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This report describes a forty-seven-year-old female patient with a complex medical history. She was suffering from an unspecified interstitial lung disease, papillary thyroid carcinoma which had been treated, hypoparathyroidism after thyroidectomy for which she was receiving dihydrotachysterol and calcium, and atrial fibrillation and congestive heart failure as a result of mitral stenosis. Shortly after mitral valve replacement she developed a severe hypercalcemia (serum calcium 5.95 mmol/l) during a febrile illness. At that time anti-tuberculous agents were also being administered for presumed tuberculosis. The possible mechanisms for this severe elevation of the calcium level are discussed. Immobilization, while Paget's bone disease was present, and perhaps enhanced activation of dihydrotachysterol by rifampicin, could have led to increased calcium-release into the circulation. Continuous supplecation of calcium and vitamin D, provoked dehydration and the mechanism of the milk-alkali syndrome also contributed to this extremely high calcium level. It is concluded that hypoparathyroid patients being treated with vitamin D and calcium should be carefully monitored in the case of an intercurrent illness or a change in medication.

A man aged 81 with bilateral hydronephrosis presented with lethargy deepening into coma caused by hyperammonaemia. The hyperammonaemia was most likely caused by excessive absorption of ammonia produced by Proteus mirabilis in the obstructed and dilated urinary tract. The patient died within a few hours.

A retrospective study of 57 surgically-managed brain abscesses at the Neurosurgical Unit, Bir Hospital during a 6-year period from October 1990 is presented. Detailed hospital case notes could be traced in only 37 cases, consisting of 25 males and 12 females with age range from 5 months to 60 years. Cryptogenic abscess was the commonest category followed by abscess caused by chronic ear infection. The diagnosis was made with enhanced computed tomography (CT) in all the cases. Positive bacteriology was found in only nine cases. The treatment consisted of 6 weeks of intensive intravenous antibiotics and emergency surgical drainage of the abscess. Five out of the total cases died (13.5%). These patients were all in an extremely poor condition at the time of presentation. All the survivors made a good recovery. With timely CT diagnosis, surgical drainage and antibiotics, good results can be achieved even in a developing country.

A case of secondary transient pseudohypoaldosteronism (PHA) in a three-month-old infant who had arrived in emergency conditions is reported. Clinically the patient presented dehydration associated with salt loss, metabolic acidosis, severe hyperkalemia, markedly elevated levels both of plasma renin activity and aldosterone concentration. Biochemical and instrumental tests and clinical evolution have given reason to consider it as a case of transient PHA, secondary to an obstructive uropathy (PUV) with urinary infection. Secondary forms of PHA have frequently been documented in young infants with urinary tract infection associated with both obstructive and non obstructive uropathy. After medical or surgical therapy the abnormalities quickly disappear. This reported case suggests that the pediatrician-neonatologist dealing with a young infant with obstructive uropathy should not only consider the surgical treatment but also the medical one, in the light of the associated physiopathological aspects.

Proteus penneri has been isolated from many different clinical sources, including surgical wound infections, urine, and blood. We describe the first reported case of P. penneri nosocomial urosepsis in a patient with diabetes. P. penneri was subsequently isolated from bronchoalveolar lavage fluid and a pulmonary artery catheter tip.

Patients with burns are predisposed to a variety of infectious complications, urinary tract infections inclusive. It is the aim of the study to assay the incidence rate, etiology and antibacterial sensitivity of the leading pathogens causing bacteriuria in burnt patients, and compare them with the respective characteristics of the pathogens causing wound infection in the same contingent of patients, and urinary tract infection in uro-nephrological patients. Over a five-year period, a total of 2452 urines and 4236 wound exudates from 963 patients with burns, and 8800 urines from 2908 uro-nephrological patients are studied. In 35.4 per cent of patients positivation of 29.2 per cent of the urines being examined is noted. The major causing agents producing bacteriuria in burns--E. coli (19.2%) and Proteus mirabilis (13.9%)--are similar to the ones found in uro-nephrological patients, and differ from the causing agents of wound infection (the isolates concur in 16.7 per cent of the cases only). The inference is reached that strict monitoring of burnt patients is absolutely necessary because they run a high risk of urinary infection development, most frequently caused by multiresistant hospital strains, worsening the prognosis of either of the conditions. Monotherapy prescription with broad-spectrum antibacterial agents, based on the sensitivity of isolates in vitro, is strongly recommended.

