Community acquired urinary tract infection: etiology and bacterial susceptibility

Purpose: Urinary tract infections (UTI) are one of the,most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. Objetive: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. Methods: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. Results: The mean age of the patients in this study was 45.34 t 23.56 (SD) years. There were 242 (60.2 percent) females and 160 (39.8 percent) males. The most conunonly isolated organism was Escherichia coli (58 percent). Klebsiella sp. (8.4 percent).and Enterococcus sp.(7.9 percent) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37 percent were sensitive to ampicillin, 51 percent to cefalothin and 52 percent to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96 percent), ceftriaxone (90 percent), amikacin (90 percent), gentamicin (88 percent), levofloxacin (86 percent), ciprofloxacin (73 percent), nitrofurantoin (77 percent) and norfloxacin (75 percent). Conclusions: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

Laparoscopic nephrectomy: analysis of 34 patients

Objective: To analyze the clinical experience of laparoscopic nephrectomy for benign and malignant diseases at a university hospital. Methods: From February 2000 to March 2003, 34 patiems (14 men and 20 women) underwent transperitoneal laparoscopic total nephrectomy at the Hospital das Clinicas - FMRP-USP: 28 (82.3 percent) patients had benign diseases and 6 (17.7 percent) malignant neoplasias. Benign diseases were represented by: urinary stones (N-9, 32.1 percent), chronic pyelonephritis (N-8, 28.6 percent), vesicoureteral reflux (N-4, 14.3 percent), ureteropelvic obstruction (N-3, 10.7 percent), multicystic kidney (N-2, 7.1 percent) and pyonephrosis (N-2, 7.1 percent). Patients age range was 2-79 years (mean - 35,1 years). Results: In 32/34 patients the procedures were accomplished successfully. In 2 (5.8 percent) cases of pyonephrosis, open conversion was necessary due to perinephric abscess and difficulties in dissection of renal hilum. Two patients had intraoperative complications (1 duodenum serous laceration an 1 vascular lesion of renal hilum), but both were managed laparoscopically. Two (5.8 percent) post operative complications (1 delayed bleeding and 1 pancreatic fistula) required open surgical exploration. The mean time of hospital stay was 58h (18 to 240h). Conclusion: Laparoscopic nephrectomy proved to be a method safe and associated with a low rate of morbidity, shorter hospital stay and no casualties.

Incontinência urinária no idoso / Urinary incontinence in the elderly

A prevalência da incontinência urinária no idoso varia de 8 a 34 por cento segundo o critério ou método de avaliação. A principais causas são: alterações teciduais da senilidade que comprometem o trato urinário inferior e o assoalho pélvico, do sistema nervoso central e periférico, alterações hormonais como a menopausa, poliúria noturna, alterações psicológicas, hiperplasia prostática benigna, doenças concomitantes e efeitos colaterais de medicamentos. A incontinência pode ser transitória ou permanente. Além da anamnese cuidadosa para caracterização das perdas urinárias, a busca de causas associadas ou concomitantes e o diário miccional, recorre-se com freqüência a exames especializados como a urodinâmica. O diagnóstico preciso é importante para o manejo adequado que pode requerer apenas medidas conservadoras baseadas em orientações e mudanças de hábitos, como o uso de medicamentos, ou então métodos invasivos que incluem procedimentos cirúrgicos específicos.

Free PSA and prostate volume on the diagnosis of prostate carcinoma

Objective: To analyse the influente of prostate volume on the performance of total prostate specific antigen (tPSA) and free PSA (fPSA) on the diagnosis of prostate adenocarcinoma. Methods: A total of 188 patients underwent transrectal ultrasound guided biopsies (10-12 cores) due to prostate nodes detected by digital rectal examination and/or tPSA range of 2.5-l0ng/ml. Mean age was 65.7±8.7 years. 19/100 (19 percent)(GI) patients with prostate volume >40m1 had prostate cancer while the corresponding figure for patients with prostate <40m1 was 26/88 (29.5 percent)(GII). We analyzed the sensitivity and specificity of tPSA at cut-off points of 2.5 and 4ng/ml as well as the influente of the ratio f/tPSA in both groups of patients. Results: In the group GI tPSA sensitivity and specificity were 94.4 percent and 19.5 percent at the cut-off level of 4ng/ml and 100 percent and 6 percent at 2.5ng/ml. The corresponding values for GIl were 76.5 percent and 62.9 percent, and 100 percent and 19.3 percent. In group GI a cut-off of 19 percent for the ratio f/tPSA kept tPSA sensitivity over 90 percent while the specificity increased to 46.2 percentn at cut-off level of 4ng/ml and to 32.9 percent at 2.5ng/ml. In the group GII the ratio f/tPSA was not able to increase the specificity of tPSA at a cut-off level of 4ng/ml without an expressive reduction of sensitivity. On the other side, for this group a cutoff of 16 percent for the f/tPSA ratio rose the specificity to 46.7 percent for a sensitivity over 90 percent. Conclusion: We recommend stratification of patients according to prostate volume to define tPSA cut-off point. The cut-off level of 2.5ng/ml for tPSA combined with f/tPSA ratio of 19 percent in prostates >40ml and 16 percent in prostates <40m1 was a better option for prostate biopsy indication than tPSA at a cutoff of 4ng/ml associated or not with f/tPSA ratio.

Tumores testiculares na infância / Testicular tumors in childhood

Trata-se de um artigo de revisão de tumores testiculares na infância que representam 1 a 2 por cento dos tumores sólidos pediátricos. Os tumores germinativos representam 60 a 75 por cento dos tumores testiculares pediátricos. Destes o mais comum é o tumor de saco vitelino cujo tratamento consiste na orquiectomia radical. Segue-se em freqüência o teratoma que na infância tem comportamento benigno e pode ser manejado com observação ou orquiectomia parcial. Os tumores de células de Leydig, e os de células de Sertoli, são os mais comuns do estroma gonadal e ambos podem ser tratados com orquiectomia simples.