Twenty Years' Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center.

Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56-180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.

Comparison of prostate cancer detection rate at targeted biopsy of hub and spoke centers mpMRI: experience matters.

BACKGROUND: Latest changes in European guidelines on prostate cancer determined a widespread of multiparametric magnetic resonance imaging (mpMRI) even in less experienced centers due to an increased demand. This could decrease diagnostic accuracy of targeted biopsy (TB) since image interpretation can be challenging and requires adequate and supervised training. Therefore we aimed to evaluate the prostate cancer (PCa) detection rate on TB according to mpMRI center's volume and experience. METHODS: We retrospectively analyzed data of 737 patients who underwent mpMRI-TB at our institution. Patients were stratified according to mpMRI center: Hub (high volume >100 exams/year with dedicated radiologists and supervised training) and Spoke center (low volume <100 exams/year without dedicated radiologists and/or supervised training). Detection rate of PCa at TB and possible predictors of clinically significant PCa (csPCa) at TB. Differences in detection rate were explored using Chi-square test. Predictors of csPCa were evaluated through uni and multivariable logistic regression. The adjustment for casemix included: age, PSA, mpMRI center, lesion's location, PSA density, PI-RADS score and index lesion's size. RESULTS: Four hundred forty-nine (60.9%) and 288 (39.1%) patients underwent mpMRI at a Hub or Spoke center, respectively. Hub group had higher detection rate for both any (60.3% vs. 48.1%) and csPCa (46.9% vs 38.7%; all P≤0.001). After stratifying for PI-RADS score, Hub group had higher detection rate for PI-RADS score 3 (csPCA 25.2% vs. 15.7%; p 0.04) and 4 (csPCa 65.7% vs. 45.7%; P=0.001). At multivariable analyses, receiving an mpMRI scan at a Spoke center was an independent predictor for csPCa on TB (OR 0.65; P=0.04). CONCLUSIONS: mpMRI performed in Hub centers provided a significantly higher PCa yield on TB. A dedicated team of experienced radiologist, a supervised training for mpMRI and a central revision of mpMRI performed in non-experienced centres are essential to avoid unnecessary and potentially harmful procedures.

Interpreting nephrometry scores with three-dimensional virtual modelling for better planning of robotic partial nephrectomy and predicting complications.

OBJECTIVE: 3D models are increasingly used as additional preoperative tools for renal surgery. We aim to evaluate the impact of 3D renal models in the assessment of PADUA, RENAL, Contact Surface Area (CSA) and Arterial Based Complexity (ABC) for the prediction of complications after Robot assisted Partial Nephrectomy (RAPN). METHODS AND MATERIALS: Overall, 57 patients with T1 and 1 patient with T2 renal mass referred to RAPN, were prospectively enrolled. 3D virtual modelling was obtained from 2D computed tomography (CT). Two radiologists recorded PADUA2D, RENAL2D, CSA2D and ABC2D by evaluation of 2D images; two bioengineers recorded PADUA3D, RENAL3D, CSA3D and ABC3D by evaluation of the 3D model, using MeshMixer software. To evaluate the concordance between 2D and 3D nephrometry scores, Cohen's j coefficient was calculated. Receiver-operating characteristic (ROC) curves were generated to evaluate the accuracy of 3D and 2D nephrometry scores to predict overall complications. Finally, the impact of 3D model on clamping approach during RAPN was compared to 2D imaging. RESULTS: PADUA3D, RENAL3D, CSA3D and ABC3D scores had a significant different distribution compared to PADUA2D, RENAL2D, CSA2D and ABC2D (all p≤0.03). 2D nephrometry scores may be unchanged, reduced or increased after assessment by 3D models: CSA3D, PADUA3D, RENAL3D and ABC3D were reduced in14%, 26%, 29% and 16% and increased in 16%, 36%, 38% and 29% of cases, respectively. At ROC curve analysis, PADUA3D, RENAL3D and ABC3D showed were significantly better accuracy to predict complications compared to PADUA2D, RENAL2D and ABC2D. PADUA3D (OR: 1.66), RENAL3D (OR: 1.69) and ABC3D (OR: 2.44) revealed a significant correlation with postoperative complications (all P ≤0.03). CONCLUSION: Nephrometry scores calculated via 3D models predict complications after RAPN with higher accuracy than conventional 2D imaging.

The robotic approach improves the outcomes of ERAS protocol after radical cystectomy: A prospective case-control analysis.

BACKGROUND: Minimally-invasive approach is one of the mainstays of Enhanced Recovery After Surgery (ERAS) pathways. Robot-assisted radical cystectomy (RARC) introduction has reduced the surgical burden on patient's recovery. Accordingly, ERAS protocol benefits may be more striking in RARC patients. We evaluated the impact of surgical approach on perioperative outcomes, Fast Track (FT) recovery steps and Trifecta success rates in patients undergoing RC followed by FT protocol. MATERIALS AND METHODS: We considered 147 patients who underwent RC, with open (Open radical cystectomy [ORC]; 47.6%) or robotic (RARC; 52.4%) approach at 2 tertiary centers. Urinary diversions were ileal conduit or orthotopic neobladder. All patients underwent FT protocol. We analyzed perioperative surgical and functional outcomes and Trifecta success rates (namely, defecation <5 days, in-hospital stay <10 days and no major complications). Uni and multivariable logistic regression explored the predictors for Trifecta success and the impact of surgical approach on recovery steps. RESULTS: Patients undergoing RARC had higher FT adherence (95% vs. 61%) compared to ORCs (P < 0.01). Trifecta success rates were higher for RARC (79.2% vs 28.6%; P < 0.001). At multivariable analyses, RARC was an independent predictor for Trifecta success (OR 9.1), early mobilization (OR 5.9) and FT adherence (OR 3.33; all P < 0.001). Surgical technique was not associated with major complications or readmission within 90 days (all P > 0.05). CONCLUSION: RARC has more favorable perioperative outcomes compared to ORC, with higher Trifecta success rates. Accordingly, robotic approach should be ideally included in every center where ERAS protocol is applied to RC for maximizing patient's recovery.

Efficacy of a Lupinus mutabilis Sweet snack as complement to conventional type 2 diabetes mellitus treatment.

INTRODUCTION: Introduction: therapeutic lifestyles changes including frequent consumption of legumes have resulted in improved metabolic control and decreased blood pressure in type 2 diabetes-mellitus (T2DM) patients. Objective: this was a quasi-experimental-28-week crossover-study that assessed the effect of daily consumption of the legume Lupinus mutabilis (LM) on metabolic control of T2DM patients under hypoglycemic oral treatment. Material and methods: we recruited 79 adult male and female patients that were followed for 14-weeks without LM consumption and then received increasing doses of a LM-based-snack for other 14-weeks. Results: there was a significant decrease in blood pressure and a significant increase in HDL-cholesterol by the end of the study period. While patients with A1C concentrations > 8 and ≤ 10 did not significantly improve their metabolic control, patients with serum A1C concentrations ≤ 8.0% reduced significantly their A1C after the intervention and 71% achieved a target concentration of 6.5%. Conclusion: patients with T2DM could benefit with the addition of LM-snack to their conventional treatment.

INTRODUCCIÓN: Introducción: los cambios recomendados sobre los estilos de vida, incluido el consumo frecuente de leguminosas, han resultado en un mejor control metabólico y disminución de la presión arterial en pacientes con diabetes mellitus tipo 2 (DMT2). Objetivo: este fue un estudio casi experimental cruzado de 28 semanas que evaluó el efecto del consumo diario de la leguminosa Lupinus mutabilis Sweet (LM) en el control metabólico de pacientes con DMT2 con tratamiento oral hipoglucemiante. Material y métodos: inicialmente se reclutaron 79 pacientes adultos, hombres y mujeres, que fueron seguidos durante 14 semanas sin consumo de LM y luego recibieron dosis crecientes de un tentempié de LM durante otras 14 semanas. Resultados: se observó una disminución significativa en la presión arterial y un aumento significativo en el colesterol-HDL después del consumo de LM. Mientras que los pacientes con concentraciones de A1C sérica > 8 y ≤ 10 no mejoraron significativamente su control metabólico, los pacientes con concentraciones séricas de A1C ≤ 8,0% redujeron significativamente su A1C después de la intervención y el 71% de estos pacientes llegó a la meta de tratamiento ≤ 6,5%. Conclusión: los pacientes con DMT2 podrían beneficiarse con la adición de un tentempié de LM a su tratamiento convencional.

