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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541948

RESUMEN

In this manuscript, we describe a rare case of neuroendocrine tumour metastatic to the testicle, presenting with testicular mass as an isolated symptom. We describe the investigations and management leading us to this uncommon histological diagnosis and explore its significance and impact on further management.


Asunto(s)
Tumores Neuroendocrinos , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/cirugía , Testículo/patología , Colectomía , Humanos , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/secundario , Orquiectomía , Compuestos Organometálicos , Tomografía de Emisión de Positrones , Neoplasias Testiculares/patología , Ultrasonografía
2.
Pediatr Emerg Care ; 37(2): 123-125, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33512891

RESUMEN

OBJECTIVES: To determine if boys with acute testicular torsion, a surgical emergency requiring prompt diagnosis and treatment to optimize salvage of the testicle, delayed presentation to a medical facility and experienced an extended duration of symptoms (DoS), and secondarily, a higher rate of orchiectomy, during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Single-center, descriptive retrospective chart review of boys presenting with acute testicular torsion from March 15, to May 4, 2020 ("during COVID-19" or group 2), as well as for the same time window in the 5-year period from 2015 to 2019 ("pre-COVID-19" or group 1). RESULTS: A total of 78 boys met inclusion criteria, group 1 (n = 57) and group 2 (n = 21). The mean age was 12.86 ± 2.63 (group 1) and 12.86 ± 2.13 (group 2). Mean DoS before presentation at a medical facility was 23.2 ± 35.0 hours in group 1 compared with 21.3 ± 29.7 hours in group 2 (P < 0.37). When DoS was broken down into acute (<24 hours) versus delayed (≥24 hours), 41 (71.9%) of 57 boys in group 1 and 16 (76.2%) of 21 boys in group 2 presented within less than 24 hours of symptom onset (P < 0.78). There was no difference in rate of orchiectomy between group 1 and group 2 (44.7% vs 25%, P < 0.17), respectively. CONCLUSIONS: Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.


Asunto(s)
/epidemiología , Torsión del Cordón Espermático/cirugía , Adolescente , Niño , Servicio de Urgencia en Hospital , Humanos , Masculino , Orquiectomía/estadística & datos numéricos , Estudios Retrospectivos , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/epidemiología , Testículo/cirugía , Factores de Tiempo , Tiempo de Tratamiento
3.
J Surg Oncol ; 123(4): 1157-1163, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33428791

RESUMEN

OBJECTIVE: To assess the response of chemotherapy on the primary tumor, compare it with the response in retroperitoneal disease, and study factors associated with pathological complete response. METHODS: We conducted a retrospective audit of all high inguinal orchidectomies (HIOs) performed after chemotherapy between 2012 and 2019 at a tertiary cancer center in India. Patient characteristics and histopathological response were extracted from electronic medical records, and predictors of testicular disease response were assessed. RESULTS: Of the 260 retroperitoneal lymph node dissections (RPLNDs) performed in the study period, 37 HIOs (14.23%) were carried out after chemotherapy. The median age of presentation was 28 years (16-41). Histopathology was divided into a viable tumor, mature teratoma, and necrosis/scarring. Residual disease was seen in 17 RPLND (46.0%) and 18 HIO (48.6%) specimens respectively. Of these 18, three patients had a residual viable tumor in the testis, and the remaining had a mature teratoma. Clinico-radiological assessment showed an average reduction of 61% in testicular disease size following chemotherapy. On orchidectomy histopathological assessment, the median tumor size was 9, 4, and 1.5 cm in specimens with a viable tumor, mature teratoma, and necrosis/scarring, respectively. CONCLUSIONS: A low threshold for upfront chemotherapy in patients with a high disease burden may be considered as tumors within the testis respond to chemotherapy in more than half of the patients. Discordance rates of residual cancer in RPLND and HIO specimens exist but post-chemotherapy tumor size in testis correlates with the presence of a residual viable tumor.


Asunto(s)
Barrera Hematotesticular/metabolismo , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Neoplasia Residual/patología , Neoplasias de Células Germinales y Embrionarias/patología , Orquiectomía/métodos , Neoplasias Retroperitoneales/patología , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Barrera Hematotesticular/efectos de los fármacos , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Neoplasia Residual/tratamiento farmacológico , Neoplasia Residual/cirugía , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/cirugía , Pronóstico , Estudios Prospectivos , Neoplasias Retroperitoneales/tratamiento farmacológico , Neoplasias Retroperitoneales/cirugía , Estudios Retrospectivos , Adulto Joven
4.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509883
5.
Clin Imaging ; 74: 106-122, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33485115

RESUMEN

Testicular ultrasound (US) studies are nowadays widely performed as being readily available, cost effective with no side effects. Testicular ultrasounds are ordered to help in the diagnosis of various conditions, but more specifically, in cryptorchidism. Other reasons for conducting testicular ultrasonography include testicular pain to confirm presence of epididymitis or orchitis. Consequently, the increase in these studies has raised the rate of finding incidental testicular and extra-testicular lesions. Consequently, knowing the variable imaging features of rare testicular and extra testicular lesions which are crucial, orchiectomy can be avoided. In this article, we present variety of unusual intra-testicular and extra-testicular masses and mass-like lesions with emphasis on key imaging features, main differential diagnosis and recommendation.


Asunto(s)
Neoplasias de Células Germinales y Embrionarias , Neoplasias Testiculares , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias de Células Germinales y Embrionarias/diagnóstico por imagen , Orquiectomía , Neoplasias Testiculares/diagnóstico por imagen , Testículo/diagnóstico por imagen , Ultrasonografía
6.
Zoo Biol ; 40(2): 135-141, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33338298

RESUMEN

To curb agonistic interactions in a bachelor group of three male capybaras (Hydrochoerus hydrochaeris), a single dose of leuprolide acetate (Lupron®) was used in an attempt to chemically sterilize the males. Concurrently, fecal androgen metabolite (FAM) concentrations were quantified via enzyme immunoassay to monitor changes in testosterone production after injection of the gonadotropin-releasing hormone agonist. When Lupron proved ineffective in suppressing intraspecific aggression, surgical castration was performed on two males, with continued noninvasive endocrine monitoring. In all three capybaras, FAM concentrations increased initially as a result of the luteinizing hormone surge, but then decreased significantly following chemical sterilization. Surgical castration resulted in further, persistent declines in FAM concentrations in two males, while the third, intact male demonstrated a rise in FAM to pre-Lupron concentrations at 8.5 and 9.5-month postadministration. Despite successful suppression of sperm and testosterone production, intermale aggression continued, ultimately necessitating separation of the animals and transfer to other holding institutions. Under this set of conditions, a single Lupron dose was inadequate for suppressing intraspecific aggression in a group of three males with a pre-established history of aggression.


Asunto(s)
Agresión/efectos de los fármacos , Leuprolida/administración & dosificación , Orquiectomía/veterinaria , Roedores/cirugía , Andrógenos/análisis , Animales , Animales de Zoológico , Conducta Animal/efectos de los fármacos , Heces/química , Roedores/fisiología
7.
Am J Physiol Endocrinol Metab ; 320(3): E415-E424, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33308013

RESUMEN

Sex steroids are critical for skeletal development and maturation during puberty as well as for skeletal maintenance during adult life. However, the exact time during puberty when sex steroids have the highest impact as well as the ability of bone to recover from transient sex steroid deficiency is unclear. Surgical castration is a common technique to study sex steroid effects in rodents, but it is irreversible, invasive, and associated with metabolic and behavioral alterations. Here, we used a low dose (LD) or a high dose (HD) of gonadotropin-releasing hormone antagonist to either temporarily or persistently suppress sex steroid action in male mice, respectively. The LD group, a model for delayed puberty, did not show changes in linear growth or body composition, but displayed reduced trabecular bone volume during puberty, which fully caught up at adult age. In contrast, the HD group, representing complete pubertal suppression, showed a phenotype reminiscent of that observed in surgically castrated rodents. Indeed, HD animals exhibited severely impaired cortical and trabecular bone acquisition, decreased body weight and lean mass, and increased fat mass. In conclusion, we developed a rodent model of chemical castration that can be used as an alternative to surgical castration. Moreover, the transient nature of the intervention enables to study the effects of delayed puberty and reversibility of sex steroid deficiency.NEW & NOTEWORTHY We developed a rodent model of chemical castration, which can be used as an alternative to surgical castration. Moreover, the transient nature of the intervention enables to study the effects of delayed puberty and reversibility of sex steroid deficiency.


