[Posterior Retroperitoneoscopic adrenalectomy in the prone position. Initial experience.] / Suprarrenalectomía retroperitoneoscópica en decúbito prono. Experiencia inicial.

OBJECTIVE: Transperitoneal laparoscopic adrenalectomy (TLA) is considered the treatment of choice for small and benign adrenal tumors. In the recent years, posterior retroperitoneoscopic adrenalectomy (PRA) has gained popularity due to its advantages over TLA, presenting a shorter surgical time and a faster recovery without increasing complications. Conversely, a greater learning curve is considered because the use of a different and unusual surgical field. MATERIAL AND METHODS: Our objective is to describe the PRA technique to ass our initial experience evaluating its feasibility, safety and effectiveness in a prospective series of patients. A total of 11 (9 left and 2 right) PRA performed between March 2017 and February 2020 were analyzed. RESULTS: Median age was 55 (36-65) years with a median BMI of 25.69 (20.8-34.5) Kg/m2. 54.55% had ASA≥3. 63.37% of adrenal tumors were hormonally functional. The tumor mean size was 4 cm (0.6-8) and cortical adenoma was the predominant pathological anatomy (72.72%). No pheochromocytoma was operated. Median operative time was 87 minutes (35-125) with an intraoperative bleeding of 50 (0-300) mL. No patient presented intraoperative complications or reconversion. Median length of stay was 1 (1-6) days. Only one patient presented postoperative complications. CONCLUSION: The PRA is feasible, reproducible and safe, even during the initial learning curve, presenting a clear early recovery with a shorter surgical time.

OBJETIVO: La suprarrenalectomía laparoscópica transperitoneal (SLT) se considera el tratamiento de elección de los tumores suprarrenales benignos y de pequeño tamaño. En los últimos años el acceso retroperitoneoscópico en decúbito prono (SRP) ha ganado popularidad por las ventajas que ofrece con respecto a la SLT, al emplear un menor tiempo quirúrgico y obtener una recuperación más rápida sin aumentar las complicaciones, a expensas de una curva de aprendizaje dificultada por emplear un campo quirúrgico diferente al habitual.MATERIAL Y MÉTODOS: Nuestro objetivo es describir la técnica quirúrgica de SRP y nuestra experiencia inicial evaluando su factibilidad, seguridad y efectividad en una serie prospectiva de pacientes. Se analizaron un total de 11 SRP (9 izquierdas y 2 derechas) realizadas entre marzo de 2017 y febrero de 2020. RESULTADOS: La mediana de edad fue de 55 (36-65) años con un IMC de 25,69 Kg/m2 (20,8-34,5). El 54,55% tenía un ASA≥3. El 63,37% de los tumores suprarrenales fueron hormonalmente funcionantes. El tamaño medio fue de 4 cm (0,6-8), siendo el adenoma cortical la anatomía patológica predominante (72,72%). No se realizó ningún feocromocitoma. La mediana de tiempo quirúrgico fue de 87 minutos (35-125) con un sangrado intraoperatorio de 50mL (0-300). Ningún paciente presentó complicaciones intraoperatorias o reconversión. La mediana de días de ingreso fue de1 (1-6) día. Sólo un paciente presentó complicaciones postoperatorias. CONCLUSIONES: La SRP es factible, reproducible y segura, incluso durante la curva de aprendizaje inicial, presentando una clara recuperación temprana con un tiempo quirúrgico corto.

Prognostic value of lymphocyte-to-monocyte ratio previously determined to surgery in patients with non-metastatic renal cell carcinoma: A systematic review and a prisma-compliant meta-analysis.

