A randomised, double-blind study comparing the efficacy and tolerability of controlled-release doxazosin and tamsulosin in the treatment of benign prostatic hyperplasia in Brazil.

Brazilian patients with benign prostatic hyperplasia were randomised in a 12-week, double-blind, double-dummy study to receive doxazosin gastrointestinal therapeutic system (GITS) 4 mg q.i.d. (n = 82) or tamsulosin 0.4 q.i.d. (n = 83). Primary endpoints were the absolute and percentage change from baseline in symptoms measured by International Prostate Symptom Score (IPSS). Secondary endpoints included IPSS, quality-of-life (QOL) question from the IPSS, and questions 6 and 7 of the Sexual Function Abbreviated Questionnaire (SFAQ) at weeks 4 and 12. Doxazosin GITS and tamsulosin improved IPSS with no significant differences between groups at week 12. During weeks 4-8, tamsulosin-treated patients demonstrated a slower improvement (p < 0.001) in IPSS than doxazosin GITS-treated patients. The proportion of satisfied patients was observed earlier with doxazosin GITS (p = 0.006) vs. tamsulosin. At week 12, the proportion of patients with little or no difficulty at ejaculation (Q6 of SFAQ) was higher in the doxazosin GITS group (p = 0.019). Both treatments were well tolerated.

Effect of thymoglobulin in graft survival and function 1 year after kidney transplantation using deceased donors.

UNLABELLED: This study evaluated 1-year graft function and survival among kidney transplantations from deceased donors using thymoglobulin (Thymo) as an induction strategy. PATIENTS AND METHODS: Fifty-seven percent of patients were men and overall mean age was 42 +/- 15 years. Cold ischemia time was 20.1 +/- 4.8 hours. The primary outcome was defined as survival not censored for death after 1 year. The secondary outcome was defined as a comparison of function and survival among patients who received more or less then six doses of Thymo. RESULTS: Four patients experienced acute rejection episodes and the other three died during follow-up. One-year graft survival was 91% with a mean serum creatinine of 1.28 +/- 0.43 mg/dL. Cytomegalovirus infection occurred in 56%. Forty-two (64%) patients displayed acute tubular necrosis of mean duration of 6.89 +/- 7.48 days. Patients who received lower doses showed better serum creatinine values 3 months (1.45 vs 1.86 mg/dL, P = .013) and 12 months (1.05 vs 1.50 mg/dL, P = .04). The difference was probably due to acute tubular necrosis that produced a RR of 1.7 (P = .02; CI 1.04-2.97) when compared with patients with Scr values above 1.30 mg/dL. When censored for death, graft survival was not different between the two groups (< or =6 doses 93% vs >6 doses 97%, P = .43). CONCLUSION: Immunologic induction with Thymo produced excellent graft survival after 1 year with preservation of graft function. Delayed graft function was the most important determinant of graft function after 1 year.

Laparoscopic left radical nephrectomy and hand-assisted isthmectomy of a horseshoe kidney with renal cell carcinoma.

A 64-year-old woman presented with recurrent gross hematuria and intermittent left-sided pain. A CT scan revealed an 8-cm mass in the left moiety of a horseshoe kidney. A laparoscopic transperitoneal approach was employed to control the vessels and release the left moiety of the kidney and a hand-assisted approach was performed for isthmectomy using compression of normal parenchyma and monopolar electrocautery. Additional sutures were applied externally in isthmus through hand-assisted incision to enhance hemostasis. The patient was discharged on postoperative day 4 with no complications and no relapse after a 1-year follow-up. We conclude that our technique is safe, cheap and effective for this complex clinical entity.

Fibrous pseudotumor of tunica vaginalis and epididymis.

Paratesticular fibrous pseudotumors are rare, and less than 10% of them affect the epididymis. We report a case of testicular trauma that progressed to a painless palpable tumor in the right hemiscrotum with increased local volume. Orchiectomy followed by anatomic-pathologic examination revealed a paratesticular fibrous pseudotumor. The best treatment is scrotal exploration and frozen biopsy. On confirmation of the diagnosis, only the tumor and the tunica vaginalis are resected. Should the benign nature not be possible to determine, orchiectomy is the procedure of choice. We also reviewed published reports for this possibility in the differential diagnosis of testicular masses.

Duodenal damage complicating percutaneous access to kidney.

CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature.

Urological evaluation of sexual partners of women with human papillomavirus (HPV) infection.

Cancer of the uterine cervix has been related to HPV infection, based on clinical and laboratory data. The high recurrence rate in couples undergoing treatment for HPV infection points to a probable viral reservoir, either in subclinical lesions or in male internal genital organs. We have evaluated 31 men, all sexual partners of women with HPV infection. Eleven patients (35.5%) had related lesions: 4 (12.9%) with condyloma acuminatum; 5 (16.1%) with lesions revealed by magnified examination after reaction with 5% acetic acid and 2 (6.5%) with condyloma and subclinical lesions. A short-term follow-up confirmed a successful treatment with podophyllin.

[Urinary citrate determination in normal persons and in patients with recurrent urinary calculi]. / Dosagem de citrato urinário em indivíduos adultos normais e em pacientes com calculose urinária recidivante.

The presence of citric acid in urine and its ability to bind calcium ions forming a soluble complex are well recognized and has led to the suggestion that citric acid may play an important role in preventing renal calcium stone disease. In this study the 24-hour urinary excretion was measured with a specific enzymatic method in 48 normal subjects and in a group of 46 non selected patients with recurrent urolithiasis. Hypocitraturia was detected in 18/46 patients (39.1%) and was the unique metabolic abnormality in 6 (13%).

[Rice bran in the treatment of idiopathic hypercalciuria in patients with urinary calculosis]. / Farelo de arroz no tratamento da hipercalciúria idiopática em pacientes portadores de calculose urinária.

Ten patients with recurrent nephrolithiasis and hypercalciuria were given rice bran during 60 days. Hypercalciuria was reduced in all patients in an average of 40%. Urinary magnesium was reduced in 28% and oxalate excretion was increased in 28%. The rate of decrease of urinary calcium was 65% in the absorptive type and 33% in the renal type of hypercalciuria.

Ureteral necrosis in dermatomyositis.

We describe a child with dermatomyositis and calcified necrosis in the middle third of both ureters. Histopathological examination showed vasculitis associated with ureteral necrosis and calcification. These findings together with a similar previous report in the literature have prompted us to correlate dermatomyositis in childhood with ureteral necrosis and to anticipate specifically a lesion in the middle third of the ureter because of the relative lack of blood flow in that segment.

Segmental priapism.

A case report of a 27-year-old male with segmental priapism of the left proximal corpus cavernosum is presented. Treatment consisted in evacuation and irrigation of the corpus.