How to diagnose and treat fungal infections in chronic prostatitis

Epidemiologic changes that include immune-compromised patients and drug-resistant fungi have caused an increase in nosocomial infections by Candida albicans and non-albicans Candida species. Other fungi, aspergilla and Cryptococcus (environmental contaminants), are opportunistic invaders of the immune-compromised (transplant, HIV) patients. The environmental fungi Coccidioides immitis (dry arid areas), Histoplasma capsulatum (Avian-infested areas), and Blastomyces dermatitidis (aquatic areas) can cause infections in immunecompetent and immune-deficient patients. Each fungus can cause changes in the prostate that mimic bacterial infection, benign prostatic hypertrophy, or neoplasm. Diagnosis can be established by urine cultures or needle biopsy of the prostate. Prostate surgery for carcinoma or benign enlargement may detect latent fungal infection. Different fungal species can have divergent clinical manifestations and require different treatment. In some cases, asymptomatic localized fungal prostatitis can be cured by removal of the infected gland. Symptomatic and disseminated infection may require prostatectomy and systemic antifungal therapy.     

腹腔镜诊治异位妊娠的应用探讨

目的:探讨腹腔镜手术诊治异位妊娠的临床应用价值。方法:回顾性分析我院2005年6月～2008年6月诊治的52例异位妊娠患者的临床资料,并根据患者是否需要生育、妊娠部位及是否破裂、出血量等选择手术方式。结果:52例均在腹腔镜下成功完成手术,无中转开腹及并发症发生,手术时间30～125min,平均80.5min。术后10～30h肛门排气,住院时间4～8d,平均6.2d,无持续性异位妊娠发生。结论:异位妊娠发生率较高,其发生与多种因素相关,腹腔镜手术诊治异位妊娠安全有效,具有术后肠道功能恢复快,住院时间短,疼痛轻,并发症少等优点,是较为理想的手术方式。     

关节镜诊治膝关节滑膜软骨瘤病及其疗效分析

目的探讨关节镜微创手术对膝关节滑膜软骨瘤病的诊断和治疗价值。方法本组21例,23膝,男13例14膝,女8例9膝,其中左膝11侧,右膝12侧;年龄28～74岁,平均48.6岁;病史1月～66月,平均18月;初次就诊20例22膝,外院开放手术后复发1例。所有病例术前均行常规X线检查,部分病员行CT或MRI检查。手术行关节镜检,瘤体和病变滑膜切除,记录该病在关节镜下的表现形式（滑膜表面型、滑膜层包裹型、关节囊纤维层包裹型、游离体型）及关节内合并症,样本全部送病理检查。术后加压包扎、局部冰敷并按计划功能锻炼。结果本组21例23膝,其中滑膜表面型6膝、滑膜层包裹型4膝、关节囊纤维层包裹型2膝、游离体型11膝,术后病理检查确诊;所有病例获得了12～42月,平均28个月随访,未见复发,患肢功能良好;术前Lysholm评分（62.4±4.2）分;国际膝关节评分委员会（IKDC）膝关节功能主观评分（47.2±3.6）分;术后12月复查Lysholm评分（80.3±4.6）分;IKDC主观评分（87.4±4.1）分。结论关节镜手术创伤小,显露充分,病灶切除彻底,术后功能恢复理想,对膝关节滑膜软骨瘤病具有较高的诊治价值。     

关节镜技术在青少年膝关节结核诊治中的初步应用

目的 总结关节镜技术在青少年膝关节结核诊断和治疗中的经验.方法 2002年6月至2006年12月,对36例诊断为结核,5例不具备结核诊断标准,按滑膜炎待查的患儿采用膝关节镜下清理及抗结核药物治疗,男13例,女28例;年龄7~16岁,平均12.5岁;均有不同程度的膝关节肿胀、轻度疼痛及功能障碍;病史3~14个月,平均4.8个月.随访时利用Lysholm进行问卷调查,同时对其临床资料进行回顾性分析.结果 41例患儿,术后病理共确诊37例,另4例报告为滑膜组织慢性炎症或坏死组织.随访6~58个月,平均43.5个月,所有患膝经关节镜和术后药物治疗均无复发.Lysholm评分75~98分,平均91.4分.6例患儿残留不同程度膝关节活动受限,活动范围70°~110°,其中2例全关节结核伸直滞缺分别为10°和25°.结论 青少年膝关节结核的诊治较为特殊,在病程早期采用膝关节镜下清理、药物治疗结合术后早期康复锻炼的方案具有创伤小、病灶清除彻底等优点,并可最大限度保留膝关节功能,避免外科介入过晚而导致的膝关节融合,是一种较为理想的治疗方法.     

