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1.
Chirurg ; 92(11): 1016-1020, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34586429

RESUMO

Different perspectives exist among the various specialist disciplines on the treatment of trauma patients with injuries of the urogenital tract. The multidisciplinary consensus guidelines of the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST), which appeared in autumn 2019, are summarized in this article. They should constitute an aid to making decisions on the optimal treatment of trauma patients with urogenital injuries.


Assuntos
Sistema Urogenital/lesões , Humanos , Estados Unidos
2.
Nutrients ; 13(9)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34578783

RESUMO

The human body is host to a large number of microorganisms which conform the human microbiota, that is known to play an important role in health and disease. Although most of the microorganisms that coexist with us are located in the gut, microbial cells present in other locations (like skin, respiratory tract, genitourinary tract, and the vaginal zone in women) also play a significant role regulating host health. The fact that there are different kinds of microbiota in different body areas does not mean they are independent. It is plausible that connection exist, and different studies have shown that the microbiota present in different zones of the human body has the capability of communicating through secondary metabolites. In this sense, dysbiosis in one body compartment may negatively affect distal areas and contribute to the development of diseases. Accordingly, it could be hypothesized that the whole set of microbial cells that inhabit the human body form a system, and the dialogue between the different host microbiotas may be a contributing factor for the susceptibility to developing diseased states. For this reason, the present review aims to integrate the available literature on the relationship between the different human microbiotas and understand how changes in the microbiota in one body region can influence other microbiota communities in a bidirectional process. The findings suggest that the different microbiotas may act in a coordinated way to decisively influence human well-being. This new integrative paradigm opens new insights in the microbiota field of research and its relationship with human health that should be taken into account in future studies.


Assuntos
Disbiose/metabolismo , Microbiota , Feminino , Microbioma Gastrointestinal , Nível de Saúde , Humanos , Masculino , Boca/microbiologia , Sistema Respiratório/microbiologia , Pele/microbiologia , Sistema Urogenital/microbiologia , Vagina/microbiologia
4.
Int J Mol Sci ; 22(14)2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34299251

RESUMO

This review paper deals with the influence of androgens (testosterone) on pelvic autonomic pathways in male mammals. The vast majority of the relevant information has been gained in experiments involving castration (testosterone deprivation) performed in male rats, and recently, in male pigs. In both species, testosterone significantly affects the biology of the pathway components, including the pelvic neurons. However, there are great differences between rats and pigs in this respect. The most significant alteration is that testosterone deprivation accomplished a few days after birth results some months later in the excessive loss (approximately 90%) of pelvic and urinary bladder trigone intramural neurons in the male pig, while no changes in the number of pelvic neurons are observed in male rats (rats do not have the intramural ganglia). In the castrated pigs, much greater numbers of pelvic neurons than in the non-castrated animals express CGRP, GAL, VIP (peptides known to have neuroprotective properties), and caspase 3, suggesting that neurons die due to apoptosis triggered by androgen deprivation. In contrast, only some morpho-electrophysiological changes affecting neurons following castration are found in male rats. Certain clinicopathological consequences of testosterone deprivation for the functioning of urogenital organs are also discussed.


Assuntos
Orquiectomia/efeitos adversos , Pelve/inervação , Sistema Urinário/inervação , Antagonistas de Androgênios/farmacologia , Androgênios/metabolismo , Animais , Sistema Nervoso Autônomo , Vias Autônomas/efeitos dos fármacos , Vias Autônomas/metabolismo , Gânglios Autônomos , Interneurônios , Masculino , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Pelve/fisiologia , Ratos , Suínos , Testosterona/metabolismo , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiologia , Sistema Urinário/efeitos dos fármacos , Sistema Urogenital
5.
Sci Rep ; 11(1): 13194, 2021 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162908

