Acute focal bacterial nephritis: a systematic approach to diagnosis and treatment.

Acute focal bacterial nephritis, synonymous with acute lobar nephronia or focal nonliquefactive pyelonephritis, represents a localized area of renal inflammation. Clinically, acute focal bacterial nephritis presents as acute pyelonephritis but is distinguishable by the presence of a focal mass on excretory urography. The further distinction between acute focal bacterial nephritis and other renal masses is aided by the appropriate use of renal sonography and computerized tomography. The clinical and imaging manifestations in 9 patients with acute focal bacterial nephritis are described. Our experience coupled with a review of the literature suggests that a systematic approach to the diagnosis and management of acute focal bacterial nephritis allows for the most efficacious use of the noninvasive imaging modalities.

Computerized tomography and neuropsychological test measures in adolescents with obsessive-compulsive disorder.

The authors administered CAT scans and neuropsychological tests to 16 adolescents with obsessive-compulsive disorder (mean age +/- SD = 13.7 +/- 1.6 years) and 16 matched controls. The patients had a mean ventricular-brain ratio (VBR) significantly higher than the controls' and showed spatial-perceptual deficits similar to those found in patients with frontal lobe lesions. Memory, reaction time, and decision time did not differ significantly from controls'. Neurodevelopmental examination of seven patients yielded a high frequency of age-inappropriate synkinesias and left hemibody signs. These results suggest CNS dysfunctioning in children with obsessive-compulsive disorder, with possible right cerebral involvement. However, the patients' neuropsychological test deficits and VBRs were not correlated.

Rapid regression of pituitary prolactinomas during bromocriptine treatment.

Therapy for large prolactinomas remains controversial. Surgery is often unsuccessful in restoring endocrine function to normal. However, medical therapy with bromocriptine, a dopamine agonist, not only suppresses PRL levels, but may also lead to a reduction in tumor size. Previous reports have demonstrated radiographic evidence of tumor regression only after 3 or more months of bromocriptine therapy. We have now documented, for the first time, objective evidence of extremely rapid reduction in tumor size in two patients harboring large PRL-secreting pituitary tumors (mean pretreatment serum PRL levels, 2350 and 3900 ng/ml) who were prospectively treated with bromocriptine (7.5 mg/day) in preference to surgical intervention despite marked visual impairment in one of the patients. After 2 and 6 weeks of therapy, respectively, marked reduction in tumor size was demonstrated radiographically in both patients. Headache, visual acuity, and visual fields had improved after only 3 days. Although the mechanism of bromocriptine's antitumor activity is unclear, we believe that a large prospective trial to study the effects of bromocriptine therapy on the size of PRL-secreting macroadenomas is urgently needed to determine whether medical therapy should become the primary modality of treatment to reduce tumor size as well as restore endocrine function.

Fiber and gastrointestinal microecology.

The gastrointestinal tract contains a unique microecology. Microorganisms living in the mouth, stomach, and most importantly in the small and large intestines produce enzymes which help metabolize certain ingested foods, as well as maintain important body homeostatic mechanisms such as the bile salt enterohepatic circulation. Recent awareness of the importance of poorly digested foods such as cellulose, hemicellulose, pectins, and lignins, as well as selectively absorbed long-chain polysaccharides, has stressed the importance of the relationship of food to the microflora. This intestinal microecology has definite effects on the human host in cholesterol metabolism, glucose tolerance, and may explain such diseases as carcinoma. The exacting details of the intestinal microecology need further elaboration.

Nonobstructing radiopaque ureteral calculi.

Twenty-two unilateral nonobstructing radiopaque ureteral calculi were found on excretory urography in 21 patients over a 6-year period. The calculi were frequently (12/22) not associated with pain at the time of urography. Of the 21 patients, 19 had intrarenal pelvis configuration which may limit the potential dilatation of the collecting system. Twelve calculi eventually passed spontaneously and two were removed surgically. Three remained in the ureter for prolonged periods (up to 18 months), still nonobstructing. The majority (13/22) of the calculi were in the distal third of the ureter.

The urographic findings in acute pyelonephritis: non-obstructive hydronephrosis.

Excretory urography was performed on 4 patients early in the course of acute pyelonephritis. These studies showed dilatation of the involved collecting system without obstruction. The dilatation resolved after therapy in 3 patients and was not present on a previous excretory urogram in the fourth. Although previous studies have shown that the excretory urogram is usually normal in cases of acute pyleonephritis these cases demonstrate that this disease can produce dilatation of the collecting system and mimic obstruction.

The radiological spectrum of acute pyelonephritis in adults and adolescents.

Excretory urograms of 40 patients with a clinical and laboratory diagnosis of acute pyelonephritis were reviewed. Eleven (28%) had abnormal urograms attributable to the acute disease process. Of the 11 abnormal patients, 7 had obvious urographic abnormalities, while in 4 the findings were few and subtle. The most common findings were renal enlargement, decreased density of contrast material, delayed calyceal appearance time, and dilatation of the collecting system; of these, the last two most frequently correlated with the clinically abnormal side.