Home About us Contact
|
Home About us Contact | ||
|
|
||
Transrectal Ultrasound (transrectal + ultrasound)
Selected AbstractsPrimary melioidotic prostatic abscess: Presentation, diagnosis and managementANZ JOURNAL OF SURGERY, Issue 6 2002James K. Tan Introduction:, In South-East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community-acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare. Methods:, The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study. Results:, The mean age at presentation was 53 years (range: 29,69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re-resection while another patient developed severe septic shock requiring intensive care and inotropic support. There was no mortality in our series. Conclusions:, Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome. [source] 65 Multi-resistant Escherichia coli septicaemia following transrectal ultrasound guided prostate biopsy , an emerging riskBJU INTERNATIONAL, Issue 2006A.-J. DAVIDSON Introduction:, Transrectal ultrasound (TRUS) guided biopsy of the prostate is the standard procedure for diagnosing prostate carcinoma. Complications range from discomfort and bleeding to asymptomatic bacteruria and sepsis. Rarely, sepsis is fatal. E. coli is the most common pathogen causing infection and although no international standard for the use of prophylactic antibiotics exists their use has decreased the incidence of infection to around 2%. Worldwide the incidence of multi-resistant E. coli (MREC) is increasing, and we report two cases of septicaemia secondary to MREC infection postprostate biopsy. Methods:, We performed a review of case records involving postprostate biopsy MREC infection. A comprehensive literature review of TRUS guided biopsy of the prostate was also performed. Results:, All patients in our series had MREC cultured following TRUS guided biopsy of the prostate. All received the same prophylactic antibiotic regime (norfloxacin and gentamicin). They required admission to hospital for intravenous antibiotics and in two cases inotropic support, eventually making full recoveries. All had a history of recent travel to a developing country whilst two had self-limiting diarrhoea and this is the first report in the English literature of MREC following prostate biopsy. Other risk factors for acquiring multi-resistant urinary tract infections have been identified including age and previous quinolone therapy. Conclusion:, Antibiotic prophylaxis for biopsy of the prostate, being predominantly quinolones, will continue to aid in reducing morbidity. However, with the prevalence of MREC increasing current regimens will not cover such organisms potentially leading to sepsis. In our cases travel to developing countries appeared to be a risk factor for being colonised with MREC. We believe through careful history risk factors for multi-resistant urinary tract infection including travel may alert doctors to the potential risk of MREC at the time of biopsy leading to the addition of a broader spectrum antibiotic such as intravenous meropenem. [source] High levels of serum prostate-specific antigen due to PSA producing follicular non-Hodgkin's lymphomaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2007Jan Jelrik Oosterheert Abstract Objective:, Both carcinoma of the prostate and non-Hodgkin's lymphoma are common in elderly patients. Measurement of serum prostate-specific antigen (PSA) is a frequently used tool to diagnose and monitor prostate carcinoma and is generally specific for diseases of the prostate. Case:, We describe a 68-yr-old patient with voiding difficulties and high PSA levels, but without inflammatory or malignant changes upon multiple transrectal ultrasound guided prostate biopsies. Digital rectal examination was normal. Laboratory showed a strongly elevated PSA level (62 ,g/L, Immulight 2000®; DPC, USA). A CT-scan showed a retroperitoneal process with mass in the right pelvis and infiltration of the bladder wall, suggestive for metastatic prostate carcinoma. Surgical excision of an axillary lymph node set the diagnosis at a stage IV follicular lymphoma, Berard grade I to II in which the majority of neoplastic cells expressed PSA. After lymphoma-specific treatment, there was a positron emission tomography (PET) confirmed complete remission with normal PSA levels (6 ,g/L), which still persists. Conclusion:, Although rare, high PSA levels can be due to the presence of non-Hodgkin's lymphoma. Such a diagnosis should be considered when patients present with lymphadenopathy other than regional prostatic lymphadenopathy. [source] Caudal analgesia for prostate biopsyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010M. CESUR Background: Although various local anesthesia techniques have been suggested to decrease pain and discomfort during a transrectal ultrasound (TRUS)-guided prostate biopsy, the best method has not yet been defined. The present prospective, double-blind, randomized study aims to investigate the clinical efficacy of ,walking' caudal block compared with an intrarectal lidocaine gel for this procedure. Methods: One hundred patients were