Xanthogranulomatous pyelonephritis (XGP) is a well recognised but rare type of chronic pyelonephritis classically occurring in middle-aged women. It is increasingly being recognised in children in whom it can be mistaken for Wilms' tumour. Awareness of the possibility of this condition occurring in children may allow early recognition and possible treatment. Two cases of XGP in children are described and the literature reviewed.

Eubacterium suis was isolated from the preputium of seven out of 16 mature boars on two farms and from the urinary bladder of one out of five sows originating from a third herd. The morphological and biochemical characteristics of the isolated strains were identical to that of the reference strain of E. suis ATTC 33144. Three out of four strains isolated from Farm A were successfully subcultured aerobically, and then anaerobically again. E. suis together with Proteus mirabilis was isolated from cystitis of a sow 4 days after artificial insemination. These are the first strains of E. suis isolated in Hungary.

Possible synergistic effects of the combination of EDTA-tromethamine (EDTA-Tris) and three antimicrobial agents (cephaloridine, kanendomycin and enrofloxacin) against resistant Gram-positive and Gram-negative bacteria are reported. Bacteria were isolated from eight cases of chronic otitis externa, five cases of chronic dermatitis and four cases of recurrent cystitis in dogs which had previously been treated with one of the three antibiotics without success. Animals exposed to EDTA-tromethamine plus the antibiotic recovered completely within 10 days, and were controlled clinically and bacteriologically for 180 days. Local irrigation with EDTA-tromethamine solution was well tolerated and no side effects were recorded.

We describe a 21-year-old male who presented with spontaneous drainage of an infratentorial extradural empyema secondary to mastoiditis. Following eradication of the primary source, the patient was commenced on high dose intravenous antibiotics. Serial computed tomography (CT) revealed complete resolution of the pus collection. Antibiotic therapy was successful and no neurosurgical intervention was necessary.

We described for the first time an alkaline encrusting cystitis in a patient with the acquired immune deficiency. This is an entity characterized by severe dysuria and long standing urinary frequency, alkaline urine and radiographically visible calcification of the urinary bladder. It has been observed in patients with permanent Foley catheter, persistent infections due to microorganisms with urolytic activity, urinary bilharziosis or tuberculosis, or malignant bladder tumors. None of these entities were described and the patient had all conditions for this syndrome.

Objectives: We report 11 cases of focal xanthogranulomatous pyelonephritis (FXGP), a disease that is very uncommon. The aim of the present work is to assess the effectivity of conservative treatment., Material and Methods: Eleven of the 82 cases of XGP (12.5%) diagnosed between 1970 and 1995 presented the focal form (FXGF). Clinical features, laboratory findings, radiological imaging studies, surgical treatment and follow-up were evaluated., Results: FXGP occurred in middle-aged women (female/male ratio 4.5:1) who had a history of calculosis, urinary infections produced by Escherichia coli and Proteus mirabilis, or urinary tract abnormalities. FXGP was unilateral in all cases. The most frequent symptom was flank pain. Some hematological and biochemical parameters were altered. Intravenous urography and sonography revealed calculosis, hydronephrosis or renal mass, but these findings are nonspecific. Only abdominal CT scan can establish the correct diagnosis. Five of these patients (45.5%) underwent partial nephrectomy at our hospital. During the follow-up, patients showed no relapse in the ipsilateral or contralateral kidney. Serum parameters were in normal range., Conclusion: When FXGP is diagnosed, local excision is recommended in all cases, since relapse in the affected kidney is unusual.

A 77-year-old man presented to our hospital following the sudden onset of left subclavicular swelling, 8 years after undergoing subtotal removal of an axillofemoral bypass. Computed tomography revealed a rupture of the left axillary artery with the formation of a false aneurysm. Emergency surgery was performed in the form of an extraanatomic, axillo-axillary bypass with resection of the false aneurysm. Prior to removal of the false aneurysm, the subclavian artery was ligated via a left thoracotomy to minimize blood loss. The pathogen was identified as Proteus mirabilis, which is a rare causative organism for prosthetic graft infection. This case report demonstrates that total removal of the graft with revascularization should be performed for graft infections.

