Anterior component separation technique for abdominal closure in bladder exstrophy repair: Primary results.

INTRODUCTION: Bladder exstrophy (BE) is a rare, complex malformation. There are three major approaches to closure. Despite this choice, abdominal wall closure in such patients is usually a challenging procedure specially in large defects and redo cases. OBJECTIVE: Our aim is to present our ten first cases' results, using Anterior Component Separation (ACS) to abdominal wall closure in BE patients. STUDY DESIGN: Ten male patients with BE (median age 7 months, range from 3 to 24 months) were operated from March 2020 to March 2021 by a multi-institutional Brazilian group using the Kelly technique. In addition to BE correction, anterior component separation was performed for abdominal closure. RESULTS: Postoperative suprapubic fistulae occurred in two of ten patients, but both closed spontaneously. No evisceration, abdominal wall dehiscence, or herniation was observed at a mean follow-up time of 14 months (range from 10 to 22 months). A 3 cm extent of advancement is achievable upon traction in each side (Fig. 3). CONCLUSION: We proposed the use of anterior component separation as an alternative for abdominal closure after BE correction using the Kelly procedure. This new technique avoids mesh usage, loosens the abdominal wall tension, and reduces complications. Even However, further studies are required.

Bladder Urothelial Carcinoma in a Child: Case Report and Review of Literature.

Bladder urothelial carcinoma (UC) it is the fifth most prevalent carcinoma in humans, nevertheless in children and young adults it's very rare. It usually occurs in older adults. Literature on UC in pediatric population is limited and important information (risk factors, follow-up protocols, etc.) are poorly defined. We present an 11-year-old boy with a painful macroscopic hematuria. Ultrasound revealed a heterogeneous intravesical mass without extravesical extension, which was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The first biopsy was compatible with urothelial papilloma. After 1 year, he returned with a bigger mass. Transurethral resection of the bladder (TURB) was performed and immunohistochemistry showed low-grade papillary UC with a high-grade component, with tumor free margin. Tumor had mutations in the BRAF and KRAS genes. Two and a half years after the resection the patient has no recurrence. Less than 1% of bladder UC occur in the first two decades of life. Gross hematuria is a common symptom. Ultrasound is generally the first diagnostic tool. MRI is also helpful, but cystoscopy allows definitive diagnosis. Transurethral resection of the bladder (TURB) is the standard treatment, with good results and low recurrence rate, and it was the treatment of choice for our patient, that remains free of disease. The BRAF and KRAS gene mutations were never described before in pediatric UC. There are only few cases in literature of pediatric UC that present a tumor genetic profile; therefore, our case report adds more information to this very rare disease in children.

Simulation in Pediatric Video Surgery: Training with Simple and Reproducible Exercises Elaborated by Residents.

Background: Most residents do not have a defined program for simulation training in video surgery in Brazil. The training takes place for the most part in vivo or in short courses. The goal of this article is to describe and evaluate a set of exercises using low-cost materials, created by the residents themselves, to enable basic skills training in video surgery. Materials and Methods: Seven exercises were elaborated aiming to simulate main maneuvers performed in video surgery. The residents were guided by a written and video description showing the execution of the exercises, performed the exercises, and answered a questionnaire. After 3 weeks of free training, the residents performed the exercises and answered the questionnaire again. Results: Seven residents started the study; however, 6 completed the two steps. Among the participants, 83% received in vivo video surgery training, and only 2 (33%) received some supervised simulation training in minimally invasive surgery before this time. All participants considered the set of seven exercises representative of the actual skills in video surgery. There was no difficulty in acquiring the materials or in assembling them to carry out the training. All the participants had a shorter training time than initially proposed, on average 1 day/week for 20 minutes. Conclusions: A simple set of exercises can be elaborated by the residents themselves and make feasible the simulated training in video surgery even without the availability of sophisticated and expensive materials. The presence of a tutor and the scheduling of exclusive training seem necessary for more satisfactory results.

