Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

OBJECTIVE:To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry.BACKGROUND:Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular accessthrough complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described.METHODS:The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year.RESULTS:A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in thepercutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year.CONCLUSION:Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI.

Is lower urinary tract dysfunction an early marker of Portuguese type familial amyloidotic polyneuropathy in women? Preliminary results.

Type 1 Portuguese Familial Amyloid Polyneuropathy was first observed in 1939 and described in 1951 by Corino Andrade. FAP is a rare autosomal dominant disease caused by a mutant gene in chromosome 18, characterized by a variant transthyretin in which valine is substituted for methionine at position 30 (ATTR V30M), affecting mainly young adults. ATTR V30M positivity does not imply disease, but the disease is only present with ATTR V30M in serum. The clinical manifestations of FAP on the pelvic floor and genitourinary system are frequent at early disease onset. Phenotypic diversity can depend on modulating agents in the deposition of the mutant TTR, such as incomplete penetration and environmental influence. Functional vesicourethral disorders appear to be primarily at the bladder filling phase, namely diminished bladder sensation, and associated with a decrease in detrusor contractility during the emptying phase. Unbalanced voiding takes place in this context, with high post-void residuals, increasing the rate of co-morbidity, namely recurrent urinary tract infections and chronic renal failure.This study describes the lower urinary tract dysfunctions in ATTR V30M positive carriers, particularly during the asymptomatic period and early stages of the disease, and additionaly it describes its association with the clinical evolution of the disease. In the preliminary phase of the study, the lower urinary tract dysfunction in FAP-women may present itself as an early manifestation in asymptomatic patients. Uroflowmetry and the evaluation of post-voiding residual volume are non-invasive and low cost tests that should be done during routine initial evaluation. Reduced bladder sensation and poor detrusor contractility may be considered initial markers of FAP. The neurogenic factor (bladder afferent neurons) appears to be mechanical in nature with myogenic repercussions. This further aggravates the bladder underactivity secondary to pelvic efferent parasympathetic neuropathy and amyloid infiltration in the bladder wall. Early diagnostic and therapeutic intervention may avoid secondary end stage renal disease.

¿Es la disfunción del tracto urinario inferior un marcador precoz de polineuropatía amiloidótica familiar en las mujeres?. Resultados preliminares / Is lovwer urinary tract dysfunction an early marker of portuguese type familial amyloidotic polyneuropathy in women?. Preliminary results

La polineuropatia amiloidea portuguesa (FAP) tipo I, fue observada por primera vez en 1939 y descrita en 1951 por Corino Andrade. La FAP es una enfermedad rara autonómica dominante, causada por una mutación genética del cromosoma 18, y caracterizada por la variación del la transretina, donde la valina es sustituida por metionina en la posición 30 (ATTRV 30 M) afectando principalmente a adultos jóvenes. La positiviadad de ATTRV 30 M no implica enfermedad. La enfermedad esta presente unicamente cuando el ATTR 30 M se encuentra en la sangre. Las manifestaciones de la FAP en el suelo pelvico y sistema genitourinario, son frecuentes al comienzo de la enfermedad. La diversidad fenotípica puede depender de diversos factores, modulando la mutación TTR, tal como penetración incompleta e influencia del ambiente. Las alteraciones funcionales del tracto urinario inferior aparecen en primer lugar en la fase de llenado vesical, principalmente con sensación vesical disminuida, y asociada con una afectación de la contractilidad del detrusor en la fase del vaciado. En este contexto aparece una micción descompensada, con residuos postmiccionales altos, incrementando la comorbilidad, principalmente de infecciones del tracto urinario e insuficiencia renal crónica. Este estudio describe las disfunciones del tracto urinario inferior en portadores positivos de ATTRV 30 M, sobre todo durante el periodo asintomático y estadios tempranos de la enfermedad, así como expone su asociación con la evolución clínica. En la fase preliminar del estudio, la disfunción del tracto urinario inferior en las mujeres con FAP, puede presentarse como una manifestación temprana en pacientes asintomáticos. La flujometría y la medida del residuo postmiccional son test no invasivos, y de bajo coste, que deberían hacerse durante la evaluación inicial rutinaria. La disminución de la sensibilidad vesical y afectación de la contractilidad del detrusor pueden considerarse como marcadores iniciales de la FAP. El factor neurogénico (elemento aferente) parece ser de naturaleza mecánica con repercusiones miogénicas. Esto último agrava un detrusor hipoactivo secundario a una neuropatía parasimpatica eferente e infiltración amiloide de la pared vesical. Un diagnostico precoz, así como una terapeutica temprana podrían evitar una enfermedad renal terminal

Type 1 Portuguese Familial Amyloid Polyneuropathy was first observed in 1939 and described in 1951 by Corino Andrade. FAP is a rare autosomal dominant disease caused by a mutant gene in chromosome 18, characterized by a variant transthyretin in which valine is substituted for methionine at position 30 (ATTR V30M), affecting mainly young adults. ATTR V30M positivity does not imply disease, but the disease is only present with ATTR V30M in serum. The clinical manifestations of FAP on the pelvic floor and genitourinary system are frequent at early disease onset. Phenotypic diversity can depend on modulating agents in the deposition of the mutant TTR, such as incomplete penetration and environmental influence. Functional vesicourethral disorders appear to be primarily at the bladder filling phase, namely diminished bladder sensation, and associated with a decrease in detrusor contractility during the emptying phase. Unbalanced voiding takes place in this context, with high post-void residuals, increasing the rate of co-morbidity, namely recurrent urinary tract infections and chronic renal failure. This study describes the lower urinary tract dysfunctions in ATTR V30M positive carriers, particularly during the asymptomatic period and early stages of the disease , and additionaly it describes its association with the clinical evolution of the disease. In the preliminary phase of the study, the lower urinary tract dysfunction in FAP-women may present itself as an early manifestation in asymptomatic patients. Uroflowmetry and the evaluation of post-voiding residual volume are non-invasive and low cost tests that should be done during routine initial evaluation. Reduced bladder sensation and poor detrusor contractility may be considered initial markers of FAP. The neurogenic factor (bladder afferent neurons) appears to be mechanical in nature with myogenic repercussions. This further aggravates the bladder underactivity secondary to pelvic efferent parasympathetic neuropathy and amyloid infiltration in the bladder wall. Early diagnostic and therapeutic intervention may avoid secondary end stage renal disease