The effect of aerobic bacteriology on the clinical presentation, complications of the disease and long-term results of surgical treatment was assessed in a cohort of 368 patients with chronic suppurative otitis media. Bacteriological findings showed no significant difference between child and adult patients. Staphylococcus aureus was isolated in cholesteatoma ears more frequently than Pseudomonas aeruginosa, in chronic ears without cholesteatoma the situation was reversed. Bacteriological findings had no significant effect on the incidence of complications caused by the disease. Failures after surgical treatment were most common in Pseudomonas ears. The bacteriology had no significant effect on pre-operative hearing levels nor post-operative hearing results. It was concluded that, in order to improve results of chronic ear surgery, more attention should be paid to pre-operative conservative treatment of chronically discharging ears, especially those infected by P. aeruginosa.

Bacterial and fungi were isolated from different tissues (brain, liver, heart) taken from 81 dead newborn mink originating from Aleutian disease (AD) infected and AD-non-infected farms. Of the 123 isolates obtained, 96% were bacterial isolates (predominantly Gram-negative) and 4% were fungi. The prevalence of microorganisms appeared less common in kits from AD-non-infected farms (55%) than from AD-infected farms (73%), although the difference was not significant. The liver was the most highly infected site in both groups and generally was only infected by one microorganism species. Proteus spp (23%), Escherichia coli (16%), Staphylococcus aureus (11%) and Enterobacter cloacae (9%) were the most frequently isolated germs. These findings are similar to those of other studies but the role of these microorganisms as specific pathogens or secondary invaders remains controversial.

To evaluate the possible effect of urinary tract infection (UTI) on the fragility of calcium-containing stones (calcium-oxalate, calcium-phosphate), the results of extracorporeal shock wave lithotripsy (ESWL) therapy in 81 patients with UTI and 30 patients with no sign of UTI were comparatively evaluated. ESWL parameters (shock wave number, kilovolt value, treatment time) and stone-free status during 3 and 6 months of follow-up were assessed for each patient, and the results were evaluated with respect to stone presence. Our results indicated that the presence of UTI may decrease stone fragility and increase stone clearance time. We believe that deterioration of peristaltic dynamics in the renal pelvis and the ureteral wall may reveal prolonged stone clearance phases in such patients.

Turkey rhinotracheitis (TRT) virus was first isolated from a commercial broiler chicken with swollen head syndrome (SHS) in Japan. At the same time, Newcastle disease virus (NDV), infectious bronchitis virus (IBV), avian reovirus (ARV), Escherichia coli (E.coli), Morganella morganii, and Proteus mirabilis were also isolated from the same broiler chicken. The presence of antibodies to TRT virus was confirmed in the sera of 34-day-old chickens of the flock with SHS, however the antibodies to TRT virus were undetectable in the sera of 17-day-old chickens. In this investigation, we confirmed avian pneumovirus infection in chickens in Japan, and the virus and other agents may be considered as a cause of SHS.

We describe the case of an elderly lady who presented with a severe crusting skin eruption, mainly affecting the flexural areas and trunk. A diagnosis of Langerhans cell histiocytosis was confirmed by electron microscopy, and her condition was eventually controlled with systemic prednisolone and short courses of etoposide. An unusual feature of this case was the development of severe pyogenic abscesses, particularly involving the cervical region. No underlying immunological defect has been found to explain this.

The disposition of ornidazole and its two major hydroxylated metabolites was studied in five pregnant women (gestational ages 25 5/7 to 38 4/7 weeks) with either chorioamnionitis or pyelonephritis treated with ceftriaxone 2 g, tobramycin 3 mg/kg body weight and ornidazole 1 g all administered once-daily. Two series of blood samples were obtained, the first on the first day of treatment and the second at steady-state on day 5. Local and systemic tolerability of ornidazole was excellent and patients showed complete remission without premature delivery. There was no evidence of ornidazole accumulation, and the pharmacokinetic parameters were very similar to those seen in healthy subjects. The dosage regimen of ornidazole therefore requires no adjustment during pregnancy. Trough concentrations of ornidazole measured at 24 h post dose were above the MIC of sensitive organisms. Children born to the trial patients showed normal initial development and their growth was normal.

We present a boy who had been under observation for 4 years, suffering since the age of nine from necrotizing vasculitis, which appeared during Proteus sp. sepsis. Complex treatment with antibiotics, large doses of steroids, antithrombotic and peripheral circulation improving drugs, as well as local drugs applied to the skin and oral cavity mucosa, resulted in a complete cure. This illness left some cosmetic skin defects on the face and extremities, a shortening of the tongue and malocclusion.

Stone formation is an uncommon complication in renal allograft recipients. We report a 61-year-old woman who had undergone cadaveric renal transplantation in 1982 because of chronic renal failure due to polycystic kidney disease. Since 1985 she has developed recurrent urinary tract infections with Proteus mirabilis, and persistent microhematuria was detectable from 1988 on. Since renal function remained stable, she was repeatedly treated with antibiotics. Following a septicemia with P mirabilis, a staghorn calculus was discovered and was surgically removed from the allograft. Stone analysis (infrared spectrometry) revealed 60% struvite and 40% carbonate apatite. Since urinary tract infections with urea-splitting bacteria are a more frequent cause of stone formation in transplant patients than in nontransplant patients with kidney stones, stone disease should be considered in every allograft recipient presenting with recurrent urinary tract infection and microhematuria.

Abscess of the liver is a comparatively rate, but very serious disease, necessitating the undertaking of diagnostic and therapeutic measures on an emergency basis. The principal diagnostic method currently in use includes two imaging techniques--echography and CT. In therapeutic respect the target puncture under echographic or CT control has rather limited scope of application. Surgical therapeutic approach is the leading one--laparotomy, drainage of the abscess, and arbitrary use of a Kerr drainage for the choledochus and regional antibiotic therapy.

We have studied anti-Proteus antibodies (APA), isolation of Proteus, and their relation to various measures of RA disease activity. Seventy RA patients with a CRP > 10 mg/l had higher APA titres than 17 RA patients with CRP < or = 10 mg/l (P = 0.006), and 36 non-RA controls (P = 0.003). However, in a cross-sectional study of the RA group, there was no correlation between APA and a number of clinical and laboratory measures of disease activity, including the CRP and Stoke RA activity index. A longitudinal study showed no correlation between changes in these measures of disease activity and change in APA titre. We were unable to isolate Proteus in the urine or faeces of RA patients more frequently than controls, and the isolation of Proteus did not correlate with serum APA titres. Urinary APA was present in equal frequencies in RA and non-RA patients. NSAIDs, DMARDs and steroids did not appear to influence APA titres in the RA group. These results suggest that APA may act as an acute phase protein, distinct from CRP, but not correlating with RA disease activity in its broadest context. The fact that the antibody we are measuring binds to Proteus may be irrelevant, and the study does not support a role for Proteus in RA.

This study examines the pathophysiology of hepatobiliary complications induced by total parenteral nutrition (TPN) by using animal models that underwent cecal ligation to produce intra-abdominal infection and received an enterostomy to mimic a high-output fistula, which causes the interruption of enterohepatic circulation of bile salt. Aspartate transaminase was elevated after TPN (p < .05). Alkaline phosphatase was increased in animals receiving TPN plus an enterostomy (p < .05). Serum albumin was significantly decreased in animals receiving TPN plus undergoing cecal ligation or enterostomy (p < .05). Liver weight and liver protein and water content decreased in animals receiving TPN alone (p < .05). Liver water content increased in animals receiving TPN plus undergoing cecal ligation (p < .05). Liver lipid content increased after TPN and to a significant degree in rats receiving TPN plus undergoing cecal ligation or enterostomy (p < .05). Bile flow diminished after TPN and to a level reaching significance in animals receiving TPN plus undergoing cecal ligation or enterostomy (p < .05). Reduction of bile flow, decrease of biliary cholesterol secretion, and increase of biliary bilirubin secretion, which may be the cause of TPN-induced bilirubinate stones, were most significant in animals receiving TPN plus undergoing cecal ligation (p < .05). In conclusion, TPN can induce hepatic dysfunction and bilirubinate stones, but these complications are more common in animals with associated intra-abdominal infection or high-output fistula.

Analysis of an aliquot of fluid from a pleural effusion will often provide the clinician with the information needed to establish a presumptive or definitive diagnosis of the patient's illness. A properly performed pleural fluid pH can maximize the diagnostic yield and provide guidelines for further clinical interventions.

A novel injectable cephalosporin, E1040, significantly eradicated Pseudomonas aeruginosa from the urine, in contrast to ceftazidime, in rats with complicated P. aeruginosa urinary tract infections associated with urinary stones, suggesting that E1040 is a prospective therapeutic agent in the management of refractory Pseudomonas urinary tract infections.

We have endeavoured to determine whether there is any difference in the bacteriological pattern of UTI and the antibiotic sensitivity patterns of the pathogens concerned between diabetic and non-diabetic patients. Over a period of 1 year, a total of 287 diabetic patients (221 females and 66 males) with community-acquired and nosocomial urinary tract infections were studied. There were 265 patients (228 females and 37 males) without any predisposition to urinary tract infections (UTI) and who served as controls. Although Escherichia coli was the predominant organism in community-acquired UTI in diabetic patients, it was found significantly less than in the non-diabetic population (P less than 0.005). The percentage of Klebsiella species causing community-acquired UTI in diabetic patients was significantly higher than in non-diabetics (P less than 0.005). The antibiotic sensitivity patterns of the organisms in the two groups, however, were not significantly different. The organisms isolated from nosocomial UTI in diabetics showed a significantly greater preponderance of Klebsiella spp. and a significantly lower percentage of E. coli when compared to community-acquired UTI in diabetics (P less than 0.005). Klebsiella spp. in nosocomial UTI of diabetics showed an overall increase in resistance to antibiotics. At least a quarter of the isolates of Klebsiella spp. in nosocomial UTI were resistant to third-generation cephalosporins. Patients with diabetes mellitus appear to have an increased incidence of Klebsiella spp. as the pathogen in both community-acquired and nosocomial UTI. Antibiotic resistance in the organisms isolated from nosocomial UTI is greater than that related to community-acquired UTI in diabetic patients.

It has been hypothesized that urinary urokinase and sialidase may play a role in urolithiasis. If these theories have substance it is to be expected that microorganisms may also affect these enzymes, since the association between urinary tract infection and renal stone formation is well known. It is generally assumed that Proteus mirabilis and Staphylococcus albus, which produce the urea-splitting enzyme urease, are responsible for stone formation. However, the importance of non-urease-producing microorganisms (Escherichia coli and Enterococcus) in urolithiasis is unclear. Spectrophotometric studies were therefore devised to clarify this problem. Microorganisms associated with infection-induced stones (Proteus mirabilis and Escherichia coli) respectively inhibited the urokinase and stimulated the sialidase activity. In contrast, microorganisms which were not associated with infection stones (Bacillus subtilis) had significantly less effect on urokinase and sialidase activity. This study may explain infection-induced stone formation and could open a completely new line of research.

We describe two patients with acute diffuse external otitis (swimmer's otitis) acquired in the Mediterranean shore, with Vibrio alginolyticus recovered from ear fluid. We describe the biochemical profile and sensitivity pattern (MIC) of both strains, comparing it to previously published data. A literature review was also performed, in which we found evidence for increasing concern of V. alginolyticus as an human pathogen. Also there is a need for considering halophilic vibrio as potential pathogens, specially if there is also epidemiologic support.

Urinary concretions, particularly in the upper urinary tract, occur in otherwise healthy children in connection with Bacillus Proteus urinary infections. In other European countries, this occurs in 40-70% while, on the other hand, it is particularly rare in Scandinavia. A case of obstructing pelvic concretion in a boy aged three months is presented. This is the youngest case which could be found in the literature. Pyelolithotomy was performed and the child has been free from recurrence for six years. At the commencement of the disease, pain due to renal calculi may be misinterpreted as being due to three-months intestinal colic. Formation of calculi is presumed to be due the ability of Bacillus Proteus to form urease. The frequency of recurrences is 3-8% and is lowest if the urine can be maintained sterile for the first three months after removal of the stone.

The authors describe a case of unilateral adrenal abscess in a neonate, which was diagnosed at 13 days of age by abdominal ultrasonography. The newborn presented with persistent high white blood cells after Proteus mirabilis omphalitis. Magnetic resonance imaging and needle aspiration confirmed the diagnosis. This is the second case of Proteus mirabilis neonatal adrenal abscess reported in the literature. Percutaneous drainage allowed complete recovery.

A series of 270 paediatric stone patients was studied retrospectively according to the clinical pattern of urolithiasis (age and sex, stone location, stone analysis, recurrence rate) and aetiology of stone disease (infection, anatomical, metabolic or idiopathic). Infection stones occurred earliest and more commonly in males and were usually upper tract struvite calculi related to Proteus infection. Anatomical stones were most commonly associated with pelviureteric junction (PUJ) obstruction and had a high recurrence rate, despite surgical correction of obstruction. Idiopathic stones most resembled those found in adult urolithiasis by virtue of occurring latest, being sited in the ureter more often and being more frequently composed of calcium oxalate. Metabolic stones were most frequently calcium phosphate or cystine and virtually all were renal. They comprised the smallest group but had the highest recurrence rate.

