Elementos neolamarckistas do selecionismo skinneriano / Neo-lamarckian elements of skinnerian selectionism

A biologia evolutiva tem sido palco de um debate entre as teorias neodarwinista e neolamarckista. Oneodarwinismo explica todo processo evolutivo em termos da seleção de variações genéticas randômicas,assim, o que acontece no âmbito da história de vida do indivíduo, no desenvolvimento e naaprendizagem, não interfere no curso evolutivo. Já a teoria neolamarckista defende a existência demúltiplas fontes de variação, nem sempre randômicas, sobre as quais a seleção opera; ela também admiteque desenvolvimento e aprendizagem podem influenciar a evolução. O objetivo deste ensaio é mostrarque o modelo selecionista skinneriano apresenta características de uma teoria evolutiva neolamarckista.Conclui-se que essa aproximação ajudaria a análise do comportamento a participar ativamente dediscussões contemporâneas da biologia evolutiva(AU)

[Evaluation of sexual activity after prostatic surgery for benign prostatic hyperplasia assessed by pre-operative and post-operative questionnaire]. / Valutazione dell'attività sessuale dopo chirurgia prostatica per ipertrofia prostatica benigna mediante questionario pre e postoperatorio.

AIM: Different authors showed a 5-40% incidence of erectile dysfunction after prostatic surgery for benign prostatic hyperplasia. The aim of our study was to evaluate the effect of prostatic surgery due to benign prostatic hyperplasia on sexual activity. METHODS: We evaluated 56 patients (mean age 63 years, range 49-70) who underwent transurethral resection of the prostate (30 patients, mean age 64 years, range 56-70) and open prostatectomy (26 patients, mean age 59 years, range 49-70) with a questionnaire regarding the presence of sexual dysfunction before and 3, 6, 12 months after surgery. All patients were not affected by previous or present metabolic, neurological, cardiovascular diseases. RESULTS: Twenty percent of the patients with a normal sexual activity before treatment presented erectile dysfunction after surgery. However, 35% of patients with erectile dysfunction before treatment presented an improvement of their erectile function after surgery. CONCLUSIONS: A high incidence of erectile dysfunction was observed in patients undergoing prostatic surgery. Patients with erectile dysfunction should also recover a normal behaviour after prostatic surgery as well as an improvement of the erectile dysfunction.

Urothelial bladder carcinoma and viral infections: different association with human polyomaviruses and papillomaviruses.

Bladder cancer is the second most commonly occurring genitourinary cancer in adults. The interaction of different carcinogenic and cocarcinogenic agents are responsible for bladder urothelial carcinoma: alcohol and smoking habits, Schistosoma haematobium infection, exposition to chemicals, analgesic and antineoplastic drugs prolonged use. Recently also viral infections have been associated to this pathology. In this study the correlation between viral infections and bladder carcinoma has been evaluated. A group of 32 patients affected by primary bladder neoplasia has been analysed. A control group of 20 autoptic samples of healthy bladder was analysed. The DNA of the following viruses has been searched by polymerase chain reaction (PCR): Adenovirus, Herpes simplex virus type 1 (HSV-1), Herpes simplex virus type 2 (HSV-2), Human Papillomaviruses (HPV), Polyomaviruses (BKV and JCV). In the examined population the association bladder carcinoma-HPV, found by others, has not been confirmed. The high percentage of human polyomaviruses present in the samples is a statistically significant data (p=0.0087) and allows to presume that BKV and JCV may play a role in the aetiology of bladder tumor. In particular the polyomavirus BK, which is found in significative percentage both in single infection (p=0.0036) and in co-infections with other viral species (p=0.035), may be an important co-factor in the pathogenesis of bladder carcinoma.

Clinical and pressure-flow changes after long-term treatment with alfuzosin SR.

