Extra corporeal shock wave lithotripsy in the management of calyceal stones

Renal stones are a life long disease characterized by formation of solid concretions within the kidney or its drainage system. The extra corporeal shock wave lithotripsy is widely used in the treatment of calyceal stones, for any given location within the calyceal system.stone, free rate varies with increasing stone size, stone composition and site of the stotne. This study was conducted to evaluate the eftectivenoss, stone free rate and complications of ESWLin the treatment of calyceal stones, also to evaluate the eftect of urinary tract infection on success rate.This study included 25 patients schoduled for ESWL for calyceal calculi exclusion crileria were body weight more than 120 Kg and stone diameter more than 2.5 cm. ESWL was done with the lithostar lithotripter. [SIEMENS LITHOSTAR II] Post ESWL assessment by plain x-ray [KUB] one day and 2 weeks after. Follow up was done by KUB monthly until patient is stone free or ESWL terminated it was found that in patients with upper calyceal stones, the success rate was 83.3%, in lower calyceal stones and in combined stones, it was 57.1%. Middle calyceal stones were all in combind cases lower calyceal stones have high success rate for the obtuse infundibulopelvic angle, wide calyceal neck and short calyx. According to number of stones, the success rate for multiple stones was 60%, while, in single stones, it was 86.6%. According to the stone burden the success rate for stones less than 1 cm was 84.6% but for stones more than 1 cm, it was 66.6%. According to the number of sessions, the mean number of sessions was 2.6 which is higher than other studies as the mean of loading voltage was 16.4 bkilovolt which is relatively low. According to stone composition, the best results were for uric acid dihydrate and calcium phosphate, the next result was for calcium oxalate dihydrate, the worst was for calcium oxalate monohydrate. According to urine culture and urosepsis, it was found that 8% of sterile cases become Infected post ESWL. Inspite of its few complications, ESWL, when properly done and when correctly indicated still provides a marvelous alternative way to solve the problem of urinary stones

comparative in-vitro activity of quinolones, piperacillin and nitrofurantoin against hospital urinary isolates

Ofloxacin, norfloxacin and pefloxacin, the recent quinolones were compared for their in-vitro antibacterial activity with the earlier ones as nalidixic acid, oxolinic acid and pipemidic acid against 110 recent hospital urinary isolates. The most active of the tested drugs were norfloxacin and ofloxacin [57.27% and 56.36%] followed by pefloxacin and oxolinic acid [both were 45.45%], while pipemidic acid and nalidixic acid were only 32.37% and 17.27%. The sensitivity to nitrofurantoin was 24.54% only. Pseudomonas isolates were more sensitive to the three new quinolones and piperacillin than to the earlier ones and nitrofurantoin. Norfloxacin and piperacillin gave high percentages of activity against those strains [78.90% and 68.42%]. 28 isolates showed multi-resistance to the earlier and recent quinolones. The MICs values of the resistant strains including Pseudomonas were higher [>128 mug/ml] with the earlier quinolones than the MICs of the recent ones [<32 mug/ml]

Immunoglobulin A in the tears and the bacterial pathogens in cases of bacterial corneal ulcers

Bacterial corneal ulcer is a serious ocular infection which can result in visual loss due to corneal scarring. This study was performed to evaluate the etiological organisms and their antibiotic susceptibility pattern in cases of bacterial corneal ulcers as well as to estimate the level of IgA in their tears as an immunological defense against microbial infections. It was found that IgA level in the tears of 40 affected eyes was markedly reduced or even undetectable. Gram- positive bacteria, particularly Staphylococcus epidermidis and Streptococcus pneumoniae were the most frequent isolates with Pseudomonas aeruginosa, the most common gram-negative isolate. In vitro sensitivity results revealed that antibiotic susceptibility was achieved in most of gram-positive isolates using bacitracin, cefotaxime and vancomycin and most Staphylococcus epidermidis strains were sensitive to fucidic acid. Gram-negative sensitivity results varied, depending on the species isolated. However, almost all Pseudomonas aeruginosa strains were susceptible to polymyxin B, gentamycin and tobramycin. Therapeutic intervention with appropriate use of antibiotics is m and atory for the successful eradication of the causative organisms

multiresistant strain of salmonella typhi isolated from the blood of a typhoid fever patient in Alexandria, Egypt

A multiresistant strain of Salmonella typhi was isolaled in Alexandria [Egypt] by blood culture from an Egyptian patient with persistent pyrexia under chloramphenicol therapy. It was found to be resistant to the standard anti-fciotics used for treatment of typhoid fever i.e chloramphenicol, ampicillin, tetracycline and trimethoprim-sulphame-thoxazole; the MICs for the first three agents being >l28, >128 and 128 micro g/ml respectively. The strain was susceptible to ofloxacin and cefotaxime. This non-lactose fermenting strain with a stable phenotypic resistance was recovered under chloramphenicol treatment. Blood culture and antibiotic susceptibility of the isolated strains should still be considered seriously in typhoid fever. Physicians and clinical microbiological laboratories should recognize the potential emergence of such multiresistant Salmonella typhi strains