Gastrointestinal and pulmonary nematodes in calves naturally infected in the cities of Botucatu and Manduri, in the Brazilian state of São Paulo / Nematódeos gastrintestinais e pulmonares em bezerros naturalmente infectados nos municípios de Botucatu e Manduri, estado de São Paulo

This study aimed to determine the occurrence of gastrointestinal and pulmonary parasites in calves and to evaluate seasonal and age patterns in parasitism. For this, we used 140 clinically healthy crossbreed calves (two to 12 months old) that belonged to two private farms in the municipalities of Botucatu (n=53) and Manduri (n=87), São Paulo state, Brazil. The calves were monitored for 12 months (from September 2014 to August 2015). Fecal samples were collected directly from the rectum every three months. Fecal egg counts were determined using the modified McMaster technique with a sensitivity of 50 eggs per gram of feces (EPG). Coproculture was performed on pooled samples to identify Strongylida infective larvae. First-stage larvae of Dictyocaulus viviparus were extracted by a modified Baermann method. The data showed non-normal distribution (Shapiro-Wilk) and the nonparametric Kruskall-Wallis test was employed to evaluate the EPG data by seasons and age groups. Dunn's post-test was used for multiple comparisons (P<0.05). The calves from Manduri farm showed significantly higher fecal egg counts (P<0.0001) in the winter when compared to other seasons. At Botucatu farm, young calves (2-3 months old) showed significantly higher EPG than old calves (8-12 months) (P=0.01). The prevalence and overall mean of animals positive for Strongylida type-eggs were 81.1% and 340 in Botucatu, respectively, versus 83.9% and 854 in Manduri, respectively. Furthermore, we found Strongyloides spp., Moniezia spp., and Trichuris spp. eggs and Eimeria spp. oocysts. The prevalent genera in all coprocultures in decreasing order were: Cooperia spp., Haemonchus spp., Oesophagostomum spp., and Trichostrongylus spp. First-stage larvae of Dictyocaulus viviparus were found only in Botucatu farm samples throughout the year, except in spring.(AU)

O objetivo deste estudo foi investigar os parasitas gastrintestinais e pulmonares que acometem bezerros bem como a possível influência de fatores climáticos e da idade no parasitismo. Para isso, durante um período de 12 meses (setembro de 2014 a agosto de 2015), amostras de fezes foram coletadas a cada três meses diretamente da ampola retal de 140 bezerros mestiços (dois a 12 meses de idade), clinicamente saudáveis, pertencentes a duas propriedades leiteiras localizadas nos municípios de Botucatu (n=53) e Manduri (n=87), estado de São Paulo. Realizou-se a contagem de ovos por grama de fezes pela técnica de McMaster modificada com sensibilidade de 50 ovos por grama de fezes (OPG). Coproculturas foram realizadas em pool de amostras para a obtenção das larvas infectantes (L3). Larvas de primeiro estágio de Dictyocaulus viviparus foram recuperadas pela modificação da técnica de Baermann. Os dados não se apresentaram normalmente distribuídos (Shapiro-Wilk), e o teste não paramétrico de Kruskal-Wallis foi utilizado para avaliar os dados de OPG em relação às estações do ano e faixa etária. Para comparações múltiplas, empregou-se o pós-teste de Dunn. Foi verificado que em Manduri, no inverno, houve um aumento significativo (P<0,0001) na contagem de OPG em comparação as demais estações do ano. Em Botucatu, os animais com dois a três meses de idade apresentaram maiores contagens de OPG quando comparados aos animais de oito a 12 meses de idade (P=0,01). A prevalência e a média global de animais positivos para ovos do tipo Strongylida, em Botucatu, foi de 81,1% e 340, respectivamente, e em Manduri foi de 83,9% e 854, respectivamente. Em adição, de maneira geral, foram encontrados ovos de Strongyloides spp., Moniezia spp., Trichuris spp. e oocistos de Eimeria spp. Foram recuperadas, em ordem de prevalência, larvas infectantes de Cooperia spp., Haemonchus spp., Oesophagostomum spp. e Trichostrongylus spp. Larvas de D. viviparus foram recuperadas somente na propriedade de Botucatu durante todo o ano, com exceção da primavera.(AU)

Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer / Baixa testosterona sérica é prognóstica de doença de alto grau em pacientes com câncer de próstata

