Recurrent urinary tract infections and bladder dysfunction in systemic lupus erythematosus.

To assess bladder function in systemic lupus erythematosus (SLE) patients with recurrent urinary tract infections (UTIs). A convenience sample of consecutive patients with SLE (American College of Rheumatology criteria), with recurrent UTIs (>/=3 events in the preceding 12 months), without history of central nervous system involvement, urolithiasis or preceding tuberculosis were studied. Disease activity (SLEDAI-2K), damage (SDI), lower urinary tract symptoms [Pelvic pain and Urgency/Frequency (PUF) and the Interstitial Cystitis Symptom and Problem Index (ICSPI) scales] and Autonomic Symptom Profile (ASP) were assessed. All patients underwent urological examination and urodynamic assessment with cystometry, uroflow, micturition and urethral pressure profile. Ten patients (nine women) were included. The majority of the patients reported urinary symptoms: urgency (n = 8), frequency (n = 8), nocturia (n = 9) and pain (n = 10). The patients had a mean (SD) ICSPI score of 18.4 (9.8), PUF score of 17.4 (5.3) and ASP weighted score of 31.7 (16.1). Abnormal urodynamics findings were identified in seven of the 10 patients, including small bladder capacity (two patients), reduced bladder sensation (four patients), subnormal urinary flow rate (one patient) and a significant amount of residual urine (two patients). The urodynamics findings suggest that bladder dysfunction could be one of the mechanisms involved on the occurrence of recurrent UTIs in patients with SLE. These findings have potential implications for the proper assessment and management of SLE patients with recurrent UTIs. Further studies are needed to corroborate our results.

Therapy with intermittent pulse cyclophosphamide for pulmonary hypertension associated with systemic lupus erythematosus.

The aim of this study was to compare the efficacy of intravenous cyclophosphamide (IVCYC) versus oral enalapril in mild or moderate pulmonary hypertension (PH) in systemic lupus erythematosus (SLE). Thirty-four patients with SLE who had systolic pulmonary artery pressure (SPAP) > 30 mmHg by Doppler echocardiography were randomized to receive IVCYC (0.5 g/mt2 body surface area, monthly), or oral enalapril (10 mg/day) for six months. The primary outcome was the significant decrease in SPAP. An additional outcome measure included the improvement in the heart functional class (NYHA). Sixteen patients received cyclophosphamide and 18 enalapril. IVCYC decreased the median values of SPAP from 41 to 28 mmHg (P < 0.001), and enalapril from 35 to 27 mmHg (P = 0.02). IVCYC reduced more than twice as much SPAP than enalapril (P = 0.04). In those patients with SPAP > or = 35 mmHg, cyclophosphamide decreased from 43 to 27 mmHg (P = 0.003), but enalapril was not effective (P = 0.14). The NYHA functional class improved only in those with cyclophosphamide (P = 0.021). Also IVCYC had a higher frequency of side effects including infections (RR = 1.6; 95% CI, 1.001-2.47), and gastrointestinal side effects (RR = 14.6; 95% CI, 2.15-99.68). We concluded that IVCYC was effective in mild and moderate PH associated with SLE. Further research is needed to evaluate its long-term efficacy.

[Multicystic kidney: retroperitoneal mass frequently found in newborn infants]. / Riñón multiquístico: masa retroperitoneal frecuente en el recién nacido.

Ten cases of multicystic kidney in newborn infants are described herein. The diagnostic value of ultrasound during the prenatal period and postnatal follow-up is highlighted. The therapeutic approach in this condition is discussed.

[Densitometric study of staghorn lithiasis using computerized tomography]. / Estudio densitométrico de la litiasis coraliforme mediante tomografía computarizada.

Fifty staghorn calculi that had been removed surgically and previously analyzed for stone composition and structure were studied by tomodensitometry. The analysis consisted of measurements in absolute units and histographic configuration of x-ray attenuation-absorption of the lithiasic material. The reconstructed images were evaluated and the areas of interest were defined. Each section and area had the following universal elements: number of pixels studied and values for mean attenuation expressed as Hounsfield units (HU). In this manner, tomodensitometric mapping of the calculi could be performed. We underscore the usefulness of this procedure in investigation and the possibility of extrapolating the results to in vivo studies of calculi composition so that we can reliably predict the results attainable with treatment modalities such as ESWL or percutaneous surgery. Little has been published on this subject. To our knowledge, this is the first in Spain.

[Seasonal effect of age, sex and drinking water composition on nephritic colic]. / Influencias estacionales de la edad, sexo y composición del agua bebida sobre los cólicos nefríticos.

The influence of the season, age, sex and composition of the drinking water on the incidence of kidney colics in patients of different villages, attended at the "San Cecilio" Clinical Hospital in Granada, is assessed. The average, of kidney colics per 1.000 inhabitants was 4.2% with 51.27% in females and 48.73% in males. We found that in the summer months the frequency of kidney colics was double that in the winter months, which may be due to a relative D hypervitaminosis, a greater intake of oxalates or a relative dehydration. No influence of the calcium, magnesium, chlorine and sulphate contents of the water, was detected. In some villages, a high calcium and magnesium content in the water, posed problems for the urolithogenic prophylaxis in some patients.