Experiencia inicial en hepatectomías en Corrientes / Initial experience in hepatectomies in Corrientes

RESUMEN Antecedentes: la cirugía hepática ha evolucionado con el correr del tiempo. No existe bibliografía publicada sobre experiencia previa de hepatectomía en Corrientes. Nuestro grupo de trabajo se desenvuelve en el ámbito público y privado. Objetivo: describir los resultados iniciales de una serie consecutiva de pacientes con hepatectomías de distinta extensión, por el mismo equipo quirúrgico. Material y métodos: trabajo retrospectivo, observacional, descriptivo, sobre datos de las historias clínicas y libros de quirófano de pacientes con hepatectomías realizadas entre septiembre de 2019 y enero de 2023, en la práctica pública y privada. Resultados: fueron intervenidos 27 pacientes, con media de edad 53 años (25-72); 16 eran mujeres. El abordaje fue convencional en 25 casos y laparoscópico en 2. Se realizaron 4 hepatectomías mayores y 23 menores. Los diagnósticos fueron de patología maligna en 22 oportunidades y benigna en 5. La sobrevida a los 90 días fue de 96,2%. La mortalidad fue de 1 paciente (3,7%). Con respecto a las complicaciones, 2 pacientes (7,4%) presentaron abscesos hepáticos en el posoperatorio, 2 pacientes (7,4%) requirieron reintervención quirúrgica por sangrado, con buena evolución posterior y alta hospitalaria. Conclusión: la morbimortalidad en la serie descripta estuvo en relación con lo comunicado por otros autores.

ABSTRACT Background: Liver surgery has evolved over time. There are no prior publications on the experience of liver surgery in the province of Corrientes. Our work group operates in both the public and private sectors. Objective: The aim of this study was to describe the initial results of a consecutive series of patients undergoing different types of liver resections, performed by the same surgical team. Material and methods: We conducted a retrospective, observational, and descriptive study based on data from the medical records and operating room records of patients undergoing liver resection at public and private institutions from September 2019 to January 2023. Results: A total of 27 patients were operated on; mean age was 53 years (25-72) and 16 were women. We used the conventional approach in 25 cases and laparoscopy in 2. Four procedures were major liver resections and 23 were minor liver resections, The diagnoses were cancer in 22 cases and benign conditions in 5. Survival at 90 days was 96.2% One patient died (3.7%). The complications included postoperative liver abscesses in 2 patients (7.4%) and re-operation due to bleeding in 2 patients (7.4%), who had a subsequent favorable course and were discharged from the hospital. Conclusion: The morbidity and mortality in the described series were similar to those reported by other authors.

Laparoscopic Enucleation of Pancreatic Neoplasms: A Single-Center Experience and Outcomes.

Background: Laparoscopic technique has been increasingly applied in the treatment of selected pancreatic tumors. The aim of this study is to evaluate the experience with laparoscopic enucleation of pancreatic neoplasms (LEPNs), for selected pancreatic diseases, at a high-volume referral center. Methods: Between May 2012 and October 2020, LEPNs was attempted in 16 patients with selected pancreatic neoplasms. The localization of tumors, etiology, indications, and clinical outcomes were analyzed. Results: Sixteen patients were included. LEPN was successfully performed in 13 patients, 3 conversions to open procedure were required. The definitive histopathological result of the resected pieces showed prevalence of intraductal papillary mucinous neoplasms. Postoperative major complications occurred for 3 patients (18.7%), the 3 of them presented postoperative pancreatic fistula (POPF). The median hospital stay was 4.5 days (range 2-7) for patients without POPF and 14.6 days (3-30) for those who presented with POPF. No deaths were registered. During a median follow-up of 43.8 months (0.2-109), no new-onset exocrine or endocrine insufficiency was diagnosed, no patient experienced tumor recurrence and, the 4 patients who underwent LEPN for insulinoma, remained asymptomatic. Conclusion: LEPNs has become a valuable alternative for patients with benign or low risk of malignancy tumors. Appropriate preoperative imaging is key for localization. Whenever feasible, this technique not only reduces the risks of exocrine and endocrine insufficiency, but also adds the well-known advantages of minimally invasive techniques, making it a safe and feasible treatment.

Role of laparoscopy in the immediate, intermediate, and long-term management of iatrogenic bile duct injuries during laparoscopic cholecystectomy.

PURPOSE: Bile duct injuries (BDI) during a laparoscopic cholecystectomy still remain as one of the most feared complications in surgery. The use of laparoscopy for its management is a controversial subject of discussion. The purpose of this study is to assess the amount of possibilities that a laparoscopic approach allows in its resolution. METHODS: A retrospective analysis of all the patients diagnosed with BDI at our center was carried out. The analysis was made considering three different scenarios in which laparoscopy can be used: (1) intraoperative management of BDI; (2) postoperative management of bile peritonitis; (3) deferred treatment of BDI. RESULTS: We analyzed 22 patients in total who were divided into three groups according to the different scenarios proposed. In the first group, the applicability of laparoscopy was 45%, some complications occurred in two patients, and primary patency was obtained in seven. In the second group, four of them presented a grade III complication. In the third group, the applicability of laparoscopy was 13.6%. Only one patient presented a IIIa complication and primary patency was obtained in all of them. CONCLUSIONS: Laparoscopy plays a more important role in BDI management every day. This approach, in selected cases, is associated with good long-term results and perioperative advantages of a minimally invasive approach.

