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Efficacy of the Routine Admission Urinalysis
ONCOLOGY AND CHEMOTHERAPY
adolescent male sex partner must be an important reservoir of sexually transmitted disease agents for the adolescent girL Among adolescent male detainees 2 per cent were found screening culture to be asymptomatic carriers of N. gonorrhoeae. In a selected population of adolescent boys attending a teen clinic for routine care others isolated C. trachomatis urethral culture from 5 of 19 asymptomatic patients. In addition, Pedgore isolated C. trachomatis by urethral culture from 11 per cent of young, asymptomatic army recruits. The authors report the prevalence of culture-verified C. trachomatis and N. gonorrhoeae infection in asymptomatic, sexually active heterosexual adolescent boys in San Francisco. Asymptomatic carriage of C. trachomatis was common among sexually active adolescent boys. The isolation rate was similar among the teen clinic and detention clinic populations (8 to 9 per cent) and it was similar to that reported for a group of young army recruits (mean age 23 years). It is noteworthy that a high rate of isolation of Chlamydia was identified in boys from the teen clinic, which serves a large, middle class working population. The study population excluded the large proportion (50 per cent) of eligible asymptomatic subjects who refused to undergo culture. However, even if one assumes that all refusers had cultures negative for Chlamydia the prevalence of Chlamydia would remain significant (4 to 5 per cent). In contrast with the prevalence of asymptomatic carriage of Chlamydia in this population, asymptomatic carriage of N. gonorrhoeae (1 per cent) was uncommon. This finding is consistent with that of Handsfield and associates who reported a carriage rate of 2 per cent among young military personnel without symptoms. The authors did not identify any subjects with both infections. The identification of the asymptomatic, sexually active male adolescent as a reservoir for sexually transmitted disease is important to the development of strategies for the prevention and control of such disease among adolescents. It emphasizes the need for screening for sexually transmitted disease among sexually active boys, who are not the traditional clientele of sexually transmitted disease clinics. It clarifies the need to teach young persons that sexual activity itself and not evidence of symptoms of sexually transmitted disease in sex partners determines the risk for acquiring such disease. Finally, the need is demonstrated for development of noninvasive disease screening techniques acceptable to the sexually active, asymptomatic adolescent boy. G. P. M. 1 table, 12 references Bacteriu.ria With a Multiply Re§istant Species of Cory;.1.ehacteriu.m (Corynehacteriu.m Group D2): An Unnoticed. Cause of Urinary Tract Infection
1481
nary symptoms (incrusted Alkaline urine had abnor-mal sediment that yielded Corynebacterium group D2 in the absence of other microorganisms, a result suggesting that this organism could be an etiological agent of urinary tract infection. Because cultures of urine may appear to be sterile, prolonged incubation must be used to detect Corynebacterium group D2. Correct treatment improved the outcome and probably prevented the development of incrusted cystitis in most of the patients. G. P. M. 4 tables, 29 references Efficacy of the Routine Admission Urinalysis
B. V. AKIN, F. A. HUBBELL, E. B. FRYE, L. RUCKER AND R. FRIIS, Division of General Internal Medicine and Primary Care, Department of Medicine, University of California, Irvine, Orange, California Amer. J. Med., 82: 719-722 (Apr.) 1987 The charts of 301 patients admitted consecutively to an internal medicine ward were studied to determine the efficacy of routine admission urinalysis. Of the patients 80 per cent underwent urinalysis, of which 50 per cent were believed to be routine in contrast to a diagnostic urinalysis as indicated by the history and physical examination. Of the routine urinalyses only 34 per cent were abnormal in contrast to 80 per cent abnormalities found in a diagnostic group of patients" However, in only 3 patients (2.4 per cent) in the routine urinalysis group was treatment instituted on the basis of the abnormal urinalysis. Of these patients 2 underwent treatment that retrospectively was believed to be unnecessaryo Routine urinalysis for screening of hospitalized patients could be eliminated with little adverse affect in patient management. The authors recommend that urinalysis should be ordered on the basis of the medical history and physical examination, and not simply because of admission to the hospital. R. K. 2 tables, 18 references