Circumcision: postoperative complications that required reoperation.

Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

Circumcision: postoperative complications that required reoperation / Postectomia: complicações pós-operatórias necessitando reintervenção cirúrgica

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.

Management of traumatic urethral injuries in children using different techniques: A case series and review of literature.

INTRODUCTION: Most pediatric urethral injuries are a result of pelvic fracture after high-impact blunt trauma, mainly due to motor vehicle accidents. The management of urethral injuries depends on if the rupture is complete or partial as well as the timing of surgical intervention. PRESENTATION OF CASES: Three male children with urethral trauma caused by motor vehicles accidents are presented in this article. Preoperative suprapubic catheterization was initially carried out in all patients. Each patient then received one of three different techniques during the deferred time to surgical intervention: anterior sagittal transanorectal approach (ASTRA) for end-to-end urethral anastomosis, perineal approach for urethroplasty using buccal mucosa, and urethroplasty with preputial skin flap. The three techniques were successfully performed. DISCUSSION: In the initial management suprapubic cystostomy has been a good solution in urgent situations. Deferred urethroplasty is the procedure of choice for the definite treatment of posterior urethral distraction defects. The anterior sagittal transanorectal approach provides excellent exposure of the posterior urethra and retrovesicular region, and allows the surgeon to perform dissection under direct vision. CONCLUSION: It's very important for the pediatric urologist to be familiar with the different techniques available in order to choose the best approach for each particular patient.

O perfil epidemiológico e o desempenho da GAL-3 e CK-19 em lesões foliculares e suspeitas para malignidade da tireoide / The epidemiological profile and the performance of GAL-3 and CK-19 in follicular lesions and suspicious for malignancy of the thyroid

Objetivos: Analisar dados epidemiológicos de pacientes submetidos à PAAF, classificados como lesões foliculares (classe IV) e suspeitos para malignidade (classe V) pelo Sistema Bethesda para Laudos Citopatológicos da Tireoide e avaliar o desempenho do painel imunocitoquímico com os marcadores CK-19, Galectina-3 e HBME-1 no diagnóstico destes pacientes. Metodologia: Estudo retrospectivo transversal, que analisou 24 laudos anatomopatológicos do Centro de Patologia de Curitiba, entre 2011 e 2014, classificados como classe IV e V do Sistema Bethesda, cujas lâminas foram avaliadas pela imunocitoquímica, usando-se os marcadores CK-19, GAL-3 e HBME-1. Resultados: 83,3% dos pacientes eram mulheres, com idade média de 45,7 anos. O tamanho médio das lesões foi 12,5mm, localizadas 56,5% no lobo D. O painel de marcadores apresentou sensibilidade 100%, especificidade 90,5% e eficácia 95,5% para as lesões avaliadas. Conclusão: A imunocitoquímica demostrou-se um exame pré-operatório eficaz para diferenciação de lesões foliculares e suspeitas para malignidade do carcinoma papilífero da tireoide

Objectives: To analyze epidemiological data of patients who undergone FNA that was classified as follicular lesions (Class IV) and suspicious for malignancy (Class V) by the Bethesda System for Reporting Thyroid Cytopathology and evaluate the performance of immunocytochemical panel with markers CK-19, Galectin-3 and HBME-1 in these patients. Methodology: This is a cross-sectional retrospective study. It was analyzed 24 pathological between 2011 and 2014, from the Curitiba Pathology Center, classified as Class IV and V in the Bethesda System for Reporting Thyroid Cytopathology, which slides were stained with immunocytochemistry using the markers: CK19 GAL-13 and HBME-1. Results: In this study 83.3% of the patients were women with a mean age of 45.7 years. The average size of the nodules was 12.5mm and 56.5% was located in the right lobe. Regarding the diagnosis of follicular lesions and suspicious for malignancy, the sensitivity of the exam with the standard biological markers used was 100%, specificity 90,5% and efficacy 95.5%. Conclusion: The immunocytochemistry demonstrated to be an effective pre-operative exam for differentiation of follicular lesions and suspicious for malignancy of papillary thyroid carcinoma

