Laparoscopic ureterocalicostomy in pigs - experimental study / Ureterocalicostomia laparoscópica em suínos - estudo experimental

This study aimed to evaluated laparoscopic ureterocalicostomy as treatment of experimental ureteropelvic junction (UPJ) obstruction in pigs. Ten male Large White pigs weighting approximately 28.4 (±1.43) kg were used in the current study. The UPJ obstruction was created laparoscopically by double-clipping of the left ureter. After 14 days the animals underwent laparoscopic ureterocalicostomy f The animals were sacrificed for subsequent retrograde pyelography in order to assess the anastomotic patency on the 28th day. The laparoscopic procedure for experimental obstruction of UPJ was successfully performed in all animals, as well as the laparoscopic ureterocalicostomy. There was intestinal iatrogenic injury in one animal. Satisfactory UPJ patency was noted in 75% of the animals. There was no stenosis of the proximal anastomosis between the ureter and the lower pole of the kidney in 37.5%, mild stenosis in 37.5% and severe stenosis in 25% of the animals. The laparoscopic approach for reestablishment he urinary flow by ureterocalicostomy was feasible in the porcine model. The ascending pyelography revealed satisfactory results of the laparoscopic ureterocalicostomy.

O estudo teve como objetivo avaliar a ureterocalicostomia laparoscópica no tratamento de obstrução da junção ureteropiélica (JUP) em modelo experimental suíno. Foram selecionados 10 suínos machos da raça Large White com peso médio de 28,4(±1,43) kg. A obstrução da JUP foi criada por técnica laparoscópica transperitoneal, com aplicação de dois clipes de titânio no ureter esquerdo. Passados 14 dias, os animais foram submetidos à ureterocalicostomia laparoscópica. No 28º dia após a ureterocalicostomia, foram sacrificados para a remoção dos rins e posterior pielografia retrógrada para avaliação da permeabilidade anastomótica. A obstrução da JUP foi obtida com sucesso em todos os animais, assim como a ureterocalicostomia laparoscópica, apesar de ter havido lesão intestinal em um dos animais. Boa permeabilidade foi observada em 75% dos casos, posteriormente à anastomose entre o ureter proximal e o cálice maior caudal do rim, onde 37,5% dos animais não apresentaram estenose, 37,5% apresentaram estenose leve, enquanto 25% apresentaram estenose severa. Foi possível restabelecer o fluxo urinário por ureterocalicostomia laparoscópica e os resultados anatômicos obtidos por meio das pielografias ascendentes foram considerados satisfatórios.

The use of double-J catheter decreases complications of retroperitoneoscopic ureterolithotomy.

OBJECTIVE: To evaluate the retroperitoneoscopic ureterolithotomy in the treatment of ureteral calculi and the need for double-J catheter to reduce the procedure-related complications. METHODS: We conducted a retrospective study with 47 patients submitted to retroperitoneoscopic ureterolithotomy, of which 31 were selected and divided into two groups: Group 1, whose patients did not have double-J catheter placement, and Group 2, who underwent perioperative double-J catheter implantation. Data collected comprised pre-and post-operative excretory urography, operative time, postoperative analgesia, length of hospital stay and catheter removal. RESULTS: The groups were similar as for age and gender, degree of dilation of the urinary tract, position and average size of the calculi (Group 1 = 15.5 ± 6.6 mm, Group 2 = 16.3 ± 6.1 mm). Operative time was also not significantly different (Group 1 = 130 ± 40.3 min, Group 2 = 136.3 ± 49.3 min). Group 1 had six patients (37.5%) with early (four cases of urinary fistula) and late complications (one case of stenosis of the ureter, one case of functional exclusion of the operated kidney), while Group 2 had no complications. This difference was statistically significant (p = 0.011). CONCLUSION: The use of double-J catheter was associated with significantly fewer complications in retroperitoneoscopic ureterolithotomy. Surgical time, postoperative analgesia and length of stay were similar between groups with and without catheter.

