Extended Safety and Tolerability of Darolutamide for Nonmetastatic Castration-Resistant Prostate Cancer and Adverse Event Time Course in ARAMIS.

BACKGROUND: Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) are usually asymptomatic and seek treatments that improve survival but have a low risk of adverse events. Darolutamide, a structurally distinct androgen receptor inhibitor (ARi), significantly reduced the risk of metastasis and death versus placebo in ARAMIS. We assessed the extended safety and tolerability of darolutamide and the time-course profile of treatment-emergent adverse events (TEAEs) related to ARis and androgen-suppressive treatment. PATIENTS AND METHODS: Patients with nmCRPC were randomized 2:1 to darolutamide (n = 955) or placebo (n = 554). After trial unblinding, patients could receive open-label darolutamide. Tolerability and TEAEs were assessed every 16 weeks. Time interval-specific new and cumulative event rates were determined during the first 24 months of the double-blind period. RESULTS: Darolutamide remained well tolerated during the double-blind and open-label periods, with 98.8% of patients receiving the full planned dose. The incidence of TEAEs of interest in the darolutamide group was low and ≤2% different from that in the placebo group, except for fatigue. When incidences were adjusted for exposure time, there were minimal differences between the darolutamide double-blind and double-blind plus open-label periods. The rate of initial onset and cumulative incidence of grade 3/4 TEAEs and serious TEAEs were similar for darolutamide and placebo groups over 24 months. CONCLUSION: Extended treatment with darolutamide was well tolerated and no new safety signals were observed. Most ARi-associated and androgen-suppressive treatment-related TEAEs occurred at low incidences with darolutamide, were similar to placebo, and showed minimal increase over time with continued treatment. TRIAL NUMBER: ClinicalTrials.gov identifier NCT02200614.

Cognitive-behavioral program to control lower urinary tract symptoms after radical prostatectomy: a randomized clinical trial / Programa cognitivo-conductual para el control de los síntomas del tracto urinario inferior después de la prostatectomía radical: un ensayo clínico aleatorizado / Programa cognitivo-comportamental para controle de sintomas do trato urinário inferior pós-prostatectomia radical: ensaio clínico randomizado

ABSTRACT Objective: to assess the effectiveness of a cognitive-behavioral program to control lower urinary tract symptoms after radical prostatectomy. Methods: a randomized clinical trial study, with 41 participants randomized into intervention (n=20) and control (n=21), for three months. The intervention group received the cognitive-behavioral program, while the control group received routine guidance from the service. Outcome variables were urinary incontinence intensity and lower urinary tract symptoms, assessed by the Pad-Test and Urinary Incontinence Scale of Radical Prostatectomy and King's Health Questionnaire. Results: at the end of the study, the intervention group had a lower urinary incontinence intensity (p≤0.001), and there were less chances of presenting changes in urinary frequency (p≤0.001), urinary urgency (p≤0.001), nocturia (p=0.005), stress urinary incontinence (p≤0.001) and urge incontinence (p≤0.045). Conclusion: the cognitive-behavioral program was effective in reducing lower urinary tract symptoms after radical prostatectomy. Brazilian Clinical Trial Registry: RBR-3sstqg.

RESUMEN Objetivo: evaluar la efectividad de un programa cognitivo-conductual para controlar los síntomas del tracto urinario inferior después de la prostatectomía radical. Métodos: estudio de ensayo clínico aleatorizado, con 41 participantes aleatorizados en intervención (n=20) y control (n=21), durante tres meses. El grupo de intervención recibió el programa cognitivo-conductual, mientras que el grupo control recibió orientación rutinaria del servicio. Las variables de resultado fueron la intensidad de la incontinencia urinaria y los síntomas del tracto urinario inferior, evaluados mediante Pad-Test y Urinary Incontinence Scale of Radical Prostatectomy y King's Health Questionnaire. Resultados: al final del estudio, el grupo intervención presentó menor intensidad de incontinencia urinaria (p≤0,001), y hubo menos posibilidades de presentar cambios en la frecuencia urinaria (p≤0,001), urgencia urinaria (p≤0,001), nicturia (p=0,005), incontinencia urinaria de esfuerzo (p≤0,001) e incontinencia de urgencia (p≤0,045). Conclusión: el programa cognitivo-conductual fue eficaz para reducir los síntomas del tracto urinario inferior después de la prostatectomía radical. Registro Brasileño de Ensayos Clínicos: RBR-3sstqg.

