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CEA and ABO(H) in upper urinary tract transitional tumors.

The expressivity of carcinoembryogenic antigen CEA and ABO(H) isoantigens is studied in a group of 40 pelvic and ureteral transitional cell carcinomas. CEA was not shown to be a tumor marker since it is not found in all tumors whereas it is demonstrated in a case of cystic pyelitis. Nevertheless, it seems to be associated with certain prognostic morphologic markers, i.e., grading and vascular invasion. The ABO(H) isoantigens do not seem to be correlated with the prognosis; many advanced-stage and grade tumors showed, in fact, positivity for these isoantigens in most neoplastic cells. Association of histological techniques and immunohistochemical studies does not seem as useful in predicting the course of upper urinary tract transitional tumors as in bladder tumors.

ABO Blood-Group System

Massive hematuria of nontraumatic renal origin in dogs.

Massive hematuria of renal origin was diagnosed in 4 dogs. In all dogs, blood and blood clots were clearly visible in the urine. Serum urea nitrogen and urine concentrating ability were normal. All dogs were anemic, and results of coagulation and platelet function tests were within normal limits. Excretory urography indicated hydroureter and hydronephrosis in all dogs, with filling defects in the bladder attributable to large blood clots in 2 dogs. Cystotomy and catheterization of the ureters enabled identification of one kidney as the source of bleeding in 3 dogs. Unilateral nephrectomy and ureterectomy resolved their hematuria. The results of histologic examination were normal in 2 dogs. The 3rd dog had evidence of pyelitis. Cystoscopy of the 4th dog did not reveal hematuria from either ureter. The dog was not operated on and it continued to have intermittent hematuria.

Animals

Spontaneous proteus nephritis among male C3H/HeJ mice.

The spontaneous occurrence of nephritis and resultant mortality was investigated among 2,836 control or treated (dermal carcinogenesis bioassays) C3H/HeJ male mice. Overall incidence of nephritis putatively caused by Proteus mirabilis was 1.2%. Incidences were similar in control and treated mice and ranged from 2.5--32.5% among 73 unrelated treatment or control groups. Diagnosis was based upon characteristic gross or histologic renal lesions. Grossly affected kidneys contained either multiple, discrete tan foci or elevated pale tan patches. Histologic renal lesions consisted of a multifocal necropurulent nephritis with numerous gram negative bacteria present in affected tubules. Necrotizing pyelitis and papillitis usually was present, an necropurulent cystitis was present in half of the cases examined histologically. Proteus mirabilis, isolated in pure culture from an affected kidney, produced similar renal lesions after intraperitoneal or intravenous inoculation of clinically normal C3H/HeJ males. The organism was reisolated from the kidneys of the experimentally produced cases. It was concluded that nephritis putatively caused by Proteus mirabilis was an important cause of mortality in male C3H/HeJ mice.

Animals

[Effects of cefoxitin on infections secondary to hematopoietic malignancies].

Cefoxitin (CFX) was administered to 12 patients for evaluation of clinical effects of CFX against secondary infections complicated with hematopoietic malignancies, and the following results were obtained. 1. The clinical effects were excellent in 1 and good in 8 out or 11 cases with efficacy rate of 81.8%. Out of 12 cases treated with CFX, 1 case was excluded from clinical evaluation because of prophylactic use. It is noted that all cases with pyelitis showed good response to CFX. 2. The serum levels of CFX were determined in 1 patient with renal failure. After intravenous drip infusion of 2 g in 200 ml of glucose solution, the serum concentrations were 67.2 micrograms/ml and 7.53 micrograms/ml at 14 hours and 24 hours (after hemodialysis), respectively. 3. No side effects attributed to CFX were observed. These results indicate that CFX is an effective and safe antibiotic for the treatment of severe infections accompanying hematopoietic malignancies.

Adult

[Laboratory and clinical studies on cefoxitin in pediatric field (author's transl)].