Asunto(s)
Desarrollo Óseo , Huesos/fisiología , Hormonas Esteroides Gonadales/deficiencia , Hipogonadismo/patología , Animales , Composición Corporal/efectos de los fármacos , Desarrollo Óseo/efectos de los fármacos , Huesos/efectos de los fármacos , Huesos/metabolismo , Hormonas Esteroides Gonadales/farmacología , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Hormona Liberadora de Gonadotropina/farmacología , Antagonistas de Hormonas/farmacología , Hipogonadismo/complicaciones , Hipogonadismo/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Orquiectomía , Maduración Sexual/fisiología , Factores de Tiempo
8.
J Urol ; 205(1): 137-144, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856980

RESUMEN

PURPOSE: Current serum tumor markers for testicular germ cell tumor are limited by low sensitivity. Growing evidence supports the use of circulating miR-371a-3p as a superior marker for malignant (viable) germ cell tumor management. We evaluated the real-world application of serum miR-371a-3p levels in detecting viable germ cell tumor among patients undergoing partial or radical orchiectomy. MATERIALS AND METHODS: Serum samples were collected from 69 consecutive patients before orchiectomy. Performance characteristics of serum miR-371a-3p were compared with conventional serum tumor markers (⍺-fetoprotein/ß-human chorionic gonadotropin/lactate dehydrogenase) between patients with viable germ cell tumor and those without viable germ cell tumor on orchiectomy pathology. Relative miR-371a-3p levels were correlated with clinical course. The Kruskal-Wallis test and linear and ordinal regression models were used for analysis. RESULTS: For detecting viable germ cell tumor, combined conventional serum tumor markers had a specificity of 100%, sensitivity of 58% and AUC of 0.79. The miR-371a-3p test showed a specificity of 100%, sensitivity of 93% and AUC of 0.978. Median relative expression of miR-371a-3p in viable germ cell tumor cases was more than 6,800-fold higher than in those lacking viable germ cell tumor. miR-371a-3p levels correlated with composite stage (p=0.006) and, among composite stage I cases, independently associated with embryonal carcinoma percentage (p=0.0012) and tumor diameter (p <0.0001). Six patients underwent orchiectomy after chemotherapy and were correctly predicted to have presence or absence of viable germ cell tumor by the miR-371a-3p test. CONCLUSIONS: If validated, the miR-371a-3p test can be used in conjunction with conventional serum tumor markers to aid clinical decision making. A positive miR-371a-3p test in patients after preoperative chemotherapy or with solitary testes could potentially guide subsequent orchiectomy or observation.


Asunto(s)
Biomarcadores de Tumor/sangre , MicroARN Circulante/sangre , MicroARNs/sangre , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Orquiectomía , Neoplasias Testiculares/diagnóstico , Adulto , Estudios de Casos y Controles , Quimioterapia Adyuvante , Toma de Decisiones Clínicas/métodos , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/sangre , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapia , Periodo Preoperatorio , Neoplasias Testiculares/sangre , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia , Testículo/patología , Testículo/cirugía , Espera Vigilante
9.
10.
BMC Med Inform Decis Mak ; 20(1): 337, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33317510

RESUMEN

BACKGROUND: Different from adult clinical stage I (CS1) testicular cancer, surveillance has been recommended for CS1 pediatric testicular cancer. However, among high-risk children, more than 50% suffer a relapse and progression during surveillance, and adjuvant chemotherapy needs to be administered. Risk-adapted treatment might reduce chemotherapy exposure among these children. METHODS: A decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as the relapse rates of different groups during surveillance or after chemotherapy were collected from the literature. A survey of urologists was conducted to evaluate the toxicity of first-line and second-line chemotherapy. Using the decision analysis model, chemotherapy exposure of the risk-adapted treatment and surveillance strategies were compared based on this series of clinical utilities. One-way and two-way tests were applied to check the feasibility. RESULTS: In the base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment resulted in a lower exposure to chemotherapy than surveillance (average: 0.7965 cycles verse 1.3419 cycles). The sensitivity analysis demonstrated that when the relapse rate after primary chemotherapy was ≤ 0.10 and the relapse rate of the high-risk group was ≥ 0.40, risk-adapted treatment would result in a lower exposure to chemotherapy, without any association with the proportion of low-risk patients, the relapse rate of the low-risk group, the relapse rate after salvage chemotherapy or the toxicity utility of second-line chemotherapy compared to first-line chemotherapy. CONCLUSIONS: Based on the decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients, and an evaluation after orchiectomy was critical to this process. Additional clinical studies are needed to validate this statement.


