Acute pyelonephritis in adults: a case series of 223 patients

Background Acute pyelonephritis (APN) is a common disease which rarely evolves into abscesses. Methods We prospectively collected clinical, biochemical and radiological data of patients hospitalized with a diagnosis of APN from 2000 to 2008. Results Urinary culture was positive in 64/208 patients (30.7%) and blood cultures in 39/182 cases (21.4%). Two hundred and thirteen patients were submitted to computed tomography (CT) or nuclear magnetic resonance (NMR): confirmation of APN was obtained in 196 patients (92%). Among these, 46 (23.5%) had positive urine culture, 31 (15.8%) had positive blood culture and 15 (7.6%) had positive cultures of both urine and blood. In 98 patients, either urine or blood cultures were negative, but CT/NMR were positive for APN. Fifty of the 213 patients submitted to CT/NMR (23.5%) had intrarenal abscesses: only 2 were evidenced by ultrasound examination. No differences were found between patients with positive or negative CT with regards to fever, leucocytosis, C-reactive protein, pyuria, urine cultures and duration of symptoms before hospitalization. No differences were found between patients with or without abscesses with regards to these parameters and risk factors. Patients with abscesses had a longer duration of treatment and hospitalization. Conclusions Our data suggest that in APN it is not always possible to routinely document urinary infection in a clinical setting. This finding could be explained by previous antibiotic treatment, low bacterial growth or atypical pathogens. Systematic CT or NMR is necessary to exclude evolution into abscesses, which cannot be suspected on clinical grounds or by ultrasound examination and may also develop in the absence of risk factors.     

肾周脓肿25例的诊断与治疗

目的：提高肾周脓肿的诊断与治疗水平。方法：回顾性分析25例肾周脓肿患者的临床资料。结果：25例患者明确诊断为肾周脓肿，72％患者尿培养阳性，CT确诊率92％。3例(12％)死亡。10例患者脓肿直径1.8cm，单独使用抗生素治疗平均住院10d；11例脓肿平均直径11cm，采用抗生素联合经皮穿刺引流治疗，平均住院30d；4例最后进行了外科探查和肾切除。结论：肾周脓肿临床变化特点并不典型，CT检查是目前确诊最可靠的方法，通过明确的分期以获得理想的疗效。     

肾结核的诊断与治疗

目的 探讨肾结核的发病特点,提高肾结核的诊断和治疗水平. 方法 1993至2007年收治肾结核患者223例.分析患者年龄分布、临床症状、影像学检查特点及其治疗情况. 结果 223例发病年龄20～40岁93例(41.7%),41～54岁81例(36.3%).病程1 d～30年,平均38.5个月.首诊时诊断为肾结核仅36例,187例有1次或多次误诊,最常见的误诊为尿路感染,占50.3%(94/187).临床表现以血尿(131例,58.7%)、尿频(122例,54.7%)、尿急(112例,50.2%)、尿痛(94例,42.2%)为主,同时存在≥3种症状者占58.3%(130/223).实验室检查尿找抗酸杆菌阳性率41.9%(65/155).221例行KUB加IVU检查,有典型肾结核影像学表现者79例(35.7%).223例行B超检查,考虑有肾结核病灶者161例(72.2%).104例行CT检查,考虑有肾结核病灶者79例(76.0 0%).首选手术治疗173例(77.6%),其中行患肾切除手术136例(78.6%)、行肾部分切除术或局部病灶清除术37例(21.4%).2例因尿毒症行透析治疗.48例(21.5%)明确诊断后门诊行抗结核药物治疗,临床治愈41例(85.4%),转行患肾切除手术7例(14.6%). 结论 肾结核患者发病趋于不典型化,临床遇到有尿路感染症状者,尤其是久治不愈的尿路感染患者,应警惕肾结核的可能.     