Studies on antimicrobial activity, absorption and excretion and clinical use of cefoxitin in pediatric field were performed. 1. MIC of cefoxitin was compared with that of cefazolin and/or ampicillin for clinical isolates of Staphylococcus aureus (36 strains), Escherichia coli (35 strains), Klebsiella pneumoniae (34 strains) and Haemophilus influenzae (80 strains). MIC of cefoxitin against S. aureus was approximately 1-2 tubes higher than that of cefazolin. Many strains of E. coli and K. pneumoniae that showed high MIC to cefazolin were sensitive to cefoxitin. It is presumed that the results are due to the strong resistance of cefoxitin to beta-lactamase degradation. MIC of cefoxitin against H. influenzae was approximately 1-2 tubes lower than that of cefazolin, but approximately 4 tubes higher than that of ampicillin. 2. Serum level and urinary recovery rate of cefoxitin after one shot i.v. injection of 25 mg/kg were examined. The serum mean levels were 33.8 microgram/ml at 1/2 hour, 7.0 microgram/ml at 1 hour and 2.9 microgram/ml at 2 hours after the injection, respectively, and the drug was not detected in serum at 4 and 6 hours after the injection. The mean half-life of serum level was 27.1 minutes. The mean urinary recovery rate within 6 hours after injection was 96.0% and most of the drug were excreted into urine within 2 hours after the injection. 3. In order to evaluate clinical response, bacteriological response and side effects, cefoxitin was applied to 19 cases, i.e., 12 cases of either acute lobar pneumonia or acute bronchopneumonia, 2 cases of acute pyelitis, 1 case each of acute bronchitis, acute purulent tonsillitis, acute purulent arthritis, acute orbital phlegmon and acute buccal abscess. As for clinical response, the overall efficacy rate (the percentage of cases showed excellent and good efficacy) was 88.9%. As for bacteriological response, among the 13 strains which were determined or supposed to be causative organisms, i.e., 6 strains of Streptococcus pneumoniae, 2 strains of H. influenzae and 1 strain each of streptococcus pyogenes, alpha-Streptococcus, Enterococcus, E. coli and Neisseria sp., all strains were disappeared except for Enterococcus which was reduced by the treatment with cefoxitin. No side effect was observed in any case. Abnormalities of laboratory findings were observed in 3 cases, i.e., 1 case each of reduction of RBC and Hb, elevation of GOT and GPT and elevation of GPT, but all of them returned to normal following completion of the dosage term.

Age Factors

Bacterial urinary tract infections in diabetes.

Bacterial UTIs are a common problem in patients with diabetes mellitus. Bacteriuria is more common in diabetic women than in non-diabetics owing to a combination of host and local risk factors. Upper tract disease is also more common in this group. Diabetics are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess to the renal carbuncle. A number of uncommon complicated UTIs, such as emphysematous pyelonephritis and emphysematous pyelitis, occur more frequently in diabetics. Because of the frequency and severity of UTI in diabetics, prompt diagnosis and early therapy is warranted.

Abscess

[Corynebacterium urealyticum in kidney transplant patients].

BACKGROUND: Corynebacterium urealyticum may produce severe urinary tract infections (UTI) in patients with renal transplantation (RT). The aim of this study was to define the prevalence, clinical spectrum and risk factors for the development of symptomatic UTI in RT receptors with bacteriuria by C. urealyticum. METHODS: The clinical data of RT patients with bacteriuria by C. urealyticum diagnosed in the Hospital Doce de Octubre in Madrid from January 1990 to September 1993 were retrospectively reviewed. The patients corresponded to two clearly differentiated periods. In the first, the presence of C. urealyticum was not actively sought in the urine sample while in the second an intentional search was carried out in all the RT with a selective culture medium containing different antibiotics, Tween-80 and urea to facilitate C. urealyticum identification and growth. RESULTS: C. urealyticum was isolated in the urine of 46 patients (14% of the RT performed in the study period). In the first phase 16 cases were diagnosed with 30 being found in the second with the selective medium. Bacteriuria by C. urealyticum was symptomatic in 18 patients (39%): 12 acute cystitis, one encrusted cystitis (IC), and 5 encrusted pyelitis (IP). Of the symptomatic patients 39% had a history of prolonged vesical catheterization, 27% carried ureteral catheterization and 50% had undergone other urologic manipulations. The clinical consequences were important with development of obstructive uropathy and alteration in renal function (28%), need for surgery (33%) and graft loss (5.5%). All the C. urealyticum strains were sensitive to vancomycin and teicoplanin which were useful in the treatment although the most severe cases (IC, IP) required surgery. CONCLUSIONS: The prevalence of UTI by Corynebacterium urealyticum is high in RT patients. Occasionally, these infections may have severe consequences, particularly in patients with a history of urologic manipulation, if early diagnosis is not performed and adequate antibiotic treatment given. A selective culture medium should be used to isolate C. urealyticum in RT patients.