Percutaneous Balloon Dilatation for Hepaticojejunostomy Stricture Following Paediatric Liver Transplantation: Long-Term Results of an Institutional "Three-Session" Protocol.

PURPOSE: The aim of this study was to report the long-term results of an institutional protocol of percutaneous biliary balloon dilatation (PBBD) on paediatric patients with benign anastomotic stricture after liver transplantation. As a secondary objective, we evaluated risk factors associated with post-treatment re-stricture. MATERIALS AND METHODS: Fourteen paediatric, post-liver transplant patients with benign anastomotic stricture of Roux-en-Y hepaticojejunostomy were included. All patients underwent the same treatment protocol of three PBBD procedures with 15-day intervals. Clinical outcome was analysed using the Terblanche classification. Primary patency rate was assessed with the Kaplan-Meier test. RESULTS: All patients had an initial successful result (Terblanche grade, excellent/good) after PBBD. At the end of the follow-up time of 35.7 ± 21.1 months (CI95%, 23.5-47.9), 10 patients persisted with excellent/good grading, while the remaining 4 had re-stricture, all of the latter occurring within the first 19 months. Patency rate after percutaneous treatment at 1, 3, and 5 years were 85.7%, 70%, and 70%, respectively. History of major complication after liver transplantation was associated with 5 times higher risk of re-stricture, HR 5.48 [95% CI, 2.18-8.78], p = 0.018. CONCLUSION: In paediatric patients with benign anastomotic stricture of hepaticojejunostomy after liver transplantation, the "Three-session" percutaneous biliary balloon dilatation protocol is associated with a high rate of long-term success. In this limited series, the history of post-liver transplant major complication, defined as complications requiring a reintervention under general anaesthesia or advanced life support, seems to be an independent risk factor for stricture recurrence.

Risk factors for perioperative complications in transurethral prostate resection in patients at a Colombian institution. / Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de Colombia.

OBJECTIVE: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolar transurethral resection of the prostate at a complex care institution in Colombia. MATERIALS AND METHODS: A mixed cohort study was conducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolar transurethral resection of the prostate between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of complications determined up to 30 postoperative days. RESULTS: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were previously hospitalized. According to the Clavien Dindo classification, 14.79% were grade I - II: secondary hematuria was the most reported complication and was present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The risk factors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 - 4.39), INR (RR: 7.59, IC95%:4.63 - 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 - 1.42) and urethral catheter use (RR: 1.04, CI95%: 1.02 - 1.05). CONCLUSIONS: In this study, the complication rate after bipolar transurethral resection of the prostate was less than 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. The risk factors that were found are modifiable, which could reduce postoperative morbidity.

OBJETIVO: Determinar la tasa de complicaciones y los factores de riesgo para complicaciones perioperatorias tempranas de la Resección Transuretral de Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio de cohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna (HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las características basales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. RESULTADOS: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%) fueron intrahospitalarias. Según la clasificación Clavien Dindo el 14,79% fueron complicaciones grado I y II: la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tracto urinario (4,64%) y disfunción de la sonda uretrovesical (1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 ­ 4,39), aumento del valor del INR por unidad (RR: 7,59, IC95%: 4,63 ­ 12,44) y cada día adicional de irrigación vesical (RR: 1,32, IC95%:1,22 ­ 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02­ 1,05). CONCLUSIONES: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de meno rdel 20%, siendo las complicaciones grados I y II las más frecuentes. Los factores de riesgo encontrados son modificables lo que podría reducir la morbilidad postoperatoria.

Impact of Cholestasis on the Sensitivity of Percutaneous Transluminal Forceps Biopsy in 93 Patients with Suspected Malignant Biliary Stricture.

PURPOSE: The aim of this study was to determine the effect of hyperbilirubinemia in the sensitivity of percutaneous transluminal forceps biopsy (PTFB) in patients with suspected malignant biliary stricture. MATERIALS AND METHODS: Ninety-three patients with suspicion of malignant biliary stricture underwent percutaneous transhepatic cholangiography followed by PTFB. Sensitivity, specificity and predictive values were analysed based on the presence or absence of hyperbilirubinemia, defined as total bilirubin equal to, or higher than 5 mg/dL. Variables included demographic and clinical features, laboratory, tumour type and localization, stricture length, therapeutic approach and histopathology. Additionally, major morbidity and mortality were assessed. RESULTS: The overall sensitivity, specificity, positive predictive value and accuracy of PTFB were 61.1%, 100%, 100%, and 62.4%, respectively. Hyperbilirubinemia affected 57% of patients at the time of PTFB. There were 35 (37%) false negative results, none of them related to tumour type or localization, stricture length, or previous biliary intervention (i.e. PBBD (percutaneous biliary balloon dilatation), ERCP (endoscopic retrograde cholangiopancreatography)) (p > 0.05). However, when bilirubin was < 5 mg/dL, false negative results decreased globally (p = 0.024) and sensitivity increased significantly for intrahepatic and hilar localization, as well as for colorectal metastasis, gallbladder carcinoma, and pancreatic carcinoma. No major morbidity occurred. CONCLUSION: The sensitivity of percutaneous transluminal biopsy for diagnosis of malignant stricture may significantly increase if samples are obtained in the absence of hyperbilirubinemia, without adding morbidity to the procedure. LEVEL OF EVIDENCE: Level 3, Case- Control studies.

