Robotic partial nephrectomy after pazopanib treatment in a solitary kidney with segmental vein thrombosis.

OBJECTIVE: To demonstrate our surgical technique of robotic partial nephrectomy (RPN) in a patient with a solitary kidney who received neoadjuvant Pazopanib, highlighting the multidisciplinary approach. MATERIALS AND METHODS: In our video, we present the case of 77-year-old male, Caucasian with 6.6cm left renal neoplasm in a solitary kidney. An initial percutaneous biopsy from the mass revealed clear cell RCC ISUP 2. After multidisciplinary tumor board meeting, Pazopanib (800mg once daily) was administered for 8 weeks with repeat imaging at completion of therapy. Post-TKI image study was compared with the pre-TKI CT using the Morphology, Attenuation, Size, and Structure criteria showing a favorable response to the treatment. Thereafter, a RPN was planned3. Perioperative surgical outcomes are presented. RESULTS: Operative time was 224 minutes with a cold ischemia time of 53 minutes. Estimated blood loss was 800ml and the length of hospital stay was 4 days. Pathology demonstrated a specimen of 7.6cm with a tumor size of 6.5cm consistent with clear cell renal carcinoma ISUP 3 with a TNM staging pT1b Nx. Postoperative GFR was maintained at 24 ml / min compared to the preoperative value of 33ml / min. CONCLUSIONS: A multidisciplinary approach is effective for patients in whom nephron preservation is critical, providing na opportunity to select those that may benefi t from TKI therapy. Pazopanib may allow for PN in a highly selective subgroup of patients who would otherwise require radical nephrectomy. Prospective data will be necessary before this strategy can be disseminated into clinical practice. Available at: http://www.intbrazjurol.com.br/video-section/20180240_Garisto_et_al.

Single-Incision Laparoscopy Surgery Excision of an Infected Urachal Cyst: Description of the Technique.

Background: Urachal cysts (UCs) are secondary to incomplete obliteration of the embryonic urachal duct and may become symptomatic when infected. Treatment is primarily surgical to excise the infected cyst. Surgical approaches include a lower midline laparotomy or minimally invasive (MI) techniques. Case: We present a case of a young male with an infected UC that was treated with a single-incision laparoscopy surgery. The operative technique is described. Conclusion: This approach is a safe and feasible option for the MI management of UCs.

Human trypanosomiasis in the eastern region of the Panama Province: new endemic areas for Chagas disease.

The epidemiology of Chagas disease was studied in five rural communities located in the eastern region of the Panama Province. Serological tests for Trypanosoma cruzi infection revealed a prevalence of 5.88% (12/204). Hemocultures coupled with polymerase chain reaction (PCR) analysis showed a Trypanosoma rangeli infection rate of 5.88% (12/204). An overall trypanosome infection index of 11.76% (24/204) was detected in this population. A total of 121 triatomine specimens were collected in domestic and peridomestic habitats. Rhodnius pallescens was confirmed as the predominant species. Molecular analysis showed that 17.8% (13/73) of the examined insects were positive for T. cruzi, 17.8% (13/73) for T. rangeli, and 35.6% (26/73) presented mixed infections. Among 73 R. pallescens evaluated, 16.4% (12/73) contained opossum blood meals. The epidemiological implications of these findings are discussed.

Giant fecaloma in a 12-year-old-boy: a case report.

BACKGROUND: Fecaloma is a mass of feces accumulated that is much harder in consistency than a fecal impactation. The aim of this report is to give a brief review of this entity and discuss the treatment options for these cases. CASE PRESENTATION: We present the case of a 12-year-old boy who developed a fecaloma associated with chronic constipation. This is a rare case on a child which was treated by a sigmoid colectomy after failure of conservative measures of evacuation. CONCLUSION: Fecaloma should be considered in the differential diagnosis of patients with history of chronic constipation and abdominal mass.

Open thoracotomy and decortication for chronic empyema.

OBJECTIVES: Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS: From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS: Twenty-seven patients (81.8 %) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8%) and trauma in 7 (21.2%). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9%) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS: Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.

Open thoracotomy and decortication for chronic empyema

OBJECTIVES: Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS: From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS: Twenty-seven patients (81.8 percent) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8 percent) and trauma in 7 (21.2 percent). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9 percent) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS: Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.