非特异性肾周围炎及肾周围脓肿诊治分析（附20例报告）

目的：报道我院近五年来收治的20例肾周围炎及肾周围脓肿病例,并对其诊断和治疗作出分析。方法：回顾性分析了自2005年1月～2010年8月期间住院的20例肾周围炎及肾周围脓肿患者的病例资料。收集分析的资料包括：临床症状及体征、合并症、影像学检查、实验室检查、细菌培养、治疗及预后。结果：20例病例中,肾周围炎5例,肾周围脓肿15例。最主要的临床表现是腰腹部疼痛、发热、腰腹部肿块,分别为16例（80％）、12例（60％）、5例（25％）。另外少见临床表现有血尿3例（15％）、尿频尿急尿痛2例（10％）、恶心呕吐腹胀1例（5％）。合并症可见糖尿病、泌尿系结石、慢性肾盂肾炎、输尿管移行细胞癌、腹膜后纤维化及肾盂输尿管连接部狭窄,分别为5例（25％）、5例（25％）、7例（35％）、1例（5％）、1例（5％）、1例（5％）。有7例患者做血、尿、脓培养,其中5例阳性（71．4％）,致病菌主要为：大肠埃希菌、肺炎克雷白杆菌、变形杆菌,混合感染为2例（28．6％）。在所有患者中,单纯抗生素治疗者5例（25％）,B超引导下穿刺引流者6例（30％）（4例复发需再次手术,其中3例行切开引流,1例肾切除）,开放切开引流者5例（25％）,行。肾切除者4例（20％）。19例患者痊愈出院,1例患者形成窦道,迁延不逾,无死亡病例。结论：随着B超、CT等影像学技术的进步和普及,肾周围炎及肾周围脓肿的诊断和治疗已有较大的改善,尽早行彻底引流及有力的抗生素治疗是疾病痊愈的关键。     

Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method

OBJECTIVE: To investigate the role of semen cultures versus segmented urine cultures for the diagnosis of bacterial chronic prostatitis. MATERIAL AND METHODS: We retrospectively examined 895 patients (age range 17-67 years) who met the consensus criteria for clinical chronic prostatitis/chronic pelvic pain syndrome, 50.1% of whom had dysuria and/or perineal discomfort, 37.4% infertility of unknown etiology and 12.5% erectile dysfunction. Segmented urine cultures, including expressed prostatic secretions (EPSs) and semen culture, were performed in all patients. RESULTS: Of the 895 patients, 182 had significant positive cultures for Gram-negative microorganisms (Escherichia coli was the commonest specimen isolated: 70.4% of cases) and 283 had significant positive cultures for Gram-positive microorganisms. We compared the culture yield in EPS and/or the urine voided after prostatic massage (VB3) sample (four-glass method) with that of the semen sample. In the Gram-negative group, 32 patients were diagnosed by means of semen culture (negative EPS and/or VB3 sample) and in only five cases was a positive diagnosis made despite a negative semen culture (positive EPS and/or VB3 sample). In the remaining subjects, diagnosis was performed with the aid of both EPS/VB3 sample and semen (both of which were positive). In the Gram-positive group, there was significant growth of such microorganisms in semen in every case considered positive, but in only 46 cases was diagnosis achieved via EPS and/or VB3 sample. A diagnosis of chronic prostatitis by Gram-positive microorganisms in these patients was only considered when the same microorganism was retrieved in repeated cultures without previous treatment. Only three cases met such criteria (all of whom had negative EPSs). To evaluate the diagnostic efficiency of the semen and EPS samples, we analyzed their sensitivity and specificity, obtaining higher sensitivity in semen than EPS samples for significant Gram-negative cultures: 97% vs 82.4%. In significant Gram-positive cultures, the sensitivity of semen samples was 100%, compared to only 16.1% for EPS. CONCLUSIONS: A semen sample has higher sensitivity than an EPS for the diagnosis of bacterial chronic prostatitis. In our clinical work-up, first-void urine and a semen culture are considered the only tests necessary to diagnose chronic prostatitis.     

187例布鲁菌病患者的临床特征和感染指标分析

目的分析布鲁杆菌感染的诊断方法、临床特征和感染指标,为布鲁菌病诊断提供依据。方法回顾性分析2012年1月至2019年1月解放军联勤保障部队第九四零医院收治的187例布鲁杆菌病患者病例资料,分析患者的诊断方法、基础疾病和并发症。以200例非细菌感染者作为阴性对照,对187例布鲁杆菌病患者感染指标[降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)和中心粒细胞百分比(N%)]进行ROC曲线分析。结果187例布鲁杆菌病患者中男性152例,女性55例;患者年龄中位数为(49.00±12.23)岁,本地区年发病率为36/100000。诊断方法中病原菌培养、血清学诊断和临床诊断分别为27%(51/187)、44.92%(84/187)和40.46%(76/187),病原菌培养以血培养为主24.6%(47/187),平均培养时间为(80.86±20.46)h,且血培养阳性瓶全部为需氧瓶。入组187例布鲁菌病患者常见基础疾病有糖尿病(8.57%、16/187)、乙型肝炎(9.09%、17/187)和胆囊炎(12.83%、24/187);并发症主要表现为腰椎病变(49.20%、92/187)、颈椎病变(10.70%、20/187)和膝关节病变(8.02%、15/187)。感染组与对照组比较,WBC、NEU%、PCT和CRP ROC曲线下面积分别为0.403、0.444、0.414和0.703;当CRP≥1.965 mg/ml时,敏感性为0.589,特异性为0.676。结论布鲁杆菌感染多发生于中老年男性,可通过临床特征、微生物学培养、血清学检测和CRP检测等手段诊断,常并发骨关节病变,需避免漏诊。     