Influencia de la modalidad de respuesta, edad y nivel de educación en el cuestionario internacional de síntomas prostáticos (IPSS) / Influence of the response modality, age and level of education in the international prostate symptoms questionnaire (IPSS)

OBJETIVOS: evaluar la influencia de la modalidad de respuesta (paciente vs. asistido por urólogo) en el cuestionario IPSS (International Prostate Symptom Score) y su relación con la edad y nivel de educación. MATERIALES Y MÉTODOS: Análisis prospectivo de 74 pacientes que acudieron a la consulta de urología por síntomas de Hiperplasia Prostática Benigna (HPB) con o sin tratamiento para su patología y que no hayan completado anteriormente el cuestionario internacional de síntomas prostáticos (IPSS). Los cuestionarios fueron completados en la misma consulta urológica, primero por el paciente y luego con ayuda del urólogo. Se categorizó por edad y nivel de educación. Se evaluó la diferencia entre los puntajes de IPSS obtenidos con la forma autocompletada y con asistencia del urólogo y si esta diferencia estaba relacionada con la edad y con el nivel de educación. Los datos fueron analizados utilizando test no paramétrico para datos apareados de Wilcoxon. RESULTADOS: no se encontró diferencia estadísticamente significativa entre el cuestionario completado por el paciente y el asistido por el urólogo. La media del score total fue de 13,66, y 13,67, respectivamente (p: 0.86). Al analizar los subgrupos, con respecto a la edad y al nivel de educación, tampoco se encontraron diferencias estadísticamente significativas. CONCLUSIÓN: en nuestra población de estudio, el cuestionario IPSS no fue influenciado por la modalidad de administración, tampoco por la edad ni por el nivel de educación.

OBJECTIVES: to evaluate the influence of the response modality (patient vs. urologist-assisted) in the IPSS questionnaire (international prostate symptom score) and its relationship with age and education level. MATERIALS AND METHODS: Prospective analysis of 74 patients who came to the urology clinic for symptoms of Benign Prostatic Hyperplasia (BPH) with or without treatment for their pathology and who have not previously completed the international prostate symptoms questionnaire (IPSS). The questionnaires were completed in the same urological consultation, first by the patient and then with the help of the urologist. It was categorized by age and education level. The difference between the IPSS scores obtained with the self-completed form and with the assistance of the urologist and whether this difference was related to age and level of education was evaluated. The data were analyzed using non-parametric test for paired Wilcoxon data. RESULTS: no statistically significant difference was found between the questionnaire completed by the patient and the one assisted by the urologist. The average of the total score was 13.66, and 13.67, respectively (p: 0.86). When analyzing the subgroups, regarding age and level of education, no statistically significant differences were found. CONCLUSION: In our study population, the IPSS questionnaire was not influenced by the modality of administration, neither by age nor by level of education.

[Complication related factors in patients undergoing open simple prostatectomy due to Benign Prostate Hyperplasia in a Colombian hospital.] / Factores asociados a complicaciones en los pacientes llevados a prostatectomía abierta retropúbica por Hiperplasia Prostática Benigna en un hospital Colombiano.

INTRODUCTION: Open prostatectomy is an efficacious treatment for Benign Prostatic Hyperplasia (BPH), but its complication rates and risk factors for these might vary due to the characteristics of populations and health systems. OBJECTIVE: To determine the frequency of complications and the risk factors for these, in the first three months after open prostatectomy in a hospital in Medellín (Colombia). METHODS: This is a cohort study in which patients undergoing retropubic open prostatectomy were taken. Medical records were reviewed to obtain demographic, preoperative, and intraoperative data. The main outcome was the incidence of complications in the first three postoperative months and this was divided into early (day 1 to 7 post-surgery) and late (day 8 to 90 post-surgery) complications. Risk factors were determined by estimating Relative Risks (RR). RESULTS: 191 patients with a median age of 70 years were included. The frequency of complications was 34.5%,14.6% occurred early and 19.9% late. Risk factors were dyslipidemia (RR: 2.37, 95% CI: 1.25 to 4.47), irrigation time (RR: 1.31, 95% CI: 1.02 to 1.67) and duration of the postsurgical catheter (RR: 1.07, 95% CI: 1.03 to 1.12); general anesthesia was a protective risk factor compared to spinal (RR: 0.47, 95% CI: 0.24 to 0.91). CONCLUSION: The frequency of complications of open prostatectomy with a retropubic approach was within the figures reported in the literature. The risk factors found could be modifiable and considered for the prevention of adverse outcomes. This study provides an updated basis for future comparisons with alternative treatments for BPH.

