Abdulelah AlAdimi;Nabil AlOdaini;Atef M. M. Darwish
Journal of Medicine and Life Science
/
v.19
no.3
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pp.116-120
/
2022
Objective: To estimate the efficacy of sequential treatment of bladder endometriosis (BE) of the vesicoureteric junction using transurethral resection (TUR) and hormonal therapy. Design: Case report. Setting: Private multispecialty hospital. Patient: A multiparous woman presented with perimenstrual lower urinary tract symptoms, cyclic chronic pelvic pain, and left loin pain. Intervention[s]: Ultrasonography revealed marked left renal dilatation. Computed tomography confirmed the presence of a bladder mass. A diagnostic cystoscopy revealed compression of the left vesicoureteral junction. Complete TUR BE with release of chocolate material during resection, followed by ureteric double J stent insertion for 3 months, was performed. Histopathology confirmed the diagnosis of BE, followed by adjuvant hormonal therapy (dienogest) for 3 months. Follow-up for about 2 years revealed complete relief of the symptoms without any recurrence. Main Outcome Measure[s]. Success and recurrence rates of sequential TUR and hormonal therapy of BE of the vesicoureteric junction. Result[s]. TUR BE followed by adjuvant hormonal therapy was very effective in eradicating BE of the vesicoureteric junction in a safe manner without recurrence on follow-up for 2 years. Conclusion[s]. BE of the vesicoureteric junction can be properly treated by sequential TUR and hormonal therapy without recurrence over a 2-year follow-up.
This study was conducted to evaluate the effectiveness of a combination of gemcitabine and nedaplatin therapy among patients with metastatic urothelial carcinoma previously treated with two lines of chemotherapy. Between February 2009 and August 2013, 30 patients were treated with gemcitabine and paclitaxel as a second-line chemotherapy. All had received a first-line chemotherapy consisting of methotrexate, vinblastine, doxorubicin and cisplatin. Ten patients who had measurable histologically proven advanced or metastatic urothelial carcinoma of the urinary bladder and upper urinary tract received gemcitabine $1,000mg/m^2$ on days 1, 8 and 15 and nedaplatin $70mg/m^2$ on day 2 as a third-line chemotherapy. Tumors were assessed by imaging every two cycles. The median number of treatment cycles was 3.5. One patient had partial response and three had stable disease. The disease-control rate was 40%, the median overall survival was 8.8 months and the median progression-free survival was 5.0 months. The median overall survival times for the first-line and second-line therapies were 29.1 and 13.9 months, respectively. Among disease-controlled patients (n=4), median overall survival was 14.2 months. Myelosuppression was the most common toxicity. There were no therapy-related deaths. Gemcitabine and nedaplatin chemotherapy is a favorable third-line chemotherapeutic option for patients with metastatic urothelial carcinoma. Given the safety and benefit profile seen in this study, further prospective trials are warranted given the implications of our results with regard to strategic chemotherapy for patients with advanced or metastatic urothelial carcinoma.
Purpose: This study was a predicative survey to provide home care clients with indwelling urinary catheters for furnishing basic educational material to their families by analyzing the family members' knowledge, educational needs and educational experience about indwelling catheter management. Method : The subjects consisted of 108 family members who cared for home care clients with indwelling catheters. Data were collected by home care nurses in nine hospitals in Pusan, who directly interviewed with them through questionnaires from Sep. 6th to 30th in 2004. The questionnaires for data collection were developed through pre-survey and reference review. The collected data was analyzed by using frequency, percentile, mean, variation, t-test, ANOVA on SPSS 10.1 package. Results : There were characters of home care clients with indwelling catheters: women(67.6%) were more than men; the average age of them was $69.60{\pm}14.99$ years old; neurogenic and cerebrovascular diseases(80.0%) were the most common disease group; 81.5% of them were totally dependent on others in terms of level of activity. Home care clients' families had these characters: women(76.9%) were more than men; the average age was $54.5{\pm}13.70$ years old; 46.3% of them were parents or sons or daughters in terms of relation with patient; tl1e average care period was $39.8{pm}34.20$ months. Level of knowledge about indwelling catheter management of the family members were 69.8% and its mean were $20.24{\pm}4.53$. Educational needs were 90.9% and its mean were $14.55{\pm}3.56$. Educational experience were 53.3% and its mean were $8.53{\pm}4.30$. 'Complications in using an indwelling catheter', 'Symptoms to call for a home care nurse' and 'Method to attach an indwelling catheter' were high ranked in both educational needs and educational experience. 'Anatomy of urinary tract', 'Functions of urinary tract' and 'Catheter placement' were low ranked in both educational needs and educational experience Level of knowledge about indwelling catheter management of the families showed a significant difference according to their age(F=5.35, p=0.01). Educational needs showed a significant difference according to care period(F=3.06, p=0.04). Conclusion: the family members' level of knowledge and educational experience about indwelling catheter management and their educational were not sufficient while their educational needs were high. In other words although the family members were acknowledged education needs, but the care for the patients with indwelling catheter weren't performed well because of their lack of related knowledge. Therefore systematic educational programs about indwelling catheter management for home care clients and their families should be made on the base of this study.
