Extracellular matrix alterations in the Peyronie's disease.

Peyronie's disease is characterized by fibrous plaque formation of the tunica albuginea, causing penile deformity and fertility problems. The aim of the present study was to investigate alterations in the extracellular matrix in Peyronie's disease. The study used tissues collected by surgical procedure from individuals that presented a well-established disease, while control samples were obtained by biopsies of fresh cadavers. Immunohistochemistry analysis followed by digital quantification was performed to evaluate TGF-ß, heparanases and metalloproteinases (MMPs). The profile of sulfated glycosaminoglycans, chondroitin sulfate and dermatan sulfate was determined by agarose gel electrophoresis, while hyaluronic acid quantification was obtained by an ELISA-like assay. The expression of mRNA was investigated for syndecan-1 proteoglycan (Syn-1), interleukine-6 (IL-6), hyaluronic acid synthases, and hyaluronidases. Pathologic features showed decreased apoptosis and blood vessel number in Peyronie's tissues. TGF-ß and IL-6 were significantly enhanced in Peyronie's disease. There was an increased expression of heparanases, though no alteration was observed for MMPs. Hyaluronic acid as well as hyaluronic acid synthases, hyaluronidases, and dermatan sulfate were not changed, while the level of chondroitin sulfate was significantly (P = 0.008, Mann-Whitney test) increased in Peyronie's samples. Heparanases and sulfated glycosaminoglycans seem to be involved in extracellular matrix alterations in Peyronie's disease.

Difficult intubation in children: applicability of the Mallampati index.

BACKGROUND AND OBJECTIVES: The concern of facing difficult airways brought the need of developing predictive testing for difficult intubation. Those tests were developed primarily for adult populations. In pediatric patients studies always focus on patients with congenital malformation, polytraumatized, and newborns. The objective of the present study was to determine the applicability of the predictive test used more often in adults, the Mallampati index, in patients 4 to 8 years old, correlating it with the Cormack-Lehane index. METHODS: One hundred and eight patients 4 to 8 years of age, ASA I, without any type of congenital malformation, genetic syndromes or cognitive deficits were evaluated. The Mallampati index was applied to patients during the pre-anesthetic evaluation. Evaluation of the Cormack-Lehane index was performed after anesthetic induction. A p<0.05 was considered significant. RESULTS: The Mallampati index showed a significant correlation with the Cormack-Lehane index. The sensitivity and specificity of the Mallampati index were 75.8% and 96.2% respectively, but the sensitivity showed a wide confidence interval. CONCLUSIONS: The Mallampati index was proven to be applicable in children 4 to 8 years old.

Intubação difícil em crianças: aplicabilidade do índice de Mallampati / Difficult intubation in children: applicability of the Mallampati index

JUSTIFICATIVA E OBJETIVOS: A preocupação de estar diante de uma via aérea difícil trouxe à tona a necessidade de se desenvolverem testes preditivos de intubação difícil. Tais testes foram, primariamente, desenvolvidos para populações adultas. Nos pacientes pediátricos, os estudos existentes sempre trataram de pacientes com malformações congênitas, politraumatizados e recém-nascidos. O objetivo deste trabalho foi verificar, em pacientes na faixa etária de 4 a 8 anos, a aplicabilidade do teste preditivo de intubação difícil mais comumente utilizado em adultos, o índice de Mallampati, correlacionando-o com o índice de Cormack-Lehane. MÉTODO: Foram estudados 108 pacientes com idades entre 4 e 8 anos, ASA I, sem quaisquer tipos de malformações anatômicas, síndromes genéticas ou déficits cognitivos. Os pacientes foram submetidos, durante a avaliação pré-anestésica, ao índice de Mallampati. Após a indução anestésica, realizava-se a avaliação do índice de Cormack-Lehane. Nos testes estatísticos p < 0,05, foi considerado significativo. RESULTADOS: O índice de Mallampati apresentou correlação significativa com o índice de Cormack-Lehane. A sensibilidade e a especificidade do índice de Mallampati foram, respectivamente, de 75,8 por cento e 96,2 por cento, mas o intervalo de confiança da sensibilidade foi muito grande. CONCLUSÕES: O índice de Mallampati se mostrou aplicável em crianças de 4 a 8 anos.

BACKGROUND AND OBJECTIVES: The concern of facing difficult airways brought the need of developing predictive testing for difficult intubation. Those tests were developed primarily for adult populations. In pediatric patients studies always focus on patients with congenital malformation, polytraumatized, and newborns. The objective of the present study was to determine the applicability of the predictive test used more often in adults, the Mallampati index, in patients 4 to 8 years old, correlating it with the Cormack-Lehane index. METHODS: One hundred and eight patients 4 to 8 years of age, ASA I, without any type of congenital malformation, genetic syndromes or cognitive deficits were evaluated. The Mallampati index was applied to patients during the pre-anesthetic evaluation. Evaluation of the Cormack-Lehane index was performed after anesthetic induction. A p < 0.05 was considered significant. RESULTS: The Mallampati index showed a significant correlation with the Cormack-Lehane index. The sensitivity and specificity of the Mallampati index were 75.8 percent and 96.2 percent respectively, but the sensitivity showed a wide confidence interval. CONCLUSIONS: The Mallampati index was proven to be applicable in children 4 to 8 years old.