Asunto(s)
Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante/métodos , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias Testiculares/tratamiento farmacológico , Niño , Técnicas de Apoyo para la Decisión , Humanos , Masculino , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/cirugía , Orquiectomía/efectos adversos , Orquiectomía/métodos , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugía , Resultado del Tratamiento
11.
J Vasc Interv Radiol ; 31(11): 1874-1885, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33129433

RESUMEN

PURPOSE: To assess the feasibility of inducing vascular occlusion by application of radiofrequency (RF) energy via conductive endovascular wires or baskets. MATERIALS AND METHODS: A retrievable nitinol basket and stainless steel guidewire with a platinum tip were evaluated as conductors for endovascular application of RF energy. Tissue-mimicking thermochromic gel phantoms that change color with heating were cast with 2-, 5-, and 7-mm-diameter lumens and filled with 37 oC saline. After ablation, the phantoms were sectioned, and the thermal footprints were evaluated. Six castrated male domestic swine underwent endovascular ablation using the basket in iliac arteries and guidewires in renal arteries. Post-procedural angiography was performed, and postmortem arterial segments were resected for histopathologic analysis. RESULTS: In the phantom, the depth of thermal change in the 5- and 7-mm lumens averaged 6.3 and 6.0 mm along the basket, respectively, and in the 2- and 5-mm lumens, the depth of thermal change averaged 1.9 and 0.5 mm along the wire, respectively. In the swine, RF energy delivery led to angiographic occlusion at 12 of 13 sites. Thermal injury and occlusion were similar at the proximal, middle, and distal basket treatment zone, whereas injury and occlusion decreased from the proximal to the distal end of the 5-cm wire treatment zone. CONCLUSIONS: Endovascular delivery of RF energy via a conductive basket in medium-sized arteries or a guidewire in small arteries led to acute angiographic and histologic occlusion. The potential to induce stasis might be useful in settings where rapid occlusion is desirable.


Asunto(s)
Procedimientos Endovasculares/instrumentación , Arteria Ilíaca/cirugía , Ablación por Radiofrecuencia/instrumentación , Arteria Renal/cirugía , Aleaciones , Animales , Conductividad Eléctrica , Diseño de Equipo , Estudios de Factibilidad , Calor , Arteria Ilíaca/patología , Masculino , Ensayo de Materiales , Modelos Animales , Orquiectomía , Platino (Metal) , Arteria Renal/patología , Acero Inoxidable , Sus scrofa
12.
Medicine (Baltimore) ; 99(31): e21545, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32756211

RESUMEN

Traditional open surgery (OS) is usually necessary when testicular torsion (TT) cannot be excluded by scrotal ultrasound. Scrotoscopy has been used as a minimally invasive technique to diagnose or treat scrotal diseases, and it may also play a role in diagnosing TT.A retrospective analysis was performed for patients with TT to evaluate the consistency of scrotoscopy and OS in the diagnosis of TT. In the cases where preoperational Color Doppler ultrasonography was performed, scrotoscopy, open surgery, and confirmed TT were included for future analysis.A total of 43 patients were studied. Twisted testes were retained in 11 cases (25.59%), and the remaining 32 patients (74.41%) underwent orchiectomy. There were significant differences in the diagnostic value between the grading of scrotoscopy and ultrasound, as well as between ultrasound grading and blood supply grading (BSG) (both P < .05). However, no significant difference was observed between the grading of scrotoscopy and BSG in traditional OS (P > .05), but a high degree of consistency existed between scrotoscopy grading and BSG in traditional OS (Kappa = 0.733, P ≤ .001).Our limited data indicate that the diagnosis of testicular torsion by scrotoscopy is highly consistent with that of traditional surgical exploration. Therefore, further studies are necessary to confirm its application value in the future. Scrotoscopy may have potential application value for the patients whom testicular torsion are insufficiently diagnosed but cannot be excluded.


Asunto(s)
Endoscopía/métodos , Escroto/cirugía , Torsión del Cordón Espermático/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adolescente , Humanos , Masculino , Orquiectomía/efectos adversos , Orquiectomía/métodos , Estudios Retrospectivos , Escroto/diagnóstico por imagen , Torsión del Cordón Espermático/diagnóstico por imagen , Torsión del Cordón Espermático/patología , Ultrasonografía Doppler en Color , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversos , Procedimientos Quirúrgicos Urológicos Masculinos/instrumentación , Adulto Joven
13.
Life Sci ; 261: 118342, 2020 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-32853655

RESUMEN

AIMS: The increased incidence of heart failure with reduced ejection fraction in men compared with women suggests that male sex hormones significantly impact myocardial contractile activation. This study aims to examine associations among molecular alterations, cellular modulations and in vivo cardiac contractile function upon deprivation of testicular hormones. MAIN METHODS: Myocardial structure and functions were compared among sham-operated control and twelve-week orchidectomized (ORX) male rats with and without testosterone supplementation. KEY FINDINGS: Echocardiography and pressure-volume relationships demonstrated a decreased left ventricular ejection fraction compared with sham-operated controls. The percentage of contractility reduction was generally similar to the decrease in tension development detected in both right ventricular trabeculae and skinned isolated left ventricular cardiomyocytes of ORX rats. Reductions in tension cost and the rate constant of tension redevelopment (ktr) in ORX samples suggested a decrease in the rate of cross-bridge formation, reflecting a reduced number of cross-bridges. Slow cross-bridge detachment in ORX rat hearts could result from a shift of myosin heavy chain isoforms towards a slower ATPase activity ß-isoform and reductions in the phosphorylation levels of cardiac troponin I and myosin binding protein-C. All the changes in the ORX rat heart, including ejection fractions and myofilament protein expression and phosphorylation, were completed attenuated by a physiological dose of testosterone. SIGNIFICANCE: Testosterone plays a critical role in regulating the mechanical and contractile dynamics of the heart. Deprivation of male sex hormones cause the loss of normal preserved cardiac contractile function leading to a high risk of severe cardiomyopathy progression.


Asunto(s)
Cardiomiopatías/fisiopatología , Miocitos Cardíacos/metabolismo , Miofibrillas/metabolismo , Testosterona/metabolismo , Animales , Progresión de la Enfermedad , Corazón/fisiología , Masculino , Cadenas Pesadas de Miosina/metabolismo , Orquiectomía , Ratas , Ratas Sprague-Dawley , Volumen Sistólico/fisiología , Testosterona/administración & dosificación , Testosterona/farmacología , Función Ventricular Izquierda/fisiología
14.
Nat Commun ; 11(1): 4278, 2020 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-32855388

RESUMEN

Activation and migration of endogenous mesenchymal stromal cells (MSCs) are critical for bone regeneration. Here, we report a combinational peptide screening strategy for rapid discovery of ligands that not only bind strongly to osteogenic progenitor cells (OPCs) but also stimulate osteogenic cell Akt signaling in those OPCs. Two lead compounds are discovered, YLL3 and YLL8, both of which increase osteoprogenitor osteogenic differentiation in vitro. When given to normal or osteopenic mice, the compounds increase mineral apposition rate, bone formation, bone mass, and bone strength, as well as expedite fracture repair through stimulated endogenous osteogenesis. When covalently conjugated to alendronate, YLLs acquire an additional function resulting in a "tri-functional" compound that: (i) binds to OPCs, (ii) targets bone, and (iii) induces "pro-survival" signal. These bone-targeted, osteogenic peptides are well suited for current tissue-specific therapeutic paradigms to augment the endogenous osteogenic cells for bone regeneration and the treatment of bone loss.


