RESUMO
OBJECTIVES: Standardized prostate-specific antigen (PSA) levels are based upon the general population levels and, although a higher incidence of prostate cancer in patients on hemodialysis (HD)has not been demonstrated, some studies point at the possibility of observing higher PSA levels in this type of patients than in males with preserved renal function. The objective of the present study is to compare PSA levels in males on hemodialysis with those of the population with normal renal function. METHODS: Comparative, transversal study of the variables age, total PSA, free PSA and PSA index in 190 patients with chronic renal disease on hemodialysis treatment (group 1) and 237 subjects without renal disease ( group 2). We carried out a descriptive analysis and a comparative study of the above mentioned variables using the SPSS software. RESULTS: Median age of patients on HD was 55 in cases (47-61)and 59 in controls (54-63.5). Mean total PSA was 1.49 ng/mL [1.24-1.73] in cases and 1.62 ng/mL [1.29-1.95] in controls; mean free PSA was 1.40 ng/mL [0.89-1.91] in group 1 and 2.31 ng/mL [-0.83-5.45] in group 2; mean PSA index was 27.67% [19.91-35.63] in cases and 14.82%[12.79-16.85]] in controls. The comparative study showed differences between the two groups in free PSA (p ≤ 0.007), PSA index (p ≤ 0.000) and total PSA (p ≤ 0.000) in patients under 50 after an age-specific analysis. CONCLUSIONS: Total PSA is higher in patients on HD within the subgroup of patients under 50 with statistically significant but not clinically relevant difference. PSA index is remarkably higher in the group of patients on HD. These data could have clinical implications as far as indications for biopsy is concerned.
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Antígeno Prostático Específico , Diálise Renal , Biópsia , Humanos , Falência Renal Crônica , Neoplasias da PróstataRESUMO
PURPOSE: Prostate cancer (PCa) is the most common malignancy among men and one of the most common neoplasms affecting renal transplant recipients (RTRs). The available treatments for localized PCa among the general population (GP), surgery and external beam radiotherapy, carry a risk of damage to the transplanted kidney, the ureters, and the bladder and therefore tend to be avoided by most groups. The objective of this study was to assess the efficacy and feasibility of low-dose-rate brachytherapy (LDR-BT) for PCa in RTRs. METHODS AND MATERIALS: We carried out a retrospective review on all RTRs diagnosed of PCa who had undergone LDR-BT at our institution between 2000 and 2015. Nine patients met these criteria, but 1 did not fulfill the followup. Hence, we analyzed 8 patients. We reviewed all clinical data for PCa and graft function in these patients and compared the results with the GP. RESULTS: Mean baseline prostate-specific antigen was 6.8 ± 1.9 ng/mL. All PCa had a Gleason score of 6 and were classified as low risk according the Europe Association of Urology guidelines. Mean followup after seed implantation was 48 ± 12.8 months. All 8 patients remain free of prostate-specific antigen failure. Five-year progression-free survival, cancer-specific survival, and overall survival rates were 100%, 100%, and 62.5%. There was no specific toxicity associated with LDR-BT, and there were no acute adverse events affecting the graft. CONCLUSIONS: LDR-BT is a feasible and acceptable treatment for localized PCa in RTRs. Oncological outcomes are similar to the GP, and there is minimal toxicity to the renal graft.
Assuntos
Braquiterapia/métodos , Falência Renal Crônica/cirurgia , Transplante de Rim , Neoplasias da Próstata/radioterapia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico , Neoplasias da Próstata/complicações , Neoplasias da Próstata/mortalidade , Dosagem Radioterapêutica , Estudos Retrospectivos , Espanha/epidemiologia , Taxa de Sobrevida/tendênciasRESUMO
OBJECTIVES: To analyse the learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. MATERIAL AND METHODS: We evaluated 32 consecutive patients treated in our department for metastatic renal cancer with tyrosine kinase inhibitors (pazopanib or sunitinib) as first-line treatment between September 2012 and November 2015. We retrospectively analysed this sample. We measured the time to the withdrawal of the first-line treatment, the time to progression and overall survival using Kaplan-Meier curves. The learning curve was analysed with the cumulative sum (CUSUM) methodology. RESULTS: In our series, the median time to the withdrawal of the first-line treatment was 11 months (95% CI 4.9-17.1). The mean time to progression was 30.4 months (95% CI 22.7-38.1), and the mean overall survival was 34.9 months (95% CI 27.8-42). By applying the CUSUM methodology, we obtained a graph for the CUSUM value of the time to withdrawal of the first-line treatment (CUSUM TW), observing 3 well-differentiated phases: phase 1 or initial learning phase (1-15), phase 2 (16-26) in which the management of the drug progressively improved and phase 3 (27-32) of maximum experience or mastery of the management of these drugs. The number of treated patients needed to achieve the proper management of these patients was estimated at 15. CONCLUSIONS: Despite the limitations of the sample size and follow-up time, we estimated (in 15 patients) the number needed to reach the necessary experience in the management of these patients with tyrosine kinase inhibitors. We observed no relationship between the time to the withdrawal of the first-line treatment for any cause and progression.
