Donor Choriocarcinoma Transmission From Solid Organ Transplantation: A Case Report.

Transplantation of any organ has some inherent risk of disease transmission, such as infection and malignancy. The present study aims to describe 2 cases of choriocarcinoma transmission after kidney and liver transplantation originating from the same patient. The donor was a 17-year-old woman who died of cerebral hemorrhage. Both organ recipients died of metastatic choriocarcinoma few months after the transplantation, within days after starting chemotherapy. Retrospective hCG (human chorionic gonadotropin hormone) analysis in donor's blood stored at the time of donation had a result of 9324 mIU/mL. Despite its rarity, clinicians should be aware of the risk of transplant-related choriocarcinoma from female donors in childbearing age. In some cases, hCG dosage should be performed before donation.

[Santa Casa de Misericórdia of Cachoeira: charity and philanthropy in the context of the imperial government's welfare policy]. / Santa Casa de Misericórdia da vila da Cachoeira: a caridade e a filantropia no contexto da política assistencial do governo imperial.

The constitution and operationalization of a religious brotherhood in Cachoeira, Bahia province, during the Brazilian imperial period, is investigated. Deserving of particular attention is the decree issued by Emperor Pedro I, which raised the then centennial São João de Deus Hospital, a royal institution administered by officials designated by the city council, to the status of Santa Casa de Misericórdia. The policy regulating the granting of privileges and provincial monies to all the institutions of this designation in Bahia is also analyzed. The study concludes that the financial policy adopted by the Brazilian State in Bahia constituted a significant stimulus both for the founding and for the financial upkeep of the Cachoeira brotherhood.

O estudo examina o processo de constituição e operacionalização de uma confraria devocional na vila de Cachoeira, província da Bahia, ao longo do período imperial brasileiro. Merecerá destaque o decreto do imperador dom Pedro I que elevou o então centenário Hospital São João de Deus, equipamento do patrimônio régio administrado por dirigentes designados pela Câmara de Vereadores, à condição de Santa Casa de Misericórdia. Além disso, será analisada a política de concessão de privilégios e consignações orçamentárias do governo da província destinada às misericórdias baianas. Conclui-se que a política das finanças públicas do Estado brasileiro, na Bahia, representou um estímulo relevante para a fundação e para a sustentação econômico-financeira da irmandade cachoeirana.

Santa Casa de Misericórdia da vila da Cachoeira: a caridade e a filantropia no contexto da política assistencial do governo imperial / Santa Casa de Misericórdia of Cachoeira: charity and philanthropy in the context of the imperial government's welfare policy

Resumo O estudo examina o processo de constituição e operacionalização de uma confraria devocional na vila de Cachoeira, província da Bahia, ao longo do período imperial brasileiro. Merecerá destaque o decreto do imperador dom Pedro I que elevou o então centenário Hospital São João de Deus, equipamento do patrimônio régio administrado por dirigentes designados pela Câmara de Vereadores, à condição de Santa Casa de Misericórdia. Além disso, será analisada a política de concessão de privilégios e consignações orçamentárias do governo da província destinada às misericórdias baianas. Conclui-se que a política das finanças públicas do Estado brasileiro, na Bahia, representou um estímulo relevante para a fundação e para a sustentação econômico-financeira da irmandade cachoeirana.

Abstract The constitution and operationalization of a religious brotherhood in Cachoeira, Bahia province, during the Brazilian imperial period, is investigated. Deserving of particular attention is the decree issued by Emperor Pedro I, which raised the then centennial São João de Deus Hospital, a royal institution administered by officials designated by the city council, to the status of Santa Casa de Misericórdia. The policy regulating the granting of privileges and provincial monies to all the institutions of this designation in Bahia is also analyzed. The study concludes that the financial policy adopted by the Brazilian State in Bahia constituted a significant stimulus both for the founding and for the financial upkeep of the Cachoeira brotherhood.

