Acute urinary retention in female patients: diagnosis and treatment.

Acute urinary retention in female patients often is attributed to psychogenic disturbances. However, it is apparent that this problem may be the harbinger of significant organic illness. Our experience with 27 patients reveals that careful evaluation and appropriate treatment prevent further urological complications and aid in the diagnosis of underlying pathological conditions.

Biochemical mechanisms of lipid-A-mediated enhancement of platelet secretory responses to aggregated immunoglobulins.

The mechanism by which endotoxins enhance the secretory response of washed preparations of human platelets to aggregated immunoglobulins (Agg-HGG) has been examined. Preparations of endotoxins from several rough mutants of bacteria enhance, by approximately 50-fold, the release of serotonin initiated by Agg-HGG. Endotoxins from smooth strains do not manifest this enhancement, and all endotoxin preparations are completely inactive in the absence of Agg-HGG. Preincubation and wash experiments have demonstrated that the critical initial interaction is the formation of complexes between the endotoxin and the Agg-HGG stimulus and is not dependent on an initial endotoxin-platelet interaction. Pretreatment of platelets with substimulatory concentrations of Agg-HGG, followed by the addition of endotoxin, causes a temporal decay in the degree of endotoxin-induced enhancement, which is inversely related to the concentration of Agg-HGG. This stimulus-specific desensitization suggests that the endotoxin-Agg-HGG complexes initiate release by a pathway similar to that initiated by Agg-HGG alone. We postulate that the endotoxin either enhances or stabilizes a localized platelet membrane perturbation or deformation, initiated by the Agg-HGG stimulus.

Cinoxacin for treatment and prevention of recurrent urinary tract infection.

Cinoxacin, an orally administered synthetic antimicrobial agent, is highly effective in the treatment of urinary tract caused by most urinary tract pathogens. Its high prolonged urinary concentration, low incidence of adverse reactions, low fecal concentration, infrequent induction of resistant bacterial strains, and broad antimicrobial spectrum are valuable attributes. Its efficacy for prolonged low-dose preventive therapy of frequently recurring infections adds to this new drug's importance.

Scrotal palpation.

Proper examination of the scrotum consists of inspection, palpation and, if indicated, transillumination. Inspection may reveal the hypoplastic appearance of an undescended testicle; enlargement caused by a testicular mass; the "bag of worms" signifying a varicocele; findings typical of torsion of the spermatic cord, or the "blue dot" sign, which indicates torsion of the appendix testis or appendix epididymis. During palpation, the testis must be differentiated from the epididymis.

Simple transvesical repair of vesicovaginal fistula.

A simple transvesical repair of uncomplicated small vesicovaginal fistulas was done successfully on 40 consecutive patients. More extensive procedures using combined intraperitoneal-transvesical approaches with extensive dissection and omental flaps probably are necessary for the repair of large, complicated or irradiated fistulas. However, these are not often encountered in urological practice. The method described herein is recommended for fistulas encountered more frequently.

Malacoplakia of the bladder: efficacy of bethanechol chloride therapy.

Present evidence suggests that malacoplakia is the result of a functional defect in the mononuclear cells of the lesion caused by a deficiency of cyclic 3',5' guanosine monophosphate. This defect results in the impaired ability of the macrophage to release lysosomal enzymes necessary for the digestion of phagocytized bacteria. The persistent inflammatory reaction produces the characteristic granuloma of malacoplakia. Previous laboratory studies indicate that the phagocytic defect is reversible by cholinergic agonists, which led to the use of bethanechol chloride in the treatment of patients with malacoplakia. We report on 3 patients with vesical malacoplakia who were treated successfully with bethanechol chloride.

The frequency of urolithiasis in hospital discharge diagnoses in the United States.

In an effort to evaluate the rate of stone disease, a questionnaire was sent to each hospital in the United States. On the basis of 1765 responses it is estimated that the average rate of hospital discharge diagnoses of urinary stone per all hospital discharges was 0.0102. It was calculated that the annual incidence of urolithiasis in the population is at least 16.41 per 10,000 and that approximately 12 per cent of the population is expected to have urinary stone disease at some time in their lives.

Cinoxacin: new antimicrobial agent for urinary tract infections.

