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Open access

Adrian Maier, Adrian Man, Călin Chibelean, Teodora Cighir, Eniko Nemes-Nagy, Ioana Maier, Ciprian Todea, Oliver Vida and Orsolya Martha

Abstract

Objective: To evaluate the bacteriological features in non-struvite nephrolithiasis and in its associated urinary tract infection, and to establish the relationship between the two pathologies.

Methods: The non-struvite calculi from 132 patients were aseptically extracted by percutaneous nephrolithotomy (PNL). The midstream urine and calculi were bacteriologically and biochemically processed.

Results: Most calculi (78%) were located to renal pelvis, associated with hydronephrosis, the biochemical composition confirming the lack of struvite and revealing the predominance of calcium oxalate. The females presented significantly more colonized calculi (50%) than males (21.9%), with higher bacteriological diversity. There is a significant relation between the presence of colonized calculi and urinary tract infections, 24.2% of calculi and 25.8% of the urine samples presenting positive cultures. In 70.4% of cases, we found the same antibiotic resistance pattern between the pathogens isolated from calculi and urine, thus considering them identical strains. The Enterobacteriaceae represented the most predominant bacteria both from calculi (62.5%) and urine (63.6%), approximatively 30% being resistant to cephalosporins and over 50% resistant to fluoroquinolones, ampicillin and tetracycline. There were 3.8% of cases in which the calculi were colonized but the urine was sterile, the bacteria being sensitive to cephalosporins that are used as prophylaxis.

Conclusions: In all the cases, the same bacterial species was found both in calculi and urine, and 70.4% of them were phenotypically identical. The resistance to the second generation cephalosporins is lower than in the case of other antibiotics, which makes them the most suitable for prophylaxis in PNL.

Open access

A. Maier, O. Vida, A. Szollosi, O. Golea, C. Todea, R. Boja and Orsolya Martha

Abstract

Introduction: One of the most common pathologies in urological praxis is urinary lithiasis. Extracorporeal shock wave lithotripsy (ESWL) or frequently retrograde ureteroscopy are modern pathways in the treatment of this kind of pathology. There are certain problems which may develop after the ureteroscopy such as infection with fever complication.

Material and method: This retrospective study evaluates 164 patients who underwent ureteroscopy treatment over a period of two years (2011-2012). We compared the infection complication episode (with fever) in 33 (20.12%) patients with antibiotic prophylaxis (group A) versus 131 (79.87%) patients without prophylaxis (group B). Antibiotics used for prophylaxis were: amoxicilinum and clavulanic acid, generation I and II cephalosporines.

Results: Twenty-four (14.63%) patients presented postsurgical fever. Most febrile patients were those with grade II hydronephrosis - 16 (66.66%), of which 2 (6.06%) patients from group A and 14 (10.68%) from group B. From group A, 3 (12%) patients with stones below 10 mm had fever, while 18 (14.87%) from group B developed this complication. Among the patients with stones’ size over 10 mm, 1 (14.28) patient from group A and 2 (25%) patients from group B had fever.

Conclusions: Patients undergoing the ureteroscopy treatment should be investigated before the procedures for the presence of bacteria in order to avoid complications like infection associated with fever. Antibiotic prophylaxis may reduce the incidence of postoperative infection in the ureteroscopy treatment.

Open access

Réka Gál, Rodica Bălaşa, Zoltán Bajkó, Smaranda Maier, Iunius Simu and Adrian Bălaşa

Abstract

Giant cell arteritis is a systemic inflammatory vasculitis, typically involving the superficial temporal arteries, but with possible ischemic and hemorrhagic cerebrovascular complications.

The case is reported of a patient with a clinical picture of giant cell arteritis, who had multiple occupational exposures to various infectious agents.

His initial favourable progress was followed by an atypical outcome. Despite immunosuppressive treatment, he developed fatal subarachnoid and intracerebral haemorrhages, possibly due to rupture of a microaneurysm of the posterior cerebral artery.

Open access

Dalila Maier, Adrian Florea, Mariana Cornelia Tilinca, Ancuța Zazgyva and Rodica Cosgarea

Abstract

Introduction: Autosomal recessive congenital ichthyosis is a non-syndromic ichthyosis, with a genetic background of mutations in 9 genes. This case series presents clinical and paraclinical particularities of 3 Romanian ARCI patients with NIPAL4 mutation c.527C>A.

Material and methods: Three Caucasian patients were investigated, two sisters and an unrelated female patient, aged 47, 49, and 42 respectively. Skin anomalies were recorded and documented photographically; peripheral blood samples were harvested for DNA extraction and gene analysis. Skin biopsies were used for histological assessment, electron microscopy, and evaluation of in situ transglutaminase 1 activity.

Results: All patients presented with generalized ichthyosis, palmoplantar keratoderma, normal hair shafts, and significant oral manifestations. Natural evolution was relatively stable in all cases, without phenotype changing. Medical treatment with retinoids in patients 1 and 2 resulted in normalisation of the skin condition.