ONCOLOGY AND CHEMOTHERAPY Congenital Mesoblastic Nephroma: A CHnico:radiologic Study of 17 Cases Representing the Pathologic Spectrum of the Disease
J. M. AGUADO, C. PONTE AND F. SORIANO, Departments of Microbiology and Internal Medicine, Fudaci6n Jimenez Diaz, Madrid, Spain
R S. L. CHAN, M.-Y. CHENG, K. MANCER, D. PAYTON, S. S. WEITZMAN, P. KOTECHA AND A. DANEMAN, Division of Hematology-Oncology, Departments of Pediatrics, Pathology and Radiology, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
J. Infect. Dis., 156: 144-150 (July) 1987
J. Ped., 111: 64-70 (July) 1987
The authors studied the records of 43 patients with significant bacteriuria caused by Corynebacterium group D2. All patients suffered from underlying diseases and 54 per cent were immunosuppressed. The predisposing factors were urological procedures (100 per cent), previous use of antibiotics (90 per cent), patient age greater than 65 years (65 per cent) and previous urinary tract infections (60 per cent). Two-thirds of the patients had urinary tract symptoms, which were more common in men than in women. The existence of previous lesions in the bladder favored the development of serious uri-
Congenital mesoblastic nephroma is a rare infantile renal tumor with a generally excellent prognosis. We describe 1 7 tumors that fit into the pathological spectrum of congenital mesoblastic nephroma proposed by Beckwith, which ranges from benign renal tumors through atypical gray zone lesions of more aggressive potential to crossover tumors akin to clear cell sarcoma of the kidney. Nine patients with histologically typical congenital mesoblastic nephroma were significantly younger and had smaller tumors than did 8 with atypical congenital mesoblastic nephroma. Clinical features did not differ in the 2
adolescent male sex partner must be an important reservoir of sexually transmitted disease agents for the adolescent girL Among adolescent male detainees 2 per cent were found screening culture to be asymptomatic carriers of N. gonorrhoeae. In a selected population of adolescent boys attending a teen clinic for routine care others isolated C. trachomatis urethral culture from 5 of 19 asymptomatic patients. In addition, Pedgore isolated C. trachomatis by urethral culture from 11 per cent of young, asymptomatic army recruits. The authors report the prevalence of culture-verified C. trachomatis and N. gonorrhoeae infection in asymptomatic, sexually active heterosexual adolescent boys in San Francisco. Asymptomatic carriage of C. trachomatis was common among sexually active adolescent boys. The isolation rate was similar among the teen clinic and detention clinic populations (8 to 9 per cent) and it was similar to that reported for a group of young army recruits (mean age 23 years). It is noteworthy that a high rate of isolation of Chlamydia was identified in boys from the teen clinic, which serves a large, middle class working population. The study population excluded the large proportion (50 per cent) of eligible asymptomatic subjects who refused to undergo culture. However, even if one assumes that all refusers had cultures negative for Chlamydia the prevalence of Chlamydia would remain significant (4 to 5 per cent). In contrast with the prevalence of asymptomatic carriage of Chlamydia in this population, asymptomatic carriage of N. gonorrhoeae (1 per cent) was uncommon. This finding is consistent with that of Handsfield and associates who reported a carriage rate of 2 per cent among young military personnel without symptoms. The authors did not identify any subjects with both infections. The identification of the asymptomatic, sexually active male adolescent as a reservoir for sexually transmitted disease is important to the development of strategies for the prevention and control of such disease among adolescents. It emphasizes the need for screening for