Manejo clínico de hemorragia subaracnoidea por aneurisma intracraneal en una mujer embarazada en Quito, Ecuador: reporte de caso / Clinical management of subarachnoid haemorrhage due to intracranial aneurysm in a pregnant woman in Quito, Ecuador: Case report

RESUMEN Objetivo: describir el diagnóstico y manejo de la hemorragia subaracnoidea secundaria a un aneurisma arterial cerebral accidentado en la primera mitad del embarazo. Materiales y métodos: se presenta el caso de una mujer de 26 años en su segundo embarazo, sin abortos previos y con una cesárea anterior, que fue atendida en un centro de referencia de atención materno perinatal ubicado en Quito, Ecuador, por diagnóstico de hemorragia subaracnoidea durante la decimoséptima semana de gestación. En la panangiografía cerebral se observó un aneurisma cerebral de cuello ancho en la arteria temporal anterior con sangrado. Resultados: se realizó un tratamiento con prótesis endovascular y microespirales, con control de la hemorragia. Posteriormente, la paciente requirió doble antiagregación plaquetaria con clopidogrel y ácido acetilsalicílico que se mantuvo hasta una semana antes del parto. A la paciente se le realizó una cesárea electiva en la que nació un niño sano de 37,2 semanas. Conclusión: el tratamiento endovascular con la colocación de microespirales, asociado al uso de antiagregantes plaquetarios, es una alternativa por considerar en gestantes en la primera mitad del embarazo. Se requieren más estudios clínicos para establecer conductas terapéuticas bien fundamentadas en el manejo de estos casos.

ABSTRACT Objective: To describe the diagnosis and management of a case of subarachnoid haemorrhage secondary to arterial cerebral aneurysm during the first half of gestation. Materials and methods: A 26-year-old woman during a second pregnancy, with no prior miscarriages, and one previous cesarean section seen at a maternal and perinatal care referral centre located in Quito, Ecuador, with a diagnosis of subarachnoid haemorrhage at seventeen weeks of pregnancy. Cerebral pan-angiography showed a wide-neck cerebral aneurysm of the anterior temporal artery with bleeding. Results: Treatment was performed using endovascular stenting and coiling. Later, the patient required dual anti-platelet therapy with clopidogrel and acetylsalicylic acid, maintained up to a week before delivery. Elective cesarean section was performed and the patient was delivered of a healthy baby at 37.2 weeks of gestation. Conclusion: Endovascular treatment with the use of micro-coils, associated with anti-platelet aggregation therapy is an option to consider in pregnant women during the first half of gestation. Further clinical studies are needed in order to identify more fundamental therapeutic approaches for the management of these cases.

THE HISTORY OF CAPOEIRA IN THE SOUTH REGION OF THE STATE OF RIO DE JANEIRO: REUPDATES FROM THE PAST BY THE GUARDIANS OF MEMORY / LA HISTORIA DE LA CAPOEIRA EN LA REGIÓN SUR FLUMINENSE: LA REVITALIZACIÓN DEL PASADO DESDE LOS GUARDIANES DE LA MEMORIA / A HISTÓRIA DA CAPOEIRA NA REGIÃO SUL FLUMINENSE: AS REATUALIZAÇÕES DO PASSADO A PARTIR DOS GUARDIÕES DA MEMÓRIA

Aim: To investigate one version of the history of capoeira in the southern region of the State of Rio de Janeiro, using the perspectives of those responsible for the consolidation of the current stabilized capoeira groups. Method: The research was structured around oral history methodologies and theories about memory. Specifically, the research is based on the narratives of eight capoeira masters, who are active in this region. Results and Conclusion: The testimonials clarified the relevance of one master who is even remembered by the collective memory of those younger practitioners. We also concluded that the masters that have chosen to limit their practices to the root identity, and to resist to the globalization of culture, nowadays have less power in the capoeira market.