Histological samples showed hyperkeratosis, acanthosisand perivascular inflammatory infiltrates in the dermis. Positive findings of transglutaminase 1 in situ activity excluded TGM1 deficiency. Direct sequencing of amplicons revealed one homozygous mutation in exon 4, a c.527C>A missense mutation.

Conclusions: This is the first report of the hotspot mutation NIPAL4 c.527C>A in Romanian autosomal recessive congenital ichthyosis patients. The phenotype was similar to that reported in the literature, while transglutaminase 1 activity in situ assay detected differences in enzyme distribution between patients bearing the same mutation but different phenotypes. Based on the current data, NIPAL4 mutations are more frequent than TGM1 mutations in Romanian patients with autosomal recessive congenital ichthyosis.

Open access

Maier Smaranda, Stirbu Nicoleta, Bajko Zoltan, Moţăţăianu Anca, Ţilea Brânduşa, Alexandrescu Adrian and Bălaşa Rodica

Abstract

The clinical manifestations of Lyme disease are protean. The meningoradiculitis is a common and well-recognized complication of neuroborreliosis but can be easily misdiagnosed without a high degree of clinical suspicion, mainly if the tick bite is not present in the medical history. We report two cases of Lyme meningoradiculitis with excellent outcome after appropriate antibiotic therapy. In an endemic area in case of neurological manifestations suggestive for neuroborreliosis the serological testing for B. burgdorferi in serum and cerebrospinal fluid is imperative for the correct diagnosis.

Open access

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Veronica Ghirca and Orsolya Mártha

Abstract

Introduction and objectives: Percutaneous nephrolithotomy represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of all procedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years.

Material and methods: A retrospective study was performed for a period of 16 years (1997-2012). A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 and with renal stones They were treated endoscopically by percutaneous nephrolithtomy or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary.

Results: Overall status of “stone free” at the end of surgery was present in 263 patients (81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new percutaneuos nephrolithtomy session, spontaneous elimination or extracorporeal shock wave lithotripsy. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary.

Conclusions: Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity of stones directly influences the state “stone free” at the end of surgery.

Open access

Attila Szollosi, Orsolya Martha, Lorand Denes, Arpad Oliver Vida, Adrian Maier and Zoltan Pavai

Abstract

Introduction: Prostate cancer is the second most diagnosed cancer in men, after lung cancer. The gold standard procedure in prostate cancer (PCa) diagnosis is the ultrasound guided prostate biopsy. Transurethral resection of the prostate (TURP) used in solving the bladder outlet obstruction, can have a role in detection of PCa. The aim of this retrospective study is to examine the role of transurethral resection of the prostate in the diagnosis and therapy of prostate cancer.

Materials and methods: At the Urology Clinic of Targu Mures we performed a total of 474 TURP over a two year period (2011-2013). The patients had a mean age of 71.857 years, and the indications were PCa with bladder outlet obstruction or bladder outlet obstruction with unknown causes but some with suspicion of PCa.

Results: In case of 474 patients with TURP performed for bladder outlet obstruction, the histopathology findings were the following: 61 cases with newly diagnosed PCa, some in spite of normal PSA values, 23 cases with already hormone treated prostate cancer, while in 50 cases TURP was preceded by prostate biopsy (in 8 cases with increased PSA and several negative biopsies, we could confirm PCa of the peripheral zone of the prostate).

Conclusion: TURP remains the elective surgical therapy of the bladder outlet obstruction, caused by BPH and even prostate cancer. Obtaining a greater volume of prostate tissue can help in the detection of prostate cancer in its early stages, especially in the transitional zone.

Open access

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Oliver Vida and Orsolya Mártha

Abstract

Introduction: The objective of this study is to evaluate the efficacy and safety of PCNL as a method of treatment of renal stones in elderly patients.

Material and method: This was a retrospective study conducted over a period of 5 years in the Clinic of Urology, where we analyzed the surgical protocols and case reports of 56 patients who underwent PCNL intervention.

Results: The incidence of urolithiasis was higher in females 69.6% (n = 39) than in males 30.4% (n = 17). Comorbidities included hypertension (48.2%), chronic ischemic cardiopathy (28.6%), chronic cardiac failure (16.1%), type II diabetes (17.9%), obesity (39.3%), chronic renal failure (8.9%), chronic or recurrent urinary tract infections (30.4%), history of kidney stones (21.4%), solitary kidney surgery (1.8%), renal malformation (horseshoe kidney and renal incomplete duplication) (3.6%), urethral stricture (3.6%). Nine patients had a duble “J” catheter inserted on admission. The group of male patients presented prostate hyperplasia in 35.3% of the cases and prostate carcinoma in 5.9% of the cases.

Conclusions: PCNL is an effective and safe treatment of kidney stones in elderly patients, with a stone- free rate increased despite existing comorbidities. The presence of comorbidities requires careful preoperative evaluation. PCNL in elderly patient has similar results to those seen in younger patients.