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OBJECTIVE: To assess the efficacy of vaginal electrical stimulation (VS) versus transcutaneous tibial nerve electrical stimulation (TTNS) in women with overactive bladder syndrome (OAB). MATERIAL AND METHODS: Sixty-nine patients were randomized to receive 12 sessions of VS versus TTNS, or no treatment (control group-CG), over 6 weeks. OAB impact according to international consultation on incontinence questionnaire overactive bladder module (ICIQ-OAB), symptoms discomfort scores and voiding diaries were evaluated at baseline, 6 weeks and 1-month post-treatment. RESULTS: Both TTNS (mean difference = -4.2; 95% confidence interval [CI] = -6.5 to -1.9) and VS (-3.8; -6.0 to -1.6) were associated with significant reduction of ICIQ-OAB scores, as well as discomfort sensation (-3.9; -6.2 to -1,7; p < 0.001 for the TTNS and -2.8; -5.0 to -0.6; p = 0.01 for the VS) at 6 weeks when compared to CG (p < 0.001). ICIQ-OAB score remained low only in the TTNS group when compared to the CG (-3.6; -6.0 to -1.2/p = 0.00) 1 month after treatment. Discomfort symptoms improved in both active groups when compared to CG (TTNS [-3.2; -5.2 to -1.2; p < 0.001] and VS groups [-2.6; -4.7 to -0.6; p = 0.01]). No statistically differences were found in primary outcomes comparing TTNS and VS Secondary analysis showed significant improvement in urinary urgency incontinence episodes (UUI) in both TTNS and VS, but CG. UUI episodes were still reduced in the VS group and urgency in the TTNS group 1-month post-treatment. CONCLUSION: Short-term interventions (6 weeks) of TTNS and VS were both effective in treating women with OAB. TTNS provided residual effects at one-month postintervention on ICIQ-OAB score.
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Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinária Hiperativa , Incontinência Urinária , Humanos , Feminino , Bexiga Urinária Hiperativa/terapia , Bexiga Urinária Hiperativa/complicações , Resultado do Tratamento , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Incontinência Urinária/terapia , Estimulação Elétrica , Nervo Tibial/fisiologia , Qualidade de VidaRESUMO
ABSTRACT Purpose This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up. Methods We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form - ICIQ-UI SF), and patient satisfaction. Results Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups. Conclusions Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.
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PURPOSE: This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up. METHODS: We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form - ICIQ-UI SF), and patient satisfaction. RESULTS: Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups. CONCLUSIONS: Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.
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Slings Suburetrais , Incontinência Urinária por Estresse , Incontinência Urinária , Feminino , Humanos , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Resultado do Tratamento , Bexiga Urinária , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos UrológicosRESUMO
AIMS: Independent external validation of a predictive nomogram for risk of reinfection in women with a history of non-complicated recurrent urinary tract infection (UTI). METHODS: A retrospective longitudinal study was conducted to validate the LUTIRE nomogram in a Brazilian female cohort. The nomogram was applied to 81 women presenting non-complicated recurring UTI screened at a urological clinic. External validation was performed using the nomogram variables in patients followed up from January 2014 to December 2016 at a urological clinic. Accuracy of the nomogram was obtained by analyzing the predictive capacity observed in the area under the receiver operating characteristic (ROC) curve. A multivariate logistic regression model was used to assess the ability of the nomogram variables to predict the recurrence of UTI over 12 months. The time to recurrence of infection was calculated using a Kaplan-Meier curve and the log-rank test with calculation of the hazard ratio. RESULTS: The mean age of the study population was 42.8 years; 57 women (70.37%) had recurrence. The independent variables with statistical significance in the multivariate analysis were gram-negative bacteria [odds ratio (OR) 18.38; p = 0.03897] and number of UTIs in the past 12 months (OR 25.11; p = 0.00006). The accuracy of the nomogram for discriminating patients who had UTI recurrence was 82.6% (95% CI = 72.5-90.1). CONCLUSION: The LUTIRE nomogram showed good accuracy among Brazilian women with recurrent UTI.
