Emphysematous pyelonephritis successfully treated with laparoscopic nephrectomy

Emphysematous pyelonephritis is a severe life-threatening infection which continues to carry significant morbidity and mortality. We present a case recently managed at our institution by laparoscopic nephrectomy. The patient survived, and in comparison to some of the more conventionally managed patients in the literature, made an extremely speedy recovery. We would advocate this option to be seriously considered when patients are suitable and appropriately trained surgeons are available.     

Socioeconomic deprivation, ethnicity, and stroke mortality in Greater London and south east England.

OBJECTIVE AND SETTING: To examine geographical variation in stroke mortality in Greater London compared with the surrounding South East Region of England. DESIGN: Cross sectional, ecological analysis based on electoral wards. SUBJECTS: Resident population aged 45 years or more. MAIN OUTCOME MEASURE: Age specific stroke mortality rates in five age bands, 1986-92. MAIN OUTCOME MEASURE: Age specific stroke mortality rates in five age bands, 1986-92. MAIN RESULTS: In the 45-54 years age band, stroke mortality rate ratios (95% confidence intervals) relative to the surrounding south east were 2.09 (1.81, 2.4) for Inner London and 1.31 (1.15, 1.5) for Outer London for men and 1.64 (1.4, 1.93) and 1.13 (0.98, 1.31) respectively for women. This gradient diminished and reversed with increasing age. In the 85+ age band, rate ratios were 0.82 (0.76, 0.89) for Inner London and 0.89 (0.84, 0.94) for Outer London for men and 0.8 (0.75, 0.85) and 0.88 (0.84, 0.92) respectively for women. Carstairs deprivation index and the percentages of Afro-Caribbean men and women and Irish born men were significantly and positively correlated with stroke mortality at the ward level. The Carstairs effect diminished with increasing age. Adjustment for these variables diminished or abolished the higher stroke mortality risks in London for younger people but had little effect on the lower risks for older Londoners. CONCLUSIONS: Higher rates of stroke mortality among middle aged adults in Greater London, compared with the surrounding South East Region, are associated with socioeconomic deprivation and ethnicity. These factors do not explain the relatively lower stroke mortality among older Londoners.     

Prospective relations between Helicobacter pylori infection,coronary heart disease,and stroke in middle aged men.

OBJECTIVE: To determine whether Helicobacter pylori, a chronic bacterial infection often acquired in childhood, is associated with increased risk of coronary heart disease and stroke later in life. DESIGN: Nested case-control study. SETTING: Prospective study of cardiovascular disease in men aged 40-59 years at entry (1978-1980) in 24 British towns. SUBJECTS: 135 cases of myocardial infarction and 137 cases of stroke occurring before December 1991; 136 controls were identified, frequency matched to cases by town and age group. METHODS: Serum samples stored at entry were analysed by an enzyme linked immunosorbent assay for the presence of H pylori specific IgG antibodies. RESULTS: 95 of the myocardial infarction cases (70%) and 93 (68%) of the stroke cases were seropositive for H pylori compared with 78 (57%) of the controls (odds ratio for myocardial infarction 1.77, 95% confidence interval (CI) 1.06 to 2.95, P = 0.03; odds ratio for stroke 1.57, 95% CI 0.95 to 2.60, P = 0.07). Helicobacter pylori infection was associated with manual social class, residence in Northern England or Scotland, cigarette smoking, higher systolic pressure and blood glucose, and a lower height-standardised forced expiratory volume in one second. Adjustment for these factors attenuated the relation between H pylori and myocardial infarction (odds ratio = 1.31, 95% CI 0.70 to 2.43, P = 0.40) and effectively abolished the relation with stroke (odds ratio = 0.96, 0.46 to 2.02, P = 0.92). The relation between helicobacter infection and fatal myocardial infarction was slightly stronger (odds ratio 2.41, 95% CI 1.13 to 5.12) but was also markedly attenuated after adjustment (1.56, 95% CI 0.68 to 3.61). CONCLUSION: In this prospective study the association between Helicobacter pylori infection and increased risk of myocardial infarction and stroke was substantially confounded by the relation between this infection, adult social class, and major cardiovascular risk factors.     

Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood

BACKGROUND: A systematic quantitative review was conducted of evidence relating parental smoking to acute lower respiratory illness in the first three years of life. METHODS: Fifty relevant publications were identified after consideration of 692 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search, completed in April 1997, identified 24 studies ascertaining illnesses in a community setting, including five surveys of schoolchildren with retrospective ascertainment of early chest illness, and 17 studies of admissions to hospital for lower respiratory illness in early life. Thirty eight studies were included in a quantitative overview using random effects modelling to derive pooled odds ratios. RESULTS: The results of community and hospital studies are broadly consistent, with only one publication reporting a reduced risk among children of smokers. The pooled odds ratios were 1.57 (95% CI 1.42 to 1.74) for smoking by either parent and 1.72 (95% CI 1.55 to 1.91) for maternal smoking. There is a significantly increased risk of early chest illness associated with smoking by other household members in families where the mother does not smoke (1.29, 95% CI 1.16 to 1.44). The associations with parental smoking are robust to adjustment for confounding factors, and show evidence of a dose-response relationship in most studies in which this has been investigated. CONCLUSIONS: The relationship between parental smoking and acute lower respiratory illness in infancy is very likely to be causal. Although it is impossible to distinguish the independent contributions of prenatal and postnatal maternal smoking, the increased risk associated with smoking by other household members suggests that exposure to environmental tobacco smoke after birth is a cause of acute chest illness in young children.


     

The influence of pentoxifylline on motility and viability of spermatozoa from normozoospermic semen samples

In order to evaluate the effects of pentoxifylline on sperm motility and longevity, a controlled in-vitro study was conducted on normozoospermic donor semen samples using the Cellsoft automated system for sperm motility analysis. After incubation and selection, pentoxifylline was found to improve the recovery of spermatozoa and to increase their velocity. In the subgroup of progressively motile spermatozoa, curvilinear velocity was also enhanced. It is concluded that pentoxifylline has an effect on the vigour, but not on the pattern, of sperm motion. Pentoxifylline did not improve the motility characteristics of senescent spermatozoa in normozoospermic sperm samples. Sperm survival, as shown by supra-vital staining, and motility longevity both decreased with time after pentoxifylline treatment.     

Prostacyclin in the treatment of painful Peyronie's disease

The effect of a prostacyclin infusion was studied in 5 men with persistent pain associated with Peyronie's disease. Marked side effects were associated with the infusion, which was of limited benefit.