PURPOSE: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. OBJECTIVE: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. METHODS: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. RESULTS: The mean age of the patients in this study was 45.34 ± 23.56 (SD) years. There were 242 (60.2%) females and 160 (39.8%) males. The most commonly isolated organism was Escherichia coli (58%). Klebsiella sp. (8.4%) and Enterococcus sp.(7.9%) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37% were sensitive to ampicillin, 51% to cefalothin and 52% to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96%), ceftriaxone (90%), amikacin (90%), gentamicin (88%), levofloxacin (86%), ciprofloxacin (73%), nitrofurantoin (77%) and norfloxacin (75%). CONCLUSION: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

PURPOSE: Urinary tract infection is the most common nosocomially acquired infection. It is important to know the etiology and antibiotic susceptibility infectious agents to guide the initial empirical treatment. OBJECTIVE: To determine the prevalence of bacterial strains and their antibiotic susceptibility in nosocomially acquired urinary tract infection in a university hospital between January and June 2003. METHODS: We analyzed the data of 188 patients with positive urine culture (= 10(5) colony-forming units/mL) following a period of 48 hours after admission. RESULTS: Half of patients were male. Mean age was 50.26 ± 22.7 (SD), range 3 months to 88 years. Gram-negative bacteria were the agent in approximately 80% of cases. The most common pathogens were E. coli (26%), Klebsiella sp. (15%), P. aeruginosa (15%) and Enterococcus sp. (11%). The overall bacteria susceptibility showed that the pathogens were more sensible to imipenem (83%), second or third generation cephalosporin and aminoglycosides; and were highly resistant to ampicillin (27%) and cefalothin (30%). It is important to note the low susceptibility to ciprofloxacin (42%) and norfloxacin (43%). CONCLUSION: This study suggests that if one can not wait the results of urine culture, the best choices to begin empiric treatment are imipenem, second or third generation cephalosporin and aminoglycosides. Cefalothin and ampicillin are quite ineffective to treat these infections.

OBJETIVO: Investigar as características e a evolução de homens adultos portadores de tumores germinativos do testículo. MÉTODOS: Estudamos as características e a evolução 29 pacientes tratados (14 seminomas e 15 não seminomas). O tempo médio de seguimento foi de 56 meses para os seminomas e de 40 meses para os não seminomatosos. Todos foram submetidos a orquiectomia. Nos estádios II e III associou-se radioterapia para os seminomas, e quimioterapia e linfadenectomia para os não seminomatosos. RESULTADOS: As queixas mais freqüentes foram aumento de volume testicular (57%) e dor (30%). Nos seminomas a idade média foi de 41,2 anos e nos não seminomas foi de 29,2 anos. Antecedente de criptorquidia foi assinalada em 28,5% dos seminomas e em 15,5% dos não seminomatosos. As proporções respectivas de estádios I, II e III foram de 79%, 14% e 7% em seminomas, e 40%, 27% e 33% em não seminomas. Os seminomas não provocaram elevação dos marcadores AFP ou b-HCG enquanto os não seminomatosos elevaram esses marcadores respectivamente em 46,6% e 33,3% dos casos. Morte pela doença ocorreu em 1 caso de seminoma e 3 de não seminomas, mas não houve diferença na sobrevida entre os grupos. CONCLUSÃO: A criptorquidia continua sendo um fator predisponente importante na etiologia dos tumores germinativos. Apesar dos tumores não seminomatosos se apresentarem em estádios mais avançados a sobrevida dos pacientes não difere da apresentada pelos portadores de seminomas.

Introduction:This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP.Patients and Methods:110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used.Results:The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad).Conclusions:The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.

Objective -To investigate microvessel density as a risk factor in squamous cell carcinoma of the penis. Methods -Fifty patients with penile carcinoma were evaluated retrospectively. The mean age and standard deviation were 60.8±11.8 years. All of them were treated by penectomy and with positive nodes underwent groin lymphadenectomy. Tumor grading was 36 G1 and 24 G2/3. Primary lesion stage was 22 pT1 and 28 pT2-4. Positive inguinal nodes were observed in 18 patients. Selected paraffin embedded sections were submitted to CD34 immunohistochemical analysis by the avidinbiotin-immunoperoxidase method with antigen retrieval. All slides were examined using an automatic analyzer system and the number of micro-vessels in 10 high magnification power fields (400X) were counted in a blind analysis. Results -Median number of microvessels was 631 in G1 versus 695 in G2/3 tumors (p=0.78), and 696 in pT1 versus 566 pT2-4 tumors (p=0.23). The respective data for pN0 patients was 525 and for pN+ was 696 (p=0.01), which is an unexpected result. Conclusion -CD34 immunoexpression or microvessel density determined by this method bear no association with tumor grade, stage or prognosis. Available from URL: http://www.scielo.br/acb Key Words -Penile carcinoma, squamous cell carcinoma of the penis, CD34.