JUSTIFICATIVA Y OBJETIVOS: La preocupación de estar frente a una vía aérea difícil, nos hizo desarrollar test predictivos de intubación difícil. Esos test fueron en principio desarrollados para las poblaciones adultas. En los pacientes pediátricos, los estudios existentes siempre trataron a pacientes con malformaciones congénitas, politraumatizados y recién nacidos. El objetivo de este trabajo fue la verificación en pacientes entre los 4 a los 8 años de edad, la aplicabilidad del test predictivo de intubación difícil que es más a menudo utilizado en los adultos, y el índice de Mallampati, correlacionándolo con el índice de Cormack-Lehane. MÉTODO: Se estudiaron 108 pacientes con edades los 4 y los 8 años, ASA I, sin ningún tipo de malformaciones anatómicas, síndromes genéticos o déficits cognitivos. Durante la evaluación preanestésica, los pacientes se sometieron al índice de Mallampati. Después de la inducción anestésica, se realizó la evaluación del índice de Cormack-Lehane. En los test estadísticos p < 0,05 fue considerado significativo. RESULTADOS: El índice de Mallampati presentó una correlación significativa con el índice de Cormack-Lehane. La sensibilidad y la especificidad del índice de Mallampati fueron respectivamente, de 75,8 por ciento y 96,2 por ciento, pero el intervalo de confianza de la sensibilidad fue mucho mayor. CONCLUSIONES: El índice de Mallampati fue aplicable en niños de 4 a 8 años.

The quality of reporting of trial abstracts is suboptimal: survey of major general medical journals.

OBJECTIVE: To evaluate the quality of reporting of abstracts describing randomized controlled trials (RCTs) published in four major general medical journals. STUDY DESIGN AND SETTING: Systematic survey of published RCT abstracts, with two reviewers independently extracting data. We searched MEDLINE and identified 227 RCT abstracts published in the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), and The Lancet in the year 2006. RESULTS: Most abstracts identified the study as a randomized trial (98.7%), reported the objectives (92.5%), described the population (90.3%), detailed the intervention (81.5%), and defined the primary outcome (71.3%). Methodological quality was poorly reported: one (0.4%) described allocation concealment; 21 (9.3%) clearly specified blinding; 51 (22.5%) described intention-to-treat analysis; and 32 (14.1%) outlined losses to follow-up. Most of the abstracts reported the effect size and the confidence intervals (62.3%), but just half of them reported side effects or harms. CONCLUSION: The quality of reporting of RCT abstracts published in main general medical journals is suboptimal. Space limitations notwithstanding, with the recent recommendations from the CONSORT for Abstracts, it is expected that the transparency of abstract reporting can and should improve.

Experiência da Faculdade de Medicina do ABC em nefrolitotripsia percutânea / Experience of the Faculdade de Medicina do ABC in percutaneous nephrolithotripsy

Objetivos: Demonstrar a experiência e os resultados em nefrolitotripsia percutânea na Faculdade de Medicina do ABC. Pacientes e métodos: Entre janeiro de 2002 e janeiro de 2005, foram revisados os prontuários de 69 pacientes foram submetidos a NLPC. Resultados: A massa calcárea média foi de 850 mm2. Todos os pacientes foram tratados através de apenas uma punção renal e somente em 1 caso foi necessária transfusão peri-operatória. A taxa de sucesso após o procedimento inicial foi de 70%, sendo 39% livre de cálculo. Após tratamentos complementares a taxa de sucesso final foi de 85,5%. Conclusão: Os nossos resultados iniciais em NLPC foram um pouco inferiores aos publicados em outras séries. Tal diferença pode ser justificada pela curva de aprendizado inicial neste procedimento, envolvimento de residentes em treinamento, pelo maior volume dos cálculos em relação aos trabalhos da literatura, por ter sido realizada apenas uma punção e não disponibilidade de material flexível para exploração completa da via excretora.

Estudo comparativo e prospectivo entre prostatectomia laparoscópicatransperitoneal e extraperitoneal / Laparoscopic prostatectomy: a comparative study between transperitoneal and extraperitoneal approachs during learning curve

Objetivos: Comparar os dados relativos à prostatectomia laparoscópicapelo acesso transperitoneal e extraperitoneal durante a experiênciapreliminar. Métodos: Foram avaliados retrospectivamente os primeiros30 pacientes submetidos à rostatectomia laparoscópica transperitoneal e 30 extraperitoneal, durante o período de 1999 a 2005. Foram analisados s resultados cirúrgicos, oncológicos e os resultados funcionais como otência e continência, sendo os resultados comparados entre osdois grupos. Resultados: O tempo cirúrgico e a perda sangüíneaintra-operatória foram em média, respectivamente, de 270 minutos e290 ml no grupo extraperitoneal e de 330 minutos e 380 ml no grupotransperitoneal. Não ocorreram diferenças significativas em relaçãoàs complicações intra-operatórias, período de internação hospitalar etempo de permanência do cateter de Foley. Nos pacientes submetidosao acesso extraperitoneal ocorreu uma reintrodução mais precoce dadieta, diminuição de casos de íleo paralítico, evolução menos mórbida defístulas urinárias e a redução da taxa de margens positivas. Em relaçãoà potência sexual e continência urinária não ocorreram diferenças significativas em relação aos dois grupos. Conclusão: A prostatectomia radical laparoscópica é um procedimento complexo, factível e que pode ser utilizado para o tratamento do câncer de próstata localizado. A viaretroperitoneal oferece algumas vantagens em relação à transperitoneal,e o período de curva de aprendizado oferece uma menor morbidade.

