Idiosyncratic reaction after injection of polyacrylate - polyalcohol copolymer.

CONTEXT: Polyacrylate-polyalcohol copolymer is a synthetic product, non-biodegradable, with low rate of therapeutic failure and lower incidence of reactions at the site of injection, when compared to biodegradable agents. We report an unprecedent, exuberant and persistent inflammatory reaction following injection of that substance. PATIENT: A 17 years-old patient with vesico-ureteral reflux and complete pyelocaliceal right duplication was submitted to treatment with polyacrylate-polyalcohol copolymer (STING technique). In the seventh day of post-operatory, she presented intense dysuria and hypogastric pain, without laboratory exams alterations; a symptomatic treatment was started. After two months, the symptoms persisted and an ultrasound detected thickening of bladder wall close to the uretero-vesical junction. After that exam, a cystostopic biopsy showed epithelial hyperplasia with increased edema of lamina propria, suggesting an adverse reaction to the polymer. After four months, there was complete remission, but the reflux persisted with the same grade. HYPOTHESIS: This is an unprecedent reaction following injection of this copolymer. The presence of characteristics such as absence of infection, temporal relation between treatment and beginning of symptoms, and detection of epithelial hyperplasia at the local of injection reinforce the hypothesis of association of the substance and adverse reaction. In that patient, important complains motivated early investigation of urinary tract, that confirmed those aspects. Maybe if that reaction had occurred in patients with lower capacity of expression (such as in infants) it would be unnoticed.

The influence of testosterone suppression on HER2 immunoexpression in prostatic neoplastic tissue.

During initial risk assessments, the metastatic potential of prostate cancer (PCa) may not be fully considered. The tumor's multicentric origin, which is associated with genetic mutations, may explain existing treatment limitations. Investigating human epidermal growth factor receptor 2 (HER2) expression in patients with different stages of PCa may therefore increase understanding of the mechanisms associated with the development of castration resistance. The present study examined the association between HER2 expression and the histologic features of PCa subjected to radical prostatectomy (RP) and evaluated the role of testosterone suppression in HER2 expression. In group 1, specimens from individuals who underwent RP without prior neoadjuvant androgen deprivation therapy (ADT) were included (n=42). In group 2 (PCa with ADT), specimens from individuals who underwent RP and received neoadjuvant cyproterone acetate during distinct periods (200 mg daily for 1-24 months) were included (n=150; cohort derived from a previous study). Immunohistochemical expression of HER2 was associated with prognostic factors such as perineural invasion, extra-prostatic disease, T stage, serum prostate-specific antigen (PSA), angiolymphatic invasion and surgical margins. Univariate regression analysis indicated that perineural invasion, PSA, International Society of Urological Pathology, angiolymphatic invasion, margin, T stage and neoadjuvant ADT was associated with HER2 expression. Ordinal regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (P<0.001). In addition, regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (odd ratio=0.01; 95% CI, 0.00, 0.02; P<0.001). HER2 was expressed in PCa samples but was not associated with known prognostic factors. The use of short-acting ADT and the consequent blockage of testosterone effect may suppress the expression of HER2 in PCa cells.

Giant prostatic hyperplasia: report of a previously asymptomatic man presenting with gross hematuria and hypovolemic shock.

Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

Idiosyncratic reaction after injection of polyacrylate - polyalcohol copolymer

ABSTRACT Context: Polyacrylate-polyalcohol copolymer is a synthetic product, non-biodegradable, with low rate of therapeutic failure and lower incidence of reactions at the site of injection, when compared to biodegradable agents. We report an unprecedent, exuberant and persistent inflammatory reaction following injection of that substance. Patient: a 17 years-old patient with vesico-ureteral reflux and complete pyelocaliceal right duplication was submitted to treatment with polyacrylate-polyalcohol copolymer (STING technique). In the seventh day of post-operatory, she presented intense dysuria and hypogastric pain, without laboratory exams alterations; a symptomatic treatment was started. After two months, the symptoms persisted and an ultrasound detected thickening of bladder wall close to the uretero-vesical junction. After that exam, a cystostopic biopsy showed epithelial hyperplasia with increased edema of lamina propria, suggesting an adverse reaction to the polymer. After four months, there was complete remission, but the reflux persisted with the same grade. Hypothesis: This is an unprecedent reaction following injection of this copolymer. The presence of characteristics such as absence of infection, temporal relation between treatment and beginning of symptoms, and detection of epithelial hyperplasia at the local of injection reinforce the hypothesis of association of the substance and adverse reaction. In that patient, important complains motivated early investigation of urinary tract, that confirmed those aspects. Maybe if that reaction had occurred in patients with lower capacity of expression (such as in infants) it would be unnoticed.

Giant prostatic hyperplasia: report of a previously asymptomatic man presenting with gross hematuria and hypovolemic shock / Hiperplasia prostática gigante: hematúria macroscópica com choque hipovolêmico em paciente previamente assintomático

Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

A hiperplasia prostática gigante é uma condição rara caracterizada por aumento benigno prostático significativo, com volume maior que 500g. Existem poucos casos relatados e, em sua maioria deles está associada a sintomas graves do trato urinário inferior. Relatamos aqui o primeiro caso de hiperplasia prostática benigna assintomática em paciente idoso com próstata de 720g, hematúria macroscópica de início súbito e choque hipovolêmico. O paciente foi submetido com sucesso à prostatectomia suprapúbica, sem intercorrências no intra e pós-operatório.

Indice de astrócitos gemistocíticos e imuno-expressäo da proteína p53 em astrocitomas, grau II e III OMS / Fraction of gemistocytic astrocytes and immunoexpression of p53 protein in astrocytomas grade II and III (WHO)

Foram estudados, retrospectivamente, 22 pacientes com diagnóstico de astrocitomas grau II (n=17) e III (n=5), OMS, no período de 1990 a 1998, cujos laudos histopatológicos descreviam a presença gemistocitos com o objetivo de determinar o índice de astrócitos gemistocíticos, investigar a imuno-expressäo da proteína p53 e confrontá-los com o intervalo até a recorrência da neoplasia. O índice de astrócitos gemistocíticos, em cada caso, foi calculado a partir da razäo entre o número de gemistocitos e o número total de células neoplásicas contadas, no mínimo 1000. Imuno-expressäo nuclear da proteína p53 foi avaliada em astrócitos e gemistocitos neoplásicos; tanto a freqüência (7/22), como o índice de imuno-expressäo positiva da p53 em gemistocitos, independentemente do grau histológico da neoplasia, foram inferiores aos relatados na literatura. Näo se observou correlaçäo entre o índice de astrócitos gemistocíticos e a imuno-expressäo positiva da p53

Imuno-expressaäo da proteína p53 em bócios e em adenomas e carcinomas diferenciados de células foliculares da tireóide associados a bócio / p53 in goiters alone, and goiters associated with adenomas and differentiated carcinomas ofthyroid follicular cell origen: an immunohistochemical study

Alterações do gene supressor de tumor p53 são incomuns em neoplasias tireoidianas de histogênese folicular, benignas e malignas diferenciadas (carcinomas folicular e papilífero), e ausentes nos poucos casos estudados da literatura. Por outro lado, anormalidades tanto do gene p53 como da proteína por ele codificada são detectadas com grande freqüência em carcinomas pouco diferenciados e indiferenciados (anaplásicos), sendo mais comum nestes últimos, sugerindo que a perda de função da p53 está relacionada com o fenótipo indiferenciado e comportamento biológico altamente agressivo destas neoplasias. Modelos hipotéticos propostos para a carcinogênese tireoidiana a partir da célula folicular, desenvolvendo-se através de várias etapas caracterizadas por mutações distintas, colocam invarialvelmente a mutação do p53 como um evento tardio. Para este trabalho foram selecionados retrospectivamente em dois anos consecutivos dentre os pacientes submetidos a tireoidectomia aqueles com um dos diagnósticos histopatológicos abaixo especificados, constituindo três grupos: Carcinomas de células foliculares diferenciados com bócio concomitante (n=l5) Adenomas com bócio concomitante (n=5) Bócios (n=49) Realizamos estudo imuno-histoquímico para investigar a imuno-expressão da proteína p53. A prevalência da imuno-reatividade da p53 nuclear e citoplasmática, nos três grupos, considerando-se como positivo o valor do índice igual ou maior que 10 por cento (valor de corte 10 por cento), foi superior ao da literatura. Os nossos resultados demonstram que a imuno-expressão da p53 não é exclusiva das neoplasias malignas da tireóide, ocorrendo em adenomas e bócios. A imuno-marcação da p53 não foi útil na distinção entre bócios com e sem neoplasia concomitante. Os dados desta pesquisa sugerem uma via distinta na carcinogênese das células foliculares quando associadas a bócio, com participação precoce da proteína p53. Casuísticas adicionais, assim como a complementação com estudos bioquímicos, cromossômicos e gênicos, são fundamentais para sustentação desta hipótese