BACKGROUND: The prognostic value of pretreatment lymphocyte to monocyte ratio in patients with renal cell carcinoma and, especially, in non-metastatic patients remains controversial. METHODS: We conducted a PRISMA-compliant meta-analysis to systematically assess the prognostic value of LMR in patients with non-metastatic RCC. Overall survival, cancer-specific survival, and disease-free survival were analyzed. Pooled hazard ratios and 95% confidence intervals were calculated. RESULTS: Seven studies comprising 4666 patients were included in the analysis. Unlike those observed in a previous meta-analysis, a lower lymphocyte to monocyte ratio was associated with poorer cancer-specific survival (fix-effect model, hazard ratio 3.04, 95% confidence intervals 2.05-4.51, P < .05). Heterogeneity Chi-squared value Q exp = 0. (P = .82) (I2 = 0%). However, the association between a low lymphocyte to monocyte ratio and overall survival or disease-free survival did not obtain significance. CONCLUSION: A lower lymphocyte to monocyte ratio implied poor cancer-specific survival in patients with non-metastatic renal cell carcinoma. Prospective studies are required to confirm our findings. REGISTRATION NUMBER: ClinicalTrials.gov (identifier: NCT04213664).

Effect of muscle density in patients with metastatic prostate cancer administered androgen deprivation therapy. / Efecto de la densidad muscular en pacientes con cáncer de próstata metastásico tratados con terapia de privación androgénica.

INTRODUCTION: Sarcopenia is a syndrome characterized by the loss of muscle mass and strength. The study objective was to determine the association between muscle density and overall survival (OS) in patients with metastatic onset prostate cancer (MPCa). MATERIALS AND METHODS: This was a retrospective study of patients diagnosed with MPCa between 2009 and 2015 who received androgen deprivation therapy alone as initial treatment. Muscle density was calculated using the Hounsfield Unit Average Calculation (HUAC) in both psoas muscles in the computed tomography (CT) scan performed for diagnosis. RESULTS: A total of 59 patients diagnosed with MPCa, with a mean age of 57.5±72.47 years, were found. Median prostate-specific antigen (PSA) level at diagnosis was 68.25 ng/dL (IQR 37.26-290). Gleason scores≥8 were recorded in 90.75% of the patients, bone metastases in 88.13%, and visceral metastases in 10.16%. Median HUAC was 20.32 HU (IQR 15.46-22.83). In a univariate analysis, the number of bone metastases, the presence of visceral metastases, and testosterone levels≥50 ng/dL at follow-up were associated with poorer OS, while high HUAC levels were associated with better OS. In a multivariate analysis, the number of bone metastases [hazard ratio (HR)=1.573, 95% confidence interval (CI)=1.103-2.243, p=0.012], the presence of visceral metastases (HR=7.404, CI=2.233-24.549, p=0.001), and the Gleason score (HR=2.001, CI=1.02-3.923, p=0.044) were associated with greater overall mortality, and HUAC (HR=0.902, CI=0.835-0.973, p=0.008) was associated with better OS. CONCLUSIONS: In our series, increased HUAC values in the psoas muscles, as a reflection of muscle density, when MPCa was diagnosed had a protective effect on OS in these patients.

Comunicação educativa e educação para o lazer: os super-heróis dos quadrinhos nas aulas de educação física / Educational communication and education for leisure: the super heroes of the comic books in physical education classes

Dentre os estudantes brasileiros do Ensino Fundamental, muitos não participam efetivamente das aulas de Educação Física por questões de ordem metodológica, de mediação didática e de conhecimento. Assim, o presente trabalho teve como objetivo analisar a eficácia de uma proposta pedagógica que parte dos estudos da Comunicação Educativa (baseada na neurociência) e da educação para o lazer. Participaram da pesquisa 20 estudantes de uma escola pública do estado de São Paulo, com idades entre 13 e 14 anos. A pesquisa é qualitativa. Foram utilizados diário de campo e observações. Resultados: novas habilidades corporais foram aprendidas pelos alunos dentro do contexto das histórias em quadrinhos de super-heróis e os estudantes deram indícios de terem desenvolvido uma atitude crítica e criativa.

