CT Urography

Each normal ureter is 25 cm long.

In hydronephrosis of the kidneys and ureters, there is inflammation of both kidneys and ureters. Inflammation of the kidneys may appear similar. However, the ureters maybe asymmetrically affected.

Two separate soft tissue masses can surround the ureters at two different locations along each ureter. The right soft tissue mass can surround the distal part of the ureter (about 4 cm). The left soft tissue mass can surround the proximal part of the ureter (about 4 cm).

The soft tissue mass may continue to grow and compress on the ureters and stop urine flow into the urinary bladder, leading to little or no urine. The patient may not suffer any pain (asymptomatic) in the beginning . However, later on, the patient may suffer great pain as renal conditions worsen.

There are 2 investigations to be done: CT Urography, and biopsy.

CT Urography is for evaluation of the ureters. The radiologist and urologist will investigate to find out the underlying cause(s):

1. Congenital abnormalities
2. Filling defects
3. Dilatation
4. Narrowing
5. Deviations in the course of urine flow and output

Biopsy is to investigate what the soft tissue mass is. Biopsy may show malignant (cancerous) growth. It maybe limited or have spread. The cytologist in Pathology will inform. Fine Needle Aspiration Biopsy (FNAB) involves aspirating a small volume of biopsy sample via a small keyhole made in the abdomen. Any biopsy is painful and will need anaesthesia.

Treatment is by surgical removal of the soft tissue masses surrounding the ureters.

The entire uterus may have to be removed too.

Radiotherapy, chemotherapy etc may be needed.


External links:

CT Urography for evaluation of the ureter
https://pubs.rsna.org/doi/full/10.1148/rg.2015140209

Retroperitoneal sarcoma of the ureters
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049017/pdf/cro-0007-0301.pdf

Soft tissue sarcomas of the kidneys
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387353/pdf/rt-2015-1-5635.pdf

Fibrosarcoma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732833/pdf/oncotarget-08-104638.pdf

Malignant soft tissue tumors
https://www.cedars-sinai.edu/Patients/Health-Conditions/Soft-Tissue-Tumors---Malignant.aspx

Urothelial Tumors of the Renal Pelvis and Ureters: Problem, Epidemiology, Etiology
https://emedicine.medscape.com/article/452449-overview#a5
https://emedicine.medscape.com/article/452449-overview#a7

Ureteral neoplasms
https://pubs.rsna.org/doi/pdf/10.1148/radiographics.10.2.2183298

Leiomyosarcoma of the distal ureter
https://www.um.edu.mt/umms/mmj/PDF/547.pdf

Kidney tumor > Renal pelvic tumors > Urothelial carcinoma of renal pelvis
http://www.pathologyoutlines.com/topic/kidneytumormalignanturothelialcarcinoma.html

Transitional cell carcinoma (TCC)
https://radiopaedia.org/articles/transitional-cell-carcinoma-ureter?lang=us

Infection and Antibiotics: Tazocin

I studied detailed bacterial structure in my fourth year of the undergraduate program It was thought by Dr Mina Hector, under Biochemistry. There were only two students. We read page by page. I still have my textbook.

Many soldiers and victims died as a result of infection and antibiotic was not yet discovered in the First World War (WW1). 

Penicillin was accidentally discovered by a Scottish bacteriologist, Alexander Fleming, on 28 September 1928 at the St Mary's Hospital in London, England. He returned from vacation and noticed a green mold, Penicillium notatum, from orange peel had contaminated his petri dishes of Staphylococcus. 

Penicillin was made available when the Second World War (WW2) almost came to a close. It helped to save many lives. Sir Alexander Fleming was bestowed the Nobel Prize in Physiology or Medicine in 1945. His laboratory is being preserved. 

The discovery of Penicillin triggered the Antibiotic Era. Many other antibiotics were then isolated, studied and produced in various laboratories by many nations.

Tazocin is an antibiotic manufactured and marketed by Pfizer, UK and a few other companies in the 1990s. Its active ingredients are sodium piperacillin and sodium tazobactam.

Tazocin is used for treating infections and septicaemia in the intensive care unit (ICU) and hospital wards. It works well for both Gram positive (Gram +) and Gram negative (Gram -) bacterial infections. Pseudomonas aeruginosa is Gram -.

Pseudomonas lung infection has a characteristics odour and productive cough, initially brown sputum and subsequently thick white sputum.  Sputum culture & sensitivity (C&S) will provide Pseudomonas aeruginosa isolate.

Sputum C&S

Tazocin is used for treating patients with severe Pseudomonas lung infection, with complicated renal infection.  Tazocin is administered intravenously (i.v.).

There are 2 types of vial packing:
Each vial of Tazocin 2 g / 0.25 g contains 5.67 mmol (130 mg) of sodium.
Each vial of Tazocin 4 g / 0.5 g contains 11.35 mmol (261 mg) of sodium.

The usual dose is 4 g piperacillin / 0.5 g tazobactam given every 8 hours (8 hourly).
For nosocomial pneumonia and bacterial infections, the recommended dose is 4 g piperacillin / 0.5 g tazobactam administered every 6 hours (6 hourly).

For renal patients, creatinine is determined and creatinine clearance calculated. Tazocin dose is reduced and administered 6 hourly. Tazocin (6 hourly is given i.v. within 30 minutes) for 5 days in renal impairment (obstructive uropathy).

Combined use of piperacillin/tazobactam and vancomycin may be associated with an increased incidence of acute kidney injury (AKI).

Intravenous Tazocin (2 g / 0.25 g) in saline 

External links

https://www.medicines.org.uk/emc/product/1267/smpc

https://www.medicines.org.uk/emc/files/pil.1267.pdf

National Center for Biotechnology Information. PubChem Compound Database; CID=23695841, https://pubchem.ncbi.nlm.nih.gov/compound/23695841 (accessed Feb. 9, 2019).

https://www.ncbi.nlm.nih.gov/pubmed/9017778

https://www.netdoctor.co.uk/medicines/infection/a7622/tazocin-piperacillin-and-tazobactam/

https://www.mims.com/malaysia/company/info/pfizer