randomly assigned to two groups. In the lidocaine gel group, 10 ml of gel containing 2% lidocaine was given intrarectally. In the caudal group, 20 ml 0.1% bupivacaine with 75 ,g fentanyl was injected. Pain scores, anal sphincter tone and patient satisfaction were evaluated. Results: The pain scores were significantly lower in the caudal group at all stages. Verbal rating scores (scale 1,4) during probe insertion, probe maneuver and biopsies were 1 (0,2), 1 (0,2) and 1 (0,2) vs. 3 (0,5), 2 (1,3) and 4 (2,6), respectively (P value <0.0001 at all stages). The anal sphincter was more relaxed in the caudal group than in the gel group (P value <0.0001 in all categories). Highly satisfied patients were more frequently encountered in the caudal group, 34 (68%) vs. 8 (16%), P<0.0001, and unsatisfied patients were more frequently found in the gel group 1 (2%) vs. 12 (24%); P<0.001. All patients were able to walk without any assistance immediately after the procedures. Conclusion: ,Walking' caudal analgesia is an efficacious method for relieving the pain during TRUS-guided prostate biopsies in ambulatory practice. [source] Comparison of prostate and transition zone volume measured by the ellipsoid and planimetric methods with transrectal ultrasonography before seed implantation of prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2008Tetsuhiro Ikeda Abstract: A total of 122 men who were diagnosed with localized prostatic cancer underwent transrectal ultrasound and the volumes of their prostates and transitional zones were obtained using the planimetric method and the ellipsoid method. Mean age was 64.2 ±13.4 (48.2,85.8), and mean preimplant prostate specific antigen was 6.01 ± 2.35 mg/mL (0.92,15.5). The clinical stage was T1c in 70 patients, T2a in 46 and T2b in 6. Prostatic volumes and transitional zone volumes obtained by the planimetric method were 18 % and 39% greater than those obtained by the ellipsoid method, respectively. There were significant differences between the volumes obtained by the two different methods. However, there was a good correlation between the prostatic volume and the transitional zone volume obtained by both the ellipsoid method (r = 0.851) and the planimetric method (r = 0.908). The regression line of the prostate volume between these two methods was calculated as Value of power Doppler sonography with 3D reconstruction in preoperative diagnostics of extraprostatic tumor extension in clinically localized prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2008Miroslav Zalesky Aim: The aim of the study is to investigate the value of preoperative power Doppler sonography with 3D reconstruction (3D-PDS) for diagnostics of extraprostatic extension of prostate cancer. Patients and Methods: In the prospective study we examined 146 patients with clinically localized prostate cancer who underwent radical prostatectomy. Prior to surgery, each patient underwent 3D-PDS, transrectal ultrasound (TRUS), and digital rectal examination (DRE). Furthermore, we determined the prostate volume, prostate specific antigen (PSA) level, PSA density (PSAD), and Gleason score. The risk of locally advanced cancer was assessed using Partin tables. We determined the sensitivity, specificity, and predictive values of these diagnostic procedures. We plotted the receiver operating characteristic (ROC) curves and calculated the areas under the curves (AUC). Multivariate logistic regression was used to identify the significant predictors of extraprostatic tumor extension. Based on this we developed diagnostic nomograms maximizing the probability of accurate diagnosis. Results: The significant differences between patients with organ confined and locally advanced tumor (based on the postoperative assessment) were observed in the PSA levels (P < 0.014), PSAD (P < 0.004), DRE (P < 0.037), TRUS (P < 0.003), and 3D-PDS (P < 0.000). The highest AUC value of 0.776 (P < 0.000) was found for 3D-PDS. The observed AUC value for TRUS was 0.670 (P < 0.000) and for PSAD 0.639 (P < 0.004). In multivariate regression analysis, the PSAD, preoperative Gleason score, and 3D-PDS finding were identified as significant preoperative predictors of extraprostatic tumor extension. Conclusion: Our data suggest that the 3D-PDS is a valuable preoperative diagnostic examination to identify locally advanced prostate cancer. Therefore, it can be used to maximize the probability of the accurate diagnosis of extraprostatic tumor extension. [source] Granulomatous cryptococcal prostatitis diagnosed by transrectal biopsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2006ILL YOUNG SEO Abstract, Cryptococcal infection primarily involves the lung and is hematogenously spread to other organs. Sometimes it might affect the genitourinary tract, and rare cases have been reported involving the prostate without systemic infection. We report a case of granulomatous prostatitis as a result of Cryptococcus neoformans yeast in an immunocompromised patient with alcoholic liver cirrhosis, which was diagnosed by transrectal ultrasound guided biopsy and treated with antifungal