Urinary tract infections in adult and adolescent females of a developing community: pattern, bacteriology and genitourinary predisposing factors.

One hundred and twenty-seven consecutive adult and adolescent female patients with culture-proven urinary tract infections were analyzed to determine the pattern, bacteriology and the predisposing causes. Age ranged from 13 to 70 years (median 32, mean 35.7 years). Community acquired urinary tract infections occurred in 85%, while hospital acquired infections in 15% of cases. Urinary tract stones were the most frequently identified genitourinary predisposing causes, which occurred in 16 patients (15%). However, 52.3% of all patients had no identifiable predisposing cause. E. coli, the most frequently isolated organisms from patients with community acquired urinary tract infections, occurred in only 55.6%, while gram-positive cocci isolated from 28 patients (22%) are emerging as important hospital and community acquired urinary tract pathogens. The implications of these findings and a comparison with the reported literature are discussed.

Ureteric obstruction in renal transplants: the role of percutaneous balloon dilatation.

With widespread use of balloon dilatation catheters outside the vascular system, percutaneous balloon dilatation has become an accepted alternative to surgery. Seventeen patients who developed ureteric stenosis following renal transplantation underwent 21 transrenal angioplastic balloon dilatations. Fifteen patients had lower ureteric strictures (2-22 mm long), and two had multiple strictures. The time interval between transplantation and obstruction ranged from 11 to 1370 days (median 71, mean 228.9 days). Nine patients were treated successfully (53%) with no stricture recurrence during the follow-up period, which ranged from 3 to 44 months (median 16, mean 17.8 months). In eight of nine patients in this group, the stricture impression on the inflation balloon was eliminated, and this appears to correlate best with a successful outcome. The eight patients who failed balloon dilatation and restenosed, did so within 7-42 days in seven patients; one patient had late stricturing at 238 days. Serious complications occurred in only one patient, who developed an A-V fistula not amenable to correction and necessitating transplant nephrectomy.

Measurement of the plasma clearance of urographic contrast media for the determination of glomerular filtration rate.

Further experience with a new method to determine glomerular filtration rate is presented. The method depends on measurement by an x-ray fluorescence technique of the plasma disappearance of the injected iodine in standard nonionic radiographic contrast media used during excretory urography. The results of comparison of contrast clearance with 99m technetium-diethylenetriaminepentaacetic acid clearance in 33 cases showed excellent agreement with a correlation coefficient of 0.95. Reproducibility of the contrast clearance method was confirmed by repeated examination of 10 plasma samples at weekly intervals for 6 weeks, the results of which showed no significant differences. The contrast clearance technique for the measurement of glomerular filtration rate during excretory urography is simple, quick and accurate, and merits further development.

High pressure chronic retention. Incidence, aetiology and sinister implications.

A prospective analysis of 36 consecutive cases of high pressure chronic retention presenting over a 3-year period is described. Thirty-nine per cent of patients had malignant prostates and 14% had bladder tumours (overall malignancy rate 53%). The dangers of mismanagement of high pressure chronic retention include uraemic death and hypovolaemic circulatory collapse from neglected post-obstructive diuresis. The clinician should be prepared to find a high incidence of urological malignant disease in patients presenting with this syndrome.

Accuracy and reproducibility of a new contrast clearance method for the determination of glomerular filtration rate.

A new method for determining the glomerular filtration rate was analysed prospectively. The method uses an x ray fluorescence technique to measure disappearance from the plasma of injected non-ionic iodinated contrast media. Eighty seven patients were studied. Fifty four had an intravenous dose of 100 ml iohexol (Omnipaque) and 33 had 50 ml iohexol. Clearances of chromium-51 labelled edetic acid (51Cr-EDTA) were measured simultaneously. In the patients given 100 ml iohexol there was excellent correlation with 51Cr-EDTA clearance (r = 0.90). The correlation using 50 ml iohexol was also good (r = 0.85). Correlation between creatinine clearance and clearance of 51Cr-EDTA in 33 patients was less satisfactory (r = 0.69). There were no adverse reactions to the contrast media. The equipment used for measuring contrast clearance was robust and simple to operate. Freezing plasma samples in 10 studies and re-examining them weekly for six weeks showed no significant variation in results; hence reproducibility was good. This new and accurate method for determining the glomerular filtration rate merits further study and might find a useful place in routine clinical practice.

The choroid--an unusual site for metastasis in patients with adenocarcinoma of the rectum--a case report.

Metastatic carcinoma is the commonest malignant tumour of the eye and usually presents with a disturbance of vision. A rare case of choroidal metastasis secondary to adenocarcinoma of the rectum is reported to emphasize the need to investigate visual symptoms in patients with known or suspected malignant disease.