Evaluating TIMP-2 and IGFBP-7 as a predictive tool for kidney injury in ureteropelvic junction obstruction

ABSTRACT A major challenge in the management of ureteropelvic junction obstruction (UPJO) is the selection of patients who would benefit from surgical treatment. Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) indicate renal cell stress and are associated with cell cycle arrest. The [TIMP-2] [IGFBP7] ratio (Nephrocheck®) has been recently applied in patients in intensive care units patients to predict the development of acute kidney injury. In this study, we evaluated the performance of these biomarkers performance to distinguishing obstructive hydronephrosis (HN) from non-obstructive HN. Materials and Methods: Consecutive patients with UPJO were enrolled in this study. Urinary [TIMP-2] [IGFBP7] and clinical characteristics (hydronephrosis grade, differential renal function, and drainage half-time) were measured in the following groups: 26 children with obstructive HN at initial diagnosis (group 1A) and after six months of dismembered pyeloplasty (group 1B); 22 children with non-obstructive HN (group 2), and 26 children without any urinary tract condition, as the control group (group 3). Results: Comparing the initial samples, [TIMP-2] [IGFBP7] had higher levels in the HN groups and lower levels in the control group; however, no difference was observed between the HN groups (obstructive vs. non-obstructive). After six months of follow-up, patients who underwent dismembered pyeloplasty showed stability in the urinary concentration of [TIMP-2] [IGFBP7]. All patients with [TIMP-2] [IGFBP7] higher than 1.0 (ng/mL)2/1000 had diffuse cortical atrophy on ultrasonography. Conclusions: We showed that urinary levels of urinary [TIMP-2] [IGFBP7] are higher in children with HN than controls. Nephrocheck® is not reliable in predicting the need for surgical intervention for pediatric patients with UPJO.

Use of contrast-enhanced ultrasound in pediatrics / Utilização da ultrassonografia com contraste de microbolhas na pediatria

Abstract Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particularly in pediatric patients, it is still used relatively rarely in Brazil. It has proven to be a safe technique, and adverse effects are rare. In this review, we address the technique and main applications of contrast-enhanced ultrasound in the pediatric population, including the evaluation of focal liver lesions, abdominal trauma, kidney grafts, liver grafts, bowel loops, and vesicoureteral reflux. It is important for pediatric radiologists to be acquainted with this promising tool, understanding its applications and limitations.

Resumo A ultrassonografia com contraste de microbolhas é um método ainda pouco utilizado no Brasil, mas que tem grandes vantagens, ainda mais na faixa pediátrica, como ausência de radiação e dispensa de sedação/anestesia. O contraste de microbolhas tem se mostrado bastante seguro e com raríssimas reações adversas graves. Apresentaremos nesta revisão a técnica para o uso desse contraste na ultrassonografia, bem como as principais aplicações na faixa pediátrica, como avaliação das lesões hepáticas focais, do trauma abdominal, do enxerto hepático e renal nos transplantes, das alças intestinais e da pesquisa de refluxo vesicoureteral. É importante que radiologistas que exerçam funções em centros pediátricos conheçam essa ferramenta promissora.

Can extended upper pole ureterectomy prevent ureteral stump syndrome after proximal approach for duplex kidneys?

ABSTRACT Introduction: Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction (megaureter, ureterocele or ectopic ureter) and/or vesicoureteral reflux. Upper-pole nephrectomy is a widely accepted procedure to correct symptomatic duplex systems with poor functioning moieties, also known as upper or proximal approach. The distal ureteral stump syndrome (DUSS) can be a late complication of this approach. There is no consensus upon the length of ureteral dissection and the better approach to symptomatic disease in duplex systems, so we aim to identify if extended ureteral dissection can prevent DUSS in top-down approach. Materials and Methods: Forty-four consecutive patients with symptomatic duplex system were retrospectively classified into two groups: those with limited ureteral excision after heminephrectomy (HN) (group-1) and those with extended ureterectomy after HN (group-2). Patients were followed-up for at least 36 months regarding outcomes of distal ureteral stump. Results: Overall complication was 20%. A total of 8 patients required unplanned further surgery in Group-1 (30%) whereas only 1 patient required unplanned surgery in group 2 (6%) (p=0.07). Subgroup analysis showed that Group-1 presented more DUSS requiring surgery during follow-up than group-2 (p=0.04). Factors possibly affecting complications incidence (such as ureterocele or ectopic ureter) did not differ between groups (p=0.72 and p=0.78). Conclusion: Upper pole nephrectomy should be performed with extended distal ureteral dissection to prevent ureteral stump complications.

