[Effects of remifentanil on awakening of propofol sedated patients submitted to upper gastrointestinal endoscopy: a randomized clinical trial]. / Efeitos do remifentanil sobre despertar de pacientes sedados com propofol para endoscopia digestiva alta: estudo clínico randomizado.

BACKGROUND AND OBJECTIVES: Sedation for endoscopic procedures aims to provide high quality sedation, lower risks, short recovery time, superior recovery quality and absence of side effects, seeking high patient level of satisfaction. The goal of the study was to assess administration of remifentanil combined with propofol regarding the effects of the drug association during sedation and recovery for patients submitted to upper GI diagnostic endoscopy. METHOD: One hundred and five patients were assessed, randomly divided into three groups of 35 patients. The Control Group was sedated with propofol alone. Study Group 1 was sedated with a fixed dose of 0.2 µg.kg-1 remifentanil combined with propofol. Study Group 2 was sedated with 0.3 µg.kg-1 remifentanil combined with propofol. We assessed the quality of sedation, hemodynamic parameters, incidence of significant hypoxemia, time for spontaneous eye opening, post-anesthetic recovery time, quality of post-anesthetic recovery, presence of side effects and patient satisfaction. RESULTS: Study Group 1 showed better quality of sedation. The groups in which remifentanil was administered combined with propofol showed shorter eye-opening time and shorter post-anesthetic recovery time compared to the control group. The three groups presented hemodynamic changes at some of the moments assessed. The incidence of significant hypoxemia, the quality of post-anesthetic recovery, the incidence of side effects and patient satisfaction were similar in the three groups. CONCLUSIONS: The combination of propofol with remifentanil at a dose of 0.2 µg.kg-1 was effective in improving the quality of sedation, and at doses of 0.2 µg.kg-1 and 0.3 µg.kg-1 reduced the time to spontaneous eye opening and post-anesthetic recovery in comparison to sedation with propofol administered alone.

Prevalence and risk factors for penile lesions/anomalies in a cohort of Brazilian men ≥ 40 years of age.

PURPOSE: To report the prevalence and risk factors of penile lesions/anomalies in a Metropolitan Brazilian city. MATERIALS AND METHODS: All participants undergoing prostate cancer screening in the city of Curitiba were systematically examined to identify penile lesions including cutaneous mycosis, sexually transmitted diseases, penile cancer, meatal stenosis, hypospadias, and Peyronie's disease. Outcomes of interest included the prevalence and the relative risk and 95% confidence intervals of the lesions/anomalies according to age, school level, race, personal history of diabetes, arterial hypertension, nonspecific urethritis, and vasectomy. RESULTS: Balanoposthitis occurred in 11.8% of all participants, with an increased risk in those with diabetes (RR = 1.73), or past history of nonspecific urethritis (RR = 1.58); tinea of the penis was present in 0.2% ; condyloma acuminata in 0.5% ; herpes virus infection in 0.4% ; urethral discharge in 0.2% ; genital vitiligo in 0.7%, with an increased prevalence in non-white men (RR = 4.43), and in subjects with lower school level (RR = 7.24); phimosis in 0.5%, with a nearly 7-fold increased risk in diabetics; lichen sclerosus in 0.3%; stenosis of the external urethral meatus in 0.7%, with a higher prevalence in subjects with lichen sclerosus (RR = 214.9), and in those older than 60 years of age (RR = 3.57); hypospadia in 0.6%; fibrosis suggestive of Peyronie's disease in 0.9%, especially in men older than 60 years (RR = 4.59) and with diabetes (RR = 3.91); and penile cancer in 0.06%. CONCLUSION: We estimated the prevalence and risk factors of commonly seen penile diseases in an adult cohort of Brazilian men.

[Sliding of the distal epineural sheath to cover nerve defects]. / Deslizamiento del epineuro distal para reparar defectos segmentarios de nervios periféricos.

Autologous nerve grafting is the most referred technique for bridging neural gaps. The aim of this study was to evaluate the effects of distally sliding the epineurial sheath to cover a defect created in the left sciatic nerve of the rat. Twenty male Wistar rats were divided into three groups: sham (n=6), in which the sciatic nerve was dissected but left intact; conventional suture (CS, n=7), in which a transverse section of the sciatic nerve was followed by an epineurial suture; sliding of the distal epineurial sheath (SDES, n=7), in which a 5 mm resection of the nerve was conducted, followed by a circumferential cut in the distal epineurium, and the epineurial sheath was slid down and sutured into the distal end of the epineurium of the proximal stump. After 12 weeks, histomorphometric analyses of the number of myelinated nerve fibers, mean cross-sectional axonal area and total fiber diameter (G-ratio) were carried out. There was no statistical differences between CS and SDES (p > 0.05, ANOVA). However, an increase in the number of myelinated nerve fibres (p < 0.001, ANOVA) and decreases in the mean axonal area (p < 0.001, ANOVA) and in the G-ratio were observed in SDES or SC groups when compared to sham, although with no statistical differences between the SDES and SC. It could be suggested this technique is efficient to cover nerve gaps in rats.

Efficiency of 6- and 12-punctures biopsies to detect prostate cancer in patients with PSA

OBJECTIVE: Establish the efficiency of 6- and 12-punctures transrectal ultrasound-guided needle biopsies in low risk patients for prostate cancer. Six-punctures (sextant) biopsies were compared to 12-punctures biopsies, assessing which is the best strategy to detect this neoplasm. MATERIALS AND METHODS: Among 240 patients submitted to prostate biopsy, 54 with suspected small and organ-localized tumors (prostatic specific antigen