Urinary infection and pregnancy: a public health problem?

A clinical case of carditis associated with Mycoplasma pneumoniae infection in a 65 year-old woman is reported in order to stress some clinical features and therapeutic problems; during a 5-year follow-up. On the basis of this experience it is possible to state that in the pathogenesis an autoimmune mechanism probably plays an important role, whereas in therapy specific antibiotics are not effective and a long-term treatment with anti-inflammatory drugs is necessary.     

Urinary tract infections and pregnancy in women who underwent antireflux surgery in childhood

PURPOSE: For several decades ureteroneocystostomy has been performed in children to correct primary vesicoureteral reflux. A purported indication for antireflux surgery is to prevent significant upper urinary tract infection during pregnancy. We performed a long-term followup of women who underwent antireflux surgery during childhood to determine outcome in regard to urinary tract infection history and pregnancy. MATERIALS AND METHODS: We identified 227 women of childbearing age who underwent ureteral reimplantation for primary vesicoureteral reflux from 1964 through 1981. Of the 122 women contacted 41 had been pregnant (77 total pregnancies). Cystitis or asymptomatic bacteriuria and pyelonephritis developed during 18 and 5 pregnancies, respectively. The 77 pregnancies resulted in 57 term births, 7 voluntary pregnancy interruptions and 13 spontaneous abortions. RESULTS: Patients who previously underwent successful antireflux surgery continued to have a significant number of urinary tract infections through the intervening years. Despite a higher than expected incidence of pyelonephritis, they had relatively little hypertension and renal insufficiency. During pregnancy the incidence of pyelonephritis was only slightly higher than that of the general population. However, severe complications of pregnancy, such as preeclampsia, premature birth and acute renal failure, occurred more frequently in women with a history of renal scarring or hypertension (7 of 12) than in those with a history of recurrent infection alone (3 of 10). CONCLUSIONS: When renal scarring is present, reflux should be corrected before pregnancy to minimize maternal and fetal morbidity. When scarring is not present, the literature suggests that women with a history of reflux are at increased risk for pyelonephritis during pregnancy whether or not ureterocystostomy was performed. Pregnant women with a history of reflux may benefit from prophylactic antibiotics and women with reflux nephropathy should be followed throughout life.     

Urinary cyclic GMP, endothelin, and prostaglandin E2 in normal pregnancy and preeclampsia

Cyclic GMP, endothelin and prostaglandin E2 (PGE2) all have systemic vasoactive properties (with cyclic GMP acting as a second messenger of nitric oxide). Intrarenally they act as natriuretics and urinary levels reflect intrarenal production. Cyclic GMP and PGE2 also act as important inhibitors of platelet activation and thrombosis. The purpose of this study was to determine if urinary levels of cyclic GMP, endothelin, and PGE2 differ in preeclamptic as compared to normal pregnancies. Parameters were compared in 13 normotensive, nonpreeclamptic pregnancies, and 32 preeclamptic pregnancies. Preeclamptic women had significantly lower levels of urinary cyclic GMP (0.67 +/- 0.12 vs. 2.1 +/- 0.5 nmol/g creatinine), endothelin (0.88 +/- 0.09 vs. 3.75 +/- 1.4 ng/g creatinine), and PGE2 (26 +/- 4 vs. 9 ng/g creatinine) as compared to normals (p < 0.05). Intrarenal production of cyclic GMP, endothelin, and PGE2 are all disturbed in preeclampsia and may have implications in the sodium retention, hypertension, and intrarenal thrombosis and vasospasm of preeclamptic pregnancy.     

Urinary iodine excretion during normal pregnancy in healthy women living in the southwest of France: correlation with maternal thyroid parameters

Detection of P-glycoprotein and other multidrug resistance protein activity is currently under investigation to identify subgroups of cancer patients with tumors resistant to chemotherapy. Application of a test that reliably evaluates the phenomenon in vivo would not only serve as a predictor for responses to chemotherapy but would also be of use in testing the efficacy of multidrug resistance reversers in humans. Tc-99m radiolabeled hexakis-2-methoxy-isobutyl-isonitrile (Tc-sestamibi) has been recently shown to be extruded from cells through P-glycoprotein activity. In the present study, we examined the uptake and extrusion rate of the radiotracer in 25 patients with advanced non-small cell lung cancer undergoing chest radiotherapy, using a novel scintigraphic technique based on simulation-guided pinhole imaging. Five-min tumor images were taken 10, 60, and 120 min postinjection of 20 mCi of Tc-sestamibi. Six of 25 (24%) of tumors showed a 1.3-1.7 times higher extrusion rate as compared to that of normal lung tissue. Increased tumor clearance of Tc-sestamibi significantly correlated with resistance to radiotherapy (P = 0.05) as well as the existence of distant metastasis (P = 0.008). Patients with known resistance to chemotherapy had a higher extrusion rate as compared to chemotherapy-naive patients (P = 0.01). Moreover, increased Tc-sestamibi tumor capture was seen in patients with distant metastasis (P = 0.09). We concluded that functional imaging of lung cancer with Tc-sestamibi may have a role in predicting responses to cytotoxic treatment and in identifying tumors with aggressive behavior. Additional clinicopathological trials are required to investigate whether Tc-sestamibi kinetics correlates with P-glycoprotein expression, intratumoral angiogenesis, or other mechanisms.     