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PURPOSE: To evaluate the association between increased intima-media thickness (IMT) and atherosclerotic carotid plaque (CP) with idiopathic overactive bladder syndrome (OAB) in women with metabolic syndrome (MetS). METHODS: This is a cross-sectional study, which included consecutive women aged 40-75 years with MetS, seeking medical assistance at a reference center between April and December 2016. OAB-V8 questionnaire was used to estimate the prevalence of OAB symptoms, which were defined by a score ≥8 points. All patients underwent bilateral carotid artery ultrasound to assess IMT and CP. Atherosclerosis was defined by the identification of CP during ultrasound, which was diagnosed according to the Mannheim carotid intima-media thickness and plaque consensus. RESULTS: Forty-five women were prospectively included. Mean age was 60±9.3 years (range 40-75 ys). Eighteen (40%) patients were diagnosed with OAB. IMT in the general population was 0.72 mm (SD = 0.20). Overall prevalence of atherosclerosis, defined by the presence of the carotid artery plaque, was 51%. OAB prevalence among women with atherosclerosis was higher than in those without atherosclerosis (56.52% versus 22.73%), with a prevalence ratio of 2.49 (p=0.04). Additionally, OAB was associated with degree of carotid stenosis (p = 0.029). CONCLUSION: In this cohort of female patients with MetS, there was an association between carotid atherosclerosis and OAB. Identification of carotid ultrasound abnormalities may lead to refined treatment decision-making among OAB patients.
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OBJECTIVES: To describe saphenous reflux patterns in patients classified as CEAP C2 by analysis of 2027 vascular ultrasound examination reports. METHODS: A total of 2027 venous mapping studies were reviewed and 1196 patients classified as CEAP C2 were selected. Patients were classified according to patterns of reflux for the great saphenous vein and for the small saphenous vein, and rates of great saphenous vein and small saphenous vein reflux were analyzed for both sexes. RESULTS: The overall prevalence of saphenous vein reflux was 45%. Males had significantly higher great saphenous vein reflux prevalence than females (p < 0.001). The most common great saphenous vein reflux pattern in females was segmental reflux and the most common pattern in males was proximal reflux. CONCLUSIONS: Saphenous vein reflux is common in C2 patients and is more frequent in males. Standardization of classifications of reflux patterns is very important for correct management of the disease.
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Veia Safena/diagnóstico por imagem , Escleroterapia/métodos , Ultrassonografia , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Veia Safena/fisiopatologia , Fatores Sexuais , Varizes/fisiopatologia , Varizes/terapia , Insuficiência Venosa/terapia , Adulto JovemRESUMO
PURPOSE: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. MATERIALS AND METHODS: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. RESULTS: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). CONCLUSION: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.
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Ácido Cítrico/análise , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Sêmen/química , Idoso , Biomarcadores Tumorais/análise , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/sangue , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Estatísticas não ParamétricasRESUMO
ABSTRACT Purpose: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. Materials and Methods: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. Results: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). Conclusion: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.
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Humanos , Masculino , Idoso , Neoplasias da Próstata/diagnóstico , Sêmen/química , Antígeno Prostático Específico/sangue , Ácido Cítrico/análise , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/sangue , Biópsia , Biomarcadores Tumorais/análise , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Medição de Risco , Pessoa de Meia-IdadeRESUMO
Resumen:
Objetivo: analizar la asociación del periodo, tipo y forma de amamantamiento con la sucesión de hábitos orales perniciosos o incorrectos y alteraciones de la motricidad orofacial en pacientes bajo intervención ortodóntica en la Universidad Estatal de Londrina (Brasil). Metodología: estudio observacional transversal realizado en 239 pacientes, con edad entre 5 y 14 años, los datos fueron obtenidos mediante cuestionarios, revisión de prontuarios y evaluación fonoaudiológica de la motricidad orofacial para evaluar el periodo (tiempo), forma (natural o artificial) y tipo (exclusivo o complementado) de lactancia y la sucesión de hábitos orales perniciosos y alteraciones de motricidad orofacial. Se ponderó, a través de pruebas estadísticas no paramétricas, la asociación entre tiempo, tipo y forma de amamantamiento con la sucesión de hábitos orales perniciosos o alteraciones de motricidad orofacial. Resultados: los pacientes sin alteraciones de motricidad orofacial, y también aquellos que no presentaban hábitos orales perniciosos o incorrectos, tuvieron una media de tiempo de amamantamiento exclusivo significativamente mayor; p= 0,0097 y p< 0,0005, que aquellos que presentaban alteraciones. Los pacientes con alteraciones de motricidad orofacial y también los que mostraban hábitos orales perniciosos tuvieron una media de tiempo de lactancia artificial significativamente mayor; p= 0,0219 y p< 0,0005, comparados con aquellos que no presentaban alteraciones. Los pacientes con hábitos orales incorrectos corrían más riesgo (122%) de presentar alteraciones de motricidad orofacial (p< 0,0001).
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Aleitamento Materno , Enfermagem Materno-Infantil , Má Oclusão , Transtornos de Alimentação na Infância , BrasilRESUMO
ß-Glucan, derived from Saccharomyces cerevisiae, is a biological response modifier which affects the innate and adaptive immune responses. The CCR5 chemokine receptor is crucial for immune cell responses. In this study, the effects of the carboxymethylated form of ß-glucan (CM-G) on the lymphocyte population of CCR5 genotype patients with prostate cancer (PCa), undergoing androgen deprivation therapy (ADT) was assessed. The CCR5 genotype and lymphocyte population was investigated by cytometry flow in 30 Brazilian patients with advanced PCa who were treated with CM-G for 28 days. The analysis of the CCR5 chemokine receptor revealed that the wild-type genotype Wt/Wt was present in 80% of patients, while the heterozygotic genotype Wt/delta32 was present in 20% of patients. After CM-G administration, a significant increase in CD3(+), CD4(+) and CD8(+) T lymphocytes was observed in patients who displayed the wild-type genotype for the CCR5 chemokine receptor. No association was found between patient's age or length of ADT and increase in T lymphocyte cells. The results demonstrated the ability of CM-G to stimulate CD4(+) and CD8(+) T cells in the peripheral blood of patients carrying a wild-type CCR5 genotype, suggesting an interaction between immunomodulation by CM-G and the CCR5 receptor.
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Glucanos/uso terapêutico , Polimorfismo Genético , Neoplasias da Próstata/genética , Neoplasias da Próstata/imunologia , Receptores CCR5/genética , Linfócitos T/imunologia , Antígenos CD/imunologia , Humanos , Masculino , Neoplasias da Próstata/tratamento farmacológicoRESUMO
Carboxymethyl-glucan (CM-G) is a soluble derivative from Saccharomyces cerevisiae (1 â 3)(1 â 6)-ß-D-glucan. The protective efficiency of CM-G against DNA damage in cells from patients with advanced prostate cancer (PCa), and undergoing Androgen Deprivation Therapy (ADT), was evaluated. DNA damage scores were obtained by the comet assay, both before and after treatment with CM-G. The reduction in DNA damage, ranging from 18% to 87%, with an average of 59%, was not related to the increased number of leukocytes in peripheral blood. The results demonstrate for the first time the protective effect of CM-G against DNA damage in patients with advanced PCa. Among smokers, three presented the highest reduction in DNA damage after treatment with CM-G. There was no observable relationship between DNA damage scores before and after treatment, and age, alcoholism and radiotherapy.
