Association between renal cysts and abdominal aortic aneurysm: A case-control study / Associação entre cistos renais e aneurismas da aorta abdominal: Um estudo de caso-controle

Summary Objective: To investigate the positive association between the presence of simple renal cysts (SRCs) and abdominal aortic aneurysm (AAA). Method: In a retrospective case-control study including subjects aged > 50 years, we evaluated the incidence of SRCs on computed tomography (CT) scan. We compared 91 consecutive patients with AAA referred from the Division of Vascular Surgery and 396 patients without AAA, randomly selected after being matched by age and gender from 3,186 consecutive patients who underwent abdominal CT. SRC was defined as a round or oval low-attenuation lesion with a thin wall and size > 4 mm on CT without obvious evidence of radiographic enhancement or septations. Patients were considered as having AAA if the size of aorta was greater than 3.0 cm. Results: Patients with AAA and without AAA were similar in terms of age (67.9± 8.41 vs. 68.5±9.13 years) (p=0.889) and gender (71.4 vs. 71.2% of male subjects, respectively) (p=0.999). There was no difference in the prevalence of SRC between case and controls. Among individuals with AAA, 38 (41.8%; [95CI 32.5-52.6]) had renal cysts compared to 148 (37.4%; [95CI 32.7-42.2]) in the control group (p=0.473), with a prevalence ratio (PR) of 1.16 (95CI 0.80-1.68). Conclusion: We found no significant differences in the prevalence of SRCs among patients with AAA and controls. Our findings suggest that the presence of SRCs is not a risk factor or a marker for AAA.

Resumo Objetivo: Avaliar uma possível associação entre presença de cistos renais simples (CRS) e aneurisma aórtico abdominal (AAA). Método: Em um estudo de caso versus controle com sujeitos com idade > 50 anos, avaliamos a prevalência de CRS detectados por tomografia computadorizada (TC). Comparamos os achados de 91 pacientes consecutivos com AAA oriundos da Divisão de Cirurgia Vascular com 396 pacientes sem AAA, randomicamente selecionados e ajustados por idade e gênero dentre 3.186 pacientes consecutivos que se submeteram a TC abdominal. Cisto simples foi definido como lesão hipodensa oval ou arredondada com paredes finas, maiores do que 4 mm em TC sem realce contrastual ou septação. Pacientes foram considerados com AAA quando o diâmetro da aorta era maior que 3,0 cm. Resultados: Pacientes com AAA e sem AAA eram semelhantes quanto a idade (67,9±8,41 vs. 68,5±9,13 anos) (p=0,889) e gênero (71,4 vs. 71,2% dos indivíduos masculinos, respectivamente) (p=0,999). Não havia diferença de prevalência de CRS entre casos e controles. Dentre indivíduos com AAA, 38 (41,8%; [IC95% 32,5-52,6]) tinham cistos renais, comparados com 148 (37,4%; [IC95% 32,7-42,2]) no grupo controle (p=0,473), com uma razão de prevalência (RP) de 1,16 (IC95% 0,80-1,68). Conclusão: Não observamos diferenças significativas na prevalência de CRS entre pacientes com AAA e controles. Nossos resultados sugerem que presença de CRS não é fator de risco ou preditor para AAA.

Community acquired urinary tract infection: etiology and bacterial susceptibility

Purpose: Urinary tract infections (UTI) are one of the,most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. Objetive: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. Methods: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. Results: The mean age of the patients in this study was 45.34 t 23.56 (SD) years. There were 242 (60.2 percent) females and 160 (39.8 percent) males. The most conunonly isolated organism was Escherichia coli (58 percent). Klebsiella sp. (8.4 percent).and Enterococcus sp.(7.9 percent) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37 percent were sensitive to ampicillin, 51 percent to cefalothin and 52 percent to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96 percent), ceftriaxone (90 percent), amikacin (90 percent), gentamicin (88 percent), levofloxacin (86 percent), ciprofloxacin (73 percent), nitrofurantoin (77 percent) and norfloxacin (75 percent). Conclusions: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

Prevalence and bacterial susceptibility of hospital acquired urinary tract infection

Purpose: Urinary tract infection is the most common nosocomially acquired infection. It is important to know the etiology and antibiotic susceptibility infectious agents to guide the initial empirical treatment. Objective: To determine the prevalence of bacterial strains and their antibiotic susceptibility in nosocomially ácquired urinary tract infection in a university hospital between January and June 2003. Methods: We analyzed the data of 188 patients with positive urine culture (= 105 colony-forming unitslmL) following a period of 48 hours after admission. Results: Half of patients were male. Mean age was 50.26 ± 22.7 (SD), range 3 months to 88 years. Gram-negative bacteria were the agent in approximately 80 percent of cases. The most common pathogens were E. coli (26 percent), Klebsiella sp. (15 percent), P. aeruginosa (15 percent) and Enterococcus sp. (11 percent). The overall bacteria susceptibility showed that the pathogens were more sensible to imipenem (83 percent), second or third generation cephalosporin and aminoglycosides; and were highly resistant to ampicillin (27 percent) and cefalothin (30 percetn). It is important to note the low susceptibility to ciprofloxacin (42 percent) and norfloxacin (43 percent). Conclusion: This study suggests that if one can not wait the results of urine culture, the best choices to begin empiric treatment are imipenem, second or third generation cephalosporin and aminoglycosides. Cefalothin and ampicillin are quite ineffective to treat these infections.

