RESUMO
Proton magnetic resonance spectroscopic imaging ((1) H-MRSI) has been advocated as a valuable tool for prostate cancer diagnosis. However, a barrier to widespread clinical use of this technique is the lack of robust quantification methods that yield reproducible results in an institution-independent manner. The main goal of this study was to develop a standardized and fully automated approach (LCModel-based) for quantitative prostate (1) H-MRSI. To this end, a dedicated basis set was constructed by the combination of simulated (citrate, Cit; choline, Cho, and creatine, CR) and experimentally acquired (spermine, Spm) spectra. The overlapping Spm, Cho, and Cr could be resolved and quantified individually, thus allowing for the independent assessment of glandular (Cit and Spm) and proliferative (Cho) components. Several metabolite ratios were calculated and compared to the histologic findings of prostatectomy specimens from 10 prostate cancer patients with Gleason scores (3 + 3) and (3 + 4). The Cho mole fraction and the Cho/(Cit + Spm) ratio were found to best discriminate between prostate cancer and healthy tissue. The comparison between the quantitative MRSI results and the histologic findings suggests that no correlation exists between the detected metabolic alterations and the Gleason score of low-grade tumors.
Assuntos
Adenocarcinoma/metabolismo , Espectroscopia de Ressonância Magnética , Próstata/metabolismo , Próstata/patologia , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Adenocarcinoma/patologia , Colina/análise , Ácido Cítrico/análise , Creatina/análise , Humanos , Técnicas In Vitro , Masculino , Imagens de Fantasmas , Espermina/análiseRESUMO
Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is characterized by leukoencephalopathy, peripheral neuropathy, ptosis, ophthalmoplegia, and gastrointestinal dysmotility. Mitochondrial myopathies are rare diseases and little is known of how to manage them when the patient requires anesthesia. We describe the anesthetic procedure used during emergency surgery for megacolon in a 26-year-old woman with MNGIE. Variables monitored were electrocardiogram, invasive arterial pressure, oxygen saturation by pulse oximetry, end-tidal carbon dioxide pressure, neuromuscular block, and depth of anesthesia (entropy). Rapid sequence induction was accomplished with midazolam, fentanyl, propofol, and rocuronium as an alternative to succinylcholine. Anesthesia was maintained with intravenous propofol; a second dose of the neuromuscular blocker was not required. No intraoperative problems developed and extubation was possible 2 hours after arrival in the postoperative critical care unit, once we had checked the level of block to confirm that reversion was not required.
Assuntos
Anestesia/métodos , Pseudo-Obstrução Intestinal , Encefalomiopatias Mitocondriais , Adulto , Tratamento de Emergência , Feminino , Humanos , Pseudo-Obstrução Intestinal/complicações , Megacolo/complicações , Megacolo/cirurgia , Encefalomiopatias Mitocondriais/complicações , Distrofia Muscular Oculofaríngea , Oftalmoplegia/congênitoRESUMO
UNLABELLED: The objective of this article is to quote under the form of a document the opinions expressed by the participants of the round table "Lasers in Urology Today" (january 2006). The material and method used is the compilation of critical and updated notions on the usefulness of lasers in urology, supplemented by bibliographic references, a limited iconography. The results achieved by lasers today enable us to state that: Holmium laser is the choice treatment for in situ lithotripsy; however, it has not significantly improved previous results when treating urologic tumours and stenoses. Nowadays we have two types of lasers: KTP and HoL, which obtain results similar to surgery regarding BPH, but with reduced morbidity. The usefulness of laser in laparoscopic surgery is still under development. CONCLUSION: Lasers in Urology Today play an active role in in situ lithotripsy (HoL), and a competitive one in BPH surgery (KTP and HoL). Regarding the rest of indications, i.e. tumours, stenoses, laparoscopic surgery, etc., further studies and enough follow-up times are still needed.
Assuntos
Fotocoagulação a Laser , Terapia a Laser , Doenças Urológicas/cirurgia , Desenho de Equipamento , Humanos , Terapia a Laser/instrumentação , Litotripsia a Laser , Cálculos Urinários/terapiaRESUMO
Arsenic trioxide has drawn renewed interest in onco-haematological therapy. Based on a number of studies quoted in this paper, it has been approved by FDA and EMEA for remission induction and consolidation therapy of acute promyelocytic leukaemia in patients refractory to treatment using trans-retinoic acid and anthracyclines. In addition to briefly discuss available therapeutic resources against this disease, this review attempts to provide an in-depth view of this drugâs characteristics and efficacy, as shown in several studies.
Assuntos
Antineoplásicos/uso terapêutico , Arsenicais/uso terapêutico , Leucemia Promielocítica Aguda/tratamento farmacológico , Óxidos/uso terapêutico , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacologia , Trióxido de Arsênio , Arsenicais/administração & dosagem , Arsenicais/efeitos adversos , Arsenicais/farmacologia , Ensaios Clínicos como Assunto , Humanos , Óxidos/administração & dosagem , Óxidos/efeitos adversos , Óxidos/farmacologiaRESUMO
INTRODUCTION AND OBJECTIVE: Prostate biopsy is a basic step towards prostate cancer (Pca) diagnosis, but usually not free from complications. In this article we have reviewed the adverse effects of this procedure in our setting. MATERIAL AND METHODS: We studied in a prospective fashion the complications arising from transrectal prostate biopsy with the aid of a questionnaire fulfilled by 303 patients who underwent this procedure, within the context of a Pca screening program. All biopsies were transrectal ultrasound guided and randomly taken (sextant). A cleaning enema was applied the night before, and 100 mg of intramuscular tobramycin were administered prior of the procedure. RESULTS: Ninety patients (29.7%) had no adverse effects at all, and 136 (44.9%) reported at least one minor complication (hematuria, hemospermia, or autolimited dysuria). Lastly 77 (25.4%) presented with major complications--urinary retention, fever, need for medical assistance (primary or hospital care) or treatment. Thirty-five patients (11.5%) reported to present with fever after biopsy, 145 (47.8%) hematuria, 95 (31.3%) hemospermia, 77 (25.4%) rectal bleeding, 67 (22.1%) urinary difficulty, and 9 (2.9%) urinary retention. Up to 39 (12.8%) needed to visit their G.P., and 19 of them were referred to Hospital, where only 6 (1.9%) were admitted longer than 24 hours. No intensive care unit admittances or deaths were reported. CONCLUSIONS: The rate of post-transrectal biopsy adverse effects is high in our experience. This phenomenon could be explained, in part, due to data collecting by means of a self-administered questionnaire. Probably the high fever rate presented here could be diminished with other type of antibiotic prophylaxis.
Assuntos
Biópsia/efeitos adversos , Próstata/patologia , Biópsia/métodos , Humanos , Masculino , Estudos Prospectivos , Reto , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To review the embryological and clinical aspects of the different types of pyelocaliceal diverticula, with special reference to the differential diagnosis and treatment. METHODS: Images of type I and II pyelocaliceal diverticula are shown. The conditions that cause difficulty in making the differential diagnosis are discussed. RESULTS: Urography continues to be the diagnostic method preferred and is sometimes aided by retrograde ureteropyelography. CONCLUSIONS: Pyelocaliceal diverticula are cystic eventrations of the upper urinary tract lying within the renal parenchyma that communicate through a narrow channel into the main collecting system. They occur in 0.2 to 0.5% of the population and are congenital in origin. Calyceal diverticula are frequently found incidentally on routine excretory urograms, but patients may complain of flank pain, hematuria or recurrent urinary infections. In the past, treatment required open renal surgery. Endourologic procedures are widely utilized today.
Assuntos
Divertículo , Nefropatias , Diagnóstico Diferencial , Diagnóstico por Imagem , Divertículo/diagnóstico , Divertículo/embriologia , Divertículo/terapia , Humanos , Nefropatias/diagnóstico , Nefropatias/embriologia , Nefropatias/terapia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia , UrografiaRESUMO
OBJECTIVE: To study the results of the second round in the subjects with negative tests in the first round of a prostate cancer screening program and to analyze the characteristics of the tumors that were not detected in the first round. METHODS: Of 5188 males evaluated in a prostate cancer screening program, 976 with negative tests in the first round (804 with PSA < or = 4 ng/ml; 172 with PSA > 4 ng/ml and a negative biopsy) accepted to undergo subsequent tests. During the second round, 163 biopsies were indicated. The biopsy results and the characteristics of the tumors detected were analyzed. RESULTS: The biopsy yield was higher (but not significantly) in the first round (80 cancers/481 biopsies; 16.6%) than in the second round (13 cancers/115 biopsies; 11.3%). Of the 163 biopsies indicated in the second round, 115 were performed and 13 cancers were detected (10 of these patients had a high PSA in the first round). The univariate analysis showed no differences for age, PSA, PSA density, prostate volume, transrectal US findings, or Gleason score in the cases diagnosed in the first round and those detected in the second round. However, there was a higher proportion of tumors with abnormal DRE in the cancers detected in the first round than in the second round, (31.3% vs 7.7%, respectively; p = 0.02). There was a higher proportion of tumors clinically detected in the second round than in the first round (100% vs 75%, respectively; p = 0.043). The multivariate analysis only showed differences for the DRE findings (p = 0.045). CONCLUSION: A significant number of tumors are undetected in prostate cancer screening programs. Although the biopsy yield may be slightly lower in subsequent rounds, there is a strong trend of detecting more localized tumors (and therefore potentially curable). We have found no correlation between a greater prostate volume and tumors that were undetected in the first round.
Assuntos
Neoplasias da Próstata/patologia , Idoso , Biópsia/estatística & dados numéricos , Reações Falso-Negativas , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Neoplasias da Próstata/epidemiologia , Controle de QualidadeRESUMO
W. H. Wollaston, who first described cystine stones, as well as the most outstanding contemporary figures and their contribution to the understanding of this uncommon type of lithiasis are described.
Assuntos
Cistina/história , Cálculos Urinários/história , Europa (Continente) , História do Século XVIII , História do Século XIX , HumanosRESUMO
OBJECTIVE: To describe a case of adult renal polycystosis causing intercostal hernia with intestinal segment. To our knowledge, no such case has been previously reported in the literature. METHODS/RESULTS: Diagnosis was by abdominal CT. Treatment was by bilateral nephrectomy and surgical repair of the diaphragmatic and intercostal hernia. CONCLUSIONS: Surgery is indicated in adult renal polycystosis if kidney size causes gastrointestinal involvement and above all, if the lungs are compromised by the intercostal diaphragmatic hernia.
Assuntos
Enteropatias/etiologia , Doenças Renais Policísticas/complicações , Idoso , Hérnia/diagnóstico por imagem , Hérnia/etiologia , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/etiologia , Hérnia Diafragmática/cirurgia , Herniorrafia , Humanos , Enteropatias/diagnóstico por imagem , Enteropatias/cirurgia , Masculino , Nefrectomia , Doenças Renais Policísticas/diagnóstico por imagem , Doenças Renais Policísticas/cirurgia , Costelas , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To establish the reliability of transrectal ultrasound to estimate prostatic volume. MATERIAL AND METHODS: Study of 27 patients diagnosed with prostate cancer who were managed with radical prostatectomy. Transrectal ultrasound assessment of prostatic volume was performed using the revolution ellipsoid equation V = (pi/6) x L x T x AP. The values obtained were compared to those from radical prostatectomy specimens calculated by the same method and with the weights of the specimens. RESULTS: Mean prostatic volume estimated through transrectal ultrasound was 38.77 cc vs. 38.46 cc in the pathoanatomical specimens. Mean difference between both was 0.31 cc (not significant). The coefficient of correlation that related both values was 0.80 and the coefficient of correlation between transrectal ultrasound volume and weight was 0.86. CONCLUSIONS: Prostatic transrectal ultrasound is an accurate tool to calculate total prostatic volume.
Assuntos
Endossonografia , Próstata/diagnóstico por imagem , Idoso , Endossonografia/estatística & dados numéricos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Prostatectomia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Reto , Reprodutibilidade dos Testes , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To describe a rare case of adenomatoid tumor of the testicular tunica albuginea and to discuss the clinical, histogenetic and therapeutic aspects. METHODS/RESULTS: A rare case of adenomatoid tumor of the testicular tunica albuginea is presented. The clinical, histogenetic and therapeutic aspects are discussed. CONCLUSIONS: Adenomatoid tumors of the testicular tunica albuginea are rare and are therefore rarely considered. Although 99% of testicular tumors are malignant, it must be emphasized that there are benign testicular tumors, such as adenomatoid tumor, that initially do not require aggressive surgical treatment but intraoperative biopsy and tumor resection.
Assuntos
Tumor Adenomatoide/patologia , Neoplasias Testiculares/patologia , Adulto , Humanos , MasculinoRESUMO
Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.
Assuntos
Algoritmos , Incontinência Urinária por Estresse/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Falha de Tratamento , Ultrassonografia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgiaRESUMO
OBJECTIVE: To confirm that metanephric adenoma is a benign tumor with no potential to malignancy, observing its course 6 years after conservative surgical management. METHODS: A light microscopic, immunohistochemical and electron microscopic study of the surgical specimen were performed and the DNA euploidy and proliferation index were determined. RESULTS: Metanephric adenoma is comprised of tubular epithelial structures of small diameter or with virtual lumen, with or without calcifications, psammoma bodies and bony trabeculae. No cell atypia or mitosis was observed. The immunohistochemical study is useful to discard the unlikely metastatic nature of the tumor. It has a euploid DNA distribution and there is practically no proliferation. Electron microscopy showed a scanty amount of microvilli and abundant material between the tubules that appeared to be similar to that of the basement membrane. CONCLUSIONS: Knowledge about this benign disease entity is emphasized in order to avoid unnecessary radical nephrectomies.
Assuntos
Adenoma/patologia , Adenoma/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Rim/patologia , Rim/cirurgia , Adenoma/diagnóstico por imagem , Adulto , Feminino , Humanos , Rim/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , RadiografiaRESUMO
OBJECTIVE: To report an additional case of nephrogenic adenoma of the bladder. METHODS/RESULTS: A case of nephrogenic adenoma of the urinary bladder in a 28-year-old female is described. Patient clinical history and diagnostic imaging findings are presented. CONCLUSIONS: Nephrogenic adenoma of the bladder is a rare benign tumor with specific histological features that has been associated with previous surgery, trauma, infections and lithiasis. Although it is currently not considered to be a premalignant lesion, its rate of recurrence is high (37%-49%). The treatment of choice is by transurethral resection and yearly cytological, ultrasound and cystoscopic follow-up evaluation to detect recurrence.
Assuntos
Adenoma/patologia , Rim/patologia , Neoplasias da Bexiga Urinária/patologia , Adulto , Biópsia , Feminino , Humanos , Metaplasia/patologia , Bexiga Urinária/patologiaRESUMO
OBJECTIVE: To describe the utility of transrectal ultrasound as an alternative imaging technique in the diagnosis of diverticulum of the female urethra. METHODS/RESULTS: A 35-year-old female that had been initially diagnosed as having a benign tumor of the vagina is described. The voiding cystogram, positive pressure urethrography with a double balloon catheter and urethroscopy were falsely negative for urethral diverticulum of the female urethra. Subsequent evaluation by transrectal ultrasound disclosed on oval-shaped, anechoic lesion located posteriorly to base of the bladder. CONCLUSIONS: Transrectal ultrasound could be the diagnostic imaging technique of choice in patients suspected as having diverticulum of the female urethra.
Assuntos
Divertículo/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Adulto , Feminino , Humanos , UltrassonografiaRESUMO
OBJECTIVE: We aim to expose our experience in the surgical correction of stress urinary incontinence (SUI) and to analyze the possible factors that could modify the outputs of this type of surgery. METHODS: We have studied 114 women who underwent surgery (60 Raz, 36 Burch, and 18 vaginal wall sling), with a mean follow-up time of 10.5 months. RESULTS: We have not succeeded in demonstrating that preoperative factors such as age, irritative voiding symptoms; history of prior hysterectomy or urethropexia, neurological disease, diabetes or recurrent urinary tract infections; the finding of cistocele, a positive Bonney-Marchetti test or bladder unstability, play any role in the outputs. The failure rate was 16.7% for vaginal wall sling procedure, 35% Raz, and 33.3% Burch. "Survival" analysis did not demonstrate differences related to the procedure or the surgeon. We discovered and important decrease of continence rate with time from the intervention. Higher incidence of postoperative pain, urinary retention and greater residual urine were detected with transvaginal procedures. There was no difference in the incidence of wound infection. CONCLUSIONS: We don't believe that the selection of candidates for this type of surgery should be carried out in base to the above mentioned preoperative factors. Also, we observed a consistent decrease of postoperative continence with time. Finally, we have detected a greater incidence of complications after transvaginal procedures.
Assuntos
Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Ultrasonography is a fairly innocuous test in the follow-up of bladder tumours. Its results, however, can not be superposed to those of cystoscopy. This study aims to identify the risk factors for failure of transabdominal ultrasonography in the FU of bladder tumors. The influence of the primary tumour, sex and age of patients on the ability of ultrasonography to detect relapses was analyzed. Chi square and Student's t tests were used to associate the characteristics of primary tumours and patients to the results of ultrasonography. Student's t test was used to estimate the effect of diagnostic oversight in terms of annual recurrence rate and progression. The characteristics of primary tumours where relapse was detected or overlooked had no influence on the results of ultrasound follow-up as neither did age and sex. No differences were detected in recurrence rate of patients with anticipated (0.57) or overlooked (0.58) tumours. Although differences in progression rates (4.76% and 9% for overlooked and identified tumours, respectively) were substantial, they did not reach statistical significance. There are no features in the original tumour or the patient to anticipate the failure of ultrasound monitoring. Multiple and/or small relapses are overlooked more frequently that single and/or large ones, and tumours located in lateral walls, base and dome may be unnoticed. In spite of oversights, alternate ultrasound/cystoscopic monitoring does not compromise the outcome of the disease.
Assuntos
Neoplasias da Bexiga Urinária/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , UltrassonografiaRESUMO
OBJECTIVE: The diagnosis of acute pyelonephritis (APN) is based fundamentally on the clinical and bacteriological findings. Radiology is useful in ruling out obstructive causes that often require surgical management. The present study analyzed the role of renal ultrasonography (US) in patients with clinical symptoms, signs and history compatible with APN that have normal plain abdominal x-rays. METHODS: 87 patients who consulted our emergency services with symptoms and signs compatible with APN were reviewed. Patients who referred renal colic and those with a previous history of urological disease other than uncomplicated recurrent urinary tract infection were excluded. Patients with a plain abdominal x-ray compatible with lithiasis were excluded. Renal US evaluation was performed by the urologist to rule out hydronephrosis. RESULTS: 37 (42.5%) of the 87 patients had an abnormal US scan. These patients were evaluated again by US or IVP, or both (one case). Obstructive uropathy was demonstrated in only 5 cases (5.8%). These foregoing 5 patients were treated by surgery. CONCLUSIONS: In our series, renal US evaluation indicated surgical treatment in 5.8% of patients with clinical features of APN and a plain abdominal x-ray with no evidence of lithiasis. This incidence is likely to be lower in the outpatient setting. It is difficult to propose a standard approach in the management of these patients. It may therefore be more reasonable to utilize US and IVP in those patients who do not respond to antibiotic therapy.
Assuntos
Pielonefrite/diagnóstico por imagem , Doença Aguda , Adulto , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
OBJECTIVES: To describe the role of transrectal ultrasonography as an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. METHODS: The means of independent samples of transrectal ultrasound parameters of two groups of patients (group I, patients who were continent after surgery; group II, patients who remained incontinent after surgery) were compared. RESULTS: Patients who were continent after surgery showed scanty caudal and dorsal mobility of the bladder neck and proximal urethra during the periods of increased intraabdominal pressure. The US finding in this group of patients is characterized by a funnel surrounding the bladder neck and the proximal urethra. The existence of an intrinsically incompetent sphincter can also be determined with this technique. CONCLUSIONS: Transrectal ultrasonography constitutes an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. It permitis determining whether incontinence is due to a failed procedure, the existence of an intrinsically incompetent sphincter, or whether other causes of incontinence should be investigated.