Santa Casa de Misericórdia da vila da Cachoeira: a caridade e a filantropia no contexto da política assistencial do governo imperial / Santa Casa de Misericórdia of Cachoeira: charity and philanthropy in the context of the imperial government’s welfare policy

O estudo examina o processo de constituição e operacionalização de uma confraria devocional na vila de Cachoeira, província da Bahia, ao longo do período imperial brasileiro. Merecerá destaque o decreto do imperador dom Pedro I que elevou o então centenário Hospital São João de Deus, equipamento do patrimônio régio administrado por dirigentes designados pela Câmara de Vereadores, à condição de Santa Casa de Misericórdia. Além disso, será analisada a política de concessão de privilégios e consignações orçamentárias do governo da província destinada às misericórdias baianas. Conclui-se que a política das finanças públicas do Estado brasileiro, na Bahia, representou um estímulo relevante para a fundação e para a sustentação econômico-financeira da irmandade cachoeirana

PanCD44 Immunohistochemical Evaluation in Prostatectomies from Patients with Adenocarcinoma.

INTRODUCTION: CD44 has been proposed as a prognostic marker and a stem cell marker but studies in patients with prostate cancer have yielded inconsistent results. PATIENTS AND METHODS: Patients submitted to radical prostatectomy between 2008 and 2013 at a university hospital were followed with biannual serum PSA tests to determine the biochemical recurrence (BR). Archived paraffin blocks with neoplastic and nonneoplastic tissue were evaluated immunohistochemically for a panCD44 and MYC. RESULTS: Sixty-nine patients completed follow-up and were included. CD44 positivity was observed in inflammatory cells (42%), nonneoplastic epithelium (39.7%), and neoplastic tissue (12.3%). In nonneoplastic tissues staining was observed in basal and luminal cells with the morphology of terminally differentiated cells. In neoplastic tissues, CD44 negativity was correlated with higher Gleason scores (Rho = -0.204; p = 0.042) and higher preoperative serum PSA levels when evaluated continuously (p = 0.029). CD44 expression was not associated with tumor stage (p = 0.668), surgical margin status (p = 0.471), or BR (p = 0.346), nor was there any association between CD44 and MYC expression in neoplastic tissue (p = 1.0). CONCLUSION: In the bulk of cells, the minority of cancer stem cells would not be detected by immunohistochemistry using panCD44. As a prognostic marker, its expression was weakly correlated with Gleason score and preoperative PSA level, but not with surgical margin status, tumor stage, or BR.

Impact of testicular sperm extraction and testicular sperm aspiration on gonadal function in an experimental rat model

ABSTRACT Purpose To assess the impact of sperm retrieval on the gonadal function of rats with impaired spermatogenesis by comparing testicular sperm extraction (TESE) to aspiration (TESA). The efficacy of these procedures to sperm obtainment was also compared. Materials and Methods A pilot study showed impaired spermatogenesis, but normal testosterone (T) production after a bilateral orchidopexy applied to 26 rats, which were randomly assigned into four groups: TESE (n=7), TESA (n=7), SHAM (n=6) and Control (n=6). The T levels were measured through comparative analysis after the orchidopexy. Results There was no statistical difference in the animal's baseline T levels after orchidopexy in comparison to the controls: the TESE and TESA groups, 6.66±4.67ng/mL; the SHAM group (orchidopexy only), 4.99±1.96ng/mL; and the Control, 4.75±1.45ng/mL, p=0.27. Accordingly, no difference was found in the postoperative T levels: TESE, 5.35±4.65ng/mL; TESA, 3.96±0.80ng/mL; SHAM, 3.70±1.27ng/mL; p=0.4. The number of sperm cells found through TESE (41.0±7.0) was significantly larger than that found through TESA (21.3±8.1, p=0.001). Moreover, higher tissue weight was found through TESE (0.09±0.02g versus 0.04±0.04g, p=0.04). Conclusions The testicular sperm capture performed in rats through extraction or aspiration, after orchidopexy, did not significantly decrease the T levels. The amount of sperm found through testicular sperm extraction was higher than that through testicular sperm aspiration.

Impact of testicular sperm extraction and testicular sperm aspiration on gonadal function in an experimental rat model.