Asunto(s)
Anabolizantes/farmacología , Fracturas Óseas/tratamiento farmacológico , Osteogénesis/efectos de los fármacos , Péptidos/farmacología , Células Madre/efectos de los fármacos , Anabolizantes/química , Animales , Calcificación Fisiológica/efectos de los fármacos , Diferenciación Celular/efectos de los fármacos , Diferenciación Celular/fisiología , Células Cultivadas , Femenino , Fracturas Óseas/patología , Humanos , Masculino , Células Madre Mesenquimatosas/efectos de los fármacos , Células Madre Mesenquimatosas/metabolismo , Ratones Endogámicos C57BL , Ratones Transgénicos , Orquiectomía , Osteogénesis/fisiología , Ovariectomía , Péptidos/química , Péptidos/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Técnicas de Síntesis en Fase Sólida , Células Madre/citología
15.
Arch. esp. urol. (Ed. impr.) ; 73(6): 499-508, jul.-ago. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-195925

RESUMEN

OBJETIVO: El cáncer de próstata (CP) avanzado es una entidad frecuente. Los objetivos de este trabajo son la presentación de una serie de pacientes con CP en tratamiento con Terapia de Deprivación Androgénica (TDA) en práctica clínica habitual y la determinación de parámetros asociados al desarrollo de resistencia a la castración (CPRC). MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional, retrospectivo que analiza pacientes tratados con TDA desde enero 2016 hasta enero 2017. Análisis descriptivo de las variables clínicas más relevantes, análisis univariante y supervivencia libre de progresión mediante test Kaplan-Meier. RESULTADOS: Muestra 952 pacientes. Al diagnóstico del CP edad mediana 74 años. Mediana de PSA al diagnóstico de CP 23 ng/ml, al inicio TDA 20,2 ng/ml. El 80,2% de pacientes tenían biopsia al diagnóstico del CP: 28,2% grado pronóstico Gleason grupo 1, 38,7% grados 2 y 3 y 33,1% grados 4 y 5. Tratamiento inicial del CP: 75,9% TDA, prostatectomía radical 8,4% y radioterapia 15,1%. De los 952 pacientes, 281 (29,6%) cumplían criterios de CPRC. En este grupo el 21,7% alcanzó PSA indetectable (<0,1 ng/ml) con la TDA 20,2 frente al grupo no CPRC en el que lo alcanzaron el 59,9%. Encontramos mayor probabilidad de progresión a CPRC en pacientes con PSA al diagnóstico de CP > 30 ng/ml (p = 0,000, OR 2,78), grado pronóstico Gleason grupos 4-5 (p = 0,000, OR 2,33) y en aquellos que no alcanzan PSA indetectable tras TDA (p < 0,01, OR 3,32) variables que se relacionan con los tiempos de progresión a CPRC y especialmente al estadio metastásico. CONCLUSIONES: Se presenta una serie de pacientes CP avanzado en tratamiento con TDA que muestra heterogeneidad de características y de manejo según práctica clínica habitual. En nuestra serie el PSA elevado al diagnóstico, histología desfavorable y no alcanzar un PSA< 0,1 ng/ml tras la TDA se presentan como indicadores de progresión a estadio CPRC


OBJECTIVES: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC undergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC). MATERIAL AND METHODS: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test. RESULTS: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria. In this group 21.7% achieved undetectable PSA (< 0.1 ng/ml) with ADT compared to the non-CRPC group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p = 0.000, OR 2.78), Gleason score group 4-5 (p = 0.000, OR 2.33), and not to reach undetectable PSA after ADT (p < 0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT. CONCLUSIONS: We present a sample of patients with advanced PC in treatment with ADT that shows heterogeneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA <0.1ng/ml after ADT is presented as an indicator of progression to the CRPC stage


Asunto(s)
Humanos , Masculino , Anciano , Neoplasias de la Próstata/terapia , Antagonistas de Andrógenos/uso terapéutico , Neoplasias de la Próstata/patología , Orquiectomía , Prostatectomía , Estudios Retrospectivos , Estimación de Kaplan-Meier , Progresión de la Enfermedad , Neoplasias de la Próstata Resistentes a la Castración , Resultado del Tratamiento , Antígeno Prostático Específico/sangre
16.
Life Sci ; 257: 118138, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32712298