Objetivo: investigar una versión de la historia de capoeira en la región sur del Estado de Río de Janeiro, desde la perspectiva de los responsables de la consolidación de los actuales grupos establecidos. Método: se realizó una encuesta estructurada a partir de la metodología de la historia oral y las teorías acerca de la memoria. Las fuentes consultadas tienen como base los informes de ocho maestros de capoeira que trabajan en la región investigada. Resultados y conclusión: los informes permiten observar la importancia de un maestro que es poco recordado por la memoria colectiva de los practicantes más nuevos. También es posible inferir que los maestros que optaron por una raíz que demarca identidad resisten las influencias culturales globalizadas, actualmente tienen menos cuotas de poder en el mercado de capoeira en la región.

Objetivo: pesquisar uma versão da história de capoeira na região sul do Estado de Rio de Janeiro, desde a perspectiva dos responsáveis pela consolidação dos atuais grupos estabelecidos. Método: realizou-se uma encuesta estruturada a partir da metodologia da história oral e as teorias a respeito da memória. As fontes consultadas têm como base os relatórios de oito maestros de capoeira que trabalham na região pesquisada. Resultados e conclusão: os relatórios permitem observar a importância de um maestro que é pouco recordado pela memória coletiva dos praticantes mais novos. Também é possível inferir que os maestros que optaram por uma raiz que demarca identidade resistem às influências culturais globalizadas, atualmente têm menos quotas de poder no mercado de capoeira na região.

A pátria de chuteiras está desaparecendo? / The Brazilian soccer style is disappearing? / ¿El fútbol-arte estas desapareciendo?

O objetivo do artigo é analisar os textos publicados na imprensa sobre as Copas do Mundo de futebol de 1958 e 1962, e compará-los com os textos sobre a Copa de 2002, buscando explicitar possíveis descontinuidades no tratamento desses eventos esportivos. Utilizamos como fontes as edições do Jornal do Brasil durante as três Copas analisadas. A análise das narrativas jornalísticas referentes ao "estilo nacional" de jogar futebol apresenta continuidade. Ora temos o estilo de ginga e dribles valorizado, quando eficaz, ora o temos como negativo diante das derrotas. As narrativas das Copas de 1958 e 1962 não têm um caráter homogêneo ao tratar o futebol brasileiro, mudando o foco do debate de acordo com a superação das dificuldades do time.

This article's objective is to analyze the texts published in the press on the World Cups of 1958 and 1962, and to compare them with the texts published in the World Cup of 2002. We used as sources, the editions of Jornal do Brasil during the World Cups of 1958, 1962 e 2002.The analysis of the journalistic narratives regarding the "national style" of playing soccer presents continuity. The narratives of the Cups of 1958 and 1962 don't have a homogeneous character when treating the Brazilian soccer, changing the focus of the debate in agreement with the overcome of the team's difficulties.

El artigo realiza analices comparativas de los periódicos sobre La Copa do Mundo de fútbol de 1958 e 1962 con la Copa de 2002. Utilizamos como material empírico las noticias del periódico Jornal do Brasil publicados durante las tres Copas. Las analices indican que las narrativas periodistas referentes al "fútbol-arte" poco cambiaran, ora tenemos el estilo de la gambeta e da ginga valorizados, cuando eficaz, ora el estilo puede ser percibido como negativo delante de la derrota. Las narrativas de las Copas de 1958 y 1962 no parecen tener un carácter homogéneo al retratar el fútbol brasileño, cambiando el foco del debate mediante la superación del equipo.