PURPOSE: To assess the impact of sperm retrieval on the gonadal function of rats with impaired spermatogenesis by comparing testicular sperm extraction (TESE) to aspiration (TESA). The efficacy of these procedures to sperm obtainment was also compared. MATERIALS AND METHODS: A pilot study showed impaired spermatogenesis, but normal testosterone (T) production after a bilateral orchidopexy applied to 26 rats, which were randomly assigned into four groups: TESE (n=7), TESA (n=7), SHAM (n=6) and Control (n=6). The T levels were measured through comparative analysis after the orchidopexy. RESULTS: There was no statistical difference in the animal's baseline T levels after orchidopexy in comparison to the controls: the TESE and TESA groups, 6.66±4.67ng/mL; the SHAM group (orchidopexy only), 4.99±1.96ng/mL; and the Control, 4.75±1.45ng/ mL, p=0.27. Accordingly, no difference was found in the postoperative T levels: TESE, 5.35±4.65ng/mL; TESA, 3.96±0.80ng/mL; SHAM, 3.70±1.27ng/mL; p=0.4. The number of sperm cells found through TESE (41.0±7.0) was significantly larger than that found through TESA (21.3±8.1, p=0.001). Moreover, higher tissue weight was found through TESE (0.09±0.02g versus 0.04±0.04g, p=0.04). CONCLUSIONS: The testicular sperm capture performed in rats through extraction or aspiration, after orchidopexy, did not significantly decrease the T levels. The amount of sperm found through testicular sperm extraction was higher than that through testicular sperm aspiration.

Francisco Antonio de Sampaio: a história natural e a cirurgia na Vila de Nossa Senhora do Rosário do Porto da Cachoeira / Francisco Antonio de Sampaio: natural history and surgery in the Village of Our Lady of the Rosary of the Port of Cachoeira

Analisa as atividades de Francisco Antônio de Sampaio, um representante das artes de curar no Brasil, especialmente a partir de sua inserção no campo da história natural e da cirurgia na vila de Nossa Senhora do Rosário da Cachoeira, na segunda metade do século XVIII. Ele estudou plantas e animais, possuía conhecimento sobre anatomia e sobre remédios utilizados para a cura das doenças de enfermos no referido contexto.(AU)

Effects of chronic administration of tamsulosin and tadalafil, alone or in combination, in rats with bladder outlet obstruction induced by chronic nitric oxide deficiency.

PURPOSE: The aim of this study was to define if tadalafil causes detrusor muscle impairment and to observe the effect of combination of tadalafil with tamsulosin on the lower urinary tract of rats with bladder outlet obstruction (BOO) induced by chronic nitric oxide deficiency. MATERIALS AND METHODS: Thirty-one male rats were randomized to following groups: 1 - control; 2 - L-Nitroarginine methyl ester (L-NAME); 3 - Tamsulosin + L-NAME, 4 Tadalafil+L-NAME; and 5 - Tamsulosin + Tadalafil + L-NAME. At the end of the treatment period (30 days), all animals were submitted to urodynamic study. RESULTS: The administration of L-NAME increased the number of non-voiding contractions (NVC) (1.04 ± 0.22), volume threshold (VT) (1.86 ± 0.35), and micturition cycle (MC) (1.34 ± 0.11) compared with control (0.52 ± 0.06, 0.62 ± 0.06, and 0.67 ± 0.30), respectively. The administration of tamsulosin reduced the number of NVC (0.57 ± 0.42) and VT (0.76 ± 0.24 ) compared with L-NAME group. Co-treatment with tadalafil decreased the number of VT (0.85 ± 0.53) and MC (0.76 ± 0.22) compared with L-NAME group. The combination of tamsulosin with tadalafil improved the number of NVC (0.56 ± 0.18), VT (0.97 ± 0.52) and MC (0.68 ± 0.30) compared with L-NAME group. CONCLUSION: In rats with BOO induced by chronic nitric oxide deficiency, tadalafil did not cause impairment in detrusor muscle and seems to have an addictive effect to tamsulosin because the combination decreased non voiding contractions as well the number of micturition cycles.

Effects of chronic administration of tamsulosin and tadalafil, alone or in combination, in rats with bladder outlet obstruction induced by chronic nitric oxide deficiency

Purpose The aim of this study was to define if tadalafil causes detrusor muscle impairment and to observe the effect of combination of tadalafil with tamsulosin on the lower urinary tract of rats with bladder outlet obstruction (BOO) induced by chronic nitric oxide deficiency. Materials and Methods Thirty-one male rats were randomized to following groups: 1 - control; 2 - L-Nitroarginine methyl ester (L-NAME); 3 - Tamsulosin + L-NAME, 4 Tadalafil+L-NAME; and 5 - Tamsulosin + Tadalafil + L-NAME. At the end of the treatment period (30 days), all animals were submitted to urodynamic study. Results The administration of L-NAME increased the number of non-voiding contractions (NVC) (1.04 ± 0.22), volume threshold (VT) (1.86 ± 0.35), and micturition cycle (MC) (1.34 ± 0.11) compared with control (0.52 ± 0.06, 0.62 ± 0.06, and 0.67 ± 0.30), respectively. The administration of tamsulosin reduced the number of NVC (0.57 ± 0.42) and VT (0.76 ± 0.24 ) compared with L-NAME group. Co-treatment with tadalafil decreased the number of VT (0.85 ± 0.53) and MC (0.76 ± 0.22) compared with L-NAME group. The combination of tamsulosin with tadalafil improved the number of NVC (0.56 ± 0.18), VT (0.97 ± 0.52) and MC (0.68 ± 0.30) compared with L-NAME group. Conclusion In rats with BOO induced by chronic nitric oxide deficiency, tadalafil did not cause impairment in detrusor muscle and seems to have an addictive effect to tamsulosin because the combination decreased non voiding contractions as well the number of micturition cycles. .

Combined liver-kidney transplantation: experience at a Brazilian university hospital.

BACKGROUND: Combined liver-kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction. Aim : To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil. METHOD: A retrospective review was conducted. All transplants were performed using grafts from deceased donors. RESULTS: Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3 ± 9.1 and 32.7 ± 13.1, respectively. The MELD score mean was 23.6 ± 3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%, 57.3% and 57.3%, respectively. CONCLUSION: The survival rates achieved in this series are considered satisfactory and show that this procedure has an acceptable morbidity and survival.

Combined liver-kidney transplantation: experience at a brazilian university hospital / Transplante combinado figado-rim: experiencia de um hospital universitario brasileiro

Background: Combined liver-kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction. Aim : To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil. Method : A retrospective review was conducted. All transplants were performed using grafts from deceased donors. Results : Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3±9.1 and 32.7±13.1, respectively. The MELD score mean was 23.6±3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%, 57.3% and 57.3%, respectively. Conclusion : The survival rates achieved in this series are considered satisfactory and show that this procedure has an acceptable morbidity and survival. .

Racional: O transplante combinado fígado-rim é procedimento de rotina em muitos centros de transplante. O aumento no seu número coincidiu com a introdução em 2002 do escore MELD (Model for End-stage Liver Disease) para alocar fígados, priorizando pacientes com disfunção renal. Objetivo : Mostrar a experiência em transplante combinado fígado-rim de um centro de transplante hepático. Método : Foi realizado estudo retrospectivo de pacientes adultos tratados com transplante combinado fígado-rim. Todos foram feitos com enxertos de doadores cadáveres. Resultados : Dezesseis transplantes combinados fígado-rim foram realizados no período, correspondendo a 2,7% e 2,5% dos transplantes de rim e fígado, respectivamente. Quatorze eram homens (87,5%) e duas mulheres (12,5%). A média de idade dos pacientes e doadores foi 57,3±9,1 e 32,7±13,1, respectivamente. A média do escore MELD foi 23.6±3.67. A principal causa de disfunção hepática foi hepatite crônica pelo vírus C (n=9). Para a disfunção renal, nefropatia diabética (n=4) foi a mais frequente. Houve seis mortes, duas por disfunção grave do enxerto hepático e quatro por causas infecciosas. A taxa de sobrevida dos pacientes submetidos ao transplante combinado fígado-rim no 1º, 3º e 5º anos foi 68.8%, 57.3% e 57.3%, respectivamente. Conclusão : As taxas de sobrevida alcançadas nesta série são consideradas satisfatórias e mostram que este procedimento tem morbidade e sobrevida aceitáveis. .

Urodynamic effects of the combination of tamsulosin and daily tadalafil in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: a randomized, placebo-controlled clinical trial.