Urinary Incontinence in Women

Despite the prevalence of urinary incontinence, most affected women don't seek help, primarily because of embarrassment or because they are not aware that effective treatment is available. Failure to store urine may be caused by an abnormality in any component of the lower urinary tract. Common abnormalities are poor bladder compliance and bladder outlet failure. Patients who experience failure to empty can present with recurrent urinary tract infections, retention or incontinence. Using a symptom-based classification of incontinence, this would be referred to as overflow incontinence. Other possible categories of urinary incontinence are failure to store and empty and functional incontinence. A combination of a failure to store and empty is difficult to diagnose and treat clinically. Treatments are directed at the particular cause of incontinence and can include medical or surgical therapies.     

Hydration effects in quaternary amine extraction systems

The extraction of Al⁺⁺⁺, Cd⁺⁺, Co⁺⁺, Cu⁺, Cu⁺⁺, Fe⁺⁺, Fe⁺⁺⁺, In⁺⁺⁺, Ni⁺⁺, and Zn⁺⁺ with quaternary amine was studied using chloride and sulfate as ligands. On the basis of loading experiments and slope analyses, the species extracted were: CdCl ₄ ⁼ , CoCl ₄ ⁼ , CuCl ₂ ^? , CuCl ₄ ⁼ , FeCl ₄ ^? , and ZnCl ₄ ⁼ . Water content of the organic phase was analyzed as a function of loading by Karl Fischer titration. These experiments indicate that unhydrated complex ions are extracted by amine.     

Urinary obstruction

Radiologic imaging is commonly used in the diagnosis, classification, and follow-up of renal obstruction. Precise definitions of the elements of urinary obstruction are critical. This article examines the physiology of renal obstruction and the use of such imaging tests as excretory urogram, retrograde pyelography, antegrade pyelography, Whitaker test, ultrasound, CT scan, MR imaging, and radionuclide renography.     

Urinary flow rates in hypospadias

OBJECTIVES: To determine long-term results of patients who underwent primary ligament repair and delayed reconstruction for lateral ligament instability. DESIGN: Retrospective. SETTING: Outpatient clinic. PATIENTS/PARTICIPANTS: Patients who had undergone acute repair or delayed reconstruction at this institution between 1958 and 1977, excluding patients who were deceased or who could not be located. INTERVENTION: Forty-eight patients (fifty-three ankles) underwent twenty-two primary ligament repairs and thirty-one delayed reconstruction operations. MAIN OUTCOME MEASUREMENTS: Clinical results graded with clinical scale and radiologic results based on stress radiographs and plain film radiographs. RESULTS: At an average of twenty years after operation (range 12 to 33 years), patients were satisfied with forty-nine ankles, satisfied with reservations with two ankles, and dissatisfied with two ankles. Clinical results after repair were excellent in twenty ankles, good in one, fair in none, and poor in one. After reconstruction, the results were excellent in twenty-one ankles, good in six, fair in one, and poor in three. In the primary repair group, the mean talar tilt with stress testing improved from 20.7 +/- 10.7 degrees before operation to 2.8 +/- 3.0 degrees after operation. In the reconstruction group, the mean talar tilt improved from 20.7 +/- 8.4 degrees before operation to 2.8 +/- 3.5 degrees after operation. CONCLUSIONS: Clinical and radiologic results were similar in the repair and reconstruction groups. The majority of severe (Grade III) ankle sprains may be treated nonoperatively, but if residual instability occurs, late reconstruction should achieve satisfactory results.     

Urinary diagnostic indices in calves

The accumulation of fluid in the pericardium in an amount sufficient to cause severe obstruction to blood inflow to the ventricles results in cardiac tamponade. In this condition, relief of intrapericardial pressure by pericardiocentesis usually dramatically improves cardiac output, and can be lifesaving. We report a case of a patient with malignant cardiac tamponade in which cardiogenic shock developed after pericardiocentesis due to severe right ventricular dysfunction.     

Urinary diversion in hypospadias repair

A one-stage urethroplasty with preputial tubularized flap was carried out in 83 hypospadias proximal to the midshaft under two different modes of urinary diversion. In 62 cases using the first mode, the urine was diverted with a French 5 indwelling catheter for five to seven days and then allowed to void through an F10-12 silicon stent in the neourethra. In 21 cases using the second mode, the urine was diverted with an F8 indwelling catheter with multiple side holes for 10 to 14 days before starting spontaneous voiding. With the first mode of diversion, 23 urethrocutaneous fistulas and two nearly total disruptions of the urethroplasty developed to give rise to a failure rate of 40.3% (25/62). Two urethrocutaneous fistulas developed with the second mode to render a failure rate of 9.5% (2/21). A longer period of intravesical drainage of the urine along with gentle autoirrigation of the neourethra appears to be essential in providing a better chance for successful hypospadias repair.