RESUMEN
PURPOSE: This study was designed to compare the effectiveness of two methods of inducing renal hypothermia through laparoscopy in pigs and humans. MATERIALS AND METHODS: Twelve pigs were divided into four groups of three animals each. Both kidneys of the animals in Groups A, B, and C were submitted to pelvic irrigation with cold saline (4 degrees C) for 20 minutes, with flow rates of 5 mL/min, 10 mL/min, and 15 mL/min, respectively. In Group D renal hypothermia was induced by intracorporeal ice slush applied to the surface for 20 minutes. All maneuvers were performed laparoscopically and renal cortex temperature was measured by a thermocouple needle. Five human patients also underwent laparoscopic partial nephrectomy due to renal cell carcinoma. In one case renoprotection was induced by retrograde endoscopic cold saline perfusion at a flow rate of 10 mL/min. In the remaining four patients we induced renal hypothermia via laparoscopic application of ice slush. The renal temperature of the human patients was also monitored using a thermocouple needle. RESULTS: In the pigs, at 20 minutes of renal pelvis perfusion the mean renal temperature, the temperature drop, and saline flow per gram of kidney were: Group A, -29.5 degrees C +/- 1.1 (-6.3 degrees C; 0.10 mL); Group B, -22.8 degrees C +/- 1.1 (-13.1 degrees C; 0.22 mL); and Group C, -21.1 degrees C +/- 0.9 (-14.9 degrees C; 0.31 mL). In Group D the mean renal cortex temperature at 20 minutes was 13.6 degrees C +/- 1.2, a drop of -22.5 degrees C. There were striking differences among the groups (P < 0.0001). The laparoscopic partial nephrectomy was uneventful in all five human patients. The lowest renal cortex temperature was 32.5 degrees C, seen in the patient who submitted to pelvic irrigation with cold saline, and the mean temperature drop was 19.1 degrees C +/- 2.5 degrees C in the patients who submitted to ice slush-induced renal hypothermia. CONCLUSIONS: Induction of renal hypothermia using intracorporeal ice slush confers lower kidney temperatures than endoscopically-induced cold saline perfusion.
Asunto(s)
Hipotermia Inducida/métodos , Riñón , Adulto , Anciano , Animales , Temperatura Corporal , Carcinoma de Células Renales/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Laparoscopía , Masculino , Persona de Mediana Edad , Nefrectomía , Sus scrofaRESUMEN
O estudo teve como objetivo a determinaçäo da prevalência do adenocarcinoma prostático em uma amostra de voluntários entre 40 e 80 anos de idade de uma regiäo nordestina. Os voluntários foram recrutados da comunidade e submetidos ao toque retal e à dosagem do PSA total. Compareceram 499 homens para essa avaliaçäo inicial. Aqueles com PSA maior que 2ng/ml e/ou toque retal suspeito tiveram a biópsia indicada. De 135 homens com indicaçäo de biópsia, 120 compareceram para o exame. A biópsia guiada por ultra-som consistiu da retirada de 10 fragmentos (5/lobo). O adenocarcinoma prostático foi encontrado em 24 voluntários, o que corresponde a 5,1 por cento dos casos. Essa prevalência parece mais elevada que a observada em voluntários da regiäo sudeste do país. A diferença pode ser conseqüência de fatores genéticos ou ambientais, mas näo se pode descartar outros fatores como variaçöes metodológicas.