OBJECTIVES: The aim of our study was to evaluate the symptomatic and urodynamic changes after 1-5 years of treatment with alfuzosin in patients with benign prostatic hyperplasia. METHODS: Out of 255 patients with lower urinary tract symptoms observed from 1992 to 1997, who completed the International Prostatic Symptom Score (I-PSS) and underwent full urodynamic investigation, 161 were found to be obstructed (Schäfer classes 2-6). One hundred and two subsequently consented to a second clinical and urodynamic evaluation. Out of these, 46 underwent surgical treatment, 20 were elected for watchful waiting (WW) and 36 received a medical treatment. Twenty out of these, with a mean age of 65 years, a mean prostatic volume of 44 ml (20-70) a median Schäfer's obstruction class of 3 (range 2-5) were treated with slow release alfuzosin 5 mg twice a day. We re-evaluated these 20 patients with a second I-PSS and pressure-flow study after 1-5 years (mean: 2 years) of treatment. The patients in the WW group with comparable baseline characteristics were considered as controls. The Wilcoxon matched-pairs signed rank test and the Kruskal-Wallis test were used for statistical analysis. RESULTS: In the group treated with alfuzosin, no differences were noted for I-PSS (14.9 +/- 6,8; 13.3 +/- 5); maximum flow (124 +/- 6; 14 +/- 6) and projected isometric pressure (105 +/- 36; 105 +/- 26). Statistically significant differences were noted for residual urine (103 +/- 100; 33 +/- 38, p = 0.02); detrusor pressure at maximum flow (64.4 +/- 23; 53 +/- 12, p = 0.04), minimum urethral opening pressure (36.5 +/- 9; 31 +/- 9, p = 0.02), Schäfer class (2.7 +/- 0.7; 2 +/- 0.8, p = 0.04); urethral resistance algorithm (34.7 +/- 11; 27 +/- 7, p = 0.02). Statistically significant differences between baseline and follow-up were noted for none of the clinical and urodynamic parameters in the WW group. CONCLUSIONS: Patients with bladder outlet obstruction seem to remain clinically stable and to improve urodynamically when treated with alfuzosin for a long period of time.

Long-term maintenance bacille Calmette-Guérin therapy in high-grade superficial bladder cancer.

OBJECTIVES: To assess the long-term results of intravesical bacille Calmette-Guérin (BCG) induction plus long-term maintenance treatment for high-grade superficial bladder cancer. METHODS: Between 1994 and 2000, 41 patients who presented to our clinic with superficial urothelial carcinoma of the bladder (T1G3, T1G3 plus carcinoma in situ, or recurrent TaG2-3) were treated by transurethral resection of all visible tumor and an induction cycle of BCG plus a long-term maintenance BCG course consisting of 11 monthly instillations followed by 4 quarterly instillations and then by 6 six-monthly instillations. The median follow-up was 40 months. RESULTS: Thirty patients remained tumor free throughout the follow-up period. Ten patients had a recurrence of superficial tumor, 9 patients during the monthly instillation course and 1 patient during the quarterly instillation course. One patient presented with progression. CONCLUSIONS: Adjuvant immunotherapy with BCG after complete transurethral resection of bladder tumor represents a highly effective primary treatment for high-grade superficial bladder cancer. Our maintenance course of BCG seemed to improve the worldwide accepted effectiveness of the BCG induction course without any important side effects.

Ocorrências iatrogênicas com medicação em Unidade de Terapia Intensiva: condutas adotadas e sentimentos expressos pelos enfermeiros / Ocurrencias iatrogénicas com medicamentos en Unidad de Cuidados Intensivos: conductas y sentimientos de los enfermeros / Iatrogenic occurrences with medication in I. C. U: nurse's procedures and feelings

Ocorrências iatrogênicas com medicação na UTI são eventos indesejáveis que exigem pronta intervenção do enfermeiro. Opresente estudo foi realizado com os seguintes objetivos:- verificar a conduta dos enfermeiros diante de uma ocorrência commedicação, identificar os sentimentos vividos nessas situações e caracterizar os fatores relacionados a esses eventos. Pormeio de um questionário respondido por 148 enfermeiros de UTI (76,7 por cento) de 7 hospitais do Município de São Paulo, nosanos de 1997 e 1998, os dados foram obtidos e analisados segundo freqüência absoluta e percentual. Os resultados permitiramconcluir que as condutas mais citadas incluíram: comunicar o fato ao médico (31,7 por cento), intensificar os controles (26,5 por cento) ecomunicar a chefia de enfermagem (13,5 por cento). Ansiedade, impotência e culpa foram sentimentos mais apontados com38,1 por cento, 14,6 por cento e 12,3 por cento, respectivamente. O fator relacionado às ocorrências mais freqüente foi a displicência do funcionário(23,1 por cento). Quanto à vivência desse tipo de ocorrência, a maior porcentagem (43,2 por cento) referiu ter vivido situação semelhanteraras vezes.

Iatrogenic occurrences with medication in ICU are adverse events that demand nurse's interventions. The aims of this studywere: - to identify nurse's procedures and feelings in this situation; - to characterize factors related to this kind of event inICU settings. A questionnaire was answered by 148 ICU nurses (76,7 percent) from 7 hospitals in São Paulo city, in 1997 and1998. The results showed that of 407 mentioned procedures, 31,7 percent included to comunicate the event to the doctor, followedby to intensify the patient control (26,5 percent). Regarding the 260 feelings informed by the nurses, anxiety and impotence werethe most frequent, respectively, 38,1 percent and 14,6 percent. Of 303 factors related to the occurrences nurses pointed out neglet (24,6 percent)and professional innexperience (15,1 percent) as the most important. Forty three point two per cent (43,2 percent) of the nurses hardlyexperimented this situation in their professional life in ICU.

Ocurrencias iatrogénicas com medicamentos en UCI no son hechos esperados y necesitan rápida actuación de los enfermeros.El estudio tuvo los siguientes objectivos: verificar la conducta de los enfermeros delante de una ocurrencia iatrogénica commedicamnetos; identificar los sentimientos provocados por tales situaciones y identificar los factores vinculados a talesocurrencias. Ciento cuarenta ocho enfermeros (76,7 por ciento) de 7 UCI de la ciudad de São Paulo, Brasil, contestaran una encuestaen los años de 1997 y 1998. Los resultados llevan a concluir que las conductas más frecuentes incluyeran: comunicar elhecho al médico (31,7 por ciento), aumentar los controles (26,5 por ciento) y comunicar el hecho al director de enfermería (13,5 por ciento). Ansiedad(38,1 por ciento), impotencia (14,6 por ciento) y culpa (12,3 por ciento)fueranlos sentimientos más frecuentes. El factor más importante relacionado a las ocurrencias iatrgénicas fue la falta de atención del trabajador de enfermería (23,1 por ciento). Otros 64 enfermeros (43,2 por ciento)relataran teneren vivido situaciones semejantes raras vetes.

[Iatrogenic events with medications at the intensive care unit: procedures and feelings expressed by nurses]. / Ocorrências iatrogênicas com medicação em unidade de terapia intensiva: condutas adotadas e sentimentos expressos pelos enfermeiros.

Iatrogenic occurrences with medication in ICU are adverse events that demand nurse's interventions. The aims of this study were:- to identify nurse's procedures and feelings in this situation;- to characterize factors related to this kind of event in ICU settings. A questionnaire was answered by 148 ICU nurses (76.7%) from 7 hospitals in São Paulo city, in 1997 and 1998. The results showed that of 407 mentioned procedures, 31.7% included to communicate the event to the doctor, followed by to intensify the patient control (26.5%). Regarding the 260 feelings informed by the nurses, anxiety and impotence were the most frequent, respectively, 38.1% and 14.6%. Of 303 factors related to the occurrences nurses pointed out neglect (24.6%) and professional inexperience (15.1%) as the most important. Forty three point two per cent (43.2%) of the nurses hardly experimented this situation in their professional life in ICU.

Technical modification of Mainz pouch II urinary diversion: preliminary experience.

Use of the Mainz pouch II technique leads to a reduction in the complications frequently observed because of the high pressure associated with ureterosigmoidostomy. A technical variation of the procedure is described in which reimplantation of the left ureter in the rectosigmoid is carried out to avoid the risk of stretching and kinking and the need to fix the pouch to the sacrum. Furthermore, this procedure is easier to perform and less time consuming.