OBJECTIVES: To evaluate the effect of association of tamsulosin/tadalafil taken daily compared with tamsulosin/placebo in the lower urinary tract with urodynamic study (UDS). METHODS: All patients underwent baseline UDS before randomization to tamsulosin 0.4 mg/tadalafil 5 mg (Group 1; n = 20) or tamsulosin 0.4 mg/placebo (Group 2; n = 20) once daily for 30 days. End-of-study UDS were performed on completion of the treatment period. The primary end point was to demonstrate changes in urodynamic variables in the voiding phase, detrusor pressure at maximum flow (PdetQmax), and maximum flow rate (Qmax), from baseline to week four. RESULTS: The primary outcome measure of this clinical trial, PdetQmax, showed a significant reduction in tamsulosin/tadalafil group (13 ± 17.0) compared to tamsulosin/placebo (-1.2 ± 14.35) group (P = 0.03). Qmax increased in both groups, tamsulosin/tadalafil (1.0 ± 2.4) and tamsulosin/placebo (1.4 ± 2.4), but the difference was not significant between treatment groups (P = 0.65). Total IPSS, storage, and voiding sub-score improved significantly in tamsulosin/tadalafil compared with tamsulosin/placebo group. CONCLUSIONS: The association of tamsulosin/tadalafil reduces detrusor pressure at maximum flow without changing the maximum flow rate during micturition and significantly improves lower urinary tract symptoms compared with the isolated use of tamsulosin.

Identification of mechanisms involved in the relaxation of rabbit cavernous smooth muscle by a new nitric oxide donor ruthenium compound.

PURPOSE: The aim of this study was to evaluate the relaxation in vitro of cavernous smooth muscle induced by a new NO donor of the complex nitrosil-ruthenium, named trans-[Ru(NH3)4(caffeine)(NO)]C13 (Rut-Caf) and sodium nitroprusside (SNP). MATERIALS AND METHODS: The tissues, immersed in isolated bath systems, were pre-contracted with phenilephrine (PE) (1 µM) and then concentration-response curves (10 (-12) - 10(-4) M) were obtained. To clarify the mechanism of action involved, it was added to the baths ODQ (10 µM, 30 µM), oxyhemoglobin (10 µM), L-cysteine (100 µM), hydroxicobalamine (100 µM), glibenclamide, iberotoxin and apamine. Tissue samples were frozen in liquid nitrogen to measure the amount of cGMP and cAMP produced. RESULTS: The substances provoked significant relaxation of the cavernous smooth muscle. Both Rut-Caf and SNP determined dose-dependent relaxation with similar potency (pEC50) and maximum effect (E(max)). The substances showed activity through activation of the soluble guanylyl cyclase (sGC), because the relaxations were inhibited by ODQ. Oxyhemoglobin significantly diminished the relaxation effect of the substances. L-cysteine failed to modify the relaxations caused by the agents. Hydroxicobalamine significantly diminished the relaxation effect of Rut-Caf. Glibenclamide significantly increased the efficacy of Rut-Caf (pEC50 4.09 x 7.09). There were no alterations of potency or maximum effect of the substances with the addition of the other ion channel blockers. Rut-Caf induced production of significant amounts of cGMP and cAMP during the relaxation process. CONCLUSIONS: In conclusion, Rut-Caf causes relaxation of smooth muscle of corpus cavernosum by means of activation of sGC with intracellular production of cGMP and cAMP; and also by release of NO in the intracellular environment. Rut-Caf releases the NO free radical and it does not act directly on the potassium ion channels.

Identification of mechanisms involved in the relaxation of rabbit cavernous smooth muscle by a new nitric oxide donor ruthenium compound

PURPOSE: The aim of this study was to evaluate the relaxation in vitro of cavernous smooth muscle induced by a new NO donor of the complex nitrosil-ruthenium, named trans-[Ru(NH3)4(caffeine)(NO)]C13 (Rut-Caf) and sodium nitroprusside (SNP). MATERIALS AND METHODS: The tissues, immersed in isolated bath systems, were pre-contracted with phenilephrine (PE) (1 µM) and then concentration-response curves (10-12 - 10-4 M) were obtained. To clarify the mechanism of action involved, it was added to the baths ODQ (10 µM, 30 µM), oxyhemoglobin (10 µM), L-cysteine (100 µM), hydroxicobalamine (100 µM), glibenclamide, iberotoxin and apamine. Tissue samples were frozen in liquid nitrogen to measure the amount of cGMP and cAMP produced. RESULTS: The substances provoked significant relaxation of the cavernous smooth muscle. Both Rut-Caf and SNP determined dose-dependent relaxation with similar potency (pEC50) and maximum effect (Emax). The substances showed activity through activation of the soluble guanylyl cyclase (sGC), because the relaxations were inhibited by ODQ. Oxyhemoglobin significantly diminished the relaxation effect of the substances. L-cysteine failed to modify the relaxations caused by the agents. Hydroxicobalamine significantly diminished the relaxation effect of Rut-Caf. Glibenclamide significantly increased the efficacy of Rut-Caf (pEC50 4.09 x 7.09). There were no alterations of potency or maximum effect of the substances with the addition of the other ion channel blockers. Rut-Caf induced production of significant amounts of cGMP and cAMP during the relaxation process. CONCLUSIONS: In conclusion, Rut-Caf causes relaxation of smooth muscle of corpus cavernosum by means of activation of sGC with intracellular production of cGMP and cAMP; and also by release of NO in the intracellular environment. Rut-Caf releases the NO free radical and it does not act directly on the potassium ion channels.

The relaxation induced by uroguanylin and the expression of natriuretic peptide receptors in human corpora cavernosa.

INTRODUCTION: Receptors for natriuretic peptides have been demonstrated as potential targets for the treatment of male erectile dysfunction. AIM: This study investigates the relaxant effects of the atrial natriuretic peptide (ANP) and uroguanylin (UGN), and expression of natriuretic peptide receptors on strips of human corpora cavernosa (HCC). MAIN OUTCOME MEASURES: Quantitative analysis of natriuretic receptor expression and relaxation of precontracted strips were used to assess the membrane-bound guanylate cyclase-cyclic guanosine monophosphate (cGMP) pathway in HCC strips. METHODS: HCC was obtained from a cadaver donor at the time of collection of organs for transplantation (14-47 years) and strips were mounted in organ baths for isometric studies. RESULTS: ANP and UGN both induced concentration-dependent relaxation on HCC strips with a maximal response attained at 300 nM, corresponding to 45.4±4.0% and 49±4.8%, respectively. The relaxation is not affected by 30 µM 1H-[1,2,4]oxaolodiazolo[4,3-a]quinoxalin-1-one (ODQ) (a soluble guanylate cyclase inhibitor), but it is significantly blocked by 10 µM isatin, a nonspecific particulate guanylate cyclase (pGC) inhibitor. UGN was unable to potentiate electrical field stimulation (EFS) or acetylcholine-induced relaxations. The potential role of pGC activation and cGMP generation in this effect is reinforced by the potentiation of this effect by phosphodiesterase-5 inhibitor vardenafil (55.0±7.5-UGN vs. 98.6±1.4%-UGN+vardenafil; P<0.05). The relaxant effect was also partially (37.6%) blocked by the combination iberitoxin-apamin but was insensitive to glybenclamide. The expression of guanylate cyclase receptors (GC-A, GC-B, GC-C) and the expression of the natriuretic peptide "clearance" receptor (NPR-C) were confirmed by real-time polymerase chain reaction. The exposure of HCC strips to ANP (1 µM) and UGN (10 µM) significantly increased cGMP, but not cyclic adenosine monophosphate (cAMP) levels. CONCLUSIONS: UGN relaxes HCC strips by a guanylate cyclase and K(ca)-channel-dependent mechanism. These findings obtained in HCC reveal that the natriuretic peptide receptors are potential targets for the development of new drugs for the treatment of erectile dysfunction.

Laparoscopic surgery in 46,XX disorder of sex development: hysterosalpingectomy with gonadectomy.

