阿莫西林/克拉维酸钾治疗尿路感染的临床研究

目的：研究阿莫西林／克拉维酸钾治疗尿路感染的临床疗效。方法：治疗组41例 尿路感染患给予阿莫西林／克拉维酸钾0．25g，每日3次口服，疗程7d；对照组29例尿路感染患给予阿莫西林0．5g，每日3次口服或乳酸左氧氟沙星0．1g，每日2次口服，疗程7d。观察两组患症状、体征及实验室检查。结果：治疗组治疗后总有效率为95．12％，对照组治疗后总有效率为75．86％。结论：用阿莫西林／克拉维酸钾治疗尿路感染安全有效，节省卫生资源。     

Renal Allograft Injury Is Associated with Urinary Tract Infection Caused by Escherichia coli Bearing Adherence Factors

Urinary tract infections are the most common infection in renal transplant patients and Escherichia coli (E. coli) is the most common clinical isolate. Although acute allograft injury (AAI) secondary to urinary tract infection (UTI) has been reported, the incidence of AAI associated with UTI, the virulence factors express by uropathic E. coli and whether virulence factors are associated with renal allograft outcome have not been described. We collected E. coli from our renal transplant patients with UTI, determined O:H serotypes, P and Dr fimbriae expression and the clinical presentation and allograft function during the UTI and post-UTI period. Pyelonephritis occurred in 40% of our patients, 82% of which had AAI (>20% increase in SCr). Sixty-two percent of E. coli isolates that expressed P fimbriae were associated with AAI, whereas only 29% that did not express P fimbriae had AAI (p = 0.03). The pattern of P fimbriae and O serotypes differed from reported isolates, as the P fimbriae PapG class II and the O25 serotype were the most common. Dr adhesin was expressed on 7 isolates, including 2 of 3 with urosepsis. We propose a unique pattern of uropathogenic serotypes and adherence factors contribute to acute allograft injury in renal transplant patients with UTI.     

mPCNL治疗上尿路结石的临床研究（附1061例报告）

目的：探讨微创经皮肾内镜取石术（mPCNL）治疗上尿路结石的疗效及安全性。方法：回顾性分析总结2003年4月～2007年12月应用mPCNL技术治疗上尿路结石1061例的临床资料。肾结石920例,输尿管上段结石141例。651例进行了Ⅰ期取石,374例行Ⅱ期取石,36例行Ⅲ期取石。手术通过单通道取石863例、双通道取石181例、三通道取石17例。结果：平均结石清除率90．1％,平均手术时间86min,肾造瘘管平均留置6．5天,平均住院13天。术中8例输血,6例术后因发迟发性大出血需要输血,其中3例经高选择性肾动脉栓塞治愈。5例术后出现尿外渗,经调整肾造瘘管位置及充分引流肾周后治愈。在开展的早期,1例患者因出血、冲洗液外漏并大量重吸收而致死亡。结论：mPCNL治疗上尿路结石安全、高效,具有并发症少、创伤小、结石清除率高、恢复快、住院时间短等优点,是治疗上尿路结石的一种好方法。     

Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

Purpose of Review

Intravesical antibiotics (IVA) has been used for prophylaxis and treatment of recurrent urinary tract infections (rUTIs). However, there is a lack of comprehensive evidence and consensus on its use. We conducted a systematic review to collect all available data about the effectiveness of IVA in prevention and treatment of rUTIs and to give an overview on the outcomes to date.

Methods

A systematic review was carried out for all English language articles from inception to August 2017, according to the Cochrane and PRISMA standards using MEDLINE, Scopus, Biomed Central, EMBASE, CINAHL, and Web of Science with references cross-checked and individual urology journals hand-searched.

Results

After an initial identification of 658 studies, we screened 37 abstracts and 18 full-text papers of which 11 were included in our final review. This included 285 patients with a mean age of 52 years and a female:male ratio of 129:117. The IVA used was gentamicin, neomycin/polymyxin, neomycin or colistin and IVA was used for rUTIs as prophylaxis in 5 studies (n?=?168) and treatment in 6 studies (n?=?117). Overall, a good reduction in symptomatic UTI was seen in 78%, with a short-term success rate and discontinuation rates of 71% (120/168) and 8% (14/168) in the prophylaxis group and 88% (103/117) and 5% (6/117) in the treatment groups respectively. There was a change in the sensitivity of organisms in 30% (50/168) and 23% (27/117) in the treatment and prophylaxis groups respectively. Twenty patients discontinued their IVA instillations which were higher for the non-gentamicin group (11%) compared to the gentamicin group (5%). The side effects were minor and included allergy, suprapubic discomfort, autonomic dysreflexia, urinary tract infections and diarrhoea.

Summary

Intravesical antimicrobial instillation seems to be a relatively safe and effective method for the prophylaxis and treatment of recurrent UTIs, especially in the short term. It gives clinicians an alternative treatment modality in high-risk patients predisposed to UTIs where all other forms of systemic treatments have failed.

