微生物检验泌尿系统的病原菌结果研究

目的探究微生物检验泌尿系统病原菌的结果。方法选取2019年6月至2020年3月本院泌尿科收治的120例泌尿系统感染患者为研究对象。使用实验室微生物检测其泌尿系统的病原菌,比较泌尿系统病原菌的类型与药敏试验结果。结果120株病原菌中革兰阴性菌65株(54.17%),革兰阳性菌30株(25.00%),假丝酵母菌25株(20.83%)。革兰阴性菌中大部分为大肠埃希菌(76.92%);革兰阳性菌中大部分为鸟肠球菌(40.00%);假丝酵母菌中大部分为白假丝酵母菌(52.00%);通过药敏试验发现,对亚胺培南与阿米卡星敏感度较高的是大肠埃希菌,对头孢他啶、阿莫西林与舒巴坦敏感度较高的是鸟肠球菌;对头孢呋辛、替考拉宁和青霉素G敏感度较高的是白假丝酵母菌。结论泌尿系统感染疾病的主要致病菌是革兰阴性菌和革兰阳性菌,因此,在对有泌尿系统感染症状患者的临床诊断与治疗过程中应对患者的病原菌实施实验室微生物检测,从而选择合适的抗菌药物。     

An Unexpected Etiology of Priapism: Infection‐Related Anti‐Protein S Antibodies

IntroductionIn adolescents, the occurrence of priapism is commonly related to sickle cell disease and rarely to other causes. We hereby report a case of priapism due to an acquired protein S (PS) deficiency.AimThe aim of this study was to describe a young man who developed a priapism with a thrombosis of the corpora cavernosa associated with an anti‐PS antibody (anti‐PS Ab).MethodsOne week after the onset of an influenza‐like illness, a young male developed multiple extensive venous thromboses including a thrombosis of the corpora cavernosa causing painful partial priapism. These thromboses along with purpuric lesions with necrotic vesicles of the feet skin were linked to an acquired PS deficiency due to an anti‐PS Ab. The optimal treatment of anti‐PS Ab‐associated thrombosis is debated but we chose to initiate (i) heparin; (ii) corticosteroids; and (iii) plasmapheresis.ResultsEven if priapism lasted more than 4 days, a full recovery of erectile function was observed within 3 months. As compared with priapism due to sickle cell disease, which is commonly associated with definitive erectile dysfunction, this favorable outcome is noteworthy. The skin healing was complete only 6 months later.ConclusionAcquired PS deficiency complicating an infectious disease is a rare, life‐threatening condition, associated with substantial morbidity related to amputations of limbs or digits. This is the first report of priapism due to acquired PS deficiency. Boissier E, Durant C, Vildy S, Glemain P, Lakhal K, Graveleau J, Masseau A, and Fouassier M. An unexpected etiology of priapism: Infection‐related anti‐protein S antibodies. J Sex Med 2014;11:2830–2833.     

Infiltration of Bupivacaine Local Anesthetic to Trocar Insertion Sites After Laparoscopy: A Randomized,Double-blind,Stratified, and Controlled Trial

Study ObjectiveTo determine if injection of local anesthetic into trocar insertion sites after laparoscopy improves postoperative pain.DesignA prospective, 2-arm, randomized, double-blind, stratified, and controlled trial (Canadian Task Force classification I).SettingA university-based teaching hospital.PatientsThis study was performed on women who had a laparoscopic gynecologic procedure for benign indications from March 2013 to June 2013. One hundred thirty-five subjects were stratified by chronic pelvic pain or no chronic pelvic pain. Chronic pelvic pain was defined as pelvic pain occurring for 6 months or more in duration. Randomization was performed for this trial, with 68 receiving a bupivacaine block and 67 receiving no bupivacaine block. Of the 71 patients with chronic pelvic pain, 35 patients were in group 1 (i.e., bupivacaine block) and 36 patients were in group 2 (i.e., no bupivacaine block).InterventionsAfter the laparoscopic surgery was completed, the trocar incision sites were closed. For subjects randomized to receive a local anesthesia block, bupivacaine (0.25%) was injected. Incisions 8 mm or greater were injected with 10 mL 0.25% bupivacaine. Incisions 5 mm or less were infiltrated with 5 mL. Injecting the local anesthetic through all preperitoneal layers provided a full-thickness local injection. Group 2 did not receive a local injection.Measurements and Main ResultsAt the preoperative suite, the nurses gauged the patient's pain using the Numeric Rating Scale. This score was used as the baseline pain level with which the postoperative pain scores were compared. The primary objective was to measure changes in pain scores, from preoperative to postoperative time frames of 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days postoperatively. These score changes were measured as the main objective. Secondary objectives include estimated blood loss, operating time, length of hospital stay, and histopathologic diagnosis. The hospital personnel caring for the patient during the preoperative and postoperative course were given standard pain evaluation protocols. All study pain evaluators and patients were blinded to treatment assignments throughout the pain assessment process. There were no statistically significant differences in patient characteristics between the 2 treatment groups. No significant difference was found in secondary outcomes including estimated blood loss, length of hospital stay, and histopathologic diagnosis. In general, Numeric Rating Scale pain scores were lower (i.e., less pain) in the “bupivacaine block” group compared with the “no bupivacaine” block group at the following postsurgery time assessments: 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days after surgery. However, the effect was not large enough (<1 point) to show a statistical difference between the treatment groups at any of these postsurgery assessments.ConclusionThe postoperative injection of bupivacaine in trocar port sites did not significantly improve pain scores after laparoscopic gynecologic surgery.     

Septate uterus: nosographic overview and endoscopic treatment

To comment on the prevalence, diagnosis, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome, we searched publications in PubMed and Embase. Original articles, meta-analysis, reviews, and opinion articles were selected. The studies suggest that the prevalence of the septate uterus is increased in women with repeated pregnancy loss and infertility. Reliable diagnosis depends on accurate assessment of the uterine fundal contour and uterine cavity by means of magnetic resonance and three-dimensional ultrasound. Pertinent published data comparing pregnancy outcome before and after hysteroscopic metroplasty indicated a marked improvement after surgery. Magnetic resonance and three-dimensional ultrasound represent the gold standard for diagnosis of septate uterus. Hysteroscopic metroplasty with its simplicity, minimal postoperative sequelae, and improved reproductive outcome is the gold standard for treatment, not only in patients with recurrent pregnancy loss and premature labor but also in patients with infertility, especially if in vitro fertilization is being contemplated.