Roger R. Lenke

Pyelonephritis in pregnancy: a prospective randomized trial to prevent recurrent disease evaluating suppressive therapy with nitrofurantoin and close surveillance

It has been advocated that if a patient develops acute pyelonephritis during pregnancy, she should receive suppressive therapy for the remainder of the gestation to prevent a recurrence of the disease. We have prospectively evaluated 200 patients following an acute episode of pyelonephritis during pregnancy. All patients were followed in a special clinic. Half the patients received nitrofurantoin as suppressive therapy. Recurrent pyelonephritis occurred in 7% of the patients receiving suppressive therapy versus 8% of those patients receiving close surveillance in the clinic. The results cast doubt upon the need for suppressive therapy and instead dramatized the beneficial effects of close surveillance with cultures. The data also suggest, at least in a high-risk population, that patients with gram-negative bacilluria of less than 10(5) colonies/ml may have a substantial risk of developing symptomatic recurrences. Prompt treatment of even low levels of gram-negative bacilluria should be considered in patients at risk for recurrent disease.

The efficacy of the nitrite test and microscopic urinalysis in predicting urine culture results

The efficacy of the nitrite dipstick and microscopic urinalysis in predicting culture results were evaluated for 146 urine cultures from 56 women at risk for recurrent pyelonephritis. There were 111 negative cultures, 18 positive cultures, and 17 contaminated cultures. Nitrites were not detectable in either negative or contaminated cultures. Bacilluria was present in 10% of negative cultures and in 18% of contaminated cultures. Pyuria was present in 14% of negative and in 24% of contaminated cultures. Among the 18 positive cultures, nitrite was present in only 22%, bacilluria in only 61%, and pyuria in only 67%. These results suggest that positive cultures cannot be accurately predicted by either microscopic urinalysis or the nitrite dipstick, and that routine culturing should be performed as part of the outpatient management of women at risk for recurrent pyelonephritis.

In utero diagnosis of benign fetal macrocephaly

Benign familial macrocephaly is an autosomal dominant disorder associated with a large absolute circumference of the head. In this disorder serial growth demonstrates a proportional rather than an excessive rate of growth. To date, we are not aware of any published case reports that confirm the diagnosis prenatally. We report a case of benign familial macrocephaly diagnosed in utero by ultrasonographic evaluation. This case report points out the necessity of combining appropriate family history and physical examination in cases of prenatally detected anomalies.

Amniocentesis in the second trimester: The effect on fetal movement

Linear array real-time ultrasound was utilized to observe gross fetal body movements before and after second-trimester amniocentesis. No significant differences were found between the two observation periods. All pregnancies continued to term, and no evidence of fetal trauma was found at delivery.

Severe fetal deformities associated with ingestion of excessive isoniazid in early pregnancy

Abstract. There is general agreement that pregnant women with active tuberculosis require immediate treatment with some combination of isoniazid (INH), ethambutol, rifampin or streptomycin. Other than the possibility of fetal ototoxicity from streptomycin none of these drugs in normal dosages has proved teratogenous to the human fetus (1). We therefore report here a possible association between fetal malformations and excessive early maternal ingestion of INH.