RESUMO

To report outcomes and risk factors of ultrahypofractionated (UHF) radiotherapy for Japanese prostate cancer patients. This multi-institutional retrospective analysis comprised 259 patients with localized prostate cancer from 6 hospitals. A total dose of 35-36 Gy in 4-5 fractions was prescribed for sequential or alternate-day administration. Biochemical failure was defined according to the Phoenix ASTRO consensus. Toxicities were assessed using National Cancer Institute Common Toxicity Criteria version 4. Tumor control and toxicity rates were analyzed by competing risk frames. Median follow-up duration was 32 months (range 22-97 months). 2- and 3-year biochemical control rates were 97.7% and 96.4%, respectively. Initial prostate-specific antigen (p < 0.01) and neoadjuvant androgen deprivation therapy (p < 0.05) were identified as risk factors for biochemical recurrence. 2- and 3-year cumulative ≥ Grade 2 late genitourinary (GU) toxicities were 5.8% and 7.4%, respectively. Corresponding rates of gastrointestinal (GI) toxicities were 3.9% and 4.5%, respectively. Grade 3 rates were lower than 1% for both GU and GI toxicities. No grade 4 or higher toxicities were encountered. Biologically effective dose was identified as a risk factor for ≥ Grade 2 late GU and GI toxicities (p < 0.05). UHF radiotherapy offered effective, safe treatment for Japanese prostate cancer with short-term follow-up. Our result suggest higher prescribed doses are related to higher toxicity rates.


Assuntos
Adenocarcinoma/radioterapia , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/uso terapêutico , Terapia Combinada , Seguimentos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Intervalo Livre de Progressão , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/cirurgia , Lesões por Radiação/etiologia , Radiocirurgia , Estudos Retrospectivos , Sistema Urogenital/efeitos da radiação
6.
Jpn J Clin Oncol ; 51(8): 1253-1260, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34128053

RESUMO

OBJECTIVE: We aimed to report the 2-year results of stereotactic body radiation therapy for prostate cancer and identify the clinical and dosimetric factors that predict acute genitourinary toxicities. METHODS: We retrospectively reviewed the medical records of patients with non-metastatic prostate cancer treated at Toyota Memorial Hospital between 2017 and 2020. The patients were treated with stereotactic body radiation therapy with a total dose of 36.25 Gy in five fractions on consecutive weekdays. While low-risk patients received radiotherapy alone, intermediate- to high-risk patients also received androgen deprivation therapy. RESULTS: We analysed a total of 104 patients, including 10, 60 and 34 low-, intermediate- and high-risk patients, respectively. The median follow-up duration was 2 years. We did not observe biochemical/clinical recurrence, distant metastasis or death from prostate cancer. One patient died of another cause. Grade 2 acute genitourinary toxicity was observed in 40 (38%) patients. Age (P = 0.021), genitourinary toxicity of grade ≥1 at baseline (P = 0.023) and bladder mean dose (P = 0.047) were significantly associated with the incidence of grade 2 acute genitourinary toxicity. The cut-off value of 65 years for age and 10.3 Gy for the bladder mean dose were considered the most appropriate. Grade 2 acute gastrointestinal toxicity was observed in five (5%) patients. None of the patients experienced grade ≥3 acute or late toxicity. CONCLUSIONS: Stereotactic body radiation therapy is feasible for Japanese patients with prostate cancer, with acceptable acute toxicity. Age, genitourinary toxicity at baseline and bladder mean dose predict grade 2 acute genitourinary toxicity.


Assuntos
Doenças Urogenitais Masculinas , Neoplasias da Próstata , Lesões por Radiação , Radiocirurgia , Idoso , Humanos , Japão/epidemiologia , Masculino , Doenças Urogenitais Masculinas/etiologia , Pessoa de Meia-Idade , Neoplasias da Próstata/radioterapia , Lesões por Radiação/etiologia , Radioterapia de Intensidade Modulada , Estudos Retrospectivos , Resultado do Tratamento , Sistema Urogenital/efeitos da radiação
7.
Radiologe ; 61(7): 677-688, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34170363

RESUMO

The acute abdomen is a potentially life-threatening condition and requires a rapid diagnosis. After clinical inspection and in cases with unclear ultrasound findings or unclear serious symptoms computed tomography (CT) and in pregnant women and children magnetic resonance imaging (MRI) is usually necessary. This second part of "Imaging in the acute abdomen" focuses on frequent organ specific causes of the gastrointestinal tract and the urogenital system.


