Responsiveness to the Portuguese version of the international consultation on incontinence questionnaire - short form (ICIQ-SF) after stress urinary incontinence surgery

OBJECTIVE: To evaluate the reliability and responsiveness (internal and external) of the Portuguese version of the ICIQ-SF. We assessed the responsiveness of the ICIQ-SF after surgical procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Prospective open label study in 2 tertiary referral centers. Sixty-one patients of both genders (54 female and 7 male) were enrolled. Patients were treated using surgical procedures, mostly with synthetic sling (82 percent). Patients were assessed before surgery and at least 1 month postoperatively using the ICIQ-SF in its translated and validated Portuguese version. Patients also underwent pre-operative urodynamic tests, Stamey incontinence grading and pad usage assessments. After surgery, patients underwent stress tests, Stamey incontinence grading and pad usage assessments. RESULTS: The mean age was 57.2 (± 11.6) years and the mean duration of follow-up was 7.2 months (± 4.5). Objective parameters such as urodynamic tests (by means of VLPP) and pad usage had significant correlation with changes in post-treatment scores on the ICIQ-SF (p = 0.0062 and p < 0.0001 respectively). The responsiveness expressed in terms of standardized effect sizes (SES) and standardized response means (SRM) was large for both questionnaires (p < 0.0001). CONCLUSION: The results showed high responsiveness (large effect sizes I and II) for the Portuguese version of the ICIQ-SF, indicating that this instrument is suitable for measuring outcomes in clinical trials for Brazilian patients with stress urinary incontinence.

Renal cell carcinoma with thrombus in the inferior vena cava: extracorporeal circulation and deep hypothermia without open-chest surgery

INTRODUCTION: Renal cell carcinoma with thrombus in the inferior vena cava and no apparent metastasis requires immediate surgical treatment. Over the last few years, extracorporeal circulation with deep hypothermia and total circulatory arrest have played an increasingly important role in the treatment of diseases not associated with primary cardiovascular disorders, such as cavoatrial tumor thrombus in uterine tumors, adrenal tumors, Wilms' tumor, as well as renal cell carcinoma. CASE REPORT: A 78-year-old patient with renal cell carcinoma and tumoral thrombus in the inferior vena cava and above the supra-hepatic veins underwent right radical nephrectomy and removal of the thrombus from the vena cava with extracorporeal circulation and deep hypothermia with total circulatory arrest without opening the chest. The patient presented good post-operative evolution.

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

Ultra-som transvaginal associado ao estudo urodinâmico na avaliaçåo da incontinência urinária na mulher / Transvaginal ultrasound associated to urodynamic study in the management of urinary incontinence in women

No período de janeiro a setembro de 1993 foram estudadas 15 pacientes com idade variando entre 29 a 54 anos (mediana de 43 anos), com história de incontinência urinária recidivada após tentativa de correçåo cirúrgica por diferentes métodos com o objetivo de avaliar a contribuiçåo da ultra-sonografia transvaginal associada à avaliaçåo urodinâmica no diagnóstico etiólogico. Durante a fase de enchimento vesical foram avaliados com a ultra-sonografia transvaginal a abertura do colo vesical em relaçåo às variaçöes da pressåo intravesical e quando da ocorrência de perdas urinárias. Abertura do colo vesical durante a micçåo também foi estudada. Foram diagnosticados cinco casos com instabilidade do detrusor, oito pacientes com abertura do colo vesical e perda urinária apenas quando submetidas à manobra de Valsalva e duas pacientes com o colo vesical aberto em repouso, com perda urinária contínua já na fase de enchimento vesical, correspondendo à insuficiência esfincteriana. A avaliaçåo urodinâmica associada à ultra-sonografia transvaginal constitui um método diagnóstico promissor em virtude da facilidade de aprendizado e aplicaçåo podendo vir auxiliar no diagnóstico etiólogico da incontinência urinária na mulher

Imunoterapia ativa especifica no tratamento do carcinoma renal estadio IV: reaçoes linfoproliferativa determinadas por um antigeno purificado da vacina / Specific active immunotherapy foe renal carcinoma stage IV: lymphooproliferitive reactions determined from a purified antigen

Proteinas associadas ao tecido tumoral (PATT) foram extraidas e utilizadas tanto para a preparaçao de uma vacina como para a comparaçao, quanto ao seu perfil imunoquimico com proteinas associadas ao tecido renal normal (PATN). A analise eletroforetica em gel de poliacrilamida na presença de SDS demonstrou a existencia de um componente na fraçao PATT praticamente ausente em PATN. A cromatografia de filtraçao em Sephadex G-100 da fraçao PATT evidenciou seis fraçoes (F1 a F6). A analise eletroforetica das fraçoes obtidas em gel de poliacrimida na presença de SDS, evidenciou que a fraçao F2 encontrada em PATT estava em PATN, sugerindo que a imunogenicidade da vacina em estudo poderia ser atribuida ao antigeno F2. A reaçao linfoproliferativa de celulas do paciente imunizado com a vacina bruta frente a F2 foi cinco vezes maior do que em celulas de individuos normais. A determinaçao de TNF (Fator de Necrose Tumoral) foi realizada no paciente, antes e depois do inicio da imunoterapia, e mostrou a queda desta citocina em torno de 47//apos seis meses de tratamento com a vacina.