Summary Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

Resumo Objetivo: Avaliar a relação entre testosterona sérica total (TT) e grau do câncer de próstata (CP) e o efeito da raça e de características demográficas sobre essa associação. Método: Foram analisados 695 pacientes submetidos a prostatectomia radical (PR), dos quais 423 tinham medidas dos níveis séricos de TT. Os pacientes foram classificados como portadores de hipogonadismo ou eugonadismo com base em dois limites de testosterona: limite 1 (300 ng/dL) e limite 2 (250 ng/dL). Avaliou-se a relação entre nível de TT e escore Gleason (GS) ≥ 7 em amostras de PR. Os resultados foram avaliados por análises univariada e multivariada, com ajuste para raça e outros fatores prognósticos demográficos. Resultados: Do total de 423 pacientes, 37,8% apresentavam hipogonadismo com base no limite 1, e 23,9% com base no limite 2. Os pacientes com hipogonadismo, independentemente do limite de referência, tiveram uma chance maior de GS ≥ 7 (OR 1,79, p=0,02 e OR 2,08, p=0,012, respectivamente). Na análise multivariada, após ajuste para idade, TT, índice de massa corporal (IMC) e raça, baixo TT (p=0,023) e idade (p=0,002) foram considerados fatores de risco independentes para GS ≥ 7. Entre os indivíduos negros, baixo TT sérico foi mais preditivo de doença de alto grau em comparação com os brancos (p=0,02). Conclusão: O hipogonadismo é independentemente associado a escores mais altos de GS no CP localizado. O efeito dessa associação é significativamente mais pronunciado entre homens negros, o que poderia explicar, em parte, as características agressivas do CP observadas nessa população.

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve

Introduction Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Materials and Methods Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. Results By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. Conclusions This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to ...

Penile enlargement with methacrylate injection: is it safe? / Aumento peniano com injeção de metacrilato: isto é seguro?

Penis size is a great concern for men in many cultures. Despite the great variety of methods for penile augmentation, none has gained unanimous acceptance among experts in the field. However, in this era of minimally invasive procedure, injection therapy for penile augmentation has become more popular. Here we report a case of methacrylate injection in the penis that evolved with penile deformity and sexual dysfunction. This work also reviews the investigation and management of this pathological condition.

A 36-year-old male sought medical care with a complaint of penile deformity and sexual dysfunction after methacrylate injection. The treatment administered was surgical removal. Satisfactory cosmetic and functional results were reached after two months.

There is a need for better structured scientific research to evaluate the outcomes and complication rates from all penile augmentation procedures. .

O tamanho peniano é uma grande preocupação para homens em diversas culturas. Apesar da grande variedade de possíveis métodos para o aumento peniano, nenhum ganhou aceitação unânime por especialistas no assunto. Mas na era dos procedimentos minimamente invasivos, a terapia de injeção para aumento peniano tem se tornado mais popular. Aqui relatamos um caso de injeção de metacrilato no pênis que evoluiu com deformidade peniana e disfunção sexual. Este trabalho também revisa a investigação e gerenciamento desta afecção.

Um homem de 36 anos procurou atendimento médico com queixa de deformidade peniana e disfunção sexual após injeção de metacrilato. Remoção cirúrgica foi realizada como tratamento. Após dois meses, satisfatórios resultados cosmético e funcional foram alcançados.

Trabalhos científicos mais bem estruturados para avaliar as taxas de complicação e resultados de todos os procedimentos para aumento peniano são necessários. .

The use of immunohistochemistry for diagnosis of prostate cancer

PURPOSE: Atypical glands (ASAP) are diagnosed in 5.0 percent of prostate biopsies, and cancer identification in a rebiopsy is higher than 40.0 percent. The use of antibodies to mark basal cells is currently a common practice, in order to avoid rebiopsies. There has been no reported study that has reviewed characteristics of radical prostatectomies (RPs) when immunohistochemistry (IHC) was necessary for definitive diagnosis. MATERIALS AND METHODS: Out of 4127 biopsies examined from 2004 to 2008, 144 (3.5 percent) were diagnosed with ASAP. IHC was performed using antibody anti-34ßE12 and p63. The results of surgical specimens of 27 patients treated by RP after the diagnosis of prostate cancer (PC) was made using IHC (Group 1) were compared with 1040 patients where IHC was not necessary (Group 2). RESULTS: IHC helped to diagnose PC in 103 patients (71.5 percent). Twenty-seven (26.2 percent) underwent RP. In Group 1, two (7.4 percent) adenocarcinomas were insignificant versus 29 (2.9 percent) for Group 2. Patients from Group 1 were younger (p = 0.039), had lower Gleason scores (GS) (p < 0.001), lower percentage of Gleason pattern 4 (p < 0.001), and smaller tumors (p < 0.001). CONCLUSION: The use of IHC did not lead to diagnosis of insignificant tumors as illustrated by absence of differences in pathological stage or positive surgical margins in men submitted to RP. Therefore, our results suggest that this modality should be routinely used for a borderline biopsy and ASAP cases.

