ABSTRACT
La cirugía robótica tiene muchos puntos comunes con la cirugía abierta con aumento visual (lupas), determinado por: la visión tridimensional aumentada, la articulación de los instrumentos que permite disecar y pasar puntos en diferentes planos y la precisión con ausencia de temblor en la cirugía.Suman en la pieloplastía robótica: la mínima invasión, el mayor aumento de la imagen, el carácter ambidextro de ella, y la menor tracción de los tejidos, al permitir una cirugía in situ de la unión pieloureteral. El video se inicia con una exposición teórica sobre los puntos importantes referidos a: preservar la irrigación de los tejidos,excision rutinaria de un trozo de uréter proximal para mejorar la distensibilidad y diámetro del uréter y la conveniencia de usar puntos separados en la boca anastomótica para garantizar un buen lumen. Luego se muestra una pieloplastía robótica, enfatizando los puntos señalados durante la cirugía.AU
Robotic surgery has many common points if compared to open surgery with visual magnification (loupes), determined by: increased three-dimensional vision, instruments articulation that enable dissection and passing through points in different planes and precision without tremor in surgery. Additionally, in robotic pyeloplasty, the following must be considered: minimal invasion, greater image magnification, its ambidextrous character and less tissue traction, allowing in situ pyeloureteral junction surgery. The video begins with a theoretical presentation about the important points related: preserving tissue irrigation, routine excision of a section of proximal ureter to improve the distensibility and diameter thereof and the convenience of using separate points in the anastomotic mouth to ensure good lumen. After that, a robotic pyeloplasty is shown, emphasizing the points indicated during the surgery. AU
Subject(s)
Humans , Male , Surgery, Computer-Assisted , Ureteral ObstructionABSTRACT
Objetivo: La introducción del Antígeno Prostático Específico (APE) como herramienta de uso masivo en la detección precoz de cáncer prostático (CaP), parece ser al menos parcialmente responsable de la disminución en la mortalidad observada en el último tiempo. Sin embargo, el APE tiene una baja especificidad como marcador de cáncer, especialmente en el rango de 4 a 10 ng/ml donde existe una alta sobreposición con otras patologías de mayor prevalencia como por ejemplo, Hiperplasia Prostática Benigna (HPB). Es por esto, que existe una búsqueda constante de nuevos marcadores. Nuestro objetivo fue caracterizar el perfil de expresión génica del CaP utilizando microarray. Material y métodos: Doce casos de CaP con PSA <10 ng/ml y 4 casos con PSA >10 ng/ml fueron seleccionados prospectivamente para análisis de microarray para 96 genes característicos de tejido prostático. Los análisis se efectuaron por el método de Hierarchical Clustering y se realizó Transcripción Reversa y Reacción de Polimerasa en Cadena para confirmar la información obtenida mediante microarray. Además, se evaluó la presencia en sangre periférica de los genes sobre-expresados en tejido y que pudieran ser marcadores sistémicos de CaP. Resultados: Se definieron 13 genes basándose en su alta expresión, los cuales se agruparon en NCOA4/NDRG1, LDHA/LIM/GSTP1 y KLK2/KLK4 y estos con CALR y CSTB. Los genes SPARCL1, KLK3(PSA), ARSDR1 y ACPP se ordenaron en ramas independientes. El gen ACPP (fosfatasa ácida prostática) fue el más independientemente sobreexpresado. Realizamos RT-PCR para ACPP en 15 tumores primarios y sangre periférica observando señal positiva en 10 (71 por ciento) de 14 casos analizados. Conclusiones: Nuestros resultados indican que el gen ACPP se encuentra sobreexpresado a nivel molecular en tumor primario y sangre periférica, convirtiéndolo en un potencial marcador de CaP con niveles de PSA <10 ng/ml.
Objective: The introduction of prostate specific antigen (PSA) as a screening tool for early detection of prostate cancer (CaP), seems to take a role in being responsible for the decreasing of mortality observed in the last time. Nevertheless, the APE has a low specificity like cancer marker, especially in the rank from 4 to 10 ng/ml where a high superposition with other pathologies of greater prevalence like Benign Prostate Hiperplasia (HPB) exists. This is why there is a constant research for new markers. Our objective was to characterize the gene expression profile of prostate using microarray. Material and Methods: Twelve cases of CaP with PSA <10 ng/ml and 4 cases with PSA >10 ng/ml were prospectively selected for microarray analysis for 96 genes characteristic of prostate tissue. The analysis was performed by the method of Hierarchical Clustering and performed reverse transcription polymerase chain reaction to confirm the information obtained by microarray. We assessed the presence in peripheral blood of over-expressed genes in tissue that could become in systemic markers of PC. Results: We identified 13 genes based on their high expression, which were grouped into NCOA4/NDRG1, LDHA/LIM/GSTP1 and KLK2/KLK4 and those with CALR and CSTB. Genes SPARCL1, KLK3 (PSA) and ACPP ARSDR1 were ordered in separate branches. The ACPP gene (prostatic acid phosphatase) was overexpressed more independently. We RT-PCR for ACPP in 15 primary tumors and peripheral blood positive signal observed in 10 (71per cent) of 14 cases analyzed. Conclusions: Our results indicate that the ACPP gene is overexpressed in a molecular level in primary tumor and peripheral blood, making it a potential marker for prostate cancer with PSA levels <10 ng/ml.
Subject(s)
Humans , Carcinoma/genetics , Prostatic Neoplasms/genetics , Gene Expression , Biomarkers, Tumor , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
We present the analysis of an intronic polymorphism of the nephrin gene and its relationship to the development of diabetic nephropathy in a study of diabetes type 1 and type 2 patients. The frequency of the single nucleotide polymorphism rs#466452 in the nephrin gene was determined in 231 patients and control subjects. The C/T status of the polymorphism was assessed using restriction enzyme digestions and the nephrin transcript from a kidney biopsy was examined. Association between the polymorphism and clinical parameters was evaluated using multivaríate correspondence analysis. A bioinformatics analysis of the single nucleotide polymorphism rs#466452 suggested the appearance of a splicing enhancer sequence in intron 24 of the nephrin gene and a modification of proteins that bind to this sequence. However, no change in the splicing of a nephrin transcript from a renal biopsy was found. No association was found between the polymorphism and diabetes or degree of renal damage in diabetes type 1 or 2 patients. The single nucleotide polymorphism rs#466452 of the nephrin gene seems to be neutral in relation to diabetes and the development of diabetic nephropathy, and does not affect the splicing of a nephrin transcript, in spite of a splicing enhancer site.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 1/complications , /complications , Diabetic Nephropathies/genetics , Membrane Proteins/genetics , Polymorphism, Single Nucleotide/genetics , Biopsy , Case-Control Studies , Genotype , Introns/genetics , Multivariate Analysis , Reverse Transcriptase Polymerase Chain Reaction , RNA Splicing/genetics , Transcription, Genetic/geneticsABSTRACT
Diffuse type gastric carcinoma is the most aggressive type of gastric cancer. This type of tumor is not preceded by precancerous changes and is associated with early-onset and hereditary syndromes. To test the hypothesis that DNA methylation profile would be useful for molecular classification of the diffuse type gastric carcinoma, DNA methylation patterns of the CpG Island of 17 genes were studied in 104 cases and 47 normal adjacent gastric mucosa by Methylation-specific PCR, Immunohistochemistry and Hierarchicalclustering analysis. The most frequent methylated genes were FHIT, E-cadherin, BRCA1 and APC (>50%),followed by p14, p16, p15, p73, MGMT and SEMA3B (20-49%). Hierarchical clustering analysis reveals four groups with different clinical features. The first was characterized by hypermethylation of BRCA1 and younger age (<45 years old), and the second by hypermethylation of p14 and p16 genes, male predominance and Epstein-Barr virus infection. The third group was characterized by hypermethylation of FHIT and antrum located tumors and the fourth was not associated with any clinical variables. In normal adjacent mucosa only the p73 gene was significantly less methylated in comparison to tumor mucosa. DNA methylation identified subgroups of diffuse type gastric cancer. Hypermethylation of BRCA1 associated with young age suggests a role in early-onset gastric carcinoma.