Superficial bladder tumors in patients under 40 years of age: clinical, prognostic and cytogenetic aspects.

Bladder carcinoma with transitional cells is the most frequent neoplasia in the urinary system, but it is quite rare in patients under 40 years of age (0.4-2%). An analysis of 21 patients under 40 and a review of other reports show that tumors in patients under 20 years old have little tendency to recur and to progress, while tumors in patients aged between 21 and 40 have a behavior pattern similar to older age groups regarding recurrence and disease progression. Preliminary results of a study using fluorescent in situ hybridization with probes for the centromere of chromosomes 7 and 17 showed a high incidence of aneusomy with regard to these chromosomes and a genetic difference between superficial tumors in the young and in adults. Using probes from chromosomes already described in bladder carcinogenesis, we obtained higher sensitivity and specificity in detecting aneuploid events.

DNA aberrations in urinary bladder cancer detected by flow cytometry and FISH: prognostic implications.

We evaluated the genetic changes in bladder cancer biopsy by fluorescence in situ hybridization (FISH) and related them to stage and grade of the tumor, ploidy (FCM) and clinical outcome, to determine a simple method to identify tumors with a poorer prognosis. Using FISH the numerical aberrations of chromosomes 1, 7, 9, 17 in tumor's imprints of 70 patients with transitional cell cancer (TCC) were determined. First of all, the data demonstrated that the sensitivity of FISH in detecting quantitative DNA aberrations exceeds FCM's sensitivity. The frequency of chromosome 1 and 9 aberrations did not show significant differences in diploid and aneuploid tumors in different stage and grade. On the contrary, the chromosome 7 and 17 aneusomy showed greater differences between pT1 and pT2-3 tumors (p<0.032 and p<0.0006, respectively) than between stage pTa and pT1. In our investigation, an increasing number of aberrations was observed in all chromosomes examined in tumors of patients who afterwards underwent cystectomy and/or had recurrent tumors. These results suggest that chromosome 7 and 17 aneusomy could be predictive of adverse outcome in a subgroup of patients with superficial tumors at presentation.

Interphase cytogenetics of bladder cancer progression: relationship between aneusomy, DNA ploidy pattern, histopathology, and clinical outcome.

In the present study, different stages of transitional cell carcinoma of the bladder were analyzed by fluorescent in situ hybridization, using probes specific for pericentromeric classical satellite. Seventy primary tumors were evaluated for chromosomes 1, 7, 9, 17, and ploidy by flow cytometry. The results were correlated, after a mean follow-up period, with ploidy, histopathological characteristics, recurrence, and progression. Firstly, our data demonstrated that the sensitivity of fluorescence in situ hybridization in detecting quantitative DNA aberrations exceeds that of flow cytometry. The frequency of chromosome 1 and 9 aberrations was not significantly different in diploid and aneuploid tumors of different stage and grade. In contrast, the chromosome 7 and 17 aneusomy showed greater differences between pT1 and pT2-3 tumors (P<0.032 and P<0.0006, respectively) than between stage pTa and pT1. An increasing number of aberrations was observed in all chromosomes examined from tumors of patients that afterwards underwent cystectomy and/or had recurrent tumors. This study indicates that fluorescence in situ hybridization could be used to detect genetic changes relevant to patient outcome. These genetic changes could identify patients at high risk of recurrence and possible progression.

Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach.

PURPOSE: Cremasteric or extrafunicular reflux is considered by many a major cause of primary and recurrent varicocele. Therefore, surgical techniques that allow ligation of the intrafunicular and extrafunicular veins are often performed. We evaluated the incidence of cremasteric reflux in patients with primary or recurrent varicocele with a new and simple venographic technique. MATERIALS AND METHODS: A series of 73 patients with primary (54) or recurrent (19) varicocele underwent venography of the left iliac vein while standing and performing Valsalva's maneuver to reveal the possible presence of reflux in cremasteric or other extrafunicular veins. In patients with recurrent varicocele antegrade transcrotal spermatic venography was also performed immediately before surgery. RESULTS: None of the patients presented with reflux of contrast material from the left iliac vein to the left pampiniform plexus via the extrafunicular veins. Cremasteric veins, in particular, were always continent at the confluence with the epigastric vein even when grossly dilated at spermatic antegrade venography in recurrent cases. CONCLUSIONS: Cremasteric reflux seems to have a limited role if any in the pathogenesis of primary and even recurrent varicocele. Dilatation of the extrafunicular veins is not necessarily a sign of reflux but may represent only a consequence of venous overflow due to insufficiency of the internal spermatic vein and possibly partial obstruction of the left iliac vein. The rationale of surgical treatments aimed at ligation of the extrafunicular veins should be questioned.

[Role of urinary cytology in the study of bladder cancer. Comparison with the BTA test]. / Ruolo della citologia urinaria nello studio delle neoplasie vescicali. Confronto con il BTA test.

Early diagnosis of bladder neoplasia at the moment makes use of urinary cytology and cystoscopy. The authors describe the results of a study on 62 patients (56 men and 6 women) with bladder neoplasia, and compare the results of urinary cytology to the BTA test (Bladder Tumor Antigen test), ones, after considering histological results of TURB (Trans Urethral Resection Bladder) or cystectomy. Sensibility of urinary cytology was quite better than BTA test sensibility (80.6% vs 48%). Finally it's described a study on 450 cases of istologically controlled bladder carcinomas, on which had been executed a cytological analysis before surgical treatment. The outcome of cytological diagnosis on 414 cases (92%) was neoplasia. On the basis of their experience, the authors regard cytology as a fundamental method in diagnostic iter and in follow-up of patients with bladder neoplasia.

[Rationale for the treatment of pyelo-ureteral obstruction]. / Le basi razionali della terapia correttiva delle ostruzioni del giunto pielo-ureterale.

On account of the reported better results of open surgical dismembered pyeloplasty over the new techniques of endopyelotomy (95-100% versus 70-80%), the Author takes into consideration the factors which might contribute to this difference in results. Among these factors, the etiology of the obstruction seems to be of importance. In fact, while dismembered pyeloplasty involve the complete removal of both the anatomical and functional causes of obstruction (stenosis, adynamic junction), endopyelotomy should only overcome the anatomic causes of obstruction, most likely being inadequate in the functional causes of obstruction due to aperistalism of the junction. Another factor involved in the lower success rate of endopyelotomy is the absence of ampullar resection which may interfere with the recovery of a normal peristalsis. A careful and updated evaluation of the etiology and pathophysiology of pyeloureteral junction is therefore mandatory for a meaningful choice of the appropriate management and for the screening of patients who will benefit the most from each type of treatment.

Scrotoscopy: a promising future? Our preliminary experience.

Scrotoscopy is a new endourologic technique for the exploration of the scrotum. After distention of the tunica vaginalis space with saline, a standard arthroscope was employed in 20 cadavers and subsequently in 5 patients before full surgical exploration for hydrocele (1 case), testicular biopsy (3 cases), or orchidectomy (1 case). There was a clear view of the testis and epididymis. The procedure was easy, and there were no major complications. Scrotoscopy could potentially be performed on an outpatient basis. Its indications in infertility appear to be particularly promising.

[Transitional cell neoplasm of the bladder in childhood: presentation of a clinical case]. / Neoplasia vesical de células de transición en edad pediátrica: presentación de un caso clínico.

A case of urothelial carcinoma of the bladder in a 13-year-old boy is reported. As observed in the literature, it is an extremely rare condition in children. The importance of gross or microscopic hematuria, which is often the only sign of this condition, is underscored. The authors comment on the possible follow-up modalities in relation with the characteristics of this tumor type in young patients. Although it is more invasive (anesthesia, trauma) than US or urinary cytology, cystoscopy is more precise. Because recurrence is extremely rare, it can be performed once a year.

Transurethral microwave thermotherapy in the treatment of symptomatic benign prostatic hyperplasia.