Diverticulitis: truly minimally invasive management

The purpose of this study is to evaluate the treatment of patients with acute diverticulitis in the inpatient setting using minimal intervention. This was a retrospective study of 75 patients admitted over a 3-year period with acute diverticulitis as evidenced by computed tomography (CT) and clinical scenario. Of the patients enrolled, 24 (32%) had abscesses identified on their initial CT scan. An additional four patients had abscesses noted on a subsequent CT scan obtained because of lack of complete improvement with medical management, thus raising the total number of abscesses to 28 (37%). Of the patients with abscesses, 10 (36%) underwent drainage using a CT-guided percutaneous or ultrasound-guided transrectal approach an average of 6 days after admission. Of the 75 patients, five (7%) required operative intervention during the initial hospitalization for failure of medical management, two (40%) of whom had abscesses on presentation. The overall median length of hospitalization was 5 (interquartile range [IQR] 4-9) days, and 18 patients (24%) had recurrences during the study period. Our conservative approach to percutaneous and surgical intervention resulted in relatively low percutaneous drainage, a low operative rate, and a reasonable length of hospitalization and recurrence rate.     

Renal and Perinephric Abscesses: Analysis of 65 Consecutive Cases

Objective The objective was to describe the last 10 years’ experience of the diagnosis and treatment of renal, perinephric, and mixed abscesses in an academic reference center. Patients and Methods The medical records of 65 patients with renal, perinephric, and mixed abscesses treated at our hospital from January 1992 to December 2002 were reviewed. The data collected included predisposing factors, symptoms, physical examination, initial diagnosis, laboratory and radiologic evaluation, treatment, and clinical outcome. Results Perinephric abscesses were found in 33 (50.8%) patients, renal abscesses were found in 16 (24.6%), and 16 (24.6%) had mixed abscesses. Urolithiasis (28%) and diabetes mellitus (28%) were the most common predisposing conditions. The duration of symptoms before hospital admission ranged from 2 to 180 days (mean 20 days). Urine culture was positive in 43% of patients and blood culture was positive in 40% of patients. Most of the perinephric abscesses received an interventional treatment: surgical drainage (24%), percutaneous drainage (42%) or nephrectomy (24%). Most patients were cured (73.3%) on discharge from hospital. Mixed (renal and perinephric) abscess treatment was similar: percutaneous drainage (37.5%), surgical drainage (18.75%) or nephrectomy (37.5%). Most patients were cured (60%) on discharge from hospital. Renal abscesses, however, were treated medically in 69% of patients and 73% were cured on discharge from hospital. Conclusions Perinephric and mixed abscesses are successfully managed by interventional treatment. Renal abscesses can be managed by medical treatment only, reserving interventional treatment for large collections or patients with clinical impairment. Early diagnosis is an important factor in the outcome of renal and perinephric abscesses.     

C-reactive protein levels in the differential diagnosis of brain abscesses

C-reactive protein (CRP) is a protein found in plasma at elevated concentrations during acute or chronic infections. As an aid in the differential diagnosis between brain tumor and abscess, the CRP levels were measured in 20 patients with intracranial mass lesions and the appearance of ring-like contrast enhancement on computerized tomography (CT) scans. In nine of these patients, the final diagnosis was abscess, based on either biopsy of the mass (eight patients) or the clinical course (one patient). In seven of the nine patients, there was a significant increase in CRP levels in two consecutive measurements. In particular, patients with cerebritis who were examined early in the course of the disease and who showed nonspecific CT scans exhibited extremely high levels of CRP. Two patients had no measurable CRP activity although they both had brain abscesses. In 12 patients harboring either gliomas or metastatic intracerebral tumors, CRP levels were significantly lower than those found in patients with brain abscesses but were nevertheless higher compared to those of a group of patients with benign tumors. It is concluded, therefore, that the measurement of CRP can have some value in the differential diagnosis between brain abscess and brain tumor. The measurement technique is inexpensive and is available in the clinical laboratories of most hospitals with a neurosurgical department.     

Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography

OBJECTIVE

To assess the value of contrast‐enhanced ultrasonography (US) with the contrast pulse‐sequence (CPS) technique for detecting renal parenchymal changes in acute pyelonephritis (APN), compared with contrast‐enhanced computed tomography (CT) as the reference standard.

PATIENTS AND METHODS

We examined 100 patients (82 women, 18 men; mean age 30.2 years, range 18–67); children (those aged <18 years) were excluded from the study. All patients had clinical symptoms suggestive of APN. For the US a Sequoia 512 (Acuson, Mountain View, CA, USA) unit including Cadence^TM CPS technology, with a 6C2 probe, was used. A bolus of a 2.4‐mL US contrast agent SonoVue (Bracco, Milan, Italy) was injected. For CT a multislice 16‐row unit was used (Sensation 16, Siemens, Erlangen, Germany), at a table speed of 2.5 mm/s and a slice thickness of 3 mm; 100 mL of intravenous iodinated contrast agent (flow 3 mL/s) was injected.

RESULTS

On contrast CT, 84 patients (84%) had renal parenchymal changes suggestive of APN; on contrast US, 82 of the 84 (98%) showed renal parenchymal changes, and APN was correctly diagnosed. Seventy‐six patients (90%) had unilateral and eight (10%) had bilateral APN, and in two (2%) with APN the diagnosis could not be confirmed by US/CPS (false‐negative). No false‐positive findings were detected on US/CPS, which had a sensitivity of 98%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 89%.

CONCLUSION

CPS/US is accurate for detecting parenchymal changes in APN; it is very sensitive and specific, and allows small renal parenchymal changes to be detected with no radiation exposure.     

彩色多普勒超声结合血清C反应蛋白在腹股沟嵌顿疝中诊断的临床意义

目的分析彩色多普勒超声（以下简称彩超）结合血清C反应蛋白（CRP）在腹股沟嵌顿疝中诊断的临床意义。 方法选择2017年3月至2020年3月于阜阳市第五人民医院收治的60例腹股沟疝患者作为研究对象，每组患者30例。对照组为门诊收治的择期腹股沟疝患者，采用彩超结合CRP诊断；观察组为急诊收治的腹股沟嵌顿疝患者，采用彩超结合CRP诊断。分析2组患者的诊断效能及诊断符合率。 结果观察组患者术前斜疝诊断阳性的CRP水平明显高于对照组（P<0.05）。对照组患者的腹股沟斜疝阳性检出率为80.00%（24/30），稍低于观察组的86.67%（26/30）（P>0.05）。观察组患者的腹股沟斜疝诊断与手术结果相符合的阳性率为100%，稍高于对照组的93.33% （P>0.05）。观察组患者的准确度为100%、特异度为50.00%、灵敏度为92.31%、阴性预测值为50.00%、阳性预测值为92.31%，均稍高于对照组的93.33%、42.86%、86.96%、50.00%、83.33%（P>0.05）。 结论彩超检查可提高腹股沟疝的诊断准确性，还可密切观察病情变化，为临床诊治提供参考依据。CRP作为炎症的一种非特异性指标，对腹股沟嵌顿疝的鉴别诊断提供较好的依据。     

Development of kidney scars after acute uncomplicated pyelonephritis: relationship with clinical, laboratory and imaging data at diagnosis

