Tissue factor expression in colorectal adenocarcinoma: association with angiogenesis and clinical and pathological aspects

Introduction: Tissue factor (TF) expression has been described in various neoplasms and was correlated with angiogenesis and metastases. Objectives: To describe TF expression in colorectal cancers, correlating it with microvessel density and clinical and pathological variables. Methods: Immunohistochemistry was used to determine TF expression and microvessel density. The Student t-test was used to compare high and low TF expression with microvessel density andwith age. The chi-squared test was used for other comparisons, and Kaplan-Meier curves were used for survival analyses. Results: Forty-three patients were operated with curative intent. Their mean age was 58.1±12.6 years old, and 62.8% were male. The rectum was the most common location (60,4%), and most tumors reached the serosa and peri-intestinal fat (72.1%). Lymph nodes were positive in 46.5%, and 72.1% of the tumors were moderately differentiated adenocarcinomas. Death occurred in 27.6±12.8months in 51.1% of the patients who had recurrence. Tissue factor expression was intense in 88.4%. There was a positive correlation between TF expression and microvessel density (p=0.02), and between TF and older age (p< 0.01). There was no correlation between TF expression and other variables (gender, histological type, penetration into the intestinal wall, and lymphatic and systemic metastases). Tissue factor expression did not correlate with survival. Conclusion: Tissue factor expression correlated with increased microvessel density and older age. Further studies are necessary to ascertain the clinical relevance of TF in colorectal cancer. (AU)

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Second brazilian consensus on the treatment of advanced prostate cancer: a SBOC-SBU-SBRT panel review

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Gastric neobladders: surgical outcomes of 91 cases using different techniques

ABSTRACT Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil. Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon. Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).

Serum tissue factor as a biomarker for renal clear cell carcinoma

ABSTRACT Purpose to determine the usefulness of serum TF as a potential marker for patients with clear cell RCC. Materials and Methods prospective study of 30 patients with clear cell RCC submitted to nephrectomy and 16 controls without clear cell RCC treated surgically for other conditions. TF is a endothelium marker that was correlated with worse prognosis in a variety of solid tumors including RCC. Serum TF was collected before surgery at the operating room and in the postoperative setting after at least four weeks. Serum samples were analyzed with a commercial ELISA kit for human TF (R&D Systems®). Results Mean preoperative serum TF levels in clear cell RCC patients and in controls were 66.8 pg/dL and 28.4 pg/dL, respectively (p<0.001). Mean postoperative serum TF levels in clear cell RCC patients were 26.3 pg/dL. In all patients with clear cell RCC postoperative serum levels of TF were lower, with a mean reduction of 41.6 pg/dL in the postoperative setting (p<0.001). Linear regression revealed that tumor size was correlated with the postoperative reduction of serum TF levels (p=0.037). Conclusions We have shown a 3-fold reduction in the median preoperative serum levels of TF in patients with clear cell RCC after surgery. We have also shown a difference of the same magnitude in the serum levels of TF compared with those of a control group of patients with benign diseases. TF appears to be a useful serum marker for the presence of clear cell RCC. Further studies are needed to validate these findings.

Análise da expressão imuno-histoquímica do fator tecidual no carcinoma gástrico: correlações com prognóstico e sobrevida / Immunohistochemical analysis of tissue factor expression in gastric carcinoma: correlations with prognosis and survival

RESUMO Objetivo: estudar a expressão do fator tecidual (FT) e sua correlação com o prognostico e sobrevida em pacientes com carcinoma gástrico. Métodos: verificamos a expressão imuno-histoquímica do FT em 50 espécimes de adenocarcinomas gástricos de pacientes submetidos a tratamento cirúrgico com intenção curativa. A intensidade da sua expressão foi comparada com dados clínicos e patológicos, estadiamento TNM, fatores prognósticos e sobrevida. Resultados: houve expressão do FT em todos os tumores; a intensidade de expressão do FT não foi associada com estágio TNM, variáveis clínicas ou patológicas ou sobrevida geral. Conclusão: este estudo mostra que o FT tem uma expressão elevada em carcinoma gástrico, mas que este não é útil como marcador de prognóstico.