A 1-year-old intact male Russian blue cat was admitted with a history of depression, partial anorexia, vomiting and dysuria. Through the blood analysis, ultrasonography and urinalysis, this cat was diagnosed as feline lower urinary tract disease with cystitis. Despite antibiotic therapy the cat showed stranguria and urinary catheterization were repeated several times. One week after, this patient appeared depression, hyperthermia and leukocytosis. Ultrasonography revealed a small amount of hypoechoic fluid around the right kidney and bacteria were found in the urine. The amount of the right subcapsular fluid was increased and bacteria were found in the fluid. On the excretory urography, leakage of contrast media were detected. The right kidney was surgically removed and suppurative fluid between the renal parenchyma and the thickened capsule was identified. After surgery, subcapsular abscess of the right kidney associated with pyelonephritis was confirmed histologically and this cat recovered without complications.
Purpose: Urinary tract infection (UTI) is a common bacterial infection in children and Escherichia coli is a predominant pathogen. The purpose of this study is to evaluate phylogenetic groups and virulence factors of E. coli causing UTI in children in Korea. Methods: From October 2010 to April 2013, urinary E. coli strains were isolated from the 33 pediatric patients of UTI. Multiplex polymerase chain reactions were performed to evaluate the phylogenetic groups and 5 virulence factor genes (fimH, sfa, papA, hylA, and cnf1) of E. coli. Distribution of molecular characteristics of E. coli was analyzed by clinical diagnosis and accompanying vesicoureteral reflux (VUR). Results: Most (84.8%) uropathogenic E. coli were belonged to phylogenetics group B2 and the others (15.2%) were belonged to group D. The virulence factors were distributed as: fimH (100%), sfa (100%), hylA (63.6%), cnfI (63.6%), and papA (36.4%). According to clinical diagnosis, phylogenetic distribution of E. coli strain was 92.3% of B2 and 7.7% of D in acute pyelonephritis and 57.1% of B2 and 42.9% of D in cystitis. Distribution of virulence factors was similar in both groups. In patients with acute pyelonephritis, phylogenetic distribution was similar in VUR and non-VUR group, but proportion of papA genes were lower in VUR group than that of non-VUR group (43.8% vs. 20.0%, P=0.399). Conclusions: This study provides current epidemiologic molecular data of E. coli causing pediatric UTI in Korea and will be a fundamental for understanding the pathogenesis of pediatric UTI.
Kim, Seong-Min;Kim, Chang-Woo;Kim, Byoung-Kyu;Oh, Jung-Tak;Han, Seok-Joo
Advances in pediatric surgery
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v.13
no.1
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pp.76-80
/
2007
The authors applied anterior sagittal transrectal apporach (ASTRA) for the repair of urethrovaginal fistula which developed after total repair of persistent cloaca. The patient had been diagnosed to have persistent cloaca, double uterus and double vagina, and received PSARP, excision of right-side uterus and vagina, and left vaginal switch operation at 22 months old. After operation, the patient admitted several times due to frequent urinary tract infection and ectopic stone formation in bladder and neovagina. Urethro-neovaginal fistula was confirmed by cystoscopy and corrected with ASTRA. Postoperative voiding cystourethrogram showed no fistula tract. ASTRA showed improved surgical field, minimized ureterocystic damage, and preserved perirectal nerve due to limited incision of rectum.
Inferior mesenteric plexus block(IMPB) is a nerve block for lower abdominal pain originating from GI tract of distal transverse colon to sigmoid colon and other polvic organ where the inferior mesenteric plexus contains visceral afferent fibers of that organ. We performed IMPB on two patients with lower abdominal pain. Case I: 61 year old female diagnosed with cancer of stomach and uterine cervix and carcinomatosis, experienced complete relief from pain for a period of 7 months after IMPB. Case II: male, 28 years old, who had contracted cancer of the descending colon with obstructive jaundice and pancreatitis had complained of pain in the whole of the abdominal area. IMPB was performed for lower abdominal pain. Seven days after, a celiac plexus block was also performed for upper abdominal pain. The patient complained of recurring pain in the left & upper lower abdomen 30 days after the IMPB. The intensity of the pain was visual analogue scale 4 and it was managed by continuous epidural block. Conclusion: It is our recommendation that IMPB is a reliable method for treatment of lower abdominal pain originating from malignant condition of GI tract from distal transverse colon to sigmoid colon and urinary bladder.