RESUMO Objetivo: avaliar a efetividade de um programa cognitivo-comportamental para controle de sintomas do trato urinário inferior pós-prostatectomia radical. Método: estudo de ensaio clínico randomizado, com 41 participantes aleatorizados em intervenção (n=20) e controle (n=21), durante três meses. O grupo intervenção recebeu o programa cognitivo-comportamental, enquanto o grupo controle recebeu orientações de rotina do serviço. As variáveis desfechos foram intensidade da incontinência urinária e sintomas do trato urinário inferior, avaliados pelo Pad-Test e Urinary Incontinence Scale of Radical Prostatectomy e King's Health Questionnaire. Resultados: ao final do estudo, o grupo intervenção apresentou menor intensidade da incontinência urinária (p≤0,001), e houve menos chances de apresentar alterações da frequência urinária (p≤0,001), urgência miccional (p≤0,001), noctúria (p=0,005), incontinência urinária de esforço (p≤0,001) e urge-incontinência (p≤0,045). Conclusão: o programa cognitivo-comportamental foi efetivo para a redução de sintomas do trato urinário inferior após a prostatectomia radical. Registro Brasileiro de Ensaios Clínicos: RBR-3sstqg.

Another Piece of the Puzzle: Echinococcus oligarthrus Recorded in Jaguarundis (Herpailurus yagouaroundi) in Southern Brazil.

Echinococcus oligarthrus is a tapeworm endemic to South America and widely distributed in the Amazon region. Its lifecycle is maintained by relationships between felids and their prey, mainly small sylvatic rodents, but humans can be infected occasionally. We report two female jaguarundis (Herpailurus yagouaroundi) harboring E. oligarthrus in southern Brazil. The felines were found road killed in periurban areas, and, during necropsy, the small intestine was examined. Visual inspection revealed helminths, which were submitted to microscopy and molecular examination. Morphologically, they were around 2.5 mm long, with four suckers and an armed scolex with two rows of hooks. Phylogenetic reconstruction using cytochrome c oxidase subunit I gene sequences placed samples from south Brazil in the same clade as all other E. oligarthrus samples, but as a sister group. Genetic distance gave similar results, resulting in a divergence of 0.087% between the samples described in this study and other samples. The geographic pattern of genetic diversity, as assessed by analysis of molecular variance, suggests that the divergency results from isolation by distance. This finding expands the geographic range of E. oligarthrus and brings new insights to help understand and prevent the zoonosis it causes.

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD / Características clínicas, laboratoriais e funcionais da sobreposição asma-DPOC em pacientes previamente diagnosticados com DPOC

ABSTRACT Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.

RESUMO Objetivo: Avaliar a frequência de asthma-COPD overlap (ACO, sobreposição asma-DPOC) em pacientes com DPOC e comparar, do ponto de vista clínico, laboratorial e funcional, os pacientes com e sem essa sobreposição conforme diferentes critérios diagnósticos. Métodos: Os participantes foram submetidos à avaliação com pneumologista, espirometria e exame sanguíneo, sendo orientados a manter o registro do PFE duas vezes ao dia. O diagnóstico de ACO deu-se através dos critérios Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO), American Thoracic Society (ATS) Roundtable e Espanhol. Foram investigados os históricos de exacerbações e hospitalizações e aplicados os instrumentos COPD Assessment Test e escala Medical Research Council modificada, utilizados para a classificação de risco e sintomas da GOLD. Resultados: Entre os 51 pacientes com DPOC, 14 (27,5%), 8 (12,2%) e 18 (40,0) foram diagnosticados com ACO segundo os critérios PLATINO, ATS Roundtable e Espanhol, respectivamente. Pacientes com sobreposição significativamente apresentaram pior CVF pré-broncodilatador (1,9 ± 0,4 L vs. 2,4 ± 0,7 L), CVF pós-broncodilatador (2,1 ± 0,5 L vs. 2,5 ± 0,8 L) e VEF1 pré-broncodilatador (1,0 ± 0,3 L vs. 1,3 ± 0,5 L) quando comparados a pacientes com DPOC. Os níveis de IgE foram significativamente mais elevados em pacientes com sobreposição diagnosticados pelo critério Espanhol (363,7 ± 525,9 kU/L vs. 58,2 ± 81,6 kU/L). O histórico de asma foi mais frequente em pacientes com a sobreposição (p < 0,001 para todos os critérios). Conclusões: Nesta amostra, pacientes com ACO relataram asma prévia com maior frequência e possuíam pior função pulmonar quando comparados a pacientes com DPOC. O critério ATS Roundtable aparenta ser o mais criterioso em sua definição, enquanto os critérios PLATINO e Espanhol apresentaram maior concordância entre si.

Neem oil increases the persistence of the entomopathogenic fungus Metarhizium anisopliae for the control of Aedes aegypti (Diptera: Culicidae) larvae.

BACKGROUND: The entomopathogenic fungus Metarhizium anisopliae is a candidate for the integrated management of the disease vector mosquito Aedes aegypti. Metarhizium anisopliae is pathogenic and virulent against Ae. aegypti larvae; however, its half-life is short without employing adjuvants. Here, we investigated the use of neem oil to increase virulence and persistence of the fungus under laboratory and simulated field conditions. METHODS: Neem was mixed with M. anisopliae and added to recipients. Larvae were then placed in recipients at 5-day intervals for up to 50 days. Survival rates were evaluated 7 days after exposing larvae to each treatment. The effect of neem on conidial germination following exposure to ultraviolet radiation was evaluated under laboratory conditions. Statistical tests were carried out using ANOVA and regression analysis. RESULTS: Laboratory bioassays showed that the fungus alone reduced survival to 30% when larvae were exposed to the treatment as soon as the suspension had been prepared (time zero). A mixture of fungus + neem resulted in 11% survival at time zero. The combination of fungus + neem significantly reduced larval survival rates even when suspensions had been maintained for up to 45 days before adding larvae. For simulated-field experiments 1% neem was used, even though this concentration is insecticidal, resulting in 20% survival at time zero. However, this toxic effect was reduced over time. When used alone under simulated-field conditions the fungus rapidly lost virulence. The formulation fungus + neem effectively maintained fungal virulence, with larval survival rates significantly reduced for up to 45 days after preparation of the suspensions. The effective half-life of the fungus or neem when used separately was 6 and 13 days, respectively. The half-life of fungus formulated in 1% neem was 34 days. Conidia suspended in neem maintained high levels of germination even following a 2-h exposure to ultraviolet radiation. CONCLUSIONS: A combination of the entomopathogenic fungus M. anisopliae with neem oil effectively increases the half-life and virulence of the fungus when tested against Ae. aegypti larvae, even under simulated field conditions. Neem oil also protected the fungus from the damaging effects of ultraviolet radiation.

Human papillomavirus (HPV) genotype distribution in penile carcinoma: Association with clinic pathological factors.

BACKGROUND: Penile carcinoma (PC) is a rare, highly mutilating disease, common in developing countries. The evolution of penile cancer includes at least two independent carcinogenic pathways, related or unrelated to HPV infection. OBJECTIVES: To estimate the prevalence, identify HPV genotypes, and correlate with clinicopathological data on penile cancer. METHODS: A retrospective cohort study involving 183 patients with PC undergoing treatment in a referral hospital in Goiânia, Goiás, in Midwestern Brazil, from 2003 to 2015. Samples containing paraffin embedded tumor fragments were subjected to detection and genotyping by INNO-LiPA HPV. The clinicopathological variables were subjected to analysis with respect to HPV positivity and used prevalence ratio (PR), adjusted prevalence ratio (PRa) and 95% confidence interval (CI) as statistical measures. RESULTS: The prevalence of HPV DNA in PC was 30.6% (95% CI: 24.4 to 37.6), high-risk HPV 24.9% (95% CI: 18.9 to 31.3), and 62.5% were HPV 16. There was a statistical association between the endpoints HPV infection and HPV high risk, and the variable tumor grade II-III (p = 0.025) (p = 0.040), respectively. There was no statistical difference in disease specific survival at 10 years between the HPV positive and negative patients (p = 0.143), and high and low risk HPV (p = 0.325). CONCLUSIONS: The prevalence of HPV infection was 30.6%, and 80.3% of the genotypes were identified as preventable by anti-HPV quadrivalent or nonavalent vaccine. HPV infections and high-risk HPV were not associated with penile carcinoma prognosis in this study.

N-acetylcysteine inhibits Mancozeb-induced impairments to the normal development of zebrafish embryos.

Mancozeb (MZ), a manganese/zinc-containing ethylene-bis-dithiocarbamate (EBCD) fungicide has been claimed to present low acute toxicity and short environmental persistence, however, its effects on embryogenesis in non-target organisms is unclear. Here, we used zebrafish embryos (5 hpf) to assess the potential embryotoxic effects induced by MZ (up to 72 hpf) as well as the role of reactive oxygen species (ROS) in this process by pre-treatment with a classical antioxidant (N-acetylcysteine, NAC). Markers of reactive oxygen species production (ROS), glutathione (GSH) levels and glutathione S-transferase (GST) activity were measured along with genotoxicity (comet assay), cell death (Acridine Orange) and behavioral parameters (spontaneous movement, touch stimulation and swimming response), in order to determine potential mechanisms of embryotoxicity. According to results, MZ was able to induce morphological abnormalities such as body axis distortion, DNA damage, cell death, increased ROS generation and changes in behavioral endpoints during zebrafish development. All these toxic effects were inhibited by the pre-treatment with NAC indicating a key role of redox unbalance during MZ-induced embryotoxicity. At least in our knowledge, this is the first report on the deleterious effect of MZ to the normal embryogenesis of zebrafish. In addition, the importance of ROS generation during this pathophysiological condition was highlighted.

Study of association between interleukin-17 and interferon-gamma and recombinant human erythropoietin dose in patients undergoing peritoneal dialysis.

BACKGROUND: A common complication in patients undergoing peritoneal dialysis (PD) is a chronic inflammatory state and anemia that can be treating by recombinant human erythropoietin (rHuEPO). Higher required dose of rHuEPO could be expected in patients with higher cytokine levels. Additionally, it is known that peritoneal inflammation can be correlated with systemic inflammation and this could contribute to the compromised rHuEPO required dose in anemic patients with end stage renal disease (ESRD). Thus, the current study aimed to evaluate the association between levels of systemic and local interferon (IFN)-γ, interleukin (IL)-17 and other cytokines and the dose of rHuEPO used by patients undergoing PD for the correction of anemia. METHODS: Thirty-one patients under PD using rHuEPO were evaluated in this cross-sectional study. Plasma and dialysate levels of IL-2, IL-4, IL-6, IL-10, IL-17, tumour necrosis factor (TNF)-α and IFN-γ were determined using the Cytometric Bead Array TM kit (CBA; BD Bioscences, San Jose, CA). The relation between the levels of each cytokine levels and the tertiles of rHuEPO were plotted on box-plot graphics and then the medians of interleukins levels were compared by median comparison test. The significance level adopted was 5% and the analysis was performed by the softwares STATA (version 12.0) and GraphPad Prism 3.0. RESULTS: The median of IL-17 and IFN-γ plasma levels were significant higher in the group with higher rHuEPO dosage. However, this association was not observed in the dialysate levels, as well as was not observed a relationship between the other plasma and dialysate cytokines evaluated in this study and the dose of rHuEPO. CONCLUSIONS: Our study found increased IL-17 and IFN-γ plasma, but no dialysate levels, in patients receiving higher doses of rHuEPO, suggesting may exist a relationship between systemic inflammation of ESRD, and the necessary levels of rHuEPO for the correction of anemia in these patients.

Neem oil increases the efficiency of the entomopathogenic fungus Metarhizium anisopliae for the control of Aedes aegypti (Diptera: Culicidae) larvae.

BACKGROUND: Entomopathogenic fungi are potential candidates for use in integrated vector management and many isolates are compatible with synthetic and natural insecticides. Neem oil was tested separately and in combination with the entomopathogenic fungus Metarhizium anisopliae against larvae of the dengue vector Aedes aegypti. Our aim was to increase the effectiveness of the fungus for the control of larval mosquito populations. METHODS: Commercially available neem oil was used at concentrations ranging from 0.0001 to 1%. Larval survival rates were monitored over a 7 day period following exposure to neem. The virulence of the fungus M. anisopliae was confirmed using five conidial concentrations (1 × 10(5) to 1 × 10(9) conidia mL(-1)) and survival monitored over 7 days. Two concentrations of fungal conidia were then tested together with neem (0.001%). Survival curve comparisons were carried out using the Log-rank test and end-point survival rates were compared using one-way ANOVA. RESULTS: 1% neem was toxic to A. aegypti larvae reducing survival to 18% with S50 of 2 days. Neem had no effect on conidial germination or fungal vegetative growth in vitro. Larval survival rates were reduced to 24% (S50 = 3 days) when using 1 × 10(9) conidia mL(-1). Using 1 × 10(8) conidia mL(-1), 30% survival (S50 = 3 days) was observed. We tested a "sub-lethal" neem concentration (0.001%) together with these concentrations of conidia. For combinations of neem + fungus, the survival rates were significantly lower than the survival rates seen for fungus alone or for neem alone. Using a combination of 1 × 10(7) conidia mL(-1) + neem (0.001%), the survival rates were 36%, whereas exposure to the fungus alone resulted in 74% survival and exposure to neem alone resulted in 78% survival. When using 1 × 10(8) conidia mL(-1), the survival curves were modified, with a combination of the fungus + neem resulting in 12% survival, whilst the fungus alone at this concentration also significantly reduced survival rates (28%). CONCLUSIONS: The use of adjuvants is an important strategy for maintaining/increasing fungal virulence and/or shelf-life. The addition of neem to conidial suspensions improved virulence, significantly reducing larval survival times and percentages.

Intervenção neurofuncional pediátrica em agenesia do corpo caloso: relato de caso / Pediatric neurofunctional intervention in agenesis of the corpus callosum: a case report

Objetivo: Descrever um relato clínico pré e pós-intervenção neurofuncional num caso de agenesia de corpo caloso. Descrição do caso: Após o nascimento prematuro foi detectada agenesia do corpo caloso e hipoplasia dos ventrículos laterais e vérmis cerebelar. Aos dois anos iniciou a intervenção proposta neste estudo. Uma avaliação neurofuncional, além da Medida da Função Motora Grossa e o Sistema de Classificação da Função Motora Grossa, foi utilizada para obter o desempenho funcional da criança. Na avaliação inicial havia ausência de reações de equilíbrio e de transferências posturais, e déficits no controle manual e de tronco. A intervenção foi realizada com enfoque na função, priorizando o controle postural e a orientação da familia para continuidade do tratamento em ambiente domiciliar. Após a intervenção houve melhora das reações corporais, controle postural e aquisição de movimentos de mãos e membros. A intervenção também mostrou melhora no desempenho funcional. Comentários: O controle postural e as transferências de posições foram beneficiadas por intervenção neurofuncional nesse paciente com agenesia de corpo caloso. O enfoque baseado na função com atividades que envolvem fortalecimento muscular e treinamento das reações de equilíbrio influenciaram a aquisição do comportamento motor mais seletivo...

Objective: To describe a clinical report pre- and post-neurofunctional intervention in a case of agenesis of the corpus callosum. Case description: Preterm infant with corpus callosum agenesis and hypoplasia of the cerebellum vermis and lateral ventricles, who, at the age of two years, started the proposed intervention. Functional performance tests were used such as the neurofunctional evaluation, the Gross Motor Function Measure and the Gross Motor Function Classification System. In the initial evaluation, absence of equilibrium reactions, postural transfers, deficits in manual and trunk control were observed. The intervention was conducted with a focus on function, prioritizing postural control and guidance of the family to continue care in the home environment. After the intervention, there was an improvement of body reactions, postural control and movement acquisition of hands and limbs. The intervention also showed improvement in functional performance. Comments: Postural control and transfers of positions were benefited by the neurofunction intervention in this case of agenesis of the corpus callosum. The approach based on function with activities that involve muscle strengthening and balance reactions training, influenced the acquisition of a more selective motor behavior...

The impact of cyclooxygenase-2 and vascular endothelial growth factor C immunoexpression on the prognosis of penile carcinoma.

PURPOSE: We assessed the influence of cyclooxygenase-2 and vascular endothelium growth factor-C immunoexpression on groin metastasis and cancer survival, and their association with histological variables in patients with penile carcinoma. MATERIALS AND METHODS: We evaluated the histological and cyclooxygenase-2/vascular endothelium growth factor-C immunohistochemical profiles of patients with penile carcinoma treated at a single institution between 2001 and 2008. Univariate and multivariate analysis was done to determine the impact of histological and immunohistochemical markers on the risk of inguinal metastasis and on cancer survival. Survival analysis of relevant variables was also done. RESULTS: Of the 127 patients enrolled 76 and 30 had positive cyclooxygenase-2 and vascular endothelium growth factor-C immunoexpression, respectively. Univariate analysis identified an association between vascular endothelium growth factor-C immunoexpression and groin metastasis, and certain histological variables. Logistic regression showed that high tumor grade, Jackson stage and vascular endothelium growth factor-C immunoexpression were independent predictors of inguinal metastasis. Cancer survival was only influenced by advanced Jackson stage and groin metastasis. CONCLUSIONS: Findings suggest that vascular endothelium growth factor-C expression may help identify patients with an unfavorable clinical course of penile carcinoma. Cyclooxygenase-2 did not alter the risk of groin metastasis or cancer death. Inguinal disease and advanced Jackson stage were independent prognostic factors for worse cancer survival.

[Clinico-epidemiological aspects associated with penile cancer]. / Aspectos clínico-epidemiológicos associados ao câncer de pênis.

The general objective of this article is to review the current literature regarding the epidemiology, biological behavior and risk factors for penile cancer development, such as HPV infection. Phimosis and chronic irritation related to poor hygiene are commonly associated with penile cancer, whereas neonatal circumcision reduces the relative risk for the disease. There is strong evidence that HPV types 16 and 18 are associated with penile carcinoma in as many as 50% of cases. Patients with penile lesions should undergo physical examination, which is often sufficient to diagnose and to define tumor stagging, as well as contributes to decision-making regarding therapeutical approaches and case management.

Aspectos clínico-epidemiológicos associados ao câncer de pênis / Clinico-epidemiological aspects associated with penile cancer

O objetivo desta revisão bibliográfica foi descrever a epidemiologia, o comportamento biológico dos tumores e os fatores de risco para o câncer de pênis, como a infecção pelo HPV. A fimose e os processos de irritação crônica relacionados à má higiene estão comumente associados com esse tumor, enquanto a circuncisão neonatal protege contra a aparição da doença. Existe forte evidência da associação dos HPV 16 e 18 com o carcinoma peniano em mais de 50 por cento dos casos. Pacientes com lesões penianas suspeitas devem se submeter ao exame físico, geralmente sendo este suficiente para determinar o diagnóstico e o estadiamento, assim como auxiliar na escolha terapêutica.

The general objective of this article is to review the current literature regarding the epidemiology, biological behavior and risk factors for penile cancer development, such as HPV infection. Phimosis and chronic irritation related to poor hygiene are commonly associated with penile cancer, whereas neonatal circumcision reduces the relative risk for the disease. There is strong evidence that HPV types 16 and 18 are associated with penile carcinoma in as many as 50 percent of cases. Patients with penile lesions should undergo physical examination, which is often sufficient to diagnose and to define tumor stagging, as well as contributes to decision-making regarding therapeutical approaches and case management.

Pilot study to compare the efficacy of the usual recommended prophylactic antibiotic to the addition of oral ciprofloxacin for patients undergoing radical prostatectomy

Background: This is a randomized, prospective, double-blind pilot study to compare the efficacy of preoperative cephalosporin to the addition of ciprofloxacin to avoid positive urinary culture in patients undergoing radical prostatectomy. Material and Methods: Sixty-four patients with similar clinical features and who underwent radical prostatectomy were split into three antibiotic groups: group A using prophylactic preoperative cephalosporin; group B using the prophylactic cephalosporin plus one day ciprofloxacin and group C using the prophylactic cephalosporin plus ciprofloxacin for 5 days. Urine samples, taken before surgery and after removal of the indwelling catheter, were evaluated. For statistical analysis, we used Chi-square test to establish the association of the antibiotic regimen and positive urinary culture in the univariate analysis and logistic regression in the multivariate analysis. Results: Less urinary infection rate was observed in both groups receiving the addition of ciprofloxacin for one and five days (20 and 9.5 percent, respectively) compared to the use of single preoperative cephalosporin (52.1 percent; p=0.0047). Conclusions: This study suggests that the usual recommendation of preoperative cephalosporin alone may not be adequate to avoid high rates of urinary positive culture in patients undergoing radical prostatectomy.

A new chest wall reconstruction: a three-layer technique

Soft tissue sarcomas are rare tumors that represents less than 1% of all neoplasms and only 5.3% of these tumors arises in the chest wall. After resection of these tumors, the defects generated by radical surgery especially when sternum or three or more ribs are resected represent a challenge to the surgeons because of the defect itself and pulmonary physiology alterations. The authors describe a new three-layer technique for chest wall reconstruction, based upon steel stitches, polypropylene mesh and myocutaneous flaps performed in six consecutive patients.

Small round blue cell tumor of seminal vesicle in a young patient.

Seminal vesicle tumor is a rare disease with unclear origin. Generally, it is presented as a pelvic mass that can be detected by sonography and digital rectal exam. The authors report a 25-year-old patient with a pelvic mass which the magnetic resonance and surgical specimen reveal a seminal vesicle tumor. Immunohistochemical findings favored a primitive neuroectodermal tumor of the seminal vesicle. Herein, the treatment, histological and histochemical findings of this entity are discussed.

Nefrectomia radical laparoscópica no tratamento do câncer renal / Laparoscopic radical nephrectomy in renal carcinoma treatment

O câncer renal é uma moléstia onde a cura é obtida essencialmente através de tratamento cirúrgico em estágios iniciais. A nefroctomia radical pode ser realizada por via aberta ou laparoscópica, sendo que a última associa as vantagens de procedimentos minimamente invasivos. Neste artigo os autores realizam uma revisão extensa da literatura para comparar os resultados da nefrectomia radical aberta (NRA) versus nefrectomia radical laparoscópica (NRL).