O emprego do cateter duplo J diminui as complicações na ureterolitotomia retroperitoneoscópica / The use of double-J catheter decreases complications of retroperitoneoscopic ureterolithotomy

OBJETIVO: Avaliar os resultados da ureterolitotomia retroperitoneoscópica no tratamento do cálculo ureteral e a necessidade do cateter duplo J para reduzir complicações relacionadas ao procedimento. MÉTODOS: Estudo retrospectivo comparativo de 47 pacientes operados pela técnica de ureterolitotomia retroperitoneoscópica, dos quais 31 foram selecionados e divididos em dois grupos: Grupo 1, cujos pacientes não receberam cateter duplo J, e Grupo 2, que foram submetidos ao implante de cateter duplo J transoperatório. Foram coletados dados de urografia excretora pré e pós-operatória, tempo cirúrgico, analgesia pós-operatória, tempo de internação e retirada do dreno. RESULTADOS: Os grupos foram semelhantes quando comparados na idade e sexo, grau de dilatação do trato urinário, posição e tamanho médio do cálculo (Grupo 1= 15,5 ± 6,6mm; Grupo 2= 16,3 ± 6,1mm). O tempo operatório também não teve diferença significativa (Grupo 1= 130 ± 40,3min; Grupo 2= 136,3 ± 49,3min). O Grupo 1 apresentou seis pacientes (37,5 %) com complicações precoces (quatro casos de fístula urinária) e tardias (um caso de estenose de ureter, um caso de exclusão funcional do rim operado), enquanto o Grupo 2 não teve complicações, sendo esta diferença estatisticamente significativa (p=0,011). CONCLUSÃO: O emprego do cateter duplo J foi associado a um número significativamente menor de complicações na ureterolitotomia retroperitoneoscópica. Tempo cirúrgico, analgesia pós-operatória e tempo de internação foram semelhantes entre os grupos com e sem cateter.

OBJECTIVE: To evaluate the retroperitoneoscopic ureterolithotomy in the treatment of ureteral calculi and the need for double-J catheter to reduce the procedure-related complications. METHODS: We conducted a retrospective study with 47 patients submitted to retroperitoneoscopic ureterolithotomy, of which 31 were selected and divided into two groups: Group 1, whose patients did not have double-J catheter placement, and Group 2, who underwent perioperative double-J catheter implantation. Data collected comprised pre-and post-operative excretory urography, operative time, postoperative analgesia, length of hospital stay and catheter removal. RESULTS: The groups were similar as for age and gender, degree of dilation of the urinary tract, position and average size of the calculi (Group 1 = 15.5 ± 6.6 mm, Group 2 = 16.3 ± 6.1 mm). Operative time was also not significantly different (Group 1 = 130 ± 40.3 min, Group 2 = 136.3 ± 49.3 min). Group 1 had six patients (37.5%) with early (four cases of urinary fistula) and late complications (one case of stenosis of the ureter, one case of functional exclusion of the operated kidney), while Group 2 had no complications. This difference was statistically significant (p = 0.011). CONCLUSION: The use of double-J catheter was associated with significantly fewer complications in retroperitoneoscopic ureterolithotomy. Surgical time, postoperative analgesia and length of stay were similar between groups with and without catheter.

Laparoscopia no tratamento do ureter retrocava: relato de caso e revisão da literatura / Laparoscopy in the treatment of retrocaval ureter: a case report and literature review

É apresentado um caso de ureter retrocava em paciente com queixa de dor lombar à direita, tratada após confirmação por tomografia computadorizada de abdome com contraste intravenoso com transposição do ureter direito (ureteroplastia) associada à implantação de cateter duplo J. sem intercorrências. Dessa forma, enfatiza-se a importância dessa malformação como uma das causas de uropatia obstrutiva e o uso de métodos de imagem para diagnosticá-la.

Tumor adenomatoide epididimário: relato de dois casos e revisão da literatura / Adenomatoid tumor of the epididimys: report a two cases and review the literature

Tumores adenomatóides são tumores mesoteliais benignos geralmente encontrados nas estruturas paratesticulares. Relatamos dois casos de tumor adenomatoide no epididímo. Revisamos a literatura sobre tumores epididimários, suas apresentações, métodos e diagn´soticos e tratamento.

Enterocutaneous fistula as a complication of percutaneous nephrolithotomy in patients with previous bariatric surgery: case report and bibliographic review.