The resistant strains due to the extended-spectrum $\beta$-lactamase (ESBL) were susceptible to cefatrizine combined with clavulanic acid. The purpose of this study was to evaluate the in vitro and in vivo antibacterial activities of cefatrizine/clavulanic acid (CTRZ/CV) combination at a ratio of 2 : 1 in comparison with cefaclor (CCLO), cefuroxime (CRXM), cefuroxime axetil (CRXMA) and amoxicillin/clavulanic acid (AMXCCV). CTRZ/CV showed good activity against laboratory strains of gram-positive and gram-negative bacteria and exhibited excellent antibacterial activity against $\beta$-lactamase-producing strains. The bactericidal activity of CTRZ/CV was superior to that of CCLO and CRXM, and almost equal to that of AMXCCV against the $\beta$-lactamase-producing strains. The in vitro results were substantiated. by in vivo mouse experimental infection studies with $\beta$-lactamase-producing and non-producing strains. In mixed experimental infection due to $\beta$-lactamase-producing and non-producing strains, the therapeutic efficacy of CTRZ/CV was superior to that of CTRZ, CCLO, CRXMA and AMXCCV. In respiratory tract infection in mice due to Klebsiella pneumoniae EB4O, CTRZ/CV was more erective than CCLO, CRXMA and AMXCCV and also more efficacious than CCLO, CRXMA and AMXCCV in urinary tract infection in mice due to Escherichia coli EB13. These results indicate that CTRZ/CV is a useful drug for the treatment of infection caused by $\beta$-1actamase-producing strains including ESBL-producing strains.
Kim, Hoon-Hee;Lee, Ok-Sang;Jung, Sun-Hoi;Lim, Sung-Cil
Korean Journal of Clinical Pharmacy
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v.22
no.1
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pp.55-64
/
2012
The quinolones are broad-spectrum antibiotics and enhanced antimicrobial activity has extended the use of the quinolones beyond the traditional indications for quinolone antibiotics in the treatment of urinary tract infections. The quinolones are effective in a wider variety of infectious diseases, including skin and respiratory infections. Because of their excellent safety and tolerability, they have become popular alternatives to penicillin and cephalosporin derivatives in the treatment of various infections. A retrospective study was performed to evaluate efficacy and safety of IV quinolones for inpatient use. Total 117 patients who administerd quinolones for longer than 3 continuous days at community hospital from October 1st, 2008 to December 31st, 2008 were reviewed. The criterias for drug evaluation were included the validation of indication, outcome, dosage and side effects. In the results, ciprofloxacin 13 (total 93), levofloxacin 3 (total 59) and moxifloxacin 2 (total 19) cases were not met the criterias based on the culture results. Major indications were pneumonia (ciprofloxacin 16.3%, levofloxacin 67.8%, moxifloxacin 84.2%), urinary tract infection (ciprofloxacin 44.1%), skin infection (ciprofloxacin 7.5%, levofloxacin 20.3%, moxifloxacin 10.5%), intra-abdominal infection (ciprofloxacin 10.8%, moxifloxacin 5.3%), etc.. In the results of quinolone monotherapy, the frequencies were each ciprofloxacin 74.2%, levofloxacin 50.8% and moxifloxacin 47.4%. In the results of dosage validation, the validities were each ciprofloxacin 54.8%, levofloxacin 94.9% and moxifloxacin 100.0%. In the results of duration validation, the validities were each ciprofloxacin 59.1%, levofloxacin 78.0% and moxifloxacin 89.5%. Adverse drug reactions were reported for total 49 cases and those were gastrointestinal tract effects including nausea, vomiting, diarrhea and central nervous system effects including headache, dizziness. In summary, the quinolones appropriately used for hospitalized patients based on this study. A focused approach emphasizing "correct use of quinolones" may reduce development of antimicrobial resistance and maximize class efficacy. Consequently, correct use of antibiotics will contribute to decrease medical expenses for person and community.
The pharmacokinetics of DWP20364 (1-cyclopropyl -5-amino-6,8-difluoro-7-(2,7-diazabiclo [3,3,0] oct-4-ene-7-yl)-1,4-dihydro-4-oxoquinoline-3-carboxylic acid), a novel fluoroquinolone containing C7-bicyc-talc structure, were compared with those of ciprofloxacin (CPFX) after single intravenous (i.v.) and oral (p.o.) administration to rats using microbiological assay (bioassay). After i.v. administration to rats, the plasma concentrations of the two drugs declined biexponentially. The terminal half-lives (t$_{1}$2$\beta$/) of DWP20364 were 110$\pm$ 13.2 min and 117$\pm$3.09 min after i.v. and p.o. administration, respectively, and they were significantly higher than those of CPFX (45.5$\pm$9.52 min and 48.3$\pm$ 12.1 min, respectively). Similar results were also obtained from plasma concentrations and area under the plasma concentration-time curves. The total body clearance of DWP20364, 7.82$\pm$0.37 ml/min/kg was significantly slower than that of CPFX, 27.3 $\pm$ 11.1 m1/ min/kg. Above data suggested that the antimicrobial activity of DWP20364 could be longer than that of CPFX. The urinary recovery after i.v. and p.o. administration of DWP20364 was significantly lower than those of CPFX suggesting that the effect of DWP20364 on urinary tract infection could be lower than that of CPFX. The serum protein binding values of DWP20364 at 2$\mu$g/ml were apparently 91.5~93.1% in rats and human. DWP20364 was distributed by the order of liver, lung, kidney, sf)leon, heart, muscle and brain collected at 30 min after orally administered.
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