气肿性肾盂肾炎致突发呼吸心跳骤停1例及文献综述

目的 报告气肿性肾盂肾炎致突发呼吸心跳骤停1例及进行文献回顾总结。方法 报告1例气肿性肾盂肾炎导致突发呼吸心跳骤停患者的临床资料并总结既往文献报道。结果 本例患者由于延误就诊,病情危重,拟急诊行患肾切除术,在进入手术室后发生呼吸心跳骤停,抢救无效而死亡。结论 气肿性肾盂肾炎广泛气肿破坏肾实质需行肾切除术,延误治疗可导致突发呼吸心跳骤停,需密切监护及预防。     

The role of gadolinium enhanced magnetic resonance imaging for children with suspected acute pyelonephritis

PURPOSE: The diagnosis of pyelonephritis is primarily clinical. However, the history and physical findings can be confusing in children, leading to adjunctive nuclear renal cortical scintigraphic studies (99mtechnetium dimercapto-succinic acid [DMSA]) to confirm the diagnosis. Nonetheless, ambiguity occurs when differentiating between acute pyelonephritis and chronic scarring. We report our initial experience with gadolinium enhanced inversion recovery magnetic resonance imaging (MRI) to diagnose acute pyelonephritis. MATERIALS AND METHODS: Nine patients 7 months to 18 years old (mean age 81 months) underwent MRI to confirm radiographically a clinical suspicion of acute pyelonephritis. All patients had at least 1 prior episode of clinical pyelonephritis. Data were collected to determine whether acute pyelonephritic changes could be differentiated from chronic pyelonephritis on the basis of MRI characteristics. RESULTS: Of the 9 patients 4 were identified as having acute pyelonephritis on MRI (persistently high signal intensity after gadolinium), 2 demonstrated evidence of postpyelonephritic scar (parenchymal loss without change in signal intensity), 1 had evidence of acute pyelonephritis and chronic changes, and 2 had a completely normal examination (decreased signal intensity after gadolinium). At our institution the billable cost of MRI to the patient is $1,329, while the billable cost of 99mtechnetium DMSA is $1,459. All patients younger than 6 years required intravenous sedation for MRI, whereas 70% of those younger than 6 years require intravenous sedation for DMSA scanning at our institution. MRI provided greater anatomical detail regarding the renal architecture without radiation exposure, and allowed the unambiguous diagnosis of acute versus chronic pyelonephritis scar in a 1-time (versus often multipart for DMSA) imaging study. CONCLUSIONS: In cases where adjunctive imaging studies are useful to make a diagnosis gadolinium enhanced inversion recovery magnetic resonance imaging allows the detection of acute pyelonephritis rapidly, cost-effectively and safely in the pediatric population.     

Value of comprehensive renal ultrasound in children with acute urinary tract infection for assessment of renal involvement: comparison with DMSA scintigraphy and final diagnosis

The aim of this study was to evaluate the value of comprehensive renal ultrasound (US), i.e., combining greyscale US and amplitude-coded color Doppler sonography (aCDS), for assessment of urinary tract infection (UTI) in infants and children, compared to (1) ^99mTc DMSA scintigraphy and (2) final diagnosis. Two hundred eighty-seven children with UTI underwent renal comprehensive US and DMSA scintigraphy. The results were compared with regard to their reliability to diagnose renal involvement, using (1) DMSA scintigraphy and (2) final diagnosis as the gold standard. Sixty-seven children clinically had renal involvement. Sensitivity increased from 84.1% using only aCDS to 92.1% for the combined US approach, using DMSA scintigraphy as the reference standard. When correlated with the final diagnosis, sensitivity for DMSA scintigraphy was 92.5%; sensitivity for comprehensive US was 94.0%. Our data demonstrate an increasing sensitivity using the combination of renal greyscale US supplemented by aCDS for differentiation of upper from lower UTI. Sensitivity for DMSA and comprehensive US was similar for both methods compared to the final diagnosis. Comprehensive US should gain a more important role in the imaging algorithm of children with acute UTI, thereby reducing the radiation burden.     

Usefulness of sonourethrography for penile abscess as a result of xanthogranulomatous granuloma in the corpus cavernosum of an adult: A case report

A 75‐year‐old man presented with a 4‐month history of a swollen and painful penis. Computed tomography showed a round‐shaped mass measuring 3 × 2 cm in the corpus cavernosum. Percutaneous drainage of the penile mass was carried out and a course of antibiotics was prescribed. Viral, fungal and selective bacterial cultures were negative. Total penectomy and urethroperineal fistula formation were carried out because of penile pain. Histopathological diagnosis was xanthogranulomatous granuloma of the corpus cavernosum. Before surgery, sonourethrography was carried out under general anesthesia. Sonourethrography is an infrequently used modality to observe the male urethra under urinary micturition or injection of saline. We previously reported modified sonourethrography with retrograde jelly injection. In the present case, sonourethrography successfully showed the damaged and deformed urethra including the abscess cavity and fistula. Although xanthogranulomatous granuloma is rare, the findings reported here showed the usefulness of sonourethrography for morphological evaluation of the male urethra.     

Xanthogranulomatous Cholecystitis. Retrospective Analysis of 12 Cases

Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in areas of destructive inflammation. The macroscopic appearance generally mimics a gallbladder carcinoma.

