Acute Infections of the Urinary Tract and the Urethral Syndrome in General Practice

Abstract

Erythrodermic Skin Diseases-Fox et al. MEDIBALJOURNAL has shown that this can stimulate non-shivering thermogenesis in man. Cold-adapted subjects also showed an increased calorigenic action of noradrenaline (Joy, 1962 ;Davis, 1963), so that the slightly raised V.M.A. excretions found in this study may be important. Shivering tends to disappear in the cold-adapted subject, and this may explain why all except one of our patients with a relative hypothermia failed to shiver.These observations emphasize certain aspects of the managements of these patients. Because of the reduced capacity to thermoregulate, with its attendant dangers of hypothermia or hyperthermia, body temperature must be accurately observed, using a low-temperature thermometer when indicated. Patients usually require more clothes and a warmer room than the average person, and the risk of hypothermia is obviously greatest during winter months and when they are treated at home, but even in hospital care is needed during treatment periods. If the patient develops a high body temperature steps should be taken to reduce it in order to avoid an excessive increase in the cardiac load. The aim should be to steer a course between the two extremes and keep body temperature close to normal. If the patient is seen to be shivering, complains of the cold, or has a subnormal temperature, the room temperature or his clothing should be promptly increased. The temperature at which he becomes comfortable and shivering ceases should be recorded and used as a guide to adjust his environment. Prompt treatment of the skin condition, usually with corticosteroids, is the best way of avoiding heart failure. The unexplained high mortality of patients with erythrodermic skin diseases may in large part be due to the haemodynamic and thermoregulatory problems we have discussed. SummaryHaemodynamic studies on six patients with widespread erythrodermic skin conditions have shown marked increases in skin blood-flow equivalent to up to two-thirds of that seen in normal subjects when fully vasodilated by heat ; there was a considerable further increase in skin blood-flow when the body temperature was raised. All had a raised venous pressure with hypervolaemia, and in two patients the cardiac output was moderately increased.Body-temperature regulation was grossly disturbed. Four out of five patients had either a fever or an elevation of the set point for temperature regulation with body temperatures below the fever level. The capacity to thermoregulate is greatly diminished in these patients, and hypothermia, which is an important risk, is related to the high skin blood-flow and inability of the skin blood-vessels to constrict fully.The basal metabolic rate was raised considerably in 9 out of 11 patients. Radioactive iodine studies showed no evidence of hyperthyroidism, but there was a slight increase in vanillyl mandelic acid excretion. The hypermetabolism is probably mainly due to the abnormal skin metabolism, but the development of non-shivering thermogenesis may also play a p...

Study of Common Urinary Problems of Females at a Government Hospital in Central India

“…[15,16]. The etiology of this urethral syndrome is obscure and has been attributed to an anxiety neurosis [17,18] In this study irritative symptoms [burning micturition (92%), urgency (42%), increased frequency of micturition (41%)] are the most common presenting complains of these undiagnosed patients followed by pain in abdomen.…”

An Analytical Study of Common Urinary Problems in Females

“…(15,16) The etiology of urethral syndrome is obscure and has been attributed to an anxiety neurosis. (17,18) In the present study irritative symptoms (burning micturition (92%), urgency (42%) increased frequency of micturition (41%)) are the most common presenting complaints of these undiagnosed patients followed by pain lower abdomen.…”

Urinary tract infection.

“…These methods were designed to rapidly screen thousands of asymptomatic individuals and in a small percentage of patients may not be appropriate. The laboratory can confirm the diagnosis of UTI in many symptomatic cases, but significant bacteriuria is found in only half of the patients with urinary symptomatology (Gallagher et al, 1965;Mond et al, 1965). In many infected patients with renal calculi or other upper tract disease, bacterial counts may be below 105 per ml.…”