Subject(s)
Female , Humans , Male , Middle Aged , DNA Methylation/genetics , DNA, Neoplasm/genetics , Genes, BRCA1 , Stomach Neoplasms/genetics , Cluster Analysis , CpG Islands/genetics , Early Diagnosis , Gastric Mucosa/pathology , Immunohistochemistry , Polymerase Chain Reaction , Precancerous Conditions/genetics , Promoter Regions, Genetic/genetics , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathologyABSTRACT
La obstrucción ureteral post trasplante renal es una complicación tardía del trasplante y la incidencia actual ha disminuido a un 5-10 por ciento en la literatura. Reportamos el caso y describimos la técnica quirúrgica, de una estenosis ureteral post trasplante renal en una niña, resuelta en forma exitosa con una anastomosis de la pelvis renal del injerto al uréter nativo. La estenosis ureteral post trasplante renal en niños es poco frecuente, puede ser manejada en forma exitosa con esta técnica quirúrgica.
Ureteral obstruction is a late complication in renal transplant. The current incidence has lowered to 5- 10 percent in the literature. We report a case of ureteral stenosis post renal transplant in a 12 years old girl. We describe the surgical technique used to correct this complication an anastomosis between the native ureter and the renal pelvis of the graft. Post renal transplant ureteral stenosis is an uncommon complication in children, and can be successfully managed using this surgical procedure.
Subject(s)
Humans , Female , Child , Anastomosis, Surgical , Ureteral Obstruction/surgery , Ureteral Obstruction/etiology , Kidney Transplantation/adverse effects , Treatment OutcomeABSTRACT
El dolor abdominal es uno de los motivos más frecuentes de consulta en los Servicios de Urgencias Pediátricas, siendo lo más importante diferenciar aquel cuadro que requiere tratamiento médico versus aquél que requería una solución quirúrgica. Aproximadamente el 5 por ciento al 15 por ciento de los niños que consultan por dolor abdominal agudo de más de 2 horas de duración serán intervenidos quirúrgicamente. La mayoría de los casos presentan una causa benigna, pero algunas requerirán un rápido diagnóstico y tratamiento para minimizar la morbimortalidad.
Subject(s)
Humans , Child , Appendicitis/diagnosis , Abdominal Pain/surgery , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Intestinal Obstruction/diagnosis , Acute Disease , Appendicitis/complications , Appendicitis/therapy , Decision Making , Diagnosis, Differential , Emergency Medical Services , Intestinal Obstruction/complicationsABSTRACT
Se presentan 10 casos de diagnóstico antenatal urológico y su evolución posterior. La ecografía en nuestras manos fue muy sensible en el diagnóstico de obstrucción no así en el diagnóstico fino de la afección causal. Ello pensamos mejorará con mayor experiencia. Los resultados de la cirugía neonatal por obstrucción pieloureteral (6 riñones) fueron buenos, recuperándose incluso un riñón excluido en la pielografía. No se usó nefrostomía ni tutor en la pieloplastía. También evolucionaron bien los casos que requirieron heminefrectomía superior, y nefrectomía con sección del puente de riñón en herradura. Sólo una vesicostomía temporal requirió de cirugía posterior al fallar por presentar prolapso grave. No se operó y mejoró en forma espontánea, al hacer una colostomía, un caso con hidronefrosis bilateral a comprensión vesical por el recto ciego de una imperforación anal