尿路感染的诊断与治疗尿路感染的发病机制

尿路感染 (简称尿感 )是由多种病原微生物引起的尿道、膀胱、输尿管、肾盂粘膜和 (或 )肾间质的炎症。病原微生物主要是细菌 ,极少数为病毒、真菌、衣原体和支原体。尿感是泌尿内科最常见的疾病 ,人群发病率约为 2 %。尿感按其是否伴有易患因素分为单纯性尿感和复杂性尿感。单纯性尿感不伴有易患因素 ,主要为女性的急性膀胱炎 ,大多可经简单治疗而痊愈 ;复杂性尿感伴有某些易患因素 ,易于复发 ,且发病后难以治愈。据我们追踪 2 2年的一组 46例尿感患者 ,其中 4例发展为慢性肾盂肾炎者均为复杂性尿感患者。1　尿路感染的易患因素尿感的易患因…     

7 Contemporary radiological examination of the upper gastrointestinal tract

Barium and endoscopy both have advantages. Endoscopy not only gives you direct visualization but also the ability to biopsy tissue. It does not give you the ability to determine the exact anatomy or the gross appearance of a lesion. Barium on the other hand gives you a dynamic examination which is particularly useful for the assessment of swallowing disorders and oesophageal motility. When the pharynx and oesophagus are not of prime concern and cost is not a problem then endoscopy is the examination of choice. It has been shown that dyspeptic patients who have had both examinations have a definite preference for endoscopy (Stevenson et al, 1991). As endoscopy requires minimal physical effort, it is also a preferable examination for the unwell patient.     

9 Contemporary radiological examination of the lower gastrointestinal tract

The morphological spectrum of colonic disease is wide. Various treatment modalities may influence the macroscopic aspect of colonic lesions and render a pathological differential diagnosis occasionally difficult or impossible. Before starting therapy in patients suspected of having colonic disease, a physician should undertake a thorough radiological and endoscopic evaluation of the extent and severity of disease activity in the large bowel (Ruderman and Farmer, 1987).DCBE and colonoscopy are complementary imaging modalities, each test has its own intrinsic advantages and merits (Lichtenstein and Rothstein, 1991). DCBE remains the cornerstone in the detection of fistulas, strictures, perforations and estimating depth of ulcerations. Colonoscopy and biopsy remain the most sensitive imaging modalities to identify mucosal involvement (Dijkstra, 1992). The main clinically relevant discrepancies between colonoscopy and DCBE consist of inflammatory lesions without distortion of the mucosal relief and inflammation in the form of small, superficial erosions and ulcers (Dijkstra, 1992).     

Breaching host defenses in the urinary tract

The sterility of the urinary tract is maintained by a variety of host mechanisms that prevent bacterial colonization and survival. The innate immune system encompasses physical barriers to infection as well as more specific soluble and cellular mediators of defense. If the mucosal barrier is breached, a rapid, effective response leading to the eradication of pathogenic microorganisms is elicited before they can cause significant injury. However, uropathogenic bacteria have developed a range of virulence factors that enable them to overcome these innate defense mechanisms and therefore persist within the urinary tract. In particular, recent evidence suggests that bacteria can actually utilize the host's own immune system to aid colonization. By hijacking host proteins, the bacteria are able to gain access to environments that are both rich in nutrients and protected for the bactericidal effects of host immunity. Fortunately, the balance between host defense and infection usually lies in favor of the host, but only minor shifts result in the development of clinical infection. We are moving into an era of greater understanding of the important factors that influence this balance between host and pathogen. In this article, we review the current understanding of the factors that influence the development of urinary tract infection. Understanding these mechanisms may contribute to the development of strategies to combat this common infection.     

Nosocomial infection of the urinary tract

Urinary tract infections appear to be responsible for 35 percent of all hospital-acquired infections, occurring in approximately two patients per 100 admissions. The great majority of infections are associated with urinary tract instrumentation. Female sex, advanced age and debilitating underlying illness appear to be associated with an increased risk of infection, but other risk factors have been poorly defined and case-control studies assessing excess morbidity and mortality associated with nosocomial bacteriuria have not been made. In most instances, the hospitalized patients are the reservoirs for the etiologic organisms, but cross infection from other infected patients also occurs. Current preventive efforts have been primarily directed at aseptic catheter care techniques and reducing catheter use. Further developments in our prevention and control of these infections require an understanding of the mechanisms responsible for colonization of the urethra and bladder with gram-negative organisms and ways to discriminate patients at especial risk.     

High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections

The aim of this study was to evaluate lower urinary tract dysfunction (LUTD) in women with recurrent urinary tract infections (UTIs). One hundred consecutive female patients with recurrent UTIs who underwent videourodynamic study (VUDS) were included. Another 25 women free from recurrent UTIs served as controls. All the underlying diseases, urine analysis and culture results, VUDS findings, and treatment outcomes of voiding dysfunction were carefully reviewed and analyzed. The mean age of the recurrent UTIs patients was 64.0 ± 16.0 years. Storage and voiding dysfunctions were found in 90 (90%) patients, including bladder neck dysfunction in 19 (19%), detrusor hyperactivity with impaired contractility in 6 (6%), detrusor overactivity in 5 (5%), detrusor underactivity in 10 (10%), dysfunctional voiding in 25 (25%), hypersensitive bladder in 6 (6%), and poor relaxation of the pelvic floor muscle in 20 (20%). Only 10 (10%) patients had normal urodynamic tracings. Compared with the controls, the recurrent UTI patients had significantly smaller cystometric bladder capacity, lower maximum flow rate, smaller voided volume, higher detrusor pressure, and larger PVR volume. However, only 6 (11.3%) patients with recurrent UTIs were free from subsequent UTIs following individualized treatment for their voiding dysfunction. A high incidence of vide urodynamic LUTD was identified in women with recurrent UTIs. Despite receiving individualized treatments based on their VUDS findings, only a small portion of these patients were subsequently free from UTIs.     

A prospective observational treatment study of aerococcal urinary tract infection

Objectives

Aerococcus urinae and Aerococcus sanguinicola cause urinary tract infections (UTIs) and antibiotic treatment recommendations are solely based on in vitro findings and limited clinical experience. Our objective was to investigate the effectiveness of different treatment strategies in aerococcal UTI through a prospective observational study.

Prospective study of urinary tract infection surveillance after kidney transplantation

Background  

Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences.