Evaluation of MR imaging-targeted biopsies of the prostate in biopsy-naïve patients. A single centre study.

PURPOSE: To evaluate the differences in prostate cancer detection rate and biopsy effectiveness between magnetic resonance imaging (MRI) target biopsy (TB) and transperineal standard biopsy (SB) in biopsy-naïve patients. MATERIAL AND METHODS: Between October 2014 and April 2016, 60 men with a mean age of 64.1±6.7 (SD) years (range: 53-82 years) were prospectively enrolled. All patients underwent a prostate MRI study, evaluated by two radiologists, before undergoing the biopsy. A transperineal 12-core SB was carried out before TB, without the information from the MRI. The detection rate for all tumors and for clinically significant tumors (CS) was recorded. Sampling variables such as the proportion of cores positive for CS cancer (PCP-CS) and the maximum cancer core length (MCCL) were also calculated. The ability of MRI to predict the presence of a CS tumor at biopsy was studied using a sector analysis. Patients with negative biopsies were followed during a minimum of 12 months. RESULTS: The detection rate for SB and TB was 53.3% (32/60) and 46.7% (28/60) respectively for all tumors (P=0.289) and 45% (27/60) in both techniques for CS tumors. TB obtained a larger PCP-CS (P<0.001) and MCCL (P=0.018). The sensitivity, specificity, positive predictive value, negative predictive value and cancer prevalence was 83.3%, 92.9%, 83.3%, 92.9% and 30% for peripheral zone sectors and 43.8%, 97.1%, 70.0%, 91.8% and 13,3% for transitional zone sectors. The proportion of patients that showed an increase of PSA faster than 0.75ng/mL/year after a negative biopsy was 26.1%. CONCLUSION: Detection rate of prostate cancer did not show significant differences between a TB and a SB technique in biopsy-naïve patients. However, targeted prostate biopsies demonstrated a better sampling effectiveness thus reducing the cores needed to diagnose clinically significant tumors.

Stent-graft repair for blunt traumatic aortic injury: functional and survival outcomes.

AIM: Traumatic aortic injury is usually lethal, most often because of serious associated wounds. The short- and midterm outcome of endovascular exclusion was assessed as the current treatment of choice due to a lower mortality and morbidity than open surgical treatment. METHODS: We reviewed the cases of 8 patients (5 male, mean age 33 years) undergoing endovascular repair of a traumatic thoracic aortic lesion, confirmed by computed tomographic angiography, at our centre. Most patients showed a contained lesion limited to the aortic isthmus and severe associated injuries. RESULTS: Intrahospital mortality was 37.5% (N.=3) and mostly due to posttraumatic brain injury (N.=2). Most patients were hemodynamically stable at the time of endovascular repair (N.=6). The median time to surgery was 12 hours (3-48 hours). The endografts used were TAG® (W.L. Gore and Associates, Flagstaff) in three patients, and Valiant® (Medtronic, Santa Rosa, CA) in four. The technical success rate was 100%. In one case, the left subclavian artery was occluded without signs of arm ischemia. There were no cases of paraplegia or stroke related to treatment. No revision procedures were needed during follow-up. CONCLUSION: Endovascular repair shortly after injury seems to be effective and safe with a low associated morbidity and mortality.

[Immediate and long-term outcomes of carotid endarterectomies in eighty-year-olds]. / Resultados inmediatos y a largo plazo de la endarterectomía carotídea en octogenarios.

AIMS: To compare the immediate results obtained after performing a carotid endarterectomy (cEDA) in patients in their eighties with those of younger patients, and to determine survival and stroke-free times following carotid surgery in the two groups. PATIENTS AND METHODS: Retrospective data was collected regarding a series of 319 cases of cEDA (302 patients) performed between January 1998 and December 2004. Group 1: patients aged 80 or above. Group 2: the rest of the series. Sample follow-up: clinical and by means of carotid duplex. RESULTS: Mean age of the sample: 70.7 years (41-86). Group 1 was made up of 30 patients (9.4% of the series). Mortality rate: group 1, 3.3%; group 2, 1%; p=0.32. Major stroke-death incidence: group 1, 6.7%; group 2, 1.4%; p= 0.1. Median follow-up time: 36 months (1-87). Total mortality of the series throughout follow-up: 36 patients (12.6%). Mortality rate: group 1, 25%; group 2, 11.3%; p=0.04; relative risk: 2.6 (1.02-6.7). Stroke: group 1, 14.3%; group 2, 2.3%; p=0.01; relative risk: 7 (1.8-26.4). At five years, 96.7% were free of strokes (group 1: 84%; group 2, 97.7%; p=0.0001). At five years, 82.4% survived free of strokes (group 1: 61%; group 2, 84.4%; p=0.004). CONCLUSIONS: The risk of perioperative complications is higher in patients in their eighties than in younger patients, although the increase is not statistically significant. Even though the risk of a stroke during follow-up was higher in the eighty-year-olds, 84% of the subjects in this group remained stroke-free at five years. The high stroke-free survival rate in the medium to long term means that cEDA can be especially beneficial for patients in their eighties.