It had already been shown with a single virulent strain (A42) of Fusobacterium necrophorum that suspension of the fusobacteria in sub-lethal doses of broth cultures of other bacteria reduced the minimum infective dose (greater than 10(6) organisms) for mice by subcutaneous inoculation, sometimes to less than 10 organisms. The present study extended the known range of bacteria with strong infectivity-enhancing properties to include Bacillus cereus, Klebsiella oxytoca and Staphylococcus aureus; and those with weaker effect to include Bacillus subtilis, 'Bacteroides melaninogenicus', Clostridium sporogenes, Pasteurella haemolytica, and Proteus mirabilis. The study also showed that five further virulent strains of F. necrophorum closely resembled A42 in respect of striking susceptibility to infectivity enhancement by Escherichia coli. Actinomyces (Corynebacterium) pyogenes and S. aureus. One further strain (A6) of F. necrophorum resembled A42 in respect of strong infectivity enhancement by A. pyogenes, S. aureus, B. cereus and K. oxytoca but differed from it and the other five strains in being only slightly affected by E. coli. This work was a necessary prelude to the development of a method, based on infectivity enhancement, for the detection and isolation of F. necrophorum present in small numbers in heavily contaminated material such as faeces.

The number of patients carrying an endocavitary pacemaker is increasing every day. The presence of a foreign body in right cavities predisposes to the formation of thrombi that can be over infected from distal septic focci usually silent. When a pulmonary embolism is diagnosed in these patients, the initial study must include an echocardiographic exam in order to rule out the presence of an intracardiac thrombosis as the origin of the emboli. We present the case of a patient with and endocardiac pacemaker who was admitted with fever and repeated episodes of pulmonary embolism. Hemocultures were positive for proteus mirabilis and a electrocatheter thrombosis was demonstrated in bidimensional echocardiography. Proteus mirabilis was positive in cultures from the material obtained by cardiothomy and clinical evolution after surgery was satisfactory.

A group of 44 patients, aged from 10 months to 14 years, underwent surgery for urinary calculi over a 7-year period (1982-1989). Eleven patients had bilateral or multiple calculi (total number of stones = 55, 20 of which were staghorn). Metabolic disorders (n = 25) and Proteus urinary infection (n = 15) were the 2 factors most often associated with lithiasis. Of the 55 stones, 51 were removed by open surgery. Complete stone clearance was achieved in 29 of 36 kidneys. Follow-up periods in the remaining 7 renal units (with small residual fragments) ranged from 3.5 to 7.5 years (mean 6.2) and revealed stone recurrence in only 2 patients. Evaluation of childhood urolithiasis should include thorough metabolic investigation and sound surgical judgment; effective management requires prolonged post-operative follow-up.

After feeding various diets we studied the effects of dietary calcium, magnesium and phosphorus on the formation of struvite stones in rats with urinary tract infections, and also studied the effects of the administration of vitamin D3 and aluminium gel on stone formation. A low-magnesium diet decreased urinary magnesium and prevented stone formation, but a medium-calcium diet did not significantly decrease stone weight. A high-calcium diet decreased urinary phosphorus and inhibited stone formation. A high-calcium and high-phosphorus diet decreased urinary excretion of magnesium and inhibited stone formation. Although the administration of vitamin D3 did not inhibit stone formation, aluminium gel decreased the urinary level of phosphorus and prevented stone formation. A marked decrease in urinary magnesium and/or phosphorus may prevent struvite stone formation in rats with urinary tract infections.

Fournier's or genito-perineal gangrene of the male genitalia typically spares the testis, urethra and deep penile components. It usually is polymicrobial and synergistic. To our knowledge, this is the first reported case in the literature with severe, deep, full penile thrombosis that caused a severe urethral stenosis and required later surgery. Only Proteus mb. could be isolated and gave rise to a disseminated intravascular coagulation syndrome that has probably accentuated the thrombotic penile phenomenon. The process was secondary to urethral lithiasis.

Two patients developed superior vena cava syndrome following total parenteral nutrition through a central venous catheter. Infection may have contributed to the development of the superior vena cava thromboses. In one patient a "sleeve thrombus" probably caused multiple pulmonary embolisms after the catheter was withdrawn. The other patient had a mural thrombosis with complete occlusion of the superior vena cava. The author emphasizes the importance of early diagnosis and correct treatment in order to reduce the high mortality rate due to this serious complication to central venous catheters.