INTRODUCCIÓN: La prostatectomía abierta es un tratamiento eficaz para la Hiperplasia Prostática Benigna (HPB) pero sus tasas de complicaciones y los factores de riesgo para estas pueden variar por particularidades de las poblaciones y los sistemas de salud. OBJETIVO: Determinar la frecuencia de complicacione sy factores de riesgo en los primeros tres meses postquirúrgicos de la prostatectomía abierta en un hospital de alta complejidad de Medellín (Colombia). MATERIALES Y MÉTODOS: Este es un estudio de cohortes en el cual se tomaron pacientes llevados a prostatectomía abierta retropúbica. Se revisaron las historias clínicas para obtener datos demográficos, prequirúrgicos e intraquirúrgicos. El desenlace principal fue la presentación de complicaciones en los primeros tres meses postquirúrgicos y éste se dividió en complicaciones tempranas (entre el día 1 y 7) y tardías (entre el día 8 y 90). Se determinaron los factores de riesgo mediante la estimación de Riesgos Relativos (RR). RESULTADOS: Se incluyeron 191 pacientes con una mediana de edad de 70 años. La frecuencia de complicaciones fue de 34,5%, 14,6% tempranas y 19,9% tardías. Los factores de riesgo fueron dislipidemia (RR: 2,37, IC95%: 1,25 a 4,47), tiempo de irrigación (RR: 1,31, IC95%: 1,02 a 1,67) y duración de sonda postquirúrgica (RR: 1,07, IC95%: 1,03 a 1,12); la anestesia general fue un factor de riesgo protector en comparación con la raquídea (RR: 0,47, IC95%: 0,24 a 0,91). CONCLUSIONES: La frecuencia de complicaciones de la prostatectomía abierta bajo enfoque retropúbico estuvo dentro de las cifras reportadas en la literatura. Los factores de riesgo encontrados podrían ser modificables  y tenerse en cuenta para la prevención de desenlaces adversos. Con este estudio se sienta una base actualizada para futuras comparaciones con tratamientos alternativos para HPB.

Hydrogen metabolic patterns driven by Clostridium-Streptococcus community shifts in a continuous stirred tank reactor.

The hydrogen (H2) production efficiency in dark fermentation systems is strongly dependent on the occurrence of metabolic pathways derived from the selection of microbial species that either consume molecular H2 or outcompete hydrogenogenic bacteria for the organic substrate. In this study, the effect of organic loading rate (OLR) on the H2 production performance, the metabolic pathways, and the microbial community composition in a continuous system was evaluated. Two bacterial genera, Clostridium and Streptococcus, were dominant in the microbial community depending on the OLR applied. At low OLR (14.7-44.1 gLactose/L-d), Clostridium sp. was dominant and directed the system towards the acetate-butyrate fermentation pathway, with a maximum H2 yield of 2.14 molH2/molHexose obtained at 29.4 gLactose/L-d. Under such conditions, the volumetric hydrogen production rate (VHPR) was between 3.2 and 11.6 LH2/L-d. In contrast, relatively high OLR (58.8 and 88.2 gLactose/L-d) favored the dominance of Streptococcus sp. as co-dominant microorganism leading to lactate production. Under these conditions, the formate production was also stimulated serving as a strategy to dispose the surplus of reduced molecules (e.g., NADH2+), which theoretically consumed up to 5.72 LH2/L-d. In such scenario, the VHPR was enhanced (13.7-14.5 LH2/L-d) but the H2 yield dropped to a minimum of 0.74 molH2/molHexose at OLR = 58.8 gLactose/L-d. Overall, this research brings clear evidence of the intrinsic occurrence of metabolic pathways detrimental for biohydrogen production, i.e., lactic acid fermentation and formate production, suggesting the use of low OLR as a strategy to control them.

Percutaneous Biliary Balloon Dilation: Impact of an Institutional Three-Session Protocol on Patients with Benign Anastomotic Strictures of Hepatojejunostomy.

BACKGROUND: Percutaneous biliary balloon dilation (PBBD) stands as a safe, useful, and inexpensive treatment procedure performed on patients with benign anastomotic stricture of Roux-en-Y hepatojejunostomy (BASH). However, the optimal mode of application is still under discussion. METHODS: A retrospective cohort study was conducted including patients admitted between 2008 and 2015 with diagnosis of BASH. Patients were divided into 2 groups: group I (n = 22), included patients treated after the implementation of an institutional protocol of 3 PBBD sessions within a fixed time interval and group II (n = 24) consisted of our historical control of patients who underwent one or 2 dilation sessions. Patency at one-year post procedure was assessed with the classification proposed by Schweizer. Symptomatic response to treatment was analyzed using the Terblanche classification. RESULTS: Patients in group I exhibited more excellent/good results (90 vs. 50%, p = 0.003) and less poor results (5 vs. 42%, p = 0.005) according to the Schweizer classification and more grade I/excellent results according to Terblanche classification (p = 0.003). Additionally, group I showed lower serum total bilirubin (p = 0.001), direct bilirubin (p = 0.002), alkaline phosphatase (p = 0.322), aspartate aminotransferase (p = 0.029), and alanine aminotransferase (p = 0.006). CONCLUSION: A protocol of 3 consecutive PBBD sessions within a fixed time interval may yield a high rate of patency, with a positive clinical, biochemical, and radiological impact on patients with BASH.

Inter-relação entre HPB, abcesso prostático e síndrome da compressão da veia ilíaca em um cão relato de caso / Interrelationship among BPH, prostatic abscess and iliac vein compression syndrome in a dog case report

A próstata é um importante sítio de afecções nos cães de meia-idade a senis. Os sintomas geralmentesão transitórios e inespecíficos, e dependem da região prostática acometida, bem como região do corpo afetadapela doença. Já a síndrome da compressão de vasos ilíacos é uma afecção que resulta de disfunção das veiaspélvicas e/ou retroperitoneais, que afetam o sistema venoso da cava inferior. Relata-se o caso de um cão, PastorAlemão, cuja hiperplasia prostática benigna associada a abcesso prostático resultaram na síndrome decompressão das veias ilíacas internas e externas. O animal foi submetido a drenagem cirúrgica e orquiectomia,entretanto veio a óbito após a cirurgia por lesão de reperfusão. Ressalta-se a importância de associar os sintomasde algumas prostatopatias em cães a distúrbios circulatórios sistêmicos, como a síndrome de compressão dasveias ilíacas.(AU)

The prostate is an important site of infection in middle aged and senile dogs. The symptoms are usuallytransient and non-specific, and depend on the affected prostate region as well as region of the body affected bythe disease. The syndrome of compression of iliac vessels results from a dysfunction of the pelvic and / orretroperitoneal veins, which affect the venous system of the inferior vena cava system. We report the case of adog, German Shepherd, whose benign prostatic hyperplasia associated with prostatic abscess resulted in theiliac vein compression syndrome. The animal underwent surgical drainage and orchiectomy, but died aftersurgery due to reperfusion injury. Thus, it is important to associate the symptoms of some prostatopathies indogs with circulatory disorders, such as the syndrome of compression of the iliac veins.(AU)

Inter-relação entre HPB, abcesso prostático e síndrome da compressão da veia ilíaca em um cão – relato de caso / Interrelationship among BPH, prostatic abscess and iliac vein compression syndrome in a dog – case report

A próstata é um importante sítio de afecções nos cães de meia-idade a senis. Os sintomas geralmentesão transitórios e inespecíficos, e dependem da região prostática acometida, bem como região do corpo afetadapela doença. Já a síndrome da compressão de vasos ilíacos é uma afecção que resulta de disfunção das veiaspélvicas e/ou retroperitoneais, que afetam o sistema venoso da cava inferior. Relata-se o caso de um cão, PastorAlemão, cuja hiperplasia prostática benigna associada a abcesso prostático resultaram na síndrome decompressão das veias ilíacas internas e externas. O animal foi submetido a drenagem cirúrgica e orquiectomia,entretanto veio a óbito após a cirurgia por lesão de reperfusão. Ressalta-se a importância de associar os sintomasde algumas prostatopatias em cães a distúrbios circulatórios sistêmicos, como a síndrome de compressão dasveias ilíacas.

The prostate is an important site of infection in middle aged and senile dogs. The symptoms are usuallytransient and non-specific, and depend on the affected prostate region as well as region of the body affected bythe disease. The syndrome of compression of iliac vessels results from a dysfunction of the pelvic and / orretroperitoneal veins, which affect the venous system of the inferior vena cava system. We report the case of adog, German Shepherd, whose benign prostatic hyperplasia associated with prostatic abscess resulted in theiliac vein compression syndrome. The animal underwent surgical drainage and orchiectomy, but died aftersurgery due to reperfusion injury. Thus, it is important to associate the symptoms of some prostatopathies indogs with circulatory disorders, such as the syndrome of compression of the iliac veins.

Efeitos cistométricos da castração hormonal e administração diária de tadalafila emcamundongos com hiperatividade detrusora induzida pela deficiência crônica de óxido nítrico

Sintomas do trato urinário inferior (STUI) representam uma das queixas mais comuns em homens. Diferentes distúrbios da micção podem resultar em STUI. Hipogonadismo é umadoença comum e subdiagnosticada no idoso, podendo estar associado a STUI. O objetivodeste estudo foi avaliar os efeitos da administração crônica da Tadalafila em camundongos hipogonádicos com deficiência crônica de óxido nítrico através de estudo cistométrico in vivo. Para tanto, foi comparado a resposta da Tadalafila em animais castrados(hipogonádicos) e após reposição de testosterona (normogonádicos). Um total de quarenta edois camundongos foram randomizados em seis grupos. Grupo 1(L-NAME): L-NAME(60mg/kg), que é um inibidor da síntese da óxido-nítrico sintase, foi administrado em água debeber. Grupo 2 (DTAD): L-NAME (60mg/kg) + diluente da Tadalafila (goma xantana emanitol). Grupo 3 (TAD): L-NAME (60mg/kg) + Tadalafila diário (4mg/kg). Grupo 4(ORQ): L-NAME (60mg/kg) + orquiectomia...

Lower Urinary Tract Symptoms (LUTS) represents one of the most commonly complaints in male. Several voiding disorders can be involved in the pathogenesis of LUTS. Hipogonadism is a common and underdiagnoseddisease in the aging male, usually presenting simultaneously with LUTS. The objective of thisstudy wasto evaluate the cystometric effects of chronic tadalafil administration in castrated micewith nitric oxide cronic deficiency.The results of tadalafiladministration were compared in castrated mice (hypogonadics) and after testosterone replacement (eugonadics). A total of 42 mice were randomized to six groups. Group 1 (L-NAME): L-name (60mg/kg), which is an oxide-nitric sintethase inhibitor, was administrated in drinking water. Group 2 (DTAD): L-name (60mg/kg) + diluent of tadalafil (mannitol and xantane gum). Group 3 (TAD): L-name + daily tadalafil (4mg/kg). Group 4 (ORQ): L-name + orchiectomy...

Administração de toxina botulínica A e a orquiectomia no tratamento da hiperplasia prostática benigna do cão / Botulinum toxin A administration and orchiectomy in the treatment of canine benign prostatic hyperplasia

A fisiopatologia da hiperplasia prostática benigna (HPB) não está totalmente compreendida, no entanto, a diidrotestosterona é o principal hormônio envolvido. Recentemente, o efeito da toxina botulínica A (TB-A) foi investigado, mostrando que esta induz atrofia do parênquima e redução do volume prostático. Com base nisso, este estudo teve como objetivos comparar os efeitos da administração da TB-A com a orquiectomia no tratamento da HPB, além de avaliar os efeitos da TB-A sobre a libido e qualidade do sêmen. Para tanto, 16 cães adultos foram submetidos à castração ou administração de 500U de TB-A, e avaliados durante 16 semanas. A orquiectomia mostrou-se um excelente tratamento, promovendo redução de 80% do volume prostático. Aplicação da TB-A não ocasionou alterações na libido, ereção ou qualidade e características seminais. Por outro lado, reduziu significamente o volume da próstata. Os resultados sugerem que a administração intraprostática de TB-A é um tratamento alternativo efetivo e sem efeitos colaterais para cães destinados a programas de reprodução. No entanto, esta terapia apresenta reduções inferiores do volume prostático, quando comparada com a orquiectomia.

The pathogenesis of benign prostatic hyperplasia (BPH) is not completely known, however, dihydrotestosterone is a hormone involved in enlargement of the prostate. Recently, the effect of botulinum toxin A (BT-A) was investigated and has shown to induce atrophy of the gland. Based on that, the aims of this study were to compare the effects of administration of BT-A with orchiectomy in the treatment of BPH, in addition to assessing the effects of BT-A on libido and semen quality. Therefore, 16 sexually intact male dogs were submitted to orchiectomy or administration of 500U BT-A, and evaluated for 16 weeks. Orchiectomy presented excellent results, reducing the prostate volume up to 80%. Administration of BT-A did not interfered on libido, erection or semen characteristics. On the other hand, reduced significantly the prostate volume. The results suggest that intraprostatic injection of BT-A is an effective alternative treatment without adverse effects for valuable breeding dogs with BPH. However, this therapy showed lower reduction of prostate volume when compared to orchiectomy.

Administração de toxina botulínica A e a orquiectomia no tratamento da hiperplasia prostática benigna do cão / Botulinum toxin A administration and orchiectomy in the treatment of canine benign prostatic hyperplasia

A fisiopatologia da hiperplasia prostática benigna (HPB) não está totalmente compreendida, no entanto, a diidrotestosterona é o principal hormônio envolvido. Recentemente, o efeito da toxina botulínica A (TB-A) foi investigado, mostrando que esta induz atrofia do parênquima e redução do volume prostático. Com base nisso, este estudo teve como objetivos comparar os efeitos da administração da TB-A com a orquiectomia no tratamento da HPB, além de avaliar os efeitos da TB-A sobre a libido e qualidade do sêmen. Para tanto, 16 cães adultos foram submetidos à castração ou administração de 500U de TB-A, e avaliados durante 16 semanas. A orquiectomia mostrou-se um excelente tratamento, promovendo redução de 80% do volume prostático. Aplicação da TB-A não ocasionou alterações na libido, ereção ou qualidade e características seminais. Por outro lado, reduziu significamente o volume da próstata. Os resultados sugerem que a administração intraprostática de TB-A é um tratamento alternativo efetivo e sem efeitos colaterais para cães destinados a programas de reprodução. No entanto, esta terapia apresenta reduções inferiores do volume prostático, quando comparada com a orquiectomia.(AU)

The pathogenesis of benign prostatic hyperplasia (BPH) is not completely known, however, dihydrotestosterone is a hormone involved in enlargement of the prostate. Recently, the effect of botulinum toxin A (BT-A) was investigated and has shown to induce atrophy of the gland. Based on that, the aims of this study were to compare the effects of administration of BT-A with orchiectomy in the treatment of BPH, in addition to assessing the effects of BT-A on libido and semen quality. Therefore, 16 sexually intact male dogs were submitted to orchiectomy or administration of 500U BT-A, and evaluated for 16 weeks. Orchiectomy presented excellent results, reducing the prostate volume up to 80%. Administration of BT-A did not interfered on libido, erection or semen characteristics. On the other hand, reduced significantly the prostate volume. The results suggest that intraprostatic injection of BT-A is an effective alternative treatment without adverse effects for valuable breeding dogs with BPH. However, this therapy showed lower reduction of prostate volume when compared to orchiectomy.(AU)

