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Milk-of-calcium stone is a rare finding in the kidney. It is diagnosed radiologically based on the fact that the opacity takes a semilunar shape and layers according to the position of the patient. An unusual observations is that layering may require some time to take place and that the semilunar configuration may be found incidentally in the supine position as well.
A case is reported of ureteral obstruction that was owing to eosinophilic pyeloureteritis, a previously unrecorded entity. The microscopic findings of extensive fibrosis and a relatively mild eosinophilic infiltrate were similar to those found in a series of eosinophilic cystitis, which was reported recently from this laboratory. Also, local injury appears to initiate some examples of eosinophilic cystitis and in the present case there was a striking history of injury 1 month before the symptoms of ureteral obstruction.
The etiology of pyeloureteritis cystica has long been attributed to chronic infection and inflammation. A case is presented that is unique in that the acute onset and the rapid resolution of pyeloureteral filling defects in this patient were documented by radiography. There is no evidence of antecedent or concurrent infection in this patient. The disease occurred subsequent to the initiation of heparin therapy for suspected pelvic thrombophlebitis and cleared rapidly subsequent to its discontinuation. The rate of resolution of the radiographic findings may be helpful in distinguishing between true pyeloureteritis cystica and submucosal hemorrhage.
In a Dutch general practice the adult female population was screened for asymptomatic bacteriuria (A.B.) by repeated urine culture after vulval cleansing. The prevalence of signficant A.B. was 4.7% and increased with age. Women with significant A.B. were followed up for one year. All symptomatic urinary-tract infections were recorded during the same period (incidence 59 per 1000 population). Women with significant A.B. at screening were divided into three groups according to the pattern of the follow-up results: transitory A.B., symptomatic A.B., and persistent A.B. The last group differed from the penultimate group with regare to the site of their urinary-tract involvement, symptomatic cases having predominantly upper-urinary-tract involvement and persistent cases lower-urinary-tract infection. In the matched control group the acquisition-rate of both symptomatic and asymptomatic 0acteriuria was over 12%, a figure similar to the percentage of women present in the practice population during one year with transient, symptomatic, and persistent A.B. Screening for A.B. in the general non-pregnant female population is not advocated at present. Screening and treatment of existing A.B. should be carried out in pregnant women who run an increased risk.
A young female presenting with a history suggestive of renal colic was found by intravenous pyelography to have Pyeloureteritis Cystica. In association with this condition she had a urinary tract infection due to a coagulase-negative staphylococcus. Following a two week course of appropriate antibiotic therapy, her urine became sterile and repeat pyelography revealed no abnormality.
In order to make an accurate comparison between ileal and colonic conduits, and ileal conduit was created from one kidney and a non-refluxing colonic conduit from the other kidney in 16 adult mongrel dogs. Colonic loops do not reflux, have equal resting pressures and rate of emptying when contrasted with ileal conduits, and carry a lower incidence of stomal complications. Colonic conduits respond more favourably to acute occlusion and produce a significantly lower rate of pyelonephritis at 3 months. These factors suggest that colonic conduits offer a definite advantage for long-term urinary diversion.
A rat-pseudomonad reflux model was employed to examine the effect of the size of inoculum on the emergence of renal infection. Widely varying degrees of renal disease observed in challenged animals indicated that a number of variables influenced the outcome of the host-parasite interaction. In this regard, animals in which there was a reduction of the colony counts below a threshold figure rarely gave evidence of renal infection when examined at autopsy on the eighth day following reflux. These results suggest that a threshold level of bacteriuria may also have to be exceeded if renal infection is to become established in patients with vesico-ureteric reflux.
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The efficacy and tolerance of Cefazedon, a new antibiotic, was investigated clinically on 90 patients with urinary tract infections who also required surgical treatment. Good clinical results were achieved in over 90% of patients after 6 to 7 days of treatment. The bacteriological examination revealed complete elimination of the initially identified pathogens in 89 cases. No difference in treatment results could be established when applying the dose 2 or 3 times daily. On the third day of treatment skin reactions were observed in one case which necessitated discontinuation of treatment. Laboratory blood values as well as control of liver and kidney function before treatment, after and one week past treatment showed no negative influence due to the drug. In approximately 27% a new colonisation mainly with Pseudomonas could not be prevented.
The course of pregnancy and delivery of 600 primiparae is being reported. These were divided into four age groups: very young primiparae (14-16 years of age, Group I), older primiparae (35-39 years of age, Group III) and old primiparae (40 years and more, Group IV). These age groups are being compared to a collective of primiparae, by whom the delivery took place at an age between 17 and 34 years (Group II). In these age groups the difference in complication rate during pregnancy, delivery and puerperium is demonstrated. The differences were statistically secured by means of X-2-test. The very young primipara shows the least tendency to delivery complications, still her pregnancy should be considered more risky as compared to Group II, owing to the higher rate of gestosis and the tendency to premature delivery. Groups III and IV show a rising risk rate with increasing age in regard to gestosis (10, 8-30, 8%) and premature delivery (15, 4-28, 6%); also the higher rate of operational delivery was significant (38, 9-44, 6%). The highest risk rate is to be expected in women, who deliver the first time at an age above 40 years. Also the perinatal mortality of newborn is at its highest in this group.
