[Renaissance for the use of methenamine in the prevention of recurrent cystitis].
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Cystitis↗
Biomedical subjects
S Hellsten
Publications and source records attributed to S Hellsten.
Organ distribution of Adriamycin after intravesical instillation with or without Tween 80 in the rat.
The absorption of Adriamycin (ADM) into the systemic circulation and into different organs including the urinary bladder was investigated in the rat after intravesical instillation of ADM with or without a surface active detergent, Tween 80. The postinstillation plasma concentration of ADM increased significantly with increasing dose of the drug. Even though the leakage of ADM into the systemic circulation and into extravesical organs in general was slight a significant increase was observed after addition of Tween 80. The uptake of ADM into the urinary bladder wall was also significantly enhanced by Tween 80 thus the role of this agent in conjunction with intravesical chemotherapy should be further investigated.
Absorption↗
Prevention of recurrent acute cystitis by methenamine hippurate: double blind controlled crossover long term study.
In a randomised, double blind, long term, crossover study 1 g twice daily of methenamine hippurate was compared with placebo for its preventive effect on recurrent attacks of acute cystitis. Methenamine hippurate and placebo were interchanged every six months for two years. During one of the years patients took 250 ml extra fluid every morning and evening. Out of 21 enrolled patients, 14 completed the first year and 13 both years of treatment, which permitted the evaluation of 27 patient years. There were 52 episodes of acute cystitis caused by reinfection: 41 occurred during placebo treatment and only 11 during the methenamine hippurate regimen (p less than 0.01). Extra fluid intake did not reduce the incidence of acute cystitis, nor did it reduce the effect of methenamine hippurate. Methenamine hippurate is an effective prophylactic agent against recurrent acute cystitis and has the advantage of not inducing cross resistance to conventional antibiotics.
Acute Disease↗
Absorption of Adriamycin into the systemic circulation after intravesical instillation with or without Tween 80 in the rat.
The absorption of Adriamycin (ADM) into the systemic circulation after intravesical administration, using an experimental model in the rat, was closely related to the volume of the instilled solution and the concentration of the drug. The post instillation plasma concentration of ADM was increased after addition of Tween 80 to the instilled solution but the magnitude of the absorption was still discreet and, from a clinical point of view, negligible.
Absorption↗
Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery.
The efficacy of a short (Group I) and a prolonged (Group II) course with ciprofloxacin was assessed in patients undergoing transurethral prostatic resection for benign hyperplasia or cancer of the prostate and compared with that of controls without antibiotic (Group III). Both regiments significantly reduced the frequency of postoperative bacteriuria (p less than 0.01) and of severe infectious complications (p = 0.004) as compared to the controls. Both regimens were equally effective in preventing perioperative and postoperative acquisition of bacteriuria in patients without bacteriuria at surgery. In patients with bacteriuria before surgery, bacteriuria was found postoperatively in 35% in Group I and 10% in Group II (p = 0.012), but in 82% of the patients in Group III. Ciprofloxacin inhibited all but 7 of 176 bacterial strains at an MIC of less than or equal to 1 microgram/ml. Given orally ciprofloxacin is a valuable alternative antimicrobial for use in conjunction with transurethral prostatic resection. A short course is sufficient for prophylaxis, and adequate therapy is achieved with a prolonged regimen.
Aged↗
The effectiveness of a short perioperative course with pivampicillin/pivmecillinam in transurethral prostatic resection: clinical results.
In a randomized control study comprising 261 patients undergoing transurethral prostatic resection (TUR), the effect of a short perioperative course with the oral combination of pivampicillin/pivmecillinam (PAPM) was analysed in 129 patients. The study was divided in 2 parts: the first 60 patients received 450 mg and the following 69 patients, 900 mg every 12 h until removal of catheter but not longer than for 1 week. 132 controls received parenterally 1 g of cefotaxime (CFT) daily throughout the study. During the first part of the study the frequency of bacteriuria in the PAPM group was 43% preoperatively and 30% 10 days postoperatively, during the second part 47% and 12%, respectively (p less than 0.025). In the CFT group the frequency of bacteriuria was reduced from 52% preoperatively to 28% postoperatively. The prophylactic effect (i.e. the protection against acquired bacteriuria) was 96% and 92% in the PAPM and the CFT groups, respectively. Preoperative bacteriuria was eliminated in 40% of the patients during first part and 69% during second part in the PAPM group, while corresponding figures were 48% and 46% in the cefotaxime group. There were 2 cases of septicemia and 5 of upper urinary tract infections throughout the study evenly distributed between the two groups. Oral pivampicillin/pivmecillinam 900 mg every 12 h was found to be a good alternative for perioperative antibiotic prophylaxis at TUR.
Administration, Oral↗
Cardiovascular complications of estrogen therapy for nondisseminated prostatic carcinoma. A preliminary report from a randomized multicenter study.