Patients with encrusted ureteral stents can be treated by a single session combined endourological approach

ABSTRACT Purpose: To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. Materials and Methods: Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. Results: We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stone-free was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). Conclusions: The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.

Onde e Como se Suicidam os Guarani e Kaiowá em Mato Grosso do Sul: Confinamento, Jejuvy e Tekoha / Where and How the Guarani and Kaiowá Commit Suicide in Mato Grosso do Sul: Confinement, Jejuvy and Tekoha / ¿Dónde y Cómo se Suicidan los Guaraníes y Kaiowás en Mato Grosso del Sur: Confinamiento, Jejuvy y Tekoha

O território para os povos originários é fundamental para a saúde e reelaboração cultural de seus modos de ser, na relação entre natureza, cultura e relações de poder/resistência. O direito a viver ou morrer se liga à territorialidade na luta pela terra. O objetivo deste trabalho consistiu em analisar onde e como ocorrem os suicídios de Guarani e Kaiowá na contemporaneidade. Realizou-se uma pesquisa qualitativa de análise documental de reportagens veiculadas em jornais de maior circulação no estado de Mato Grosso do Sul. A busca foi realizada em 23 jornais, mas apenas 12 deles apresentaram notícias com a temática a partir da combinação dos descritores: Suicídio, Guarani, Kaiowá, Índio e Indígena. Constituiu-se uma amostra com 100 reportagens que informaram 105 ocorrências de suicídio no período entre 2002 a 2018. Os dados revelam que a violência é frequente nas reservas indígenas em que os Guarani e Kaiowá foram confinados no sul do estado. Os casos se concentram em aldeias dos municípios de Dourados e Amambai, a maioria entre jovens adultos com idade entre 12 e 22 anos, do sexo masculino. A eminente maioria (95%) cometeu suicídio pela prática do enforcamento (jejuvy). As causas para o suicídio variam desde explicações orientadas pela cosmologia, o feitiço, formas culturais de morrer, desterritorialização de seus tekoha e a inserção econômica marginal. Considerando os dados alarmantes, sugere-se a criação e implementação do CAPS indígena, com o envolvimento de atores institucionais, como a Sesai e a Secretaria Municipal de Saúde, além de lideranças religiosas, Ñhanderu e Nhandecy....(AU)

The territory for the native peoples is fundamental to the health and cultural re-elaboration of their ways of being, in the link between nature, culture and relations of power/resistance. The right to live or die is connected to territoriality in the struggle for land. The objective of this work was to analyze where and how the suicides of Guarani and Kaiowá occur in contemporary times. A qualitative research with documentary analysis of reports published in the newspapers with the largest circulation in the state of Mato Grosso do Sul was performed. The search was carried out in 23 newspapers, but only 12 of them presented news with the theme, combining the descriptors: Suicide, Guarani, Kaiowá, Indian and Indigenous. A sample of 100 reports that reported 105 suicide occurrences between 2002 and 2018 was composed. Data reveal that violence is frequent in the indigenous reserves where the Guarani and Kaiowá were confined in the south of the state. The cases are concentrated in villages in the municipalities of Dourados and Amambai, mostly among male young adults between 12 and 22 years of age. The eminent majority (95%) committed suicide by the practice of hanging (jejuvy). The causes for suicide range from explanations guided by cosmology, the spell, cultural forms of dying, deterritorialization of their tekoha, and marginal economic insertion. Considering the alarming data, it is suggested the creation and implementation of indigenous CAPS, with the involvement of institutional actors, such as Sesai and the Municipal Health Secretariat, as well as religious leaders, Ñhanderu and Nhandecy....(AU)