Angioplastia carotídea com reversão do fluxo em octogenários: relato de caso / Carotid angioplasty with flow reversion in octogenarians: a case report

Pacientes octogenários submetidos à angioplastia carotídea apresentam maior incidência de eventos neurológicos quando comparados a grupos de pacientes mais jovens e a grupos da mesma faixa etária submetidos à endarterectomia carotídea. A maior taxa de complicações pode ser explicada por fatores anatômicos e anatomopatológicos que aumentam a dificuldade técnica e o risco de ateroembolismo do procedimento endovascular. O procedimento foi realizado no centro cirúrgico, com o paciente em decúbito dorsal e sob anestesia geral. Realizamos acesso cirúrgico transverso limitado, na base do pescoço à direita, com dissecção, identificação e reparo da artéria carótida comum e veia jugular interna. Foram administradas 10.000 U de heparina e puncionada a carótida comum pela técnica de Seldinger com introdução de bainha 8F em sentido cranial. Na sequência, foi puncionada a veia jugular interna com instalação de bainha 8F em sentido caudal. Em seguida, ambas as bainhas foram conectadas, utilizando-se um segmento de equipo de soro. A carótida comum foi fechada por cadarço duplo de silicone e o fluxo retrógrado pela carótida interna foi estabelecido. Subsequentemente, foi introduzido fio guia 0.014 x 190 cm com cruzamento da lesão, realizando-se angioplastia com balão 5 x 20 mm e em seguida stent (Wallstent® 7 x 50 - Boston Scientific) foi introduzido, posicionado e liberado. A angioplastia carotídea com reversão de fluxo, por via transcervical, constitui estratégia de proteção cerebral custo-eficiente e com menor potencial emboligênico em pacientes octogenários com anatomia desfavorável.

Octogenarian patients submitted to carotid angioplasty present higher incidence of neurological events when compared to younger patients and to patients in this same age submitted to carotid endarterectomy. The higher complication rate could be related to anatomic and anatomopathological factors that increase technical difficulties and atheroembolic risk associated with the endovascular procedure. At the operating room, the patient was in dorsal decubitus position and submitted to general anesthesia. Limited transversal surgical access was carried out on the right neck base, with dissection, identification and restoration of the common carotid artery and internal jugular vein. A 8F sheath was implanted cranially oriented into the common carotid by Seldinger technique after endovenous injection of 10.000 UI of heparin. Another 8F sheath was implanted into the internal jugular vein in caudal orientation. Both sheath were connected by the use of infusion set segment. The common carotid artery was clamped with a silastic double lace, establishing reversion of blood flow in the internal carotid artery. The lesion was crossed by 0.014 x 190 cm wire and the carotid angioplasty was performed employing a 5 x 20 mm ballon and a stent (Wallstent® 7 x 50 - Boston Scientific) was introduced, positioned and released. Carotid angioplasty with transcervical flow reversal is a cost effective brain protection strategy, associated to low embolic potential in octagenarian patients with unfavorable anatomy.

Cavernous nerve reconstitution with the use of bone marrow stem cells and erectile function evaluation: an experimental animal study / Avaliação da função erétil após a reconstituição do nervo cavernoso com o uso de células-tronco de medula-óssea: estudo experimental em ratos