Assuntos
Abdome Agudo , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Criança , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Gravidez , Tomografia Computadorizada por Raios X , Sistema Urogenital/diagnóstico por imagem
8.
Adv Parasitol ; 112: 51-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34024359

RESUMO

Urogenital schistosomiasis remains a major global challenge. Optimal management of this infection depends upon imaging-based assessment of sequelae. Although established imaging modalities such as ultrasonography, plain radiography, magnetic resonance imaging (MRI), narrow band imaging, and computerized tomography (CT) have been used to determine tissue involvement by urogenital schistosomiasis, newer refinements in associated technologies may lead to improvements in patient care. Moreover, application of investigational imaging methods such as confocal laser endomicroscopy and two-photon microscopy in animal models of urogenital schistosomiasis are likely to contribute to our understanding of this infection's pathogenesis. This review discusses prior use of imaging in patients with urogenital schistosomiasis and experimentally infected animals, the advantages and limitations of these modalities, the latest radiologic developments relevant to this infection, and a proposed future diagnostic standard of care for management of afflicted patients.


Assuntos
Esquistossomose Urinária/diagnóstico por imagem , Animais , Humanos , Imageamento por Ressonância Magnética , Microscopia Confocal , Microscopia de Fluorescência por Excitação Multifotônica , Imagem de Banda Estreita , Tomografia Computadorizada por Raios X , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/parasitologia , Sistema Urogenital/parasitologia
9.
Br J Radiol ; 94(1124): 20210246, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34048274

RESUMO

Vascular anomalies represent a rare congenital disease with manifestation at diverse anatomical sights and presenting with heterogenous symptoms. Undetected, they can progress and create acute and chronic complications with functional impairment. The manifestation in the female and male pelvis and the urogenital tract represents a multidisciplinary challenge for physicians. Especially outpatient management in gynaecology and urology is affected. Diagnostic Radiology holds an important supportive role in early diagnosis of the underlying urogenital vascular anomaly and referral to interventional radiology, either for minimal invasive treatment, or to surgery for further assessment. This pictorial review creates awareness for the spectrum of vascular anomalies of the gynaecological and urogenital tract, their characteristic imaging findings and dedicated interventional treatment options. The individual description of vascular anomalies, based on an appropriate nomenclature and classification standard, is a guide for radiologists to distinguish the underlying vascular anomaly from other vascular disorders and to accelerate diagnosis as well as therapeutic proceedings. In consequence, interdisciplinary management of patients with vascular anomalies of the female and male pelvis will benefit.


Assuntos
Genitália Feminina/irrigação sanguínea , Sistema Urogenital/irrigação sanguínea , Malformações Vasculares/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Adulto Jovem
10.
Strahlenther Onkol ; 197(6): 505-519, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33929558

