No Relationship Between the International Prostate Symptom Score and Post-Void Residual Volume in Primary Care.

BACKGROUND: Lower urinary tract symptom (LUTS) is a common condition in older men. In accordance with the Dutch College of General Practitioners Guideline "Micturition symptoms in men", the diagnosis can be made based on a patient's medical history and a physical examination. GPs lack additional tools in primary care to assess the residual urine volume. A residual volume usually requires a referral to a urologist. We hypothesized that the IPSS screening questionnaire score (measuring the severity of symptoms) might be related to patients' residual urine volume. The research objective was to examine the relation between the IPSS score and the residual urine volume. METHODS: In a cross-sectional study, we analysed patients' IPSS and residual urine volume. Men aged over 50 with LUTS who consulted Dutch primary-care physicians were included. The interventions comprised an IPSS screening and a bladder scan. Data regarding the patients' residual volume, total IPSS score, single IPSS score, IPSS storage score, and IPSS voiding score were recorded and analysed. We used odds ratios to describe the relation between the IPSS categories associated with the presence of a normal or abnormal (above 100 cc and above 200 cc) residual urine volume. RESULTS: A total of 126 patients were included in this study. Patients with higher scores on the overall IPSS, separate IPSS, IPSS storage and IPSS voiding showed no higher odds ratios of having an abnormal residual volume, neither above 100 mL or 200 mL. CONCLUSION: We did not find a relation between the IPSS core to an abnormal residual urine volume in men aged over 50 with LUTS consulting primary-care physicians. TRIAL REGISTRATION: This study has been approved by the Central Committee on Research Involving Human Subjects for the Arnhem-Nijmegen Region and is registered with ToetsingOnline under ID number 29822.091.10.

Planning of empirical antibiotic therapy for women with pelvic inflammatory diseases: a geographical area-specific study.

OBJECTIVE: Elaboration of an empiric antibiotic regimen for women with pelvic inflammatory disease (PID) for a geographical area in eastern Hungary. STUDY DESIGN: Pathogens were identified by culturing or polymerase chain reaction (PCR) from 2215 patients with suspected PID between 1 January 1999 and 31 December 2001. Empiric guidelines for PID treatment were based on susceptibility testing of the recovered bacteria, patient acceptance and cost-effectiveness of drugs and recommendations of earlier studies. RESULTS: Chlamydia trachomatis was detected in 11%, Neisseria gonorrhoeae in 2%, Streptococcus spp. in 17%, Enterococcus spp. 9%, genital mycoplasmas in 25%, all obligate anaerobic pathogens in 30% of the patients. All antibiotics chosen for our regimen were effective in vitro against one or more recovered pathogens at least in 80%; this regimen produced 98% clinical cure rate in mild cases of PID. CONCLUSION: Early detection and prompt empirical antimicrobial therapy adapted to the local microflora and its resistance pattern can lead to good clinical results.

Pelvic inflammatory disease is a risk factor for cervical cancer.

The acquisition of human papillomavirus (HPV), the most important etiological agent of cervical cancer, does not cause clinical complaints. Although HPV spreads together with agents causing pelvic inflammatory disease (PID) with complaints forcing the patient to seek medical advice, PID has not yet been evaluated as a predictor of cervical cancer. The present study aimed to determine the relationship between PID and HPV in order to evaluate the possible risk factor role of PID for cervical cancer. Two groups of patients were studied: (i) 2,215 women with PID; (ii) 4,217 women participating in a cervical cancer screening programme who were found to have cytological atypia, mucopurulent cervicitis or other colposcopically detected disorders but were free of symptoms of PID. The presence of HPV and other STD agents in cervical smears was detected with polymerase-chain reaction. HPV prevalence was 33.74% in patients with PID and 26.40% in the group of women without PID (p < 0.001). This suggests that patients suffering from PID apparently have a higher risk of cervical cancer.

Mycobacterial identification by computer-aided gas-liquid chromatography.