OBJECTIVE: Enterocutaneous fistula is a rare complication after percutaneous nephrolithotomy. Some situations are risk factors for it to occur, such as horseshoe kidney, retrorenal colon and chronic colonic dilation by several factors, among them late postoperative time after yeyunoileal bypass in morbid obesity treatment. METHODS: 35-year-old female patient with a 2.5 cm calculus in the right renal pelvis. Late postoperative time after bariatric surgery using duodenal switch technique, and 55 kg lost till present. She undergone percutaneous nephrolithotomy (PCNL) with two punctures, one in the lower calyx, lost during dilation, and other in the upper calyx through which surgery was successfully carried out. During immediate postoperative time it enteric secretions were observed through the lower chalice puncture. Once the intraperitoneal lesion was removed, decision for conservative treatment was taken with fistula drainage, broadspectrum antibiotic therapy, fasting and total parenteral nutrition. The fistula debt ceased in the 8th postoperative (PO) day, when drain and nephrostomy tube were withdrawn and patient was discharged from the hospital on 10th PO day. On ambulatory follow up the patient is in good conditions. RESULTS: One case of enterocutaneous fistula after PNL presented in a patient in late postoperative time after yeyunoileal bypass. She was successfully treated by conservative therapy. Several authors point to chronic colonic distention and to great loss of retroperitoneal fat as causes for the increase of inadvertent colonic punctures in percutaneous renal access. CONCLUSIONS: The risk of complications with enterocutaneous fistula is significantly higher during the postoperatory in patients of bariatric surgery than in others.

[Effect of Passiflora edulis (passion fruit) extract on rats' bladder wound healing: morphological study]. / Efeito do extrato de Passiflora edulis (maracujá) na cicatrização de bexiga em ratos: estudo morfológico.

PURPOSE: To evaluate the effects of hydroalcoholic extract of Passiflora edulis leaves in the healing of urinary bladder in rats from histological aspects. METHODS: Forty Wistar male rats were submitted to a longitudinal incision of the bladder followed by a stetching in only one level. After this common procedure, animals were divided at random two groups: Passiflora and Control. In the Passiflora group the only dosage used was administered by intraperitoneal injection of hydroalcoholic extract of Passiflora edulis leaves while in the Control group distilled water was injected. Each subgroup was then divided in two subgroups according to the death of these animals: Control, three and seven days, Passiflora, three and seven days. After the death of these animals, an inventory of the abdominal cavity was performed and the bladder was removed. A comparative analysis was done between the two groups with microscopic evaluation of the healing. There was less acute inflammation (p=0.008), greater collagenous formation (p=0.001) and greater capillary neo-formation (p=0.000) in the third day Passiflora subgroup when compared to the Control subgroup of the third day. RESULTS: There was less acute inflammation (p=0.001), greater fibroblastic proliferation (p=0.011) and greater collagenous formation (p=0.001) in the Passiflora subgroup of seventh day when compared with the Control seventh day subgroup. CONCLUSION: The use of Passiflora edulis leaves extract resulted in less acute inflammation, greater fibroblastic proliferation, collagenous formation and capillary neo-formation on rats' bladder wound healing.

[Topic use of aqueous extract of Orbignya phalerata (babassu) in rats: analysis of its healing effect]. / Efeito do uso tópico do extrato aquoso de Orbignya phalerata (babaçu) na cicatrização de feridas cutâneas: estudo controlado em ratos.

INTRODUCTION: The mesocarp of Babassu (Orbignya phalerata) has been used in experimental studies trying to check its pro-inflammatory effect. PURPOSE: To analyse comparatively the histological changes made by the water extract of Babassu in skin surgical wounds. METHODS: Sixty Wistar adult male rats were used. The experimental procedure was a circle skin incision of 2 cm in diameter made with a metal punch. After this procedure done in all animals, they were randomized in two groups of 30. In the control group, the phytotherapeutic agent wasn't used but saline solution. In the experimental group, the water extract of Orbignya phalerata was used in the cut sites. All animals were followed and killed after seven, 14 and 21 days. Comparative histological analysis was made among the groups. RESULTS: In the microscopic view, a significant reepitelization effect on the healing process of the experimental group in relation to the control group in the 7th and 14th days, was recognized. CONCLUSION: The use of the mesocarp of Orbignya phalerata in skin surgical wounds contributed positively in the healing process in rats.