ABSTRACT Objective: to study the expression of the tissue factor (TF) and its correlation with prognosis and survival in patients with gastric carcinoma. Methods: we measured the immunohistochemical expression of TF in 50 specimens of gastric adenocarcinomas from patients submitted to curative surgery. We then compared the intensity of its expression with clinical and pathological data, TNM staging, prognostic factors and survival. Results: all tumors displayed TF expression; the intensity of TF expression was not associated with TNM stage, clinical or pathological variables or general survival. Conclusion: TF has a high expression in gastric carcinoma, but that it is not useful as a prognostic marker.

First brazilian consensus of advanced prostate cancer: recommendations for clinical practice

ABSTRACT Introduction Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. Objectives This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. Materials and Methods Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. Results and Conclusions The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.

Recomendações para a proteção da privacidade do paciente / Recommendations for the protection of patient privacy / Recomendaciones para la protección de la privacidad del paciente

Resumo A preocupação sobre aspectos bioéticos da privacidade do indivíduo e da privacidade dos dados de seus atendimentos é crescente no meio médico. Processos propedêuticos e terapêuticos atuais requerem envolvimento multidisciplinar de uma série de indivíduos, especialmente em se tratando de internações hospitalares. A transmissão e o armazenamento das informações clínicas e laboratoriais dos pacientes envolvem diferentes mídias, com problemas inerentes de acessibilidade e proteção da informação. Os autores sugerem situações hipotéticas que exemplificam problemas comumente abordados na atuação de comitê de bioética clínica, contextualizando-os no Brasil e no mundo, e sugerindo passos para minimizar potenciais problemas de quebra de privacidade e confidencialidade.

Abstract Concerns regarding the bioethical aspects of the privacy of the individual and the confidentiality of their medical treatment data is increasing in the medical community. The current preliminary clinical and therapeutic processes require the multidisciplinary involvement of a number of individuals, especially in the case of hospitalization. The transmission and storage of clinical and laboratory patient information involves different media, with inherent problems of accessibility and protection of information. The authors describe hypothetical situations that exemplify issues commonly addressed in the work of a clinical bioethics committee, contextualizing these problems in Brazil and globally, and suggest steps to minimize potential problems of the breaching of privacy and confidentiality.

Resumen La preocupación sobre los aspectos bioéticos de la privacidad del individuo y de la confidencialidad de los datos de su asistencia está aumentando en la comunidad médica. Los actuales procesos clínicos y terapéuticos requieren la participación multidisciplinar de una serie de personas, especialmente en el caso de las internaciones hospitalarias. La transmisión y el almacenamiento de informaciones clínicas y de laboratorio de los pacientes implican diferentes canales de comunicación, con los problemas inherentes de accesibilidad y protección de la información. Los autores aluden a situaciones hipotéticas que ejemplifican problemas comúnmente tratados en el desempeño de un comité de bioética clínica, contextualizándolos en Brasil y en el mundo, y sugiriendo medidas para minimizar los posibles problemas de violación de la privacidad y de la confidencialidad.

Torção testicular: suspeita clínica e abordagem / Testicular torsion: clinical suspicion and approach

A torção testicular é uma emergência urológica frequente e seu reconhecimento e conduta precoces são necessários visto que a janela terapêutica é estreita e são graves os prejuízos quando retardada a correção, que geralmente é cirúrgica.

Testicular torsion is a frequent urological emergency and its early recognition and management are imperative, since the therapeutic window is narrow and there are serious losses when the correction is delayed, which is usually surgical.

Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients / Nefropatia induzida por contraste (NIC) em pacientes adultos internados submetidos à tomografia computadorizada por contraste

Introduction: Contrast induced nephropathy (CIN) is one of the complications of the use of intravascular contrast agents, being defined as a reduction of the glomerular filtration rate caused by the iodinated contrast. Most CIN data derive from the cardiovascular literature, which identified as the most consistent risk factors pre-existing chronic renal insufficiency and diabetes mellitus. However, these studies limit their conclusions to a more specific patient population. Computerized tomography as a cause of CIN has been studied less often. Objective: To report on the incidence of computerized tomography contrast induced nephropathy (CIN) in an inpatient population of a tertiary general hospital, identifying potentially avoidable risk factors. Methods: We performed a prospective cohort study with inpatients admitted at a tertiary hospital requiring contrast-induced CT. The primary outcome was the development of CIN, measure by the alteration of serum creatinine or glomerular filtration rate in 48 or 72 hours. Through clinical interview, we verified possible risk factors and preventive measures instituted by the medical team and their association with development of CIN. Results: Of a total of 410 patients, 35 (8.5%) developed CIN. There was a positive correlation between CIN and the presence of diabetes mellitus (OR = 2.15; 95%CI 1.35-4.06; p = 0.02), heart failure (OR = 2.23; 95%CI 1.18-8.8; p = 0.022), and renal failure (OR = 3.36; 95%CI 1.57- 7.17; p = 0.002) Conclusion: Incidence of CIN varies according to the population. Diabetes mellitus, heart failure and renal failure were independent risk factors for the development of CT-associated CIN. Further studies are needed to better understand and treat CT-associated CIN. .

Introdução: Nefropatia induzida por contraste (NIC) é consequência do uso de meios de contraste intravenoso, sendo definida como uma redução da taxa de filtração glomerular. A maioria dos dados de NIC são da literatura cardiovascular, que identificou como fatores de risco insuficiência renal crônica e diabetes. Entretanto, esses estudos limitam suas conclusões a uma população especifica de pacientes. Tomografia Computadorizada contrastada como causa de NIC foi menos estudada. Objetivo: Reportar incidência de NIC numa população de pacientes internados em hospital terciário submetidos à tomografia computadorizada com contraste, identificando possíveis fatores de risco evitáveis. Métodos: Realizamos um estudo de coorte prospectivo com pacientes internados em hospital terciário e que necessitaram de tomografia computadorizada com contraste. O desfecho primário foi desenvolvimento de NIC, verificado por meio da variação da creatinina sérica ou taxa de filtração glomerular em 48 ou 72 horas. Em entrevista clínica, verificamos possíveis fatores de risco, assim como medidas preventivas instituídas pela equipe médica e suas possíveis associações com desenvolvimento de NIC. Resultados: Do total de 410 pacientes, 35 (8,5%) desenvolveram NIC. Houve correlação positiva entre desenvolvimento de NIC e a presença de diabetes mellitus (OR = 2,15; 95%CI 1,35-4,06; p = 0,02), insuficiência cardíaca (OR = 2,23; 95%CI 1,18-8,8; p = 0,022), e insuficiência renal (OR = 3,36; 95%CI 1,57-7,17; p = 0,002). Conclusão: A incidência de NIC varia de acordo com a população. Diabetes, insuficiência cardíaca e insuficiência renal foram fatores de risco independentes para o desenvolvimento de NIC. Mais estudos são ...

Increased Tissue Factor Expression is an Independent Predictor of Mortality in Clear Cell Carcinoma of the Kidney

Purpose Increased expression of tissue factor (TF), a primary initiator of the extrinsic coagulation pathway, has been associated with a worse prognosis in a variety of solid tumors. We report for the first time the correlation of the immunohistochemical expression of tissue factor with clinical and pathological outcomes in clear cell carcinomas of the kidney. Materials and Methods immunohistochemical expression of tissue factor was evaluated in 58 paraffin-embedded samples of clear cell carcinomas of the kidney treated at the same university hospital, that was correlated with clinical and pathological variables and with overall survival. Results high intensity tissue factor expression (TF area > 10µm2) was observed in 22.4% of the tumors (13 patients), and was an important predictor of overall mortality, both in univariate and multivariate analysis (p < 0.05). Median overall survival for both groups was 66 months; 78.2 months for patients in the group of lower TF expression and 27.5 months for patients in the group of higher TF expression (log rank p < 0.001). The hazard ratio for mortality was 9.7 (CI 3.7-25.6) for tumors with increased TF expression. Conclusions Increased immunohistochemical expression of TF was an important independent predictor of mortality in a contemporary cohort of patients with clear cell carcinoma of the kidney. Further studies are necessary to define the role of TF in clinical practice. .

