Sensibilidad microbiana de Escherichia coli en infecciones urinarias extrahospitalarias / Antimicrobial susceptibility of Escherichia coli associated with community-acquired urinary tract infections

OBJETIVO: El tratamiento empírico de las infecciones urinarias extrahospitalarias debe tener en cuenta la sensibilidad de las bacterias potencialmente causantes de las mismas. Además, la comparación con años anteriores permite observar la evolución de la sensibilidad microbiana. Analizamos estos aspectos con respecto a Escherichia coli en nuestro medio. MATERIAL Y MÉTODOS: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras enviadas desde atención primaria en El Bierzo (León) durante los años 2002 y 1998, en número de 895 y 595, respectivamente. Se determinó la sensibilidad de este germen a nueve antibióticos de uso frecuente. Se analizó mediante chi cuadrado la existencia de diferencias estadísticamente significativas de sensibilidad en los años estudiados. RESULTADOS: El 63,4 por ciento de todos los urocultivos positivos de atención primaria en 2002 y el 50,8 por ciento en 1998 resultaron positivos para Escherichia coli. La sensibilidad in vitro en 2002 y 1998, respectivamente, ha sido la siguiente: fosfomicina (99,2 por ciento-99,3 por ciento; p=NS*), cefixima (98,3 por ciento-92,9 por ciento; p<0,001), cefuroxima (96,5 por ciento-94,1 por ciento; p<0,05), nitrofurantoína (94,5 por ciento-86,9 por ciento; p<0,001), amoxicilina-clavulánico (93,1 por ciento-90,1 por ciento; p<0,05), ciprofloxacino (77,1 por ciento-81,6 por ciento; p<0,05), norfloxacino (75,8 por ciento-80,3 por ciento; p<0,05), cotrimoxazol (71,5 por ciento-73,4 por ciento; p=NS*) y ampicilina (44 por ciento-41,4 por ciento; p=NS*). (*NS= No significativo). CONCLUSIONES: El conocimiento de los patrones de sensibilidad de los gérmenes más frecuentemente aislados en muestras de orina en cada zona permite aplicar el tratamiento empírico más adecuado en caso de infección (AU)

[Microbial sensitivity of Escherichia coli in community-acquired urinary tract infections]. / Sensibilidad microbiana de Escherichia coli en infecciones urinarias extrahospitalarias.

OBJECTIVE: For effective empiric therapy of urinary tract infections in the extra-hospital setting the susceptibility pattern of uropathogens should be considered. Moreover, the evolution in sensitivity can be observed when comparing with susceptibility patterns in the previous years. This paper presents an analysis of our experience with Escherichia coli. MATERIAL AND METHODS: During 2002 and 1998, 895 and 595 strains of Escherichia coli respectively, isolated from extrahospitalary bacteriurias were collected in ten health centers in Bierzo (León, Spain). Sensitivity to nine most commonly antibiotics used in the clinical practise was determined. The existence of significant differences of susceptibility among years (2002-1998) was analyzed by the chi square test. RESULTS: Escherichia coli accounted for 63.4% of all isolates in 2002 and 50.8% in 1998. The prevalence of in-vitro susceptibilities to antibiotics were (2002-1998): fosfomycin (99.2%-99.3%; p = NS*), cefixime (98.3%-92.9%; p < 0.001), cefuroxime (96.5%-94.1%; p < 0.05), nitrofurantoin (94.5%-86.9%; p < 0.001), amoxycillin-clavulanic acid (93.1%-90.1%; p < 0.05), ciprofloxacin (77.1%-81.6%; p < 0.05), norfloxacin (75.8%-80.3%; p < 0.05), cotrimoxazole (71.5%-73.4%; p = NS*) and ampicillin (44%-41.4%; p = NS*). (*NS = No significant differences). CONCLUSION: The knowledge of the sensitivity of uropathogens to antimicrobians in a specific medium can allow us to use antibiotics rationally and initiate empirical therapy.

[Priapism secondary to testosterone administration in the treatment of delayed puberty]. / Priapismo secundario a la administración de testosterona en el tratamiento del retraso puberal.

OBJECTIVE: To describe a case of priapism following testosterone administration. METHODS/RESULTS: A 14-year-old boy treated with testosterone for delayed puberty presented with priapism after the administration of a single depot dose of 100 mg testosterone. Punction-aspiration of the corpora cavernosa was required to resolve the priapism. CONCLUSION: Administration of testosterone for delayed male puberty is safe but may occasionally cause priapism.

[Vaginal wall sling in the treatment of female stress urinary incontinence. Analysis of 27 cases]. / Cabestrillo con pared vaginal en el tratamiento de la incontinencia urinaria de esfuerzo femenina. Análisis de 27 casos.

OBJECTIVE: To evaluate the results of the vaginal wall sling procedure in the treatment of stress incontinence. METHODS: A retrospective study was conducted to evaluate the clinical outcome of the vaginal wall sling procedure in the treatment of genuine stress incontinence. The study comprised 27 women with a mean follow-up of 15 months postoperatively. RESULTS: Of the 27 patients who underwent this surgical procedure, 12 (44%) are continent and 9 (33%) have improved, accounting for 77% overall cure and improvement rate. Six patients (22%) remained incontinent. Mean operating time was 90 minutes and mean length of hospital stay was 8 days. CONCLUSION: In our experience, the vaginal wall sling procedure for genuine stress incontinence did not achieve the good results obtained in other series.

[Penile primary melanoma; report of a case]. / Melanoma primario de pene; a propósito de un caso.

OBJECTIVE: An uncommon variant of penile tumor associated with chronic lymphoid leukemia is presented. METHODS/RESULTS: A case of primary melanoma of the penis associated with chronic lymphoid leukemia is presented. Diagnosis was based on the anatomopathological findings. Lymph node involvement could not be determined due to the associated leukemia. Conservative management was instituted due to the patient's age. CONCLUSIONS: Primary melanoma of the penis is a very aggressive and uncommon tumor. To our knowledge, less than 140 cases have been reported. Hyperpigmented lesions must be biopsied to rule out melanoma.

[Extra-adrenal pheochromocytoma. Report of a case]. / Feocromocitoma extraadrenal. Descripción de un caso.

OBJECTIVE: To report a case of extraadrenal pheochromocytoma with special reference to the diagnostic and therapeutic aspects. METHODS: A case of extraadrenal pheochromocytoma in a 20-year-old female with severe hypertension is presented. The clinical and biochemical aspects are reviewed with special reference to the diagnostic imaging methods. RESULTS: Plasma noradrenaline and urinary normetanephrine levels were elevated. CT and MRI showed a well-defined mass, 6 cm in diameter, adjacent to the left kidney, abdominal aorta and psoas muscle. Angiography demonstrated a high vascularization in the area of the tumor. MIBG scintigraphy revealed a well-defined mass, but no other distant lesions. Surgical treatment was performed with preoperative alpha and beta adrenergic blockade. Currently the patient has a normal blood pressure and catecholamine levels, with no evidence of lesions on the MIBG scintiscan. CONCLUSIONS: Plasma catecholamine and urinary normetanephrine levels levels confirmed the presumptive diagnosis of pheochromocytoma. MIBG is the technique of choice for the localization of the mass and suspected metastases. CT, MRI and angiography demonstrated the anatomic relationships of the tumor. The best results are achieved with complete resection and preoperative adrenergic blockade.

[Spermatic cord torsion in the Comarca del Bierzo. Clinico-epidemiological analysis of the 5-year period 1994-1998]. / Torsiones de cordón testicular en la Comarca del Bierzo. Análisis clínicoepidemiológico del quinquenio 1994-1998.

OBJECTIVE: To review the cases of torsion of the spermatic cord diagnosed at the emergency and urology services of our hospital over the last 5 years and analyze the clinical and epidemiological features. METHODS: The cases of torsion of the spermatic cord diagnosed at our hospital from 1994-1998 were reviewed. Age, reason for consultation, time from onset of symptoms to consultation, location of the torsion, final diagnosis, treatment, and other data were analyzed. RESULTS: There were 20 cases of torsion of the spermatic cord in patients aged 1 to 25 years, with the highest incidence at age 14 years. The left testis was more frequently compromised. Six patients had a history of testicular pain and/or inflammation. The mean time from presentation of symptoms to consultation was 13.5 hours (range 1 hour to 7 days). The diagnosis was torsion of the spermatic cord in 14 cases and hydatid torsion in 6. Treatment was fundamentally by surgery (orchidopexy), except in three cases that spontaneously resolved or were detorsioned by manipulation. Two patients underwent excision of the compromised testis. CONCLUSIONS: Torsion of the spermatic cord is a urological emergency due to the high risk of complications that may even require orchidectomy. The epidemiological findings for our area are similar to those reported in other series.

[Multilocational cystic nephroma. Review of a case with reference to echographically observed changes]. / Nefroma quístico multilocular. Aportación de un caso con referencia a los cambios ecográficos observados.

OBJECTIVE: To describe an additional case of multilocular cystic nephroma, with special reference to the sonographic features of a renal cystic lesion. METHODS: The clinical and radiological features of a kidney tumor in a 61-year-old female patient were retrospectively analyzed. RESULTS: The preoperative diagnosis was that of a complex multicystic renal mass suggestive of a renal carcinoma. Radical nephrectomy was performed; histopathological analysis of the surgical specimen disclosed a multilocular cystic nephroma. An ultrasound scan 18 months earlier had demonstrated a simple renal cyst in the same site. CONCLUSIONS: Multilocular cystic nephroma is a tumor that is difficult to diagnose preoperatively. Making an accurate differential diagnosis is of interest, since it will permit conservative treatment. The case described herein supports the hypothesis with regard to the pathogenesis of this lesion, since it had previously showed sonographic features of a simple renal cyst.

[Hemangioma of the spermatic cord. Presentation of a case with review of the literature]. / Hemangioma de cordón espemático. Aportación de un caso y revisión de la literatura.

OBJECTIVE: To describe a rare variety of spermatic cord tumor, with special reference to the differential diagnosis. The literature is briefly reviewed. METHODS: The clinical and pathological features of a tumor located in the right inguino-scrotal region of a 27-year-old male patient are described. RESULTS: The preoperative evaluation disclosed an irregular mass in the right hemiscrotum that was unconnected to the testis. The patient underwent orchidectomy and resection of the tumor. Pathological analysis of the surgical specimen revealed a hemangioma of the spermatic cord. CONCLUSIONS: Hemangioma of the spermatic cord is a very uncommon tumor, it is a slow growing, indolent, benign scrotal lesion that must be distinguished from other paratesticular masses or tumors with similar clinical features. Ultrasound and other diagnostic imaging techniques are not useful in making the preoperative differential diagnosis.

[Mumps orchitis; review of 8 cases]. / Orquitis urliana; revisión de 8 casos.

OBJECTIVE: To determine the incidence of mumps orchitis in young males in the area of El Bierzo (Ponferrada, Spain) and the complications arising from this condition. METHODS: The cases of mumps orchitis referred by the primary care services to the emergency services of Hospital del Bierzo referral center were reviewed. We analyzed patient age, unilateral or bilateral testicular involvement, whether the patients had been vaccinated against mumps and the changes observed in the semen analysis. RESULTS: The diagnosis of mumps orchitis was confirmed in 8 patients, aged 15 to 19 years. Two patients had bilateral testicular involvement. Seven patients had not been vaccinated against parotiditis. Three patients had oligoasthenospermia and are currently being followed at the Urology services. CONCLUSIONS: The utility of large scale vaccination against mumps is emphasized. Long-term follow-up is recommended for all patients with abnormal semen analysis, particularly those with bilateral testicular involvement, since they may develop oligoasthernospermia several years after the infection or improve with item. A high incidence of mumps orchitis was found for this 12-month study period.

