RESUMEN
ABSTRACT Introduction: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. Materials and Methods: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. Results: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). Conclusions: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.
Asunto(s)
Humanos , Laparoscopía , Neoplasias Renales/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Nefrectomía/efectos adversos , Nefronas/cirugíaRESUMEN
INTRODUCTION: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. MATERIALS AND METHODS: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. RESULTS: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). CONCLUSIONS: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.
Asunto(s)
Neoplasias Renales , Laparoscopía , Humanos , Neoplasias Renales/cirugía , Nefrectomía/efectos adversos , Nefronas/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to analyze the type and frequency of cranial computed tomography and magnetic resonance imaging anomalies in patients with idiopathic growth hormone deficiency, and also to investigate the possible relationship between neuroradiological images and the presence of isolated growth hormone or multiple pituitary hormone deficiency. METHODS: Magnetic resonance and computed tomography images were obtained for 37 patients with idiopathic growth hormone deficiency. The patients were divided into two groups: patients with isolated growth hormone (group A) and patients with multiple pituitary hormone deficiencies (group B). RESULTS: Computed tomography was normal in 25 (68%), and abnormal in 12 (32%) patients. We observed empty sella in 50%, partially empty sella in 17% and anterior pituitary hypoplasia in 33% patients. MRI studies revealed normal findings in the hypothalamus-pituitary area in 17 (46%) and abnormal in 20 (54%) patients. We did not observed differences in the frequency of computed tomography alterations when groups A and B were compared (p = 0.55). With magnetic resonance imaging we observed, empty sella in 10%, partially empty sella in 15% and anterior pituitary hypoplasia in 75% patients. Among those patients whose magnetic resonance images were altered, the posterior lobe of the pituitary gland was identified in an abnormal position in 70%, and the hypophyseal stalk was thin or interrupted in 60%. The patients from group B presented a higher frequency of magnetic resonance imaging anomalies (90%) when compared to group A (10%), p = 0.03. There was disagreement between the two methods in 43% of cases, but we didn't observe a difference in the frequency of alterations when computed tomography was compared with magnetic resonance imaging (p = 0.06). CONCLUSIONS: The most frequent defects observed using magnetic resonance imaging are anterior pituitary hypoplasia and ectopic posterior pituitary lobe. The association of glandular hypoplasia with other magnetic resonance imaging abnormalities can suggest the presence of multiple anterior pituitary deficiencies.
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Trastornos del Crecimiento/diagnóstico , Hormona de Crecimiento Humana/deficiencia , Hipopituitarismo/diagnóstico , Sistema Hipotálamo-Hipofisario/anomalías , Sistema Hipotálamo-Hipofisario/diagnóstico por imagen , Anomalías Múltiples/diagnóstico , Distribución de Chi-Cuadrado , Trastornos del Crecimiento/diagnóstico por imagen , Humanos , Hipopituitarismo/diagnóstico por imagen , Hipopituitarismo/patología , Imagen por Resonancia Magnética , Registros Médicos , Estudios Retrospectivos , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos XRESUMEN
OBJETIVO: Avaliar a freqüência e os tipos de alterações observadas à tomografia computadorizada e ressonância magnética em pacientes com deficiência aparentemente idiopática de hormônio do crescimento e investigar a possível relação entre imagem neurorradiológica e presença de deficiência isolada e múltipla de hormônio do crescimento. MÉTODOS: Realizamos tomografia computadorizada e ressonância magnética da região hipotálamo-hipofisária em 37 pacientes com deficiência de hormônio do crescimento. Os pacientes foram divididos em deficiência isolada de hormônio do crescimento (Grupo A) e deficiência múltipla de hormônio do crescimento (Grupo B). RESULTADOS: A tomografia computadorizada foi normal em 25 (68 por cento) e alterada em 12 (32 por cento) pacientes. Observamos sela vazia em 50 por cento dos pacientes, parcialmente vazia em 17 por cento e hipoplasia hipofisária em 33 por cento. Não observamos diferença entre o percentual de alterações à tomografia computadorizada entre os Grupos A e B (p = 0,55). A ressonância magnética foi normal em 17 (46 por cento) e alterada em 20 (54 por cento) pacientes. A ressonância magnética, observamos sela vazia em 10 por cento, parcialmente vazia em 15 por cento e hipoplasia hipofisária em 75 por cento dos pacientes. Entre os pacientes com ressonância magnética alterada, 70 por cento apresentavam neuro-hipófise ectópica, e em 60 por cento a haste hipofisária estava afilada ou ausente. Os pacientes do Grupo B apresentaram maior percentual de alterações à ressonância magnética quando comparados aos do Grupo A (p = 0,03). Houve discordância entre tomografia computadorizada e ressonância magnética em 43 por cento; entretanto, não observamos diferença no percentual de anormalidades quando comparamos tomografia computadorizada e ressonância magnética (p = 0,06). CONCLUSAO: A hipoplasia hipofisária e a neuro-hipófise ectópica são as alterações mais encontradas em pacientes com deficiência de hormônio do crescimento. A associação de hipoplasia hipofisária com outras anormalidades observadas à ressonância magnética pode sugerir a presença de deficiência múltipla de hormônio do crescimento.