The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

Abstract Purpose: To investigate the glomerular number after different warm ischemia times. Methods: Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Results: Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. Conclusions: About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

ABSTRACT PURPOSE: To evaluate the glomerular loss after arteriovenous or arterial warm ischemia in a swine model. METHODS: Twenty four pigs were divided into Group Sham (submitted to all surgical steps except the renal ischemia), Group AV (submitted to 30 minutes of warm ischemia by arteriovenous clamping of left kidney vessels), and Group A (submitted to 30 minutes of ischemia by arterial clamping). Right kidneys were used as controls. Weigh, volume, cortical volume, glomerular volumetric density (Vv[Glom]), volume-weighted glomerular volume (VWGV), and the total number of glomeruli were measured for each organ. RESULTS: Group AV showed a 24.5% reduction in its left kidney Vv[Glom] and a 25.4% reduction in the VWGV, when compared to the right kidney. Reductions were also observed when compared to kidneys of sham group. There was a reduction of 19.2% in the total number of glomeruli in AV kidneys. No difference was observed in any parameters analyzed on the left kidneys from group A. CONCLUSIONS: Renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage, but arteriovenous clamping caused significant glomerular loss in a swine model. Clamping only the renal artery should be considered to minimize renal injury after partial nephrectomies.

Penile primary melanoma: analysis of 6 patients treated at Brazilian national cancer institute in the last eight years

Purpose To describe our experience in treating penile melanoma in 06 patients followed at our institution. Materials and Methods Between 2004 and 2012 six consecutive patients with penile melanoma were treated at our Institution. Stage of the disease was classified according to the 2002 AJCC pathologic system. Melanoma in situ (TIS) was diagnosed in one patient. One patient was staged as T1b, two patients as T2b and two patients as T4b. The clinical and pathological findings were evaluated. Immunohistochemical tests were performed for Melan-A, HNB-45, S-100 and C-KIT. All histological specimens were examined by the same pathologist (ABSS). The patients with Cis, stages T1b and one patient T2b underwent only local excision. One patient T2b underwent local excision and sentinel lymph node dissection. Two patients with melanoma stage T4b underwent partial penile amputation. One of these last patients had palpable inguinal lymph nodes at diagnosis and underwent bilateral inguinal lymphadenectomy and received systemic chemotherapy (dacarbazine, 30 cycles). Results Mean follow-up was 36.3 months. One patient, with stage T2b, died after 12 months due to disease recurrence with bilateral inguinal involvement. The patient who underwent chemotherapy progressed with lung metastases and died after 14 months of follow up. The disease-free survival at five years was 33.3%. Conclusion: Penile melanoma is a disease with poor prognosis in most cases. Local excision or partial penile amputation may have effective control for stages T1 and T2 lesions. Patients who have clinically proven metastases died despite surgical and adjuvant chemotherapy. .

Avaliação da morfologia testicular e dos parâmetros espermáticos em ratos espontaneamente hipertensos e tratados com enalapril / Evaluation of testicular morphology and sperm parameters in spontaneously hypertensive rats treated with enalapril

A hipertensão arterial sistêmica (HAS) é um problema de saúde pública, geralmente associada a outras doenças, como obesidade, diabetes, doença renal, aterosclerose, acidente vascular cerebral (AVC) e identificado como um dos fatores de risco mais prevalentes para o desenvolvimento de doenças cardiovasculares. Orgãos-alvo, como coração, rins, cérebro e olhos, são comumente afetados em pacientes hipertensos. No entanto, o dano testicular causado pela hipertensão não foi claramente definido. A hipertensão é um fator de risco bem estabelecido para a disfunção erétil, mas sua relação com o dano testicular e a fertilidade masculina não é claramente compreendida. Este estudo avalia a morfologia testicular e alguns parâmetros espermáticos de ratos espontaneamente hipertensos (SHR), virgem de tratamento e tratados com enalapril. Ratos SHR foram distribuídos em dois grupos, um grupo hipertenso (H), e um grupo tratado com enalapril (HE). Ratos Wistar-Kyoto (WKY) foram utilizados como controles. A pressão arterial sistólica foi medida semanalmente, até o final do experimento. A concentração de espermatozóides, motilidade e viabilidade foram determinadas em amostras coletadas da cauda do epidídimo. Métodos estereológicos foram usados para analisar objetivamente a morfologia testicular macroscopicamente e microscopicamente. Todos os dados foram analisados por ANOVA com pós-teste de Tukey, considerando p <0,05. Ao final do experimento a pressão arterial sistólica no grupo HE (153,9 mmHg ± 21,03 ) foi semelhante a dos animais pertencentes ao grupo WKY (153,4 ± 24,41) e menor que a dos animais H (205,1 ± 24,9). A concentração espermática do grupo H (1,31 x 107 sptz/ml ± 0,27) foi inferior à do grupo WKY (2,11 x 107 sptz/ml ± 0,34), entretanto o controle da pressão arterial com o enalapril melhorou este parâmetro e a concentração espermática do grupo HE (2,46 x 107 sptz/ml ± 0,54) foi semelhante a do WKY...

Hypertension is a major public health problem, usually associated with other disorders such as obesity, diabetes, kidney disease, atherosclerosis, stroke and identified as one of the most prevalent risk factors for developing cardiovascular diseases. Target organs, such as heart, kidney, brain and eyes, are very commonly affected in hypertensive patients. However the testicular damage caused by hypertension has not been clearly defined. Hypertension is a well-established risk factor for erectile dysfunction, but its relation to testicular damage and male fertility is not clearly understood. This study evaluates the testicular morphology and some spermatozoid parameters of spontaneously hypertensive rats (SHR) untreated and treated with enalapril. SHR rats were assigned into two groups, a hypertensive group (H), and an enalapril treated group (HE). Wistar-Kyoto rats (WKY) were used as controls. Systolic blood pressure was measured weekly until at the end of the experiment. The spermatozoid concentration, motility and viability were determined in epididimal tail collected sample. Stereological methods were used to analyze testicular morphology macroscopically and microscopically. Data were analyzed by one-way ANOVA and Tukey´s post test, considering p<0.05. At the end of the experiment systolic blood pressure in the HE group (153,9 mmHg ± 21,03 ) was similar to WKY animals (153,4 ± 24,41), and lower than H animals (205,1 ± 24,9). Sperm concentration of the H group (1,31 x 107 sptz/ml ± 0,27) was lower than WKY group (2,11 x 107 sptz/ml ± 0,34). The blood pressure control with enalapril improved this parameter and HE group (2,46 x 107 sptz/ml ± 0,54) was similar to WKY...