Twelve cases of xanthogranulomatous cholecystitis were identified from a retrospective analysis of the patient records of 770 cholecystectomy cases operated on in our department from January 1996 to October 2001. There were four men and eight women. Mean age of presentation was 52.5 years. Eleven patients had gallbladder stones. Seven patients had a history of acute cholecystitis and five patients of biliary colicky pain. Five cases were presented with obstructive jaundice and five with acute cholecystitis. Right upper quadrant mass was palpable in three patients. All patients underwent cholecystectomy. Open surgery was planned and performed in three patients. Laparoscopic cholecystectomy was planned in nine patients but converted to open surgery in three cases. Nine patients had an uneventful postoperative course. One patient developed wound infection and one patient a postoperative pulmonary infection. One patient developed acute abdomen in the 2^nd postoperative day and was re-operated for bile peritonitis. No mortality was seen in the series.     

The Use of Ultrasonography in Evaluating Adults with Febrile Urinary Tract Infection

Background.?Urinary tract infection (UTI) is a common disease. Controversy exists about the role of radiological evaluation in the patient with urinary tract infection. Materials and Methods.?From 04 2001 to 12 2001, patients with febrile UTI admitted to Chang Gung Memorial Hospital, Chiayi were prospectively evaluated by ultrasonography. The inclusion criteria of febrile UTI was a body temperature of more than 38°C with a bacterial count of 10³ or more per mL in a freshly voided midstream or catheterized urine. Results.?A total of 94 patients were evaluated and all patients recovered. Major abnormal sonograms were present in 17 (18%) of the patients. A history of urolithiasis and a duration of fever ≥ 3 days after admission were statistically significant clinical parameters in predicting major abnormal sonogram. Although diabetes mellitus was not statistically significant in predicting major abnormal sonogram, diabetic patients had 2.5 times the likelihood of major structural abnormalities than nondiabetic patients. Conclusion.?Ultrasonographic study of patients with febrile UTI should be limited only to those with a duration of fever ≥ 3 days and a history of urolithiasis. Ultrasonographic study should also be considered in febrile UTI patients with diabetes mellitus     

螺旋CT多期扫描诊断慢性肾盂肾炎的价值

目的探讨螺旋CT多期扫描在诊断慢性肾盂肾炎的应用价值。方法回顾分析26例慢性肾盂肾炎的螺旋CT多期扫描图像。结果本组26例中凹陷征26例,占100%;肾盏变形26例,占100%;肾盏裸露征24例,占92%;肾功能减退26例,占100%。凹陷征、肾盏变形、肾盏裸露征、肾功能减退是慢性肾盂肾炎的特征性的CT表现。结论螺旋CT多期扫描能准确的显示慢性肾盂肾炎的特征性的CT表现,为临床的诊断和治疗提供依据。     

HCMV抗原、抗体和DNA的同时检测在慢性肾盂肾炎中的意义

目的　进一步探讨人巨细胞病毒 (HCMV)感染与慢性肾盂肾炎的关系及同时检测 HCMV抗原、抗体和 DNA三项指标的意义。方法　对 95例慢性肾盂肾炎患者和 83例正常对照 ,分别用免疫斑点法测尿中 HCMV抗原 ,酶联免疫吸附测定 (ELISA)测血清中 HCMV抗体 (Ig G型 ) ,聚合酶链反应 (PCR)测尿中 HCMV- DNA。结果　患者组 HCMV抗原、抗体 (Ig G型 )及 DNA阳性率分别为 5 5 .8% ,82 .1 % ,2 4 .2 % ,抗体 (Ig G型 ) S/N值 (标本 45 0 nm吸光度 /阴性对照 45 0 nm平均吸光度 )为 3 .40± 0 .86 ,均明显高于正常对照组。三项指标的出现并非完全一致。结论　 HCMV感染可能与慢性肾盂肾炎有关 ,三项指标同时检测可能更有意义     

Change of antimicrobial susceptibility among Escherichia coli strains isolated from female patients with community-onset acute pyelonephritis

Purpose

There is a concern on which antimicrobials are appropriate as empirical agents for community-onset acute pyelonephritis (APN) in regions where the fluoroquinolone resistance rate is high, such as in Korea.

Materials and Methods

Three hundred and two strains of E. coli in 2001-2002 and 349 strains in 2008-2009 were isolated from the urine cultures of female adult APN patients, and the antimicrobial susceptibility was compared according to each study period. All the patients were classified as uncomplicated or complicated APN, and a subgroup analysis was done thereafter.

Results

The E. coli strains isolated in 2008-2009 showed improved susceptibility to trimethoprim-sulfamethoxazole compared to those isolated in 2001-2002. However, the third generation cephalosporin and gentamicin susceptibility was worsened. Of the 232 isolates from the uncomplicated APN patients, there was no difference between the two different time periods. On the other hand, of the 419 isolates from the complicated APN patients, the susceptibility to third generation cephalosporin, gentamicin and ciprofloxacin was significantly worsened.

Conclusion

The antimicrobial susceptibility of E. coli changed over the study period, however, this change occurred mainly in the complicated APN patients. In Korea, ciprofloxacin is still useful as an empirical agent for uncomplicated APN patients, but this is not the case for patients with complicated APN because of high resistance rate to ciprofloxacin in these patients. For the complicated APN patients, the rate of resistance to ciprofloxacin is already more than 30%.