[Transitional cell bladder carcinoma in patients younger than 40 years of age]. / Carcinoma vesical de células transicionales en pacientes menores de 40 años.

OBJECTIVE: The clinical and pathological characteristics of bladder cancer in young patients were analyzed to determine if patients with bladder cancer under the age of 30 have a better prognosis than older adults and if transitional cell carcinoma of the bladder in patients aged 30 to 40 years has a similar behaviour to that observed in the higher risk population. METHODS: A retrospective review of transitional cell carcinoma of the bladder in patients less than 40 years old that had been treated between January, 1993 to August, 1997 was undertaken. RESULTS: We found 8 patients (5 men and 3 women) with urothelial tumor, accounting for an incidence of 4%. Four cases were diagnosed and staged TaG1, 2 T1G1 and 2 T1G2. Recurrence was observed in one case (12.5%) and progression in none. CONCLUSIONS: Transitional cell carcinoma of the bladder in patients under the age of 40 is usually associated with low grade and low stage tumors. The foregoing finding is certainly observed in those aged less than 30 years old. Bladder cancer is relatively rare in this age group, although we have found a higher incidence than that reported elsewhere. Treatment and follow-up depend on tumor grade and stage, regardless of age.

[Granulomatous prostatitis. Analysis of 15 cases and review of the literature]. / Prostatitis granulomatosa. Análisis de 15 casos y revisión de la literatura.

OBJECTIVES: The present study describes our experience with granulomatous prostatitis, an uncommon disease entity, with special reference to the etiological factors and the clinical and pathological features. METHODS: 15 cases of granulomatous prostatitis seen at our department over a 2-year period were retrospectively analyzed. RESULTS: The most frequent etiological factor was surgery (TUR) or prostatic needle biopsy (53%). Prostate cancer was suspected in 8 patients based on the findings of DRE. CONCLUSIONS: The diagnosis of granulomatous prostatitis is based on the histological findings. Despite its low incidence, it is currently diagnosed more frequently due to the increase in TURP and prostatic biopsy procedures and the widespread use of intravesical BCG therapy for some superficial bladder tumors.

[Secondary bladder melanoma. Report of a case concomitant with urothelial tumor of the bladder]. / Melanoma vesical secundario. A propósito de un caso coincidente con tumor urotelial de vejiga.

OBJECTIVES: To report on a case of melanoma, a rare tumor type metastatic to the bladder. METHOD/RESULTS: A case of melanoma metastatic to the bladder was incidentally discovered in a patient with urothelial cancer. The clinical features, diagnostic and therapeutic aspects are described. CONCLUSIONS: In a patient with malignant melanoma presenting irritative micturion syndrome and/or hematuria, endoscopic bladder exploration with multiple random biopsy must be performed to rule out melanoma metastatic to the bladder metastasis.

[Bladder sarcomatoid carcinoma. Bladder carcinoma simulating lymphoma]. / Carcinoma sarcomatoide vesical. Carcinoma vesical simulando un linfoma.

OBJECTIVE: To describe an unusual type of vesical carcinoma (sarcomatoid carcinoma) associated with the spread of inflammation. The article discusses the diagnostic difficulties and prognosis. METHOD/RESULTS: We describe a patient with vesical sarcomatoid carcinoma associated with the spread of inflammation that practically obscured the undifferentiated area, mimicking a lymphoma. This is interpreted as a favourable immunological reaction, despite the highly aggressive behaviour of the sarcomatoid component. CONCLUSIONS: Only on rare occasions do vesical carcinomas present such a prominent degree of spindle-shaped cells. This finding could create some diagnostic confusion, hence an immunohistochemical study is essential. The identification of sarcomatoid carcinoma has important implications both for treatment and for prognosis. The literature refers to the marked aggressiveness of this type of tumour. The peculiarity of the case resides in the associated spread of inflammation which improved the prognosis.