Asymptomatic spontaneous migration of double pigtail ureteral stent outside the ureter.

We report a case of asymptomatic spontaneous migration outside the ureter of a double pigtail ureteral stent. This previously undescribed complication confirms the need for regular follow-up of patients with indwelling stents.

Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam.

OBJECTIVE: To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). PATIENTS AND METHODS: Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. RESULTS: Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects. CONCLUSIONS: This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.

[Echodynamics of the cervical ureter junction]. / Ecodinamica della giunzione cervico uretrale.

Transrectal dynamic ultrasonography is a 3 dimensional study that identifies accurately bladder neck (B.N.) diseases during micturition, providing precise noninvasive images of the B.N. orifice and the posterior urethra. This technique requires a 7-10 Mhz high frequency linear transducer. Benign Prostaic Hyperplasia (BPH) may restrict the urethral lumen and deviate its intra prostate tract. The images obtained allow a detailed and precise analysis of the B.N. and intravesical development of the median lobe. The urethra classically has a stretched and elongated appearance. This technique is useful in the diagnosis and in the follow up of neuropathic bladder. It is also useful in morphological and dynamic study of the B.N. after TURP. Diagnosis of B.N. hypertrophy or sclerosis is easy if a posterior beak at internal meatus level and positive stop test are present. After radical prostatectomy or radical cystectomy with orthotopic neobladder, this technique is useful to evaluate the internal urethral meatus and voluntary skeletal sphincter providing to a continence mechanism. We believe dynamic transrectal echography should become a procedure to be included as a part of the routine pre-surgical investigation of the B.N. diseases, for its non invasive nature, easiness to perform, and highly useful information.

[Echo-color doppler in the topographic study of varicocele]. / Eco color Doppler nello studio topografico del varicocele.

The echo color doppler allows an easy topographical distinction of the spermatic reflux (in front of the deferens) from cremasteric one (back to the deferens). This distinction consents a rational surgical choice, the selective interruption of the refluent vein and a less morbidity due to the surgical intervention. We evaluated 20 infertile patients (mean age 23 years) with echo color doppler testicular vessels (B & K 7.5 Mhz transducer). Seven varicoceles were clinically evident, 13 varicoceles were subclinic. After locating the deferens, we evaluated the venous reflux in the spermatic and cremasteric veins. The evaluation has been performed at rest and during Valsava maneuver. We used, in the correction of the anterior (spermatic) reflux, a retroperitoneal surgical access, while in the back (cremasteric) reflux isolated or combined, we performed middle or under inguinal access. The mean follow up has been of 4 months. In all cases the veins with reflux have been easily characterized. In 16 patients (80%) the spermatic vein was concerned; in an isolated case (5%) the reflux concerned only the cremasteric vein, in 3 patients (15%), with clinical varicocele, the reflux was present in both the veins (Coolsaet III type). In the 16 spermatic varicoceles, treated with retroperitoneal access (Palomo), the echo color doppler check demonstrated the absence of venous reflux. In the 4 varicoceles regarding the isolated or associate cremasteric vein treated with middle or under inguinal access, the existence of extra funicular varix was highlighted and after surgery the echo color doppler check was negative. In our few cases the echo color doppler diagnosis demonstrated a total correspondence with the surgical finds and with the doppler follow up. This diagnostic approach allows to reserve the retroperitoneal surgery to the spermatic pure reflux avoiding the false relapses due to the persistence of an undiagnosed cremasteric reflux. The middle or under inguinal approaches, generally loaded from a greatest morbidity, could be only employed in presence of an isolated or combined cremasteric reflux.

Chronic lymphocytic leukaemias and non-Hodgkin's lymphomas by histological type in farming-animal breeding workers: a population case-control study based on job titles.

OBJECTIVES: A population based case-control study was conducted in a highly agricultural area in the north east of Italy to evaluate the association between farming and animal breeding and the risk of developing non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukaemia (CLL). METHODS: Occupational histories and other data were collected by personal interview on 164 NHLs, 23 CLLs, diagnosed in 1988-90, and on 977 controls. This paper only reports the results of the analysis relative to the coding of job titles through the modified International Labour Office (ILO) classification. Estimates of odds ratios (ORs) for occupational variables were calculated, after adjustment for sex, age, altitude of municipality, first degree familiarity, and previous Herpes zoster infection. RESULTS: From the analysis of the most frequent occupational categories, no occupation showed a significantly high risk. When the two job titles farmers only and farmer-breeders who are also involved in animal breeding are classified within the extremely varied occupation of agriculture or animal-breeding or fishing, a high risk for NHLs and CLLs is seen in the farmer-breeders (OR 1.79, 95% CI 1.22 - 2.63). Analyses according to histological type show that the risks are concentrated in CLLs and in low grade NHLs. No effect or trend by period at work or duration of employment in farming and animal breeding was found. CONCLUSION: Subjects working in agriculture associated with animal breeding are at high risk of NHL/CLLs, particularly CLLs and low grade NHLs. This finding could be related to the use of chemicals in agriculture or to exposure to animal transmitted diseases or specific chemicals used in animal breeding.

Metastases to the submaxillary gland from breast cancer: case report.

A case of metastases to the submaxillary gland from breast carcinoma is reported. The patient, a 68-year-old female, had been operated for a stage II N+ breast carcinoma 4 years before. She then received six courses of CMF adjuvant program. A literature review is presented concerning the 8 well-documented cases reported.