RESUMO

PURPOSE: Predicting morbidity for patients with locally advanced cervix cancer after external beam radiotherapy (EBRT) based on dose-volume parameters remains an unresolved issue in definitive radiochemotherapy. The aim of this prospective study was to correlate patient characteristics and dose-volume parameters to various early morbidity endpoints for different EBRT techniques, including volumetric modulated arc therapy (VMAT) and adaptive radiotherapy (ART). METHODS AND MATERIALS: The study population consisted of 48 patients diagnosed with locally advanced cervix cancer, treated with definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT). Multiple questionnaires (CTCAE 4.03, QLQ-C30 and EORTC QLQ-CX24) were assessed prospectively for patients treated with different EBRT techniques, including online adaptive VMAT. Contouring and treatment planning was based on the EMBRACE protocols. Acute toxicity, classified as general, gastrointestinal (GI) or genitourinary (GU) and their corresponding dose-volume histograms (DVHs) were first correlated by applying least absolute shrinkage and selection operator (LASSO) and subsequently evaluated by multiple logistic binomial regression. RESULTS: The treated EBRT volumes varied for the different techniques with ~2500 cm3 for 3D conformal radiotherapy (3D-CRT), ~2000 cm3 for EMBRACE­I VMAT, and ~1800 cm3 for EMBRACE-II VMAT and ART. In general, a worsening of symptoms during the first 5 treatment weeks and recovery afterwards was observed. Dose-volume parameters significantly correlating with stool urgency, rectal and urinary incontinence were as follows: bowel V40Gy < 250 cm3, rectum V40Gy < 80% and bladder V40Gy < 80-90%. CONCLUSION: This prospective study demonstrated the impact of EBRT treatment techniques in combination with chemotherapy on early morbidity. Dose-volume effects for dysuria, urinary incontinence, stool urgency, diarrhea, rectal bleeding, rectal incontinence and weight loss were found.


Assuntos
Braquiterapia/efeitos adversos , Quimiorradioterapia/efeitos adversos , Trato Gastrointestinal/efeitos da radiação , Lesões por Radiação/radioterapia , Radioterapia Conformacional/efeitos adversos , Sistema Urogenital/efeitos da radiação , Neoplasias do Colo do Útero/terapia , Adolescente , Adulto , Idoso , Braquiterapia/métodos , Quimiorradioterapia/métodos , Relação Dose-Resposta à Radiação , Feminino , Humanos , Irradiação Linfática/efeitos adversos , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões por Radiação/patologia , Dosagem Radioterapêutica , Radioterapia Conformacional/métodos , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Carga Tumoral , Sistema Urogenital/lesões , Perda de Peso , Adulto Jovem
11.
PLoS One ; 16(4): e0250044, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33878134

RESUMO

INTRODUCTION: The longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms. METHODS: Radio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men. RESULTS: Among 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts. CONCLUSIONS: Syndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Doenças Sexualmente Transmissíveis/etiologia , Adulto , Candida albicans , Candidíase/diagnóstico , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/patogenicidade , Feminino , Genitália , Gonorreia/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Inflamação , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Neisseria gonorrhoeae/patogenicidade , Prevalência , Ruanda/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Trichomonas vaginalis , Sistema Urogenital , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/epidemiologia
12.
Brachytherapy ; 20(4): 866-872, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33896731

RESUMO

PURPOSE: The purpose of the study was to elucidate the usefulness of a dose evaluation method for reducing late genitourinary (GU) toxicity in high-dose-rate brachytherapy (HDR-BT) of prostate cancer. METHODS AND MATERIALS: GU toxicity was scored in accordance with the Common Terminology Criteria for Adverse Events version 4.0. The prostatic urethra was divided into three segments (base = B, midgland = M, apex = A), which were subclassified into seven subgroups (B, M, A, BM, BA, MA, BMA) using a D10% color map of the urethra. Significance testing was conducted on urethral D0.1% and D10% among the seven subgroups. Grade < 2 GU toxicity was also implemented. RESULTS: Data of 174 patients with localized prostate cancer treated with HDR-BT combined with external beam radiotherapy between November 2011 and July 2014 were analyzed retrospectively. Median age was 74 (53-84) years, and median followup period was 44 (6-69) months. The number of Grade < 2 and Grade ≥ 2 toxicity was significantly different in the M subgroup than in the other subgroups (p < 0.05), suggesting increased radioresistance in the midgland urethra. CONCLUSIONS: A high-dose-area evaluation method using a urethral D10% color map may be helpful in reducing late GU toxicity in HDR-BT for prostate cancer.


Assuntos
Braquiterapia , Neoplasias da Próstata , Lesões por Radiação , Idoso , Braquiterapia/métodos , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica , Estudos Retrospectivos , Sistema Urogenital
13.
J Urol ; 206(1): 139-140, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33881342
14.
Int J Radiat Oncol Biol Phys ; 111(1): 93-100, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33745951

RESUMO

PURPOSE: To assess the toxicity profile of prostate cancer stereotactic body radiation therapy (SBRT) in 3 fractions. METHODS AND MATERIALS: This was a prospective, multicenter phase 2 toxicity study enrolling patients with low to favorable intermediate-risk prostate cancer. Before simulation, 3 to 4 fiducial markers along with a rectal spacer were placed. The target (prostate only) was prescribed 40 Gy, whereas the maximum dose to the urethra was limited to 33 Gy with the highest priority at planning; less stringent objectives were placed on the bladder, the filling of which was controlled via a Foley catheter. Treatment was delivered every other day. Toxicity was prospectively scored with Common Terminology Criteria for Adverse Events, and several patient-reported outcomes were collected. The maximum allowed prevalence rate of grade 2+ genitourinary (GU) toxicity at 1 year was set at 15%, and the study was sized accordingly. RESULTS: Between November 2015 and May 2019, 59 patients were enrolled by 3 participating institutions. Acute gastrointestinal toxicity was occasional and mild, whereas 11.9% of patients developed acute grade 2 GU toxicity and 1.7% developed acute grade 3 GU toxicity. No patient had persistent treatment-related grade 2+ GU toxicity at 12 months after SBRT; thus, the null hypothesis was rejected. We observed a clinically relevant worsening of both International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores at 12 months compared with baseline. Moreover, we found a strong association between all selected bladder dose/volume metrics at planning and ICIQ-SF worsening at 12 months, whereas for the IPSS, the correlation with bladder dose metrics was marginal. CONCLUSIONS: The results suggest that at 12 months after treatment, the toxicity profile of SBRT in 3 fractions is acceptable.


Assuntos
Neoplasias da Próstata/radioterapia , Radiocirurgia/efeitos adversos , Idoso , Fracionamento da Dose de Radiação , Trato Gastrointestinal/efeitos da radiação , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Sistema Urogenital/efeitos da radiação
15.
Radiother Oncol ; 159: 67-74, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33766703

RESUMO

AIM: The dominant intraprostatic lesion (DIL) is the commonest site of relapse after single dose high-dose-rate brachytherapy (HDR-BT) for localised prostate cancer. This study investigated toxicity and clinical outcomes of focal dose escalation to the DIL with dose de-escalation to the remaining prostate. MATERIALS/METHODS: Between November 2012 and July 2016, 50 patients with localised prostate adenocarcinoma received single fraction HDR-BT. 21 Gy was prescribed to the DIL, with two de-escalation prescription schedules for the remaining prostate. Primary outcomes included biochemical no evidence of disease (bNED), local recurrence free survival (LRFS), and metastasis free survival (MFS). Secondary outcomes included late genitourinary, gastrointestinal and sexual toxicity. Kaplan-Meier analyses with log rank tests were used to estimate bNED, LRFS and MFS. RESULTS: With a median follow up of 70.6 months, 15 patients developed biochemical failure, including 8 in the group that received minor dose de-escalation to the non-DIL prostate (group 1) and 7 in the group that received moderate de-escalation (group 2). Five-year bNED was 88% in group 1 and 76% in group 2 (p = 0.05). Overall 4-year and 5-year FFLF in group 1 was 100% and 96% and in group 2 92% and 84%. These differences were statistically significant (p = 0.03). No acute ≥G3 genitourinary or ≥G2 gastrointestinal toxicity was reported. The median IIEF decreased in the first 6 months improving to a peak median score of 20 at 54 months. CONCLUSION: Focal boost to the DIL did not improve biochemical or local control after single-fraction HDR monotherapy compared to what would be expected from 19 Gy single fraction treatment to the whole gland.