Associação entre massa óssea e estresse oxidativo: análise de marcadores séricos e dados epidemiológicos / Association between bone mass and oxidative stress analysis of serum markers and data epidemiological

Objetivo: Avaliar a relação entre a massa óssea e marcadores séricos de estresse oxidativo/ antioxidação (bilirrubina total/frações e ácido úrico), bem como averiguar a associação entre tais variáveis e outros dados que interferem na massa óssea (idade, alcoolismo, tabagismo, raça, tempo de menopausa e histórico de fraturas). Dosagem de aminotransferases e de enzimas canaliculares foram usadas como marcadores de integridade hepática. Método: Foram selecionados 105 pacientes.A análise do índice de massa óssea foi feita pela verificação dos escores Z, T e g/cm2 (BMD) em fêmur total e coluna vertebral lombar por densitometria pelo método DEXA.Resultados: Foram encontradas correlações entre bilirrubina direta e: T-score (p = 0,0004) e BMD (p=0,0177) de coluna lombar. Também houve correlação entre a bilirrubina total e o T-score de quadril (p= ,0239). Os estudos de correlação entre massa óssea e bilirrubina indireta e com acido úrico não obtiveram resultado significante (p=ns).Conclusão: Existe associação entre bilirrubina total e bilirrubina direta com massa óssea, mostrando que o prejuízo de massa óssea está associado com consumo destes marcadores.

Objective: To evaluate the relation between bone mass and serum markers of oxidative stress/oxidation (total bilirubin / fractions and uric acid), and investigate the association between these variables and other data that interfere with bone (age, alcoholism, smoking, race, time since menopause and history of fractures). aminotransferase dosage and GGT were used as liver integrity markers.Method: About 105 patients were selected. Analysis of bone mass index was made by checking the Z scores, and T g / cm2 (BMD) in total hip and lumbar spine by densitometry by DEXA method.Results: Correlations were found between and direct bilirubin: T-score (p = 0.0004) and BMD (p = 0.0177) in the lumbar spine. There was also a correlation between total bilirubin and hip T-score (p = 0239). The correlation studies between bone mass and indirect bilirubin and uric acid did not obtain significant result (p = ns).Conclusion: There is an association between total bilirubin and direct bilirubin with bone mass, showing that the loss of bone mass is associated with consumption of these markers.

Fatores clínicos, epidemiológicos e histopatológicos associados à instabilidade de microssatélites em câncer colorretal / Factors clinical, epidemiological and histopathological associated with microsatellite instability in colorectal cancer

Objetivo: Verificar a frequência de instabilidade de microssatélites (IMS) em casos de carcinoma colorretal, bem como seus fatores de risco. Material e Método: Foram analisados históricos de pacientes com CCR, avaliando sexo, idade, presença ou ausência de instabilidade de microssatélites MLH-1 e MSH- 2, positividade e negatividade do marcador p53, reatividade do marcador Ki67, profundidade da lesão, invasão vascular e linfonodal e localização do tumor. Resultados: Obteve-se 10,37% de casos com IMS. Não houve correlação entre IMS e idade, gênero, localização do tumor, invasão linfonodal e vascular, profundidade da lesão, mutação de TP53 e taxa de proliferação por anti Ki67. Conclusão: Nesse estudo a presença de IMS no CCR não apresentou relação com fatores clínicos e epidemiológicos conhecidos para essa neoplasia.

Objective: The aim of this study was to verify the frequency of microsatellite instability (MSI) in cases of colorectal carcinoma and their risk factors. Material and Method: We analyzed historical CRC patients, evaluating sex, age, instability MLH -1 microsatellite and MSH- 2 , positivity of the p53 marker, percentage of Ki67 marker , presence of lymph nodes metastases , depth of lesion , vascular and lymph nodes invasion and tumor location. Results: There was 10.37 % of cases with IMS. There was no correlation between IMS and age, gender, tumor location , lymph node and vascular invasion, depth of the lesion , TP53 mutation and proliferation rate by anti Ki67. Conclusion: The presence of IMS in CRC is not related with clinical and epidemiological factors known to this neoplasm.

Fibromialgia e qualidade de vida: um estudo comparativo com portadores de artrite reumatóide / Fibromyalgia and quality of a life: a comparative study with arthritis patients with rheumatoid

Portadores de fibromialgia queixam-se de dor generalizada, fadiga e distúrbios do sono. Os exames laboratoriais são caracteristicamente negativos nesta patologia. Devido à natureza pouco específica dos sintomas e a falta de provas palpáveis de um processo inflamatório, estes pacientes nem sempre têm as suas queixas devidamente valorizadas. No presente estudo procurou-se demonstrar o grande impacto desta patologia na qualidade de vida de seus portadores comparando-a com a de portadores de artrite reumatóide. Além disso procurou-se verificar se este prejuízo estava associado com o grau de dor percebido pelo paciente ou com o número de pontos sensíveis encontrados ao exame físico.

Fibromyalgia patients complain of generalized pain, fatigue and sleep disturbance. Laboratory exams are typically negative in this pathology. Due to this lack of symptom's specificity and palpable proofs of inflammatory disease, these patients complaints are not taken seriously. In this study we try to demonstrate the high impact of fibromyalgia in the patient's life quality comparing them with rheumatoid arthritis patients. We also try to verify the relationship between poor life quality with generalized pain and number of tender points at physical examination.

Artropatia por hemocromatose / Hemochromatosis arthropathy

A hemocromatose pode se manifestar como osteoartrite de inicio precoce e que afeta, de maneira atipica, as articulações metacarpofalangianas. Seu reconhecimento pode permitir o diagnóstico precoce e tratamento de uma doença potencialmente fatal. Descrevem-se aqui dois casos de hemocromatose com manifestações articulares.

Hemochromatosis can manifest as early-onset osteoarthritis and affects, in atypical way, the metacarpophalangeal joints. Its recognition may allow a nearly diagnosis and treatment of a potentially fatal disease. Here, two patients with hemochromatosis and articular manifestations are described.

O perfil epidemiológico e o desempenho da GAL-3 e CK-19 em lesões foliculares e suspeitas para malignidade da tireoide / The epidemiological profile and the performance of GAL-3 and CK-19 in follicular lesions and suspicious for malignancy of the thyroid

Objetivos: Analisar dados epidemiológicos de pacientes submetidos à PAAF, classificados como lesões foliculares (classe IV) e suspeitos para malignidade (classe V) pelo Sistema Bethesda para Laudos Citopatológicos da Tireoide e avaliar o desempenho do painel imunocitoquímico com os marcadores CK-19, Galectina-3 e HBME-1 no diagnóstico destes pacientes. Metodologia: Estudo retrospectivo transversal, que analisou 24 laudos anatomopatológicos do Centro de Patologia de Curitiba, entre 2011 e 2014, classificados como classe IV e V do Sistema Bethesda, cujas lâminas foram avaliadas pela imunocitoquímica, usando-se os marcadores CK-19, GAL-3 e HBME-1. Resultados: 83,3% dos pacientes eram mulheres, com idade média de 45,7 anos. O tamanho médio das lesões foi 12,5mm, localizadas 56,5% no lobo D. O painel de marcadores apresentou sensibilidade 100%, especificidade 90,5% e eficácia 95,5% para as lesões avaliadas. Conclusão: A imunocitoquímica demostrou-se um exame pré-operatório eficaz para diferenciação de lesões foliculares e suspeitas para malignidade do carcinoma papilífero da tireoide