The suitability of the Microbial Identification System (MIS) marketed by Microbial ID (Newark, DE, USA) for routine diagnosis of clinically important mycobacteria was investigated and assessed. Cellular fatty acids were extracted from 1077 stock and recent clinical isolates. They were analyzed using a gas-liquid chromatograph combined with MIS software. The MIS system finally identifies the isolates by comparing their fatty-acid compositions with a standard library for mycobacteria. As the library search usually results in more than one possible match, suitable identification criteria were determined. The stricter these criteria are, the more the percentage of false-positive identifications can be reduced, but at the cost of more cases that remain undecided and require additional analysis. Under conditions similarity index (SI) SI1 > or = 0.4 and SI1-SI2 > or = 0.1, 63% of all isolates were correctly and 6% incorrectly identified.

The use of radiometric tests in the speciation of mycobacteria--a review.

Besides a more rapid detection and susceptibility testing, radiometry offers possibilities for the identification of mycobacteria. This paper gives a chronological summary of radiometric techniques used in the BACTEC system (Becton Dickinson) for the identification of mycobacterial complexes/species, employing chemical compounds as selective inhibitory agents or for testing biochemical activities. Thirteen tests are presented and discussed.

Experience of gas-liquid chromatography in clinical microbiology.

In clinical microbiology, gas-liquid chromatography (GLC) is used mainly for the following applications: (1) demonstration of microbial metabolites in cultures: studies of short-chain fatty acids (chain length 2 to 6 carbon atoms) and of the non-volatile lactic and succinic acids are the basis of taxonomy of obligate anaerobes on the genus level. Demonstration of these compounds in spent culture media is also used for identification of anaerobic bacteria in the clinical laboratory. (2) Investigation of long-chain fatty acids of cell membranes and the cell wall: analysis of fatty acids with chain lengths of 9 to 20 carbon atoms are used primarily for taxonomic purposes. A practical application for use in clinical bacteriology is the Microbial Identification System (MIS) based on equipment built by Hewlett-Packard. Although this system is excellently suited for quantitative analysis of long chain fatty acids and gives valuable preliminary or confirmative information, it often requires additional testing for identification of bacteria to species level. (3) Direct rapid diagnosis of infection: demonstration of metabolic products in body fluids can be of value in infections with anaerobes (demonstration of fatty acids) and yeasts (sugars). GLC combined with mass spectrometry or frequency-pulsed electron capture GLC techniques have been applied to studies of sera, fecal specimens, and cerebrospinal fluids. These latter applications are still in an experimental stage. However, the rapid diagnosis of tuberculosis directly from cerebrospinal fluid and sputum is well advanced. The potential of direct diagnosis without the resort to cultures warrants continued research with these techniques.

Impact of pregnancy termination on subsequent fertility.

The effects of pregnancy termination on subsequent fertility was studied in a group of 845 patients within a WHO organized multicentre trial. After comparing the index (abortion) and control groups by using the cumulative pregnancy rates per 100 women it was found at 30 months after recruitment to be 96.9 and 98.7, respectively. The difference was not significant statistically.

[The coincidence of gonadal dysgenesis and hyperprolactinemia]. / Koinzidenz von Gonadendysgenesie und Hyperprolaktinämie.

It was reported about 6 female patients aged from 3 to 31 years (average age 18 years) with gonadal dysgenesis and hyperprolactinemia. Beside one all these females were not treated with synthetic sexual steroids. In 5 of the 6 patients both hyperprolactinemic and hypergonadotropic serum levels were observed. In one case the gonadotropic serum levels were normal. In 4 patients a stimulation test with GRH-TRH or Arg-GRH-TRH, respectively, was performed. In patients with gonadal dysgenesis a change on the area of the hypothalamic-hypophyseal axis is supposed to cause the hyperprolactinemia.

[Primary hyperprolactinemic amenorrhea. Report of 4 patients]. / Hyperprolaktinämische primäre Amenorrhoe. Bericht über 4 Patientinnen.

Report about 4 female patients with hyperprolactinemic primary amenorrhea. In two of these women there was a suspicion of adenoma of hypophysis. In the stimulation test with gonadotropin-releasing hormone and thyrotropin-releasing hormone in two females the very high basal PRL secretion could not have been stimulated in one case. In the other case the TRH-stimulated PRL serum levels increased. Biphasic menstrual cycles resulted by therapy in two females treated with bromoergocryptine.

Migration of I-cells from ectoderm to endoderm in Hydra attenuata Pall (Cnidaria, Hydrozoa) and their subsequent differentiation.

