Prevalence and spatial distribution of bovine brucellosis in San Luis and La Pampa, Argentina.

BACKGROUND: Bovine brucellosis (BB) is a zoonotic disease caused by Brucella abortus. BB is endemic in Argentina, where vaccination with Brucella abortus strain 19 is compulsory for 3-to-8 month-old heifers. The objectives of this study were to quantify the prevalence of BB and to identify factors associated with its occurrence, along with the spatial distribution of the disease, in the provinces of La Pampa and San Luis. A two-stage random sampling design was used to sample 8,965 cows (3,513 in La Pampa and 5,452 in San Luis) from 451 farms (187 in La Pampa and 264 in San Luis). RESULTS: Cow and herd prevalence were 1.8 % (95 % CI: 1.3-2.2; n = 157) and 19.7 % (95 % CI: 17.0-22.4; n = 89), respectively. Both cow-level and herd-level prevalence in La Pampa (2.4 and 26.0 %, respectively) were significantly higher than in San Luis (1.4 and 15.5 %, respectively). There were not differences between the proportions of reactive cattle compared to that obtained in a survey conducted in 2005. However, herd prevalence in La Pampa was significantly (P < 0.05) higher compared to that study. Disease was found to be spatially clustered in west La Pampa. The lower the bovine density and the calf/cow ratio, the higher odds of belonging to the cluster. CONCLUSIONS: The increase of farm prevalence in the last five years suggests that the disease is spreading and that control measures should be applied in the region. The cluster of infected farms was located in the west region of La Pampa. There, farms have lower animal densities and smaller cow/calf indices compared to the rest of the province. Although western La Pampa has more infected herds, within-farm prevalence was not higher, which suggests that the control program has been relatively successful in controlling the disease at the farm level, and/or that low animal density inherently results in low disease prevalence. Our results provide baseline information on the epidemiology of BB and its potential pattern of transmission in Argentina, which will ultimately help to improve BB control programs in the country.

Long-segment ureteral replacement with expanded polytetrafluoroethylene grafts.

OBJECTIVES: Traumatic loss of significant lengths of ureter all too often results in nephrectomy when vascularized pedicles of bowel or bladder fail or are not available for substitution. Historically, alloplastic replacement of ureters has failed due to obstruction, bioincompatibility, or graft migration. This study was undertaken to test the performance of ringed expanded polytetrafluoroethylene (PTFE) tube grafts as ureteral replacements in a canine model. METHODS: Eight female dogs underwent partial ureteral replacement with ringed PTFE tube grafts. An involuting anastomosis was used to anchor the graft to the bladder. The dogs were followed with intravenous urograms and Whitaker infusion pressure tests for up to 12 months. RESULTS: Six of 8 animals (75%) had preservation of excellent renal function with normal intravenous urograms and low Whitaker infusion pressures. One animal had mild hydronephrosis with an elevated infusion pressure. One animal died of spontaneous renal rupture secondary to obstruction at the ureteral-graft anastomosis. All other grafts were patent by histologic examination without encrustation or infection. CONCLUSIONS: Although not suggested as first-line therapy after ureteral loss, expanded PTFE may have a use as a prosthetic ureteral replacement in situations where conventional surgical therapies are unsuccessful. This material appears to be biocompatible, and the technique of bladder anastomosis described here prevented migration of the prosthesis.

Report of a multicenter clinical evaluation of the Dura-II penile prosthesis.

PURPOSE: Information was collected during the first 2 years of an ongoing, prospective, multi-institutional evaluation of the Dura-II penile prosthesis. Evaluation included data on clinical outcomes and a patient satisfaction survey, and will continue for 5 years after implantation for each patient. MATERIALS AND METHODS: To date 196 patients have been evaluated. Surgical data, adverse events and information from satisfaction surveys are reported. RESULTS: At a followup of 13.4 +/- 8.4 months postoperatively, adverse events occurred in 8.2% of the patients, resulting in reoperation in 5.1%. There have been no mechanical failures. Overall satisfaction rates were 85% at 3 months, 83% at 1 year and 91% at 2 years after implantation, and levels of sexual functioning were correspondingly high. A majority of patients assigned high scores to rigidity, concealability, ability to have intercourse and erection size, although satisfaction with erection size ranked lower than the other measures. CONCLUSIONS: The Dura-II penile prosthesis provides a satisfactory result and has an acceptable level of complications associated with its use. Further followup will assess temporal changes in satisfaction rates and sexual functioning for these patients.

Iliac vein compression syndrome: an unusual cause of varicocele.

Iliac vein compression syndrome is the phenomenon of nonthrombotic iliac vein obstruction caused by compression of left iliac vein between the right iliac artery and fifth lumbar vertebra. Affected patients usually present with unilateral leg edema. The condition is most often seen in women, in whom it may also be a cause of vulvar varicosities. Presented here is a case of idiopathic iliac vein obstruction associated with an ipsilateral varicocele in a young man. This varicocele was caused by multiple collateral venous channels and was resistant to surgical high ligation. This case illustrates an unusual cause of varicocele formation and an anatomic reason for failure of standard surgical therapy.

An assessment of the need for the voiding cystourethrogram for urologic screening prior to renal transplantation.