Objectives: To analyze epidemiological data of patients who undergone FNA that was classified as follicular lesions (Class IV) and suspicious for malignancy (Class V) by the Bethesda System for Reporting Thyroid Cytopathology and evaluate the performance of immunocytochemical panel with markers CK-19, Galectin-3 and HBME-1 in these patients. Methodology: This is a cross-sectional retrospective study. It was analyzed 24 pathological between 2011 and 2014, from the Curitiba Pathology Center, classified as Class IV and V in the Bethesda System for Reporting Thyroid Cytopathology, which slides were stained with immunocytochemistry using the markers: CK19 GAL-13 and HBME-1. Results: In this study 83.3% of the patients were women with a mean age of 45.7 years. The average size of the nodules was 12.5mm and 56.5% was located in the right lobe. Regarding the diagnosis of follicular lesions and suspicious for malignancy, the sensitivity of the exam with the standard biological markers used was 100%, specificity 90,5% and efficacy 95.5%. Conclusion: The immunocytochemistry demonstrated to be an effective pre-operative exam for differentiation of follicular lesions and suspicious for malignancy of papillary thyroid carcinoma

Polianeurismas de aorta abdominal, artérias ilíacas e artérias de membros inferiores / Polianeurysms of abdominal aorta, iliac arteries and lower limb arteries

Polianeurismas são dilatações arteriais simultâneas ou sequenciais.Neste relato, homem, 64 anos, hipertenso e dislipidêmico,histórico dealcoolismo e tabagismo, procurou atendimento com dor em flanco direito irradiada para fossa ilíaca direita. Ecografia de abdômen mostrou litíases renais e aneurismas em artérias ilíacas comuns e internas. Realizada angiorressonância que mostrou dilatações em aorta abdominal, ilíacas comuns, ilíacas internas, femorais comuns e poplíteas. Foram colocadasendopróteses em aorta abdominal e ilíacas e o paciente evoluiu com endoleak em ilíaca interna direita. Como este não regrediu espontaneamente, foi colocado stent revestido, selando o vazamento. Posteriormente,realizada aneurismectomia femoral esquerda.Atualmente, paciente em acompanhamento dos aneurismas de femoral comum direita e poplíteas. O tratamento endovascular leva à menor agressão cirúrgica e menor tempo necessário para a recuperação do paciente.Evidencia-se a importância deste trabalho ao descrever o desenvolvimento da doença, além dos procedimentos realizados para a resolução das principais dilatações.

Polianeurysms are a sequential or simultaneous arterial dilatation. This is a case report of a man, 64 years-old, hypertensive and dyslipidemic, history as alcoholism and tabagism, who sought treatment with right flank pain expanded to the right iliac fossa. Ultrasound of abdomen presented kidney lithiasis and aneurysms of iliac arteries. An angioresonace showed dilatation of abdominal aorta, iliac, femoral and popliteal arteries. Stents were placed in the aorta and iliac arteries. The patient developed an endoleak in the right iliac artery and, as it did not repair spontaneously, another stent had to be placed. Subsequently, an aneurysmectomy was performed in the left femoral artery. Currently, aneurysms at the right femoral and popliteal arteries are being monitored. Endovascular treatment leads to less surgical aggression and time for the patient´s recovery. This work is important because of its description of the disease development and the methods used to solve the main dilatations.

Variações anatômicas dos troncos supra­aórticos com subclávia esquerda originando-se de divertículo de Kommerell / Anatomical variations of the supra aortic trunks with left subclavian originating from diverticulum of Kommerell

As variações dos troncos supra-aórticos são de diversos tipos. O divertículo de Kommerell (DK) é um aneurisma aórtico incomum na origem da artéria subclávia. Neste relato, mulher, 46 anos, apresentou parestesia progressiva há 4 anos em membro superior esquerdo (MSE) ao elevá-lo. Exame físico revelou manobra de Wright positiva em MSE. Angiotomografia mostroupresença de variações anatômicas dos troncos supra-aórticos e de DK na origem da artéria subclávia esquerda (ASE). Atualmente paciente segue em acompanhamento do aneurisma. As variações dos troncos supra-aórticos do presente relato associada são DK na origem da ASE com arco aórtico esquerdo são raras.Esta patologia pode ser assintomática, apresentar sintomas de dilatação e rotura aneurismática ou sintomas relacionados à compressão de estruturas adjacentes. O diagnóstico se da com métodos de imagem pouco invasivos. O tratamento geralmente é cirúrgico. A possibilidade de intercorrências fatais impõe uma avaliação clínica e imaginológica minuciosa para abordar o melhor tratamento.

