[Significance of the movement of pathogens into the upper urinary passages in female patients with recurring nonobstructive urinary tract infections. I. Pyelonephritis].
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Adolescent↗
Biomedical subjects
H Scherf
Publications and source records attributed to H Scherf.
[Pathogenetic significance of the passage of microorganisms into the upper urinary tract in female patients with recurring, nonobstructive urinary tract infections. II. Pyelitis].
With the help of three arguments which come from the data analysis of a special consulting hour is demonstrated the ascents of germs into the prevesical urinary tracts in female patients with relapsing, non-obstructive urinary infections not in the least in every case lead to a recognizable lesion of the kidney. The thesis is erected that the generally tabooed pyelitis by all means corresponds to a clinical reality. This thesis is discussed in the light of findings from animal experiments and clinical findings from literature.
Adolescent↗
Mezlocillin: a new acyl ureidopenicillin. Antimicrobial activity and combination effects with four aminoglycoside antibiotics.
Mezlocillin (Baypen), carbenicillin and mezlocillin combined with gentamicin, sisomicin, tobramycin and amikacin, respectively, were tested in vitro against 325 fresh clinical isolates of pathogenic gram-negative bacteria using the tube dilution procedure. The new acyl ureidopenicillin has a greater antimicrobial activity than carbenicillin against nearly all species tested. The comparison of the effectiveness of the mezlocillin-aminoglycoside combinations demonstrates the superiority of mezlocillin-sisomicin against Escherichia coli, Klebsiella, Serratia and Proteus spp., whereas mezlocillin-tobramycin is most active against gentamicin-sensitive Pseudomonas aeruginosa, and mezlocillin-amikacin against Enterobacter and gentamicin-resistant P. aeruginosa. The combination effects achieved in the majority of strains were addition or synergism. The resistance rate and the bactericidal efficacy of mezlocillin were clearly improved when mezlocillin was combined with aminoglycoside antibiotics. Mezlocillin-amikacin showed the lowest resistance rate (10.2%) followed by mezlocillin-sisomicin (12.3%), mezlocillin-gentamicin (15.1%) and mezlocillin-tobramycin (18.5%). In most species, mezlocillin-sisomicin has proved to be the combination with the best bactericidal potency.
Amikacin↗
[Antibody-coaded bacteria in urine sediment of children with urinary tract infections (author's transl)].
In 40 girls and 9 women with recurrent, non-obstructive urinary tract infections, and in 5 patients with nephrolithiasis the site of infection was determined by 108 bladder washout tests. The corresponding sediments were examined for antibody-coaded bacteria using an immunofluorescence test (IFT). The IFT was positive in 18 (72%) of 25 supravesical bacteriurias. Out of 75 vesical bacteriurias 39 infantile and 7 adult (together 61%) specimens contained antibody-coaded bacteria. We think the IFT is of no diagnostic value in localizing recurrent urinary tract infections in girls. For adults such an evaluation is not yet possible due to our small number of cases.
Adolescent↗
[Occult reflux (author's transl)].
Level diagnosis repeatedly performed in patients without roentgenologically demonstrable reflux demonstrated bladder bacteriuria in 80% of the cases. The remaining 20% had supravesical bacteriuria. We called this occult reflux, if reinfection was demonstrated. Contamination of the upper tract by occult reflux can, but must not induce pyelonephritis. Bilateral antireflux surgery frequently eliminates occult reflux of bacteria, so this seems a debatable method of treatment.
Adolescent↗
[The value of direct localization studies for the surgical treatment of urinary tract infections (author's transl)].
Techniques to localize an upper urinary tract infection--the bladder wash-out test and the ureteral catheterization method--are described. Case reports are given to demonstrate the usefulness of these methods when surgical treatment of urinary tract infections seems to be indicated.
Adolescent↗
[Can recurrent urinary tracts infections with existing vesicoureteral reflux be checked (author's transl)].
Of 35 female patients with vesicoureteral reflux, 9 had a cessation of their urinary tract infections while the reflux persisted. These findings contrast with the thesis that vesicoureteral reflux is the major cause of susceptibility to urinary tract infections in these patients.
Adult↗
["Removing of infection" through nephrectomy of the pyelonephritic atrophic kidney].
On the basis of own examinations is shown: 1. In female patients with non-obstructive infections of the urinary tract and unilateral pyelonephritic cirrhosis of the kidney the recidivations of the infections are in general not to be traced back to the flaring up of old germinal areas in them. 2. For this reason the removal of the diseased kidney also does not in general effect a sanation of the infection. In most cases it is not necessary, occasionally even harmful. 3. The nephrectomy with the aim of the sanation of the infection is indicated only then, when was proved that kidney is focus of the germ. This is possible only with the help of an exact localisation diagnostics and identification of the germs.
Atrophy↗
[Functional efficiency of the vesico-ureteral closure mechanism in female patients with recurrent urinary tract infections without reflux].