Surgery for aortoiliac aneurysm after kidney transplant.

OBJECTIVE: Although aortoiliac aneurysm in kidney transplant patients is uncommon, aortic clamping during the surgical repair of an aneurysm could pose a risk to the grafted kidney and might also increase the risk of vascular prosthesis infection due to immunosuppression. Herein, we present our results related to the treatment of the aortoiliac aneurysm subsequent to kidney transplant. MATERIAL AND METHODS: Four male kidney transplant recipients underwent surgery for aortoiliac aneurysm repair. RESULTS: In the first patient, we protected the kidney graft by perfusion with cold physiological saline. No such protective measures were taken in the remaining three patients other than reducing warm ischemia to a minimum. In one patient with occlusive disease and impaired graft function, renal function improved after surgery. In the other three patients renal function was unaffected by surgery. Despite immunosuppression, no infection of the prostheses was observed. CONCLUSIONS: Surgery for aortoiliac aneurysm can be safely performed in kidney transplant patients. No ischemic damage is incurred by the graft and perioperative infection can be easily avoided. The need to protect the graft during the surgical procedure should be evaluated in each individual case according to predicted times of ischemia and vascular reconstruction and preoperative graft function.

Estudio de prevalencia de microalbuminuria y macroproteinuria en diabéticos y su relación con otras complicaciones / A collaborative study on the prevalence of microalbuminuriaand macroproteinuria in diabetic patients and their relation to other complications

Se determinó la prevalencia de microalbuminuria(Mi) y macroproteinuria(Ma) y otras complicaciones en diabéticos en un estudio multicéntrico en la Argentina. Se entrevistaron 214 pacientes sin selección previa, se evaluó historia clínica, se dividió por tipo de diabetes. La Mi se realizó por radioinmunoanálisis o inmunoturbidimétrico la Ma por método sulfosalicílico. Se relacionaron con edad, antigüedad y prevalencia de hipertensión,dislipemia y retinopatía. Se aplicó para análisis el método estadístico DBase con programa EPI INFO 50. Se calcularon estadísticas descriptivas, se aplicó prueba de chi cuadrado con unnivel de significación p=0.05. La población insulinodependiente (DID)n73(34,1), la no insulinodependinte (DNID) n101(47,2), la insulinorrequiriente(DIR)n40(18,7), la edad promedio del DID 34,88+ 16,3; el DNID 64,27 + 9,83; DIR 61,85 + 9,37,lo que mostró una diferencia estadísticamente significativa para el DID con respecto al DNID y al DIR. La antigüedad de la diabetes no mostró diferencias significativas, lo mismo sucedió con la hemoglobina glicosilada para los diferentes grupos.La prevalencia de Mi fue 26,22,23.17,30 y la Ma fue 21,13, 10,9,26,66 respectivamente. El 19,20 careció de datos para la proteinuria. La prevalencia de hipertensión arterial fue para el DID 15.06,DNID 54,45,DIR 57.50, la dislipemia 13,69, 39,60,47,50 y retinopatía 35,10,24.757 y 57,50 respectivamente,la hipertensión y dislipemia mostraron diferencias estadísticamente significativas si se comparaba los DNID y DIR con respecto DID

Hepatic infarction: an unusual complication of nephrotic syndrome in a patient with diabetes mellitus.

A 67 year old woman with widespread atherosclerosis and diabetic nephropathy manifested by nephrotic syndrome and moderate renal failure developed multiple hepatic infarctions. The infarctions were documented by computed tomographic scan and needle aspiration biopsy of the liver. Except for the nephrotic syndrome and the atherosclerosis no other cause of hepatic infarction was found. We suggest that hepatic infarction should be considered in the thrombotic complications of the nephrotic syndrome secondary to diabetic nephropathy.