medication. [source] Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2003SOO-JEON PARK AbstractBackground: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. Methods: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. Results: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. Conclusion: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS. [source] Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsyJOURNAL OF CLINICAL ULTRASOUND, Issue 2 2008Ahmet T. Turgut MD Abstract Purpose To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy. Methods A total of 200 patients receiving 10 cm3 (5 cm3 on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection. Results The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001). Conclusion TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Use of transrectal ultrasound-guided biopsy in the diagnosis of pelvic malignanciesJOURNAL OF CLINICAL ULTRASOUND, Issue 9 2006Ludwig Rinnab MD Abstract Purpose. To describe our experience with transrectal ultrasound (TRUS)-guided needle biopsy of pelvic malignancies. Methods. Eleven patients with clinical suspecion of advanced malignant pelvic tumor were referred to our institution with a history of unsuccessful CT-guided biopsy, although a target lesion was demonstrated on pelvic CT or MRI. Cholin-PET and FDG-18-PET were also obtained individually in each patient. TRUS was performed using a commercially available three-dimensional scanner. Biopsies were performed with an 18G biopsy gun. In 9 of 11 patients, biopsy was successfully performed under analgesia, whereas general anesthesia was required in the other 2 patients. Results. The lesions were identified with TRUS in all patients, and biopsies were taken successfully under TRUS guidance. In all patients, the harvested material was of excellent quality and was adequate for definitive pathological diagnosis. Pathological results included 6 nodal metastases from transitional cell carcinoma, 1 case of lymph node metastasis from prostate cancer, 1 paravesical recurrence of cervical cancer, 1 metastasis from cecal cancer, and 2 cases of paravesical metastasis of a gastric cancer. Conclusion. TRUS-guided biopsy is a useful technique for the diagnosis of pelvic malignancies. It is faster and less expensive than CT-guided biopsy, and in most cases sufficient material can be harvested for a definitive pathological diagnosis. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound, 2006 [source] Evaluation of lactate and alanine as metabolic biomarkers of prostate cancer using 1H HR-MAS spectroscopy of biopsy tissuesMAGNETIC RESONANCE IN MEDICINE, Issue 3 2008May-Britt Tessem Abstract The goal of this study was to investigate the use of lactate and alanine as metabolic biomarkers of prostate cancer using 1H high-resolution magic angle spinning (HR-MAS) spectroscopy of snap-frozen transrectal ultrasound (TRUS)-guided prostate biopsy tissues. A long-echo-time rotor-synchronized Carr-Purcell-Meiboom-Gill (CPMG) sequence including an electronic reference to access in vivo concentrations (ERETIC) standard was used to determine the concentrations of lactate and alanine in 82 benign and 16 malignant biopsies (mean 26.5% ± 17.2% of core). Low concentrations of lactate (0.61 ± 0.28 mmol/kg) and alanine (0.14 ± 0.06 mmol/kg) were observed in benign prostate biopsies, and there was no significant difference between benign predominantly glandular (N = 54) and stromal (N = 28) biopsies between patients with (N = 38) and without (N = 44) a positive clinical biopsy. In biopsies containing prostate cancer there was a highly significant (P < 0.0001) increase in lactate (1.59 ± 0.61 mmol/kg) and alanine (0.26 ± 0.07 mmol/kg), and minimal overlap with lactate concentrations in benign biopsies. This study demonstrates for the first time very low concentrations of lactate and alanine in benign prostate biopsy tissues. The significant increase in the concentration of both lactate and alanine in biopsy tissue containing as little as 5% cancer could be exploited in hyperpolarized 13C spectroscopic imaging (SI) studies of prostate cancer patients. Magn Reson Med 60:510,516, 2008. © 2008 Wiley-Liss, Inc. [source] Transrectal ultrasound-guided biopsy of prostate voxels identified as suspicious of malignancy on three-dimensional 1H MR spectroscopic imaging in patients with abnormal digital rectal examination or raised prostate specific antigen level of 4,10 ng/mlNMR IN BIOMEDICINE, Issue 1 2007Virendra Kumar Abstract Results of the evaluation of transrectal ultrasound (TRUS) guided needle biopsy of voxels identified as suspicious of malignancy on magnetic resonance spectroscopic imaging (MRSI) in a large cohort of men (n,=,83) with abnormal digital rectal examination (DRE) [prostate specific antigen (PSA) 0,4,ng/ml] or PSA less than 10,ng/ml, are reported. Three-dimensional 1H MRSI was carried out at 1.5 T using a pelvic-phased array coil in combination with an endorectal surface coil. Voxels were classified as suspicious of malignancy based on Cit/(Cho,+,Cr) metabolite ratio. TRUS-guided biopsy of suspicious voxels was performed using the z - and x -coordinates obtained from MR images and two to three cores were taken from the suspected site. A systematic sextant biopsy was also carried out. MRSI showed voxels suspicious of malignancy in 44 patients while biopsy revealed cancer in 11 patients (25%). Patients who were negative for malignancy on MRSI were also negative on biopsy. An overall sensitivity of 100%, specificity of 54%, negative predictive value of 100% and accuracy of 60% were obtained. The site of biopsy was confirmed (n,=,20) as a hypo-intense area on repeat MRI while repeat MRSI revealed high choline and low citrate. The overall success rate of MRI-directed TRUS-guided biopsy of 25% was higher compared with a 9% success rate achieved without MR guidance in another group of 120 patients. Our results indicate that TRUS-guided biopsy of suspicious area identified as malignant from MRSI can be performed using the coordinates of the voxel derived from MR images. This increases the detection rate of prostate cancer in men with PSA level <10,ng/ml or abnormal DRE and also demonstrates the potential of MR in routine clinical practice. Copyright © 2006 John Wiley & Sons, Ltd. [source] ,Multimodal' approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium , a prospective randomized trialANDROLOGIA, Issue 1 2010T. Aktoz Summary We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function. Ninety patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate and were randomly assigned to three groups: group D received diclofenac sodium suppository; Group L received periprostatic injection of levobupivacaine; group DL received diclofenac suppository and levobupivacaine in addition. Patients were asked to use a visual analogue scale score (VAS) questionnaire about pain after 10 core prostate biopsy. Sixty-two patients reported to be prostate cancer-free underwent further evaluation with the International Index of Erectile Function-5 (IIEF-5) questionnaire at 1 and 3 months after biopsy. Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D (P < 0.001). Mean IIEF-5 score prior to biopsies was significantly higher when compared with the mean IIEF-5 score 1 month after biopsy (P < 0.0001). Mean IIEF-5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF-5 scores 3 months after biopsy (P = 0.002). TRUS-guided prostate biopsies have a statistically significant impact on short-term erectile function, but this difference is not clinically significant; however, medium-term erectile function is not affected both statistically and clinically. [source] Inflammatory-associated obstructions of the male reproductive tractANDROLOGIA, Issue 5 2003G. R. Dohle MD Summary. A history of urogenital inflammation occurs in 5,12% of men attending infertility clinics. Usually, infection has a detrimental effect on sperm quality by reducing concentration and motility, and possibly affecting the number of morphological normal spermatozoa. In addition, infection may be the source of auto-antibodies against spermatozoa, found in about 8% of the infertile male population. In contrast to the situation in women, there is no clear evidence that male accessory gland infections can result in epididymal blockage or vassal obstruction, with the exception of genital tuberculosis. Although Chlamydia trachomatis is a well-documented source of chronic prostatitis, the infection does not seem to cause obstruction of the reproductive tract, as it does in women. If male urogenital infection causes obstruction it is most likely located at the level of the ejaculatory ducts. Chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts, resulting in low seminal volume with low fructose and alpha-glucosidase. Many of these men present with severe oligozoospermia or azoospermia, normal size testis and normal gonadotrophins. We performed an excisional testicular biopsy in all men presenting with <1 million spermatozoa per millilitre and found that 39 of 78 (50%) had a normal spermatogenesis. A history of male accessory genital infection was found in 12% of the men and 10% had abnormalities found on transrectal ultrasound of the prostate (like oedema, dilatation of the seminal vesicles and ejaculatory ducts) intraprostatic calcifications and dilatation of the periprostatic venous plexus. Ejaculatory duct obstruction is a common cause of male infertility and infections are present in at least 22,50% of these men. Transurethral resection of the ejaculatory ducts may result in a significant improvement of the sperm quality and in spontaneous pregnancies in up to 25% of the couples. In case of failure sperm aspiration from the epididymis and intracytoplasmic sperm injection is the treatment of choice. [source] Primary melioidotic prostatic abscess: Presentation, diagnosis and managementANZ JOURNAL OF SURGERY, Issue 6 2002James K. Tan Introduction:, In South-East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community-acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare. Methods:, The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study. Results:, The mean age at presentation was 53 years (range: 29,69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re-resection