RESUMO
Urinary tract infection in the pediatric population can lead to significant morbidity if not treated promptly and appropriately. All first infections may signify possible underlying anatomic or functional abnormality and require imaging of the lower and upper tracts. Accurate diagnosis of UTIs requires a properly collected quantitative urine culture. Treatment should be tailored to the pathogen as dictated by the urine culture sensitivities to minimize the development of multidrug-resistant organisms. Prophylactic agents should differ from the antibiotic used in the acute setting and preferably concentrated in the urinary tract, with minimal effects on the normal fecal flora. In the long term, patients with documented evidence of renal scarring should be followed up for signs of renal deterioration and hypertension.
Assuntos
Infecções Urinárias , Criança , Humanos , Infecções Urinárias/classificação , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/terapia , Infecções Urinárias/urinaRESUMO
PURPOSE: This study was designed to compare the prevalence of prostatic bacterial growth between circumcised and uncircumcised males and determine whether the lack of circumcision results in a change in the incidence of bacterial seeding following prostate needle biopsy. MATERIALS AND METHODS: Forty-six men (21 circumcised and 25 uncircumcised) undergoing ultrasound and biopsy to rule out prostate cancer were evaluated with questionnaires regarding previous history of urinary tract infection (UTI), any symptoms suggestive of UTI, and obstructive voiding symptoms. None of the patients received preprocedure antibiotics. Preprocedure and postprocedure urine samples, prostate biopsy core, and postprocedure blood samples were obtained for culture. After the cultures were obtained, patients received oral antibiotics. RESULTS: Patient characteristics between circumcised and uncircumcised patients were similar in terms of age, prostate-specific antigen level, voiding symptoms, history of UTI, prostate biopsy technique, and incidence of prostate cancer. The prevalence of preprocedure bacteriuria was slightly higher in the uncircumcised men (14 [56%] of 25 patients) vs. the circumcised men (8/21 [38%] patients), although this was not statistically significant (r = .2, p = .1). The prevalence of postprocedure bacteriuria was significantly higher (p = .04) in the uncircumcised men (12/25 [48%] patients) vs. the circumcised men (4/21 [19%] patients). No correlation was found between circumcision status and incidence of bacterial colonization in the prostate tissue. A statistically significant difference (p = .003) was found between the lack of circumcision and postprocedure bacteremia. CONCLUSIONS: Circumcision status does not effect the prevalence of bacterial growth in the urine and the prostate tissue. Uncircumcised men have a higher incidence of bacteriuria and bacteremia following prostate needle biopsies.
Assuntos
Bacteriúria/epidemiologia , Biópsia por Agulha/efeitos adversos , Circuncisão Masculina , Próstata/patologia , Infecções Urinárias/epidemiologia , Idoso , Bacteriúria/etiologia , Biópsia por Agulha/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Ultrassonografia , Infecções Urinárias/etiologiaRESUMO
Clinical presentation of aortic dissection is similar to that of acute myocardial infarction (AMI). Clinical differential diagnoses from lethal chest pain in emergency department include AMI, aortic dissection, pulmonary embolism, tension pneumothorax, etc. Thrombolytic therapy for recanalization of thrombotic occluded coronary artery in AMI must be considered, but it is absolutely contraindicated for aortic dissection. However, AMI secondary to aortic dissection is a rare condition, which might be caused by compression of the coronary arteries by a hematoma or extension of the dissection into the coronary arterial wall. Surgery is the first choice for AMI secondary to aortic dissection caused by extension of dissection into the coronary arterial wall. We present a case of inferior wall AMI caused by type I aortic dissection with presentation of chest pain and hemiparaplegia of right lower limb.
Assuntos
Doenças da Aorta/complicações , Infarto do Miocárdio/etiologia , Ecocardiografia Transesofagiana , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Primary malignant fibrous histocytoma (MFH) of the heart is extremely rare. Herein, we report the case of a 17-year-old woman with a primary MFH in the right ventricular outflow tract, presenting with increasing dyspnea on exertion. Wide excision of the tumor, including part of the pulmonary artery and pulmonary valve, was performed under cardiopulmonary bypass. Her postoperative recovery was uneventful.
Assuntos
Neoplasias Cardíacas/complicações , Histiocitoma Fibroso Benigno/complicações , Adolescente , Feminino , Ventrículos do Coração , HumanosRESUMO
Spontaneous bacterial peritonitis (SBP) rarely presents as pneumoperitoneum. Only four such cases have been reported in the English literature. This report concerns a 65 year-old male patient with SBP and pneumoperitoneum. He has had a history of peptic ulcer. However, upon examination, no associated diseases or compromised immunity was detected. He presented with acute abdominal pain and subphrenic free air. An emergency laparotomy was performed, under the impression of a perforated peptic ulcer. Yet, no intraabdominal pathology except 200 ml of purulent ascites was found. The ascites culture yielded E. coli, B. fragilis, and P. aeruginosa confirming the diagnosis of SBP. Antibiotics which are sensitive to gas-forming bacteria should be prescribed before the result of the ascites culture is known.
Assuntos
Infecções Bacterianas/complicações , Peritonite/complicações , Pneumoperitônio/etiologia , Idoso , Humanos , MasculinoRESUMO
Primary aldosteronism caused by an aldosterone-producing adrenal adenoma was documented in an 11-year-old girl who presented with persistent hypertension, headache, tinnitus and hypokalemia. Elevated plasma aldosterone concentration (PAC) (45.5 ng/dl) and suppressed plasma renin activity (PRA) (< 0.3 ng/ml/hrs) were detected. Saline infusion test and postural test helped to confirm the diagnosis. The tumor site was localized by magnetic resonance imaging (MRI). Surgical removal of the tumor yielded dramatic improvement in blood pressure; PAC and PRA returned to normal range. This rare case illustrates the feasibility of recognition and localization of adrenal adenoma in children. The high cure rate by surgical excision warrants careful screening of hypertensive patients with this entity.