On account of different relapses of infections in 15 female patients with relapsing non-obstructive infections of the urinary tract without radiologically provable vesico-ureteral reflux altogether 183 washing out tests of the urinary bladder were performed. 83.6% of the tests resulted in a pure bacteriuria of the bladder and 14.2% in a supra-vesical participation. Of the 51 female patients 38 = 74,5% were always suffering only from bacteriurias of the bladder. In 13 patients = 25.5% we also or always found a supravesical participation. 15 female patients underwent a reflux test with technetium-levelled sulphocolloid. In no patient the tracer could be localised in the supravesical urinary tract. By reason of these results we are of the opinion that in the majority of female patients the vesico-ureteral occlusion mechanism does not allow an ascent of the germs. Therefore, the majority of patients is not imperilled by pyelonephritis. Among the female patients with relapsing non-obstructive infections of the urinary tract without radiologically provable reflux are some with marginally competent ostia. In these more or less frequently an occult reflux with ascent of the germs into the supravesical urinary tract may develop. These patients are potentially imperilled by pyelonephritis.
Adolescent↗
[The susceptibility to urinary tract infections after antireflux operations (author's transl)].
The results of a prospective bacteriologic follow-up of 21 consecutive female patients, who had an antireflux operation are given. Only those patients with a proven active susceptibility to urinary tract infection at the time of operation were included in this study. Of these patients, 89% had persistent recurrent urinary tract infection, though the reflux was corrected. Bacteriologic controls and long-term chemotherapy seem warranted in those patients after operation.
Adolescent↗
[Determination of serum antibodies using the fluorescent antibody technic in children with recurrent urinary tract infections].
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Adolescent↗
[The periurethral flora in female patients with recurrent urinary tract infection (UTI) (author's transl)].
In 52 girls and 38 women with recurrent nonobstructive UTI 529 bacterial samples were obtained from the periurethral area under the following conditions: no bacteriuria and no chemotherapy for at least 3 weeks before the examination. In 225 samples we found E. coli and enterococci as the most frequent potentially uropathogenic bacteria. In the periurethral region these were found approximately twice as frequently as in urologically normal persons. 36 (40%) of the patients had no further recurrences during the follow-up, though 107 (44%) of the swabs showed an abnormal bacterial colonization. 54 (60%) of the patients, many of them with very frequent recurrences, in only 118 (41%) of the obtained samples showed an abnormal periurethral flora. The findings suggest that the periurethral flora is not the most important factor in the pathogenesis of UTI.
Adolescent↗
[Potentially uropathogenic enterobacteria on the periurethral mucosa of urologically normal individuals (author's transl)].
Swabs from the periurethra from 160 urologically normal individuals, male and female, of various age groups were examined for potentially uropathogenic enterobacteria. Children from 0--3 years constantly showed (100%) high numbers of different enterobacteria. The frequency of identification and the number of these bacteria diminished abruptly with advancing age. In adult women we found a prevalence of 15%. The periurethral flora with regard to enterobacteria is probably the result of a dynamic equilibrium between contamination and elimination. The important role of contamination is documented by the massive seeding in the 0--3 years age group and the abrupt diminuition after successful bowel training. The mechanism of elimination is unknown. Personal hygiene, the pH of the periurethral mucosa, a special antibacterial substance and the ecological equilibrium of the periurethral flora are discussed as possible factors.
Adolescent↗
[Localizationstudies in female patients with recurrent urinary tract infection. I. Patients without ureterovesical reflux (author's transl)].
In 16 girls and 12 women with recurrent urinary tract infection without ureterovesical reflux we performed 75 bladder washout-tests. 52 (72%) tests indicated a vesical, 19 (27%) of supravesical bacteriuria. The 16 girls had less often (18%) supravesical bacteriurias than the 12 women (58%). If follows that in the absence of reflux, ascension of bacteria from the bladder to the upper tract is a relatively frequent phenomenon, the pathogenic importance of which is not yet clear. Clinical manifestations and urographic aspect correlated rather poorly with the results of the bladder-washout-test.
Adolescent↗
[Localizationstudies in female patients with recurrent urinary tract infection. II. Patients with ureterovesical reflux (author's transl)].
In 17 girls and 5 women with urinary tract infection and low-pressure reflux we performed 23 bladder-washout-tests. 12 were interpreted as supravesical, 11 as vesical bacteriurias. All patients with vesical bacteriurias had a normal IVP. The majority of patients with supravesical bacteriurias had clubbing and scarring. The possibility of interpreting the supravesical bacteriurias as a sign for pyelitis rather than pyelonephritis is discussed.
Adolescent↗
[Localizationstudies in female patients with recurrent urinary tract infection. III. Patients after successfull antireflux-operation (author's transl)].
In 14 girls and 5 women with recurrent urinary tract infections after successfull antireflux-operation we performed 72 bladder-wash-out-tests. Whereas preoperatively 50% of the patients had a supravesical bacteriuria, only 25% had it postoperatively. Most of the postoperativ vesical and supravesical bacteriurias were interpreted as reinfections. The demonstrated postoperativ ascension of bacteria in the upper urinary tract in spite of successfull surgical treatment cannot be taken as an argument against operation. The postoperative supravesical bacteriurias are less frequent and have less morbidity than the prepoerative supravesical infections.
Adult↗
[Letter: Incident in infusion therapy using the perfusator].
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Aged↗
[Localization of urinary infection after antireflux surgery (author's transl)].
Bladder wash-out tests were performed in a series of patients after successful antireflux surgery. The majority (65.5%) of infections were localized in the bladder, even if the IVP demonstrated signs of pyelonephritis (renal scarring and calcieal clubbing). 21.3% of the tests demonstrated a participation of the upper urinary tract. The bladder bacteriurias were interpreted as reinfections, and also some of the supravesical bacteriurias. In other cases, this differentiation could not be made.
Adult↗