- Email: [email protected]
Prevalence of bacteriuria in infants and preschool children
one of the periurethral infections, the one resistant organism being S. faecalis. The authors conclude that low-dose trimethoprimsulfamethoxazole therapy is effective in the prophylaxsis of recurrent urinary tract infection in women with minimal side effects. However, more bacteriuria with S. faecalis may result from long-term therapy with either trimethoprim-sulfamethoxazole or sulfamethaxazole alone.
Correlation of Pretreatment Serum Corticosteroid with Survival in Prostatic Cancer, C. E. Blackard, D. P. Byar, U. S. Seal, R. P. Doe, and the Veterans Administration Cooperative Urologic Research Group (291: 751, 1974) - Predicting the survival of the patient with prostatic carcinoma has been limited to the combined usage of the clinical stage and the histologic pattern neither of which has proved to be totally accurate. To these the Veterans Administration Cooperative Urologic Research Group has found that the pretreatment serum nonprotein-bound cortisol (NPC) and the total 17-hydroxycorticosteroid (17OHCS) levels to be important variables helping to predict survival during the first year of treatment. Serum NPC and 17-OHCS levels were drawn on 715 patients with all stages of prostatic carcinoma. The Research Group found that in patients with lower pretreatment levels of NPC and 17-OHCS there was a significantly increased survival during the first year of treatment. Only 10 per cent of men with an initial serum NPC value of 1 microgram per 100 ml. or less died during the first year of treatment as opposed to 40 per cent of men with an initial value greater than 2 micrograms per 100 ml. Similarly only 15 per cent with a pretreatment serum 17-OHCS level below 14 micrograms per 100 ml. died during the first year as compared with 31 per cent with a level greater than 30 micrograms per 100 ml. After the first year, there was little additional spreading apart of the survival curves. Elevated 17-OHCS levels have been correlated with poor prognosis in breast and lung cancer. A higher resetting of cortisol-ACTH feedback regulation is believed to be the mechanism for the elevation of 17-OHCS and NPC. It is concluded that these higher risk patients should be treated more vigorously for their disease.
thirty-five apparently healthy infants and preschool children attending a child’s health clinic in Leeds were screened for bacteriuria. The authors found only one boy among 528 who had asymptomatic bacteriuria. He was only five weeks old and had no radiologic abnormalities. Four girls of 507 had bacteriuria. Three of the 4 girls had radiologic abnormalities. Testing girls under one year of age caused, by far, the most work for the staff and the most worry for parents. The authors, therefore, conclude screening boys under the age of five years and girls under the age of twelve months for bacteriuria is likely to cause more work and concern for the parents than is justified by the results. But screening preschool girls who can void on request may reveal a significant urologic problem at an earlier age in the natural history of the disease.
PLASTIC AND RECONSTRUCTIVE SURGERY by S. Kallet,
M.D.
The Surgical Construction of Male Genitalia for the Female-to-Male Transsexual, J. M. Noe, D. Birdsell, and D. R. Laub (53: 511, 1974) -The authors present their method of penile construction used in 12 patients in the Stanford Gender Identity Program. A two-stage procedure is employed. First a lower abdominal longitudinal bipedicled tube flap is made with a skin-lined tunnel down the center. At a second stage a hysterectomy and bilateral salpingo-oophorectomy are done, followed by proximal release of the tube with fashioning of a glans penis at the released end. The center tunnel of skin is left open at both ends to accommodate a T-shaped removable penile prosthesis for purpose of intercourse. This prosthesis abuts against the symphysis pubis and stimulates the clitoris, which is left untouched by the operation. For technical reasons no attempt is made to fashion a urethra within the new penis. Also, during the second stage, the labia majora are fused, the inferior end being left open so that the patient may urinate. Of 12 patients, 10 were able to have intercourse, 9 said they attained orgasm, all I2 were “pleased’ with the result, and there was only one complication (a wound infection).
