RESUMO
OBJECTIVE: To develop and validate a novel perineal nerve block approach for transperineal prostate biopsy. PATIENTS AND METHODS: Five adult male cadavers were dissected to delineate the superficial and deep branches of the perineal nerve. Afterwards, 90 out of 115 patients were selected and randomly assigned to receive periprostatic, periapical triangle, or branches of perineal nerve (BPN) block. The primary outcome was the maximal pain intensity associated with transperineal prostate biopsy, which was assessed by the 10-point visual analog scale. The secondary outcomes included the number of biopsy with visual analog scale of ≥4 in each biopsy procedure, and the incidences of complications. RESULTS: On the horizontal line of the upper anal border, the locations of the superficial branch of perineal nerve on the left and right sides were 1.87 ± 0.05 cm and 1.86 ± 0.06 cm, respectively; and the deep branch were 2.15 ± 0.07 cm and 2.16 ± 0.06 cm, respectively, from the midline, and lied between the deep layer of superficial fascia and prostate capsule. The number of cases finally enrolled in data analysis in periprostatic block, periapical triangle block, and BPN block groups were 26, 27, and 30, respectively. The maximal pain intensities were 3.4 (3.1-3.7), 3.3 (3.0-3.6), and 1.8 (1.5-2.2) in the 3 groups, respectively, and the numbers of biopsy with the pain intensity of ≥4 were 4.0 (3.2-4.9), 4.2 (3.3-5.2), and 0.7 (0.1-1.2), respectively. There were 4, 3 and 4 cases developing hematuria, and 1, 1 and 2 burdened with urine retention after biopsy in the 3 groups, respectively. CONCLUSION: Collectively, BPN block is a safe, effective and repeatable local anesthesia approach for transperineal prostate biopsy.
Assuntos
Biópsia/métodos , Bloqueio Nervoso/métodos , Próstata/cirurgia , Neoplasias da Próstata/diagnóstico , Nervo Pudendo/anatomia & histologia , Idoso , Anestesia Local/métodos , Biópsia por Agulha/métodos , Cadáver , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Método Simples-Cego , Resultado do TratamentoRESUMO
OBJECTIVE: Effects of tea catechin epigallocatechin-3-gallate (EGCG) against biofilm formation by Streptococcus mutans and probiotic Lactobacillus casei in Yakult® (LcY) were examined. DESIGN: Biofilms were formed by S. mutans alone (Sm) and co-culture of S. mutans and LcY (Smâ¯+â¯LcY) in the absence or presence of EGCG. The biomass of biofilms, which were sonicated or not, was measured by the crystal violet assay. Biofilm morphology was observed by scanning electron microscopy. Bacterial viability and extracellular polysaccharides were determined by SYTO9/propidium iodide and dextran-conjugated fluorescein staining, respectively, and confocal microscopy. Gene expression of glucosyltransferase was determined by quantitative polymerase chain reaction. RESULTS: While 250⯵g/ml EGCG significantly decreased the biomass and acid production of Sm biofilms, 500⯵g/ml EGCG was required to inhibit Smâ¯+â¯LcY biofilm formation and acid production. EGCG decreased the amount of live bacteria present in both Sm and Smâ¯+â¯LcY biofilms. The level of dead bacteria in Smâ¯+â¯LcY biofilms was higher than in Sm biofilms when formed in the presence of 250⯵g/ml EGCG. EGCG decreased levels of extracellular polysaccharides in Sm and Smâ¯+â¯LcY biofilms. The extent of biofilm removal by sonication was not different between Sm and Sm+LcY biofilms formed in the absence or presence of 62.5 or 125⯵g/ml EGCG. The level of Sm gtfB and gtfD expression in Smâ¯+â¯LcY biofilms was higher than those in the Sm biofilms when formed in the presence of EGCG at 250⯵g/ml. CONCLUSION: The results indicated that LcY might interfere the inhibitory effects of EGCG against biofilm formation by S. mutans.