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Urology ; 115: 71-75, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29501625


OBJECTIVE: To compare the distance between the colon and the trajectory of percutaneous nephrolithotomy (PCNL) access both in prone and flank-free modified supine (FFMS) positions as measured on computed tomography and to study the effect of age, gender, BMI, side, and previous renal surgery as influencing factors. PATIENTS AND METHODS: In this prospective study, we included 367 patients scheduled for PCNL. All patients underwent low dose abdominal computed tomography both in prone and FFMS positions. Patients <18 years and those with previous colonic surgery or renal congenital anomalies were excluded. The perpendicular distance between the imaginary line of the renal access and the colon was measured. Findings were correlated to different influencing factors. RESULTS: Two hundred nineteen patients were males, and 148 were females. BMI of <30 were reported in 158 patients whereas BMI >30 in 209 patients. Data analysis showed that the mean perpendicular distance between colon and the renal access in FFMS and prone positions were 35.92 ± 0.22 mm and 17.78 ± 0.09 mm, respectively. In prone position only obesity, age, and overall interaction effect were the significant factors on the studied distance. In FFMS position, in addition to the effect of the prior factors, previous renal surgery also significantly reduces this distance. CONCLUSION: The distance between the colon and assumed PCNL trajectory at a puncture on the posterior axillary line was influenced mainly by patient position. In FFMS position the colon appears to be farther than in prone position. BMI and age significantly influence this distance to a lesser extent.

Colo/diagnóstico por imagem , Cálculos Renais/cirurgia , Rim/diagnóstico por imagem , Nefrolitotomia Percutânea , Posicionamento do Paciente , Adulto , Fatores Etários , Índice de Massa Corporal , Feminino , Humanos , Masculino , Decúbito Ventral , Estudos Prospectivos , Punções , Fatores Sexuais , Decúbito Dorsal , Tomografia Computadorizada por Raios X
Clin Imaging ; 40(4): 780-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27317224


OBJECTIVE: To compare the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in characterizing adrenal masses. MATERIALS AND METHODS: A total of 45 adrenal masses in 38 patients underwent unenhanced CT, enhanced CT, and chemical-shift MRI. Sensitivities and accuracies using the lesion attenuation values, absolute or relative percentage washout for CT, and adrenal-to-spleen ratio or signal intensity index for MRI were calculated. Follow-up or histopathology was used as standard reference. RESULTS: A total of 15 lipid-rich adenomas, 6 lipid-poor adenomas, and 24 nonadenomas were obtained. The sensitivities for adenoma on MRI versus CT were 81% and 95%, respectively. The specificities were 100%. CONCLUSION: CT is superior to MRI in characterizing adenomas.

Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Iohexol , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Intensificação de Imagem Radiográfica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
BJU Int ; 107(10): 1605-10, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20825396


OBJECTIVE: • To evaluate the efficacy of a bladder preservation multimodality protocol for patients with operable carcinoma invading bladder muscle. MATERIALS AND METHODS: • In this prospective study, we included 33 patients with transitional cell carcinoma (TCC) (T2 and T3, Nx, M0) who were amenable to complete transurethral resection. • These patients refused radical cystectomy as their first treatment option. After maximum transurethral resection of bladder tumour (TURBT), all patients received three cycles of adjuvant chemotherapy in the form of methotrexate, vinblastin, adriamycin and cisplatin (MVAC) followed by radical radiotherapy. • Four weeks later, all cases had radiological and cystoscopical re-evaluation. • Complete responders were considered to be those patients who had no evidence of residual tumour. All patients were subjected to a regular follow-up by cystoscopy and tumour site biopsy conducted every 3 months. Abdomino-pelvic computed tomography and chest X-ray were conducted every 6 months. • The study endpoint was the response to treatment after completion of the first year of follow-up after therapy. RESULTS: • Out of 33 eligible patients, a total of 28 patients completed the study treatment protocol. Their mean ± SD age was 56.7 ± 6 years. Trimodal therapy was well tolerated in most of cases, with no severe acute toxicities. After 12 months of follow-up, a complete response was achieved in 39.3% and a partial response in 7.1%, with an overall response rate of 46.4%. • By the end of the first year, disease-free survival was reported in 39.3%, whereas 25% were still alive with their disease, giving an overall survival of 64.3% for all patients who maintained their intact, well functioning bladders. • Tumour stage and completeness of transurethral resection of bladder tumour were the most important predictors of response and survival. T2 lesions had complete and partial response rates of 69.2% and 23%, respectively, whereas T3 lesions had rates of 40% and 13.3%, respectively (P = 0.001). • The response rate in patients who had complete TURBT was 82.6% vs 20% in those with cystoscopic biopsy only (P = 0.001). In addition, disease-free survival was 72.7% in T2 patients and 27.3% in T3 patients (P = 0.001). CONCLUSION: • In the present study, bladder preservation protocol with MVAC and radical radiotherapy achieved suboptimal response rates at 1 year in patients with localized TCC invading bladder muscle. Patients with solitary T2 lesions that are amenable to complete TURBT achieved the best response rates. Longer follow-up is needed to verify these results. Patients with localized disease should be encouraged for radical cystectomy, which achieved better results.

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/terapia , Cistectomia , Neoplasias da Bexiga Urinária/terapia , Idoso , Biópsia , Carcinoma de Células de Transição/patologia , Cisplatino/administração & dosagem , Terapia Combinada , Doxorrubicina/administração & dosagem , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia , Vimblastina/administração & dosagem