OBJECTIVETo observe the difference in the clinical efficacy on female chronic pyelonephritis between abdominal cluster-needling therapy and western medicine so as to explore the optimal therapeutic method for the disease.

METHODSSeventy cases of female chronic pyelonephritis were randomized into an abdominal cluster-needling group and levofloxacin group, 35 cases in each one. In the abdominal cluster-needling group, the lower abdominal point was selected in combination with Zusanli (ST 36), Sanyinjiao (SP 6) and Taixi (KI 3). The treatment was given once a day and 10 treatments made one session. In the levofloxacin group, levofloxacin capsules were prescribed for oral administration, once a day. Three months later, the clinical efficacy was observed before and after treatment in two groups.

RESULTSThe curative rate was 65.7% (23/35) and the total effective rate was 100.0% (35/35) in the abdominal cluster-needling group. The curative rate was 22.9%, (8/35) and the total effective rate was 71.4% (25/35) in the levofloxacin group. The clinical efficacy in the abdominal cluster-needling group was superior to that in the levofloxacin group (P < 0.01, P < 0.05).

CONCLUSIONThe abdominal cluster-needling therapy achieves the significant efficacy on female chronic pyelonephritis and it is the optimal therapy for the disease.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Chronic Disease ; therapy ; Female ; Humans ; Middle Aged ; Pyelonephritis ; therapy ; Treatment Outcome

Drainage ; methods ; Electrocardiography ; Emphysema ; diagnosis ; therapy ; Female ; Humans ; Middle Aged ; Pyelonephritis ; diagnosis ; therapy

During 5 years, from January 1976 to December 1980, clinical observation on management of ureteral stones was made on 169 admitted patients with ureter stones. Following results were obtained. 1) Among total 1054 in-patients, 169 cases (16.0%) had ureteral stones, and male to female ratio was 2 : 1. 2) Patients with 20-40 of his age was half. 3) On seasonal distribution, it was most prevalent on Summer. 4) 113 cases were located on lower ureter, and laterality was even. 5) Most common symptoms were renal colic and hematuria (91.8%) 6) Ureterolithotomy was done in 127 cases. In 86 cases of lower ureter stones, less than 1cm in size. conservative fluid therapy and cystoscopic extraction was successful in 44 cases. 7) Post-operative complications were urinary leaking (16 cages), wound infection(12 cases), hematuria (3 cases), ureteral stricture (1 case), and pyelonephritis (1 case).
Constriction, Pathologic ; Female ; Fluid Therapy ; Hematuria ; Humans ; Male ; Pyelonephritis ; Renal Colic ; Seasons ; Ureter* ; Wounds and Injuries

Objective: To examine the modalities of treatment and clinical outcomes of emphysematous pyelonephritis (EPN), in order to improve the survival rate of EPN patients. Methods: Totally 14 patients diagnosed as EPN between October 2011 and November 2020 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this article. Data collection including patient demographics, clinical manifestations, management and clinical outcomes were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 11 females and 3 males with a median age of 59 years (range: 52 to 73 years). The lesions were located on the left side in 10 patients and right side in 4 patients. All the 14 patients suffered from fever, and present with severe sepsis or septic shock. The median time from symptom onset to admission to hospital was 3 days(range: 2 to 5 days). All cases had diabetes mellitus. Escherichia coli was the most common organism been cultured (11 cases), while Klebsiella pneumonia was the second (3 cases). CT scan showed bubbly or located gas in the renal parenchyma in 5 cases and presence of steaky or mottled gas in the renal parenchyma in 9 cases. All patients had been admitted to ICU for anti-septic shock therapy. Three patients had undergone percutaneous catheter drainage along with broad-spectrum antibiotics therapy while 3 patients had immediate nephrectomy, the other 8 cases had a combination of an initial percutaneous catheter drainage and second stage nephrectomy. Results: In this case series, 3 patients were died from EPN while the other 11 were survived. The median ICU stay time was 6 days (range: 3 to 11 days). Of the 3 patients died from EPN, 2 had undergone percutaneous catheter drainage along and 1 had received immediate nephrectomy. Among the 11 patients who were survived, only 1 had received percutaneous catheter drainage while the other 10 received nephrectomy (8 patients had staged nephrectomy). Follow-up was performed 6 months after discharge. Of the 11 surviving patients, 2 were lost to follow-up, and the remaining 9 patients had an creatine level of (118.4±29.4) μmol/L (range: 89 to 176 μmol/L). Conclusions: For patients coupled with diabetes who were initially diagnosed as acute pyelonephritis, the possibility of EPN should be considered when the disease progressed rapidly especially septic shock occurred. On the basis of empirical broad-spectrum antibiotics therapy and standardized anti-septic shock treatment, a combination of an initial percutaneous catheter drainage and second stage nephrectomy could be efficacious.
Aged ; Emphysema/therapy* ; Escherichia coli Infections ; Female ; Humans ; Male ; Middle Aged ; Pyelonephritis/therapy* ; Retrospective Studies ; Treatment Outcome