[Surgical bladder wounds treated with Orbignya phalerata aqueous extract: controlled study in rats]. / Análise da cicatrização da bexiga com o uso do extrato aquoso da Orbignya phalerata (babaçu): estudo controlado em ratos.

INTRODUCTION: Wound healing is a complex process that deals with different biological and immunological systems and is essential to keep the organism integrity. Three well-defined phases occur: inflammatory, proliferative and maturation. A failure or lengthy phase may result in a delay or absence of it. PURPOSE: The aim of this paper is to analyse comparatively the histological alteration provided by the use of the aqueous extract of Orbignya phalerata, in the healing process of bladder surgical wounds. METHODS: Forty adult, male Wistar rats were used. The experimental procedure consisted of a longitudinal 2 cm long bladder incision and single layer interrupted suture of 5-0 polyglactine 910. Post-operatively, the rats were randomly divided into two groups of 20. The substance was not used in the control group. The Orbignya phalerata aqueous solution was used in the study group. The animals were observed and killed three and seven days later. Comparative histological analysis was accomplished between the groups. RESULTS: Significant statistical differences were observed in the neo-formation variables (p= 0.001), chronic inflammation (p= 0.002) and fibroblastic proliferation (p= 0.023). Acute inflammation was very evident in the control group. CONCLUSION: The time factor of wound healing showed homogeneity between experimental and control groups, however faster in the experimental one. The Orbignya phalerata had a favoring healing effect in the surgical incision on rats bladder.

Análise da cicatrização da bexiga com o uso do extrato aquoso da Orbignya phalerata (babaçu). Estudo controlado em ratos / Surgical blader wounds treated with Orbignya phalerata aqueous extract: controlled study in rats

INTRODUÇÃO: A cicatrização constitui processo complexo, envolvendo diferentes sistemas biológicos e imunológicos, sendo essencial para manter a integridade do organismo. Três fases bem definidas ocorrem: inflamatória, proliferativa e maturação. Falha ou prolongamento em uma delas pode resultar em retardo ou ausência da cicatrização. OBJETIVO: Analisar comparativamente as alterações histológicas proporcionadas pelo uso do extrato aquoso da Orbignya phalerata na cicatrização de lesões cirúrgicas da bexiga. MÉTODOS: Quarenta ratos da linhagem Wistar, adultos e machos foram utilizados. O procedimento experimental constituiu-se em incisão longitudinal de 2cm na bexiga e síntese em plano único com pontos separados de poliglactina 910 cinco zeros. Após este procedimento comum, os animais foram distribuídos aleatoriamente em dois subgrupos contendo 20 animais cada. No grupo controle não foi utilizada a substância Orbignya phalerata. No grupo-experimento utilizou-se solução aquosa de Orbignya phalerata na dose de 50mg/kg por via intraperitoneal. Os animais foram acompanhados e mortos em três e sete dias. Foi feita análise histológica comparativa entre os grupos. RESULTADOS: Os resultados mostraram que foi observada diferença estatística significante nas variáveis neoformação (p= 0,001) e proliferação fibroblástica (p= 0,010) nos subgrupos controle e experimento do 3º dia. Ainda no grupo experimento a neoformação capilar foi mais intensa que no grupo controle, apresentando significância estatística. No grupo de sete dias observou-se que as variáveis inflamação aguda (p= 0,001), inflamação crônica (p= 0,002) e proliferação fibroblástica (p=0,023) apresentaram significância estatística, sendo bem evidente a inflamação aguda no grupo controle. CONCLUSÃO: Foi observada homogeneidade no fator tempo da cicatrização nos grupos experimento e controle sendo mais rápida no grupo experimento. Houve efeito favorecedor cicatrizante na utilização do extrato aquoso do mesocarpo da Orbignya phalerata na bexiga do ratos.