PURPOSE: We present the outcomes of one of the largest series specifically of laparoscopic hysterosalpingectomy with bilateral gonadectomy in 46,XX patients with congenital adrenal hyperplasia raised as a male. PATIENTS AND METHODS: From June 2005 to March 2008, five patients raised as male were treated at our institution using laparoscopic surgery. 46,XX disorder of sex development was diagnosed in all the patients because of congenital adrenal hyperplasia. Hysterosalpingectomy with bilateral gonadectomy was performed completely laparoscopically in all five patients. RESULTS: All procedures were completed with minimal blood loss. The duration of the surgeries was 70-125 minutes. There were no complications during surgery or conversion to open surgery. The hospital stay ranged from 1 to 2 days, except in one patient who presented urinary retention and was discharged from the hospital a week after the surgery. CONCLUSIONS: Laparoscopic surgery can be safely used as part of the diagnosis and treatment of 46,XX disorder of sex development. Laparoscopy can be useful in the diagnosis as well as surgical management of Müllerian structures as well as intraabdominal gonads contrary to social sex.

Single-incision multiport laparoscopic orchidopexy: initial report.

PURPOSE: We report the first use of single-incision multiport access to perform 1-stage laparoscopic orchidopexy in children without section of the spermatic vessels. MATERIAL AND METHODS: Three boys with cryptorchidism were submitted to primary laparoscopic 1-stage orchidopexy by using 3 ports (a 10-mm [or 5-mm] port placed using open technique and 2 additional 5-mm [or 3-mm] ports) inserted through the same periumbilical skin incision with different entrances through the abdominal wall. After dissection of the testicular vessels and vas deferens, a 5-mm port was placed in a tunnel from the scrotum to pull the remnant of the gubernaculum down and fix the testicle in a dartos pouch. RESULTS: The mean operative time was 83.3 minutes. The estimated blood loss was almost nil, and there were no intraoperative complications. CONCLUSION: This approach was feasible and safe. However, as with any new technique, its use requires a larger number of cases and a longer follow-up to fully evaluate its benefits and limitations.

Use of titanium knot placement device (TK-5) to secure dorsal vein complex during laparoscopic radical prostatectomy and cystoprostatectomy.

INTRODUCTION: We evaluated the feasibility and describe the surgical technique of using the Ti-Knot device TK-5 to secure the dorsal vein complex (DVC) during 20 consecutive cases of laparoscopic radical prostatectomy and cystoprostatectomy. TECHNICAL CONSIDERATIONS: Bloodless DVC ligation and transection was successfully achieved in 19 (95.03%) of 20 cases. In only 1 case, venous bleeding occurred after DVC transection. However, in this case, the two stitches used to ligate the DVC were tightly tied, and the bleeding probably occurred because the stitches were passed too superficially on the DVC. In another case, a third stitch had to be placed and tied with the aid of the Ti-Knot device because the second 2-0 Vicryl stitch placed at the DVC broke. In only 1 case did we experience some degree of trouble with the knotting process because one of the ends of the Vicryl suture slipped back into the abdominal cavity. The time to tie each suture with the Ti-Knot device, defined after the moment the needle was passed underneath the DVC to the moment the titanium knot was crimped and the Vicryl suture trimmed, was less than 1 minute (median 50 seconds, range 45 to 56) in all cases, except the case described above. No cases of the Ti-Knot device misfiring or malfunction occurred in this series. CONCLUSIONS: In our experience, the Ti-Knot titanium knot placement device proved to be safe and efficient during laparoscopic ligation and control of the DVC.

Laparoscopic radical cystectomy with intracorporeally constructed Y-shaped orthotopic ileal neobladder using nonabsorbable titanium staples exclusively.

Increasing evidence in published reports has suggested that titanium staples may be well tolerated inside the urinary tract. Recently, the Italian Group from Piedmont described an "easy, fast, and reliable" technique of a Y-shaped ileal neobladder that was created during open surgery with nonabsorbable mechanical staples. They observed an acceptable 6% rate of stone formation at a median follow-up of 20 months (range 8 to 47). We describe our initial experience with laparoscopic Y-shaped orthotopic ileal neobladder constructed entirely intracorporeally using titanium staples exclusively in an attempt to mitigate the time-consuming and skill-intensive task of freehand suturing required during laparoscopic creation of continent reservoirs.