Potential preventive strategies and therapies in urinary tract infection

There are perhaps five strategies either presently advocated or under investigation for prevention of recurrent urinary tract infection (UTI): antibiotics, including natural peptides; functional foods; vaccines; probiotics; and miscellaneous, including avoidance of spermicides and maintenance of good hygiene. It is not possible to state the proportion of patients using antibiotics versus foods such as cranberry or using alternative approaches such as avoidance of spermicides. The majority of women who are referred to specialists will be prescribed long-term, low-dose antibiotics. However, given the magnitude of the problem, it is safe to state that large numbers of women are at least experimenting with alternative remedies such as drinking of cranberry juice or ingestion of herbal remedies with a view to enhancing their immune response. Vaccine development remains a long way from human use and has yet to be developed for organisms other than Escherichia coli. The use of probiotics to restore the normal vaginal flora and provide a competitive bacterial barrier to pathogens is close to becoming available as an alternative preventive approach. The next decade should see the introduction of new methods for reduction of the high incidence of UTI and better management of recurring urogenital infections.     

Differential diagnosis of anterior segment cysts by ultrasound biomicroscopy

BACKGROUND: To describe the ultrasound biomicroscopic (UBM) features of anterior segment cysts. DESIGN: A retrospective case series. PARTICIPANTS: One hundred eighteen eyes with anterior segment cysts examined by UBM at The New York Eye and Ear Infirmary between August 1992 and November 1997 were included in this study. INTERVENTION: The authors reviewed demographic and diagnostic data from the medical record including ocular and medical history, age, race, gender, and intraocular pressure. Ultrasound data concerning the type, number, position, and acoustic characteristics of cysts were recorded. The authors then correlated the written, clinical, and UBM characteristics. RESULTS: One hundred eyes (92.6%) had neuroepithelial cysts. Ninety (83.3%) of these had primary neuroepithelial cysts, 10 (9.3%) had cysts associated with uveitis, 7 (6.5%) had implantation cysts, and 1 (0.9%) had a cavitated ciliary body tumor. Neuroepithelial cysts typically were round or ovoid, thin-walled, and echolucent. Of the 90 eyes with primary neuroepithelial cysts, 56 (62.2%) had 3 or fewer cysts; multiple cysts (>3 per eye) were found in 34 eyes (37.8%). The multiple cysts occupied more than 180 degrees in 12 patients (13.3%). Primary neuroepithelial cysts were located at the iridociliary junction (74.2%), pars plicata (14.0%), pars plana (6.8%), and iris (5.0%). Implantation cysts (seven eyes) tended to have thicker walls and two contained a copious, echogenic material. CONCLUSION: The UBM results provide important information regarding location and extent of anterior segment cystic lesions. Ultrasound characteristics may help differentiate between neuroepithelial, implantation, and neoplastic cysts.     

Neutropenia, fever, and infection

With the advances in the management of various neoplastic diseases and subsequent improvement in "disease-free" states, complications of therapy--particularly, infectious complications--have evolved as stumbling blocks to survival. Among neutropenic (absolute neutrophil count below 1,000/mm3) patients with cancer, infection is the major autopsy-determined cause of death. With expected "cure rates" of childhood leukemia approaching 60 to 70 percent, it seems unreasonable to lose such patients to an infectious cause of death, yet this, indeed, happens. The purpose of this review is to (1) define the magnitude of the problem; (2) describe the various agents responsible for infections in neutropenic patients; (3) attempt to more sharply define degrees of neutropenia and mechanical defenses; and (4) consider various approaches to studying and treating these infections.     

Effect of low-dose phenobarbital on hepatic microsomal UDP-glucuronyl transferase activity

To determine whether hepatic microsomal enzyme induction occurs in rats following administration of phenobarbital at doses similar to those used in humans (0.5 to 7.5 mg/kg), UDP-glucuronyl transferase (UDPGT) and cytochrome P-450 activities were measured in liver homogenate and microsomal preparations from control rats and rats treated for 6 days with phenobarbital at 1 and 3 mg per kg per day. While no significant increases in liver weight and protein content of homogenate and microsomal preparations were observed with either dose of the drug, both UDPGT and P-450 activities were enhanced significantly following administration of phenobarbital at 3 mg per kg per day. The activity of P-450 was increased by approximately 30% and that of UDPGT by 15-24 and 45-66%, respectively, employing bilirubin and p-nitrophenol as the acceptor substrate. The extent of induction of bilirubin or p-nitrophenol UDPGT was similar when measured with "native" enzyme or with enzyme activated by UDP-N-acetyl glucosamine, digitonin or deoxycholate. These data suggest that the discordant effects of phenobarbital on UDPGT and cytochrome P-450 previously reported in humans and rats may not be attributable solely to differences in the drug doses employed.     

Focal segmental membranous glomerulonephropathy associated with other glomerular diseases

In four patients with the nephrotic syndrome, renal biopsy revealed focal segmental membranous glomerulonephropathy (FSMGN) associated with the histologic patterns of "nil" disease (two cases), hereditary nephritis and diffuse diabetic glomerulosclerosis. The occurrence of FSMGN in association with other glomerular diseases, presumably unrelated to immune complex deposition, is infrequent in our experience. Rather than necessarily representing an early stage or milder form of membranous glomerulonephropathy, it may be an epiphenomenon. This interpretation has prognostic and therapeutic implications and raises important pathogenetic questions. In particular, this study suggests that in some instances, preexisting functional and structural abnormalities may play a role either in the deposition of preformed circulating immune complexes or in the local formation of immune complexes.     