El territorio para los pueblos originarios es fundamental para la salud y reelaboración cultural de sus modos de ser, en la relación entre naturaleza, cultura y relaciones de poder/resistencia. El derecho a vivir o morir se une a la territorialidad en la lucha por la tierra. El objetivo de este trabajo consistió en analizar dónde y cómo ocurren los suicidios de Guaraníes y Kaiowás en la contemporaneidad. Se realizó una investigación cualitativa de análisis documental de reportajes publicados en periódicos de mayor circulación en el estado de Mato Grosso do Sul. La búsqueda fue realizada en 23 periódicos, pero sólo 12 de ellos presentaron noticias con la temática a partir de la combinación de los descriptores: Suicidio, Guaraní, Kaiowá, Indio e Indígena. Se constituyó una muestra con 100 reportajes que informaron 105 casos de suicidio en el período entre 2002 y 2018. Los datos revelan que la violencia es frecuente en las reservas indígenas en que los Guaraníes y Kaiowás fueron confinados en el sur del estado.Los casos se concentran en aldeas de los municipios de Dourados y Amambai, la mayoría entre jóvenes adultos con edad entre 12 y 22 años, del sexo masculino. La eminente mayoría (95%) cometió suicidio por la práctica del ahorcamiento (jejuvy). Las causas para el suicidio varían desde explicaciones orientadas por la cosmología, el hechizo, formas culturales de morir, desterritorialización de sus tekohas y la inserción económica marginal. Considerando los datos alarmantes, se sugiere la creación e implementación del CAPS indígena, con la participación de actores institucionales, como la Sesai y la Secretaría Municipal de Salud, además de líderes religiosos, Ñhanderu y Nhandecy....(AU)

Mid- and Longterm Neo-Aortic Valve Regurgitation after Jatene Surgery: Prevalence and Risk Factors / Regurgitação da Valva Neo-Aórtica a Médio e Longo Prazo após Cirurgia de Jatene: Prevalência e Fatores de Risco

Abstract Background: Jatene surgery became the surgical procedure of choice to repair transposition of the great arteries (TGA) in neonates and infants. Late complications, mainly related to the pulmonary outflow tract and coronary arteries, are well known. The behavior of the neo-aortic valve is a cause of concern because of its potential for requiring late reoperation. Objectives: To assess the prevalence and risk factors of neo-aortic valve regurgitation in 127 patients in the late postoperative period of the Jatene surgery. Methods: Of the 328 survivors of the Jatene surgery at the Biocor Institute from October 1997 to June 2015, all patients undergoing postoperative follow-up were contacted via telephone, 127 being eligible for the study. The patients were divided into two groups, simple TGA and complex TGA groups, with follow-up means of 6.4 ± 4.7 years and 9.26 ± 4.22 years, respectively. Echocardiography was performed with adjusted measurements (Z-score) of the neo-aortic annulus, sinus of Valsalva, sinotubular region and ascending aorta, as well as quantification of the neo-aortic valve regurgitation grade. Results: The incidence of mild neo-aortic valve regurgitation was 29% in a follow-up of 7.4 ± 4.7 years. Moderate regurgitation was identified in 24 patients with age mean (± standard-deviation) of 9.81 ± 4.21 years, 19 of whom (79%) in the complex TGA group. Those patients had a higher aortic annulus Z-score. The reoperation rate due to neo-aortic regurgitation associated with aortic dilation was 1.5%, all patients in the complex TGA group. Conclusion: This study shows that, despite the low incidence of reoperation after Jatene surgery due to neo-aorta dilation and neo-aortic valve regurgitation, that is a time-dependent phenomenon, which requires strict vigilance of the patients. In this study, one of the major risk factors for neo-aortic valve regurgitation was the preoperative pulmonary artery diameter (p < 0.001).