PURPOSE: Xanthogranulomatous pyelonephritis (XGP) is rare among children. In most cases, XGP is diffusely or focally enlarged, mimicking the neoplastic process. The aim of this study was to examine clinical characteristics and outcomes of Korean children with XGP. MATERIALS AND METHODS: Fourteen children (9 boys, 5 girls) with XGP were reviewed retrospectively. The cohort included 2 children managed at our institution and 12 children reported in the Korean literature. The patients' records were reviewed with respect to age at diagnosis, clinical presentation, management method, and other characteristic features. RESULTS: The mean age was 79.4+/-66.5 months (range 1-168 months). Common clinical presentations included fever (85.7%), abdominal pain (57.1%), and palpable mass (28.6%). Laboratory abnormalities included leukocytosis (57.1%), anemia (57.1%), and pyuria (57.1%). The types of XGP that were diagnosed based on preoperative radiologic studies included the focal form in 9 children and the diffuse form in 5. Thirteen children underwent nephrectomy, and 1 child received conservative medical therapy. CONCLUSION: The possibility of XGP should be considered if a child is diagnosed with a renal mass, especially if it is a small renal mass associated with fever, leukocytosis, or stone. Nephrectomy is the treatment of choice for the diffuse form, whereas partial nephrectomy or conservative medical therapy may be indicated to manage focal XGP.
Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Korea ; Male ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous/*diagnosis/drug therapy/surgery ; Retrospective Studies

Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
Adult ; Cardiomyopathies* ; Endotoxins ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Hemoperfusion* ; Humans ; Membranes* ; Oxygen* ; Polymyxin B* ; Polymyxins* ; Pyelonephritis ; Salvage Therapy ; Sepsis ; Shock ; Shock, Septic*

BACKGROUND: If acute renal failure develops in patients with acute pyelonephritis, it is most commonly due to hypovolemia, sepsis, drug therapy or urinary obstruction. But there have been reported many cases about patients of acute renal failure derived from acute pyelonephritis itself without any predisposing factor. To find out the predisposing related factors, we analysed the clinical patterns of patients of acute pyelonephritis with acute renal failure compared to that of patients of acute pyelonephritis without acute renal failure. METHODS: From January 1996 to December 2000, the authors identified 172 patients older than 16 years of age who admitted to Korea University Hospital for acute pyelonephritis. Among them, patients whose serum creatinine level had been less than 1.5mg/dL before admission and who did not have any of chronic renal failure, diabetic nephropathy or hypertensive nephropathy were recruited. According to the level of serum creatinine at admission, the patients were divided into two groups. If ones serum creatinine level at admission was less than 1.5mg/dL, he or she included to control group, if more than 1.5 mg/dL to acute renal failure group. And we compared their clinical features and laboratory values. RESULTS: The patients with acute pyelonephritis complicated to renal failure showed the tendency of older age, more dehydration, more inflammation, more frequent abnormal findings in abdominal ultrasonography and more frequency of chronic systemic disease than those without renal failure. Acute renal failure due to acute pyelonephritis might be recovered rapidly by general supportive care like fluid replacement and adequate antimicrobial therapy. CONCLUSION: Acute pyelonephritis should be considered rare cause of acute renal failure. Especially in case of old age, severe dehydration, severe inflammation and comorbidity with chronic systemic disease involved in kidney, it would be helpful to observe the clinical course closely.
Acute Kidney Injury* ; Causality ; Comorbidity ; Creatinine ; Dehydration ; Diabetic Nephropathies ; Drug Therapy ; Humans ; Hypovolemia ; Inflammation ; Kidney ; Kidney Failure, Chronic ; Korea ; Pyelonephritis* ; Renal Insufficiency ; Sepsis ; Ultrasonography

Aortic thrombus is a rare but life threatening disorder. The usual causes of aortic thrombus are primary or secondary thrombocythemia, malignancy, atherosclerosis, trauma, and acute infectious disease. Here, we report a case of aortic arch thrombus associated with acute pyelonephritis in a patient with thrombocythemia. A 78-year-old woman was admitted with acute pyelonephritis. A complete blood cell count showed severe thrombocythemia with platelet count of 1, 340, 000/mm3. Chest CT scan demonstrated floating thrombus in the aortic arch. After antibiotic treatement, platelet count decreased to 770, 000/mm3 and aortic thrombus disappeared without thrombolytic therapy.
Aged ; Aorta, Thoracic* ; Atherosclerosis ; Blood Cell Count ; Communicable Diseases ; Female ; Humans ; Platelet Count ; Pyelonephritis* ; Thrombocytosis* ; Thrombolytic Therapy ; Thrombosis* ; Tomography, X-Ray Computed

Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
Adult ; Cardiomyopathies ; Endotoxins ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Hemoperfusion ; Humans ; Membranes ; Oxygen ; Polymyxin B ; Polymyxins ; Pyelonephritis ; Salvage Therapy ; Sepsis ; Shock ; Shock, Septic

No abstract available.
Anti-Bacterial Agents/therapeutic use ; *Emphysema/diagnosis/microbiology/therapy ; Escherichia coli/isolation & purification ; *Escherichia coli Infections/diagnosis/microbiology/therapy ; Female ; Humans ; *Kidney/pathology/surgery ; Middle Aged ; Necrosis ; Nephrectomy ; *Pyelonephritis/diagnosis/microbiology/therapy ; Renal Dialysis ; Tomography, X-Ray Computed ; Treatment Outcome