trimethoprim--sulfamethoxazole-drug-combination and Hematuria

Topics: Adult; Age Factors; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Antineutrophil Cytoplasmic; Cyclophosphamide; Diagnosis, Differential; Drug Therapy, Combination; Emergencies; Glomerulonephritis; Granulomatosis with Polyangiitis; Hematuria; Humans; Immunosuppressive Agents; Male; Middle Aged; Plasmapheresis; Prednisone; Prognosis; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method.. A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy.. The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group.. Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.

Topics: Aged; Anesthesia, Local; Antibiotic Prophylaxis; Bacteriuria; Biopsy, Needle; Endosonography; Fever of Unknown Origin; Gastrointestinal Hemorrhage; Hematuria; Humans; Lidocaine; Male; Middle Aged; Patient Readmission; Prostate; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, in children is an uncommon chronic organ- and life-threatening systemic vasculitis that may share at time of initial presentation a number of clinical features in common with Henoch-Schönlein purpura (HSP), a very common and comparatively benign form of childhood vasculitis. Diagnosis of GPA requires a high index of suspicion, and antineutrophil cytoplasmic antibody tests along with tissue biopsy are helpful tools for diagnosis. We report 2 patients with GPA masqueraded as HSP at time of initial presentation. Both patients presented with nonthrombocytopenic purpura on lower extremities, in addition to abdominal pain, and/or microscopic hematuria and fulfilled both the American College of Rheumatology and the Pediatric Rheumatology European Society classification criteria for HSP. Both patients eventually developed significant renal and pulmonary disease and were diagnosed with GPA. We aim to raise awareness of such atypical presentations of GPA to avoid delayed management.

Topics: Abdominal Pain; Anti-Infective Agents; Antibodies, Antineutrophil Cytoplasmic; Azathioprine; Child; Cyclophosphamide; Diagnosis, Differential; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Glucocorticoids; Granulomatosis with Polyangiitis; Hematuria; Humans; IgA Vasculitis; Immunosuppressive Agents; Male; Plasmapheresis; Proteinuria; Trimethoprim, Sulfamethoxazole Drug Combination

• To review a contemporary cohort of patients undergoing a transrectal ultrasound-guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits.. • The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed. • All patients received peri-procedural antibiotic prophylaxis with either ciprofloxacin or co-trimoxazole. • Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome. • Patient comorbidities and biopsy characteristics were reviewed for association with complications.. • Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. • Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. • Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. • All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. • No demographic or biopsy variables were particularly associated with development of a post-procedure complication.. • In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit. • No clinical or biopsy variables were directly associated with development of complications. • These data may be valuable when counselling patients before biopsy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Biopsy, Needle; Ciprofloxacin; Emergencies; Emergency Service, Hospital; Hematuria; Hospitalization; Humans; Ischemic Attack, Transient; Male; Middle Aged; Prostate; Prostatic Neoplasms; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional; Urinary Retention; Urinary Tract Infections

Xanthogranulomatous pyelonephritis is a chronic, inflammatory disease of the kidney rarely found in the pediatric population. We report the case of a 16-year-old boy with fever, microscopic hematuria, and an enlarging cystic renal mass on ultrasonography. The patient had no evidence of renal stones and no known risk factors, other than a recent tattoo performed with unsterile equipment. Because the differential diagnoses included Wilms tumor, he underwent open exploration and nephrectomy. The histopathologic findings were consistent with xanthogranulomatous pyelonephritis, and cultures grew methicillin-resistant Staphylococcus aureus. The etiology was believed to be bacterial seeding from the unsterile tattoo.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Combined Modality Therapy; Diagnosis, Differential; Fever; Hematuria; Humans; Kidney Neoplasms; Male; Methicillin-Resistant Staphylococcus aureus; Nephrectomy; Pyelonephritis, Xanthogranulomatous; Staphylococcal Infections; Tattooing; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Wound Infection

Topics: Aged; Anti-Infective Agents, Urinary; Choroid Diseases; Ciliary Body; Exudates and Transudates; Glaucoma, Angle-Closure; Hematuria; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Uveal Diseases

To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder.. After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion.. Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Topics: Anti-Bacterial Agents; Chronic Disease; Cystoscopy; Electrocoagulation; Escherichia coli Infections; Female; Follow-Up Studies; Hematuria; Histiocytes; Humans; Malacoplakia; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases; Urinary Tract Infections

Three children aged 3-11 years had ultrasonography of the urinary tract for the investigation of dysuria and haematuria. A bladder mass was seen in these 3 children. One child had computed tomography scan, cystoscopy and bladder biopsy because rhabdomyosarcoma was considered. The biopsy revealed an inflammatory process. The urine culture of the other 2 children revealed E. coli. On ultrasonography, the inflammatory mass may appear homogeneously hypoechoic or may contain moderate level echoes. The mucosal surface of the mass may be smooth or lobulated. It is important to consider an infective cause for a bladder mass in children because computed tomography, cystoscopy and biopsy may be avoided.

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Cystitis; Diagnosis, Differential; Female; Hematuria; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Urinary Bladder Neoplasms; Urination Disorders

Wegener granulomatosis was diagnosed in a 42-year-old woman in 1965. Although a regimen of azathioprine and prednisone was helpful, the disease progressed. Cyclophosphamide was added to this regimen in 1969. On three separate occasions her disease relapsed when cyclophosphamide therapy was discontinued. In 1984, she developed cyclophosphamide-resistant disease and drug toxicity. We were able to discontinue cyclophosphamide therapy after a trimethoprim-sulfamethoxazole regimen that was begun in February 1985 led to rapid improvement, a fall in the erythrocyte sedimentation rate, and a complete remission. Her 22-year survival is the longest one reported. Because patients with Wegener granulomatosis sometimes respond to trimethoprim-sulfamethoxazole, this therapy deserves careful study and implies that Wegener granulomatosis is an as yet unidentified infection.

Topics: Blood Sedimentation; Cyclophosphamide; Drug Combinations; Drug Therapy, Combination; Female; Granulomatosis with Polyangiitis; Hematuria; Hemoglobins; Humans; Leukocyte Count; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Boutonneuse Fever; Child; Drug Combinations; Female; Hematuria; Humans; Rickettsiaceae Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Escherichia coli Infections; Female; Hematuria; Humans; Melena; Sulfamethoxazole; Thrombocytopenia; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Eight acute spinal injury patients with deep vein thrombosis and/or pulmonary emboli are presented witn an in-depth analysis and management of anticoagulation therapy. Special considerations for acute spinal cord injury patients with regards to prophylactic and therapeutic anticoagulation by heparin and coumadin are discussed. There was a wide variation in the requirement of heparin and/or coumadin to maintain effective coagulability which could only be elicited by frequent laboratory monitoring. Inadequate dose and shorter duration of administration of anticoagulant resulted in recurrence of thromboembolism in three out of eight patients in the present series. Haemorrhagic complications were minor and easily manageable. Co-trimoxazole potentiation of coumadin action occurred in two of our patients and it requires special mention as the drug is used increasingly in the treatment of urinary tract infections.

Topics: Administration, Oral; Adult; Anticoagulants; Drug Combinations; Drug Interactions; Hematuria; Heparin; Humans; Injections, Subcutaneous; Male; Middle Aged; Pulmonary Embolism; Spinal Cord Injuries; Sulfamethoxazole; Thrombophlebitis; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin