 0,001) while a worsening has been observed in the children less than 6 years aged (p less than 0,005), with a statistically significant difference between the two groups considered.

Adolescent↗

[Antibiotic prophylaxis for transurethral resection of the prostate--comparison of oral administration therapy with intravenous administration therapy].

To compare the prophylactic effect of oral and intravenous antibiotics against postoperative fever and urinary tract infection (UTI) after transurethral resection of the prostate (TUR-P), we conducted a multi-center prospective randomized study. The incidence of pyrexia over 38 degrees C was defined as the primary endpoint. One hundred and fifty patients with sterile urine before TUR-P were entered into this study. The patients were allocated randomly into the two arms; arm A cefotiam 4 g a day for 7 days, arm B tosufloxacin 300 mg a day for 7 days, based on the stratification into the 4 groups determined with/without preoperative indwelling catheters and with/without the history of preoperative UTI. Of these patients, 143 were eligible. We divided 124 patients without preoperative UTI and without indwelling catheters as the "low risk group", and the other 19 patients with preoperative UTI and/or with indwelling catheters as the "high risk group". In the low risk group, 9 patients out of 63 (14.3%) in arm A and 6 out of 61 (9.8%) in arm B had pyrexia during 7 postoperative days. The incidence of fever in arm B was 4.4% less than that in arm A and the 95% confidence limit was from -7% to 16%. In the high risk group, 4 out of 11 (36.4%) patients in arm A and none of 8 in arm B had fever but the difference was not significant. The incidence of post operative UTI in the low risk group on the 4 to 5, 9 to 12, 23 to 26 and 37 to 40 postoperative days was 8.3, 16.4, 25.0 and 23.9% in arm A and 6.7, 16.7, 29.6 and 36.7% in arm B, respectively. The prophylactic effect of oral administration of tosufloxacin is equivalent to that of the intravenous administration of cefotiam. The use of oral antibiotics is beneficial to reducing the cost of medication.

Administration, Oral↗

[Alport's-syndrome: diagnosis, light- and electronmicroscopic findings (author's transl)].

Alport's syndrome is a hereditary nephropathy with grave prognostic consequences. The occurrence of this disease is probably more frequent than was assumed until now - many cases are not immediately recognized as such. It is possible to make a clinical diagnosis from detailed family histories and through careful examinations of family members including audiometric tests. In the early stages of the disease children merely have recurrent macro- or microhematuria. Renal functional tests are normal and there is general well-being of the patient. Whereas the biopsy specimens examined by light microscopy show non-specific alterations, those examined under the electronmicroscope already show specific defects of the basement membrane. Our studies lead us to believe that these morphologic findings correspond with changes of the basement membrane, detectable by immunochemical investigations. 6 of 12 patients have been biopsied in recent time and the above cited typical changes of the basement membrane could be demonstrated. Therefore these investigations are recommended in Alport's syndrome.

Adolescent↗

Elevated prostate-specific antigen: a case report and analysis.

Prostate cancer is a frequent concern of the clinician caring for older male patients. The certainty of arriving at the correct diagnosis is related to the presenting patient's risk for prostate cancer, the results of the digital rectal examination, and the value of the serum prostate-specific antigen (PSA). A case report of a patient with acute urinary retention and an elevated PSA is presented. Possible explanations for the elevated PSA are discussed. The clinician's intuitive thought process is compared with an analytic approach using calculated probabilities. Several factors that complicate the estimation of the likelihood of prostate cancer are discussed.

Aged↗

Urinalysis predictive of urine culture results.

BACKGROUND: Most clinicians treat patients for presumptive urinary tract infections based on urinalysis findings. Which of these findings is the best predictor of infection? METHODS: A retrospective cross-sectional study of 202 serial subjects of all ages was conducted over 8 months in a typical family medicine setting. Urinalysis and culture were performed concurrently. RESULTS: The best predictors for significant bacteriuria (defined as a culture with more than 50,000 colony-forming units) were > or = 2+ bacteriuria (sensitivity, 0.74; specificity, 0.80), or > or = 10 white blood cells per high-power field (sensitivity, 0.816; specificity, 0.651), or a positive nitrite test (sensitivity, 0.395; specificity, 0.929). The optimal combination of any two of the three predictor variables also was determined. CONCLUSIONS: Standard urinalysis results can be highly predictive of infection in typical family practice patients.

Adolescent↗

Treatment of recurrent urinary tract infection in children. II. Compliance of parents and children with antibiotic therapy regimen.

Since none of the studies of long-term management of recurrent urinary tract infections considered the possibility of patients' not taking medication, compliance with long-term antibiotic therapy was tested by urine check in 93 children with recurrent urinary tract infection. Only 30 children (32.2%) took the prescribed drugs at regular intervals, 27 children (19.1%) did not take the antibiotics at all and 36 patients took the drugs irregularly, skipping one or two doses a day. The difference in infection rate between regular takers (3.9/year) and non-takers (7.2/year) and irregular takers (4.8/year) and non-takers was statistically highly significant. Forgetfulness and negligence of the parents was found to be the main reason for not giving the child the medication. Treatment studies which show the advantage of one regimen over another or which try to define optimal duration of therapy should take particular care in evaluation compliance.

Administration, Oral↗