Resumo Fundamento: A operação de Jatene tornou-se o procedimento cirúrgico de escolha para o reparo da transposição das grandes artérias (TGA) em neonatos e lactentes. Complicações tardias, principalmente relacionadas à via de saída pulmonar e às artérias coronarianas, já são bem reconhecidas. O comportamento da valva neo-aórtica tem sido motivo de crescente preocupação pelo seu potencial de necessidade de reoperações tardias. Objetivos: Avaliar a prevalência e os fatores de risco associados à regurgitação da valva neo-aórtica em 127 pacientes em pós-operatório tardio de cirurgia de Jatene. Métodos: Dos 328 sobreviventes da cirurgia de Jatene no Biocor Instituto operados de outubro de 1997 a junho de 2015, todos os pacientes em seguimento de pós-operatório foram contatados via ligação telefônica, sendo 127 elegíveis para o estudo. Os pacientes foram divididos em dois grupos, Grupo TGA simples e Grupo TGA complexa, com médias de follow-up de 6,4 ± 4,7 anos e 9,26 ± 4,22 anos, respectivamente. Foi realizada avaliação ecocardiográfica com medidas indexadas (escore Z) do anel da valva neo-aórtica, do seio de Valsalva, da região sinotubular e da aorta ascendente, bem como quantificação do grau de regurgitação da valva neo-aórtica. Resultados: A incidência de leve regurgitação da valva neo-aórtica em nossa casuística foi de 29% em um follow-up de 7,4 ± 4,7 anos. Regurgitação moderada foi observada em 24 pacientes, com idade média (± desvio-padrão) de 9,81 ± 4,21 anos, sendo 19 (79%) no Grupo TGA complexa. Nesses pacientes, observou-se maior escore Z do anel aórtico. A taxa de reoperação por regurgitação da valva neo-aórtica associada a dilatação da aorta foi de 1,5%, sendo todos os casos no Grupo TGA complexa. Conclusão: O estudo demonstra que, embora reoperações após cirurgia de Jatene por dilatação da neo-aorta e regurgitação da valva neo-aórtica tenham incidência baixa, esse é um fenômeno dependente de tempo, requerendo rígida vigilância desses pacientes. Na nossa casuística, um dos principais fatores de risco para regurgitação da valva neo-aórtica foi o diâmetro da artéria pulmonar no pré-operatório (p < 0,001).

Neoplasmas cutâneos em cães: 656 casos (2007-2014) em Cuiabá, MT / Cutaneous neoplasms in dogs: 656 cases (2007-2014) from Cuiabá, MT

Os neoplasmas cutâneos em cães apresentam elevada e relevante prevalência em todo o Brasil. Sendo assim, objetivou-se determinar a frequência e algumas características epidemiológicas dos neoplasmas cutâneos em cães diagnosticados no Laboratório de Patologia da Universidade Federal de Mato Grosso (LPV-UFMT), Cuiabá, entre os anos de 2007 a 2014. Foram revisados os protocolos de necropsias e biopsias do LPV-UFMT, de cães com neoplasmas cutâneos. Dados referentes à idade, sexo, raça dos cães afetados, localização anatômica, tamanho, diagnóstico histomorfológico e comportamento biológico foram coletados e analisados através de uma análise estatística descritiva. Adicionalmente o teste χ2, foi utilizado para associações entre comportamento biológico e tamanho da massa. Dos 3566 exames realizados, 656 (18,4%) foram diagnosticados como tumores cutâneos sendo cães adultos e idosos das raças Pit Bull, Boxer e Poodle os mais acometidos. Dentre os 11 padrões morfológicos mais diagnosticados o mastocitoma, carcinoma de células escamosas (CCE) e os tumores de origem vascular foram os mais frequentemente relatados. Em relação ao sítio anatômico, a cabeça foi a mais acometida. A maioria dos tumores benignos apresentaram menos de 1cm de diâmetro e os malignos de 3 a 5cm. O aumento de neoplasmas em adultos e idosos pode estar relacionado ao somatório de danos causados por agentes carcinogênicos e o comprometimento imunológico.(AU)