Carcinogenicidad del D-004 en ratas Sprague Dawley. Reporte parcial a los 18 meses / Carcinogenicity of D-004 in Sprague Dawley rats. A partial report at 18 months

Introducción: el D-004, un extracto lipídico del fruto de la palma real, Roystonea regia, constituido por una mezcla reproducible de ácidos grasos, principalmente oleico, palmítico, láurico y mirístico, ha mostrado prevenir la hiperplasia prostática (HP) inducida con T en roedores y actúa mediante un mecanismo multifactorial que implica la inhibición de 5a-reductasa prostática, el antagonismo de las respuestas mediadas por los a1-ADR, efectos anti-inflamatorios y antioxidantes. Objetivo: el presente trabajo tiene como propósito resumir los resultados parciales (18 meses) del estudio de carcinogenicidad a largo plazo del D-004 en ratas, el cual culminará con el tiempo establecido de 24 meses. Métodos: se distribuyeron ratas Sprague Dawley (SD) de ambos sexos aleatoriamente, en cuatro grupos (50 ratas/sexo/grupo): un grupo como control de vehículo, y tres tratados con D-004 (500, 1 000 y 1 500 mg/kg, respectivamente). Los tratamientos se administraron por intubación gástrica. Este reporte incluye los resultados de peso corporal, observaciones clínicas, mortalidad y frecuencia de aparición de tumores hasta ese momento. Resultados: la frecuencia de mortalidad es baja, en los grupos tratados fue de un 8.3 por ciento por un 9 por ciento en los controles, no se evidencia disminución en el tiempo de supervivencia y las observaciones diarias no revelaron signos indicativos de toxicidad atribuibles al tratamiento. Además, el momento de aparición y la frecuencia de tumores en animales tratados y controles fueron estadísticamente similares en ambos sexos. Conclusiones: en conclusión, la administración de D-004 (5001500 mg/kg) a ratas durante los primeros 18 meses del estudio, no mostró evidencias de toxicidad o carcinogenicidad temprana relacionadas con el tratamiento

Introduction: D-004, a lipid extract from royal palm (Roystonea regia) fruit made up of a reproducible mixture of fatty acids, mainly oleic, palmitic, lauric and myristic, has shown to prevent prostate hyperplasia (PH) induced by T in rodents. It acts through a multifactorial mechanism involving prostatic 5a-reductase inhibition, antagonism of a1-ADR-mediated responses, and antiinflammatory and antioxidant effects. Objective: the paper is aimed at summarizing the partial results (18 months) of the long-term carcinogenicity study of D-004 in rats, which is set to conclude in the established 24-month period. Method: Sprague Dawley (SD) rats of both sexes were randomly distributed into four groups (50 rats/sex/group): one group as vehicle control and three treated with D-004 (500, 1 000 and 1 500 mg/kg, respectively). Treatments were administered by gastric intubation. This report presents the results obtained so far concerning body weight, clinical observations, mortality and frequency of appearance of tumors. Results: mortality rate is low: 8.3 percent in the treated groups and 9 percent among controls. No evidence was found of survival time reduction, and daily observations did not reveal any signs of toxicity attributable to the treatment. The time of appearance and the frequency of tumors in treated animals and controls were statistically similar in both sexes. Conclusions: administration of D-004 (5001 500 mg/kg) to rats during the first 18 months of the study did not show any evidence of early carcinogenicity or toxicity associated with the treatment

Métodos de diagnóstico para detecção de prostatopatias caninas / Canine prostatic disease: diagnosis methods

As doenças prostáticas são comuns em cães, desenvolvendo-se após a maturidade sexual. Entre as afecções que acometem a próstata desses animais, a mais frequente é a hiperplasia prostática benigna (HPB). As neoplasias prostáticas, apesar de menos frequentes, são altamente malignas e um diagnóstico tardio está associado a um prognóstico ruim. Os principais métodos de diagnóstico das enfermidades prostáticas em cães incluem um exame clínico detalhado, ultrassonografia, punção aspirativa e biópsia. A utilização de biomarcadores séricos vem sendo estudada como uma maneira de se detectar a doença precocemente, evitando possíveis complicações no quadro clínico dos pacientes. Assim, estudos visando ao diagnóstico precoce de prostatopatias caninas, especialmente o câncer prostático, são cruciais para um tratamento eficaz e melhora da qualidade de vida do animal acometido.

Prostatic diseases are common in older dogs, developing after sexual maturity. The most common affecting canine prostate is benign prostatic hyperplasia (BPH). Although less frequent, prostatic neoplasias are highly malignant, and a late diagnosis is closely associated with a poor prognosis. The main methods of diagnosis of the canine prostatic disease include a detailed clinical exam, ultrasound, prostatic fine-needle aspirate and biopsy. Studies towards early diagnosis of this condition are crucial for effective treatment and improvement of quality of life of affected animals. The use of biomarkers has been studied for early detection of the disease, avoiding possible complications in clinical patients.