Adenoid cystic carcinoma: factors influencing survival.

We have reviewed our experience with 264 patients treated for adenoid cystic carcinoma of salivary origin. This study updates a previous report from our hospital and includes all patients treated during a 30 year period who were eligible for a minimum follow-up of 10 years. The tumor arose in minor salivary (mucous) glands in two thirds of the patients; half had received treatment elsewhere, and both sexes were equally represented. Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide. We are unable to demonstrate that the microscopic appearance of the tumor exerts a predictable effect on treatment results. Although some patients lived for many years after resection despite local recurrence and distant metastases, prolonged survival was unusual in patients with stage 3 lesions, particularly in those with sinus or submaxillary gland primaries. Based on the site of origin of the tumor and its clinical stage, it is now possible to select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation. More importantly, these data may help focus on the subpopulation at greatest risk, which is vital to the design of any prospective study to assess the value of adjunctive irradiation and chemotherapy.     

DermRx. An experiment in computerizing information on dermatologic therapy

The Task Force for Creating a Biomedical Communications System for Dermatology was commissioned by the American Academy of Dermatology to develop an experimental segment of a computerized data bank on dermatologic therapy. The Task Force has completed such a "first generation" system and has named it DermRx. Its data bank carries the following information on each entry: the name of the disease; topical, systemic, physical, and other kinds of treatment; caveats; references to the literature; and the date and reviewer(s). The DermLit and DermRx programs are two components of a projected broader concept of an eventual comprehensive Biomedical Communications System for Dermatology. Such a system is envisaged as a means of making available to dermatologists diverse data relevant to practice, teaching, research, and business aspects of the specialty. At the moment, access to the stored information on dermatologic literature and therapy is by telephone call to, or by correspondence with, the central computer facility at Northwestern University. Eventually it is projected to be accessible by dedicated microcomputers housed in the physician's office. This preliminary report on DermRx is presented to review the progress of the project to date and to elicit comment upon its structure and value.     

Prosthetic arteriovenous fistula for vascular access in hemodialysis.

Vascular access through subcutaneous prosthetic arteriovenous fistulas was studied in eighteen dogs. Dacron velour and woven Dacron grafts (6 mm diameter) were constructed across the lower abdomen between the common femoral artery and the opposite common femoral vein. In heparinized animals 197 percutaneous punctures were made with a "14 guage hemodialysis cannula at weekly intervals. Over a period of one and a half years there was no instance of infection. One of the fourteen Dacron velous and all four woven Dacron fistulas thrombosed. These data suggested the feasibility of achieving repetitive blood access through Dacron velour vascular prostheses. Nineteen Dacron velour fistula bypasses between the brachial artery and median basilic vein were performed in fifteen selected patients for a total dialysis period of ninety-six months. Failed standard subcutaneous fistulas or absence of suitable vessels in the upper extremity were indications for the primary procedure. Of three looped forearm fistulas, two thrombosed at twenty-two and two months. Complications among sixteen straight bypasses in the arm included two graft infections and one cannula tract infection. There were no instances of thrombosis in this group. The advantages of single needle dialysis in these high risk patients have been emphasized. Eleven grafts are presently functioning two to nine months postoperatively. Our preliminary results suggest that a Dacron velour fistula merits consideration as an alternative for vascular access in maintenance hemodialysis.     

Lipoplastics of Legs: Our Experience with a New Cannula Compared with Classical Technique

The Authors compare the results obtained between two groups of patients suffering from leg lipodystrophy, who were subjected to a reducing lipoplasty. In the first group, surgeons made use of a new sort of cannula, deprived of the classical grip, whereas in the second group, they employed the traditional probe. The best results, achieved with the first group, prove this new operating system is really effective, particularly on legs, for the following reasons: (1) Higher precision and better control of the instrument (2) Swan-neck cannula abolition (3) Opportunity to operate with both hands (4) Halved operating time (5) No tiredness after the operation.     

Implication of brevetoxin B1 and PbTx-3 in neurotoxic shellfish poisoning in New Zealand by isolation and quantitative determination with liquid chromatography-tandem mass spectrometry.

Brevetoxin B1 (BTX-B1) was isolated from Austrovenus stutchburyi following the 1992-1993 outbreak of neurotoxic shellfish poisoning (NSP) in New Zealand. We report here the first isolation of PbTx-3 from the same shellfish and the development of a procedure for quantitative determination of PbTx-3 and BTX-B1. PbTx-3 was isolated by chromatography on columns of SiO2, ODS, and LH-20, followed by reverse-phase HPLCs. In mass spectrometry (MS) with an electrospray ionization (ESI) interface operating in the positive or negative ion mode, the abundant protonated ion [M+H]+ of PbTx-3 (m/z 897) and the de-sodiated ion [M-Na]- of BTX-B1 (m/z 1016) were generated, respectively. These served as precursor ions for collision-induced dissociation, and the product ions of m/z 725 from PbTx-3 and m/z 80 from BTX-B1 were identified, allowing unambiguous confirmation of these toxins by selected reaction monitoring liquid chromatography-tandem mass spectrometry (SRM LC-MS/MS) analysis. The determination limits were 0.4 and 2 ng/g for BTX-B1 and PbTx-3 at a signal-to-noise ratio of five, respectively. This LC-MS/MS method was successfully applied to determine BTX-B1 and PbTx-3 in the NSP-associated toxic shellfish. BTX-B1 was found in both A. stutchburyi and Perna canaliculus, but not in Crassostrea gigas, while PbTx-3 was found in all three.