Canine cutaneous neoplasms present high and relevant prevalence throughout Brazil. Here we determine the frequency and epidemiological characteristics of canine cutaneous neoplasms in dogs diagnosed at the Laboratory of Veterinary Pathology of the Federal University of Mato Grosso (LPV-UFMT), Cuiabá, from 2007 to 2014. The necropsy and biopsy protocols from canine cutaneous neoplasms diagnosed at the LPV-UFMT were reviewed. Data regarding age, sex, breed of affected dogs, anatomical location, size, histomorphological diagnosis and biological behavior of the tumors were evaluated through a descriptive statistical analysis. In addition, the χ2 test was used for associations between biological behavior and mass size. Of the 3566 examinations performed, 656 (18.4%) were diagnosed as cutaneous tumors being adult and old dogs of Pit Bull, Boxer and Poodle races most affected. Among the diagnoses, 11 morphological patterns were the most prevalent, being mastocytoma, squamous cell carcinoma (SCC) and tumors of vascular origin most frequently reported. In relation to the anatomical site, the head was the most affected. Most of the benign tumors were less than 1cm in diameter and the malignant were 3 to 5cm. The increase of neoplasms in adults and old age dogs may be associated to the sum of damage caused by carcinogenic agents and the immunological impairment.(AU)

Transperitoneal laparoscopic pyeloplasty in children: does upper urinary tract anomalies affect surgical outcomes?

ABSTRACT Objective To assess the feasibility and outcomes of laparoscopic pyeloplasty in children with complex ureteropelvic junction obstruction (UPJO) and compare to children with iso-lated UPJO without associated urinary tract abnormalities. Material and Methods Medical records of 82 consecutive children submitted to transperi-toneal laparoscopic pyeloplasty in a 12-year period were reviewed. Eleven cases were con-sidered complex, consisting of atypical anatomy including horseshoe kidneys in 6 patients, pelvic kidneys in 3 patients, and a duplex collecting system in 2 patients. Patients were di-vided into 2 groups: normal anatomy (group 1) and complex cases (group 2). Demographics, perioperative data, outcomes and complications were recorded and analyzed. Results Mean age was 8.9 years (0.5-17.9) for group 1 and 5.9 years (0.5-17.2) for group 2, p=0.08. The median operative time was 200 minutes (180-230) for group 1 and 203 minutes (120-300) for group 2, p=0.15. Major complications (Clavien ≥3) were 4 (5.6%) in group 1 and 1 (6.3%) in group 2, p=0.52. No deaths or early postoperative complications such as: urinoma or urinary leakage or bleeding, occurred. The success rate for radiologic improvement and flank pain improvement was comparable between the two groups. Re-garding hydronephrosis, significant improvement was present in 62 patients (93.4%) of group 1 and 10 cases (90.9%) of group 2, p=0.99. The median hospital stay was 4 days (IQR 3-4) for group 1 and 4.8 days (IQR 3-6) for group 2, p=0.27. Conclusions Transperitoneal laparoscopic pyeloplasty is feasible and effective for the management of UPJO associated with renal or urinary tract anomalies.

Urethral duplication type influences on the complications rate and number of surgical procedures

ABSTRACT Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.

One - staged reconstruction of bladder exstrophy in male patients: long - term follow-up outcomes

ABSTRACT Introduction The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant. Objective To present our experience of our modified one-stage reconstruction of bladder exstrophy in male patients. Materials and Methods Medical records of male patients submitted to one-stage reconstruction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2±7 years were treated at our institution between 1999-2013. Results 2 5 Conclusions One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies.

Angiosarcoma of small intestine: case report and literature review / Angiossarcoma de intestino delgado: relato de caso e revisão da literatura

ABSTRACT Introduction: Angiosarcomas are rare pathologies, and their appearance in the small intestine is extremely unusual. Case report: Female patient presenting vomiting, colic, abdominal distension and peritoneal irritation. An exploratory laparotomy and an enterectomy were performed. Histopathology revealed vascular neoplasm; immunohistochemistry, markers CD31, p53 and cell proliferation antigen Ki-67. The patient developed diffuse sarcomatosis and died two months after the onset of symptoms. Conclusion: This case demonstrates the difficulty in early diagnosing this pathology, due to its nonspecific clinical presentation. The disease aggressiveness, its unestablished predisposing factors and the controversy around the adequate treatment engender the poor prognosis.

RESUMO Introdução: Angiossarcomas são patologias raras, e o aparecimento deles no intestino delgado é extremamente incomum. Relato de caso: Paciente do sexo feminino apresentando vômitos, cólica, distensão abdominal e irritação peritoneal. Foram realizadas laparotomia exploratória e enterectomia, evidenciando-se neoplasia vascular ao anatomopatológico e marcadores CD31, p53 e antígeno de proliferação celular Ki-67 à imuno-histoquímica. A paciente evoluiu com sarcomatose difusa e faleceu dois meses após o início dos sintomas. Conclusão: Demonstra-se a dificuldade em diagnosticar precocemente essa patologia devido à sua clínica inespecífica. A agressividade da doença, seus fatores predisponentes indeterminados e a controvérsia referente ao tratamento adequado suscitam seu péssimo prognóstico.

Male urethral sarcoma: a case report and literature review / Sarcoma de uretra masculina: relato de caso e revisão de literatura

Urethral tumors are rare and aggressive. They usually affect men (2:1) and occur more commonly in white (85% of cases). Soft tissue sarcomas are a heterogeneous group of tumors that arise from embryonic mesoderm. It represents 1% of all cases of urinary tract malignancies and rarely primary affect the ureter. We report a case of male urethral sarcoma. To date, only two similar cases have been published in literature.

Os tumores de uretra são muito raros e bastante agressivos. Acometem mais frequentemente homens (2:1) e são mais comuns na raça branca (85% dos casos). Os sarcomas de tecidos moles são um grupo heterogêneo de tumores que surgem a partir da mesoderme embrionária e representam 1% de todos os casos de doença maligna urinária, raramente acometendo a uretra primariamente. Relamos aqui um caso extremamente raro de sarcoma uretral masculino com somente dois semelhantes publicados na literatura.

INITIAL EXPERIENCE WITH ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION OF RENAL MASSES: indications, applications and limitations / Ecoendoscopia com punção aspirativa de massas renais: indicações, aplicações e limitações

Context Tissue sampling of renal masses is traditionally performed via the percutaneous approach or laparoscopicaly. The utility of endoscopic ultrasound to biopsy renal lesions it remains unclear and few cases have been reported. Objectives To evaluate the feasibility and outcome of endoscopic ultrasound fine needle aspiration of renal tumors. Methods Consecutive subjects undergoing attempted endoscopic ultrasound fine needle aspiration of a kidney mass after evaluation with computerized tomography or magnetic resonance. Results Ten procedures were performed in nine male patients (median age 54.7 years) on the right (n = 4) and left kidney (n = 4) and bilaterally (n = 1). Kidney masses (median diameter 55 mm ; range 13-160 mm) were located in the upper pole (n = 3), the lower pole (n = 2) and the mesorenal region (n = 3). In two cases, the mass involved more than one kidney region. Surgical resection confirmed renal cell carcinoma in six patients in whom pre-operative endoscopic ultrasound fine needle aspiration demonstrated renal cell carcinoma. No complications were reported. Conclusions Endoscopic ultrasound fine needle aspiration appears as a safe and feasible procedure with good results and minimal morbidity. .