宫腔镜下白泥鳅导丝输卵管复通术在不孕诊治中的价值

目的探讨宫腔镜下白泥鳅导丝输卵管复通术用于诊断和治疗输卵管不通的临床价值。方法自2006年7月至2010年7月于我院门诊行宫腔镜输卵管通液的患者160例随机分为2组,一组91例182根输卵管,术前通畅51根,部分阻塞66根,阻塞65根,予以加压复通;另一组69例共138根输卵管,术前通畅29根,部分阻塞23根,阻塞86根,经白泥鳅导丝复通。结果加压复通后通畅81根,部分阻塞52根,阻塞49根;白泥鳅导丝复通后通畅129根,部分阻塞6根,阻塞3根。两种方法相比较,差异具有统计学意义(P=0.01)。结论宫腔镜下用白泥鳅导丝复通输卵管简便、有效,值得进一步推广。     

Incidence and detection of nosocomial infections in technical orthopedics

The significance of nosocomial infections is increasing. The reasons for this are a higher concentration of problematic patients in hospitals due to the increasing number of outpatient surgeries, the increase of invasive therapeutic and diagnostic procedures, the growing share of immunodeficient patients as well as the increase in antibiotic-resistant and multiresistant pathogenic organisms. Basic changes in the medical system call for a systematic discussion about directed quality management. Surveillance, i.e., the systematic registration and evaluation of occurred diseases as well as the feedback to the personnel in charge is very important in this context, particularly when complemented by comprehensive hygienic measures. The growing significance of hospital infections increasingly triggered by multiresistant pathogenic organisms emphasizes the importance of general prevention. Each hospital has to determine which surveillance methods for the registration of nosocomial infections and multiresistant pathogenic organisms are the most appropriate under their respective conditions. To get a first idea of possible problem areas, prevalence studies are very suitable for the start before moving on to well-directed incidence studies in certain wards and for certain kinds of infection.     

The role of biofilm infection in urology

In the process of endourological development a great variety of foreign bodies have been invented besides urinary catheters on which biofilm can be formed. Bacteria in the biofilm are less sensible to antibiotics. An additional problem of medical biomaterials in the urinary tract environment is the development of encrustation and consecutive obstruction. In this review, we tried to sum up the conditions where biofilm formation has a great impact on the development or maintenance of urological infections and on treatment success. Modification of the biomaterial surface seems to be the most promising prevention strategy for bacterial biofilms. Easier methods for diagnosing and quantifying biofilm infection, to develop more specific antimicrobial agents and ideal device surfaces would surely help the fight against biofilm formation.     

Newly developed techniques to study and diagnose acute renal failure

Progress in treating human acute renal failure (ARF) is dependent on developing techniques that allow for the rapid diagnosis, quantification of injury, further understanding of the pathophysiology, and the effects of therapy. Therefore, four techniques that will facilitate this progress are described and illustrated by four different investigative teams. Techniques to measure rapid changes in GFR are available for rapid diagnosis and quantification of ARF in humans. State-of-the-art magnetic resonance imaging (MRI) presently allows for enhanced resolution of regional renal blood flow and functional evaluations in patients. Furthermore, new probes and techniques for MRI that allow for identification and quantitation of inflammation, applicable to human ARF, are being developed and tested in animal models. Finally, two-photon microscopy will allow for four-dimensional cellular and subcellular studies in animal models of ARF providing rapid insights into pathophysiology and the therapeutic effects of a variety of promising agents. Further development and utilization of these techniques, especially in concert with genetic, proteomic, and molecular approaches, will allow for needed insights into the pathophysiology and therapy in human ARF.     

应用腹腔镜诊治不孕症135例疗效分析

目的 :探讨应用腹腔镜手术诊断治疗不孕症的临床价值。方法 :回顾分析 1 35例不孕症腹腔镜手术诊断、治疗和术后的妊娠情况。结果 :1 35例腹腔镜手术均获成功 ,子宫内膜异位症 2 9例 ,术后妊娠率6 9 % ,输卵管伞端闭锁 2 8例 ,术后妊娠率 4 4 5 % ,多囊卵巢综合征 1 7例 ,术后妊娠率 5 3 9% ,盆腔粘连 38例 ,术后妊娠率 5 0 % ,其它 2 3例 ,术后妊娠率 30 4 %。结论 :腹腔镜对各种疾病引起的不孕症均有一定的疗效 ,有效者多在术后 1年内妊娠     

骨科创伤患者伤口感染的危险因素分析

目的调查分析骨科创伤患者伤口感染的发生率及危险因素。方法通过横断面调查研究采用便利抽样的方法选取2012年7月~10月入住我院骨科的348例骨科创伤患者,观察患者的伤口感染情况,分析创伤类型、首次处理时间等因素对伤口感染率的影响。结果开放性创伤192例,其中创面感染57例,创面感染率达29.7%;闭合性创伤156例,经过手术治疗形成手术切口后发生感染8例,伤口感染率为5.1%。开放性创伤患者伤口的平均首次处理时间是在受伤后(4.3±2.4)h。开放性创伤患者的伤口感染率高于闭合性创伤患者,差异具有统计学意义(χ2=34.177,P=0.000);多发伤患者的伤口感染率高于非多发伤者,差异具有统计学意义(χ2=7.693,P=0.006);休克患者的伤口感染率高于非休克者,差异具有统计学意义(χ2=16.020,P=0.000);开放性创伤患者中,比较感染组与非感染组的平均创面首次处理时间,差异具有统计学意义(F=12.84,P=0.000)。2012年11月至2014年11月围绕筛选得出的危险因素进行验证,进一步证实该危险因素与伤口感染的相关性。结论开放性创伤、多发伤、休克、创面首次处理时间均为骨科创伤患者伤口感染的危险因素。因此针对具备上述特点的患者应该给予高度的关注,同时缩短创面首次处理时间以提高伤口治疗的质量,降低患者伤口感染率,促进伤口愈合,提供患者的生活质量和满意度。     

Guest editorial - Surveillance of surgical-site infections in orthopedics

No Abstract available.