Hygiene monitoring in a hospital immunohaematological laboratory.

Purpose Of The Study: Not only in blood donation services, but also in the immunohaematological laboratory of a hospital including the depository for blood products a hygiene plan must be drawn up and its realization has to be documented.

Material And Methods: From 2011 to 2014, some equipment in the depository and in the immunohematological laboratory was microbiologically monitored once a year. The examinations were done by direct contact cultures taken from several places of each device.

Complete urethral duplication: description of surgical approach mimicking distal epispadias repair.

Objective: To present two cases of type IIA urethral duplication and propose a reproducible surgical approach.

Methods: Two cases are presented in this report. The first was a male child with a type IIA1 urethral duplication with two urethral channels arising from the bladder through separate bladder necks coursing to the glans penis.

Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD).

Objective: To determine the influence of selective oropharyngeal decontamination (SOD) on the rate of colonization and infection of the respiratory tract in intensive care patients requiring mechanical ventilation for more than 4 days. A financial assessment was also performed.

Design: Randomized, prospective, controlled study using amphotericin B, colistin sulfate (polymyxin E), and tobramycin applied to the oropharynx and systemic cefotaxime prophylaxis.

Testicular trauma: potential impact on reproductive function.

Purpose: The long-term effects of testicular trauma on reproductive function are unknown. In an effort to define the relationship between testicular injury and fertility in humans, we identified patients with a history of testicular trauma and assessed parameters commonly associated with fertility.

Materials And Methods: We reviewed 15 patients 23 to 59 years old who underwent immediate exploration after testicular trauma between 1972 and 1991.

Lasers in urology.

Laser therapy has many applications in the treatment of urologic diseases. The advantages of laser treatment over conventional techniques are less bleeding and pain and a reduced need for anesthesia. The development of new fibers and right-angle delivery systems allows new applications for laser therapy.

Testicular carcinoma in situ and nonpalpable seminoma eight years after contralateral teratocarcinoma.

A thirty-five-year-old man had invasive seminoma and extensive carcinoma in situ in his remaining testicle eight years after orchiectomy and lymphadenectomy for Stage I teratocarcinoma. Beyond orchiectomy and hormone replacement, suitable treatment for such second neoplasms, which occur in at least 1 percent of patients, is not clear. More work also is needed to determine appropriate follow-up after treatment of the first cancer now that long-term survival of testicular cancer is the rule.

Transcervical resection of uterine myomas with a resectoscope.

As a surgical option, transcervical resection of uterine myomas is in the early stages of development. Although promising and a logical extension of the increasing reliance on hysteroscopy in gynecology, the comparison with the surgical standards of care for myomas (hysterectomy and hysterotomy) remains incomplete. The safety of the procedure, in the hands of a skillful resectionist, should be equivalent to that of a transurethral prostatectomy or bladder tumor resection.

Erectile impotence: evaluation and management.

Dramatic progress in the understanding and treatment of erectile impotence has occurred over the past decade. Most cases have an organic cause that is related to vascular (arterial or venous) supply, innervation, or the hormonal milieu of the penis. Multifactorial causes of organic impotence are common and include diabetes mellitus, alcoholism, renal failure, and liver failure.

Utricular papilloma.

A benign prostatic utricular papilloma was found in a twenty-seven-year-old man complaining of urethral bleeding and intermittent hematuria after sexual intercourse. Local endoscopic resection was performed. Since the natural history of this lesion is not known, follow-up cystourethroscopy will be performed.

Deaths from urologic injury due to external trauma.

The priority for treatment of a urologic injury in multiple injured patients from external trauma should be determined by the frequency of death from the urologic injury. The medical records of 2,058 patients with urologic injury from external trauma including 214 deaths were reviewed. Four deaths were attributed mainly to the urologic injury; one early in the postinjury period from continued severe hemorrhage from a ruptured kidney managed conservatively and three 6 to 8 weeks after injury from sepsis with a pelvic abscess from a ruptured urethra or bladder.

Long-term results of conservative and surgical management of blunt renal lacerations.

In the management of renal lacerations most attention has centered on surgical or non-surgical treatment and little attention has been given to the long-term results. We have evaluated the medical records and radiographs of 70 patients with blunt renal lacerations; 30 had initial non-surgical management and 40 had initial surgical management. Patients with initial non-surgical management were followed up for an average of 40.

Management of urinary calculi in pregnancy.