Contexto A amostragem de tecido de massas renais é tradicionalmente realizada através da abordagem percutânea ou pelo método laparoscópico. A utilidade do ultrassom endoscópico para biópsia de lesões renais ainda não está clara e poucos casos foram relatados na literatura. Objetivos Avaliar a factibilidade e os resultados da biópsia de tumores renais guiada por ultrassom endoscópico. Métodos Trata-se de uma série retrospectiva de casos de biópsias ecoguiadas de massa renal após avaliação com tomografia computadorizada ou ressonância magnética. Resultados Dez procedimentos foram realizados em nove pacientes do sexo masculino (idade média de 54,7 anos), no rim direito (n = 4), esquerdo (n = 4) e bilateralmente (n = 1). Massas renais (diâmetro médio 55 mm; variando de 13 a 160 mm) localizadas no pólo superior (n = 3), inferior (n = 2) e na região mesorenal (n = 3). Em dois casos, a massa envolvida mais de uma região renal. A ressecção cirúrgica confirmou carcinoma de células renais em seis pacientes nos quais a biópsia ecoguiada pré-operatória demonstrava carcinoma de células renais. Não foram relatadas complicações. Conclusões A biópsia de massas renais guiadas por ultrassom endoscópico é um procedimento seguro e viável, com bons resultados e mínima morbidade. .

Recurrence of acute myeloid leukemia in cryptorchid testis: case report / Recidiva de leucemia mieloide aguda em testículo criptorquídico: relato de caso

A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associated with right hydronephrosis. Due to the risk of germ-cell tumor in undescended testicle, the patient underwent radical right orchiectomy. The pathological examination showed recurrence of acute myeloid leukemia in the testis. He was referred to oncology for adjuvant therapy. Our literature review found no similar cases described.

Paciente de 23 anos, masculino, com antecedente de transplante de medula óssea por leucemia mieloide aguda. Há 5 anos, apresentou volumosa massa em região inguinal direita. No exame físico, foi constatada criptorquidia à direita. Os marcadores tumorais alfa-fetoproteína e beta-HCG encontravam-se dentro da normalidade, e a desidrogenase láctica estava aumentada. A tomografia computadorizada de abdomen e pelve revelou massa testicular direita com contiguidade pelo canal inguinal, até o retroperitônio ipsilateral, associada a hidronefrose direita. Devido ao alto risco de neoplasia germinativa em testículo criptorquídico, o paciente foi submetido à orquiectomia radical direita, cujo anatomopatológico revelou recidiva de leucemia mieloide aguda em testículo. Foi encaminhado para oncologia para terapia adjuvante. Nossa revisão não revelou nenhum caso semelhante na literatura.

Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES: To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS: In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS: Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment ...

Avaliação dos valores séricos e urinários de CA 19-9 e TGFbeta1 na obstrução parcial e completa de ureteres em ratos / Seric and urinary evaluation of CA 19-9 and TGF beta1 in a rat model of partial or complete ureteral obstruction

Introdução: A alteração dos níveis normais de marcadores séricos e urinários ocorre na presença de dano renal associado à uropatia obstrutiva. Valores séricos e e urinários de TGF beta1 e CA 19-9 ainda não foram avaliados em modelo experimental de uropatia obstrutiva. Material e Métodos: Ratos foram divididos em sete grupos: referência, sham operation, nefrectomia unilateral, ligadura completa de ureter unilateral, obstrução parcial de ureter unilateral, obstrução parcial de ambos ureteres, nefrectomia unilateral associada à obstrução parcial do ureter contralateral. Morfometria renal e ureteral, concentrações séricas e urinárias de TGF beta1 e CA 19-9 e expressão tecidual renal de CA 19-9 foram analisadas. A correlação destes marcadores com os grupos submetidos a obstrução completa, obstrução parcial ou sem obstrução foi realizada. Resultados: Achados anatomopatológicos correlacionaram-se positivamente à intensidade da obstrução ureteral e negativamente aos níveis urinários de CA 19-9. Subexpressão acentuada do CA 19-9 foi observada em unidades renais com obstrução completa. Não foram encontradas diferenças estatisticamente significativas para os marcadores TGF beta1 urinário, TGF beta1 sérico e para o CA 19-9 sérico Conclusões: O CA 19-9 urinário correlacionou-se negativamente com o grau de obstrução ureteral. A análise imuno-histoquímica demonstrou a expressão do CA 19-9 no citoplasma das células epiteliais tubulares, sugerindo produção renal do marcador. O TGF beta1 sérico e urinário não apresentaram modificações de acordo com o grau de severidade e tempo de obstrução, o que pode estar relacionado a remodelamento renal menos intenso em resposta à uropatia obstrutiva nestes ratos