[Surgical treatment of complete penile duplication]. / Tratamiento quirúrgico de duplicidad peneana completa.

Penile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is almost associated with other malformations like double bladder, presence of the cloaca, imperforate anus, duplication of the recto sigmoid and vertebral deformities. The authors present the surgical technique to resolve a rare case of complete penile duplication in a 4 years old child, without any other malformation.

Tratamiento quirúrgico de duplicidad peneana completa / Surgical treatment of complete penile duplication

La duplicidad peneana es una anomalía rara, con una incidencia de 1 entre 5.500.000. Normalmente está asociada a otras malformaciones como duplicidad vesical, cloaca, ano imperforado, duplicidad de recto y sigma y a deformidades vertebrales. Los autores presentan la técnica quirúrgica que aplicaron para la resolución de un caso raro de duplicidad peneana completa en un individuo de sexo masculino, de cuatro años de edad, sin otras malformaciones sistémicas asociadas (AU)

Penile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is almost associated with other malformations like double bladder, presence of the cloaca, imperforate anus, duplication of the recto sigmoid and vertebral deformities. The authors present the surgical technique to resolve a rare case of complete penile duplication in a 4years old child, without any other malformation (AU)

[Penile abscess. Case report]. / Absceso del pene. A propósito de un caso.

OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeutic aspects. METHODS: One case of penile abscess is presented in a patient referred for penile swelling. RESULTS: During surgical exploration it showed to be a corpora cavernosum rupture with drainage of a small volume of purulent fluid. CONCLUSIONS: Penile abscess is uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully.

Absceso del pene. A propósito de un caso / No disponible

OBJETIVO: Este trabajo pretende aportar un caso clínico más a la literatura de esta infrecuente entidad haciendo hincapié en aspectos del diagnóstico y del tratamiento. MÉTODO: Se presenta un paciente que consulta por tumefacción peniana resultando ser un absceso de pene. RESULTADO: Al efectuar el acto quirúrgico constatamos una fractura del cuerpo cavernoso con pequeña salida de pus por el orificio de la fractura. CONCLUSIONES: El absceso de pene es de aparición clínica poco frecuente. La ultrasonografia de alta frecuencia nos permite identificarlo. En cuanto al tratamiento abogamos por el drenaje y la cobertura con antibióticos de amplio espectro de acción (AU)

OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeutic aspects. METHODS: One case of penile abscess is presented in a patient referred for penile swelling. RESULTS: During surgical exploration it showed to be a corpora cavernosum rupture with drainage of a small volume of purulent fluid. CONCLUSIONS: Penile abscess is uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully (AU)

[Clinical, multicentric, and open study to evaluate the efficacy of and tolerance to sildenafil in patients with erectile dysfunction]. / Estudo clínico, multicêntrico, aberto para avaliar a eficácia e a tolerância do sildenafil no tratamento de doentes com disfunção eréctil.

Erectile dysfunction (ED), defined by the Impotence-NIH Consensus Conference as the "persistent inability to achieve and/or maintain erection sufficient for satisfactory sexual activity" affect more than 100 million men worldwide, at particular severity levels. The global prevalence of ED is estimated to affect about 10%, but has been found to increase significantly with age (39% in men 40 years of age and 67% at 70 years of age). In men aged 40 to 70 years, the severe ED prevalence increased of three folds, 5 to 15%. In order to evaluate the efficacy and tolerance of sildenafil, it was conducted a national open, multicentre study on a portuguese population affected by ED. Subjects under ambulatory treatment were recruited in Psychiatry/Sexology Clinical units and Urology/Andrology. The results of the study carried out on a group of 62 men with ED, demonstrate that sildenafil was effective in the recovering of erectile function, increasing the number of attempts to sexual activity and improving their success rates (mainly in severe dysfunction). Fifty one patients treated with sildenafil, at the end of the study referred a global improvement in their erections (92.2%). Doses of 50 mg and 100 mg sildenafil were used and were well tolerated and also effective in the treatment of this pathology (70% and 69% respectively). Being this study a flexible dose one and taking into consideration that the final dose used was found the more suitable to the patients, can be concluded that 43.1% of the patients elected dose of 50 mg whereas 56.9% elected the maximum prescribed dose of 100 mg. Over and above global efficacy experimented by patients, a significant improvement in the sexual activity with partners was occurred. These results make possible a final conclusion--in the studied patients group affected by Erectile Dysfunction, aside from associated somatic pathology, sildenafil use provided a remarkable clinical profit, in what concerns global efficacy, by erectile function mechanisms improvement, concerning patients sensitivity of improvement, occurring in the major part of them, being these of high importance to the lifting up of their self-esteem.