Assuntos
Braquiterapia , Neoplasias da Próstata , Braquiterapia/efeitos adversos , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica , Sistema Urogenital
16.
Arch Microbiol ; 203(5): 2219-2228, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33630118

RESUMO

Candida genus comprises several species that can be found in the oral cavity and the gastrointestinal and genitourinary tracts of healthy individuals. Under certain conditions, however, they behave as opportunistic pathogens that colonize these tissues, most frequently when the immune system is compromised by a disease or under certain medical treatments. To colonize the human host, these organisms require to express cell wall proteins (CWP) that allowed them to adhere and adapt to the reactive oxygen (ROS) and nitrogen (RNS) species produced in the macrophage during the respiratory burst. The aim of this study was to determine how four Candida species respond to the oxidative stress imposed by cumene hydroperoxide (CHP). To this purpose, C. albicans, C. glabrata, C. krusei and C. parapsilosis were exposed to this oxidant which is known to generate ROS in the membrane phospholipids. Accordingly, both mock and CHP-exposed cells were used to extract and analyze CWP and also to measure catalase activity and the levels of protein carbonylation. Results indicated that all four species express different CWP to neutralize ROS. Most relevant among these proteins were the glycolytic enzymes enolase and glyceraldehyde-3-phosphate dehydrogenase, known as moonlight proteins because in addition to participate in glycolysis they play an important role in the cell response to ROS. In addition, a thiol-specific antioxidant enzyme (Tsa) was also found to counteract ROS.


Assuntos
Derivados de Benzeno/farmacologia , Candida/classificação , Candida/metabolismo , Oxidantes/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Antioxidantes/metabolismo , Candida/enzimologia , Parede Celular/metabolismo , Trato Gastrointestinal/microbiologia , Gliceraldeído-3-Fosfato Desidrogenases/metabolismo , Humanos , Macrófagos/imunologia , Boca/microbiologia , Fosfopiruvato Hidratase/metabolismo , Proteômica , Espécies Reativas de Nitrogênio/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Sistema Urogenital/microbiologia
17.
J Pediatr Urol ; 17(3): 410.e1-410.e7, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549475

RESUMO

BACKGROUND: 'Persistent Cloaca' refers to one of the major groups of anorectal anomalies in the female when a single perineal orifice is located at the normal site of the urethra draining both urogenital and alimentary tracts. However, 'posterior cloaca' is a new term developed by Pena to describe a unique defect in females in which a common urogenital sinus is deviated posteriorly to open into normally located anorectum (type A) or in the perineum slightly anterior to the anus (type B). METHODS: The study included seven girls diagnosed as posterior cloaca. Their age at presentation ranged from 1 to 108 months (median 12 months). The main presentation was abnormal external genitalia, while two cases underwent colostomy (±vaginostomy) at birth. Surgical reconstruction varied according to the degree of deviation from normal anatomy. Partial urogenital sinus mobilization (PUM) was used to correct minor forms; while at the other end of the spectrum (absent urinary bladder), continent urinary diversion was performed. Due to the high incidence of renal and urological anomalies, regular follow up at paediatric nephrology/urology clinics was advised for affected cases. RESULTS: All seven cases had a common urogenital confluence characteristically deviated posteriorly. The degree of backward deviation of the common urogenital orifice was variable ranging from mild to severe posterior displacement. In six cases (85%), the common urogenital orifice was shifted backwards in the perineum approaching the anal verge (type B). In one case, the common urogenital orifice opened internally into the anorectum (type A). Major urinary tract anomalies were quite common (5 of 7 cases; 71%): absent urinary bladder (2 cases); single kidney (2 cases); crossed ectopic kidney (1 case); hydroureteronephrosis (2 cases). CONCLUSION: Posterior cloaca is a rare anomaly in the female essentially affecting the lower urogenital tract with a high incidence of associated renal anomalies. Management should be tailored according to the degree of developmental defect.


