[KTP-80 laser endovaporisation of prostate symptomatic hypertrophy in patients under anticoagulant and/or antiagregant therapy]. / Endovaporisation au laser KTP-80 de l'hypertrophie symptomatique de la prostate chez les patients sous médication antithrombotique.

Our population is ageing along with the rate of cardiovascular pathologies, which frequently require administration of antithrombotic treatments. Consequently, prostatic surgery becomes increasingly delicate. Thus per- and post-operative macroscopic hematuria contributes significantly to the duration of hospitalization and the morbidity of conventional surgery of symptomatic prostate hypertrophy. Moreover, these patients require transient suspension of their anticoagulation or anti-aggregation treatment. The recent KTP-80 laser limits post-operative hematuria and allows to operate on the growing population of patients under antiagregant and/or anticoagulant therapy. We review in these patients the operative modalities and the results of this surgery, in comparison with transurethral resection of the prostate.

Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia.

To determine the causes of treatment failure and to evaluate the prognostic factors in patients hospitalized for community-acquired pneumonia, a prospective, observational study of 228 adult patients hospitalized for a community-acquired pneumonia in the University Hospital of Geneva and the La Chaux-de-Fonds Community Hospital, Switzerland, was conducted. The percentage of patients who failed to improve (as defined by guidelines of the Infectious Disease Society of America) and the causes of treatment failure were assessed, and patients who failed to improve under antimicrobial therapy were compared with those who did improve. In the 54 (24%) patients who failed to improve, a mean increase in length of hospitalization of 4 days was observed. Most causes of treatment failure could be attributed to host factors (61%) rather than to the pathogen (16%) or to an inappropriate antibiotic regimen (3%). After adjusting for potentially confounding variables, concomitant neoplasia (OR 3.25; 95%CI 1.11-9.56), neurological disease (OR 2.34; 95%CI 1.07-5.13), and aspiration pneumonia (OR 2.97; 95%CI 29-6.86]) were associated with failure to improve, whereas monocytosis improved prognosis (OR 0.40; 95%CI 0.20-0.80). Almost one out of four patients hospitalized for community-acquired pneumonia failed to respond to empirical antibiotic treatment. Aspiration pneumonia, concomitant neoplasia, and neurological disease were factors positively associated with failure to improve, whereas monocytosis was linked to a better prognosis.

Causes of macrocytosis in HIV-infected patients not treated with zidovudine. Swiss HIV Cohort Study.

OBJECTIVE: Zidovudine is a well known cause of macrocytosis. However, many HIV-infected patients develop macrocytosis even though they do not receive zidovudine. The aim of this case-control study was to evaluate other causes of high mean corpuscular volumes (MCV) in HIV infected patients. METHODS: Thirty patients with a MCV > or = 100 fl (cases) were compared to 60 randomly selected controls with MCV A< or = 99 fl, none of them receiving zidovudine. RESULTS: Sex ratio, age, mean CD4, prevalence of alcohol abuse and liver disease were similar in both groups. Vitamin B12 or folic acid levels were not decreased in patients with macrocytosis. In contrast, there was an association between macrocytosis and use of stavudine alone or in combination with another antiviral drug (28/30 cases, 15/60 controls, odds ratio 40.6 (95% confidence interval 5.1-325.2), P< 0.001). The haemoglobin concentration among cases (mean 13.5 g/dl) was similar to that of controls (mean 13.0 g/dl). CONCLUSIONS: Stavudine use increase the risk of macrocytosis more than 40-fold in HIV-infected patients who do not receive zidovudine. None of the stavudine-treated patients, however, developed anaemia or had to interrupt treatment because of this side effect.