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Resume But La prostatite aigue represente la principale complication des biopsies prostatiques (BP); elle necessite parfois une hospitalisation et un traitement antibiotique adapte. Ce travail a etudie les germes en cause pour suggerer une antibiotherapie probabiliste. Patients et methodes L’etude retrospective (de 2000 a 2006) dans 2 centres a inclus les 17 patients ayant ete hospitalises pour prostatite aigue apres BP sur 1216 biopsies. Une documentation bacteriologique a ete realisee avec urocultures, hemocultures, identification du germe et antibiogramme. Resultats Tous les patients avaient eut une antibioprophylaxie par une fluoro-quinolone systemique monodose prise au moins 1 h avant la BP. L’identification des bacteries a ete possible dans quatorze cas: E.Coli (neuf cas), Proteus mirabilis (un cas), Klebsiella pneumoniae (un cas), Enterococcus fecalis (un cas), Staphylococcus Spp (un cas), Clostridium Perfringens (un cas). L’ECBU uniquement a ete positif dans 6 cas (35%), les hemocultures uniquement dans 3 cas (17%), urocultures et hemocultures positives et concordantes dans 5 cas (29%). Une haute resistance de l’E.Coli pour les fluoro-quinolones a ete retrouvee dans 88% des cas et pour cotrimoxazole dans 77% des cas. Par contre le germe etait sensible aux cephalosporines de deuxieme et troisieme generation (C2G et C3G) et a l’amikacine dans 100% des cas. La prostatite a ete associee a une orchi-epididymite (3 cas), une retention aigue d’urines (4 cas) et une endocardite d’Osier (1 cas). Conclusions Devant une prostatite aigue apres biopsie, l’identification du germe necessite obligatoirement la realisation d’hemocultures associees a l’ECBU. Le traitement antibiotique probabiliste est base sur l’utilisation d’une C2G ou C3G, associee ou non avec l’amikacine selon l’intensite du tableau clinique.

Patients with renal cell carcinoma (RCC) can exhibit fever, weight loss and increases in acute phase proteins. Interleukin (IL)-1, tumour necrosis factor (TNF) and IL-6 are considered major mediators of local and systemic inflammation. We measured plasma IL-1 beta, TNF-alpha (immunoradiometric assay) and IL-6 (ELISA) in 78 consecutive patients with untreated RCC and in 56 normal subjects. IL-6 plasma levels were higher in patients with RCC (mean 24.2 pg/ml, 11.1-37.3, 95% confidence interval) than in normal subjects (11.6 pg/ml, 10.1-13.1, n = 39, P0.01). The patients with fever or weight loss had higher blood levels of IL-6. IL-6 blood levels were also higher in patients with lymph node invasion and/or distant metastases (94.7 pg/ml, 39.0-150.4, n = 15) than in patients with undisseminated RCC (7.4, 4.1-10.7, n = 63, P0.0001). An abnormal IL-6 plasma value (40 pg/ml) had a positive predictive value of 91.0% for lymph node and/or metastatic spread of RCC. IL-6 was statistically correlated with C-reactive protein (nephelometric assay) blood values r' = 0.67, n = 78, P0.001). The TNF-alpha and IL-1 beta levels were not significantly different in patients with or without fever or weight loss. The plasma levels of the three cytokines were not correlated with the size of the primary tumour. An increased plasma value of IL-6 is a good marker for tumour dissemination in patients with untreated RCC.

This report reviews the authors' experience in diagnosing and managing 17 consecutive patients with inflammatory abdominal aortic aneurysm (AAA). Among 491 patients undergoing repair for AAA during a 10-year period, 17 (3%) had evidence of associated periaortic fibrosis, which was confirmed histologically. No patient had acute rupture, and two patients (12%) had chronic contained rupture. Ureteral obstruction was evident in seven patients. In 41% of the patients, available surgical correlation demonstrated that computed tomographic (CT) scan accurately delineated the extent of the disease. Sixteen patients underwent aneurysm resection. Ureteral obstruction was relieved by ureterolysis in three patients treated early in this series. In the last period of the study, well-documented hydronephrosis spontaneously subsided in two patients without special treatment. Of these 17 patients, 15 (88%) were early (30-day) survivors. There were two late deaths at 2 months and 5 years; 12 (71%) patients are still alive and free of symptoms up to 10 years after operation. On the basis of our study, we conclude the following: (1) precise preoperative diagnosis and detailed anatomic information are widely available with CT; (2) aneurysm resection is the treatment of choice because the risk of rupture still exists, and this procedure seems to reverse the inflammatory process; (3) good early and late results can be expected with proper surgical technique; and (4) routine follow-up with CT is recommended to document resolution or progression of the fibrotic process after aneurysm resection.

Eighteen self-expandable metal prostheses inserted for the treatment of recurrent urethral strictures produced excellent clinical results in 13 of 17 patients after a mean follow-up of 9 months. Tw...

Acute prostatitis is the main complication of prostatic biopsies (PB) and sometimes requires hospitalisation and appropriate antibiotic therapy. This study evaluated the pathogens responsible and proposes a statistically adapted empirical antibiotic therapy.This retrospective (from 2000 to 2006) two-centre study included 17 patients hospitalised for acute prostatitis after PB in a series of 1,216 biopsies. Bacteriological documentation was based on urine cultures, blood cultures, identification of bacteria and antibiotic susceptibility testing.All patients received prophylactic antibiotics with a single dose of systemic fluoroquinolone at least 1 h before PB. Bacterial identification was possible in fourteen cases: E. coli (nine cases), Proteus mirabilis (one case), Klebsiella pneumoniae (one case), Enterococcus faecalis (one case), Staphylococcus Spp (one case), Clostridium perfringens (one case). Only urine culture was positive in 6 cases (35%), only blood culture was positive in 3 cases (17%), and urine cultures and blood cultures were positive and concordant in 5 cases (29%). A high rate of resistance of E. coli to fluoroquinolones was observed in 88% of cases and to cotrimoxazole in 77% of cases. However, the strain was susceptible to second and third generation cephalosporins (2GC and 3GC) and amikacin in 100% of cases. Prostatitis was associated with epididymo-orchitis (3 cases), acute urinary retention (4 cases) and infective endocarditis (1 case).Identification of the micro-organism responsible for acute prostatitis after biopsy requires a combination of blood cultures and urine cultures. Empirical antibiotic therapy is based on the use of 2GC or 3GC, alone or in combination with amikacin depending on the severity of the clinical features.