Purpose Urinary antiseptics including methenamine and methylene blue are used in the symptomatic treatment of urinary tract infections (UTIs). Patients and Methods This was a prospective, double-blind, randomized, double-dummy safety and efficacy study of 2 urinary antiseptic combinations in the symptomatic treatment of recurrent cystitis: methenamine 120mg + methylene blue 20mg (Group A) versus acriflavine 15mg + methenamine 250mg + methylene blue 20mg + Atropa belladonna L. 15mg (Group B). All subjects underwent pretreatment urine culture and antibiotic sensitivity tests prior to 3-day oral treatment with study drug, followed by 3 days of antibiotic therapy (based on urine culture) + study drug treatment. Efficacy was evaluated using the Urinary Tract Infection Symptoms Assessment Questionnaire (UTISA). The primary endpoint was the percentage of patients presenting improvement in cystitis manifestations on the UTISA domain “Urination Regularity” at Visit 2. The primary safety variable was the incidence of treatment-related adverse events. Results A total of 144 subjects were randomized per group and 272 completed the study. Primary endpoint analysis demonstrates homogeneity between treatment groups, with 69.4% and 72.2% subjects, respectively, showing improvement in the score of the urinary regularity UTISA domain after 3 days of treatment ( p = 0.87). At Visit 2, incidence of treatment-related adverse events was higher in Group B (Group A: n= 11, Group B: n= 31, p = 0.0057). Conclusion Both treatments were effective in reducing UTI symptoms assessed by UTISA questionnaire after 3 days of treatment. The two regimens were comparable in incidence of adverse events, but the combination of methenamine + methylene blue resulted in fewer treatment-related adverse effects.

A 41-year-old woman was admitted to our hospital with a 3-week history of swollen legs and abdominal distension that persisted after diuretic therapy. Physical examination revealed a blood pressure of 110/70 mm Hg, a heart rate of 76 bpm, and a respiratory rate of 15 breaths per minute. Cardiac auscultation was remarkable for a tricuspid pansystolic regurgitation murmur. On abdominal examination, a nontender mass resembling a uterus 12 to 13 weeks pregnant was noted in the lower abdomen. An ECG showed sinus rhythm with nonspecific findings, and the chest radiograph was normal. An abdominal ultrasound revealed an elongated inferior vena cava (IVC) and a filling defect inside the vein suggesting thrombosis. A CT scan revealed a large, heterogeneous, and irregular pelvic mass arising from the uterus (Figure 1) and a thrombus-like image extending from the IVC into the left renal vein (Figure 2) and up the right atrium. Echocardiography showed a mobile mass extending from the IVC through the right atrium and right ventricle (Figure 3), with its apparent tip moving within the pulmonary valve, producing tricuspid regurgitation.A presumptive diagnosis of uterine intravenous leiomyomatosis was made. MRI demonstrated a large mass in the uterus extending via the left iliac vein and the inferior vena cava into the right cardiac cavities, with the same signal intensity through the full extent of the tumor (Figure 4). Angiography of the inferior vena cava and iliac veins revealed almost complete occlusion of the IVC, with prominent collateral circulation ( Figure 5). Tumors in the heart and inferior vena cava were successfully removed under deep hypothermia and circulatory arrest (Figures 6 and 7).

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We investigated anatomical and radiological morphometric parameters, aiming to minimize the risk of hepatic and colonic injuries during right percutaneous kidney access under either ventral or dorsal decubitus of patients. Prone and supine abdominal computerized tomographic examinations from 31 normal adult volunteers (men = 12; women = 19; without history of abdominal pathology) were analyzed morphometrically in order to study the dynamic anatomical relations between the liver and the right kidney. The age of the volunteers ranged from 22 to 64 years old (mean +/- SD = 42.77 +/- 2.10). We observed a significantly greater distance between the liver and the right kidney (hepatorenal space) when the examinee is positioned in ventral decubitus (3.93 +/- 0.37 cm) in comparison with dorsal decubitus (1.98 +/- 0.20 cm). Accordingly, we conclude that right percutaneous access to the inferior right renal pole implies a significantly lower risk (P < 0.01) of both hepatic and biliary injuries when performed in ventral decubitus, comparatively to dorsal decubitus.