When a calculus is present in the upper urinary tract during pregnancy, the upper tract dilatation seen on radiography and ultrasonography can be due to the calculus or to the pregnancy. This makes the decision on management difficult unless there are associated clinical findings of pain or sepsis. The records of 24 pregnant patients with proved urinary calculi were reviewed.

Clinical indications for radiographic evaluation of blunt renal trauma.

The evaluation of patients with blunt renal trauma has become controversial. We tested the hypothesis that renal contusion can be diagnosed clinically and that these patients do not require radiographic evaluation. To evaluate the association of microhematuria without shock and with renal contusion, we reviewed the medical records of 831 patients with hematuria following blunt renal trauma.

Management of perirenal hematoma found during laparotomy in patient with multiple injuries.

The medical records of 158 patients with perirenal hematoma found during laparotomy for intra-abdominal injury from external trauma were analyzed. Small perirenal hematomas were usually associated with renal contusions and renal artery thrombosis, while large perirenal hematomas often were present with large renal lacerations, renal ruptures, and renal pedicle injuries with rupture of the renal vein, renal artery, polar artery, or branch of the renal artery. The management of the perirenal hematoma found during laparotomy depends on the degree of the underlying renal injury and not on the size or extent of the perirenal hematoma.

Renal trauma found during laparotomy for intra-abdominal injury.

Whether renal injury found during a laparotomy for intra-abdominal injury should have surgical or nonsurgical management is controversial. Five hundred twenty-one renal injuries were found during laparotomy for such injury in 513 patients. Blunt external trauma was the cause in 88%.

Type of blunt renal injury rather than associated extravasation should determine treatment.

The significance of extravasation of dye during excretion urography in blunt renal injuries has been controversial, with some believing that extravasation, even if copious, is largely innocuous and characterized by spontaneous resolution, and others believing extravasation is an indication for surgical correction of the underlying blunt renal injury. Thirty-two patients with extravasation diagnosed on excretion urography after blunt external trauma were evaluated. Immediate surgical management of the renal injury was performed in 18 patients who had a contusion in 1, laceration in 13, rupture in 3, and pedicle injury in 1, and averaged 2.

Renal pedicle injury in patients with multiple injuries.

In a study of 41 patients seen over 24 years, renal pedicle injuries were associated with life-threatening multiple system injuries and the immediate surgical management of these associated injuries by general surgeons took precedence over that of the renal pedicle injury. The result was the delayed diagnosis of the renal pedicle injury with loss of function of the kidney. In an effort to improve the renal salvage rate aggressive management of renal pedicle injuries with immediate radiologic evaluation and early surgical treatment was instituted in 1969.

Male genital injuries from external trauma.

External trauma from a variety of causes, some unusual and bizarre, affect the male genitalia. Certain injuries are more common, have more severe consequences, or their management may be controversial. Seventy male genital injuries from external trauma are reported and include vacuum cleaner injuries, fracture of penis and the tourniquet syndrome.

Self-inflicted foreign bodies involving lower urinary tract and male genitals.

A great variety of self-inflicted foreign bodies have been removed from the lower urinary tract and male external genitalia. These foreign bodies were inserted or applied for autoerotic, psychiatric, therapeutic, or no definite reasons by the patient. Most patients were too ashamed to admit they had inserted or applied any object and usually presented when a complication had occurred from the foreign body such as difficulty voiding, hematuria, pain or swelling, extravasation, or abscess formation.

Incidence of urinary tract complications with myelomeningocele.

Children born with myelomeningocele face the morbidity of urinary tract complications after they have survived the neurologic complications of the first years of life. The incidence of urinary tract complications was evaluated in 258 children before any operation or intermittent catheter management was performed. In 119 children under one year of age the incidence of urinary tract infection of more than 10(5) colonies was 23 per cent, reflux was 22 per cent, and upper tract dilatation was 6 per cent.

Simultaneous bladder and prostatomembranous urethral rupture from external trauma.

Simultaneous bladder and prostatomembranous (posterior) urethral ruptures from external trauma occur in 10 to 29 per cent of male patients with traumatic rupture of the posterior urethra. The records of 47 male patients with traumatic rupture of the posterior urethra were evaluated. A total of 8 patients (17 per cent) had simultaneous rupture of the bladder (4 extraperitoneal, 3 intraperitoneal and 1 both) and posterior urethra (5 complete and 3 partial ruptures).