The cellular composition of isolated ecto- and endoderm of the gastric column of Hydra attenuata Pall were recorded qualitatively and quantitatively. The endoderm contains a small population of I-cells ("basal cells") which give rise to the endodermal neurons. The recombination of live ecto- and endoderm, one of which had previously been [3H]thymidine labeled, revealed that the endodermal I-cells and their neural derivatives originate from ectodermal I-cells which migrate across the mesoglea. No other cell types were found to pass from one cell layer to the other. The experiments support the idea that the endodermal gland cells constitute an autoreproductive cell line independent of the pluripotent I-cells.

[Treatment of Asherman's syndrome (intra-uterine synechia) (author's transl)]. / Behandlung des Asherman-Syndroms.

The authors gave treatment to 126 patients with Asherman's syndrome. The principles of that treatment are described, and the results are evaluated with regard to aetiology, localisation, and extent of adhesions. Menstruation was completely settled in 44.4 per cent of the above cases and partially in 19.8 per cent. Forty per cent of the sterile patients then turned pregnant. Twenty-two patients had normal deliveries and 20 miscarriages. Placenta praevia and accreta occurred quite often due to defective implantation. The therapeutic results depended primarily on the dimensions of the adhesions and on the functionality of the remaining endometrium.

[Curettage during puerperium and its late consequences]. / Kürettagen im Wochenbett und ihre Spätfolgen.

The authors examined data of 160 cases of puerperal curettage. The histological examination proved placental residue in 15,61 per cent, decidual residue in 65,61 per cent of the patients. It was a very important finding that the histological examination proved the presence of acute (66 patients), subacute and chronic (23 patients) inflammation, but the patients had no symptoms that would indicate endometritis. 71,86 per cent of the curettage were performed in the 2nd to 4th week of puerperium. Follow-up examinations were made in 69 patients in a period up to 1--5 years after the post-partal curettage. Out of the 69 patients only 14 were free of complications, 32 of them had amenorrhoe or hypomenorrhoe, 20 suffered from Asherman's syndrome (intrauterine synechiae).--49 of the patients intended delivery, but 22 were infertile. The authors' own principles on the treatment and prevention of puerperal hemorrhage are also summed up.

[Diagnosis of Asherman's syndrome (intrauterine synechiae)]. / Diagnose des Asherman-Syndroms (intrauterine Synechien)

On the basis of 120 cases, the authors discuss the diagnostic problems of the Asherman's syndrome. They propose the accomplishment of hysterography in all cases when amenorrhea, hypomenorrhea, sterility or infertility develops after curettage during gestation period and puerperium. They describe the technical difficulties of X-ray examination, the appraisal of medicine certificates and the problems of differential diagnosis. The diagnosis of intrauterine synechia is usally based on the roentgen examination, but uterine sounding must also be performed, and these findings must be compared with the symptoms.

[LH-excretion in healthy omen and in patients with gynecologic-endocrine diseases]. / A luteinizáló hormon (LH) ürítés vizsgálata egészségeseken és nögyógyászati endocrin betegségekben

PIP: Within the framework of gynecologic-endocrine examinations, the authors tested with an immunochemical method using Luteonosticon, the excretion of luteinizing hormone in 4 healthy women and in 18 patients with endocrinal disorders. The method gave modest results in the case of primary amenorrhea; however in the case of secondary amenorrhea, the excretion of luteinizing hormone proved to be very useful in establishing a diagnosis, particularly when the absence of bleeding is accompanied by infertility. The method was found to be simple and very useful in establishing diagnosis in gynecologic-endocrine disorders.^ieng

[Management of female patients with the Stein-Leventhal syndrome]. / Behandlung der Patientinnen mit Stein-Leventhal-Syndrom

The treatment by wedge resection of the ovaries in the Stein-Leventhal syndrome has been considered in 47 cases. The periods were restored to normal in 31 of cases. Ovulation occurred in 19 of cases. Pregnancy was achieved in 15 cases of 39 patients complaining of infertility. The authors discuss the method of wedge resection, the results of therapy, the problems of the recidivation and deal with the oncological, hormonal and psychical follow-up care of the patients. The authors' own principles of treatment are also summed up.