In a prospective multicenter study, 244 men with highly or moderately differentiated prostatic cancer in stage I, II or III (VACURG) were consecutively randomized to three groups of treatment: Group A (77 patients) received polyestradiol phosphate (Estradurin, Leo) 80 mg i.m. every fourth week + ethinyl estradiol (Etivex, Leo) 150 micrograms daily, group B (72 patients) estramustine phosphate (Estracyt, Leo) 280 mg twice daily, and group C (76 patients) no therapy. Only men without current or previous other malignancy and without cardiovascular disease were admitted to the study. After 4 1/2 years 125 of the 244 patients had left the study, 9 because of cancer progression (stage IV, VACURG). The most serious complications were cardiovascular, including ischemic heart disease, cardiac decompensation, cerebral ischemia and venous thromboembolism, which occurred in 24 patients from group A and 9 from group B as compared to only one patient in group C. The subgroup superficial or deep venous thrombosis comprised 11 group A and 2 group B patients. Estrogens (E + e) offered as palliative treatment to patients with non-generalized prostatic carcinoma is burdened with a high incidence of serious cardiovascular complications.
Aged↗
Long-term follow-up after transurethral prostatic resection with or without a short peri-operative antibiotic course.
This study was undertaken to analyse the results in 192 patients who 3 to 4 years earlier had undergone transurethral resection (TUR) in a controlled clinical trial on the value of a short peri-operative course of antibiotics. The survival rate was comparable in both groups. Most deaths were due to cardiovascular disease and/or cancer of the prostate and the gastrointestinal tract. Infectious events predominated in the control group and more antibiotics were prescribed for these patients during follow-up than for the patients in the peri-operative antibiotic group. Bacteriuria was found in 24% of patients, evenly distributed between the groups. Eighty-three per cent were satisfied with the results of prostatectomy but 38% complained of symptoms from the lower urinary tract. The maximum urinary flow rate was not influenced by the presence of bacteriuria and/or symptoms. There was no difference between the groups regarding mortality or morbidity except for the frequency of post-operative urethral stricture formation, which was significantly higher in the controls. It was concluded that prospective long-term follow-up is indicated to assess the effect of short peri-operative antibiotic courses.
Aged↗
[Vasectomy--a follow-up study of 53 patients after surgery].
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Adult↗
Species distribution and antibiotic sensitivity of bacteria isolated pre- and postoperatively from patients undergoing transurethral prostatic resection.
The identity and antibiotic sensitivity of the isolated bacteria from 179 patients undergoing transurethral resection of the prostate were analysed. The patients were randomized into a group receiving a short course of cefotaxime in conjunction with the operation and a control group given no antibiotics. Preoperatively 70 patients had bacteriuria (greater than or equal to 10(7) CFU/l) with a predominance of Gram-negative bacteria (57 isolates, mainly Escherichia coli, Enterobacter, Klebsiella ssp, Proteus ssp), although Gram-positive species (24 isolates, mainly enterococci and Staphylococcus epidermidis) were also frequently encountered. Preoperatively isolated pathogens were evenly distributed in both groups and the sensitivity pattern was comparable. In the cefotaxime group postoperative recurrence of the preoperatively identified bacteria occurred in a lower frequency (11/43) than persistence in the control group (24/38). Only Gram-negative pathogens were isolated from patients with postoperative septicemia and upper urinary tract infections indicating that it is most important to direct prophylaxis against Gram-negative bacteria. A high degree of sensitivity against cefotaxime, gentamicin, trimethoprim, co-trimazine and a combination of ampicillin and mecillinam was recorded among both pre- and postoperatively isolated bacteria.
Adult↗
A short antibiotic course given in conjunction with and after catheter removal consecutive to transurethral prostatic resection.
In a prospective randomized study of 96 patients, the effect of a short antibiotic course given after transurethral prostatic resection was analysed. Cefotaxime (1 g. i.m. every 12 hours to a total of 3 g) was given to 47 patients with the first doses when the postoperative catheter was removed while 49 were assigned to a control group without antibiotic. The frequency of bacteriuria was 48% preoperatively in the cefotaxime group and 33% six weeks postoperatively. In the control group the corresponding figures were 63% and 50% (p greater than 0.1). There were two cases of septicemia in each group immediately post-operatively whereas upper urinary tract infection developed in five patients in the control group and one patient in the cefotaxime group (p greater than 0.1). The total number of infectious and non-infectious complications was significantly greater in the control group (22) compared to the cefotaxime group (12) (p less than 0.05). The patients receiving the antibiotic remained a shorter time in hospital as compared to the controls. Bacteriological analysis showed a good in vitro effect of cefotaxime on isolated bacteria.
Aged↗
The effect of a short antibiotic course in transurethral prostatic resection.