sexually transmitted disease among sexually active boys, who are not the traditional clientele of sexually transmitted disease clinics. It clarifies the need to teach young persons that sexual activity itself and not evidence of symptoms of sexually transmitted disease in sex partners determines the risk for acquiring such disease. Finally, the need is demonstrated for development of noninvasive disease screening techniques acceptable to the sexually active, asymptomatic adolescent boy. G. P. M. 1 table, 12 references Bacteriu.ria With a Multiply Re§istant Species of Cory;.1.ehacteriu.m (Corynehacteriu.m Group D2): An Unnoticed. Cause of Urinary Tract Infection
1481
nary symptoms (incrusted Alkaline urine had abnor-mal sediment that yielded Corynebacterium group D2 in the absence of other microorganisms, a result suggesting that this organism could be an etiological agent of urinary tract infection. Because cultures of urine may appear to be sterile, prolonged incubation must be used to detect Corynebacterium group D2. Correct treatment improved the outcome and probably prevented the development of incrusted cystitis in most of the patients. G. P. M. 4 tables, 29 references Efficacy of the Routine Admission Urinalysis
B. V. AKIN, F. A. HUBBELL, E. B. FRYE, L. RUCKER AND R. FRIIS, Division of General Internal Medicine and Primary Care, Department of Medicine, University of California, Irvine, Orange, California Amer. J. Med., 82: 719-722 (Apr.) 1987 The charts of 301 patients admitted consecutively to an internal medicine ward were studied to determine the efficacy of routine admission urinalysis. Of the patients 80 per cent underwent urinalysis, of which 50 per cent were believed to be routine in contrast to a diagnostic urinalysis as indicated by the history and physical examination. Of the routine urinalyses only 34 per cent were abnormal in contrast to 80 per cent abnormalities found in a diagnostic group of patients" However, in only 3 patients (2.4 per cent) in the routine urinalysis group was treatment instituted on the basis of the abnormal urinalysis. Of these patients 2 underwent treatment that retrospectively was believed to be unnecessaryo Routine urinalysis for screening of hospitalized patients could be eliminated with little adverse affect in patient management. The authors recommend that urinalysis should be ordered on the basis of the medical history and physical examination, and not simply because of admission to the hospital. R. K. 2 tables, 18 references
ONCOLOGY AND CHEMOTHERAPY Congenital Mesoblastic Nephroma: A CHnico:radiologic Study of 17 Cases Representing the Pathologic Spectrum of the Disease
J. M. AGUADO, C. PONTE AND F. SORIANO, Departments of Microbiology and Internal Medicine, Fudaci6n Jimenez Diaz, Madrid, Spain
R S. L. CHAN, M.-Y. CHENG, K. MANCER, D. PAYTON, S. S. WEITZMAN, P. KOTECHA AND A. DANEMAN, Division of Hematology-Oncology, Departments of Pediatrics, Pathology and Radiology, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
J. Infect. Dis., 156: 144-150 (July) 1987
J. Ped., 111: 64-70 (July) 1987
The authors studied the records of 43 patients with significant bacteriuria caused by Corynebacterium group D2. All patients suffered from underlying diseases and 54 per cent were immunosuppressed. The predisposing factors were urological procedures (100 per cent), previous use of antibiotics (90 per cent), patient age greater than 65 years (65 per cent) and previous urinary tract infections (60 per cent). Two-thirds of the patients had urinary tract symptoms, which were more common in men than in women. The existence of previous lesions in the bladder favored the development of serious uri-
Congenital mesoblastic nephroma is a rare infantile renal tumor with a generally excellent prognosis. We describe 1 7 tumors that fit into the pathological spectrum of congenital mesoblastic nephroma proposed by Beckwith, which ranges from benign renal tumors through atypical gray zone lesions of more aggressive potential to crossover tumors akin to clear cell sarcoma of the kidney. Nine patients with histologically typical congenital mesoblastic nephroma were significantly younger and had smaller tumors than did 8 with atypical congenital mesoblastic nephroma. Clinical features did not differ in the 2