Prediction of infection caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: development of a clinical decision-making nomogram.

OBJECTIVE: This study aimed to assess the population at risk of infection by extended-spectrum beta-lactamase (ESBL)-producing organisms, using clinical criteria. MATERIALS AND METHODS: All urine cultures positive for Enterobacteriaceae in a Spanish hospital department from January 2010 to 2014 were reviewed. All isolates with ESBL-positive strains were collected, and isolates received during the first week of each month with ESBL-negative strains from symptomatic patients hospitalized or admitted to the emergency room. Multivariate analysis of the factors involved was undertaken and a nomogram developed to predict the probability of infection by ESBL-producing microorganisms. RESULTS: The study included 1524 patients with urinary tract infection (UTI): 416 ESBL-positive and 1108 ESBL-negative. In univariate analysis, risk factors were: male gender (p = 0.036), age (p < 0.0001), nursing home (p < 0.0001), previous antimicrobial therapy (p < 0.0001) or hospitalization (p < 0.0001), diabetes (p < 0.0001), chronic renal insufficiency (p < 0.0001), severe underlying disease (p < 0.0001), neoplasia (p = 0.0005), urological (p < 0.0001) and non-urological invasive procedure (p = 0.0003), recurrent UTI (p < 0.0001), urological (p < 0.0001) or abdominal surgery (p < 0.0001) and permanent urethral catheter (p < 0.0001). In multivariate analysis, the data set was split into a development cohort of 1067 patients and a validation cohort of 457 cases. A nomogram was developed to predict the probability of infection by ESBL-producing bacteria, which included seven variables: age (p < 0.0001), gender (p = 0.004), nursing home (p < 0.0001), previous antimicrobial therapy (p = 0.04) or hospitalization (p < 0.0001), recurrent UTI (p < 0.0001) and non-urological invasive procedure (p = 0.005). The discriminative accuracy was 0.79 (95% confidence interval 0.77-0.83). CONCLUSIONS: A nomogram was developed that predicts the risk of infection by ESBL-producing Enterobacteriaceae with reasonable accuracy. It could improve clinical decision making and enable more efficient empirical treatment.

Tumor de células de la granulosa testicular de tipo adulto. Presentación de un nuevo caso y revisión de la literatura / Adult type granulosa cell testicular tumor. Case report and bibliographic review

OBJETIVO: Describir y conocer los tumores de células de la granulosa testicular del adulto (TCG) (clasificado como tumores del estroma y cordones sexuales de las gónadas) ya que conforman una variante rara con pocos casos publicados y de comportamiento clínico poco conocido. Método; Presentación de un nuevo caso de TCG testicular del adulto en un varón de 59 años, asintomático, con hallazgo ecográfico de una masa intratesticular de 3,3 cm heterogénea, con áreas sólidas y quísticas; marcadores tumorales y estudio de extensión negativos. RESULTADO: Confirmación del caso con análisis anatomopatológico e inmunohistoquímico, similar a su homólogo ovárico. CONCLUSIONES: El TCG del adulto, es un tumor infrecuente de comportamiento incierto. Aunque suele cursar con buen pronóstico, se ha descrito su potencial metastásico incluso años después de la orquiectomía, por lo que requiere un seguimiento a largo plazo

OBJECTIVE: To describe the adult type granulosa cell testicular tumors (classified as sex cord-stromal tumor) due to their behavior, hardly known with a small number of cases reported. METHOD: We report a new case of a 59-year-old man presenting an adult type granulosa cell tumor of the testis (AGCTT), painless, with a 3.3 centimeter intratesticular heterogeneous mass on ultrasound, with solid and cystic areas. Serum tumor markers and extension study were negative. RESULTS: Histologic and inmunohistochemical studies confirmed an AGCTT, similar to its ovarian counterpart. CONCLUSION: AGCTT are rare neoplasms with unpredictable behavior. Their metastatic potential has been described, reason why they need a long follow-up; however, they usually have a good prognosis

[Adult type granulosa cell testicular tumor. Case report and bibliographic review.] / Tumor de células de la granulosa testicular de tipo adulto. Presentación de un nuevo caso y revisión de la literatura.

OBJETIVE: To describe the adult type granulosa cell testicular tumors (classified as sex cordstromal tumor) due to their behavior, hardly known with a small number of cases reported. METHOD: We report a new case of a 59-year-old man presenting an adult type granulosa cell tumor of the testis (AGCTT), painless, with a 3.3 centimeter intratesticular heterogeneous mass on ultrasound, with solid and cystic areas. Serum tumor markers and extension study were negative. RESULTS: Histologic and inmunohistochemical studies confirmed an AGCTT, similar to its ovarian counterpart. CONCLUSION: AGCTT are rare neoplasms with unpredictable behavior. Their metastatic potential has been described, reason why they need a long follow-up; however, they usually have a good prognosis.

Two-Port Laparoscopic Reconstructive Surgery of the Urinary Tract with Reusable Umbilical System (Hybrid Less): A Proof of Concept Study.

OBJECTIVES: We compared perioperative results and complications of reconstructive surgery of the urinary tract performed using a multichannel platform through the umbilicus and one additional 3.5-mm with a cohort of patients simultaneously treated with conventional 4-port laparoscopy. MATERIALS AND METHODS: Matched-pair study comparing perioperative outcomes, postoperative visual analogue pain scale (VAPS) and morbidity of 2-port (n = 20) and 4-port (n = 10) laparoscopic reconstructive urological surgery. Preoperative and perioperative data compared included demographics, type of surgery, operative time, blood loss, decrease in serum hemoglobin, operative complications, length of stay and postoperative complications according to Clavien-Dindo classification. RESULTS: There was no significant difference between groups regarding age, gender, body mass index, American Society of Anesthesiologists score, type of surgery, operative time, operative complications and intraoperative or postoperative transfusion. Estimated blood loss was lower using reduced-port approach. VAPS at postoperative day one was significantly lower for 2-port approach and so was the length of stay. Patient satisfaction with the wound was higher for 2-port surgery. Differences were not observed in number and severity of postoperative complications. CONCLUSIONS: Urological reconstructive operations can be safely performed using the hybrid laparoendoscopic single-site umbilical approach, resulting in lower blood loss, higher patient satisfaction and lower postoperative pain, which also facilitate earlier hospital discharge, than the same reconstructive procedures performed through multiport conventional laparoscopy.