Laparoscopic radical prostatectomy by extraperitoneal access with duplication of the open technique

INTRODUCTION: The laparoscopic radical prostatectomy is a continually developing technique. Transperitoneal access has been preferred by the majority of centers that employ this technique. Endoscopic extraperitoneal access is used by a few groups, nevertheless it is currently receiving a higher acceptance. In general, the antegrade technique is used, with dissection from the bladder neck to the prostate apex. The objective of the present paper is to describe the extraperitoneal technique with reproduction of the open surgery's surgical steps. SURGICAL TECHNIQUE: With this technique, the dissection of the prostate apex is performed and, following the section of the urethra while preserving the sphincteric apparatus, the Foley catheter is externally tied and internally recovered, which allows cranial traction, similarly to the way it is performed in conventional surgery. The retroprostatic space is posteriorly dissected and the seminal vesicles are identified by anterior and posterior approach, obtaining with this method an optimal exposure of the posterolateral pedicles and the prostate contour. The initial impression is that this technique does not present higher bleeding rate or difficulty level when compared with antegrade surgery. Potential advantages of this technique would be the greater familiarity with surgical steps, isolated extraperitoneal drainage of urine and secretions and a good definition of prostate limits and lateral pedicles, which are critical factors for preserving the neurovascular bundles and avoiding positive surgical margins. A higher number of cases and a long-term follow-up will demonstrate its actual value as a technical option for endoscopic access to the prostate.

Laparoscopic radical prostatectomy by extraperitoneal access with duplication of the open technique.

INTRODUCTION: The laparoscopic radical prostatectomy is a continually developing technique. Transperitoneal access has been preferred by the majority of centers that employ this technique. Endoscopic extraperitoneal access is used by a few groups, nevertheless it is currently receiving a higher acceptance. In general, the antegrade technique is used, with dissection from the bladder neck to the prostate apex. The objective of the present paper is to describe the extraperitoneal technique with reproduction of the open surgery's surgical steps. SURGICAL TECHNIQUE: With this technique, the dissection of the prostate apex is performed and, following the section of the urethra while preserving the sphincteric apparatus, the Foley catheter is externally tied and internally recovered, which allows cranial traction, similarly to the way it is performed in conventional surgery. The retroprostatic space is posteriorly dissected and the seminal vesicles are identified by anterior and posterior approach, obtaining with this method an optimal exposure of the posterolateral pedicles and the prostate contour. The initial impression is that this technique does not present higher bleeding rate or difficulty level when compared with antegrade surgery. Potential advantages of this technique would be the greater familiarity with surgical steps, isolated extraperitoneal drainage of urine and secretions and a good definition of prostate limits and lateral pedicles, which are critical factors for preserving the neurovascular bundles and avoiding positive surgical margins. A higher number of cases and a long-term follow-up will demonstrate its actual value as a technical option for endoscopic access to the prostate.

Atualidades em terapia oncogênica antiangiogênica / New fatures in antiangiogenesis oncogenic therapy

O cancer é uma das principais causas de morte no mundo, e a busca da cura desse mal é uma das principais preocupações da medicina moderna. Neste sentido, na última década dois nomes têm se destacado no estudo do crescimento tumoral e a busca da cura: Judah Folkman e Michael O`Reilly. Seus estudos sobre a angiogênese tumoral permitiram a identificação de dois agentes, angiostatina e endostatina, que mostram grande potencial na terapêutica antineoplásica, agindo justamente na inibição dessa angiogênese. O marco desse estudo foi a observação clínica e laboratorial do rápido crescimento e disseminação de imúmeros focos tumorais após a retirada de um tumor primário. Conclui-se, portanto, que a presença deste inibia de alguma forma o crescimento dos demais focos. Essas duas novas substâncias vêm se somar às várias terapias antiangiogênicas tumorais em estudo, como o trombospondin, interferon, inibidores das metaloproteinases; porém com a vantagem de serem até o presente momento, sem efeitos colaterais...

Lambert-eaton myasthenic sydrome: report of two cases

Two cases of Lambert-Eaton myasthenic syndrome, in female patients whose neoplasm investigation was negative, are reported. Repetitive stimulation of ulnar nerve showed an incremental response (=187 per cent and +198 per cent). Needle EMG was normal in one of them, however, the other patient showed fibrillation potentials, positive sharp waves, potentials of low amplitude and short duration. The authors discuss the clinical, electrophysiological, and pathological features of the disease, as well as some aspects of the treatment and follow-up of these patients.