Variations of the supra aortic trunks are of several types. Kommerell diverticulum (DK) is an unusual aortic aneurysm at the origin of the subclavian artery. In this report, woman, 46 years, had progressive paresthesia for 4 years in the left upperlimb (MSE) to raise it. Physical examination revealed positive Wright maneuver in MSE. CT angiography showed the presence of anatomical variations of the supra aortic trunks and DK at the origin of the left subclavian artery (ASE). Currently, the patient keeps on monitorating the aneurysm. Variations of the supra aortic trunks of this report associated with DK at the origin of ASE with left aortic arch are rare. This condition can be asymptomatic, present symptoms of aneurysmal dilation and rupture or symptoms related tocompression of adjacent structures. Diagnosisis with the minimally invasive imaging methods. The treatment is surgical. The possibility of fatal complications imposes a thorough clinical evaluation and by imaging to offer the best treatment.

Estudo de biodisponibilidade relativa de ibandronato de sódio após administração oral de dose única em voluntários sadios / Bioavailability study of sodium ibandronate after single oral dose in health volunteers

O objetivo do estudo foi verificar a biodisponibilidade de duas formulações de ibandronato de sódio, comprimidos de 150 mg, com base em comparações estatísticas dos parâmetros farmacocinéticos urinários, quantidade total excretada na urina (Ae), velocidade de excreção máxima (Rmax) e tempo médio em que o Rmax foi observado (tmax). O estudo foi cruzado, aberto, aleatório, com dois tratamentos, dois períodos, duas sequências com administração de dose única de ibandronato de sódio após jejum de 10 horas, em 70 voluntários sadios do sexo masculino. O intervalo entre os períodos (washout) foi de 21 dias. As amostras de urina foram obtidas por um período de 48 horas após a administração dos medicamentos. O ibandronato foi quantificado em urina por LC-MS-MS após extração em fase sólida, seguida de um procedimento de derivatização. Os parâmetros farmacocinéticos Ae, Rmax e tmax foram calculados e a média da razão teste/referência e os IC90% para Ae e Rmax foram obtidos. O Rmax médio dos medicamentos teste e referência foi, respectivamente, de 496.374,11 ng/h e 467.524,28 ng/h, ambos atingidos em 1,5 hora. O Ae médio foi de 1.996,29 µg para o medicamento teste e de 1.870,37 µg para o referência. Os IC90% para Rmax e Ae estão dentro dos limites de 80% a 125%, portanto, podemos concluir que os medicamentos teste e referência são bioequivalentes de acordo com os critérios da ANVISA.

Absolute measurement of androgen receptor mRNA in peripheral blood mononuclear, preputial skin and urethral mucosa cells of control individuals with phimosis using qRT-PCR / Valor absoluto do mRNA do receptor androgênico em células mononucleares do sangue periférico e células da pele do prepúcio e mucosa uretral em indivíduos controle com fimose, determinado por meio de qRT-PCR

INTRODUCTION: Androgen actions are exerted upon the androgen receptor (AR), and complete genital virilization of normal 46,XY individuals depends on adequate function and expression of the AR gene in a tissue-specific manner. OBJECTIVE: Standardization of normal ARmRNA in androgen-sensitive tissues. MATERIALS AND METHODS: In this study, we determined the quantitative amounts of ARmRNA in peripheral blood mononuclear, urethral mucosa and preputial skin cells of control subjects with phimosis by using RT-PCR. RESULTS: The mean (SD) values of AR expression in blood, urethra and prepuce were: 0.01 (0.01); 0.43 (0.32); 0.31 (0.36), respectively. CONCLUSION: The AR expression is low in blood and equivalent in urethral mucosa and preputial skin, which may be useful in the diagnosis of individuals with abnormal external genitalia.