RESUMEN

AIMS: Hypertension is a relevant sex and sex hormones-dependent risk factor where the cardiovascular and renal health of the population are concerned. Men experience greater losses of renal function (RF) than women, but the mechanisms remain somewhat unclear. Our goal was to evaluate the relationship between oxidative stress (OS), angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) activities and RF in male and female SHR. MAIN METHODS: Twelve-week-old spontaneously hypertensive rats (SHR) were submitted to either castration or SHAM surgery and divided into 4 groups, SHAM or Castrated (CAST) males or females. After 51 days we evaluated RF (inulin and sodium para-aminohippurate), ACE and ACE2 activities (fluorimetry), OS (flow cytometry), collagen deposition (picrosirius red) and protein expression (western blot). KEY FINDINGS: Males presented lower RF than females and castration impaired this parameter in both groups. Sexual dimorphism was not observed regarding OS and inflammation; however, castration increased this parameter more severely in males than in females. SHAM males exhibited higher collagen deposition than females, though castration increased it in both sexes, eliminating the difference. We found sexual dimorphism regarding renal ACE and ACE2 activities, which were lower in males than in females. Although castration did not alter ACE activity, it reduced ACE2 activity in females and increased it in males. SIGNIFICANCE: These results indicate that sex hormones affect RF in SHR. As alterations in the oxidative system were capable of promoting podocyte injury, inflammation, and collagen deposition, we put forward that these effects are differently modulated by ACE and ACE2.


Asunto(s)
Hormonas Esteroides Gonadales/metabolismo , Enfermedades Renales/etiología , Estrés Oxidativo , Peptidil-Dipeptidasa A/metabolismo , Ratas Endogámicas SHR/metabolismo , Animales , Western Blotting , Colágeno/metabolismo , Femenino , Riñón/enzimología , Riñón/metabolismo , Riñón/patología , Riñón/fisiopatología , Enfermedades Renales/patología , Enfermedades Renales/fisiopatología , Masculino , Orquiectomía , Ovariectomía , Estrés Oxidativo/fisiología , Ratas , Ratas Endogámicas SHR/fisiología , Especies Reactivas de Oxígeno/metabolismo , Factores Sexuales
17.
Arch Esp Urol ; 73(6): 499-508, 2020 Jul.
Artículo en Español | MEDLINE | ID: mdl-32633245

RESUMEN

OBJECTIVES: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC undergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC). MATERIAL AND METHODS: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test. RESULTS: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria.In this group 21.7% achieved undetectable PSA (group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p=0.000, OR 2.78), Gleason score group 4-5 (p=0.000, OR 2.33), and not to reach undetectable PSA after ADT (p <0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT. CONCLUSIONS: We present a sample of patients with advanced PC in treatment with ADT that shows heterogeneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA<0.1 ng/ml after ADT is presented as an indicator of progression to the CRPC stage.


Asunto(s)
Neoplasias de la Próstata/terapia , Anciano , Antagonistas de Andrógenos/uso terapéutico , Humanos , Masculino , Orquiectomía , Antígeno Prostático Específico , Prostatectomía , Estudios Retrospectivos
18.
Hinyokika Kiyo ; 66(6): 171-176, 2020 Jun.
Artículo en Japonés | MEDLINE | ID: mdl-32605355

RESUMEN

A 49-year-old male visited our department of gastroenterology with chief complaints of blackish feces and ill complexion in February 1997. Computed tomography (CT) revealed a right retroperitoneal tumor, which was removed the same month. Histopathological examination showed teratoma and yolk sac tumor. He was diagnosed with primary retroperitoneal extragonadal germ cell tumor, and received three cycles of chemotherapy (bleomycin/etoposide/cisplatin ; BEP) starting in March 1997. Periodic imaging and determination of tumor markers (α fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) showed no recurrence or metastasis for five years after treatment. After his visit in April 2002 he stopped visiting our outpatient ward. In November 2017, the patient visited our department with chief complaints of indolent right scrotum enlargement and a right inguinal mass. Past history showed that he had undergone hydrocele of the right testicle in August 1999. Contrast enhanced CT showed a 35-mm contrast effect with uneven contents in the right testis, and enlarged nodes that were suspicious of metastases in the right inguinal and right external iliac lymph nodes. All tumor markers were within the normal ranges. He underwent right high orchiectomy and resection of the right inguinal lymph nodes in the same month. Histopathological findings revealed seminoma (pT1, pN2, M0, S0, and clinical Stage IIA). He received postoperative chemotherapy starting in January 2018 ; one cycle of BEP therapy and three cycles of etoposide and cisplatin (EP) therapy. Post-chemotherapeutic CT confirmed clinical complete response at the right external iliac lymph nodes, and this response was confirmed 12 months later. Neither recurrence nor metastasis has occurred so far.


