Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam.

OBJECTIVE: To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). PATIENTS AND METHODS: Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. RESULTS: Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects. CONCLUSIONS: This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.

Tunica albuginea plication for the correction of penile curvature.

OBJECTIVE: To evaluate the efficacy of tunica albuginea plication (TAP) in the correction of congenital and acquired penile curvatures and determine key points for a successful outcome of this procedure. MATERIALS AND METHODS: From December 1995 to January 2001, 40 patients with penile curvature (10 congenital and 30 secondary to Peyronie's disease) underwent surgical correction by TAP. Indications were difficult or impossible penetration, normal erectile function, stable disease. For TAP we used non-absorbable inverted stitches tied with the assistant pushing down the tunica albuginea with a mosquito clamp to create an adequate groove for the knot. The results were evaluated subjectively and objectively. RESULTS: At mean follow-up of 30 months, full subjective and objective success (straight penis, mild shortening, normal erection, penetration and sensation) was achieved in 37 (92.5%) patients. Objective but not subjective success was achieved in 2 patients (5%), 1 complaining of psychogenic erectile dysfunction and the other of excessive penile shortening. There was only one failure, namely persistent glans numbness due to damage of the non-mobilized neurovascular bundle. CONCLUSIONS: TAP is a simple and effective method for the correction of congenital and acquired penile curvatures. Key points for successful outcome are adequate preoperative evaluation and counselling, careful preparation of tunica albuginea, mobilization of urethra or neurovascular bundle when needed, use of inverted stitches carefully buried, objective postoperative evaluation with a pharmacological erection test.

[Echo-color doppler in the topographic study of varicocele]. / Eco color Doppler nello studio topografico del varicocele.

The echo color doppler allows an easy topographical distinction of the spermatic reflux (in front of the deferens) from cremasteric one (back to the deferens). This distinction consents a rational surgical choice, the selective interruption of the refluent vein and a less morbidity due to the surgical intervention. We evaluated 20 infertile patients (mean age 23 years) with echo color doppler testicular vessels (B & K 7.5 Mhz transducer). Seven varicoceles were clinically evident, 13 varicoceles were subclinic. After locating the deferens, we evaluated the venous reflux in the spermatic and cremasteric veins. The evaluation has been performed at rest and during Valsava maneuver. We used, in the correction of the anterior (spermatic) reflux, a retroperitoneal surgical access, while in the back (cremasteric) reflux isolated or combined, we performed middle or under inguinal access. The mean follow up has been of 4 months. In all cases the veins with reflux have been easily characterized. In 16 patients (80%) the spermatic vein was concerned; in an isolated case (5%) the reflux concerned only the cremasteric vein, in 3 patients (15%), with clinical varicocele, the reflux was present in both the veins (Coolsaet III type). In the 16 spermatic varicoceles, treated with retroperitoneal access (Palomo), the echo color doppler check demonstrated the absence of venous reflux. In the 4 varicoceles regarding the isolated or associate cremasteric vein treated with middle or under inguinal access, the existence of extra funicular varix was highlighted and after surgery the echo color doppler check was negative. In our few cases the echo color doppler diagnosis demonstrated a total correspondence with the surgical finds and with the doppler follow up. This diagnostic approach allows to reserve the retroperitoneal surgery to the spermatic pure reflux avoiding the false relapses due to the persistence of an undiagnosed cremasteric reflux. The middle or under inguinal approaches, generally loaded from a greatest morbidity, could be only employed in presence of an isolated or combined cremasteric reflux.

Indoor air climate and microbiological airborne: contamination in various hospital areas.

Indoor climate indices and microbiological airborne contamination were evaluated in a department of a general hospital in Bologna only partially equipped with an air conditioning system. To determine the environmental parameters, an ANADATA (LSI) climate analyzer with relative transducers was used. The Effective Temperature (ET), the New Effective Temperature (ET*) and the Fanger indices (PMV-PPD) were calculated using the parameters measured. Microbial count measurements were taken with an S.A.S. (Surface Air System) sampler, to ascertain the total bacterial count at 37 degrees C, and the fungal particle, Staphylococcus aureus and Pseudomonas aeruginosa counts. Carbon dioxide air concentrations were also measured to evaluate the efficacy of air exchange. The Fanger indices were not within the range of thermal comfort in most rooms (52% in winter, 62% in summer). Air microbial counts were higher in the hospital wards and surgeries than in the offices and laboratories. In particular, coagulase-positive staphylococci were present only in the air of the patients' rooms. The microbial contamination was not correlated with the air conditioning system, but probably caused by the turnover in the hospital population, the number of people and their behaviour. However the most important measure to prevent airborne contamination and to reduce the number of microorganisms in the air is an efficient source control. Better management of the air conditioning system, by means of adequate air exchange and thermal adjustment, would lead to a notable improvement in indoor air quality, especially in units with hospitalized patients.

Indoor climate and air quality in new offices: effects of a reduced air-exchange rate.

In response to a request from the personnel of a credit bank that had been moved into a new building, an evaluation was made of employee health complaints. The prevalence of symptoms was determined using a self-administered questionnaire. Ventilation effectiveness, contaminant concentrations (which included chemicals and bioaerosols) and microclimate were studied to establish their relationship to environmental discomfort and to the health problems mentioned by the employees. Indoor air quality--which was assessed in different seasons--revealed relatively high levels of carbon dioxide and bioaerosols in areas occupied by employees as compared with other places. Temperature and humidity were considered to be satisfactory. Although a causative agent was not isolated, the authors conclude that an ineffective rate of room air exchange, possibly in interaction with chemical contaminants, may be responsible for the discomfort and, perhaps, for the health symptoms experienced by workers in fully enclosed rooms.

[Evaluation of working conditions at the work place with video terminals: a survey conducted in 6 business offices]. / Valutazione ergonomica del posto di lavoro al videoterminale: indagine condotta in sei aziende del terziario.

The Authors have taken under study 6 office buildings and a total of 165 work stations with VDTs. Lighting conditions, postures, indoor climate and air-quality have been evaluated, besides worker's subjective approach sounded by individual questionnaire. Concerning visual comfort, it has been noticed that the most simple and well-known rules are often disregarded, such as avoiding to place a screen in front of a light source because of its glare. Also, operators postures are often incorrect, making problems related to their own fixity worse. Air conditioning systems assure almost excellent conditions for thermal comfort, but air changes are often poor and microbiologic quality suffers from plant's inadequate servicing. Finally, the survey of questionnaires shows a complaint percentage which only partly corresponds with the objective data collected, reflecting instead an uneasiness to the kind of work and its organisation.

[Endoscopy findings in gastroduodenal pathology in a group of welders]. / Rilievi endoscopici di patologia gastroduodenale in un gruppo di saldatori.

Fourteen welders were examined with the purpose to evaluate the incidence and the type of pathologic changes of the gastrointestinal tract due to the exposure to welding fumes. The medical examination was followed by endoscopic and bioptic study of gastric and duodenal mucosa. The results show the presence of pathologic changes, mainly of flogistic type, in all the microscopic investigations, although the appearance of the mucosa was generally normal. Moreover, the results of this investigation suggest that pathologic changes of gastrointestinal tract could precede those of the respiratory tract.