Ampicillin-cloxacillin (Rectocillin 'Kyowa') was administered either orally (capsules) or by intravenous drip infusion to a total of 40 patients and the following results were obtained: 1. Effectiveness obtained in the group received Rectocillin capsules (1,500 mg/day) was 80%. 2. Effectiveness obtained in the group received Rectocillin intravenous drip infusion (3 similar to 10 g/day) was 64.7%. 3. Side effects were encountered in 2 of 40 patients, but none of them were serious, and clinical abnormalities due to this antibiotic were not observed.
116 women with obstetric hepatosis gave birth in the years 1971-1972 at the First and Second Departments of Obstetrics and Gynaecology, University Central Hospital, Helsinki. This accounts for a 1.1% incidence of all deliveries at this hospital. During most of these pregnancies fetal well-being was monitored by amnioscopy, by the oxytocin challenge test, by maternal urinary oestriol determinations and by estimating the fetal biparietal diameter weekly. In 38% of these pregnancies, signs of fetal distress were found, mainly an abnormal heart rate, or heart rate pattern, and/or meconium-stained amniotic fluid. These led to increased frequencies of induction of labour and of Caesarean sections performed because of asphyxia or imminent asphyxia as compared with a control group with similar age and parity distribution. There was an increase in the occurrence of twin pregnancies in the hepatosis series (7.6%). There were 4 intrauterine and altogether 8 perinatal losses of 125 infants born to hepatosis mothers. These observations suppport the opinion that there are increased risks for the fetus in pregnancies complicated by obstetric hepatosis. Amnioscopy and fetal heart rate recording during the delivery and oxytocin challenge test were found to be valuable in monitoring the fetal condition. The use of oestriol determinations, at least by employing the method in general clinical practice, was found to be of limited value in the predictive assessment of fetal distress in hepatosis. This might be due to impurities disturbing the determinations or to changed oestrogen metabolism in cholestasis.
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Cefoxitin was given to the 7 patients of infections in the field of obstetrics and gynecology, and the following results were obtained: 1) The clinical response was excellent in 2 patients, good in 4 and poor in 1 patient with the efficacy rate of 85.7%. Out of the 4 patients resistant to the previous therapy with other antibiotics, 3 patients responded to cefoxitin, and all the 3 patients of anaerobic infections responded satisfactorily to cefoxitin. 2) Microorganisms isolated were 2 strains each of E. coli and Staphylococcus aureus, 3 strains of Peptococcus and 1 strain of Eubacterium lentum. All the 8 strains isolated were sensitive to cefoxitin. As to bacteriological response, all the strains isolated were eradicated except 1 strain of Staphylococcus aureus which recurred on the 9th day after completion of the therapy with the eradication rate of 87.5%. 3) No subjective nor objective side effects were noted. Especially, the elevated GOT and GPT observed on a patient complicated with hepatitis prior to the initiation of cefoxitin treatment were found to be normal upon completion of the treatment.
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The present paper reports on 7 cases of primary infections, pyelonephritis and pyelocystitis, in which acrids were found in the urine during acute attacks. The cases were detected in the clinical laboratory of a county Hospital. All the 7 patients, ranging in age from 6 to 60 years, exhibited characteristic symptoms of pyelonephritis and pyelocystitis. Numerous acarids were found in the urinary sediment and, in some cases, also their eggs. Some of the acarids were motile, others were encrusted with salts. A female acarid was detected while laying eggs. In 6 patients the acardis were found in the urine only at the first examination and disappeared following the of urinary infection; in the seventh case they were detected at three consecutive examinations performed at 3--6 days interval.
Thirteen cases of inflammatory changes in the urothelium with formation of glandular and cystous structures, 3 cases of glandular metaplasia in transitional cell carcinoma and 8 adenocarcinomas were examined. In inflammation, initial glandular and cystic structures have signs of somehow incompleted metaplasia of the intestinal type. In advanced glandular structures metaplasia is completed and urothelium acquires similarity in the structure and properties of the produced mucus with the large intestine epithelium (numerous goblet, cylindrical limbic and non-differentiated cells, prevalence of argentaffinic cells over argirophilic, lack of Panet cells, secretion of sulfomucines). In loci of glandular metaplasia of transitional cell carcinoma there are also signs of somehow incompleted intestinal differentiation. Most typical variants of urothelial adenocarcinoma are quite similar to glandular carcinoma by the structure and properties of the produced mucus.