CTX-M-15 extended-spectrum beta-lactamases in Enterobacteriaceae in the intensive care unit of Tlemcen hospital, Algeria

The aim of this study was to detect extended-spectrum beta-lactamases [ESBL] in Enterobacteriaceae isolates in the intensive care unit [ICU] of Tlemcen hospital in north-western Algeria. Antimicrobial susceptibility testing, molecular typing, characterization of ESBL-encoding genes and the genetic environment, conjugation experiments and plasmid analysis were carried out. In all, 28 Enterobacteriaceae isolates were isolated from specimens recovered from patients in the ICU and 2 from surfaces of the unit. Of these, 11 isolates [4 Escherichia coti, 5 Klebsiellapneumoniae and 2 Enterobacter cloacae] produced ESBL of the CT-X-M-15 type. Molecular typing of the isolates showed the clonal nature of 4 K, pneumonlae isolates. The bla[CTMX-15] gene was genetically linked to insertion sequence ISEcp1B and was transferable by conjugation from 3 isolates. Regular monitoring of resistance mechanisms, the establishment of a prevention strategy, and more rational and appropriate use of antibiotics are needed

[Treatment of urethral strictures by endoscopic internal urethrotomy: anatomical and functional results in a series of 244 cases]

To evaluate the results of a homogeneous series of urethral strictures treated exclusively by endoscopic internal urethrotomy and to determine the factors that may predict the outcome. Between 1989 and 2007, 244 patients were treated for urethral stricture. All of them were subjected to endoscopic direct vision internal urethrotomy [DVIU]. 34.3% of good results were achieved after the first DVIU. Mean follow-up was 3.5 years. No mortality was encountered, while the rate of morbidity was.5%. Better results were achieved in patients with short [<2 cm] and single strictures in the proximal urethra. Mean post-operative catheterization was 2 days; a further extension of the catheterization time did not yield any significant improvement. Unsatisfactory results [65.5%] were found in patients with large urethral strictures located in the distal urethra or in elderly patients. 62.5% of the patients showed a satisfactory outcome after a second urethrotomy, while the other patients required urethral dilatation or urethroplasty. DVIU is a simple procedure which does not have a high rate of morbidity and requires short hospitalization. With a steady success rate of around 75.4% after a follow-up of 3.5 years we feel that DVIU can be recommended as treatment of choice for all short, single and proximal urethral strictures, preferably in young patients without previous interventions on the urethra

[Testicular infarction. Case report and review of the literature]

Testicular infarction is a rare pathology whose etiology has not yet been identified. The main presenting symptom is severe testicular pain in the absence of trauma or torsion, often simulating a tumor, but tumor markers are normal and urine is sterile. Ultrasonography shows a hypoechogenic area, which on Doppler is avascular. Magnetic resonance imaging [MRI] remains the diagnostic tool of choice. Treatment usually consists of orchidectomy. In case of segmental testicular infarction a resection of the segment in question can be done instead. The authors report on a case of segmental testicular infarction for which they propose a policy of watchful waiting

[Tumors of the male urethra. A study of 7 cases]

To study the epidemiological, diagnostic and therapeutic features of primary tumors of the male urethra. In this retrospective study we evaluate 7 cases with tumors of the male urethra seen at our department over a period of 16 years [1989 -2005]. The following parameters were studied: the age of the patients, their medial history, clinical signs and symptoms, imaging and treatment modalities used and follow up. The patients' mean age was 56.1 years. Medical history revealed episodes of urethritis in 4 cases and treatment of cervico-urethral strictures in 4 cases. All patients complained of chronic irritating and obstructive symptoms - most patients presented with more than one symptom. Acute urinary retention was found in 5, bleeding per urethram and pyuria in 5 cystourethrography and confirmed by urethrocystoscopy and biopsy. All our patients were found to have squamous cell carcinoma. The tumor was localized in 6 patients. Treatment consisted endoscopic transurethral resection in one patient. Two patients were subjected to surgery. One of them with a stage T3N0M0 tumor of the prostatic urethra underwent urethrectomy in combination with cystoprostatectomy followed by urinary diversion [Coffey], while the other patient with a tumor at the bulbomembranous urethra [stage T4N0M0 with scrotal invasion] was subjected to penectomy and orchidectomy combined with perineal urethrostomy. Both these patients received adjuvant radiotherapy. Excision of a penile phlegmon was carried out in 3 patients. In one of them a urethral stent was left indwelling, while two were subjected to cystostomy. Due to bilateral lymphatic invasion, the remaining patient received preoperative radiotherapy, but he died three months later due to lung metastases. None of our patients received chemotherapy. Mean follow up was 9.5 months. At the end of the follow-up period 3 patients [one treated endoscopically and the two patients that had been subjected to surgery] were disease-free, while one patients had died and the 3 remaining ones were lost to follow up. Despite the availability of a variety of treatment modalities, tumors of the male urethra still have a poor prognosis. Due to their rarity, it is difficult to properly evaluate the treatment options which mainly depend on the tumor stage and whether or not there is lymphatic invasion

[Renal Hydatid cyst: report on 31 cases]

To present recent diagnostic and therapeutic aspects of the renal hydatid cyst. Thirty-one consecutive cases of renal hydatid cyst were seen between January 1989 and June 2006. The patient group consisted of 13 males and 18 females with a mean age of 43 years. The clinical symptoms, biological and radiological investigations as well as the treatment were evaluated. Clinical and radiological examination was diagnostic of renal hydatid cyst in 80.6% of the cases, when combined with serological tests for hydatidosis in 90% of the cases. CT scan confirmed the diagnosis in cases where the radiological examination was not conclusive [4 cases of type IV and 2 cases of type I]. Thirty patients were treated surgically. Percutaneous puncture was done in one case of type I. Twenty-eight patients [90.3%] were subjected to extraperitoneal lombotomy. The anterior approach was chosen in 2 patients due to associated hepatic involvement. The surgical methods consisted of partial cystopericystectomy in 27 [87.1%] patients, pericystectomy in one and nephrectomy in two patients. The immediate postoperative period was uneventful in all but one patient who developed acute pyelonephritis due to the migration of hydatic vesicles into the ureter. The problem resolved after administration of antibiotics and placement of a double-J catheter. Mean follow up was 68 months. During the long-term follow-up based on clinical and radiological examination no recurrence was detected. Radiological and serological examination is the most important step in the diagnosis of renal hydatid cyst. Surgery is the treatment of choice. Percutaneous puncture has recently been used with promising results

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis