Microbiological quality of indoor and outdoor swimming pools in Greece: investigation of the antibiotic resistance of the bacterial isolates.

During 1997-2005, the microbiological quality and susceptibility of bacterial isolates of swimming pool waters were investigated. A total of 462 water samples were collected from three indoor swimming pools (a teaching pool, a competition public pool, a hydrotherapy pool) and two outdoor swimming pools (a hotel semi-public and a residential private pool) in Northwestern Greece. All water samples were analyzed for the presence of bacteria, protozoa and fungi and susceptibility tests were performed for the bacterial isolates. Sixty-seven percent of the examined water samples conformed to the microbiological standards and 32.9% exceeded at least one of the indicated limits. Out of 107 bacterial isolates, 38 (35.5%) resistant strains were detected. Multi-resistant Pseudomonas alcaligenes, Leuconostoc, and Staphylococcus aureus (isolated from the teaching pool), Staphylococcus wernerii, Chryseobacterium indologenes and Ochrobactrum anthropi (isolated from the competition pool), Pseudomonas aeruginosa, P. fluorescens, Aeromonas hydrophila, Enterobacter cloacae, Klebsiella pneumoniae and S. aureus (isolated from the hydrotherapy pool) and A. hydrophila (isolated from the hotel pool) were detected. The swimming pool with the poorest microbiological quality (THC 500 cfu/ml in 12.1% of the samples, P. aeruginosa counts 1500 cfu/100 ml in 6% of the samples) and the highest prevalence of multi-resistant isolates (73.6%) was the hydrotherapy pool. No Cryptosporidium or Giardia cysts and no Legionella, Mycobacteria and Salmonella were detected, but there were isolations of Candida albicans, Aspergillus spp., Mucor spp., Alternaria spp., Rhizopus spp., Trichophyton spp., and Penicillium spp.

Adjuvant and neoadjuvant therapies in high risk localized prostate cancer.

In this review article adjuvant and neoadjuvant therapies in patients at high risk for localized prostate cancer are presented in some detail. Adjuvant hormone therapy by antiandrogens as well as antineoplastic chemotherapeutic agents such as estramustine and taxanes are referred. Neoadjuvant therapies in addition to systemic therapy before or after local treatment for prostate cancer may improve the outcome of high risk patients otherwise destined to treatment fail. Data regarding some substances used in neoadjuvant therapies such as androgen deprivation therapy and use of rapamycin with its analogs, as well as some novel therapeutic approach strategies are also discussed.

Solitary fibrous tumour of the epididymis: MRI features.

We present a case of a solitary fibrous tumour, located at the epididymis, in a 65-year-old man, presented with a scrotal mass. Ultrasound and MRI of the scrotum revealed a paratesticular mass, with rich vascularity, arising in the left epididymis. Radiological findings were non-specific and the patient underwent surgery.

Giant simple renal cyst complicated with hypertension.

Solitary renal cysts are a common and usually asymptomatic occurrence in older patients. They may be associated with hypertension or abdominal disturbances, as they can be responsible for compression of surrounding tissues and distortion of renal vessels. This report presents an interesting case of a hypertensive patient with a solitary renal cyst of a marked size. Owing to the high risk of performing a surgical procedure in such a patient, a distinct therapeutic solution was opted for. Successful management of this case was achieved by a combination of percutaneous fluid aspiration and injection of alcohol and Vibramycin inside the cystic cavity. Percutaneous fluid evacuation combined with the administration of a sclerosing agent is suggested as a safe and effective alternative for cyst decompression and blood pressure normalisation.

Retroperitoneal barytoma.

A rare case of retroperitoneal fibrosis after rectal perforation during a barium enema is reported. Pelvic cellulitis due to infiltration of barium and fecal matter is a serious complication and needs an energetic treatment. Urologic complications appear later and result from the formation of a foreign body granuloma.

Sachse urethrotomy versus endoscopic urethrotomy plus transurethral resection of the fibrous callus (Guillemin's technique) in the treatment of urethral stricture.

OBJECTIVES: Advances in endoscopic instrumentation and technique have expanded the urologist's armamentarium for effective and safe treatment of urethral strictures. This prospective study included 80 patients who presented with single, iatrogenic, annular strictures of the bulbar urethra. The length of the stricture was 1 to 2 cm, with an average of 1.5 cm. METHODS: Patients were randomly divided into two groups: group A, 40 patients who underwent direct-optical endoscopic urethrotomy with a guide catheter via cold-knife incision at the 12 o'clock position (Sachse urethrotomy), and group B, 40 patients who underwent double direct-optical endoscopic urethrotomy with a guide catheter via cold-knife incisions at the 11 and 1 o'clock positions, followed by transurethral resection of all scar tissues (Guillemin's technique). The results obtained were analyzed and compared at 6 months, 12 months, 24 months, 3 years, and 5 years postoperatively by clinical evaluation, uroflowmetry, and retrograde and voiding urethrographies. RESULTS: Group A obtained 95% good results at 6 months, 85% at 12 months, 55% at 24 months, 45% at 3 years, and 25% at 5 years. Group B obtained 98% good results at 6 months, 95% at 12 months, 90% at 24 months, 80% at 3 years, and 70% at 5 years. CONCLUSIONS: The differences between the two groups are not significant at 6 and 12 months (P > 0.05). They are statistically significant after 24 months, 3 years, and 5 years (P < 0.05).

Renal oncocytoma and renal pelvis carcinoma: a rare coexistence of double renal tumors.

We report a case of renal oncocytoma which was found incidentally during the nephroureterectomy for renal pelvis carcinoma. The coexistence of two tumors on the kidney with absolutely different origin one from the other is extremely rare and interesting. Herein we discuss the clinical, morphological, histological, ultrastructural and angiographical characteristics of oncocytoma.

Intrauterine unilateral torsion of the spermatic cord.

A case of unilateral torsion of the spermatic cord in a newborn is reported. Extra-vaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Treatment requires immediate surgical exploration. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not a risk for torsion. Treatment of the ipsilateral testicle is determined by operative findings.

Benign fibroepithelial ureteral polyps. Report of 3 cases.

Three rare cases of benign ureteral polyps are presented. The rareness of benign mesenchymal ureteral tumors and the difficulty in pre-operative differential diagnosis from malignant epithelial are remarkable. The diagnosis is made on characteristic appearance at operation and is confirmed by frozen section and histological examination.

Inhibition of benzo(a)pyrene-induced carcinogenesis by vitamin C alone and by vitamin C/vitamin E and selenium/glutathione.

The reduction on peroxidation caused by benzopyrenes by some naturally occurring antineoplastic agents was studied in this experimental work. Inhibition/reduction of experimental carcinogenesis induced by benzo(a)pyrene by vitamin C alone and by vitamin C/vitamin E and selenium/ glutathione was attempted in 224 female Wistar rats divided in four groups. Injected with 10.08 mL benzo(a)pyrene, the animals were treated with some naturally occurring substances like vitamin C alone and a combination of anticarcinogens. By calculating the carcinogenic potency of benzo(a)pyrene and the anticarcinogenic potency of substances used as well as histological examination of developed tumors and survival time of treated animals, it was found that vitamin C exerts a significant anticarcinogenic effect of 8.3 units and that the combination of the two anticarcinogens used produced a significant prolongation of the animals survival time with anticarcinogenic potency of 22.1 and 22.2 units, respectively. This is considered a potent anticarcinogenic effect. The question of an additional supportive administration of such agents complementary to the conventional cancer chemotherapy in humans is raised. Of course, further studies are needed.

The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens.

This 6-month double-blind, randomized, parallel-group study compared two dose regimens of Libeprosta, the lipidosterolic extract of Serenoa repens in 100 male outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The patients received two 80-mg tablets twice daily or two 80-mg tablets three times daily. Baseline evaluations included maximum and mean urinary flow rates, postvoid residual urine volume, and International Prostate Symptom Score (I-PSS) total and quality-of-life scores. Both regimens significantly reduced the I-PSS mean total score from baseline values (P<.001); improvements achieved statistical significance after month 3 and were maintained for the duration of the study. Significant improvements from baseline also occurred in quality-of-life scores, maximum and mean urinary flow rates, and residual urine volume (P<.05). The decrease in residual urine with both regimens was highly significant (P<.001). No significant differences in efficacy were noted between the two dose groups, and no treatment-related complications or clinical adverse events occurred. In this clinical study, the lipidosterolic extract of Serenoa repens was a well-tolerated agent that may significantly improve lower urinary tract symptoms and flow measurements in men with BPH.

Massive haemorrhage of inoperable bladder carcinomas: treatment by intravesical formalin solution.

Numerous modalities of treatment have been used in the past to control massive bladder haematuria, with varying degrees of success. Formalin has been used in urology only for the treatment of intractable haematuria of inoperable bladder carcinomas, usually as the last resort when all other nonsurgical attempts have failed and before more aggressive surgical measures are considered. Eight patients with bladder tumours classified T2 (2 cases), T3 (2 cases) or T4 (4 cases) and 2 patients with radiation cystitis were assessed as being beyond the scope of even palliative surgery, severe haemorrhage being present in all cases. The treatment was instituted in all cases by intravesical instillation of a 10 per cent formalin solution under general anaesthesia. Four patients received 4 and 6 instillations, respectively, the former over 4 weeks and the latter over 10 months. The bladder was filled completely and an indwelling-catheter introduced, the formalin solution being left in the bladder for 5 to 30 min (mean: 12 min). Haematuria was absent after 1 to 25 days (mean: 11 days) in 9 cases. The 10th patient died before arrest of haemorrhage. Survival after instillation was 65 days to 27 months (mean: 11.5 months). The outcome was fatal within 4 months or less in 3 cases and 4 patients died of renal failure within 3 months, one within 65 days after instillation. In 4 cases, treatment with formalin reduced bladder capacity to less than 100 ml. Other complications included retroperitoneal fibrosis (1 case), urinary incontinence (3 cases) and severe frequency and nocturia (3 cases). This procedure should therefore be reserved for terminal cases unable to support more aggressive therapy.

The blind-ending bifid ureter.

A bifid blind-ending ureter is an extremely rare congenital anomaly of the upper urinary tract. This unusual ureteric condition appears to be more common in female subjects. Such patients may be asymptomatic or present with recurrent urinary tract infections, frequency, nycturia, abdominal pain or calculi. Asymptomatic patients without urinary tract infection require no treatment. When symptoms or infection are present, the treatment is surgical excision of the blind branch with antireflux reimplantation of the normal ureter. If hydronephrosis, pyonephrosis or renal damage is present, nephroureterectomy may be required.

Squamous cell carcinoma of the penis arising from balanitis xerotica obliterans.

Penile squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe a 58-year-old man in whom penile squamous cell carcinoma developed after 25 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment.

Human bladder urine oxygen content: implications for urinary tract diseases.

Urine dissolved oxygen (DO) was measured in 40 healthy subjects and 115 patients divided into 4 groups according to their disease. Group 1 (20 patients) had lower urinary tract infection (UI), Group 2 (30 patients) had urinary stone disease (USD), Group 3 consisted of 50 end-stage chronic renal failure patients (CRF) and 15 patients in Group 4 were affected by influenza viral infection (IVI). Urinary and arterial PO2, PCO2 and pH were also measured in 20 healthy subjects. The other 20 healthy volunteers were subjected to submaximal exercise and afterwards urinary DO was estimated. Results revealed that in healthy subjects urinary DO or PO2 is not correlated with urinary pH or arterial pH, PO2 and PCO2. Also, urinary DO did not significantly vary on consecutive days. Urinary DO reflects mainly the renal metabolic state, being increased in conditions of decreased kidney metabolism such as CRF. Submaximal physical exercise, fever or urinary tract infection may significantly reduce urinary DO, whereas DO remains unaffected in uncomplicated USD. Human urinary DO is related to serum creatinine and urine volume. Our results indicate that urinary DO may be a useful indicator in clinical practice.

