Efficiency of short and long term antimicrobial therapy in transrectal ultrasound-guided prostate biopsies.

OBJECTIVE: Prostate biopsy is a frequent diagnostic measure to detect prostatic conditions, including primarily prostate cancer. Its performance does not follow a pattern, mainly regarding preparation for the examination through antimicrobial prophylaxis. The aim of this study is to compare the efficiency of short and long term antimicrobial prophylaxis in transrectal ultrasound-guided prostate biopsies. MATERIALS AND METHODS: A clinical study was conducted with a total of 140 patients submitted to prostate biopsy with transrectal ultrasonographic control. Patients were randomly separated in two groups: Group 1 receiving norfloxacin 400mg single dose before the procedure and Group 2 receiving norfloxacin 400mg initiating before the procedure and then bid up to 6 doses. Efficiency control was determined by the incidence of urinary tract infection (UTI) and complications in both groups after statistical analysis. RESULTS: The incidence of minor complications in our study was 75%, consistent with data found in the literature. Among the patients with diagnosis of simple UTI, 23% belonged to Group 1 and 8% to Group 2 (p=0.08). Among the patients with complicated UTI, 37% belonged to Group 1 and none belonged to Group 2 (p=0.44). CONCLUSIONS: Several advances made transrectal ultrasound-guided prostate biopsies a useful and safe diagnostic tool in the workup of urologic patients. There is no optimal prophylactic preparation to the performance of this procedure. Long term antimicrobial prophylaxis presents a trend toward lower incidence of infectious complications.

Cervical anastomosis of the esophagus for esophageal carcinoma: an alternative approach

OBJETIVO: Avaliar o papel da técnica de anastomose esofagovisceral cervical retardada em relaçäo à incidência de complicaçöes anastomóticas. MATERIAIS E MÉTODOS: Oito pacientes (grupo 1) e 12 pacientes (grupo 2) submetidos a cirurgias em uma ou duas etapas, respectivamente, foram selecionados com base em avaliaçäo intra-operatória por um cirurgiäo. A avaliaçäo levou em conta, principalmente, o fluxo sanguíneo do tecido do órgÝo recolocado, depois da sua colocaçäo na regiäo cervical. RESULTADOS: No Grupo 1 foi observada deiscência anastomótica em 37,5 por cento dos pacientes, enquanto no Grupo 2 näo ocorreu nenhum caso de deiscência (p=0,049). No entanto, a taxa de mortalidade pós-operatória näo foi diferente para os dois grupos (12,5 por cento versus 0 por cento, näo significativo). CONCLUSÄO: Quando a viabilidade do órgäo é incerta, a anastomose esofagovisceral é melhor realizada em duas etapas, uma vez que dessa forma, diminuiu a incidência de vazamento anastomótico