Association between Literacy, Compliance with Prostate Cancer Screening, and Cancer Aggressiveness: Results from a Brazilian Screening Study

Purpose Little is known about the effects of literacy levels on prostate cancer screening. This study evaluates the association between literacy, compliance with screening, and biopsy findings in a large Brazilian screening study. Materials and Methods We analyzed 17,571 men screened for PCa with digital rectal examination (DRE) and total and free prostate-specific antigen (PSA) from January 2004 to December 2007. Of those, 17,558 men had information regarding literate status. Full urological evaluation in a specialized cancer center was recommended in the case of: a) suspicious DRE, b) PSA > 4.0 ng/mL, or c) PSA 2.5-3.9 ng/mL and free/total PSA (f/tPSA) ratio < 15%. Transrectal ultrasound guided prostate biopsy (14 cores) was performed upon confirmation of these findings after the patient's consent. Patients' compliance with screening recommendations and biopsy results were evaluated according to literacy levels. Results an abnormal PSA, a suspicious DRE, or both were present in 73.2%, 19.7%, and 7.1% of those men who underwent biopsy, respectively. PCa was diagnosed in 652 men (3.7%). Previous PSAs or DREs were less common among illiterate men (p < 0.0001). Additionally, illiterate men were less prone to attend to further evaluations due to an abnormal PSA or DRE (p < 0.0001). PSA levels > 10 mg/mL (p = 0.03), clinical stage > T2a (p = 0.005), and biopsy Gleason > 7 (p = 0.02) were more common among illiterate men. Conclusions In a screened population, literacy levels were associated with prior PCa evaluations and with compliance with screening protocols. Illiterate men were at higher risk of being diagnosed with more advanced and aggressive PCa. .

Lack of association between the ICIQ-SF questionnaire and the urodynamic diagnosis in men with post radical prostatectomy incontinence / Falta de associação entre o questionário ICIQ-SF e o diagnóstico nos homens portadores de incontinência urinária pós-prostatectomia radical

PURPOSE: To analyze the correlation between the "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-UISF) survey and the urodynamic findings in men with urinary incontinence (UI) following radical prostatectomy (RP). METHODS: 88 men who presented post-RP UI for a minimum of 1 year were enrolled prospectively. All answered the ICIQ-UISF survey and underwent urodynamic testing. Patients were divided in 3 Groups according to their urodynamic diagnosis: Group 1, patients with sphincteric incontinence (SI) alone; Group 2, patients with mixed UI (SI + Bladder Dysfunction (BD)); and Group 3, patients with BD alone. Data were analyzed using SPSS v16.0 software. RESULTS: There were 51 men in Group 1 (57.9%); 30 in Group 2 (34%); and 7 (7.9%) in Group 3. BD was found in 37/88 patients (42%), but it was the main cause of UI in only 14 patients (15.9%). There was no statistically significant difference among the mean ICIQ-UISFs values from groups 1, 2, or 3 (p>0.05). The symptoms of stress incontinence correlated with the urodynamic finding of SI (r = 0.59), and complaints of urinary urgency correlated with the presence of detrusor overactivity (DO) (r = 0.37), but these complaints did not predict the main cause of UI. CONCLUSION: The etiology of UI following RP cannot be predicted by the ICIQ-UISF survey. Symptoms of stress and urge incontinence predict the findings of SI and DO on urodynamic tests, but they cannot ascertain the main cause of UI. Urodynamic testing remains the gold standard to assess the etiology of post-RP UI.

OBJETIVO: Analisar a relação entre as queixas clínicas mensuradas pelo "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-UISF) e os achados urodinâmicos em homens com incontinência urinária (IU) após a prostatectomia radical (PR). MÉTODOS: 88 homens que apresentavam IU por um período mínimo de 1 ano após a PR foram incluídos prospectivamente. Todos responderam o questinário "ICIQ-UISF" e foram submetidos a avaliação urodinâmica. Os pacientes foram categorizados em 3 grupos de acordo com o diagnóstico urodinâmico: Grupo 1, pacientes com incontinência esfincteriana isolada (IE); Grupo 2, pacientes com IU mista (IE + disfunção vesical (DV)); e Grupo 3, pacientes com DV isolada. Os dados foram analisados utilizando o software SPSS v16.0. RESULTADOS: Dos 88 pacientes avaliados, após a avaliação urodinâmica, 51 homens (57,9%) apresentaram IE isolada (Grupo 1); 30 homens (34%) apresentaram IE associada a DV (Grupo 2) e 7 homens (7,9%) tinham somente DV (Grupo 3). A DV foi encontrada em 37/88 pacientes (42%), mas foi a principal causa de IU em apenas 14 pacientes (15,9%). Não houve diferença estatisticamente significativa entre os valores das médias do "ICIQ-UISFs" entre os grupos 1, 2 ou 3 (p> 0,05). Os sintomas de incontinência de esforço se correlacionaram com o diagnóstico urodinâmico de IE (r = 0,59), e as queixas de urgência miccional se correlacionaram com a presença de hiperactividade do detrusor na avaliação urodinâmica (r = 0,37), entretanto apesar da correlação encontrada, os sintomas não foram capazes de identificar a principal causa da UI . CONCLUSÃO: A etiologia da UI após a PR não pode ser previsto pelo escore de sintomas obtidos através do "ICIQ-UISF". Os sintomas de perda urinária as manobras de estresse e de urgência miccional estão relacionados a presença de IE e hiperatividade detrusora na avaliação urodinâmica, entretanto estes sintomas não conseguem identificar com segurança qual é o principal fator da IU após a PR.O teste urodinâmico continua sendo o padrão ouro para avaliar a etiologia da IU após a PR.

Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy / Ureterostomia cutânea como opção de derivação urinária em pacientes em condições clínicas após cistectomia radical

PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.

OBJETIVO: Relatar a experiência do emprego da ureterostomia cutânea (UC) como forma de derivação urinária definitiva em pacientes portadores de neoplasia vesical avançada, em más condições clínicas e que necessitam de tratamento paliativo. MÉTODOS: Foram analisados retrospectivamente os parâmetros clínicos e operatórios de 41 pacientes submetidos a cistectomia radical e UC em três centros oncológicos especializados. A UC foi a derivação urinária escolhida quando os pacientes não apresentavam condições clínicas de serem submetidos a outro tipo de derivação . Foram avaliados a morbidade peri-operatória e a sobrevida global. RESULTADOS: A idade média dos pacientes foi de 69 anos (intervalo interquartil - IQR 62, 76); 30 (73%) pacientes eram do sexo masculino. Vinte e cinco pacientes (61%) foram submetidos a cirurgia de urgência sendo a maioria devido a hemorragia grave associada a instabilidade hemodinâmica. O tempo cirúrgico médio foi de 180 minutos (IQR 120, 180). As complicações peri-operatórias ocorreram em 30 (73%) pacientes sendo a maioria classificadas como "Clavien" graus I e II (66,6%). Não houve óbito per-operatório. A reabordagem cirúrgica foi necessária em 7 (17%) dos pacientes e a sobrevida global foi de 24% após 9,4 meses de seguimento. CONCLUSÕES: A UC com implante de "stent" ureteral é uma alternativa simples de derivação urinária, após cistectomia paliativa, em pacientes sem condições clínicas de serem submetidos a procedimentos cirúrgicos mais complexos. A UC é um procedimento rápido e apresenta taxas de complicações aceitáveis. Essa alternativa cirúrgica permite melhorar a qualidade de vida dos pacientes portadores de tumores vesicais localmente avançados.

Hematúria / Hematuria

Hematúria é uma manifestação clínica importante, muitas vezes o primeiro sinal de várias doenças do trato urinário. Portanto, a sua investigação adequada é de suma importância para o diagnóstico e tratamento de várias condições urológicas.

Hematuria an important clinical manifestation of many diseases of the urinary tract. Therefore, its evaluation is important to adequately diagnose and treat such clinical conditions.

Tratamento do câncer de próstata localizado / Treatment of localized prostate cancer

O câncer de próstata é a neoplasia maligna mais frequente na população masculina excetuando os tumores de pele, sendo comumente diagnosticado em estágios localizados da doença. Quando localizado, tem boa perspectiva de tratamento com diversas modalidades terapêuticas. O capitulo se propõe a discutir sobre algumas das atuais opções que o paciente e seu médico assistente têm à sua dispozição.

Revisão sobre tumor de Wilms / Review of Wilms' tumor

Os autores fazem uma revisão bibliográfica sobre Tumor de Wilms: sua epidemiologia, classificação, diagnóstico, estadiamento e tratamento.

Há uma associação entre anti-inflamatórios não-esteroides e nefropatia induzida por contraste? / Is there an association between non-steroidal anti-inflammatory drugs and contrast nephropathy? / ¿Hay una asociación entre antiinflamatorios no esteroides y nefropatía inducida por contraste?

FUNDAMENTO: A associação entre o uso de anti-inflamatórios não-esteroides (AINEs) e insuficiência renal aguda ou crônica é bem documentada, mas evidências sobre a associação entre AINEs e nefropatia induzida por contraste (NIC) não são encontradas na literatura. OBJETIVO: Avaliar uma possível associação entre AINEs e NIC. MÉTODOS: Em um estudo de coorte, através da entrevista clínica de pacientes que foram submetidos à cateterização cardíaca, analisamos o uso de AINEs e sua associação com desenvolvimento de NIC, através da alteração dos níveis de creatinina sérica ou taxa de filtração glomerular em 48 ou 72 horas. RESULTADOS: No período de julho de 2005 a julho de 2006, 236 pacientes foram incluídos no estudo, dos quais 29 foram posteriormente excluídos. A incidência de NIC foi 10,37 por cento (20 de 207) e 42 por cento dos pacientes estavam recebendo AINEs até o momento da avaliação. Não houve associação entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95 por cento (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95 por cento (1,05-7,47) e insuficiência renal crônica com OR de 3,48; IC95 por cento (1,1-11,07) e também sugeriu uma ação protetora da hidratação com solução salina com OR de 0,166; IC95 por cento (0,03-0,92). CONCLUSÃO: Com base nos dados obtidos, concluímos que não houve associação entre NIC e uso prévio de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.

BACKGROUND: The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE: To evaluate the possible association between NSAIDs and CIN. METHODS: In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS: From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37 percent (20 of 207) and 42 percent of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95 percent CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95 percentCI (1.05-7.47) and chronic renal failure with OR 3.48 95 percentCI (1.1-11.07). A protective action of saline solution hydrationis also suggested, with OR of 0.166 95 percentCI (0.03-0.92). CONCLUSION: Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

FUNDAMENTO: La asociación entre el uso de antiinflamatorios no esteroides (AINEs) e insuficiencia renal aguda o crónica está bien documentada, pero evidencias sobre la asociación entre AINEs y nefropatía inducida por contraste (NIC) no son encontradas en la literatura. OBJETIVO: Evaluar una posible asociación entre AINEs y NIC. MÉTODOS: En un estudio de cohorte, a través de la entrevista clínica de pacientes que fueron sometidos a cateterismo cardíaco, analizamos el uso de AINEs y su asociación con desarrollo de NIC, a través de la alteración de los niveles de creatinina sérica o tasa de filtrado glomerular en 48 o 72 horas. RESULTADOS: En el período de julio de 2005 a julio de 2006, 236 pacientes fueron incluidos en el estudio, de los cuales 29 fueron posteriormente excluidos. La incidencia de NIC fue 10,37 por ciento (20 de 207) y 42 por ciento de los pacientes estaban recibiendo AINEs hasta el momento de la evaluación. No hubo asociación entre el uso de AINEs y el desarrollo de NIC con OR de 1,293; IC95 por ciento (0,46-4,2). El estudio detectó factores de riesgo conocidos para el desarrollo de NIC, tales como diabetes, con OR de 2,77; IC95 por ciento (1,05-7,47) e insuficiencia renal crónica con OR de 3,48; IC95 por ciento (1,1-11,07) y también sugirió una acción protectora de la hidratación con solución salina con OR de 0,166; IC95 por ciento (0,03-0,92). CONCLUSIÓN: Con base en los datos obtenidos, concluimos que no hubo asociación entre NIC y uso previo de AINEs, por lo menos con un OR > 2,85, el cual nuestra muestra detectó.