Bacteriuria

[Ureteritis].

We relate our experience about ureteritis, especially non specific ureteritis. The traumatic, radiation ureteritis will be discussed in others chapters. Most cases of ureteritis are infective, and may be due to any of the organism normally found in urinary tract infections, particularly Escherichia Coli, staphylococci, streptococci, enterococci, proteus and pyocyaneus. It is really primary, but it usually ascending from an associated cystitis, descending from pyelonephritis, or due to direct spread from and adjacent inflammatory lesion such as appendicitis or salpingitis. The infection may also reach the ureter by lymphatic spread, particularly from the prostate and seminal vesicles. Any associated abnormalities of the ureter, such as stricture, megaloureter, ureterocele, and so on, will naturally predispose to infective ureteritis. As ureteritis is rarely primary, the first step in treatment must be toward the elucidation and cure of any underlying lesion. Thus calculi, cystitis, pyelitis, and so on, will need appropriate therapy, and this in itself will considerably improve or cure the ureteritis, and specially in the more acute cases. In the chronic cases with stricture formation, dilation or even excision of the stenosed portion may be required. For the treatment of the strictures we want emphasize the role of the ureteral stenting thinking its use is necessary to preserve the renal function.

Bacterial Infections

[Clinical and laboratory studies on S-6437 (a new longacting granule of cephalexin) in pediatric field (author's transl)].

Clinical and laboratory studies on S-6437 were made, and the following results were obtained. 1. Thirty pediatric patients with various types of infections such as tonsillitis, bronchitis, pneumonia, cystitis, pyelitis, lymphadenitis colli and pyodermia were treated with S-6437 at the daily dosage of 50 mg/kg orally, the clinical effectiveness was 89.3%. 2. The peak blood level of cephalexin after a single oral administration (25 mg/kg) was observed after 4 hours and the average peak blood level of 10 cases was 7.4 microgram/ml. 3. The average urinary excretion rate of 5 cases was 71.2%. 4. Mild side effects were noticed in a few cases.

Administration, Oral

Management of urological tumours in pregnancy.

Urological tumours are rare in pregnancy and may be mistaken for other, more common conditions such as urinary infection, pyelitis, threatened abortion or pre-eclampsia. With modern imaging techniques, especially ultrasonography and NMR, the diagnosis can be accurately established. In collaboration with obstetric and medical colleagues, the urologist can deal with these tumours safely and effectively, provided that the timing and extent of treatment are carefully tailored to the stage of the pregnancy.

Adrenal Gland Neoplasms

[Pathology of renal tuberculosis (author's transl)].

Introduction of specific chemotherapy and vaccination leads to a remarkable recession of renal tuberculosis in the younger age group. Renal tuberculosis is the result of a haematogenous spread of tubercle bacillus. Haematogenous spreading occurs immediately after primary infection, or, in elderly patients, in combination with recurrency of tuberculous foci in lungs and hilar-lymphnodes. Simultaneous metastasis in the skeleton, especially in the vertebrae, are observed in 30%. The incubation period between tuberculous spread and clinical manifestation of renal tuberculosis lasts several years, in the average 5-8 years, for calcareous kidneys it may last as long as 20 years and more, for tuberculous pyelitis only a few months. Today it is possible to treat renal tuberculosis with drugs (Streptomycin, PAS and INH). In 13% the cicatrisation is combined with obstruction of calices and partial hydronephrosis, in 7% with obstruction of the ureter and total hydronephrosis. Early chemotherapy may prevent the development of tuberculous hydronephrosis.

Aged

[Blind ureter diagnosed through hematuria].

Blind ureter is a rare and incidental condition that, alike other congenital diseases, can be associated to other urological malformations. This papers presents one case report of a blind ureter diagnosed as a result of a apparent anaemic haematuria from the left renoureteral system due to unspecific diffused pyelitis.

Adult

Leukocyte response to somatostatin in normals and patients with bacterial leukocytosis.

In normals and patients with acute bakterial leukocytosis synthetic somatostatin decreases cell count of stab neutrophils, neutrophils and eosinophils. After termination of somatostatin infusion a rebound phenomenon occurred. In healthy normals lymphocyte count increased during somatostatin infusion. This effect outlasts the end of infusion for more than 24 h. No significant effect could be demonstrated in patients with a bacterial leukocytosis.

Adult