Small round blue cell tumor of seminal vesicle in a young patient

Seminal vesicle tumor is a rare disease with unclear origin. Generally, it is presented as a pelvic mass that can be detected by sonography and digital rectal exam. The authors report a 25-year-old patient with a pelvic mass which the magnetic resonance and surgical specimen reveal a seminal vesicle tumor. Immunohistochemical findings favored a primitive neuroectodermal tumor of the seminal vesicle. Herein, the treatment, histological and histochemical findings of this entity are discussed.

The impact of prior prostatic surgery on urinary continence in patients undergoing orthotopic ileal neobladder

OBJECTIVE: To establish if previous surgery for benign prostatic hyperplasia (transurethral resection of the prostate or open prostatectomy), age, and preservation of prostatic apex can influence postoperative urinary continence in patients submitted to radical cystectomy and orthotopic ileal neobladder. PATIENTS AND METHODS: We analyzed 62 patients with bladder cancer who were treated with radical cystectomy and orthotopic ileal neobladder between 1987 and 1998 and had been followed for at least 24 months. The average age and median follow up were 61 years and 53 months, respectively. Postoperative urinary continence was correlated with 3 factors: patient age, preservation of prostatic apex during surgical excision and prior prostatic surgery for benign disease. Patients were defined as incontinent when they had to use more than 1 protective pad at the daytime. RESULTS: The overall incidence of urinary incontinence was 12.9 percent (8 out of 62 patients). The only statistically significant factor that impacted upon urinary continence was previous prostatic surgery, with respectively 33 percent versus 7 percent rate of incontinence for patients previously operated on and for those without previous operation (p = 0.023 odds ratio = 6.5, 95 percent confidence interval). Preservation of prostatic apex did not reach difference, 12 percent versus 13 percent, for those with and without preservation, and age also did not influence the postoperative continence rate. CONCLUSIONS: Prior prostatic surgery for benign prostatic hyperplasia probably can increases the risk for postcystectomy incontinence and preservation of prostate apex did not affect the continence rate. This issue deserves to be considered by the surgeon and must be discussed previously with the patients when planning an orthotopic bladder replacement.

Can selective retroperitoneal lymphadenectomy be better than unilateral retroperitoneal lymphadenectomy?

OBJECTIVE: To propose a new modality of retroperitoneal lymphadenectomy as a complementary treatment for patients with high risk, stage I nonseminomatous testicular tumor. MATERIALS AND METHODS: We studied 76 patients with stage I nonseminomatous testis tumor (T1-T4, NX, M0) treated by orchiectomy and retroperitoneal lymphadenectomy. Among them, 33 patients underwent unilateral retroperitoneal lymphadenectomy (URL) and 43 selective retroperitoneal lymphadenectomy (SRL). URL consisted in removing the lymph nodes located around the great vessel homolateral to the tumor (aorta or vena cava and iliac vessels), and anterior and posterior to the contralateral great vessel (aorta or vena cava). SRL was performed removing the lymph nodes located anterior and between the great vessels (aorta or vena cava) and laterally to the homolateral great vessel, extending the distal dissection until the level of inferior mesenteric artery. In these groups of patients, the incidence of disease recurrence, disease-free survival index, and frequency of post-operative aspermia were assessed. Mean post-operative follow-up time was 96 months. RESULTS: In the SRL group there was only 5 percent of aspermia versus 79 percent in the URL group (p < 0.0001). Tumor recurrence was observed in only 5 of the 76 patients and was not related to the surgical technique. The disease-free survival rate after the mean follow-up of 96 months was similar in both groups, being 94 percent in the SRL group and 93 percent in the URL group. CONCLUSION: The selective retroperitoneal lymphadenectomy constitutes an effective technique with a lower morbidity than unilateral lymphadenectomy, representing an excellent option for the management of patients with high-risk, stage I nonseminomatous testis tumor.