[Effect of furosemide on the obstructed kidney]

The effect of furosemide on the obstructed kidney was studied in dogs. In control kidneys (n = 4) the renal blood flow (RBF) was increased transiently after intravenous infusion of 20 mg of furosemide; from 12.9 +/- 1.2 to 14.8 +/- 1.4 ml/min/kg.B.W. No change in the renal pelvic pressure was observed. Urine flow increased from 0.47 +/- 0.12 to 4.98 +/- 1.15 ml/min at 20 minutes after furosemide administration. Increases in the fractional fluid excretion rate (V/GFR), the fractional sodium excretion rate (FENa) and the fractional potassium excretion rate (FEK) were observed and the maximum values were obtained at 20 minutes after furosemide administration. In two-week unilateral incompletely obstructed kidneys (incomplete UUO; n = 5), RBF was lower than that of the control kidney, whereas a tendency of transient increase was also noticed after furosemide administration; from 8.4 +/- 1.9 to 10.5 +/- 2.3 ml/min/kg.B.W. The renal pelvic pressure increased immediately and transiently after furosemide infusion. Increase in the urine flow was significant, but the value was lower than that of control, and the maximum value was marked at 20 minutes after furosemide administration. V/GFR, FENa and FEK were also increased in incomplete UUO, but the peak values were lower than those of control. In two-week unilateral completely obstructed kidneys (complete UUO; n = 5), RBF was markedly decreased (3.14 +/- 0.38 ml/min/kg.B.W.), and no significant increase was noticed after furosemide administration. The renal pelvic pressure was gradually and continuously increased after furosemide infusion. The fractional excretion rate of pelvic urine components was variable. In particular, V/GFR was significantly increased 60 minutes after furosemide administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical studies on tofisopam in patients with lower urinary tract symptoms]

The clinical effects of tofisopam were studied on 29 patients with lower urinary tract symptoms. Tofisopam was administered at a dose of 50 mg three times a day for more than 2 weeks. The clinical effects of tofisopam were revealed to be 79% in all patients. Only one patient (3%) complained of thirst. These results suggest that tofisopam is an effective drug to treat lower urinary tract symptoms.

An outbreak of Clostridium difficile associated diarrhoea in urological practice: a potential consequence of excessive antibiotic prophylaxis?

During an outbreak of Clostridium difficile associated diarrhoea, 17 patients on a urological ward developed symptoms in a 17-day period. Of these patients, 15 had received antibiotics during their admission. In order to eradicate the infection, it was necessary to close the unit for 1 month. Antibiotic associated diarrhoea is a serious complication of the prophylactic and therapeutic use of such agents and, because of the common use of antimicrobials on urological units, there is potential for similar epidemics.

[Efficacy and tolerability of nimesulide in inflammatory diseases of the genito-urinary system]

In a controlled clinical trial 80 patients of both sexes, aged between 19 and 70 years, with acute or chronic reacutized flogistic bacterial affections of the genito-urinary tract, were randomly assigned to anti-inflammatory treatment with nimesulide (200 mg/day p.o.) or placebo for a mean period of 9 days, in association to the specific antibiotic therapy. In the group treated with nimesulide a significant clinical improvement of the symptomatology was observed in the majority of cases. The therapeutic activity appeared quickly and complete remission of the symptomatology was achieved in a number of cases significantly higher than in the reference group. The tolerability of nimesulide was good.

Lower urinary tract function and pharmacologic management of lower urinary tract dysfunction

Because of renewed interest in the neuropharmacology and neurophysiology of the urinary bladder and its outlet, drug therapy can now help manage many types of voiding dysfunction. This article summarizes the scientific foundations on which this type of therapy is based and the current drug usage in this area.

Estriol in the postmenopause

Estriol is regarded as a mild and brief-acting hormone and, as such, has been prescribed for over four decades as a therapeutic agent for postmenopausal women with urogenital disorders. The dosages administered and the results obtained have varied considerably in earlier studies. Pharmacokinetic studies of estriol and the effects induced on the target tissues have been contradictory. The pharmacokinetics of unconjugated estriol after vaginal and oral medication was studied. One mg estriol applied vaginally resulted in plasma estriol concentrations similar to those obtained when 10 mg estriol was given orally. The clinical importance of the enterohepatic recirculation on plasma estriol concentrations after orally administered estriol was demonstrated. Factors that influence the pharmacokinetics of estriol are the time of estriol administration, fat-rich food, as well as the spacing of meals. Thus, the enterohepatic recirculation of estriol affects the plasma estriol elevation time and thereby the potency of estriol. The enterohepatic recirculation seemed to be less important in vaginal administration of estriol as the first liver passage is circumvented. Instantaneous and substantial conjugation of estriol in the liver is thereby avoided. By cytological assessment of the vaginal and the urethral epithelium in 40 patients treated in a geriatric hospital, the commonly recommended maintenance dosages of estriol (0.5 mg vaginally 1-2 times per week) were found to be too low to cure vaginal and urethral atrophy in very old women. This study suggests that estriol is a biologically potent estrogen by both oral and vaginal administration. The route and the time of administration, the food habits as well as the dosages given are factors which contribute to the estrogenicity of estriol. In clinical use, vaginal treatment seems preferable because the first liver passage is avoided. Vaginal administration allows a more standardized estriol regimen, while the oral treatment is more difficult to tailor for suit most women's needs.

A review of study findings of the risks and benefits of oestrogen therapy in the female climacteric

A literature review was conducted to assess the evidence regarding the risks and benefits of oestrogen therapy in climacteric women. Consideration was given to the route of administration, effects on lipid levels, the skin and urinary symptoms, endometrial cancer, mortality and replacement therapy. It was concluded from the data examined that properly administered oestrogen treatment does not increase the risk of endometrial cancer and that the relative risk of death in oestrogen users aged over 40 is markedly lower than than in non-users.