INTRODUCTION: Wound healing is a complex process that deals with different biological and immunological systems and is essential to keep the organism integrity. Three well-defined phases occur: inflammatory, proliferative and maturation. A failure or lengthy phase may result in a delay or absence of it. PURPOSE: The aim of this paper is to analyse comparatively the histological alteration provided by the use of the aqueous extract of Orbignya phalerata, in the healing process of bladder surgical wounds. METHODS: Forty adult, male Wistar rats were used. The experimental procedure consisted of a longitudinal 2cm long bladder incision and single layer interrupted suture of 5-0 poliglactine 910. Post-operatively, the rats were randomly divided into two groups of 20. The substance was not used in the control group. The Orbignya phalerata aqueous solution was used in the study group. The animals were observed and killed three and seven days later. Comparative histological analysis was accomplished between the groups. Resuts: Significant statistical differences were observed in the neo-formation variables (p= 0,001), chronic inflammation (p= 0,002) and fibroblastic proliferation (p= 0,023). Acute inflammation was very evident in the control group. CONCLUSION: The time factor of wound healing showed homogeneity between experimental and control groups, however faster in the experimental one. The Orbignya phalerata had a favoring healing effect in the surgical incision on rats bladder.

Efeito do extrato de Passiflora edulis (maracujá) na cicatrização de bexiga em ratos: estudo morfológico / Effect of Passiflora edulis (passion fruit) extract on rats bladder wound healing: morphological study

OBJETIVO: Avaliar o efeito do extrato das folhas de Passiflora edulis na cicatrização de bexiga em ratos, sob aspectos histológico. MÉTODOS: Quarenta ratos da linhagem Wistar, machos foram submetidos à incisão longitudinal na bexiga e síntese em plano único. Após este procedimento comum, os animais foram distribuídos aleatoriamente em dois grupos, Passiflora e Controle. No grupo Passiflora utilizou-se dose única intra-peritoneal do extrato hidroalcoólico das folhas de Passiflora edulis e no grupo controle utilizou-se dose única intraperitoneal de água destilada. Cada grupo foi dividido em dois subgrupos, conforme o dia de morte dos animais, subgrupos Controle três e sete dias e subgrupos Passiflora três e sete dias. Após a morte dos animais, foi feito o inventário da cavidade abdominal e a retirada da bexiga. Uma análise comparativa entre os dois grupos, utilizando-se parâmetros microscópicos da cicatrização, foi realizada. RESULTADOS: Houve menor inflamação aguda (p=0,008), maior colagenização (p=0,001) e maior neoformação capilar (0,000) no subgrupo Passiflora do terceiro dia, quando comparado com o subgrupo Controle do terceiro dia. Encontrou-se menor inflamação aguda (p=0,001), maior proliferação fibroblástica (p=0,011) e maior presença de colágeno (p=0,001) no subgrupo Passiflora do sétimo dia quando comparado ao subgrupo Controle do sétimo dia. CONCLUSÃO: O extrato das folhas de Passiflora edulis diminuiu a inflamação aguda e aumentou a proliferação fibroblástica, a colagenização e a neoformação capilar na cicatrização da bexiga de ratos.

PURPOSE: To evaluate the effects of hydroalcoholic extract of Passiflora edulis leaves in the healing of urinary bladder in rats from histological aspects. METHODS: Forty Wistar male rats were submitted to a longitudinal incision of the bladder followed by a stetching in only one level. After this common procedure, animals were divided at random two groups: Passiflora and Control. In the Passiflora group the only dosage used was administered by intraperitonial injection of hydoalcoholic extract of Passiflora edulis leaves while in the Control group distilled water was injected. Each subgroup was then divided in two subgroups according to the death of these animals: Control, three and seven days, Passiflora, three and seven days. After the death of these animals, an inventory of the abdominal cavity was performed and the bladder was removed. A comparative analysis was done between the two groups with microscopic evaluation of the healing. There was less acute inflammation (p=0.008), greater colagenous formation (p=0.001) and greater capillary neo-formation (p=0.000) in the third day Passiflora subgroup when compared to the Control subgroup of the third day. RESULTS: There was less acute inflammation (p=0.001), greater fibroblastic proliferation (p=0.011) and greater colagenous formation (p=0.001) in the Passiflora subgroup of seventh day when compared with the Control seventh day subgroup. CONCLUSION: The use of Passiflora edulis leaves extract resulted in less acute inflammation, greater fibroblastic proliferation, colagenous formation and capillary neo-formation on rats bladder wound healing.