One hundred forty-six patients with recurrent urinary tract infections were treated with 500 mg. of cinoxacin twice daily for seven to fourteen days. Satisfactory clinical response occurred in 94 per cent. Of the 100 patients with significant pretherapy bacteriuria (greater than or equal to 10(4) organisms/ml. of urine), 65 had complicated infections. Approximately the same per cent of patients with (90 per cent) as without (94 per cent) complicating conditions had a satisfactory clinical response to treatment. The pathogen was eliminated in a higher percentage of patients without underlying disease (90 versus 80 per cent), and infections recurred less frequently in this group (3 versus 14 per cent). Emergence of resistance by initially susceptible organisms during the course of therapy occurred in 4 of 76 patients (5 per cent). A satisfactory clinical response occurred in all 46 patients with an initial colony count of less than 10(4) organisms/ml. urine. Only 1 patient in this group was a bacteriologic failure. Adverse effects of a relatively wild nature were seen in 4 of 146 patients (2.7 per cent). Successful eradication of 12 of 23 urinary infections in patients whose pathogens were resistant to the 30-microgram. cinoxacin disk suggests that the 100-microgram. disk may be more realistic for determining bacterial susceptibility by the disk diffusion method in view of the very high urinary concentration of the drug.

Vesical exstrophy with epispadias. Twenty-year follow-up.

A case we believe to be the longest with successful anatomic closure of exstrophy and epispadias witholt reflux or incontinence is reported. The persistence of the squamous metaplasia in the bladder despite twenty years of "turn-in" is noteworthy. The original method of closure reveals no "secret" to account for the success. The method of repair of traumatic rupture is presented.

Effect of preoperative antibiotic therapy on bacterial prostatitis after transurethral prostatectomy.

Transurethral prostatectomy was performed on 237 patients who required no preoperative antimicrobial therapy and on 182 patients with symptoms of urinary tract infection who received preoperative antimicrobial therapy. At operation all patients were asymptomatic. Data are presented on the incidence of infected prostates, bacteriuria at operation, and postoperative morbidity for the two groups. The findings refute the concept that the chronically infected prostate is resistant to antimicrobial therapy. Transurethral prostatectomy in an infected field was found to increase morbidity. The data suggest that an appropriate preoperative antimicrobial regimen be administered to patients undergoing transurethral prostatectomy with asymptomatic bacteriuria.

Activation of platelets by platelet activating factor (PAF) derived from IgE-sensitized basophils. IV. PAF does not activate platelet factor 3 (PF3).

Platelet activating factor (PAF) derived from antigen-stimulated, IgE-sensitized rabbit basophils acts on platelets to induce aggregation and secretion of their content of granule-bound vasoactive amines. Despite this, PAF did not activate platelet factor 3. In contrast, collagen induced aggregation, secretion and PF3 activation in the washed platelets. Other stimuli (ADP, C3b, thrombin) also initiated both secretion and PF3 activation. A wide dose range of PAC, including those giving maximal secretion and aggregation, were ineffictive in making PF3 available and the possibility that PAF inhibited PF3, or its generation, was also excluded. It is concluded that PAF is a unique stimulus for platelets and that secretion and aggregation are not necessarily accompanied by PF3 generation.

Single daily doses of tobramycin in therapy of urinary tract infections.

Results of therapy with tobramycin for infections caused by susceptible pathogens have been impressive. The usual multiple dose regimen is aimed at maintenance of the serum concentration of tobramycin above the minimal inhibitory concentration of the causative pathogen throughout the course of therapy. Evidence is accumulating, however, that the urinary concentration of antibiotics may be of greater importance than the serum concentration in the treatment of urinary tract infections. This concept has been supported by results of studies with nitrofurantoin, naladixic acid, tetracycline, and, more recently, gentamicin. The present study of 90 patients with urinary tract infections treated with a single intramuscular daily dose of tobramycin resulted in round-the-clock urinary levels of tobramycin that exceeded the minimal inhibitory concentration of the offending pathogen. The clinical and bacteriologic response to therapy was excellent, and no oto- or nephrotoxicity occurred. This regimen frequently allows for therapy on an outpatient basis, fewer painful injections for the patient, and the saving of nursing time and expensive supplies.