[Radical prostatectomy: which quality of life?]. / Prostatectomia radicale retropubica: quale qualità di vita?

The aim of the present study was to evaluate quality of life in patients submitted to radical prostatectomy, by correlating the results of the postoperative condition with follow- up data at 6 and 12 months. MATERIALS AND METHODS. Between october 2004 and december 2005, 68 patients - mean age 68 (range 49-76) - treated with radical retro-pubic prostatectomy for localized prostate cancer (T2a, T2b, No, Mo) were consecutively enrolled onto the study. All patients underwent sexual as well as urinary incontinence rehabilitation, showing good compliance. We evaluated quality of life before prostatectomy (T0), 6 (T1) and 12 (T2) months after surgery through the Short Form 36 questionnaire, for which an analysis of variance for repeated measures was carried out. Patients were interviewed by our department psychologist regarding urinary incontinence and erectile dysfunction. All patients were disease-free at the time of evaluation. RESULTS. No significant differences were observed between physical and mental health indices. Conversely, a significant improvement (p<0.001) was seen in all SF-36-questionnaire 8 scales, comparing preoperative T0 values with T1 and T2 values. Of the 68 patients, 53 (78%) no longer needed pads at the T2 follow-up, while 15 (22%) reported using 3-4 pads/day. A significant worsening of the sexual function (maintenance of erection) was observed in 51 (75%) patients, who had reported having normal sexual activity preoperatively (T0). On the other hand, 17 (25%) patients reported having an adequate erection to engage in sexual intercourse. CONCLUSIONS. Despite the differences observed in physical and mental health scores during the three periods evaluated (T0, T1 and T2), overall quality of life does not appear to have been greatly compromised by surgery. At T2 follow-up, in fact, all 68 patients reported to be satisfied with having undergone radical prostatectomy because of its benefits in terms of survival and its limited effects on their quality of life.

Aspectos atuais da resposta isquêmica no eletrocardiograma de esforço além do segmento ST / Current aspects of ischemic response in stress electrocardiography beyond the ST segment

As alterações eletrocardiográficas observadas no segmento ST compatíveis com isquemia miocárdica induzida pelo exercício, durante o teste ergométrico, apresentam maior acurácia diagnóstica e prognóstica quando correlacionadas com variáveis hemodinâmicas e outros parâmetros eletrocardiográficos.

Renal cell carcinoma: histological findings on surgical margins after nephron sparing surgery.

PURPOSE: We evaluated the incidence of peritumoral satellite lesions in nephron sparing surgery and examined whether these findings have a negative effect on cancer specific survival and on the percent of local recurrence. MATERIALS AND METHODS: We performed nephron sparing surgery in 63 patients with kidney cancer, including 53 elective (group 1) and 10 imperative (group 2) operations. In all cases we removed 10 mm. of apparently healthy peritumoral parenchyma with the tumor. This tissue was subsequently examined by an anatomical pathologist to identify any satellite lesions. RESULTS: Four satellite lesions were identified, including 3 in group 1 and 1 in group 2, at a mean of 5.3 mm. from the primary lesion. None of the patients in either group had local recurrence at followup. Cancer specific survival was 96.3% in group 1 (mean followup 61 months) and 58% in group 2 (mean followup 39 months). It was not influenced by the presence of satellite micro-lesions. CONCLUSIONS: Despite common perplexities concerning the risk of multifocality in renal cell carcinoma we believe that the nephron sparing procedure in select patients is as effective as radical surgery. Based on our experience the surgical safety margin must be at least 10 mm. of macroscopically healthy, peritumoral tissue.

Teste Ergométrico em Idosos: Parâmetros clínicos, metabólicos, hemodinâmicos e eletrocardiográficos

Apresenta uma análise de testes ergométricos aplicados em indivíduos maiores de 65 anos com vistas a identificar as adaptações clínicas, hemodinâmicas, metabólicas e eletrocardiográficas decorrentes do trabalho físico efetuado. Apresenta os métodos utilizados, os resultados do estudo e a bibliografia consultada. Documento em formato pdf; requer o Acrobat Reader.

Teste de esforço cardiopulmonar durante estimulaçäo colinérgica com dose única de piridostigmina em indivíduos saudáveis / Exercise stress testing in healthy subjects during cholinergic stimulation after a single dose of pyridostigmine

OBJETIVE: The evaluation, by exercise stress testing, of the cardiorespiratory effects of pyridostigmine (PYR), a reversible acetylcholinesterase inhibitor. METHODS: A double-blind, randomized, cross-over, placebo-controlled comparison of hemodynamic and ventilation variables of 10 healthy subjects who underwent three exercise stress tests (the first for adaptation and determination of tolerance to exercise, the other two after administration of placebo or 45mg of PYR). RESULTS: Heart rate at rest was: 68 + or - 3 vs 68 + or - 3bpm before and after placebo, respectively (P=0.38); 70 + or - 2 vs 59 + or - 2bpm, before and after pyridostigmine, respectively (P<0.01). During exercise, relative to placebo: a significantly lower heart rate after PYR at, respectively, 20 per cent (P=0.02), 40 per cent (P=0.03), 80 per cent (P=0.05) and 100 per cent (P=0.02) of peak effort was observed. No significant differences were observed in arterial blood pressure, oxygen consumption at submaximal and maximal effort, exercise duration, respiratory ratio, CO2 production, ventilation threshold, minute ventilation, and oxygen pulse. CONCLUSION: Pyridostigmine, at a dose of 45mg, decreases heart rate at rest and during exercise, with minimal side effects and without interfering with exercise tolerance and ventilation variables.

Condicionamento físico e limitacoes do adolescente / Fitness and Limitations of Adolescents

O condicionamento fisico de adolescentes pode ser obtido atraves de um programa de exercicios aerobicos, melhor tolerados pela utilizacao predominante da energia oxidativa, ao contrario das atividades anaerobicas que levam a um nivel elevado de acido latico, pouco tolerado pelo adolescente, com exaustao muitas vezes precoce. O condicionamento fisico e de grande utilidade em adolescentes hipertensos, obesos, diabeticos, e, contribui para elevacao de hormonios do crescimento. Deve-se pesquisar a presenca de anemia, incompativel com a boa performance. Para a avaliacao cardiorespiratoria de adolescentes que vao iniciar a pratica esportiva torna-se indispensavel a execucao de teste ergometrico em esteira rolante, em que se realiza o eletrocardiograma de esforco. Ecocardiograma tambem tem uma indicacao importante na deteccao de anomalias valvares ou miocardicas, e, em casos especiais, se indica o ecocardiograma com esforco, realizado em bicicleta ergometrica. Os parametros obtidos nestes exames permitem a liberacao do individuo para os programas de condicionamento fisico e colaboram na quantificacao destes programas. A atividade esportiva em adolescentes tem uma grande importancia no desenvolvimento fisico e psiquico, devendo ser mais estimulada nas escolas e nas comunidades