Efeito do uso tópico do extrato aquoso de Orbignya phalerata (babaçu) na cicatrização de feridas cutâneas: estudo controlado em ratos / Topic use of aqueous extract of Orbignya phalerata (babassu) in rats: analysis of it's healing effect

INTRODUÇÃO: O mesocarpo de Orbignya phalerata tem sido usado em estudos experimentais procurando verificar sua ação pró-inflamatória. OBJETIVO: Analisar comparativamente as alterações histológicas proporcionadas pelo extrato aquoso do babaçu nas feridas cutâneas. MÉTODOS: Sessenta ratos da linhagem Wistar, adultos, machos, foram utilizados. O procedimento experimental constituiu-se em uma incisão circular de 2cm de diâmetro na pele com punch metálico. Após este procedimento comum a todos, os animais foram distribuídos aleatoriamente em dois grupos contendo 30 animais cada. No grupo controle não foi utilizada a substância pesquisada e sim, solução fisiológica (Cloreto de sódio a 0,9 por cento). No grupo experimento utilizou-se solução aquosa de Orbignya phalerata em uso tópico. Os animais foram acompanhados e mortos em sete, 14 e 21 dias. Foi feita análise histológica comparativa entre os grupos. RESULTADOS: Observou-se diferença significativa a favor da cicatrização do grupo experimento em relação ao grupo controle nos 7° e 14° dias, no que diz respeito à reepitelização. CONCLUSÃO: O uso tópico do mesocarpo de Orbignya phalerata (Babassu) contribuiu positivamente para a cicatrização das feridas cutâneas em ratos com a dosagem de 25mg/ml.

INTRODUCTION: The mesocarp of Babassu (Orbignya phalerata) has been used in experimental studies trying to check its pro-inflammatory effect. PURPOSE: To analyse comparatively the histological changes made by the water extract of Babassu in skin surgical wounds. METHODS: Sixty Wistar adults male rats were used. The experimental procedure was a circle skin incision of 2 cm in diameter made with a metal punch. After this procedure done in all animals, they were randomized in two groups of 30. In the control group, the phytotherapic agent wasn't used but saline solutin. In the experimental group, the water extract of Orbignya phalerata was used in the cut sites. All animals were followed and killed after seven, 14 and 21 days. Comparative histological analysis was made among the groups. RESULTS: In the microscopic view, a significant reepitelization effect on the healing process of the experimental group in relation to the control group in the 7th and 14th days, was recognized. CONCLUSION: The use of the mesocarp of Orbignya phalerata in skin surgical wounds contributed positively in the healing process in rats.

Cistite bacteriana aguda: tratamento com dose única de fosfomicina trometamol / Acute bacterial cystitis: treatment with single-dose of fosfomycin trometamol

O objetivo deste estudo, realizado em nível ambulatorial, foi o de avaliar a eficácia e segurança, no tratamento da cistite bacteriana aguda näo complicada, dcom uma dose única de fosfomicina trometamol equivalente a 3 g de fosfomicina, administrada por via oral na ocasiäo do diagnóstico. Foram tratadas 32 pacientes do sexo feminino, com avaliaçöes pós-tratamento nos 3§, 7§ e 10§ dias, incluindo urinálise completa. O índice de sucesso foi de 96 por cento, com mínimos efeitos colaterais.

Norfloxacino em infecçöes urinárias recidivantes / Norfloxacin in recidivant urinary infections

Foram estudados 29 pacientes (idades entre 14 e 68 anos), nove homens e 20 mulheres, com diagnóstico de infecçöes urinárias recidivantes, para a avaliaçäo de eficácia e tolerabilidade do norfloxacino. Foram incluídos no trabalho apenas pacientes que houvessem sido previamente tratados com sulfametoxazol + trimetoprim sem sucesso. Norfloxacino foi administrado por via oral durante 7 dias, sendo os pacientes avaliados clínica e bacteriologicamente em diferentes etapas do estudo. A análise dos resultados mostrou que o agente etiológico predominante foi E. coli (72,4%) e em menores percentuais seguiram Proteus, Klebsiella, Enterococcus e Staphylococcus aureus. O índice de cura clínica foi de 93,1% e a erradicaçäo dos patógenos infectantes foi obtida em 89,6% dos casos. Reaçöes adversas, quando ocorreram, foram de pequena intensidade e transitórias, obrigando à interrupçäo do tratamento em apenas um paciente. Concluímos ser o norfloxacino uma droga bactericida de amplo espectro, eficaz, bem tolerada e com baixa incidência de efeitos colaterais