Cardiopatia y embarazo (reporte de caso)

Se trata de un caso del servicio de patología Obstétrica de la Maternidad Isidro Ayora, de una paciente de 35 años de edad, embarazada de 38 semanas y portadora de una prótesis valvular mitral, que durante su embarazo cursa complicaciones tanto obstétricas como es la hipertensión inducida por el embarazo, así como de complicaciones cardiológicas como la insuficiencia cardiaca. Se descrive el manejo, esto es la compensación hemodinámica y luego de ello la terminación del embarazo por vía vaginal con el uso de prostaglandinas para maduración cervical, en este caso el uso de misoprostol. Por último se hace un comentario acerca del correcto manejo que deben tener estas pacientes, tanto por parte del médico cardiólogo como del obstétra.

Cardiopatía y Embarazo

El presente es un estudio prospectivo realizado en dos períodos con un total de 48 meses de revisión. La finalidad fue investigar las caracteristicas y tipos más frecuentes de cardiopatia con las que cursa el embarazo en un hospital de especialidad como es el Hospital Gineco-Obstétrico Isidro-Ayora. Se pudo ver asi, que la forma de Cardiopatia más frecuente es la insuficiencia Mitral y la doble lesión mitral, además que las pacientes decurrían su embarazo en grado funcional I-II(NYHA) en la gran mayoría de casos. Es este estudio no se registró mortalidad materna y la mortalidad neonatal fue de 6.7 por ciento.

Cardiopatía y embarazo complejo de eisenmenger y embarazo a término / Cardiopathy and complex pregnancy of eisenmenger and pregnancy upon maturity

Presenta el caso de una complicación poco frecuente en el embarazo, se realiza una revisión sobre el significado de la cardiopatía que se presenta durante la gestación y sus consecuencias fisiopatológicas. Presentamos un caso de una paciente portadora de una cardiopatía congénita del tipo complejo de Eisenmenger con severa hipertensión arterial pulmonar que cursa con un embarazo a término. El caso llega a un desenlace feliz tanto para la madre como para el feto. También hacemos incapié en la necesidad de terminar estos embarazos por vía vaginal, presentamos en este artículo la utilización de análogos sintéticos de las prostaglandina para maduración cervical en casos de score de Bishop inadecuado.

Cardiopatía y embarazo estenosis mitral severa y embarazo: presentación de caso / Cardiopathy and complex pregnancy of eisenmenger and pregnancy upon maturity

Presenta una revisión de los cambios hemodinámicos del embarazo, se revisan algunos aspectos de importancia sobre la estenosis mitral durante la gestación y se presenta el caso de una mujer gran multípara sin hijos vivos portadora de una estenosis mitral severa y un cuadro de hipertensión arterial esencial grave. La paciente termina su embarazo tempranamente, aborto diferido y es reparada su valvulopatía mitral en forma exitosa.

Resultados da Unidade de Terapia de Reidratacao Oral implantada em hospital infantil / Results of the Units of Oral Rehydration Therapy implanting in infantile hospitals

Os autores apresentam resultados da utilizacao da Terapiade Reidratacao Oral (TRO) em 9.773 casos de criancas portadoras de diarreia agu-da, atendidas na Unidade de Terapia de Reidratacao Oral (UTRO) do Hospital Infantil Nossa Senhora da Gloria (vitoria-ES), com ou sem sinais de desidratacao, in-dependente da etiologia, na faixa etaria de 0 a 14 anos, no periodo de agosto de1984 a maio de 1988. Foi utilizada a Solucao Reidratada Oral (SRO) e realimenta-cao precoce, com manutencao de alimentacao habitual durante a fase aguda e de recuperacao da diarreia, associadas a pratica educativa, segundo recomendacoes da Organizacao Mundial da Saude e seguidas as normas do Ministerio da Saude. Foram estudados, ao acaso e retrospectivamente, 8.612 prontuarios. Evolucao favoravel apenas com o uso das medidas propostas foi patente, sendo o indice de encaminha-mento para a Terapia de Reidratacao Endovenosa de apenas 6,13% dos casos. Os au-tores analisam a eficacia da TRO e comentam tambem sobre as vantagens operacio- nais e administrativas.