Objective: To assess the influence of adult stem cells from bone marrow of rats in the regeneration of cavernous nerve, taking the return of erectile function as a parameter in animals subjected to the apomorphine-induced test of erection. Methods: Forty-eight male Wistar-EPM rats, aged between nine and ten weeks, and weighing approximately 250 g were used. They were randomly divided into four study Groups containing 12 animals each, as follows: Group I: surgical exposure of the cavernous nerves bilaterally without injury; Group II: bilateral surgical injury of the cavernous nerve of approximately 3 mm, without reconstruction; Group III: bilateral surgical injury of the cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone guiding tubes containing saline solution inside; Group IV: bilateral surgical injury of the cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone guiding tubes filled with adult stem cells. Four weeks after surgery, the animals were injected with apomorphine for induction of erection. Results: In Group I there was complete erectile response in all animals (100% ? 12 out of 12). On the other hand, none of the animals in Group II presented erection after the use of apomorphine. Five of the twelve animals of Group III (41.7%) and nine of the 12 animals of Group IV (75%) had erections after the stimulus. When we compared the frequency of restoration of erection in the four Groups, Group IV was shown to have a similar performance to Group I (p = 0.217), while Group III animals had a frequency of erections inferior to those in Group I (p = 0.005). Moreover, comparison of results of Groups III and IV versus Group II showed that the frequency of erections was statistically higher in the first two Groups (p = 0.037 and p < 0.001, respectively). Finally, Group IV presented a tendency to a larger number of erections when compared to Group III (75 versus 41.7%) but this difference was not statistically significant (p = 0.098). Conclusion: This study shows that adult stem cells from bone marrow, filling silicone guiding tubes, may promote the regeneration of cavernous nerves and restore erectile function in an animal model.

Objetivo: Avaliar a influência de células-tronco adultas da medula óssea de ratos na regeneração do nervo cavernosos lesado, tomando-se como parâmetro o retorno da função erétil nos animais submetidos ao teste de ereção induzido pela apomorfina. Métodos: Quarenta e oito ratos Wistar-EPM machos, com idades entre nove e dez semanas, pesando aproximadamente 250 g, foram usados e randomicamente subdivididos em quatro grupos de estudo contendo 12 animais cada. Os grupos experimentais foram divididos em: Grupo I: exposição cirúrgica bilateral do nervo cavernoso sem lesão do mesmo. Grupo II: lesão cirúrgica bilateral do nervo cavernoso de aproximadamente 3 mm, sem reconstrução. Grupo III: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas-guia de silicone contendo solução salina em seu interior. Grupo IV: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas-guia de silicone semeadas com células-tronco adultas em seu interior. Quatro semanas após a cirurgia, os animais foram injetados com apomorfina para indução da ereção. Resultados: No grupo I observou-se resposta erétil completa em todos os animais (100% ? 12 em 12). Por outro lado, nenhum dos animais do grupo II apresentou ereções após a administração de apomorfina. Cinco dos doze animais do grupo III (41,7%) apresentaram ereções, enquanto nove dos 12 animais do grupo IV (75%) evidenciaram ereções após o estímulo. Quando foram comparadas as frequências de restauro de ereção nos quatro grupos, demonstrou-se que Grupo IV teve um comportamento semelhante ao Grupo I (p = 0,217), ao passo que os animais do Grupo III apresentaram frequência de ereções inferiores aos do Grupo I (p = 0,005). Por outro lado, a comparação dos resultados entre os Grupos III e IV versus o Grupo II demostrou que a frequência de ereções foi estatisticamente superior nos dois primeiros Grupos (p = 0,037 e p < 0,001, respectivamente). Finalmente, o Grupo IV apresentou tendência a maior número de ereções quando comparado ao Grupo III (75 versus 41,7%), mas essa diferença não foi estatisticamente significante (p = 0,098). Conclusão: O presente estudo demonstra que células-tronco adultas da medula óssea, semeadas em sondas-guia de silicone, favorecem a regeneração dos nervos cavernosos e promovem o restabelecimento da função erétil em um modelo animal.

Patient's reactions to digital rectal examination of the prostate

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9 percent). Before DRE, about 59.4 percent of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5 percent (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance.

Trauma urológico / Urologic trauma

Os traumas geniturinários representam 10% de todos os traumas em nosso Serviço de Emergência (HC-FMUSP). O rim é, em geral, o órgão mais frequentemente envolvido, sendo os traumas de ureter e bexiga mais raros e associados a traumas de alta energia e a outras lesões severas concomitantes...

The genitourinary trauma represents 10% of all traumas in our Emergency Service (HC-FMUSP). The kidney is the organ most frequently affected. The ureteral and bladder traumas are rare and are associated wit traumas of high energy and with other severe injuries...

