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Accelerated atherosclerosis and cardiovascular diseases are frequent complications in hypertensive patients with chronic kidney disease (CKD), being mainly driven by cardiovascular risk factors as lipid disorders and an unfavorable blood pressure profile. The objectives of the study were to evaluate the lipid profile and to assess the characteristics of blood pressure (BP) in patients with primary arterial hypertension associating chronic kidney disease (CKD) in a primary care population in Timis County, Romania. Lipid disorders were highly prevalent in hypertensive patients with CKD, consisting in hyper LDL-cholesterolemia in 50.3%, hypertriglyceridemia in 52%, low HDL-cholesterol levels in 35.8%. More than 2 lipid abnormalities were present in 68.8% of CKD hypertensive. CKD hypertensive patients, compared with those without CKD, presented a BP profile with higher systolic and diastolic office BP. On ambulatory blood pressure monitoring they also registred higher systolic and diastolic BP, the systolic BP (SBP), both for 24 h SBP, day-time and night-time SBP being statistically significant higher than in hypertensive patients without CKD. The circadian 24 h BP profile demonstrated in the CKD hypertensive population an unfavourable nocturnal profile in 67%, consisting of a high prevalence of the non-dipping profile and of nocturnal riser pattern.

Organ damages, which contribute to the overall cardiovascular risk of hypertensive patients, should be early detected, prevented and treated. The study evaluated organ damage in a hypertensive study group with chronic kidney disease (CKD), compared with a study group of hypertension without CKD. Albuminuria was present in 41.2% and reduced estimated glomerular filtration rate [60 ml/min/m2 was present in 72.5% of hypertensive with CKD. The comparison of organ damage revealed in the CKD group a statistical significant higher prevalence of organ damage as follows: intima-media thickness ]0.9 mm in 39.9% vs 10.5%, carotid plaques in 28.2% vs 12.6%, left ventricular hypertrophy in 39.9% vs 31%, ankle brachial index in 6.2% vs 3.5%. Early detection and treatment of additional cardiovascular risk factors as dyslipidaemia and hyperglycaemia, that have significant role in the pathogenesis of organ damage, contribute to the better prevention of cardiovascular and renal complications in hypertension with CKD.

Hypertension has been recognized as an important cause of chronic kidney disease (CKD). As the most important part of the hypertensive patients are managed in primary care, implementation of routine early detection of CKD by determination of albuminuria and the estimated glomerular filtration rate (eGFR) at this level is essential for diagnosis and prevention. The present study demonstrated that prevalence of chronic kidney disease in hypertensive patients was 13.32%, being higher in female than men, with old age and in the presence of diabetes mellitus and associated cardiovascular diseases. The reduction of the eGFR depended significant statistically on age, gender and presence of diabetes mellitus, while albuminuria depended on the presence of diabetes and old age. Early detection of CKD in hypertensive patients permits optimal treatment of cardiovascular risk factors, especially concerning the reduction of high blood pressure, therapy with renin-angiotensin system blockers in order to reduce albuminuria and the progression of eGFR decline and treatment of hyperlipidaemia.

Purpose We report an outbreak of urinary tract infections (UTIs) caused by Myroides odoratimimus, which occurred in the largest clinical hospital in western Romania. Patients and methods From June to August 2017, four strains of M. odoratimimus were isolated from the urine samples of patients hospitalized in the urology, diabetes, and surgery departments. Hospital records of all patients whose urine cultures were positive for M. odoratimimus were reviewed retrospectively. We also reviewed the cases reported in the literature. Results All UTIs, except one, were hospital-acquired infections. All patients with M. odoratimimus UTIs were immunocompromised. Three patients underwent urinary catheterization with a Foley's catheter upon admission in the emergency department and one presented for replacement of ureterostomy tubes. All Myroides isolates were resistant to almost all the tested antibiotics. Two patients were successfully treated with tigecycline and one was receiving antimicrobial treatment for another infection at the time of isolation of the microorganism. Conclusion Although M. odoratimimus is an uncommon pathogen, clinicians should be aware of its ability to cause UTI outbreaks, especially in the immunocompromised population. Due to its multi-drug resistance, it is important to rapidly identify Myroides spp. in order to choose the best treatment regimen.

A new method for a differential diagnosis of focal liver lesions (FLL), using cellular neural networks (CNN), intended to develop a computer assisted diagnosis (CAD) procedure, is presented. Two types of lesions with a known typical behavior were selected for the CNN image processing. The database consisted of 20 cases of video recordings of contrast enhancement ultrasound (CEUS) examination. The images processed by the CNN algorithm were selected by ultrasound experts. The images resulted from the CNN processing were accurate and characteristic enough to make possible an instant differential diagnosis between hemangioma and hepatocellular carcinoma.