Introduction: Abnormal levels of serum and urinary markers occur in the presence of renal damage associated to obstructive uropathy. Urinary and serum TGFbeta1 and CA 19- 9 have not yet been evaluated in an experimental model of obstructive uropathy. Material and Methods: Rats were divided into seven groups: reference, sham operation, unilateral nephrectomy, complete unilateral ureteral obstruction, partial unilateral ureteral obstruction, partial bilateral ureteral obstruction, and unilateral nephrectomy with contralateral partial ureteral obstruction. Kidney and ureter morphometry, TGFbeta1 and CA 19-9 serum and urinary concentrations and CA 19-9 renal tissue expression were analysed. Correlation of these markers to complete, partial obstruction or unobstructed groups was performed. Results: Pathological findings correlated positively with the degree of ureteral obstruction, but negatively with urinary CA 19-9 levels. Marked underexpression of CA 19-9 was observed in kidneys with complete ureteral obstruction. No statistically significant differences were found for urinary and serum TGFbeta1 and also for serum CA 19-9. Conclusions: Urinary CA 19-9 correlated negatively with ureteral obstruction grade. Immunohistochemistry depicted CA 19-9 expression on epithelial tubular cells cytoplasm, suggesting renal origin. Serum and urinary TGFbeta1 did not show alterations in response to severity and length of urinary obstruction, which might be associated with less intense renal remodeling

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. .

Síndrome de Boerhaave: relato de caso / Boerhaave´s syndrome: case report

Spontaneous esophageal rupture carries high morbidity and mortality. The main prognostic factor is early diagnosis, before 12 hours, and appropriate treatment. This is a case report of a 41-years-old man with late esophageal rupture diagnosis treated successfully with transmediatinal esophagectomy and esophageal-gastric tube cervical anastomosis.

Aspectos parasitológicos do pescado comercializado na costa da Mata Atlântica / Parasitological aspects of the fish commercialized on Costa da Mata Atlantica

O objetivo deste trabalho foi relatar a ocorrência de nematóides da família Anisakidae e trematódeos da espécie Ascocotyle (Phagicola) longa em pescado marinho comercializado na costa da Mata Atlântica. Foram examinadas 257 amostras de peixes colhidas pelos Serviços de Inspeção Federal, Estadual e Municipal em oito municípios, oriundas de toda cadeia produtiva, desde as unidades de captura até os pontos de comercialização. As análises parasitológicas foram conduzidas no Instituto de Pesca de Santos (URLTP), constituídas de peixes refrigerados inteiros, eviscerados, em postas ou filés. O pescado foi considerado infectado quando apresentava ao menos a presença de uma larva na cavidade abdominal e/ou no tecido muscular, após análise macroscópica e em mesa de inspeção (candling-table). Do total de 257 amostras de peixes, 63 estavam parasitadas por nematóides anisaquídeos e trematódeos digenéticos, representando 25,29% da amostragem. Este trabalho permitiu concluir que o consumidor pode infectar-se por esses parasitos ao se alimentar de produtos elaborados com carne de pescado crua, insuficientemente cozida ou defumada a frio.