Angioplastia subintimal sem o uso de stent em paciente diabético portador de lesão complexa no pé / Subintimal angioplasty without stenting on a patient with complex foot lesion

Pacientes diabéticos portadores de doença ateroesclerótica obliterativa periférica e lesões complexas de partes moles são freqüentemente tratados por amputação primária. Os autores relatam o caso de paciente de 66 anos, sexo feminino, portadora de múltiplas comorbidades, apresentando volumoso abscesso plantar esquerdo e lesão femoral superficial conforme TASC C. Optou-se por realizar revascularização endovascular do membro inferior esquerdo por técnica de angioplastia subintimal sem o emprego de stent ou endoprótese. A abordagem combinada de revascularização endovascular do membro inferior associada a cuidados intensivos com feridas de pés diabéticos deve sempre ser considerada antes da amputação. Assim, sugere-se a técnica de angioplastia subintimal como uma opção em pacientes de elevado risco cirúrgico portadores de feridas complexas nas extremidades.

Diabetic patients presenting with both peripheral vascular disease and complex soft-tissue defects are often treated by primary amputation. We report the case of a 66-year-old female patient with multiple comorbid conditions. She presented left foot plantar abscess and TASC C superficial femoral lesion. Endovascular revascularization of the left lower limb was performed employing the subintimal angioplasty technique, without stenting or endografting. This combined approach of lower limb revascularization associated with intensive care in diabetic foot wounds should always be considered before amputation. We recommend subintimal angioplasty as an option for high-risk patients with complex limb wounds.

Well-differentiated prostate cancer in core biopsy specimens may be associated with extraprostatic disease / Adenocarcinoma bem diferenciado de próstata na biópsia pode estar associado a doença extraprostática

CONTEXT AND OBJECTIVE: Accurate determination of the Gleason score in prostate core biopsy specimens is crucial in selecting the type of prostate cancer treatment, especially for patients with well-differentiated tumors (Gleason score 2 to 4). For such patients, an inaccurate biopsy score may result in a therapeutic intervention that is too conservative. We evaluate the role of Gleason score 2-4 in prostate core-needle biopsies for predicting the final pathological staging following radical prostatectomy. DESIGN AND SETTING: Retrospective study at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We analyzed the medical records of 120 consecutive patients who underwent radical retropubic prostatectomy to treat clinical localized prostate cancer at our institution between December 2001 and July 2006. Thirty-two of these patients presented well-differentiated tumors (Gleason score 2 to 4) in biopsy specimens and were included in the study. The Gleason scores of the core-needle biopsies were compared with the pathological staging of the surgical specimens. RESULTS: Sixteen of the 32 patients (50 percent) presented moderately differentiated tumors (Gleason score 5 to 7) in surgical specimens. Eighteen patients (56 percent) had tumors with involvement of the prostate capsule and ten (31 percent) had involvement of adjacent organs. Evaluating the 16 patients that maintained Gleason scores of 2 to 4 in the pathological staging of the surgical specimens, 11 (68.7 percent) had focal invasion of the prostate capsule and five (31.25 percent) had organ-confined disease. CONCLUSION: Well-differentiated tumors (Gleason score 2 to 4) seen in biopsies are not predictive of organ-confined disease.

CONTEXTO E OBJETIVO: A determinação acurada do escore de Gleason nas biópsias prostáticas é fundamental para seleção do tratamento adequado para o câncer de próstata, especialmente em relação aos tumores bem diferenciados (Gleason 2 a 4), para os quais a abordagem terapêutica pode ser mais conservadora. O objetivo deste trabalho foi avaliar a correlação entre o escore de Gleason 2 a 4 na biópsia de próstata com o estádio patológico final após a prostatectomia radical. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. MÉTODOS: Foram revisados os prontuários médicos de 120 pacientes submetidos a prostatectomia radical retropúbica para tratamento de câncer de próstata localizado em nossa instituição entre dezembro de 2001 e julho de 2006. Trinta e dois destes pacientes apresentavam diagnóstico de câncer de próstata bem-diferenciado na biópsia prostática com agulha e foram incluídos no estudo. Os resultados das biópsias de próstata com agulha foram comparados com o estadiamento patológico final dos espécimes cirúrgicos obtidos com a prostatectomia radical. RESULTADOS: 16 de 32 pacientes (50 por cento) apresentaram câncer de próstata moderadamente diferenciado (escore de Gleason 5 a 7) na avaliação do espécime cirúrgico. 18 de 32 pacientes (56 por cento) apresentavam acometimento da cápsula prostática pelo tumor, sendo que 10 (31 por cento) destes pacientes apresentavam, em associação, envolvimento de órgãos adjacentes. Avaliando os 16 pacientes que mantiveram escore de Gleason 2 a 4 no estadiamento patológico da peça cirúrgica, 11 (68,7 por cento) destes pacientes apresentavam invasão focal da cápsula prostática e 5 (31,25 por cento) pacientes apresentavam doença confinada à próstata. CONCLUSÃO: Tumores bem diferenciados da próstata na biópsia com agulha (escore de Gleason 2 a 4) não são preditivos de doença órgão-confinada.