while another patient developed severe septic shock requiring intensive care and inotropic support. There was no mortality in our series. Conclusions:, Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome. [source] In this issue , August 2009AUSTRALIAN VETERINARY JOURNAL, Issue 8 2009A Jackson Editor in Chief Post-weaning mortality of Merino sheep , Transcutaneous ultrasound over the right flank for pregnancy diagnosis in cows , Right flank transcutaneous vs transrectal ultrasound for pregnancy diagnosis in cows , Ultrasound of soft tissue tumours in dogs , Idiopathic hypereosinophilic syndrome in a Rottweiler , Toxicity from accidental oral dosing of a topical endectocide , Scrub-itch mite in an endangered wallaby , Cerebellar cortical degeneration in a koala [source] Comparison of transcutaneous ultrasound over the right flank with transrectal ultrasound for pregnancy diagnosis in the dairy cowAUSTRALIAN VETERINARY JOURNAL, Issue 8 2009JC Hunnam Objective Evaluate the sensitivity and specificity of transrectal ultrasound and transcutaneous ultrasonography across the right flank between days 31 and 196 of pregnancy in the dairy cow. Procedure Pregnancy status and stage of gestation at date of pregnancy diagnosis by transcutaneous and transrectal ultrasonography were determined for 1570 dairy cattle. Sensitivity and specificity values and probabilities of a correct diagnosis for both techniques were determined and compared. Possible effects of gestational age, herd, method of transcutaneous ultrasound diagnosis, cow age, cow and bull breed, and calf sex on the determination of a correct diagnosis of pregnancy status were evaluated for both techniques. Results The overall sensitivity and probability of a correct diagnosis of pregnancy status from days 31 to 196 of gestation were significantly higher when using transrectal ultrasound relative to transcutaneous ultrasound over the right flank. However, the sensitivity of transcutaneous ultrasound changed over the course of pregnancy: it was low (7,8%) before day 84, increased to 89% between days 141 and 154, and was close to 100% thereafter. The specificity of both methods did not differ significantly. Herd and gestational age at date of pregnancy diagnosis were significantly associated with making a correct test result using transcutaneous ultrasound, although only the latter predictor was significantly associated with making a correct test result using transrectal ultrasound. Conclusion Transcutaneous ultrasound can not be recommended as an accurate method for early pregnancy diagnosis in the dairy cow, particularly on a whole-herd basis. However, if pregnancy testing is undertaken in mid to late gestation, this technique could provide an accurate and rapid alternative to transrectal ultrasound or manual palpation per rectum. [source] 65 Multi-resistant Escherichia coli septicaemia following transrectal ultrasound guided prostate biopsy , an emerging riskBJU INTERNATIONAL, Issue 2006A.-J. DAVIDSON Introduction:, Transrectal ultrasound (TRUS) guided biopsy of the prostate is the standard procedure for diagnosing prostate carcinoma. Complications range from discomfort and bleeding to asymptomatic bacteruria and sepsis. Rarely, sepsis is fatal. E. coli is the most common pathogen causing infection and although no international standard for the use of prophylactic antibiotics exists their use has decreased the incidence of infection to around 2%. Worldwide the incidence of multi-resistant E. coli (MREC) is increasing, and we report two cases of septicaemia secondary to MREC infection postprostate biopsy. Methods:, We performed a review of case records involving postprostate biopsy MREC infection. A comprehensive literature review of TRUS guided biopsy of the prostate was also performed. Results:, All patients in our series had MREC cultured following TRUS guided biopsy of the prostate. All received the same prophylactic antibiotic regime (norfloxacin and gentamicin). They required admission to hospital for intravenous antibiotics and in two cases inotropic support, eventually making full recoveries. All had a history of recent travel to a developing country whilst two had self-limiting diarrhoea and this is the first report in the English literature of MREC following prostate biopsy. Other risk factors for acquiring multi-resistant urinary tract infections have been identified including age and previous quinolone therapy. Conclusion:, Antibiotic prophylaxis for biopsy of the prostate, being predominantly quinolones, will continue to aid in reducing morbidity. However, with the prevalence of MREC increasing current regimens will not cover such organisms potentially leading to sepsis. In our cases travel to developing countries appeared to be a risk factor for being colonised with MREC. We believe through careful history risk factors for multi-resistant urinary tract infection including travel may alert doctors to the potential risk of MREC at the time of biopsy leading to the addition of a broader spectrum antibiotic such as intravenous meropenem. [source]
| | |||||||||||||||||||||