To assess the effect of the intravesical protrusion of the prostate (IPP) on the response to medical treatment with tamsulosin for a 3 month period.The study, which was conducted between 2009 and 2011 in the ambulatory clinic of an academic hospital, divided 183 patients with lower urinary tract symptoms due to benign prostatic obstruction in 2 groups (90 and 93 patients, respectively) according to intravesical prostatic protrusion (IPP): group A ≤10 mm; group B10 mm. Patients were treated with tamsulosin (0.4 mg, once daily) for 3 months. The International Prostate Symptom Score (IPSS; -35% and -3 points) and maximum urinary flow (Qmax) assessed by uroflowmetry (+1.6 mL/s and +25%) response criteria were defined. Patients' responses from the 2 groups were compared.After 3 months of treatment, Qmax increased, with 2.74 mL/s (25%) in group A (P .01) and 1.59 mL/s (19%) in group B (P = .07). IPSS decreased, with 39.9% (P .01) and 29.7% (P = .08), respectively. Statistically significant differences were noted for IPSS -35% responders (78% group A vs 58% group B, P .01), -3 points IPSS responders (82% vs 64%), Qmax +25% responders (82% vs 58%), and Qmax +1.6 mL/s responders (85% vs 62%, P .01). No major adverse events occurred. The relative small number of patients enrolled was the main study limitation.Men with IPP exceeding 10 mm seem to be more frequently poor responders to medical treatment with tamsulosin among patients with lower urinary tract symptoms due to benign prostatic obstruction, prostatic volume 40 mL, and prostate-specific antigen 1.5 ng/mL.

In this paper the problem of prostatic capsule penetration prediction is approached using artificial neural networks (NN). The neural networks input variables were data carefully selected and preprocessed from the database records of 650 patients treated by radical prostatectomy for prostate cancer. Different NN architectures and algorithms have been tested. A comparison with the performance of the best and most widely used prediction statistical method, the logistic regresion, has been done. In all the cases the NN models performed better than the logistic regression. The model with the best accuracy/complexity ratio was a recurrent NN. The obtained performances of a mean square error of 0.00428 and a global prediction of 96.07% are better than the results of similar experiments available in literature. Yet, in our opinion, the limitations of predicting performance of NN are given by the reduced dimension of the database and by the data gathering methods, therefore could be further improved.

Background and purpose: Choosing the optimal approach of the collecting system is crucial for the success of percutaneous nephrolithotomy (PCNL). We present the experience of 3017 cases performed using radiological approach, ultrasound approach or a combination of these two methods. Patients and methods: PCNL was introduced in our department in 1993, and a number of 3017 procedures were performed until the end of 2007. The ultrasound guided puncture of the kidney is used since 1997 having a growing trend (45% of the cases in 2007 used ultrasound or combined ultrasound and fluoroscopic approach). Without exception, all cases had an ultrasound examination before surgery. Out of the 3017 cases, 2023 (67%) had fluoroscopic approach only (group A), 331 (10.9%) used the ultrasound approach (group B), while other 663 (22.1%) used the combined approach (group C). It it worth mention that in 6 cases the whole procedure was performed exclusively under ultrasound control. In all cases the puncture was performed by the urologist. In 91% of the cases we punctured a postero-inferior calix by a subcostal approach, but middle and upper calix were also used. 97.5% of the cases needed a single nephrostomy, the other needed two and exceptionally three approaches. In some situations a stone was moved from its position in a middle calix into the renal pelvis by pushing it with the punction needle under ultrasound control. Results: Introducing the ultrasound approach reduced the number of failures of PCNL (12.75% in group A, 7.5% in group B and 4.9% in group C). The stone free rate had the same variations (74.17% in group A, 77.59 in group B, 79.1% in group C). The number of serious complications (except those of infectious ethiology) was also smaller in the two groups which used ultrasonography (for example the blood transfusion was needed in 0.8% in group A, 0.3% in group C and in no case in group B). The mean duration of the use of X-rays during the whole procedure was 6.5 minutes in group A and only 3.1 minutes in group C. Conclusions: Ultrasound guidance of the punction offers a better accuracy of this crucial phase of PCNL and gives the possibility to choose the best approach to the stone burden. This reflects in the better stone free rate and the smaller number of complications. An association of ultrasound and fluoroscopic control of the punction seems to have the best results. The use of ultrasound reduces the exposure to X-rays of both the patient and the surgeon

There were investigated 583 cases with tumors of the urinary bladder and 612 patients with non-malignant diseases of the urinary tract. Samples of voided urine were taken from all cases and direct smears fixed by drying were stained by rapid blue polychrome-tanin Drăgan method Cytological results were compared with endoscopical and pathological findings. The overall rate of real positive results was 91.7% and false negative results were noticed in 8.3% of cases. A direct relationship between real positive results and histological "G" was found. Causes for false negative results were: tumor developed in a bladder diverticulum, calcified tumor, irradiated tumor, insufficient quantity of voided urine, chronic urinary infections and underestimation of cytological criteria of cellular malignancy. There were 9 false positive results in patients with nonmalignant diseases, due to lithiasis, chronic renal failure and chronic urinary infections. The cytological grade of differentiation was performed by the method purposed by Friedman and Ash, and concordance with the standard histological finding was 76.4%. Urine cytology is thought to be a useful method in the primary diagnosis and recurrences of transitional cell carcinoma of the urinary bladder, in all patients with hematuria, recurrent infections of the urinary tract and neglected lithiasis.

During 18 months 38 patients with anuria due to lithiasis were admitted in our department, 8 of them developed septic shock. Twenty eight patients were cured using different procedures and were released from the hospital with normal urinary output. Ten patients died, 6 of them from septic shock, which has a high mortality rate. Emergency restoration of urinary flow, correction of fluid and electrolyte imbalance, massive antibiotherapy may improve results.