Adrenalectomia laparoscópica: análise de 11 pacientes / Laparoscopic adrenalectomy: analysis of 11 pacients

OBJETIVO: Analisar a experiência inicial da Divisão de Urologia do HCFMRP-USP na adrenalectomia transperitoneal videolaparoscópica. MÉTODOS: Análise retrospectiva de 11 casos de adrenalectomia transperitoneal laparoscópica realizados de fevereiro de 1999 a março de 2003 sendo 3 em homens( 27 por cento) e 8 em mulheres (73 por cento), idade média de 40,2 ± 13,1 anos. Os pacientes apresentavam os diagnósticos seguintes: adenoma - 5, síndrome de Cushing - 3, feocromocitoma - 1, hiperaldestorismo - 1 e síndrome de Carney - 1. RESULTADOS: A cirurgia foi bilateral em 05 pacientes (45,4 por cento) e unilateral em 06 pacientes (54,6 por cento), destes 04 à direita (36,4 por cento) e 02 à esquerda (18,2 por cento). O tempo médio de internação foi de 3,6 ± 1,1 dias, o tempo médio de cirurgia foi de 220,5 ± 103,7 minutos e a taxa de conversão foi de 18,2 por cento. CONCLUSAO: Os resultados apresentados são similares aos relatados pela literatura, demonstrando que a adrenalectomia videolaparoscópia pode ser realizada de maneira segura e eficiente com benefícios: tempo cirúrgico aceitável, rápida recuperação pós-operatória e alta precoce.

Laparoscopic nephrectomy: analysis of 34 patients

Objective: To analyze the clinical experience of laparoscopic nephrectomy for benign and malignant diseases at a university hospital. Methods: From February 2000 to March 2003, 34 patiems (14 men and 20 women) underwent transperitoneal laparoscopic total nephrectomy at the Hospital das Clinicas - FMRP-USP: 28 (82.3 percent) patients had benign diseases and 6 (17.7 percent) malignant neoplasias. Benign diseases were represented by: urinary stones (N-9, 32.1 percent), chronic pyelonephritis (N-8, 28.6 percent), vesicoureteral reflux (N-4, 14.3 percent), ureteropelvic obstruction (N-3, 10.7 percent), multicystic kidney (N-2, 7.1 percent) and pyonephrosis (N-2, 7.1 percent). Patients age range was 2-79 years (mean - 35,1 years). Results: In 32/34 patients the procedures were accomplished successfully. In 2 (5.8 percent) cases of pyonephrosis, open conversion was necessary due to perinephric abscess and difficulties in dissection of renal hilum. Two patients had intraoperative complications (1 duodenum serous laceration an 1 vascular lesion of renal hilum), but both were managed laparoscopically. Two (5.8 percent) post operative complications (1 delayed bleeding and 1 pancreatic fistula) required open surgical exploration. The mean time of hospital stay was 58h (18 to 240h). Conclusion: Laparoscopic nephrectomy proved to be a method safe and associated with a low rate of morbidity, shorter hospital stay and no casualties.

Fatores de risco em carcinomas de células transicionais da bexiga / Risk factors in transitional cell carcinoma of the bladder

Objetivo: Investigar alguns dados epidemiológicos do câncer vesical bem como fatores de risco. Métodos: Foram selecionados 125 pacientes atendidos no período 1980-2002, com idade média de 63,6 +/- 11,3 anos, sendo 97 (77,6 por cento) homens e 28 (22,4 por cento) mulheres. As proporções de tumor G1, G2 e G3 foram: 48 por cento, 35,2 por cento e 16,8 por cento, As proporções dos estádios da lesão primária foram: pTa-5 - 85 (68 por cento) e pT2-4 - 40 (32 por cento). Entre os pacientes com tumores superficiais houve recidiva eem 41 (48,2 por cento). Resultados: O grau da lesão primária mostrou relação com o estádio T (p<0,0001) e sobrevida (p<0,0001), mas não com a taxa de recidiva vesical dos tumores superficiais (p=0,72). O estádio T também mostrou forte correlação com a sobrevida (p<0,001). Conclusões: O CCT é mais comum em homens que mulheres e acomete pacientes com idade média de 63,9 anos. O grau e o estádio T mostram forte correlação com a progressão da doença e a sobrevida.