Métodos de diagnóstico para detecção de prostatopatias caninas

Prostatic diseases are common in older dogs, developing after sexual maturity. The most common affecting canine prostate is benign prostatic hyperplasia (BPH). Although less frequent, prostatic neoplasias are highly malignant, and a late diagnosis is closely associated with a poor prognosis. The main methods of diagnosis of the canine prostatic disease include a detailed clinical exam, ultrasound, prostatic fine-needle aspirate and biopsy. Studies towards early diagnosis of this condition are crucial for effective treatment and improvement of quality of life of affected animals. The use of biomarkers has been studied for early detection of the disease, avoiding possible complications in clinical patients.

As doenças prostáticas são comuns em cães, desenvolvendo-se após a maturidade sexual. Entre as afecções que acometem a próstata desses animais, a mais frequente é a hiperplasia prostática benigna (HPB). As neoplasias prostáticas, apesar de menos frequentes, são altamente malignas e um diagnóstico tardio está associado a um prognóstico ruim. Os principais métodos de diagnóstico das enfermidades prostáticas em cães incluem um exame clínico detalhado, ultrassonografia, punção aspirativa e biópsia. A utilização de biomarcadores séricos vem sendo estudada como uma maneira de se detectar a doença precocemente, evitando possíveis complicações no quadro clínico dos pacientes. Assim, estudos visando ao diagnóstico precoce de prostatopatias caninas, especialmente o câncer prostático, são cruciais para um tratamento eficaz e melhora da qualidade de vida do animal acometido.

Métodos de diagnóstico para detecção de prostatopatias caninas

Prostatic diseases are common in older dogs, developing after sexual maturity. The most common affecting canine prostate is benign prostatic hyperplasia (BPH). Although less frequent, prostatic neoplasias are highly malignant, and a late diagnosis is closely associated with a poor prognosis. The main methods of diagnosis of the canine prostatic disease include a detailed clinical exam, ultrasound, prostatic fine-needle aspirate and biopsy. Studies towards early diagnosis of this condition are crucial for effective treatment and improvement of quality of life of affected animals. The use of biomarkers has been studied for early detection of the disease, avoiding possible complications in clinical patients.

As doenças prostáticas são comuns em cães, desenvolvendo-se após a maturidade sexual. Entre as afecções que acometem a próstata desses animais, a mais frequente é a hiperplasia prostática benigna (HPB). As neoplasias prostáticas, apesar de menos frequentes, são altamente malignas e um diagnóstico tardio está associado a um prognóstico ruim. Os principais métodos de diagnóstico das enfermidades prostáticas em cães incluem um exame clínico detalhado, ultrassonografia, punção aspirativa e biópsia. A utilização de biomarcadores séricos vem sendo estudada como uma maneira de se detectar a doença precocemente, evitando possíveis complicações no quadro clínico dos pacientes. Assim, estudos visando ao diagnóstico precoce de prostatopatias caninas, especialmente o câncer prostático, são cruciais para um tratamento eficaz e melhora da qualidade de vida do animal acometido.

La vaporización fotoselectiva del adenoma prostático con el ktp-láser (kalium-titanyl-phosphat) de 80 watt y la RTU-P de baja presión hidráulica / The photoselective vaporization of prostate adenoma with the 80 watt ktp-laser (kalium-titanyl-phosphat) and the low hydraulic pressure tur-p

El objetivo de este trabajo prospectivo es determinar la eficacia del método KTP-láser de 80 watt para la vaporización y ablación de la HPB sintomática. También se analizan los resultados al combinar el KTP-láser con la RTU-P y su repercusión sobre la hemoglobina. Material y Método: 300 pacientes con HPB sintomática fueron tratados entre agosto del 2004 y noviembre del 2006 con el KTPláser o combinado con RTU-P. La resección adicional fue efectuada en pacientes con adenomas grandes o por lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS. Resultados: 300 pacientes fueron tratados en 2 grupos. El grupo 1 (n: 50) con sólo tratamiento láser y pequeños adenomas, la hemoglobina se redujo un 3,2 por ciento y nadie requirió una transfusión. El grupo 2 (n: 250) con tratamiento combinado de KTP-láser y RTU-P en adenomas grandes, la hemoglobina se redujo en promedio 15,2 por ciento después de la intervención; 2 pacientes (0,8 por ciento) necesitaron una transfusión. Conclusión: El estudio pone de manifiesto, las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma sobre todo en próstatas de gran tamaño.

The objective of this prospective study is to determine the effectiveness of the 80 watt KTP laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the TUR-P and their repercussion on the haemoglobin are analysed. Material and Method: 300 patients with symptomatic BPH were treated between august 2004and november 2006 with the KTP-Laser or combined with TUR-P. The additional Resection was carried out in those patients with great adenomas or to have accentuated middle lobule. The ablative effect was controlledat the end of the operation with TRUS (transrectal ultrasound). Results: 300 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas, the haemoglobin was reduced a 3.2 percent and nobody required a transfusion. Group 2 (n: 250) with combined treatment of KTP-laser and TURP in great adenomas, the haemoglobin was reduced in average 15,2 percent after the intervention; 2 patients (0,8 percent) needed a transfusion. Conclusion: Our study puts of open, the advantages to combine both surgical procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.