Clinical outcome of long-term renal transplant survivors: a nephrourologic approach.

BACKGROUND: Long-term renal transplant survivors display high incidences of hypogonadism, neoplasms, erectile dysfunction, and metabolic syndrome. Although the urologist has a major role in the kidney transplantation surgery and treatment of the graft-related surgical complications, the follow-up of these patients is essentially focused on kidney function and the immunosuppressive regimen. We sought to evaluate the role of a nephrourologic follow-up for kidney transplant recipients. METHODS: We evaluated 27 male patients of mean age of 48.1 +/- 7.5 years and mean renal allograft follow-up of 12.3 +/- 4.3 years. The nephrourologic approach consisted of evaluation of the urinary system, prostate cancer screening, and assessment of voiding function, fertility, erectile dysfunction, hypogonadism, and metabolic syndrome. We also assessed quality of life. RESULTS: Major urologic findings were found in 18 (66.7%) patients. Four patients reported posttransplantation parenthood. The mean serum creatinine was 1.5 +/- 0.6 mg/dL and the calculated clearance, 72.6 +/- 27.4 mL/min/1.73 m(2). Regarding the voiding pattern, 92.6% of patients showed mild to moderate bladder outlet obstruction. Clinically significant increases in prostate volume were observed in 3.7% of patients. Mean serum total prostate-specific antigen was 1.6 +/- 1.5 ng/mL. Erectile dysfunction was displayed by 46.2% and hypogonadism by 74.1% of patients. Metabolic syndrome was diagnosed in 44.4% of patients, and quality of life was generally rated as good (4/5). CONCLUSION: Long-term renal transplantation survivors show high prevalences of treatable urologic diseases. Thus, we strongly recommend routine complete nephrourologic follow-up of this population.

Nutritional Risk and Quality of Life in Community-Dwelling Elderly: A Cross-Sectional Study.

OBJECTIVES: To evaluate the association between nutritional risk and quality of life in community-dwelling elderly. METHOD: A cross-sectional study of individuals aged 60 years or older living in the Brazilian state of Minas Gerais was conducted. Nutritional status was evaluated using the Mini Nutritional Assessment, and quality of life was determined using the WHOQOL-bref and WHOQOL-old. The absolute and relative frequency distributions for each domain were calculated, and chi-square tests were used to examine the association between nutritional risk and quality of life (dichotomous variables). Poisson regression was used to perform univariate and multivariate analyses. RESULTS: 789 (27.9%) of the 2823 elderly patients in the sample were at nutritional risk. The risk of malnutrition was associated with the physical, environment, psychological, sensory abilities, social participation and intimacy domains of quality of life [(PR= 1.42, 95%CI 1.23-1.63); (PR= 1.28, 95%CI 1.12-1.47); (PR= 1.18, 95%CI 1.03-1.36); (PR= 1.36, 95%CI 1.20-1.54); (PR= 1.29, 95%CI 1.13-1.46); (PR= 1.14, 95%CI 1.01-1.29); respectively]. CONCLUSION: The present findings contribute to the understanding of nutritional risk, and support the association between quality of life and nutritional status. These factors should be considered in the diagnosis, monitoring and treatment of nutritional disorders, and may contribute to the prevention and reduction of nutritional risk in this especially vulnerable population.

Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men.

A 12-week, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of flexible-dose sildenafil citrate (Viagra) treatment (25, 50 or 100 mg) in Brazilian and Mexican men with erectile dysfunction (ED) of broad-spectrum etiology. Efficacy was assessed on the basis of responses to the 15-item International Index of Erectile Function (IIEF) questionnaire, completed at baseline and after 12 weeks of treatment. At end point, mean scores for all IIEF domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were significantly (P<0.0001) higher in the sildenafil group (n=109) than in the placebo group (n=105). These findings confirm the significant increases in frequency of penetration and frequency of maintained erections reported previously. Sildenafil treatment was well tolerated. The most common adverse events were headache and flushing. In conclusion, sildenafil is a well-tolerated and effective treatment for ED of broad-spectrum etiology in Latin American men.

Uroflowmetry in the management of lower urinary tract symptoms of children and adolescents with cerebral palsy.

OBJECTIVE: To evaluate uroflow measurements in the initial management of lower urinary tract dysfunction in children and adolescents with cerebral palsy. MATERIALS AND METHODS: A total of 54 patients was enrolled in this study. All patients reported their urinary symptoms and underwent a physical examination, renal and urinary tract ultrasonography, and uroflow assessment. RESULTS: Twenty-three patients were female. Mean age was 9 years and 6 months (SD: 2 years and 10 months), with a range of 5-18 years. Twenty-eight of the patients (51.8%) were symptomatic. Urgency (42.6%), urge incontinence (40.7%), and enuresis (16.7%) were the most frequently observed symptoms. No association was found between gender, ambulatory status, or distribution of the paralysis and uroflow parameters. Symptomatic patients presented a statistically lower maximum flow (Qmax) than asymptomatic patients (17.2 ± 7.8 ml/s vs 22.6 ± 7.5 ml/s, p = 0.013, respectively). Normal bell-shaped curves were observed more frequently in asymptomatic patients, while abnormal curves were observed more frequently in symptomatic patients (p = 0.022). CONCLUSIONS: Gender, ambulatory status, and the distribution of the paralysis do not affect Qmax rate or flow pattern. Symptomatic patients present lower Qmax and may also have an abnormal uroflow curve. Uroflowmetry may be useful in the initial urological evaluation.

Safety and efficacy of intravenous doripenem for the treatment of complicated urinary tract infections and pyelonephritis.

