Durable biochemical response following adrenal metastasectomy for oligometastatic castrate-resistant prostate cancer.

A 77 year-old man was referred to Urology with an enlarging left adrenal mass after treatment with androgen deprivation therapy for metastatic castrate-resistant prostate cancer. He underwent a robotic-assisted left radical adrenalectomy, with pathology revealing metastatic adenocarcinoma consistent with a primary prostate adenocarcinoma. The patient had a durable oncological response to metastasectomy with no evidence of biochemical or radiological recurrence after 5 years of follow-up. Adrenal metastases from prostate cancer are extremely rare, representing only 1% of metastatic cases. Surgical resection of oligometastatic prostate cancer recurrences may be considered in select patients and may improve progression-free survival.

Extent of Baseline Prostate Atrophy Is Associated With Lower Incidence of Low- and High-grade Prostate Cancer on Repeat Biopsy.

OBJECTIVE: To evaluate whether baseline prostate atrophy (PA) extent is associated with prostate cancer (PCa) incidence at 2-year repeat prostate biopsy in a clinical trial with systematic biopsies. MATERIALS AND METHODS: We performed a retrospective analysis of 3165 men 50-75 years old with prostate-specific antigen between 2.5 and 10 ng/mL and a prior negative biopsy in the placebo arm of the Reduction by Dutasteride of PCa Events trial who underwent a 2-year repeat biopsy. PA extent was defined as the percentage of cores with atrophic changes. The association of baseline PA with positive 2-year biopsies was evaluated with logistic regression in uni- and multivariable analysis, controlling for baseline covariates. RESULTS: PA involving none, 1%-25%, 26%-50%, 51%-75%, and >75% of the baseline cores was observed in 966 of 3165 (30.5%), 1189 of 3165 (37.6%), 677 of 3165 (21.4%), 209 of 3165(6.6%), and 124 of 3165 (3.9%) cases, respectively. More extensive PA was associated with older age, lower prostate-specific antigen, larger prostate volume, and higher prevalence of acute and chronic inflammations (all P < .05). Compared to subjects without PA, those with 1%-25%, 26%-50%, 51%-75%, and >75% core involvement had an odds ratio for PCa of 0.65 (95% confidence interval [CI] = 0.52-0.81), 0.60 (95% CI = 0.46-0.78), 0.56 (95% CI = 0.37-0.86), and 0.35 (95% CI = 0.19-0.67), respectively. In multivariable analysis, the extent of PA was independently associated with lower PCa risk (P < .001). More extensive PA was associated with lower incidence of low-grade (Gleason 2-6) and high-grade (Gleason 7-10) PCa. CONCLUSION: The extent of baseline PA is independently associated with lower PCa risk in a dose-dependent fashion.

Tratamento de mucocele com emprego da técnica de Shira: relato de caso / Mucocele treatment with work Shira's technique: case report

A mucocele é uma patologia das glândulas salivares menores que acomete frequentemente a cavidade oral. Clinicamente, apresenta-se como um aumento de volume circunscrito, submucoso, assintomático e de cor rósea ou azulada. A escolha do tratamento da mucocele dependerá de alguns fatores importantes da lesão, tais como tamanho, localização e profundidade. A excisão cirúrgica convencional é a técnica mais utilizada para tratamento de mucoceles e a recidiva é uma das principais complicações desta abordagem. A técnica de Shira, que consiste na injeção cuidadosa de material hidrocolóide dentro da lesão com o objetivo de delimitá-la e removê-la por completo, diminui as chances de recorrência desta patologia. O objetivo deste trabalho é relatar um caso clínico de mucocele de grande volume em lábio inferior que foi tratada cirurgicamente com a técnica de Shira, discutir algumas formas de tratamento para mucoceles em região labial, dando ênfase às vantagens da técnica de Shira.

The mucocele is a pathology of the salivary glands that often affects the oral cavity. Clinically, it presents as an increase in volume circumscribed, submucosal, asymptomatic and in pink or blue. The choice of treatment will depend mucocele of some importante factors of injury, such as size, location and depth. The conventional surgical excision is the most used technique for the treatment of mucoceles and recurrence is a major complication of this approach. A technique that consists of injecting Shira careful hydrocolloid material within the lesion in order to enclose it and remove it completely diminishes the chances of recurrence of this disease. The objective of this study is to report a case of mucocele large volume bottom lip which was treated surgically using the technique of Shira and discuss some forms of treatment for mucoceles in lip region, emphasizing the advantages of the technique Shira.

Urodynamic features of the voiding dysfunction in HTLV-1 infected individuals.

OBJECTIVE: To describe urodynamic abnormalities in HTLV-1 infected individuals presenting urinary symptoms and verify if these findings and quality of life (QOL) evaluation correlate with overall neurological impairment. MATERIALS AND METHODS: From January/2001 to May/2004, 324 HTLV-1 seropositive subjects were evaluated to determine the occurrence of urinary symptoms. Urodynamic testing was performed in those who complained of frequency, urgency, or incontinence. They went through a complete clinical, neurological, and urological examination to investigate symptoms and signs of myelopathy. Neurological disability was assessed by Expanded Disability Status Scale (EDSS). RESULTS: From the 324 patients evaluated, 78 underwent the urodynamic testing. Fifty-seven individuals were females (73.1%) and age ranged from 23 to 76 years (mean=48.7 years; SD +/- 11.6). Urodynamic testing was abnormal in 63 patients (80.8%). The major abnormality was detrusor overactivity (DO), observed in 33 individuals (33/63; 52.4%), followed by detrusor-external sphincter dyssynergia (DESD), diagnosed in 15 subjects (15/63; 25.4%). HAM/TSP patients had significantly more DESD than the HTLV-I carriers (p=0.005; OR=5.5; CI: 1.6 to 19.4). QOL was severely compromised in HAM/TSP patients. CONCLUSIONS: Prominent urodynamic abnormalities were identified in individuals genuinely considered as HTLV-I carriers, suggesting an early compromise of the urinary tract; whereas HAM/TSP patients presented urodynamic findings, which posed a potential risk to the upper urinary tract (dyssynergia). Urodynamic evaluation should be performed in all HTLV-I-infected individuals with voiding complaints.

Urinary symptoms associated with human T-cell lymphotropic virus type I infection: evidence of urinary manifestations in large group of HTLV-I carriers.

OBJECTIVES: To describe the frequency of urologic manifestations in human T-cell lymphotropic virus type I (HTLV-I) seropositive individuals from Salvador and other cities in Bahia, Brazil, with or without clinical HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). METHODS: A total of 218 HTLV-I seropositive subjects referred from blood banks or neurologic clinics were admitted to the HTLV-I multidisciplinary outpatient clinic from January 2001 to April 2004. They were assessed using a standardized questionnaire to determine urinary complaints and quality of life. Neurologic impairment was established using the Expanded Disability Status Scale (EDSS). HAM/TSP was considered as an EDSS score of 2 or greater. RESULTS: Nocturia (35.8%) was the most frequent finding, followed by incontinence (29.8%), urgency (25.2%), frequency (22.0%), and dysuria (15.6%). Differences were found between individuals with an EDSS score of 0 and those with an EDSS score greater than 0 but less than 2 regarding frequency, nocturia, urgency, urinary loss of any degree, and quality of life. Dysuria and great or total urinary loss were more frequent among those with severe HAM/TSP (EDSS score greater than 6). CONCLUSIONS: Even HTLV-I subjects considered not to have HAM/TSP may have prominent urinary findings already present. Urologic manifestations, including nocturia and urinary loss, might be early manifestations of neurologic disease in those with HTLV-I.

Urodynamic features of the voiding dysfunction in HTLV-1 infected individuals

OBJECTIVE:To describe urodynamic abnormalities in HTLV-1 infected individuals presenting urinary symptoms and verify if these findings and quality of life (QOL) evaluation correlate with overall neurological impairment. MATERIALS AND METHODS: From January/2001 to May/2004, 324 HTLV-1 seropositive subjects were evaluated to determine the occurrence of urinary symptoms. Urodynamic testing was performed in those who complained of frequency, urgency, or incontinence. They went through a complete clinical, neurological, and urological examination to investigate symptoms and signs of myelopathy. Neurological disability was assessed by Expanded Disability Status Scale (EDSS). RESULTS: From the 324 patients evaluated, 78 underwent the urodynamic testing. Fifty-seven individuals were females (73.1 percent) and age ranged from 23 to 76 years (mean = 48.7 years; SD ± 11.6). Urodynamic testing was abnormal in 63 patients (80.8 percent). The major abnormality was detrusor overactivity (DO), observed in 33 individuals (33/63; 52.4 percent), followed by detrusor-external sphincter dyssynergia (DESD), diagnosed in 15 subjects (15/63; 25.4 percent). HAM/TSP patients had significantly more DESD than the HTLV-I carriers (p = 0.005; OR = 5.5; CI: 1.6 to 19.4). QOL was severely compromised in HAM/TSP patients. CONCLUSIONS: Prominent urodynamic abnormalities were identified in individuals genuinely considered as HTLV-I carriers, suggesting an early compromise of the urinary tract; whereas HAM/TSP patients presented urodynamic findings, which posed a potential risk to the upper urinary tract (dyssynergia). Urodynamic evaluation should be performed in all HTLV-I-infected individuals with voiding complaints.

Prevalência de anticorpos antimicrossomais em pacientes com esclerose múltipla / Prevalence of antimicrosomal antibodies in patients with multiple sclerosis

O objetivo deste estudo consiste em avaliar a prevalência de anticorpos antimicrossomais (AAM), a função tireóidea e a ocorrência de sintomas relacionados ao hipotireoidismo em pacientes com esclerose multipla (EM). Em um grupo de 21 pacientes com EM, foi realizado exameclínico, foram dosados o TSH, T4 e T4 livre e pesquisados AAM. A média de idade foi 41,05 anos e a média de tempo de doença foi 85,9 meses. Os sintomas relacionados ao hipotireoidismo foram fadiga, fraqueza, letargia e parestesias. Os AAM foram encontrados em 4 pacientes (19 por cento). O tempo de doença foi dividido em três períodos: <60 meses (3 pacientes AAM+/7AAM-), 60-120 meses (8 pacientes AAM-) e >120 meses (1 paciente AAM+/2 AAM-). Dois pacientes apresentaram níveis de T4 livre diminuídos, porém com T4 e TSH normais. Em 1 paciente, constatou-se hipotireoidismo subclínico, e em outro, hipotireoidismo clássico. Conclui-se que na avaliação dos pacientes com EM, em vista da falta de precisão na avaliação clínica do hipotireoidismo ocasionada pela sobreposição de sintomas referentes à EM, devam ser incorporadas as dosagens das provas de função tireóidea (PFT) e dos AAM.

[Prevalence of antimicrosomal antibodies in patients with multiple sclerosis]. / Prevalência de anticorpos antimicrossomais em pacientes com esclerose múltipla.

The aim of this study was to assess the prevalence of Antimicrosomal Antibodies AMA, thyroid function and the occurrence of hypothyroidism symptoms in patients with Multiple Sclerosis (MS). Clinical examination was carried out in 21 MS patients; thyroid-stimulating hormone (TSH), thyroxine (T4), free T4 and AMA were measured. Mean age was 41.05 years. Hypothyroidism symptoms included fatigue, weakness, lethargy and paresthesia. AMA were found in four patients (19%). Three categories of disease duration were considered: <60 months (3 patients AMA+; 7 AMA-), 60-120 months (8 patients AMA-), and >120 months (1 patient AMA+; 2 AMA-). Two patients presented decreased free T4 levels, but there was no associated decrease in T4 and TSH levels. In two patients, a mild increase in TSH levels was observed: one presented normal T4 levels (subclinical hypothyroidism) and the other one had low free T4 levels (classical hypothyroidism). We conclude that AMA measurement and thyroid function tests should become part of the routine assessment of MS patients, in view of the inaccuracy currently observed in the assessment of clinical hypothyroidism as a result of the superposition of hypothyroidism and MS signs and symptoms.