In a prospective randomized study of 192 patients, the effect of a short course of cefotaxime in connection with transurethral prostatic resection was analyzed. The antibiotic was given to 98 patients, while 94 were assigned to a control group without antibiotic. The frequency of bacteriuria in the cefotaxime group was 43% preoperatively and 18% six weeks postoperatively. In the control group the corresponding figures were 40 and 42% (p less than 0.01). Complicated postoperative infection did not occur in the cefotaxime group, but in the control group there was one case of septicemia and seven patients had upper urinary tract infections (p less than 0.01). In the cefotaxime group, patients with preoperatively negative urine culture were prevented from acquiring bacteriuria, and 67% of preoperatively present infections were eliminated at six weeks after the operation, as compared with 30% in the control group. There were essentially no side effects of cefotaxime. Renal function was not influenced by the combination of cefotaxime and furosemide.
Aged↗
Intravesical adriamycin therapy in carcinoma in situ of the urinary bladder.
Intravesical Adriamycin treatment was given to 22 patients with carcinoma in situ of the urinary bladder. The treatment schedule consisted of monthly Adriamycin instillations in a dose related to bladder capacity. Endoscopic inspection with multiple bladder biopsies and cytoanalysis of urine was performed after every third instillation. In two patients there was lasting disappearance of the carcinoma in situ. Another 10 patients possibly had a beneficial effect of the treatment. The remaining 10 patients showed persistent malignancy and in 6 of these, progression of carcinoma in situ during Adriamycin treatment necessitated cystectomy or radiotherapy. The histologic and cytologic findings showed distinct variability in most patients, with atypia or even absence of malignant cells often followed by recurrence. Adriamycin was discontinued in four cases because of severe cystitis, and in one case because of an anaphylactoid reaction following instillation of the drug.
Aged↗
Clinically unrecognised renal carcinoma: aspects of tumor morphology, lymphatic and haematogenous metastatic spread.
In a series comprising 235 clinically unrecognised renal carcinoma, metastatic spread was found in 56 cases (24%). In 82% of cases with metastases the spread involved more than one site. Lymphatic spread was diagnosed in 37 patients. Lymph node metastases were usually multiple and multifocal and were almost as common in the mediastinum as in the retroperitoneal space. In cases with involvement of these sites and/or supraclavicular nodes, concomitant metastases in the lungs were observed in 86% and in other organs in 11%. Since lymph node invasion is a strong indicator of systemic spread, the therapeutic benefit of radical lymphadenectomy seems very low, whereas a limited unilateral dissection is justified mainly for its value as a staging procedure.
Adenocarcinoma↗
Bladder carcinoma. Long-term survival and late recurrence.
The records of 115 patients with bladder carcinoma and five years or longer post-diagnosis survival were surveyed after reclassification of the histologic specimens according to UICC. Late recurrence, 5-10 years after the initial diagnosis, was found in 39 patients (34%). Fourteen patients (12%) had died of bladder carcinoma during the observation period, generally as a consequence of transformation to higher tumour stage. Intercurrent disease, i.e. cardiovascular disorders or a second malignancy, led to 21 intercurrent deaths (18%). Large size and high grade of the primary tumour, but not multiplicity, were significantly associated with poorer long-term prognosis. The study underlines the importance of close long-term follow-up of patients with bladder carcinoma in order to permit early detection and treatment or recurrent tumours.
Adult↗
Clinically unrecognized renal cell carcinoma. An autopsy study.
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Adenocarcinoma↗
Therapy of bladder carcinoma. Long-term results of a retrospective study of 214 cases.
Two hundred and fourteen bladder carcinomas were evaluated retrospectively after reclassification of histological specimens according to UICC. Follow-up time was 7 years or longer. Large size but not multiplicity of the primary tumour indicated a poor prognosis. Local infiltration, even if superficial and restricted to the lamina propria, worsened prognosis as well as high grade of the tumour. Late deaths in the present series were generally explained by a progression in stage in patients with high grade tumours at initial assessment. Therefore a close longterm follow-up should be performed in these patients.
Adult↗
Unrecognized renal cell carcinoma. Clinical and diagnostic aspects.
In a series of 16294 autopsies 350 cases of renal cell carcinoma were found. Of these tumours 235, i.e. two thirds, were unrecognized during lifetime. Metastatic spread was revealed in 56 patients (24%) with unrecognized renal cell carcinoma and was the main cause of death of 49 patients (21%). In 67 patients (33%) a second malignant tumour was observed causing the death of 47 patients (20%). Most patients died with rather than from the renal malignancy. The symptomatology as to the renal malignancy was generally poor. Haematuria, palpable mass, polycythemia and fever of unknown origin were less common findings in the present series as compared with fatigue, loss of weight and symptoms from metastatic sites.
Adenocarcinoma↗