ABSTRACT
OBJETIVO: Analisar a experiência inicial da Divisão de Urologia do HCFMRP-USP na adrenalectomia transperitoneal videolaparoscópica. MÉTODOS: Análise retrospectiva de 11 casos de adrenalectomia transperitoneal laparoscópica realizados de fevereiro de 1999 a março de 2003 sendo 3 em homens( 27 por cento) e 8 em mulheres (73 por cento), idade média de 40,2 ± 13,1 anos. Os pacientes apresentavam os diagnósticos seguintes: adenoma - 5, síndrome de Cushing - 3, feocromocitoma - 1, hiperaldestorismo - 1 e síndrome de Carney - 1. RESULTADOS: A cirurgia foi bilateral em 05 pacientes (45,4 por cento) e unilateral em 06 pacientes (54,6 por cento), destes 04 à direita (36,4 por cento) e 02 à esquerda (18,2 por cento). O tempo médio de internação foi de 3,6 ± 1,1 dias, o tempo médio de cirurgia foi de 220,5 ± 103,7 minutos e a taxa de conversão foi de 18,2 por cento. CONCLUSAO: Os resultados apresentados são similares aos relatados pela literatura, demonstrando que a adrenalectomia videolaparoscópia pode ser realizada de maneira segura e eficiente com benefícios: tempo cirúrgico aceitável, rápida recuperação pós-operatória e alta precoce.
Subject(s)
Humans , Male , Female , Adult , Adrenalectomy , Laparoscopy , Adrenocortical Adenoma , Hyperaldosteronism , Pheochromocytoma , Retrospective Studies , Cushing Syndrome/diagnosis , SyndromeABSTRACT
Objective: To analyse the influente of prostate volume on the performance of total prostate specific antigen (tPSA) and free PSA (fPSA) on the diagnosis of prostate adenocarcinoma. Methods: A total of 188 patients underwent transrectal ultrasound guided biopsies (10-12 cores) due to prostate nodes detected by digital rectal examination and/or tPSA range of 2.5-l0ng/ml. Mean age was 65.7±8.7 years. 19/100 (19 percent)(GI) patients with prostate volume >40m1 had prostate cancer while the corresponding figure for patients with prostate <40m1 was 26/88 (29.5 percent)(GII). We analyzed the sensitivity and specificity of tPSA at cut-off points of 2.5 and 4ng/ml as well as the influente of the ratio f/tPSA in both groups of patients. Results: In the group GI tPSA sensitivity and specificity were 94.4 percent and 19.5 percent at the cut-off level of 4ng/ml and 100 percent and 6 percent at 2.5ng/ml. The corresponding values for GIl were 76.5 percent and 62.9 percent, and 100 percent and 19.3 percent. In group GI a cut-off of 19 percent for the ratio f/tPSA kept tPSA sensitivity over 90 percent while the specificity increased to 46.2 percentn at cut-off level of 4ng/ml and to 32.9 percent at 2.5ng/ml. In the group GII the ratio f/tPSA was not able to increase the specificity of tPSA at a cut-off level of 4ng/ml without an expressive reduction of sensitivity. On the other side, for this group a cutoff of 16 percent for the f/tPSA ratio rose the specificity to 46.7 percent for a sensitivity over 90 percent. Conclusion: We recommend stratification of patients according to prostate volume to define tPSA cut-off point. The cut-off level of 2.5ng/ml for tPSA combined with f/tPSA ratio of 19 percent in prostates >40ml and 16 percent in prostates <40m1 was a better option for prostate biopsy indication than tPSA at a cutoff of 4ng/ml associated or not with f/tPSA ratio.