Asunto(s)
Neoplasias de Células Germinales y Embrionarias , Neoplasias Retroperitoneales , Neoplasias Testiculares/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica , Bleomicina , Cisplatino/uso terapéutico , Etopósido/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Orquiectomía
19.
Food Chem ; 333: 127451, 2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-32683255

RESUMEN

Castration may decrease off-odors and improve meat flavor. Meat flavor is generated through complex chemical reactions that involve hydrophilic and hydrophobic flavor precursors. In this study, we investigated the flavor precursors in psoas major muscles of castrated and intact sheep using lipidomics and targeted metabolomics. Castration decreased testosterone levels and increased intramuscular fat content. Six hundred fourteen lipid molecules confirmed showed a separation between castrated and intact sheep based on principal component analysis. Fourteen lipid species and 224 lipid molecules increased in castrated sheep. Targeted metabolomics analysis showed that 18 hydrophilic metabolites were affected by castration; however, only hypoxanthine significantly increased in the castration group. Among 45 volatiles identified, 1-octen-3-ol and hexanal were significantly higher in castrated sheep. These results revealed that lipids, hydrophilic metabolites, and volatile compounds in lamb were affected by castration, which might be beneficial in lamb quality.


Asunto(s)
Carne , Orquiectomía , Músculos Psoas/química , Músculos Psoas/metabolismo , Oveja Doméstica/metabolismo , Gusto , Animales , Estradiol/metabolismo , Aromatizantes/análisis , Metabolismo de los Lípidos , Lipidómica , Lípidos/análisis , Masculino , Carne/análisis , Metabolómica , Odorantes/análisis , Testosterona/metabolismo , Compuestos Orgánicos Volátiles/análisis
20.
J Zoo Wildl Med ; 51(2): 297-302, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32549558

RESUMEN

Contraception is needed to prevent overpopulation and inbreeding in highly fecund captive bat colonies. Reports on surgical contraception in bats are limited. The objective of this study was to describe surgical castration techniques in a megachiropteran and a microchiropteran fruit bat species. Open orchiectomy by transfixing ligation of the spermatic cord was performed in 14 Ruwenzori long-haired fruit bats (Rousettus lanosus) (RL-LIG), and orchiectomy with radiosurgery alone was performed in 125 Jamaican fruit-eating bats (Artibeus jamaicensis) (AJ-RS) and one Ruwenzori bat (RL-RS). The surgical techniques were not compared in different species with the exception of the one Ruwenzori bat operated with RS. Anesthesia was induced and maintained with isoflurane in oxygen via facemask. Preoperatively, all bats received butorphanol and subcutaneous fluids. Meloxicam was administered postoperatively for the RL-LIG. For the RL-LIG, anesthesia lasted 49 ± 15 min (mean ± SD) with a total surgery time of 26 ± 12 min. In comparison, the RS was considerably shorter, lasting 10 ± 3 min for anesthesia and 5 ± 2 min for surgery. Complications were rare, with a morbidity rate of 6.7% with the RL-LIG (prolonged recovery [n = 1]) and of 4.8% with the RS (dyspnea [n = 3], hemorrhage [n = 2], and prolonged recovery [n = 1]). One of the cases of hemorrhage was in the single Ruwenzori bat castrated using the RS technique. Mortality rate was 1.6% (n = 2) with the RS. No mortality occurred with the RL-LIG. In conclusion, using radiosurgery alone appears to be a safe and rapid surgical technique in smaller species of fruit bats. For larger species, such as the Ruwenzori fruit bats, ligation or use of an advanced vessel sealing system is recommended.


Asunto(s)
Animales de Zoológico/cirugía , Quirópteros/cirugía , Orquiectomía/veterinaria , Animales , Animales de Zoológico/clasificación , Quirópteros/clasificación , Masculino , Orquiectomía/métodos , Quebec
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