INTRODUÇÃO: As ações androgênicas são exercidas por meio do receptor androgênico (AR), e a completa virilização genital de indivíduos 46,XY normais depende de adequada expressão do gene AR de forma tecido específica. OBJETIVO: Padronizar valores normais de ARmRNA em tecidos sensíveis aos andrógenos. MATERIAIS E MÉTODOS: Neste estudo, determinamos as quantidades de ARmRNA em células mononucleares do sangue periférico e em células da mucosa uretral e pele do prepúcio de indivíduos controles com fimose, utilizando RT-PCR. RESULTADOS: A média (dp) dos valores de expressão do AR em sangue, uretra e prepúcio foram: 0,01 (0,01); 0,43 (0,32); 0,31 (0,36), respectivamente. CONCLUSÃO: A expressão do AR é baixa em sangue periférico e equivalente em mucosa uretral e pele prepucial, sendo sua quantificação útil no diagnóstico de indivíduos com alterações da genitália externa.

Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles.

PURPOSE: We studied the clinical evolution of vesicoureteral reflux after endoscopic puncture of ureterocele in pediatric duplex systems. MATERIALS AND METHODS: We retrospectively reviewed charts of children with duplex system ureteroceles treated between 1992 and 2007. We analyzed patient age, prenatal diagnosis, urinary tract infection at presentation, differential renal function and preoperative vesicoureteral reflux. The fate of associated vesicoureteral reflux after endoscopic puncture of ureterocele was specifically addressed. RESULTS: We analyzed 60 patients with a mean age of 12 months, of whom 32 (52%) were diagnosed prenatally and 40 (66%) presented with a urinary tract infection. The majority of ureteroceles were ectopic, and pre-puncture vesicoureteral reflux was seen in 40 patients (67%). Postoperative voiding cystourethrogram was performed in 50 cases. New onset of vesicoureteral reflux occurred postoperatively in 24 patients (40%), mainly ipsilateral to the lower pole or contralaterally. Spontaneous vesicoureteral reflux resolution or improvement occurred in 16 of 22 patients (72%) observed after primary endoscopic puncture of ureterocele. Surgical intervention after endoscopic puncture of ureterocele was performed in 25 patients (42%), of whom 9 underwent more than 1 reparative procedure. CONCLUSIONS: Vesicoureteral reflux after endoscopic puncture of ureterocele may occur in the ipsilateral upper or lower poles, or in the contralateral renal segments. Therefore, the reflux is not necessarily related to the puncture itself. Vesicoureteral reflux after endoscopic puncture of ureterocele can resolve spontaneously in a significant number of patients. Therefore, initial management by close surveillance is warranted. Considering the simplicity of the procedure, our findings support that endoscopic puncture of ureterocele is an attractive alternative for the initial management of pediatric duplex system ureteroceles.

Absolute measurement of androgen receptor mRNA in peripheral blood mononuclear, preputial skin and urethral mucosa cells of control individuals with phimosis using qRT-PCR.

INTRODUCTION: Androgen actions are exerted upon the androgen receptor (AR), and complete genital virilization of normal 46,XY individuals depends on adequate function and expression of the AR gene in a tissue-specific manner. OBJECTIVE: Standardization of normal ARmRNA in androgen-sensitive tissues. MATERIALS AND METHODS: In this study, we determined the quantitative amounts of ARmRNA in peripheral blood mononuclear, urethral mucosa and preputial skin cells of control subjects with phimosis by using RT-PCR. RESULTS: The mean (SD) values of AR expression in blood, urethra and prepuce were: 0.01 (0.01); 0.43 (0.32); 0.31 (0.36), respectively. CONCLUSION: The AR expression is low in blood and equivalent in urethral mucosa and preputial skin, which may be useful in the diagnosis of individuals with abnormal external genitalia.