THE LANCET INVESTIGATIVE UROLOGY by M. Josem,
M.D. by A. Thomas
Prevalence of Bacteriuria in Infants and Preschool Children, J. M. Davies, G. L. Gibson, J. M. Littlewood, and S. R. Meadow (2: 7,1974) - One thousand
292
Pharmacoclinical Study of Oral Estramustine Phosphate (Estracyt) in Advanced Carcinoma of the
UROLOGY
/ FEBRUARY
1975 / VOLUME
V, NUMBER 2
Correlation of Pretreatment Serum Corticosteroid with Survival in Prostatic Cancer, C. E. Blackard, D. P. Byar, U. S. Seal, R. P. Doe, and the Veterans Administration Cooperative Urologic Research Group (291: 751, 1974) - Predicting the survival of the patient with prostatic carcinoma has been limited to the combined usage of the clinical stage and the histologic pattern neither of which has proved to be totally accurate. To these the Veterans Administration Cooperative Urologic Research Group has found that the pretreatment serum nonprotein-bound cortisol (NPC) and the total 17-hydroxycorticosteroid (17OHCS) levels to be important variables helping to predict survival during the first year of treatment. Serum NPC and 17-OHCS levels were drawn on 715 patients with all stages of prostatic carcinoma. The Research Group found that in patients with lower pretreatment levels of NPC and 17-OHCS there was a significantly increased survival during the first year of treatment. Only 10 per cent of men with an initial serum NPC value of 1 microgram per 100 ml. or less died during the first year of treatment as opposed to 40 per cent of men with an initial value greater than 2 micrograms per 100 ml. Similarly only 15 per cent with a pretreatment serum 17-OHCS level below 14 micrograms per 100 ml. died during the first year as compared with 31 per cent with a level greater than 30 micrograms per 100 ml. After the first year, there was little additional spreading apart of the survival curves. Elevated 17-OHCS levels have been correlated with poor prognosis in breast and lung cancer. A higher resetting of cortisol-ACTH feedback regulation is believed to be the mechanism for the elevation of 17-OHCS and NPC. It is concluded that these higher risk patients should be treated more vigorously for their disease.
thirty-five apparently healthy infants and preschool children attending a child’s health clinic in Leeds were screened for bacteriuria. The authors found only one boy among 528 who had asymptomatic bacteriuria. He was only five weeks old and had no radiologic abnormalities. Four girls of 507 had bacteriuria. Three of the 4 girls had radiologic abnormalities. Testing girls under one year of age caused, by far, the most work for the staff and the most worry for parents. The authors, therefore, conclude screening boys under the age of five years and girls under the age of twelve months for bacteriuria is likely to cause more work and concern for the parents than is justified by the results. But screening preschool girls who can void on request may reveal a significant urologic problem at an earlier age in the natural history of the disease.
PLASTIC AND RECONSTRUCTIVE SURGERY by S. Kallet,
M.D.
The Surgical Construction of Male Genitalia for the Female-to-Male Transsexual, J. M. Noe, D. Birdsell, and D. R. Laub (53: 511, 1974) -The authors present their method of penile construction used in 12 patients in the Stanford Gender Identity Program. A two-stage procedure is employed. First a lower abdominal longitudinal bipedicled tube flap is made with a skin-lined tunnel down the center. At a second stage a hysterectomy and bilateral salpingo-oophorectomy are done, followed by proximal release of the tube with fashioning of a glans penis at the released end. The center tunnel of skin is left open at both ends to accommodate a T-shaped removable penile prosthesis for purpose of intercourse. This prosthesis abuts against the symphysis pubis and stimulates the clitoris, which is left untouched by the operation. For technical reasons no attempt is made to fashion a urethra within the new penis. Also, during the second stage, the labia majora are fused, the inferior end being left open so that the patient may urinate. Of 12 patients, 10 were able to have intercourse, 9 said they attained orgasm, all I2 were “pleased’ with the result, and there was only one complication (a wound infection).
THE LANCET INVESTIGATIVE UROLOGY by M. Josem,
M.D. by A. Thomas
Prevalence of Bacteriuria in Infants and Preschool Children, J. M. Davies, G. L. Gibson, J. M. Littlewood, and S. R. Meadow (2: 7,1974) - One thousand
292
Pharmacoclinical Study of Oral Estramustine Phosphate (Estracyt) in Advanced Carcinoma of the
UROLOGY
/ FEBRUARY
1975 / VOLUME
V, NUMBER 2