Use of the gamma probe in sentinel lymph node biopsy in patients with prostate cancer.

OBJECTIVE: To describe the reproducibility of the sentinel lymph node technique in patients with prostate cancer and verify if there is improved accuracy over modified lymphadenectomy. MATERIAL AND METHODS: Twenty-three patients with biopsy proven prostate cancer were enrolled in this study. Lymphoscintigraphy was performed after the transrectal administration of Tc sulfur colloid guided by ultrasound, with one injection in each prostate lobe. Images were obtained 15 and 180 min after injection. Sentinel lymph node was harvested during surgery using a gamma probe, followed by extended lymphadenectomy. RESULTS: The mean age of the patients in this study was 66 years. An average of 3.36 sentinel lymph nodes was found for each patient. Radioactive lymph nodes were identified by the gamma probe in 21 out of 23 patients. In one of the patients there was no radiopharmaceutical migration from the injection site and in another the sentinel lymph node was visualized by lymphoscintigraphy but was not found during surgery. Three patients had lymph node metastasis; in one of these patients the sentinel lymph node was the only positive node and was found outside the modified lymphadenectomy region (obturator fossa and the external iliac). CONCLUSION: Sentinel lymph node biopsy in prostate cancer adds important information to the staging of patients, not always attained through the lymphadenectomy restricted to the obturator fossa and external iliac. Such information is essential for the choice of the best treatment to be applied.

Increasing the dose of furosemide in patients with azotemia and suspected obstruction.

Diuresis renography is widely used to distinguish obstructed from nonobstructed kidneys; however, the delivery of furosemide to its site of action in the loop of Henle is impaired in patients with azotemia. Consequently, the standard adult dose of 40 mg furosemide could be insufficient to generate an adequate diuretic response. This problem is illustrated by a patient with azotemia with bilateral nephrostomies who underwent Tc-99m MAG3 (mercaptoacetyltriglycine) diuresis renography with 40 mg furosemide to determine if his bilateral ureteral obstruction had resolved. The study showed findings typical for obstruction despite the fact that the patient could not have been obstructed because the nephrostomy tubes had not been clamped. When the study was repeated 6 days later with 80 mg furosemide and clamped nephrostomy tubes, there was good drainage bilaterally excluding obstruction. The nephrostomy tubes were removed and the patient's creatinine has subsequently remained stable for 3 years. In summary, this report illustrates the rationale for increasing the dose of furosemide in patients with azotemia referred for diuresis renography and shows how increasing the dose of furosemide could improve the diuretic response and minimize false-positive or indeterminate results.

Perfil sérico da molécula de adesão intercelular-1 no pós-operatório cardiáco de lactentes submetidos à circulação extracorpórea / Intercellular adhesion molecule-1 serum profile in the cardiac postoperative period of infants undergoing cardiopulmonry bypass

Objetivos: mensurar os níveis séricos da molécula de adesão intercelular-l, solúvel em condições basais e após exposição ao circuito de circulação extracorpórea, em lactentes submetidos à cirurgia cardíaca para correção de defeitos cardíacos congênitos. Métodos: estudo de coorte contemporâneo envolvendo 21 lactentes submetidos à cirurgia cardíaca com uso de circulação extracorpórea. Foram medidos os níveis séricos da molécula de adesão intercelular-l, solúvel na indução anestésica, ao término e 8 e 26 horas após o término da circulação extracorpórea. As amostras foram dosadas através do método de ELISA.Resultados: as patologias cardíacas congênitas mais comuns foram defeito do septo atrioventricular e Tetralogia de Fallot. As médias de idade e de peso foram 6,6 meses e 5,8 quilos. As medianas dos tempos de circulação extracorpórea e de clampeamento da aorta foram, respectivamente, 87 e 53 minutos. Todos os lactentes utilizaram inotrópicos. As medianas dos tempos de intubação e de internação foram 72 horas e 21 dias. A taxa de mortalidade dos pacientes foi de 9,5por cento. Os níveis basais da molécula avaliada foram mais elevados do que aqueles considerados normais (p

[Intercellular adhesion molecule-1 serum profile in cardiac postoperative period of infants undergoing cardiopulmonary bypass]. / Perfil sérico da molécula de adesão intercelular-1 no pós-operatório cardíaco de lactentes submetidos à circulação extracorpórea.

OBJECTIVE: To measure the intercellular adhesion molecule-1 serum levels at baseline and after cardiopulmonary bypass exposure in infants undergoing surgery of congenital heart disease. METHODS: Contemporary cohort study, which consisted of 21 infants undergoing cardiac surgery with cardiopulmonary bypass. The intercellular adhesion molecule-1 serum levels were measured at induction of anesthesia, at the end of cardiopulmonary bypass, and 8 hours and 26 hours after cardiopulmonary bypass. The samples were measured using ELISA. RESULTS: Atrioventricular septal defects and tetralogy of Fallot were the most common congenital cardiac pathologies. The age and weight mean values were 6.6 months and 5.8 Kg. The median values of cardiopulmonary bypass time and aortic cross-clamping time were 87 minutes and 53 minutes. All infants used inotropic drugs. The median values of intubation time and length of stay were 72 hours and 21 days. The patients' mortality rate was 9.5%. The baseline levels of the molecule were higher than the normal values (P<0.0001). The levels of the molecule significantly decreased at the end of the cardiopulmonary bypass (P<0.001), significantly increasing 8 hours after that period (P<0.005), without reaching baseline values 26 hours after that. CONCLUSIONS: The soluble intercellular adhesion molecule-1 baseline serum level is higher than normal in infants presenting congenital cardiac defects. This molecule serum levels vary after cardiopulmonary bypass exposure, presenting a characteristic behavior in these patients.

Correlacao entre citologia, colposcopia, histologia e tipagem viral em lesoes precursoras de cancer de cervice uterina na infeccao pelo papiloma virus humano (HPV) / Correlation of citology, colposcopy, histology and viral typing in pre-cancerous lesions of the uterine cervix in human papilovirus infection (HPV)

Realizou-se um estudo prospectivo de marco a setembro de 1991, incluindo todas as pacientes encaminhadas ao ambulatorio de Doencas Sexualmente Transmissiveis do Hospital de Clinicas de Porto Alegre (HCPA), que apresentassem infeccao pelo Papiloma Virus humano (HPV) a nivel da cervice uterina. As pacientes foram submetidas a uma rotina preliminar com exames citologicos, colposcopicos e histologicos das lesoes cervicais. A amostra totalizou em 76 pacientes. Um subgrupo de 11 pacientes foram submetidas a tipagem viral. Verificamos que 64 (84,2 por cento ) das pacientes apresentaram zonas de transformacao atipica (ZTA) na colposcopia e destas, quando submetidas ao exame citopatologico, 7 (19.9 por cento ) ja possuiam algum grau de displasia. Ja no exame histologico, em 15 (23,4 por cento ) mulheres foi evidenciado neoplasia intra-epitelial NIC e uma (1,6 por cento ) apresentava ca microinvasor. De todas as pacientes submetidas a tipagem viral, 11 (100 por cento ) possuiam o tipo 16 e/ou 18, sendo que destas, 3 evidenciaram NIC e 1 carcinoma microinvasor (36,4 por cento ). Concluimos que o rastreamento da infeccao pelo HPV deve ser baseado no exame citologico, colposcopico e histologico das lesoes, alem da determinacao do tipo viral a fim de estabelecer o prognostico e avaliar a necessidade de tratamento mais agressivo