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Bladder hernia is an uncommon condition with a frequency between 0.5 and 3%, reaching the 10% between patients older than 50 years. It's more predominant in males aged between 50 and 70. The diagnosis usually happens in the course of surgical repair of inguinal hernias, because the bladder hernia has no specific clinical findings. Management includes the resection or reduction of the bladder hernia, with de-obstruction of the lower urinary tract, if present, and repairmen of inguinal path. We report a new case and review the literature.
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Hérnia Inguinal/diagnóstico , Doenças da Bexiga Urinária/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , EscrotoRESUMO
We report a case of a presacral benign schwannoma which causes right hydroureteronephrosis without other clinical findings. After a fine-needle aspiration (FNA) biopsy under computed tomography (CT) guidance, a fusocellular tumour without athypia was demonstrated. With the initial diagnosis of benign schwannoma the patient was operated on, removing the tumour, and with the immunohistochemical examination (reactivity for S-100) this diagnosis was confirmed.
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Hidronefrose/etiologia , Neurilemoma/complicações , Obstrução Ureteral/etiologia , Idoso , Humanos , Masculino , SacroRESUMO
Contribution of a case report of cutaneous horn of penis surgically treated with extensive resection of the implantation base. A well differentiated, microinvasive epidermoid carcinoma was histopathologically demonstrated on a hyperkeratosis squamous papilloma. Although underlying lesions to cutaneous horn are usually benign, malignant changes have been reported in up to one third of cases; surgical treatment should therefore include extensive resection of the implantation base.
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Carcinoma de Células Escamosas/patologia , Neoplasias Penianas/patologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/cirurgiaRESUMO
Contribution of a case report of multiple cystine lithiasis with underlying homozygous cystinuria in a 5-year old male child. Following surgical management of the lithiasic episode the patient was followed-up with super-hydration, urine alkalinization and captopril prophylaxis. After three and a half years evolution, the patient has not developed new lithiasic episodes and maintains normal dibasic amino acids values in 24 h urine.
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Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Captopril/uso terapêutico , Cistina , Cálculos Urinários/prevenção & controle , Pré-Escolar , Cistina/análise , Humanos , Masculino , Cálculos Urinários/químicaRESUMO
Contribution of a retrospective series of 16 patients with type II absorptive hypercalciuria over a total of 1.041 patients undergoing metabolic study due to relapsing renal lithiasis. Clinical history of lithiasis, biochemistry prior to treatment and instituted therapy were examined in all cases. Stones composition, radiologic appearance of lithiasis and evolution of biochemical parameters after medical treatment with a mixture of phosphates were also studied.
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Cálcio/urina , Cálculos Renais/metabolismo , Fosfatos/metabolismo , Adulto , Feminino , Humanos , Cálculos Renais/química , Masculino , Estudos RetrospectivosRESUMO
Squamous cell carcinoma of the renal pelvis is uncommon, accounting for approximately 10% of all renal pelvic tumours. It's often associated with chronic renal calculi or infection and it usually presents at an advanced stage with pain or a palpable mass. We report an incidental case of squamous cell carcinoma of the renal pelvis, associated with chronic renal calculi and infection, and weight loss. The prognosis of patients with advanced squamous cell carcinoma of genitourinary origin is poor. In patients with chronic stones or infection squamous cell carcinoma of renal pelvis must be suspected if survival is to be affected.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias Renais/diagnóstico , Pelve Renal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery. MATERIALS AND METHODS: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported. RESULTS AND CONCLUSIONS: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens.
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Tumor Adenomatoide/patologia , Epididimo/patologia , Neoplasias dos Genitais Masculinos/patologia , Tumor Adenomatoide/química , Tumor Adenomatoide/diagnóstico por imagem , Tumor Adenomatoide/cirurgia , Adulto , Calbindina 2 , Diagnóstico Diferencial , Epididimo/cirurgia , Neoplasias dos Genitais Masculinos/química , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , Queratinas/análise , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Proteínas de Neoplasias/análise , Estudos Retrospectivos , Proteína G de Ligação ao Cálcio S100/análise , Testículo/patologia , UltrassonografiaRESUMO
OBJECTIVE: To analyze the biochemical impact of treatment with phosphates in patients with recurrent calcium lithiasis and hypercalciuria. METHODS: 20 patients were selected according to the following criteria: normal renal function, recurrent calcium nephrolithiasis, hypercalciuria, hypophosphatemia, normal calcium and low tubular phosphate reabsorption (TPR). The mean duration of treatment was 7.5 +/- 3.8 months. The pre and post-treatment phosphatemia, calciuria, phosphaturia and TPR were analyzed. The results were analyzed by the Wilcoxon statistical method. RESULTS: We found a moderate but significant decrease of calciuria (326.5 +/- 52-4 to 266.4 +/- 31.7 mg/24 h), while phosphatemia (2.21 +/- 0.09 to 2.52 +/- 0.30 mg/24 h) and TPR (65.7 +/- 6.3 to 71.3 +/- 4.1) increased significantly. Overall treatment was well-tolerated and no patient abandoned treatment. CONCLUSIONS: The short-term biochemical results obtained are similar to those reported in the literature. However, definitive conclusions cannot be made since treatment application is not standardized and studies that demonstrate its clinical efficacy are scanty.