[The clinical effects of Tsumura No. 111 Seishin-rensi-in on irregular complaints of the urinary tract]

We studied the effects of Tsumura No. 111. Seisin-rensi-in on irregular complaints accompanying urological and renal diseases. Of 105 patients who visited our medical facilities, 99 served as the subject of this study. In principle, Tsumura Seisin-rensi-in was administered at a dose of 2.5 g x 3 times/day before meals for 4 or more weeks. Of 99 cases, 8 showed excellent results (8.2%), and 42 showed positive effects (41.2%). Adverse effects were observed in 7 cases, and in 4 cases drug administration was discontinued. This drug was recognized to be effective against irregular complaints accompanying chronic cystitis and acute or chronic pyelonephritis.

Extra-ocular chlamydial infection. WHO Working Group

Chlamydia trachomatis, the causative agent of trachoma, affecting hundreds of millions of people, is now recognized as a major cause of sexually transmitted disease. In many countries chlamydial infection now outstrips gonorrhoea as the major cause of genital tract infection. Chlamydial urethritis and cervicitis are frequently complicated by ascending infection involving the endometrium, the fallopian tubes and epididymis. This often results in serious reproductive sequelae, e.g., infertility in the female and ectopic pregnancy. Extra-genital manifestations of chlamydial infection may occur involving the eyes (follicular conjunctivitis), joints (arthritis), and distal intestinal tract. Infection of the newborn child during birth may result in ocular or lung disease.There is need for further research on chlamydial infection, with the involvement of a number of different fields including medicine, epidemiology, microbiology, immunology, molecular genetics and operational research. The role of chlamydia has also to be defined in a variety of clinical syndromes for the development of improved diagnostic reagents and vaccine and the production of improved control and intervention strategies.

Indications and contraindications for the use of nonsteroidal antiinflammatory drugs in urology

Prostaglandins are ubiquitous biologically active compounds that are involved in inflammatory reactions, hemostasis, and, under certain circumstances, the maintenance of renal function. NSAIDs, which inhibit PG synthesis, are used therapeutically most often as antiinflammatory agents in conditions of inflammation and pain, mostly of a nonurologic nature. However, since NSAIDs inhibit systemic PG synthesis, administration of NSAIDs can lead to adverse side effects. For example, the gastrointestinal irritation caused by NSAIDs probably reflects removal of a cytoprotective effect of gastrointestinal PGs. Similarly, the kidney may be especially susceptible to adverse effects of NSAIDs. In diseases such as peptic ulcers, diabetes, hypertension, congestive heart failure, liver disease with ascites, and renal insufficiency, PGs seem to play a protective role in the kidney. This protective role, which results from increased synthesis of vasodilator PGs in the face of elevated vasoconstrictors, is diminished in the presence of NSAIDs. Other side effects include the antagonism by NSAIDs of the action of diuretics, such that the dose of the diuretic must be adjusted accordingly. The diuretic triamterene should not be used in conjunction with indomethacin due to several reported cases of toxicity. Another drug interaction involves the salicylates, which have been shown to diminish the uricosuric effects of probenecid and sulfinpyrazone. Likewise, since corticosteroids increase the renal clearance of salicylates, it is important to monitor the patient carefully following termination of steroid treatment in patients receiving large doses of salicylates, since this change in elimination can precipitate toxicity. In addition, the NSAIDs bind to plasma proteins and, as such, can displace or be displaced by other drugs that bind in the same manner and can result in either decreased efficacy or toxicity. Despite the fact that the kidney may not be the target of NSAID therapy, renal function may be adversely affected by NSAID treatment. It has therefore been proposed that a renal-sparing NSAID would be a very useful therapeutic agent. Sulindac (Clinoril) has been suggested to be such an agent, eg, able to inhibit systemic PG synthesis (usually monitored by measuring serum thromboxane synthesis) without an apparent effect on renal PG synthesis (monitored by measurement of urinary PGs). However, recent data have suggested that Sulindac does inhibit renal PG synthesis and does not exhibit selectivity. The reasons for the discrepancy are not clear, but may relate to the doses or time intervals examined.(ABSTRACT TRUNCATED AT 400 WORDS)

Pharmacologic treatment of lower urinary tract dysfunction in the female patient

As a result of the renewed interest in the neuropharmacology and neurophysiology of the urinary bladder and its outlet, pharmacologic therapy now exists that is helpful in the management of many types of voiding dysfunctions. This article summarizes the pharmacologic principles upon which this drug therapy is based and shows how pharmacologic treatment fits into a functional scheme of therapy for disorders of micturition, here specifically related to the female patient with lower urinary tract dysfunction.

Folk medicine in Tonga. A study of the use of herbal medicines for obstetric and gynaecological conditions and disorders

We report on a study of the role of traditional medicinal practices in two communities in the South Pacific Kingdom of Tonga, with particular emphasis on obstetric and gynaecological complaints of women and the traditional practitioners consulted by them. Data on the nature and frequency of obstetric and gynaecological complaints, patterns of consultations and preferences for the type of practitioner, Western or traditional, were collected from housewives. The nature, range and extent of expertise possessed by traditional practitioners were also assessed. The results indicate that reliance on traditional medicine is rapidly declining in favour of Western medicine. This seems to be due to urbanisation, increased acceptance of Western values and a lack of availability of traditional practitioners in sufficient numbers. However, self-administration of herbal remedies was still common, especially in rural areas, and might even be on the increase. The practitioners treated a variety of obstetric and gynaecological complaints using 60 plant species which were collected and identified.