Many Brazilian students in Elementary School do not take part in Physical Education classes effectively because of various reasons such as matters of methodology issues, didactic mediation and knowledge. So, the present work had the objective of analyzing the effectiveness of a pedagogical proposal from Educational Communication (based on neuroscience) and education for leisure. 20 students from a public school in the state of São Paulo between 13 and 14 years old participated in the research. The research is a qualitative study. A field research and observations were used. Results: new body skills were learned by the students within the super heroes comic books context and the students have shown signs of having developed a critical and creative attitude.

Comunicación educativa y educación para el ocio en educación física escolar / Educational communication and education for leisure in physical education at school

Este trabajo tiene como objetivo discutir y analizar las aproximaciones teóricas de la Comunicación educativa y de la educación para el ocio en Educación Física escolar. En la Educación Primaria, en Brasil, es donde existen las tasas más altas de abandono de alumnos. En las clases de Educación Física muchos alumnos no tienen una participación efectiva, debido a factores didáctico-metodológicos y de construcción curricular. Los estudios de la Comunicación educativa, con fundamentos en neurociencia, podrán ser útiles en la búsqueda de soluciones para este problema. Esta es una investigación bibliográfica y cualitativa. Tomando como base las discusiones de la Comunicación educativa y los estudios del ocio, las clases de Educación Física pueden ser más interesantes e incentivar a los alumnos para la construcción y la producción de conocimiento en torno al cuerpo, a las prácticas corporales y a los medios.

The objective of this study is to discuss and analyze how close the Educational communication and education for leisure are in Physical Education classes at school. The Elementary School is where you can find the highest dropout rate in Brazil. At the Physical Education classes the students do not have an effective participation due to didactic-methodological matters and curriculum construction. So, the Educational Communication studies, based on the neuroscience assumptions, can be useful for searching solutions for this problem. This refers to a bibliographic and qualitative investigation. The Educational communication discussions and leisure studies, can make the Physical Education classes more interesting and encourage students for knowledge construction and production on their body, body practices and mass media.

Superhéroes y villanos en las clases de educación física / Superheroes and villains in physical education classes

El objeto de este trabajo es analizar una experiencia pedagógica que se incluyeron los cómics de superhéroes en las clases de Educación Física, tomando como base las contribuciones de la Comunicación Educativa. La dificultad de tratar las diferencias sociales es un problema que se agudiza en la medida en que las personas desconocen sus emociones y su singularidad, expresadas por su cuerpo. Se realizó una experiencia pedagógica con 20 alumnos de la Educación Primaria de una escuela pública del estado de São Paulo, Brasil. Se utilizaron como técnicas un diario de campo y observaciones. Se grabaron los diálogos con los alumnos. Los principales resultados fueron la construcción de conocimientos por parte de los alumnos acerca de las diferencias corporales y de valores sociales a favor del colectivo.

The objective of this work is to analyze a pedagogical experience in which superhero comics were introduced in Physical Education classes, based on the Educational Communication contributions. The difficulty of dealing with social differences is a problem that is exacerbated by the fact that people are unaware of their emotions and their uniqueness, expressed by their bodies. A pedagogical experience was carried out with 20 primary school students f rom a public school in São Paulo, Brazil. A field diary and observations were used as techniques. Dialogues with the students were recorded. The main results were the students' construction of knowledge about bodily differences and social values in favor of the collective.

Pancreatitis, una presentación inusual de aumento escrotal / Pancreatitis, an unusual presentation of scrotal swelling

El aumento de tamaño escrotal acompañado de inflamación y dolor es una consulta frecuente en la práctica clínica habitual. Sin embargo, existen causas extraurológicas capaces de mimetizar dicho cuadro que deben ser incluidas en el diagnóstico diferencial. La etiología pancreática en estos casos es inusual, con poco más de 30 casos descritos en la literatura, y puede conducir a un diagnóstico y tratamientos equivocados. Presentamos el caso de un varón de 62 años que fue ingresado por una pancreatitis aguda, comenzando un mes después con un aumento del tamaño escrotal derecho que se trató de forma conservadora (AU)

Scrotal swelling, soreness and tenderness is a common consultation in ordinary clinical practice. However, extra urological causes are able to mimic this situation which should be included in the differential diagnoses. Pancreatic etiology in these cases is unusual, with few more than 30 cases described in the literature, which could lead to a wrong diagnosis and treatment. We aim to present a 62-year-old male patient who was admitted with acute pancreatitis, developing within a month a right scrotal swelling, treated conservatively (AU)

Giant Prostatic Hyperplasia: Case Report of 3987 mL.

We present herein a 72-year-old male with a long history of mild lower urinary tract symptoms, with a serum prostate-specific antigen level value of 87.9 ng/mL and an estimated prostate size of 3987 mL, according to magnetic resonance imaging. Prostatic biopsies showed benign prostatic hyperplasia. Prostatic surgery has not been required. To the best of our knowledge, this is the highest prostate volume reported in the medical literature.

Spanish (Spain) validation of a specific symptomatic questionnaire for male patients with nocturia.

OBJECTIVES: To validate in Spanish (Spain) a self-administered questionnaire on the quality of life (QoL) specific to nocturia in an older adult male population. MATERIAL AND METHODS: We analysed the Spanish version of the ICIQ-Nqol questionnaire (provided by ICIQ who owns the copyright), which meets the translation criteria required by the validation protocol. The study included 69 male patients older than 60 years of age with 1 or more nocturia episodes. The participants completed the questionnaire on two occasions, along with other Spanish-validated questionnaires that measure the QoL related to urinary symptoms. We analysed the internal reliability and consistency, reproducibility, convergent validity and discriminant validity. RESULTS: The study included 69 men, with a mean age of 70.64 years (range, 60-87 years). Both the overall scale and the energy/sleep subscale met the minimum criteria for internal reliability and consistency. A good correlation has been demonstrated between the overall index of the ICIQ-Nqol questionnaire and the other questionnaires included in the study. The reproducibility (test-retest reliability) of both the overall scale and subscales of the ICIQ-Nqol and the other questionnaires was demonstrated. Conclusions The ICIQ-Nqol questionnaire has been shown to be an appropriate instrument for assessing the symptomatic intensity and impact on the QoL of patients with nocturia. This study confirms its validity for a Spanish-speaking male population. Neurourol. Urodynam. 35:847-850, 2016. © 2015 Wiley Periodicals, Inc.

Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary?

The aim of this study was to assess infectious complications in transrectal ultrasound-guided prostate biopsy (TRUSPB), comparing two groups of patients: one group with antibiotic prophylaxis and the other without prophylaxis. A total of 1,018 TRUSPBs were performed from April 1996 to July 2003. No antibiotic prophylaxis was given in the first 614; the remaining 404 procedures were performed under antibiotic prophylaxis. Biopsy complications were assessed at outpatient urologist visits after the procedure in the 212 first biopsies and by telephone interview in the remaining 806. A total of 78 infectious complications were found. Major infectious complications (n=41) were septic shock (n=3), sepsis (n=3), Fournier gangrene (n=1), urinary tract infection (n=2), and fever requiring hospital admission (n=32). Minor infectious complications were fever that did not require admission (n=29), prostatitis (n=6), and epididymitis (n=2). Infectious complications occurred in 63 of 614 (10.3%) procedures without antibiotic prophylaxis and in 15 of 404 (3.7%) of those with antibiotic prophylaxis (P=0.0001). Of the 41 major infectious complications, 31 (75.6%) occurred in procedures without antibiotic prophylaxis (n=583) versus ten (24.4%) in those with prophylaxis (n=394) (P=0.0410). In conclusion, transrectal ultrasound-guided biopsy of the prostate has a statistically significant higher risk of infectious complications when performed without antibiotic prophylaxis.