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Prostate cancer detection at rebiopsy after an initial benign diagnosis: results using sextant extended prostate biopsy

INTRODUCTION: Sextant prostate biopsy remains the standard technique for the detection of prostate cancer. It is well known that after a diagnosis of small acinar proliferation (ASAP) or high grade prostate intraepithelial neoplasia (HGPIN), the possibility of finding cancer is approximately 40 percent and 30 percent, respectively. OBJECTIVE: We aim to analyze follow-up biopsies on patients who initially received a benign diagnosis after exclusion of HGPIN and ASAP. METHODS: From July 2000 to December 2003, 1177 patients were submitted to sextant extended prostate biopsy in our hospital. The mean patient age was 65.5 years old, and the median number of fragments collected at biopsy was 13. HGPIN and ASAP were excluded from our study. We only considered patients who had a diagnosis of benign at the first biopsy and were subjected to rebiopsies up until May 2005 because of a maintained suspicion of cancer. RESULTS: Cancer was initially detected in 524 patients (44.5 percent), and the diagnosis was benign in 415 (35.3 percent). Rebiopsy was indicated for 76 of the latter patients (18.3 percent) because of a persistent suspicion of cancer. Eight cases of adenocarcinoma (10.5 percent) were detected, six (75 percent) at the first rebiopsy. Six patients were submitted to radical prostatectomy, and all tumors were considered clinically significant. CONCLUSION: Our data indicate that in extended prostate biopsy, the first biopsy detects more cancer, and the first, second, and third rebiopsies after an initial benign diagnosis succeed in finding cancer in 7.9 percent (6/55), 5.9 percent (1/15) and 20 percent (1/4) of patients, respectively.

Microvascular invasion is an independent prognostic factor in patients with prostate cancer treated with radical prostatectomy

OBJECTIVE: Current published data regarding the prognostic value of microvascular invasion (MVI) in patients with prostate cancer (PCa) have yielded mixed results. Furthermore, most important series had surgical procedures performed by multiple surgeons and surgical specimens analyzed by multiple pathologists. We determined the relation of MVI with other pathologic features and whether this finding can be used as an independent prognostic factor in patients with PCa. MATERIALS AND METHODS: We selected 428 patients with clinically localized PCa treated with radical prostatectomy (RP). MVI was correlated to other pathologic features. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. RESULTS: Eleven percent out of the 428 patients presented MVI. Except for the lack of association with biopsy Gleason score, MVI was related to all clinical and pathologic features of RP specimens. Mean follow up after surgery was 53.9 ± 20.1 months. Patients with MVI presented a recurrence rate of 44.6 percent compared to only 20.2 percent for patients without MVI (Log-rank test - p < 0.001). After Cox regression analysis, MVI was an independent prognostic feature related to biochemical recurrence. CONCLUSIONS: MVI is associated to advanced pathologic features of PCa and is an important prognostic factor regarding disease recurrence in patients treated with RP. These findings support the recommendations to the routine evaluation of this variable in pathologic reports of RP specimens.

Hiperplasia prostática benigna na terceira idade / Benign prostatic hyperplasia

A hiperplasia prostática benigna (HPB) é uma condição tão freqüente na população masculina geriátrica que sua presença pode ser considerada como um achado normal. São as seqüelas ou complicações da HPB que vão ditar a necessidade de tratamento do paciente. As mais freqüentes são: sintomas miccionais, infecção urinária, hematúria e obstrução urinária. Nos últimos anos surgiram várias opções de tratamento para HPB, incluindo medicamentos e alternativas cirúrgicas menos agressivas. Entretanto, a ressecção transuretral da próstata (RTUP) ainda é considerada o padrão-ouro com a qual outras formas de tratamento devem ser comparadas em termos de eficácia(au)

Retroperitoneal migration of a self-inflicted ballpoint pen via the urethra

Numerous accounts documenting the introduction of foreign bodies into the urinary bladder have been reported. These foreign bodies are typically self-inserted via urethral but migration from adjacent organs by an ulcerative process and penetrating injuries are also reported. However, "contrary" migration of a self-inflicted vesical foreign body to the retroperitoneum was not previously reported in literature. We report here a case of a ballpoint pen self-inserted via urethral by a female patient, which was identified in retroperitoneal position years later.