The intravenous pyelogram in acute pyelonephritis.

In a cohort of 67 otherwise healthy patients with acute pyelonephritis that was severe enough to warrant hospitalization and uroradiography, 8% had a genitourinary abnormality that influenced management. Consequently, over 90% of patients had studies that did not alter their care. In an attempt to identify clinical clues that might increase specificity without compromising sensitivity of the intravenous pyelogram in acute pyelonephritis, only the fever curve was statistically useful. Confined to patients who were febrile through 72 hours of appropriate antibiotic treatment, the yield of urography in demonstrating anomalies of immediate clinical significance rose from 8% to 36%. The likelihood of an acutely important abnormality was also increased fivefold in both diabetic patients and patients with a urinary pathogen other than ampicillin-sensitive Escherichia coli, but small numbers precluded statistical significance. Bacteremia was common (27%), but not helpful other than in confirming the microbiological diagnosis. Nonacute structural abnormalities were present in 43% of the patients, three to nine times more frequently than in reported cases without upper tract infection.

Use and abuse of retrograde pyelography.

Retrograde pyelography to demonstrate the renal pelvis and ureters is a common urologic procedure. Newer contrast materials and better radiographic techniques have obviated many of the previous indications for retrograde studies were independently reviewed by two urologists and a radiologist to determine if the studies were indicated, appropriately timed, informative, and complete. Our results indicate a high percentage of these examinations are incompletely performed and uninformative and could have been replaced by noninvasive studies. What constitutes a complete retrograde study and when to utilize this examination is discussed.

Postpregnant vasectomies.

PIP: An outpatient postpregnant vasectomy service in a Pittsburgh, Pennsylvania, maternity hospital provided by the Departments of Obstetrics and Gynecology and Urology and complementing the existing postpartum tubal ligation services offered women delivering at this hospital is described and examined to determine the characteristics of the patients using the service and reasons for requesting vasectomy. Prevasectomy counseling was done by the Director of the Department of Obstetrics and Gynecology's Division of Community Health and covered such aspects as the patient's immediate as well as long-term interests, conviction and motivation in having the vasectomy, exploration of nonpermanent methods of contraception, and determination of contraindications. A fee was charged to private patients only for use of outpatient facility and professional services. Counseling and sperm examination were included without charge. Of 283 men receiving counseling, 232 had vasectomies performed and 29% of these were classified as postpregnant (a pregnancy by a partner completed with 6 months of vasectomy). Average age of postpregnant patients was 33 years, with an average of 3.3 living children. 46% had been referred by their partner's obstetrician. The reason for vasectomy was to prevent further pregnancy. Subsequent to the last pregnancy 29% had used noncoitally related contraception, 54% coitally related contraception and 12% were without contraception. The possibility of tubal ligation of the partner was discussed, as well as therapeutic abortion. 59% received semen checks 2 months after surgery and were aspermic. 7% of the 8328 women delivering while this program has been in operation have received tubal ligation and .4% of their partners vasectomies. Most patients receiving vasectomies were private patients. However, the availability of vasectomy to poor and/or black patients can be greatly increased by such a vasectomy program.^ieng

Opportunistic lung infections in renal transplant patients: a comparison of Pittsburgh pneumonia agent and legionnaires' disease.

From July 1977 to January 1980, 5 cases of pneumonia owing to Pittsburgh pneumonia agent and 4 cases owing to Legionella pneumophila occurred in our renal transplant population. Comparison of the clinical manifestations, laboratory features an radiographic changes demonstrated no unique characteristics that allowed differentiation from other bacterial pneumonias. Diagnosis in all cases required histologic or serologic identification of the infecting organism. We herein present our protocol for establishing rapidly the diagnosis of pneumonia in renal transplant patients with emphasis on the use of open lung biopsy.

Early experience with the DuraPhase penile prosthesis.

A retrospective review of the medical records of 26 consecutive patients who underwent surgical implantation of the DuraPhase penile prosthesis for erectile impotence was performed. In addition, telephone interviews were used to evaluate patient and partner satisfaction with the device. Average patient age was 61 years. The presumed etiology of erectile dysfunction was vascular in 19 patients, postoperative in 4 and neurogenic in 3. Followup averaged 5 months (range 1 to 15 months). Sixteen patients and partners with a minimum of 3 months of followup were evaluated for satisfaction with the device. On a scale of 1 to 10 the average patient score was 8.6 and the average partner score was 9. Our early experience with the DuraPhase penile prosthesis has been favorable. Surgical insertion is simple, and patient and partner satisfaction has been superior. The device functions easily, can be well concealed and has excellent axial rigidity for intercourse.

Autosuture ileal conduit construction: experience in 110 cases.

Our experience with 110 cases of ileal conduit construction with autosuture stapling devices is discussed. The technique is described briefly and the results are compared to results with ileal conduits constructed with the conventional suture technique. Analysis of our data revealed a significant reduction in operating time and postoperative morbidity.

Toxicity of intravesical recombinant human tumor necrosis factor in cynomolgus monkeys.

Six groups of two cynomolgus monkeys were treated with escalating intravesicular doses of recombinant human tumor necrosis factor (rHuTNF) for a 6 week interval. The doses of rHuTNF ranged from 10 ng to 1 mg and were instilled weekly. Two monkeys had instillation of saline only and served as controls. The monkeys were weighed and temperatures determined before, immediately after, and 2 days following each treatment. Cystoscopic examination was performed 2 days after each treatment and blood samples were obtained. At the conclusion of the study, animals were killed and necropsy was performed. There was no observable toxicity from treatment with rHuTNF. There was no difference between treated and control monkeys with respect to temperature, weight, or blood measurements. No drug-induced alteration in bladder morphology was found by either cystoscopic or microscopic pathologic examination.