Assuntos
Malformações Anorretais , Anormalidades Urogenitais , Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Criança , Pré-Escolar , Cloaca/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/cirurgia , Sistema Urogenital
18.
J Urol ; 205(5): 1495-1496, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33625901
19.
Brachytherapy ; 20(5): 966-975, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33612395

RESUMO

PURPOSE: To describe technical challenges and complications encountered during and after high-dose-rate prostate brachytherapy (HDR-BT) and review management of these complications. METHODS AND MATERIALS: The authors performed a systematic review of the literature on toxicities encountered after prostate HDR-BT +/- external beam radiotherapy. A total of 397 studies were identified, of which 64 were included. A focused review of literature regarding the management of acute and late toxicities also performed. RESULTS: Most acute toxicities include grade 0-2 genitourinary and gastrointestinal toxicity. Overall, Grade 3+ Common Terminology Criteria for Adverse Events toxicity after HDR-BT was low [genitourinary: 0-1%; gastrointestinal 0-3%]. Rates of fistula formation were <1%, and radiation cystitis/proctitis were <14% and more commonly reported in cohorts treated with HDR-BT boost and external beam radiotherapy. CONCLUSIONS: HDR-BT both as monotherapy or combined with external beam radiotherapy for prostate cancer is well tolerated. Serious complications are rare.


Assuntos
Braquiterapia , Neoplasias da Próstata , Lesões por Radiação , Braquiterapia/métodos , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Lesões por Radiação/etiologia , Sistema Urogenital
20.
Radiother Oncol ; 158: 184-190, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33639192

RESUMO

PURPOSE: To compare the biochemical control rates (BCRs), late gastrointestinal (GI) and genitourinary (GU) toxicities in patients with low- and intermediate risk prostate cancer (PCa) treated with high-dose-rate brachytherapy (HDR BT) of 19 Gy/1 fraction, 26 Gy/2 fractions, or stereotactic ablative radiotherapy (SABR) of 36.25 Gy/5 fractions. METHODS AND MATERIALS: Between August 2008 and December 2017, patients with low- and intermediate risk PCa who received single dose or 2-fraction HDR BT, or 5-fraction SABR at a single institution were included. BCR for the whole population and the individual treatment groups were calculated using the Phoenix definition. Post treatment GI and GU toxicities were evaluated according to the CTCAE v4.0 guidelines. RESULTS: 185 patients with low- and intermediate risk PCa were included in this study with a median follow up of 60.5 months. BCRs at 3 and 5 years were 95% and 85% for all patients. The 5-year BCRs were 69%, 95% and 92% for the 19 Gy/1 fraction, 26 Gy/2 fractions and 36.25 Gy/5 fractions groups respectively. The cumulative 5-year incidence rates of ≥grade 2 GI events in the 19 Gy/1fr, 26 Gy/2fr and 36.25 Gy/5fr groups were 0%, 2% and 4%, respectively. Incidence rates in those treated in the 5-fraction SABR arm were significantly higher (p < 0.05) than those treated in both HDR BT arms where no statistically significant difference between the two HDR BT groups was seen (p = 0.15). The cumulative 5-year incidence rates of ≥grade 2 GU events in the 19 Gy/1fr, 26 Gy/2fr and 36.25 Gy/5fr groups were 30%, 5% and 6%, respectively. No statistically significant difference was found between the 26 Gy/2fr and 36.25 Gy/5fr (p = 0.37) treatment arms but the incidence rate in the 26 Gy/2fr were significantly lower than those seen after 19 Gy/1fr (p < 0.05). CONCLUSIONS: 26 Gy/2 fractions HDR BT provided equivalent BCR with lower toxicity compared to 36.25 Gy/5 fractions SABR. Both 2-fraction HBR BT and 5-fraction SABR achieved better BCRs than single dose 19 Gy HDR BT. The two-fraction HDR BT schedule should be considered as an important comparator in future clinical trials.


Assuntos
Braquiterapia , Neoplasias da Próstata , Braquiterapia/efeitos adversos , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Dosagem Radioterapêutica , Sistema Urogenital
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