SummaryIn order to test their value in urinary infection a doubleblind trial was carried out using ampicillin, cephalexin, trimethoprim-sulphamethoxazole (co-trimoxazole), and trimethoprim. Eighty-three courses of treatment were given to hospital patients, 149 to pregnant women, and 107 to patients with dysuria and frequency seen in domiciliary practice. Thus infections of varying severity in defined groups of patients caused by organisms with different antibiotic sensitivities were treated.Analysis of the overall results (339 courses) was compared with those from the individual groups and considerable variation in response was found. In domiciliary infections and bacteriuria in pregnancy trimethoprim alone proved to be at least as effective as the other three compounds and caused fewer than half the number of side effects. In the hospital patients co-trimoxazole was superior to trimethoprim.The overall results for ampicillin and cephalexin were similar although cephalexin proved to be inferior in treating symptomatic domiciliary infections. IntroductionAt present, for the treatment of urinary infection sulphonamide, trimethoprim-sulphamethoxazole (co-trimoxazole), ampicillin, and cephalexin are the most commonly used substances which

, [541][542][543][544] ummary: Trimethoprim is inhibitory for a wide range of bacteria, and when used in combination with a sulphonamide marked synergy has been reported.In order to test its value in the treatment of urinary infections 154 hospital patients with infections of varying severity and due to a wide range of organisms were treated with combinations of sulphamethoxazole and trimethoprim. Combinations of these substances in two different ratios (2 : 1 and 10: 1) were used in 113 patients, and one week after the end of treatment about threequarters were cured by both combinations. In a second study 106 patients were treated with a sulphamethoxazoletrimethoprim combination (5: 1), ampicillin, or sulphadimidine. The cure rate with the 5: 1 combination was higher than that found with ampicillin or sulphadimidine both one week after finishing treatment (sulphamethoxazole-trimethoprim 85%, ampicillin 70%, sulphadimidine 40%) and at the fourth-to fifth-week follow-up (sulphamethoxazole-trimethoprim 67%, ampicillin 52%, sulphadimidine 15%).The results obtained with the various sulphamethoxazole-trimethoprim combinations did not indicate that a particular ratio was superior for treating urinary infections in general or for those caused by any particular species of organism.Laboratory studies showed that many bacteria causing urinary infections in hospital were sensitive to trimethoprim, and the therapeutic results could have been largely predicted from a knowledge of the in-vitro sensitivity tests to trimethoprim alone. For example, sulphamethoxazole-trimethoprim in the treatment of Proteus mirabilis infections was less successful than in those due to Escherichia coli, and this finding was clearly reflected in the higher minimal inhibitory concentrations for trimethoprim of Pr. mirabilis.The sulphamethoxazole-trimethoprim combination was simple to administer, free from side-effects, and gave satisfactory results in the treatment of urinary infections that occurred in hospital patients.

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Twenty cases of extrarenal renin-secreting tumors have been reported, but this is the first case of a renin-producing teratoma. The patient was a 17-year-old African American girl who presented with hypertension and hypokalemia, and who was documented to have a plasma aldosterone-to-renin activity ratio consistent with secondary aldosteronism. Computed tomography demonstrated a pelvic tumor suspicious for a teratoma. With no other apparent etiology for the secondary aldosteronism, the teratoma was suspected to be an extrarenal renin-secreting tumor. This was confirmed after surgery by pathologic evaluation, and significantly reduced requirements for antihypertensive medication and potassium supplementation.