non-IC Patients Research Articles

Pulmonary Cryptococcosis

Cryptococcosis is an invasive fungal infection (IFI), caused predominantly by Cryptococcus neoformans or Cryptococcus gattii, that affects both immunocompromised (IC) and non-IC patients. Although the most serious disease manifestation is meningoencephalitis, cryptococcal pneumonia is underdiagnosed and may disseminate to the central nervous system (CNS) and other sites depending upon host defenses and administration of appropriate antifungal therapy. The clinical presentation of pulmonary cryptococcosis varies along a spectrum from asymptomatic infection to severe pneumonia and respiratory failure, and the radiological presentation can be characterized by an array of findings, including nodules, consolidation, cavitary lesions, and a diffuse interstitial pattern. Diagnosis most often relies upon isolation of Cryptococcus from a pulmonary specimen in the appropriate clinical and radiological context. Treatment recommendations include induction therapy with an amphotericin B preparation and flucytosine for IC patients and those with severe disease and fluconazole for mild-to-moderate, localized disease. Knowledge of the pathophysiology, epidemiology, clinical presentation, and treatment of pulmonary cryptococcosis may lead to greater recognition of this underdiagnosed IFI and improved outcomes.

Urodynamic Study and Potassium Sensitivity Test for Women with Frequency-Urgency Syndrome and Interstitial Cystitis

Purpose: The intravesical potassium chloride (KCl) sensitivity test has been used to detect urothelial leakage in patients with frequency-urgency syndrome and interstitial cystitis (IC). It is unclear whether urodynamic studies can predict a positive KCl test. This study compared the urodynamic results for women with different KCl responses who suffered from frequency-urgency syndrome and IC. Methods: A total of 196 women suffering from frequency, urgency and/or bladder pain were enrolled in this study. These patients underwent a urodynamic study with a concurrent KCl test. The urodynamic results were compared between the patients who had positive and those who had negative KCl tests and between the patients with and without characteristic IC under cystoscopic hydrodilatation. Results: Among 196 women, 138 (70.4%) had a positive and 58 (29.6%) a negative KCl test. Among the patients with a positive KCl test, 128 underwent cystoscopic hydrodilatation: 44 were proven to have characteristic IC, and 84 were not. Patients with a negative KCl test had a larger residual urine volume and a higher incidence of poor relaxation of the urethral sphincter than those with a positive test. However, patients with a positive KCl test and proven IC did not differ in urodynamic parameters from non-IC patients. The symptom of bladder pain could not predict a positive KCl test nor characteristic IC either. Conclusions: This study shows that no specific urodynamic parameter or specific symptoms can predict a positive KCl test in patients with frequency-urgency syndrome or IC. Patients with bladder pain at full bladder and a positive KCl test had only a 45.2% chance to have characteristic IC.

Lung abscess in adults: clinical comparison of immunocompromised to non-immunocompromised patients

Information related to the clinical characteristics and isolated microbes associated with lung abscesses comparing immunocompromised (IC) to non-immunocompromised (non-IC) patients is limited. A retrospective review for 1984–1996 identified 34 consecutive adult cases of lung abscess (representing 0·2% of all cases of pneumonia), including 10 non-IC and 24 IC patients. Comparison of age, gender, tobacco use, pre-existing pulmonary disease or recognized aspiration risk factors were not significantly different between the two groups. Upper lobe involvement accounted for the majority of cases, although multi-lobe involvement was limited to IC patients. There were no differences in the need for surgical intervention, and mortality was very low for both groups. Anaerobes were the most frequent isolates for non-IC patients (30%), whereas aerobes were the most frequent isolate for IC patients (63%). Importantly, certain organisms were exclusively isolated in the IC group and multiple isolates were obtained only from the IC patients. Thus, comparing non-IC to IC patients, clinical characteristics may be similar whereas important differences may exist in the microbiology associated with lung abscess. These findings have important implications for the clinical management of these patient groups, and support a strategy to aggressively identify microbial agents in abscess material.

Urinary tissue factor in glomerulonephritis: a potential marker of glomerular injury?

AIM: To investigate the significance of urinary tissue factor (uTF) concentrations in patients with glomerulonephritis. METHODS: Urine samples were collected from normal subjects (n = 57), patients with uncomplicated renal...

A marked decline in the prevalence and incidence of intermittent claudication in icelandic men 1968–1986: A strong relationship to smoking and serum cholesterol—The Reykjavik study

The epidemiology of peripheral vascular disease has been studied much less extensively than the epidemiology of coronary heart disease (CHD). The prospective Reykjavik Study gave an opportunity to monitor secular trends from 1968 to 1986 of clinical intermittent claudication (IC) amongst Icelandic males, aged 34–80 and to assess the importance of possible risk factors. Both prevalence and incidence of IC decreased sharply after 1970 in all age groups, and this decline occurred a few years earlier than the decline of CHD in Iceland. The only significant risk factors for intermittent claudication, in addition to age, were smoking which increased the risk of IC 8- to 10-fold and serum cholesterol level. Approximately one-half of the striking decline in the incidence of IC can be explained by decreased smoking and cholesterol levels amongst Icelandic men. A follow-up study verified that IC patients stood twice the risk of cardiovascular and total mortality as non-IC patients, indicating that IC is a high risk group which should receive all possible preventive measures.