Doripenem was evaluated in adults with complicated urinary tract infections and pyelonephritis in two phase 3 studies. DORI-05, a randomized, double-blind study compared doripenem 500 mg every 8 hours with levofloxacin 250 mg every 24 hours. DORI-06 was a single-arm study designed to confirm the doripenem response in DORI-05. 799 received doripenem, 372 levofloxacin. Microbiological eradication rates in microbiologically evaluable populations were 82.8% for doripenem, 83.4% for levofloxacin (Δ: -0.6%; 95% confidence interval: -6.4, 5.2), and 80.9% and 78.2%, respectively (Δ: 2.7%; 95% confidence interval: -3.0, 8.3) in the co-primary microbiologically modified intent-to-treat populations. Clinical cure rates in the clinically evaluable populations were 94.1% for doripenem, 90.2% for levofloxacin (Δ: 3.9%; 95% confidence interval: -0.5, 8.2). In subjects infected with levofloxacin- resistant Escherichia coli, outcomes were statistically significantly greater with doripenem. Genotyping data indicate persistent E. coli infections were often due to infection with new strains. Doripenem was generally found to be safe and well tolerated.ClinicalTrials.gov registration numbers: DORI-05 = NCT00229021, DORI-06 = NCT00210990.

A randomised, double-blind study comparing the efficacy and tolerability of controlled-release doxazosin and tamsulosin in the treatment of benign prostatic hyperplasia in Brazil.

Brazilian patients with benign prostatic hyperplasia were randomised in a 12-week, double-blind, double-dummy study to receive doxazosin gastrointestinal therapeutic system (GITS) 4 mg q.i.d. (n = 82) or tamsulosin 0.4 q.i.d. (n = 83). Primary endpoints were the absolute and percentage change from baseline in symptoms measured by International Prostate Symptom Score (IPSS). Secondary endpoints included IPSS, quality-of-life (QOL) question from the IPSS, and questions 6 and 7 of the Sexual Function Abbreviated Questionnaire (SFAQ) at weeks 4 and 12. Doxazosin GITS and tamsulosin improved IPSS with no significant differences between groups at week 12. During weeks 4-8, tamsulosin-treated patients demonstrated a slower improvement (p < 0.001) in IPSS than doxazosin GITS-treated patients. The proportion of satisfied patients was observed earlier with doxazosin GITS (p = 0.006) vs. tamsulosin. At week 12, the proportion of patients with little or no difficulty at ejaculation (Q6 of SFAQ) was higher in the doxazosin GITS group (p = 0.019). Both treatments were well tolerated.

Fatores preditores do alcance das metas de um programa de intervenção em nipo-brasileiros / Predictors of goal achievement in an intervention program among Japanese-Brazilians

Identificar fatores da linha de base preditores do alcance das metas do programa de intervenção no estilo de vida após 12 meses em população de nipo-brasileiros, empregando-se modelos de regressão logística ajustados. Em 2005, 321 participantes eram portadores de excesso de peso e houve maior chance [OR (IC95 por cento)] de alcance da meta de perda de peso após 12 meses entre mulheres [2,45 (1,33; 4,13)], indivíduos de maior idade [1,03 (1,00; 1,06)] e menor chance entre portadores de morbidades no início do estudo [0,33 (0,14; 0,77)]. Dos 261 indivíduos sedentários, o alcance da meta de atividades físicas foi inversamente relacionado ao exercício de atividades profissionais [0,40 (0,17; 0,95)]. Não se verificou fatores da linha de base associados ao alcance das metas do consumo de legumes, verduras e frutas e gorduras saturadas da dieta após 12 meses. Indivíduos de maior idade, mulheres, não portadores de morbidades e sem exercício de atividades profissionais na linha de base apresentaram maior chance de alcance das metas após 12 meses de intervenção no estilo de vida.

The aim of this study was to identify baseline factors associated with achieving goals after a 12-month lifestyle intervention program in a Japanese-Brazilian population, using adjusted logistic regression models. In 2005, 321 participants were overweight. The odds [OR (IC95 percent)] of reaching the goals after 12 months of intervention were directly related to female gender [2.35 (1.34, 4.13)] and older age [1.03 (1.00, 1.06)] and inversely related to baseline morbidity [0.33 (0.14, 0.77)]. Of the 261 sedentary individuals, achieving the goal for physical activity was inversely related to working [0.44 (0.17, 0.95)]. No baseline predictors were found for reaching the goal of fruit and vegetable consumption or saturated fat intake after 12 months. At baseline, women, older individuals, and individuals without diseases or not working showed increased odds of achieving the goals after 12 months of the lifestyle intervention.

Arterial supply of the human fetal testis during its migration.

PURPOSE: Irrespective of the surgical technique chosen to treat high undescended testis, preservation of an adequate arterial supply for the testis is crucial for successful orchiopexy with maintenance of normal testicular size and texture. To provide an anatomical background for such a procedure, we performed a systematic study on the number and origin of arteries supplying the fetal testis during its migration from the abdomen to the scrotum. MATERIALS AND METHODS: We studied bilaterally 64 testes from 32 fresh human fetuses 13 to 33 weeks after conception. The fetuses were injected through the thoracic aorta with a microvascular silicone rubber red resin to fill in the arterial tree, thereby enabling identification and dissection of all arteries supplying the testes. RESULTS: Of the 64 testes 3 arteries (testicular, deferential and cremasteric) were found in 46 (71.9%), 2 (testicular and deferential) in 15 (23.4%) and 4 in 3 (4.7%). CONCLUSIONS: The fetal testis is always supplied by at least 2 arteries (testicular and deferential arteries) and by 3 or 4 arteries in nearly 80% of the cases.