One hundred and forty-four patients with symptomatic benign prostatic hyperplasia were treated by transurethral microwave thermotherapy between January and December 1991. Before entering the study, all patients had a Boyarsky symptom score > or = 8, peak flow rate < or = 15 ml/s and postvoiding residual urine < or = 200 ml. Transurethral thermotherapy with the Prostatron (Technomed) was carried out as a single session (60 min) without any analgesia or sedation. Acute urinary retention occurred in 19.4% of the patients after treatment requiring catheterization for 2-3 weeks; morbidity rate was 5.5%. Six months after treatment, Boyarsky symptom score decreased from 11.73 +/- 4.97 to 4.40 +/- 3.21 (mean values +/- SD); peak flow rate increased on average from 8.97 +/- 4.18 to 13.07 +/- 4.87 ml/s and postvoiding residual urine decreased from 135 +/- 17.9 to 63 +/- 34.7 ml. Slight further improvement was shown, in a few patients, at the 1-year follow-up visit.

Abnormalities of colonic mucin secretion and metabolic changes after internal urinary diversion for bladder exstrophy. A prospective study.

Ten patients with different types of internal urinary diversion for bladder exstrophy were studied prospectively in order to assess metabolic abnormalities and morphological, histochemical and lectin binding changes in the colorectal mucosa. The histochemical and/or lectin binding changes which were found in the majority of patients were identical to those observed in premalignant and malignant conditions of the colon. In some cases they were detectable 3 years after the initial examination but were completely absent from the colorectal mucosa of normal subjects. Metabolic disturbances (metabolic acidosis, increased anion gap, hyperchloraemia) were observed in a substantial number of asymptomatic patients. These findings stress the need for regular endoscopic, histological and metabolic follow-up in these patients and for life-long treatment with bicarbonate or citrate.

The incidence of post-operative urinary tract infection in patients with ureteric stents.

Despite the many advantages provided by the ureteric stent, it produces a foreign body reaction and increases the risk of infection. We undertook a study on the rate of infection in a group of paediatric patients with ureteric stents; 40 ureteric stents, 6 to 9 F, were used in 36 children undergoing the following procedures: 18 pyeloplasties, 20 antireflux ureteric reimplantation and 2 uretero-rectal anastomoses. Only patients with sterile urine pre-operatively were included in the study. All received antibiotic cover in the post-operative period. Positive urine cultures were found in only 3 patients (7.5%). In spite of this low incidence, the urine specimens collected from all children 1 month after removal of the stent showed a much higher incidence of infection. It was concluded that ureteric stenting is a safe procedure with a low rate of infection provided that antibiotic cover is given.

[Unilateral primary vesico-ureteral reflux: uni- or bilateral reimplantation?]. / Reflux vésico-urétéral primitif monolatéral: réimplantation mono ou bilatérale?

The need of bilateral reimplantation in unilateral reflux is still stressed by some authors. The following represents the rationale for this surgical management. 1. correction of unilateral reflux may increase bladder pressure and in this way induce a contralateral reflux; 2. the operation on one side may lead to changes in the muscles and cause reflux on the opposite one; 3. reflux, though unilateral, is the result of a malformation involving the whole trigone. Nevertheless, the authors regard as unjustified the reimplantation of a normal ureterovesical junction being in-acceptable the risk, even if low, of operative failure on a ureter without reflux. Literature data show an incidence of contralateral reflux after unilateral reimplantation of 11-32%. Such incidence, however, tends to decrease (1.9-20%) one year after the operation due to the spontaneous resolution of reflux in most of the cases. The grade of reflux was low (I-II grade) in the majority of cases. The authors report on 38 cases of unilateral primitive vesico-ureteral reflux who underwent unilateral ureteral reimplantation between 1981 and 1982. Minimum follow-up was 2 years. After surgery, contralateral reflux occurred in 4 cases (10.5%) but it spontaneously subsided within 3 years in all of them. Contralateral reflux was asymptomatic in 3 cases and in no cases caused renal scars. The authors conclude that unilateral ureteral reimplantation is the procedure of choice in children with unilateral reflux. Bilateral reimplantation, however, will be performed in patients with bilateral reflux who showed disappearance of reflux on one side before the operation.