Bladder cancer mortality in the Epirus district population (Greece).

OBJECTIVE: To describe the pattern of bladder cancer mortality in the Epirus district population (North-Western Greece) and to establish some relationships with cigarette smoking. PATIENTS AND METHODS: Mortality rates of bladder cancer in the Epirus district population were analysed according to the official data from the Department of Statistics of the University Hospital of Ioannina during the last decade (January 1990-January 2000). Age standardization of death rates was done by the direct method, using the world population as a standard. Fisher's test was used as a significance test for linear regression coefficient in time trend analysis of mortality. RESULTS: The average annual standardized mortality rates from bladder cancer during the study period were 5.23 per 100,000 population (96% Confidence Interval--Cl 4.02-5.63) in males and 1.63 per 100,000 population (96% Confidence Interval--CI 1.18-1.96) in females. Significantly increasing trends of the rates were observed in males (y = 2.421 + 0.231x; p < 0.01), but not in females (y = 1.263 + 0.027x: p > 0.05). The greatest increase in age - specific rates in males was observed in the age group of 70 and more years (y = 25.602 + 3.673x; p < 0.01). In females, all age--specific rates except for the group 60-69 years showed significantly increasing tendency. The increasing tendency of bladder cancer mortality is followed by the rise of per capita cigarette consumption among the Epirus district population. CONCLUSION: Further studies are needed for the explanation of the irregularities in the age-specific rates.

Large infectious bladder stone after long delay in removing ureteral stent.

We herein present a case of formation of a large infectious bladder calculous resulted from placement of a double pigtail catheter for an extensive period. The concomitant poor function of the corresponding renal unit made selection of nephroureterectomy unavoidable in the management of our patient.

An experimental comparison of neural algorithms for independent component analysis and blind separation.

In this paper, we compare the performance of five prominent neural or adaptive algorithms designed for Independent Component Analysis (ICA) and blind source separation (BSS). In the first part of the study, we use artificial data for comparing the accuracy, convergence speed, computational load, and other relevant properties of the algorithms. In the second part, the algorithms are applied to three different real-world data sets. The task is either blind source separation or finding interesting directions in the data for visualisation purposes. We develop criteria for selecting the most meaningful basis vectors of ICA and measuring the quality of the results. The comparison reveals characteristic differences between the studied ICA algorithms. The most important conclusions of our comparison are robustness of the ICA algorithms with respect to modest modeling imperfections, and the superiority of fixed-point algorithms with respect to the computational load.

[Bilateral testicular metastasis of an adenocarcinoma of the prostate]. / Métastases testiculaires bilatérales d'adénocarcinome de la prostate.

Secondary testicular tumors are very rare. Since 1935, approximately 200 cases have been documented in the international literature. Testicular metastases of prostatic carcinoma are reported more frequently and other common primary tumor sites are the lung, kidney, colon, stomach and other sites. A review of the literature revealed 43 cases originating from prostatic carcinoma with 4 bilateral cases. The authors add a rare case of bilateral metastasis to the testis originating from prostatic carcinoma. This patient had been treated by transurethral resection of the prostate and bilateral orchidectomy 24 months previously.

[Urinary infection in urolithiasis patients in the Epirus district (northeastern Greece)]. / L'infection urinaire chez les lithiasiques dans le département d'Epirus (Grèce du nord-ouest).

The relationship between renal stones and urinary tract infection is frequent but not well-known. In this study, urinary tract infection was found in 12% of renal stone formers. It is four times more common in females than in males. Urea splitting bacteria (Proteus, Klebsiella, Staphylococcus and Pyocyaneus) lead to stone formation. They were identified in 72% of cases. Proteus was predominant and the organism most frequently found in staghorn stone formers. Other non urea-splitting bacteria (E. coli, Enterobacter, Streptococcus) were observed in 25% to 30% of cases. The percentage of the various bacteria varies according to the degree of resistance to therapy and the patients sex.