Abordagem laparoscópica de incidentaloma de adrenal: um caso raro de ganglioneuroma / Laparoscopic approach of adrenal incidentaloma: a rare case of ganglioneuroma

Objetivo: discutir a abordagem e o manejo laparoscópico de um raro caso de ganglioneuroma de adrenal em incidentaloma. Descrição do caso: um paciente masculino de 45 anos teve diagnóstico de incidentaloma de adrenal com 7,5 cm à ultrassonografia e padrão tomográfico incaracterístico. A suprarrenalectomia laparoscópica transperitoneal durou 63 minutos e utilizou quatro portais (um de 12, um de 11 e dois de 5 mm) para a abordagem da glândula, a qual foi removida por uma ampliação do portal de 12 mm até cerca de 3,5 cm, em saco coletor. O sangramento computado foi inferior a 50 ml. O exame anatomopatológico revelou tratar-se de ganglioneuroma. Houve excelente evolução pós-operatória, com alta hospitalar 72 horas apos o procedimento. Conclusões: a propedêutica dos incidentalomas de adrenal é motivo de controvérsias na literatura. Este relato busca chamar a atenção para a possibilidade do ganglioneuroma como causa de incidentaloma de adrenal, principalmente em pacientes jovens. A remoção cirúrgica desse tumor normalmente resulta em cura clínica e a abordagem laparoscópica é a opção preferencial.

Aims: To discuss the diagnostic and therapeutic options in a rare case of ganglioneuroma as cause of adrenal incidentaloma. Case description: A 45-year old male presented with a diagnosis of adrenal incidentaloma during routine clinical evaluation. The lesion measured 7.5 cm on ultrasound, and computerized tomography findings were non-characteristic. A transperitoneal laparoscopic adrenalectomy was performed in 63 minutes of surgery time, through four ports (12, 11, and two of 5 mm). The specimen was removed through an augmentation of the 12 mm port until roughly 3.5 cm, inside an endocatch bag. Intraoperative bleeding was less than 50 ml.Pathological examination revealed an adrenal ganglioneuroma.Postoperative course was uneventful, and the patient was discharged home 72 hours after the procedure. Conclusions: In the literature reviewed, the diagnostic and therapeutic approaches of adrenal incidentalomas are controversial. Our report points out to the possibility of ganglioneuroma as a cause of adrenal incidentalomas, especially among young patients. Its surgical removalgenerally results in cure, and the laparoscopic approach is currently the preferred option.

Existe associação entre antiinflamatórios não-esteróides e nefropatia induzida por contraste?: [revisão] / Is there association between non-steroiddal anti-inflammatory drugs and contrast media-induced nephropathy?: [review]

Objetivos: revisar a literatura médica sobre a possíbilidade de exixtir associação entre uso de antiinflamatórios não esteróides e aumento na incidência da nefropatia induzida por contraste. Fonte de dados: busca de artigos na base de dados Pubmed/Medline. Síntese dos dados: a investigação demonstrou não haver nenhum estudo observacional ou ensaio clínico que sustente a existência de associação entre a exiStência de associação entre uso de AINES e nefropatia induzida por contraste. Existem apenas relatos apenas relatos anedóticos em meio a artigos de revisão que incluem os antiinflamatórios não esteróides como drogas nefrotóxicas. Revisando mecanismos de lesão renal induzida pelo uso de meios de contrastes e pelos antiinflamatórios não esteróides, não parece haver razão para acreditar em um sincronismo que leve a lesão renal. Conclusões:faltam evidências, na literatura médica indexada, que sustetentem a afirmação de que os antiinflamatórios não esteróides seriam de risco para o desenvolvimento de nefropatia induzida por contraste.