A retrospective review of the records of 450 patients who were evaluated for renal transplantation was undertaken to determine whether a voiding cystourethrogram (VCUG) influenced the surgical care of the recipient. Three hundred and forty eight of these patients proceeded to transplantation, with 333 of them receiving a VCUG as part of their evaluation. A urologic abnormality was identified by VCUG in 51 individuals, 19 of whom had a known urologic abnormality as the etiology of their renal disease. None of the other 32 patients with abnormalities discovered by VCUG required surgical correction. In the remaining 282 patients the VCUG was normal. The VCUG is not essential for the preparation of potential recipients for renal transplantation and should be utilized selectively in individuals with a history of urologic disease or when urinary tract abnormalities are identified by physical examination or an abnormal urine analysis.

Sucralfate inhibition of tumor cell implantation in the murine urinary bladder.

Superficial transitional cell carcinoma of the bladder has a 50 to 70% recurrence rate. Recurrences may be related to tumor cell implantation during transurethral resection which disrupts the glycosaminoglycan layer of the bladder. This study demonstrated decreased tumor formation in murine bladders which were pre-treated with sucralfate, a synthetic glycosaminoglycan, prior to tumor cell instillation. These results suggest a possible role for sucralfate as a glycosaminoglycan supplement.

Development of nongerm cell malignancies in nonseminomatous germ cell tumors.

We report 2 cases of sarcomatous transformation of mixed germ cell tumors of the testis. Both patients received cisplatin-based combination chemotherapy. Embryonal rhabdomyosarcoma, chondrosarcoma and spindle cell sarcoma were the dominant pathological patterns in the metastatic sites. Nongerm cell malignancies in mixed germ cell tumors following chemotherapy may be more common than previously described.

Effect of vasectomy on high density lipoproteins.

Primate research has associated vasectomy with accelerated rates of atherogenesis. We have evaluated the effect of vasectomy on serum lipoprotein profiles in healthy men. There was a decrease in high density lipoprotein levels, which was greatest in men with a family history of atherosclerotic disease. With the great number of variables known to affect high density lipoprotein levels further studies are needed to determine if this change can be attributed to the vasectomy.

PIP: The short-term effect of vasectomy on human lipoprotein profiles, a known risk factor for atherosclerosis, was evaluated. The 28 subjects had a single profile measured before vasectomy and 3 months postoperatively. The mean change in high density lipoprotein levels was a decrease of 6.6 mg/dl, which was significant. The mean decrease in cholesterol levels of 22.5 mg/dl was also significant. The decrease in high density lipoprotein levels was noted in 26 of the 28 patients. The 13 patients with a family history of atherosclerotic disease had a mean change in high density lipoprotein levels of -9.3 mg/dl, compared with an average decrease of -4.6 mg/dl among the 15 patients with a negative family history. There was no significant difference in the change in cholesterol levels between the 2 groups. Smoking, obesity, hypertension, diabetes, age, or level of physical activity did not correlate with lipoprotein levels, and there was no association between the change in high density lipoprotein levels and cholesterol or triglyceride levels. Previous primate research has associated vasectomy with accelerated rates of atherogenesis. This is thought to be the 1st study to investigate the influence of vasectomy on lipoprotein profiles in humans. The modest decrease in lipoprotein levels in vasectomized men observed in this study, especially among men with a family history of atherosclerotic disease, raises questions about the longterm safety of vasectomy and calls for futher investigation.

Ureteral ectopia into seminal vesicle: embryology and clinical presentation.

The cause of ureteral ectopia in a single nonduplicated system is probably an abnormally high origin of the ureteral bud on the mesonephric duct. In the male patient with vague and unexplained lower urinary tract symptoms, extravesical ureteral ectopia must be considered, especially in prepubertal males with epididymitis and a solitary kidney. Physical examination, seminal vesiculography with delayed films, and voiding cystourethrogram should provide a diagnosis.

Paratesticular mesotheliomas.

Paratesticular mesotheliomas are uncommon tumors. We report 2 such cases and discuss their clinical and pathological findings.

Renal axis deviation in the elderly.

Renal axis variations occurring in age-grouped populations are described. We discovered a significant difference in renal axis deviations between young and old population groups with a tendency for a more vertical axis as age increases. Possible reasons for these changes are proposed. We suggest that not all renal axis deviations in the elderly population require extensive evaluation.

Complications of retroperitoneal lymphadenectomy.

Complications found in 47 individuals who underwent radical retroperitoneal node dissection were retrospectively analyzed. Our results indicate no mortality and an over-all complication rate of 29.7 per cent. An increased number of complications was noted in those patients who underwent elective appendectomy and in those node dissection above the renal vessels.

Accuracy of preoperative studies in staging nonseminomatous germ cell testicular tumors.

The preoperative staging procedures used in 45 patients with surgical Stage I and Stage II nonseminomatous germ cell tumors of the testis were analyzed retrospectively. Our results indicate that gallium-67-citrate scan and supraclavicular lymph node biopsy add little information in the routine preoperative evaluation of these patients. Bipedal lymphangiography, in our experience, was no more accurate than excretory urograms in selecting patients with retroperitoneal disease and in addition provides no information regarding the status of the upper urinary tract. Thus, we suggest that physical examination, excretory urography, chest x-ray film, whole lung tomography, serum tumor markers, and liver scan provide sufficient information to proceed with surgical treatment when appropriate.