Genitourinary tuberculosis : Clinical features in a general hospital population

Seventy-eight patients with genitourinary tuberculosis were evaluated during a 12 year period. Active tuberculosis was confined to the genitourinary tract in all but 10 patients. Aside from five cases of miliary tuberculosis, most genitourinary infections developed from the breakdown of granulomes acquired earlier during transient dissemination from a primary pulmonary infection. Patients with genitourinary tuberculosis exhibited features of local organ dysfunction rather than systemic symptoms of infection; fever, weight loss and anorexia were uncommon. Seventy-one per cent of the patients with active tuberculosis of kidneys, ureters and bladder presented because of urinary tract symptoms. Twenty per cent were asymptomatic and were detected because of abnormal urinary sediments. The diagnosis of genitourinary tuberculosis should be suspected on the basis of an abnormal urinalysis (hematuria and/or pyuria) with negative routine cultures, and a positive tuberculin skin test. Intravenous pyelograms disclosed abnormalities in most patients but were rarely diagnostic. Serial intravenous pyelograms disclosed increasing ureteral obstruction during chemotherapy in three patients. Multiple drug chemotherapy is the mainstay of treatment, but reconstructive surgery remains important.     

Chlorpropamide-induced hypoglycemia : Successful treatment with diazoxide

A healthy adolescent boy was treated on two occasions for an overdose of chlorpropamide (Diabinese^®). Glucose therapy alone was not sufficient to control the hypoglycemia, but the administration of glucose plus diazoxide raised the blood sugar to supranormal levels. A bolus of intravenous glucagon briefly raised the blood sugar level to within normal limits, increased the blood ketones but also augmented insulin secretion. An overdose of sutfonylurea may cause prolonged and fatal hypoglycemia. Rational therapy, both in diabetic and normal persons, is glucose plus an “insulin antagonist.” The administration of diazoxide was effective in our patient, substantially reducing the plasma insulin level; this agent may be the “insulinantagonist” of choice for use in sulfonylurea-induced hypoglycemia.