Background: Acute pyelonephritis is a potential cause of kidney scars. Aim: To evaluate the relationship between clinical, laboratory and imaging data and the development of kidney scars in acute pyelonephritis. Methods: All consecutive patients hospitalized for acute uncomplicated pyelonephritis in our nephrology unit from June 1996 to June 2004 were considered: 58 females, median age 25.6 years (16–52). Diagnosis of pyelonephritis required parenchymal lesions shown by CT or NMR scan. Results: The lesions were bilateral in 17.2% (10/58) patients, unilateral, but multifocal in 81.0% (47/58); at CT or NMR, 65.5% of the lesions were classified as simple, 19% with tendency to colliquation and 15.5% abscessual. The median interval between first symptoms and diagnosis was 5 days (1–25); at referral, only 20.7% had a positive urine culture and 94.8% (55/58) had undergone previous antibiotic treatment. The therapeutic protocol required intravenous therapy for ≥2 weeks, followed by 2–4 weeks of oral therapy. At 6–8 months, the prevalence of kidney scars was 29.3%. Their development was highly correlated with the type of lesions at diagnosis (highest risk with abscessual lesions; uni- and multivariate analysis). No other clinical or laboratory marker (age, fever, positive cultures, levels of acute phase reactants, interval between onset and diagnosis) was correlated with the outcome (scars). Conclusions: The type of lesion at diagnosis of acute uncomplicated pyelonephritis is highly correlated with the development of kidney scars. Further studies are needed to test the therapeutic schedules tailored according to the imaging data.     

Frequency of development of early cortical scarring in acute primary pyelonephritis

Fifty-five cases of primary (that is, without urinary tract abnormalities), acute pyelonephritis (PN) were studied by computed tomodensitometry (CT). There were 48 women and 7 men. All were febrile and 16 had positive blood cultures. In 7 cases, (4 diabetics and 3 malnourished alcoholics) PN was painless, diagnosis was delayed and lesions were severe. Two diabetics underwent emergency nephrectomy for sepsis. Conventional radiological techniques (IVP and ultrasonography) were poorly informative. In contrast, initial CT abnormalities were visible in 44 patients. They consisted of triangular or round hypodense images, diffuse hypodensity in a grossly swollen kidney, and/or abscesses. Hypodense images were presumably due to acute focal ischemia. Renal histology was available in five patients. It showed acute interstitial nephritis with leukocyte infiltrates, edema and hemorrhagic streaks. Pyelonephritis was due to E. coli in 48 cases (87.5%). In 27 cases E. coli isolates were studied by genotypic assays which detect the three most frequent (pap, afa and sfa) of the four operons known to encode adhesin. In all cases, at least one of these genotypic markers of uropathogenicity was found. In 27 cases, repeat CT was done shortly after treatment. It showed healing in only 12. Early cortical scar formation was visible in 2. Final evaluation in 27 cases with adequate follow-up showed that (in addition to the 2 patients who had been nephrectomized), in only 17 of 27 (63%) had the kidneys recovered a normal appearance. In two cases one kidney had undergone atrophy; renal biopsy showed subacute-chronic interstitial nephritis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: a prospective study

BACKGROUND: Numerous studies suggest a strong association between nutrition and clinical outcome in chronic hemodialysis (CHD) patients. Nevertheless, the pathophysiological link between malnutrition and morbidity remains to be clarified. In addition, recent evidence suggests that nutritional indices may reflect an inflammatory response, as well as protein-calorie malnutrition. In this study, we prospectively assessed the relative importance of markers of nutritional status and inflammatory response as determinants of hospitalization in CHD patients. METHODS: The study consisted of serial measurements of concentrations of serum albumin, creatinine, transferrin, prealbumin, C-reactive protein (CRP), and reactance values by bio-electrical impedance analysis (BIA) as an indirect measure of lean body mass every 3 months over a period of 15 months in 73 CHD patients. Outcome was determined by hospitalizations over the subsequent three months following each collection of data. RESULTS: Patients who required hospitalization in the three months following each of the measurement sets had significantly different values for all parameters than patients who were not hospitalized. Thus, serum albumin (3.93 +/- 0.39 vs. 3.74 +/- 0.39 g/dl), serum creatinine (11.0 +/- 3.7 vs. 9.1 +/- 3.5 mg/dl), serum transferrin (181 +/- 35 vs. 170 +/- 34 mg/dl), serum prealbumin (33.6 +/- 9.2 vs. 30.0 +/- 10.1 mg/dl), and reactance (50.4 +/- 15.6 vs. 43.0 +/- 13.0 ohms) were higher for patients not hospitalized, whereas CRP (0.78 +/- 0.89 vs. 2.25 +/- 2.72 mg/dl) was lower in patients who were not hospitalized. All differences were statistically significant (P < 0.05 for all parameters). When multivariate analysis was performed, serum CRP and reactance values were the only statistically significant predictors of hospitalization (P < 0.05 for both). When a serum CRP concentration of 0.12 mg/dl was considered as a reference range (relative risk 1.0), the relative risk for hospitalization was 7% higher (relative risk = 1.07) for a CRP concentration of 0.92 mg/dl and was 30% (relative risk = 1.30) higher for a CRP concentration of 3.4 mg/dl. When a reactance value of 70 ohms was considered as a reference range with a relative risk of 1.0, the relative risk of hospitalization increased to 1.09 for a reactance value of 43 ohms and further increased to 1.14 for a reactance value of 31 ohms. CONCLUSIONS: The results of this study strongly indicate that both nutritional status and inflammatory response are independent predictors of hospitalization in CHD patients. CRP and reactance values by BIA are reliable indicators of hospitalization. Visceral proteins such as serum albumin, prealbumin, and transferrin are influenced by inflammation when predicting hospitalization. When short-term clinical outcomes such as hospitalizations are considered, markers of both inflammation and nutrition should be evaluated.     