     

Counterfactual (‘if only’) thinking in women with chronic widespread pain

The study explored the counterfactual thinking that women with chronic and widespread pain showed in response to what they themselves considered to be particularly stressful situations. Counterfactual thinking in 125 women sick‐listed due to chronic and widespread pain was investigated in terms of structure, function and control focus. The women were asked, for each of three types of problems that they indicated in a questionnaire to affect them most strongly, to describe a typical occurrence of it and to complete a counterfactual sentence in connection with it of the type ‘If only . . .’. The majority of counterfactuals pertained to predominantly somatic problems (e.g. musculo‐skeletal problems, pain and fatigue) classified as being affective rather than preparative and self‐focused rather than external, whereas in counterfactuals relating to predominantly psychological/psychosocial problems a preparative function and an external focus were more prominent. The numbers of problems listed and the numbers of situations responded to counterfactually were positively correlated. The counterfactuals, although often related to somatic problems, generally concerned psychological or psychosocial matters such as finances and paid or unpaid work. A contextual approach to elucidating counterfactual thinking based on subjects' own experiences is seen as providing valuable insight into what bothers them most. Copyright © 2006 John Wiley & Sons, Ltd.     

Significance of Urinary Tract Involvement in Patients Treated with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Background

Urinary tract involvement in patients with peritoneal surface disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often requires complex urologic resections and reconstruction to achieve optimal cytoreduction. The impact of these combined procedures on surgical outcomes is not well defined.

Methods

A prospective database of CRS/HIPEC procedures was analyzed retrospectively. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, morbidity, mortality, and overall survival were reviewed.

Results

A total of 864 patients underwent 933 CRS/HIPEC procedures, while 64 % (550) had preoperative ureteral stent placement. A total of 7.3 % had an additional urologic procedure without an increase in 30-day (p = 0.4) or 90-day (p = 1.0) mortality. Urologic procedures correlated with increased length of operating time (p < 0.001), blood loss (p < 0.001), and length of hospitalization (p = 0.003), yet were not associated with increased overall 30-day major morbidity (grade III/IV, p = 0.14). In multivariate analysis, independent predictors of additional urologic procedures were prior surgical score (p < 0.001), number of resected organs (p = 0.001), and low anterior resection (p = 0.03). Long-term survival was not statistically different between patients with and without urologic resection for low-grade appendiceal primary lesions (p = 0.23), high-grade appendiceal primary lesions (p = 0.40), or colorectal primary lesions (p = 0.14).

Conclusions

Urinary tract involvement in patients with peritoneal surface disease does not increase overall surgical morbidity. Patients with urologic procedures demonstrate survival patterns with meaningful prolongation of life. Urologic involvement should not be considered a contraindication for CRS/HIPEC in patients with resectable peritoneal surface disease.     

肛管直肠周围脓肿的细菌培养及药敏分析(附35例报告)

目的研究肛周脓肿的菌群分布以及对抗生素的耐药情况。方法对35例肛周脓肿脓液进行革兰氏染色、细菌培养及药物敏感试验。结果革兰氏阴性杆菌33例,占94.29%(33/35),革兰氏阳性球菌2例,占5.71%(2/35)。大肠埃希菌26例,占74.29%(26/35),其他细菌(阴沟杆菌、产酸克雷伯菌、普通变形杆菌、产气肠杆菌、肺炎克雷伯菌、奇异变形杆菌、弗劳地枸橼酸杆菌、金黄色葡萄球菌、B型溶血性链球菌各1例)占25.71%(9/35)。产ESBLs株10例,占30.30%(10/33),均为大肠埃希菌。药物敏感试验结果显示细菌平均耐药率为29.14%～60.61%。结论肛周脓肿以大肠埃希菌感染为主,对抗生素耐药率较高,单独使用抗生素治疗肛周脓肿没有价值,应及时手术治疗。     

International clones of extended‐spectrum β‐lactamase (CTX‐M)‐producing Escherichia coli in peri‐urban wild animals,Brazil

CTX‐M‐type extended‐spectrum β‐lactamase (ESBL)‐producing Escherichia coli clones have been increasingly reported worldwide. In this regard, although discussions of transmission routes of these bacteria are in evidence, molecular data are lacking to elucidate the epidemiological impacts of ESBL producers in wild animals. In this study, we have screened 90 wild animals living in a surrounding area of São Paulo, the largest metropolitan city in South America, to monitor the presence of multidrug‐resistant (MDR) Gram‐negative bacteria. Using a genomic approach, we have analysed eight ceftriaxone‐resistant E. coli. Resistome analyses revealed that all E. coli strains carried bla_CTX‐M‐type genes, prevalent in human infections, besides other clinically relevant resistance genes to aminoglycosides, β‐lactams, phenicols, tetracyclines, sulphonamides, trimethoprim, fosfomycin and quinolones. Additionally, E. coli strains belonged to international sequence types (STs) ST38, ST58, ST212, ST744, ST1158 and ST1251, and carried several virulence‐associated genes. Our findings suggest spread and adaptation of international clones of CTX‐M‐producing E. coli beyond urban settings, including wildlife from shared environments.     

The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from ‘what’ to ‘how’ of psychosocial screening – a pilot study

Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence‐based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening 1 were used to structure our tool: motivation and decision‐making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot‐tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi‐structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.     

Urinary incontinence with effort: surgical management in the maternity ward of a Tunisian military hospital (91 case reports)

We bring back a retrospective study on the surgical treatment of the incontinence in the effort about 91 cases. Our objective is to estimate the results of our surgical techniques. Three procedures were used: plicatures under urethrales; intervention of bologna; intervention of Burch. The incontinence in the effort was associated to a genital prolapse in every cases; prolapse was of third degree in 70% of cases. We obtained a good functional result in 94% of cases and a good anatomical result in 96% of cases on an average recession of 60 months. The complications per and postoperating are marked especially by the urinary infections. Our study shows that classical technics are still available.     

Acute Mediastinitis – Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience)

Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.