O antígeno nuclear de proliferação celular (PCNA) foi descrito como marcador da atividade proliferativa. Correlacionamos a marcação do PCNA com a evolução dos pacientes com carcinoma de células transicionais de bexiga. Revisamos 90 pacientes do HC-FMRP-USP de 1980-2000; com idade variando de 29 a 93 anos e média de 71 anos; sendo 77,8% homens e 22,2% mulheres; seguimento médio de 55 meses (2-231 meses). Constatamos 50% de tumores grau I, (32,2%) grau II e 17,8% grau III; estadiados em pTA-60%, pT1-8,9% e >pT1 31,1%. Utilizamos o anticorpo primário Monoclonal Mouse Anti-Proliferating Cell Nuclear Antigen (PCNA) Clone PC10 (DAKO). Foram contadas 500 células (X400), e utilizado ponto de corte de 50%. A análise estatística foi realizada com o teste de Mann-Whitney. Kaplan-Meier e Logrank Oitenta e sete tumores (96,66%) expressaram PCNA (mediana 72.5%, média 60,16%). Observamos diferença não significativa (P=0,39) na imunomarcação do PCNA entre tumores pT2-4 e pTA-1. A comparação de medias entre G1 e G2 (P=0,087), G1 e G3 (P=0,11) e entre G2 e G3 (P=0,66) não mostraram significado estatístico,assim como entre tumores com recidiva e sem recidiva (P=0,84). Os indivíduos PCNA positivos não tiveram intervalo livre de doença significativamente diferente (P=0,86); entretanto foi significativa a diferença nas curvas de sobrevida (P=0,003) e nas curvas de intervalos livres de metástase (P=0,01). A expressão imunohistoquímica do PCNA não foi efetiva para diferenciar os tumores mais avançados e agressivos, assim como para predizer recidivas. Desta forma, apesar da correlação com o tempo livre de metástase e a sobrevida, não mostrou utilidade prática.

OBJECTIVE: To verify the efficacy and safety of compressed air to produce pneumoperitoneum for laparoscopic surgery in pigs for a training program of residence. METHODS: Dalland pigs weighing 15-17kg underwent general anethesia and mechanical ventilation. They were divided in 3 groups: A - (38) the pneumoperitnoneum was established with an automatic CO2 insufflator, B - (7) as in A except the CO2 gas was changed by compressed air, and C - (11) abdomen insufflation was obtained with compressed air directly from hospital pipe network system. Intra-abdominal pressure in all groups was kept between 12 and 15 mmHg. The laparoscopic procedures performed were distributed proportionally among groups: 20 bilateral nephrectomy, 20 dismembered pyeloplasty and 16 partial nephrectomy. Arterial blood sampling for gasometry was obtained before and 2h after establishment of pneumoperitoneum in 5 pigs of group C. RESULTS: The cost of 25 4,5kg CO2 container used in group A was R$ 3,150.00 (U$ 1,050.00). The mean length time of surgeries in groups A, B and C were respectively: 181±30min, 196±39min e 210±47min (p>0.05). Respiratory alkalosis occurred in 3 out of 5 pigs of group C. No animal exhibited signs of gas embolism or died during surgery. CONCLUSION: The use of compressed air for laparoscopy in pigs was safe, reduced costs and did not require the use of an automatic gas insufflator.

O óxido nítrico atua como neurotransmissor não adrenérgico e não colinérgico na bexiga e na uretra. Sua forma de ação se faz pela ativação da guanilatociclase responsável pela transformação de GMP em GMPc que promove o relaxamento da fibra muscular lisa. O citrato de sildenafil causa aumento do GMPc, através da inibição de fosfodiesterases, que hidrolisam o GMPc. Assim, o objetivo do experimento foi verificar sua ação na uretra. MÉTODOS: Estudou-se 6 ratas com peso aproximado de 200g. A anestesia foi com uretana na dose de 1,25 mg/kg. As cistometrias, em número de 3, foram realizadas através de cistostomia com cateter P50. A primeira logo após a cistostomia; a segunda depois da desnervação cirúrgica da bexiga e a terceira uma hora após a infusão gástrica do citrato de sildenafil. O sistema de registro das pressões constou de uma bomba de infusão contínua regulada para 0,3ml/minuto conectada em Y com o cateter P50 e a um polígrafo Narco-Bioystem. Nas cistometrias avaliou-se as pressões vesicais máxima e mínima nos momentos: normais-(I); desnervadas (II) e desnervadas com citrato de sildenafil na dose de 1 mg/kg (III). A análise estatística foi feita pelo método de Wilcoxon. RESULTADOS: As médias das pressões máximas (pma) foram: momentos I (x=86,6 - SD=10,1) ; momentos II (x=42,6 - SD=15,0) e momentos III (x=30,8 - SD=12,4). As médias das pressões mínimas (pmi) foram: momentos I (x=72,1 - SD=18,9); momentos II (x=31,1 - SD=9,8); momentos III ( x=14,5 - SD=9,5). A análise estatística entre as pma e pmi no mesmo grupo mostrou p< 0,01 para o grupo III, sendo maior que 0,05 para os demais. A comparação das pma revelou p< 0,002 entre os momentos I-II e I-III, sendo maior que 0,05 entre os momentos II e III. A comparação das pmi mostrou p< 0,004 entre os momentos I-II; p< 0,002 entre os momentos I -III e p <0,01 entre os momentos II-III, havendo portanto nível de significância entre os 3 momentos. CONCLUSÕES: 1) A desnervação vesical promove queda nas pressões uretrais máxima e mínima; 2) O Citrato de sildenafil amplia a faixa pressórica de trabalho da uretra devido a diminuição da pressão mínima; 3) O citrato de sildenafil não altera a pressão uretral máxima depois da desnervação.