Psoasabszesse

BACKGROUND: A psoas abscess is a rarely encountered entity with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, increased morbidity, and prolonged or recurrent hospitalization. PATIENTS AND METHODS: Between January 1996 and January 2002 we treated ten patients (approximately 54.8, 5 males,5 females). These cases were analyzed retrospectively relative to a review of the literature. RESULTS: CT scanning was decisive in the final diagnosis of psoas abscess. Primary psoas abscess occurred in four cases and six patients had secondary abscesses. In all except one case, the psoas abscess was located on the right side. The causes of primary abscesses were retroperitoneal perforated appendicitis, paravertebral injections for lumboischialgia, Pott's disease, and repeated intravenous drug application in the groin. Five patients underwent retroperitoneal open drainage and four patients CT-guided drainage. One patient with retroperitoneal perforated appendicitis was treated by laparotomy. Staphylococcus aureus, Bacteroides fragilis, and Escherichia coli were the most common infective agents. There was no postoperative mortality and no cases of abscess recurred. CONCLUSIONS: CT scan is a diagnostic "gold standard" for psoas abscess. CT-guided drainage is the method of first choice, but is not possible in all cases. Open retroperitoneal drainage is a standard method of treatment. Postoperative antibiotic therapy is obligatory and should be adapted individually.     

Role of Tc-99m DMSA scintigraphy in the diagnosis of culture negative pyelonephritis

The aim of this work was to evaluate prospectively the proportion of children with a clinical and biological presentation of acute pyelonephritis, abnormal Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy and negative or equivocal urine cultures. All patients aged 6 weeks to 15 years suspected of acute pyelonephritis (APN) were admitted to the Paediatric Department and underwent Tc-99m DMSA scintigraphy within 3 days after admission and at 6 months. Of 166 patients enrolled in the study, 15 (9%) had negative or equivocal urine culture despite clinical and scintigraphic evidence of APN. Of these 15 children, renal ultrasound was normal in 7 patients and vesicoureteric reflux was found in 9 patients. Control DMSA 6 months after acute episode showed the disappearance of cortical lesions in eight and partial improvement in four patients. In this prospective series, as many as 9% of patients with APN would have been missed on the basis of equivocal or negative urine cultures. It is suggested that Tc-99m DMSA scintigraphy should be performed in children with severe infection without clear aetiology, especially in those with abnormal urinalysis. Received: 9 August 2000 / Revised: 12 January 2001 / Accepted: 25 January 2001     

泌尿系结核的诊断体会（附36例报告）

目的：提高泌尿系结核的诊断水平,方法：回顾性分析36例泌尿系结核的临床资料,总结其诊断经验,结果：最常见的主诉为尿路刺激征和血尿,分别为64％和47％;尿沉渣涂片找抗酸杆菌和尿PCR－TBDN阳性率分别为22％和30％,IVU,逆行肾盂造影,CT的确诊率分别为33％,29％和68％,36例接受手术治疗,且术后病理检查均证实为泌尿系结核。结论：泌尿系结核的临床诊断应综合病史,尿液分析,影像学检查,病原学诊断等多种方法,力求寻找更多证据,X线检查应首选IVU和逆行肾盂造影,对两者未能明确诊断者,可选择CT检查,对于中,晚期肾结核,CT的诊断价值较逆行肾盂造影更大。     

Retroperitoneal abscesses--analysis of a series of 66 cases

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.