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BACKGROUND/OBJECTIVE: Genetic polymorphisms in cytochrome P-450 (CYPs) and glutathione S-transferase (GSTs) genes can influence the appearance of tumors by the formation of new enzymes with altered activities. In the present study, 5 polymorphic variants were examined in 154 patients with prostate carcinoma and in 154 controls. MATERIALS AND METHODS: DNA analysis was carried out through PCR-based methods. The statistical methods used were odds ratio and confidence interval (95% CI), χ(2), Fisher, and Mann-Whitney. RESULTS: The study showed absence of association for CYP1A1 2B, CYP1B1 2, GSTM1 0, and GSTT1 0. The statistical analysis implied a positive association of variant CYP3A4 1B for prostate cancer. The combined analysis of CYP1A1 2B, CYP1B1 2, and CYP3A4 1B genotypes showed positive association. The analysis of histopathologic parameters detected statistically significant differences for Gleason score and biochemistry recurrence risk. The presence of the GSTT1 0 genotype in red meat consumers increased the risk for this disease. CONCLUSION: Some polymorphic variants analyzed can influence the development and the progression of prostate cancer.
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Hidrocarboneto de Aril Hidroxilases/genética , Citocromo P-450 CYP1A1/genética , Citocromo P-450 CYP3A/genética , Glutationa Transferase/genética , Neoplasias da Próstata/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Citocromo P-450 CYP1B1 , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Neoplasias da Próstata/enzimologiaRESUMO
Carboxymethyl-glucan (CM-G) is a soluble derivative from Saccharomyces cerevisiae (1 → 3)(1 → 6)-β-D-glucan. The protective efficiency of CM-G against DNA damage in cells from patients with advanced prostate cancer (PCa), and undergoing Androgen Deprivation Therapy (ADT), was evaluated. DNA damage scores were obtained by the comet assay, both before and after treatment with CM-G. The reduction in DNA damage, ranging from 18 percent to 87 percent, with an average of 59 percent, was not related to the increased number of leukocytes in peripheral blood. The results demonstrate for the first time the protective effect of CM-G against DNA damage in patients with advanced PCa. Among smokers, three presented the highest reduction in DNA damage after treatment with CM-G. There was no observable relationship between DNA damage scores before and after treatment, and age, alcoholism and radiotherapy.
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Humanos , Masculino , Feminino , Antioxidantes , Glucanos , Neoplasias da PróstataRESUMO
Numerous enzymes, including Cytochrome P450s (phase I) and Glutathione-S-transferases (phase II), are involved in the metabolic activation and detoxification of carcinogens. Epidemiological studies have consistently demonstrated that bladder cancer is strongly associated with cigarette smoking, and the risk for the development of this neoplasia may be modified by individual differences in carcinogen-metabolizing genes. We investigated the relationship between polymorphisms in the CYP1A1, GSTM1, GSTT1, and GSTP1 genes in a case-control study with 100 bladder cancer patients and 100 controls matched for age, gender, race, and smoking status. The GSTM1, GSTT1, CYP1A1 (A2455-->G), and GSTP1 (A313-->G) genotypes were determined using a multiplex PCR, an allele specific PCR, and a restriction fragment length polymorphism-PCR method. The present case-controlled association study did not detect any positive or negative association for the GSTM1 and GSTP1 genes [odds ratios (OR) = 1.35; 95% confidence interval (CI) = 0.76-2.41 and OR = 0.75; 95% CI = 0.41-1.38, respectively]. Notably, the genes GSTT1 and CYP1A1 exhibited a statistically significant association with bladder cancer (OR = 1.77; 95% CI = 1.01-3.12 and OR = 1.99; 95% CI = 1.07-3.73). No differences for GSTM1 and GSTP1 genotype prevalence between the bladder cancer cases and the controls were observed, however, the null genotype for the GSTT1 gene and the A/G and G/G variants of the CYP1A1 gene may contribute to the development of bladder cancer.
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Citocromo P-450 CYP1A1/genética , Glutationa S-Transferase pi/genética , Glutationa Transferase/genética , Neoplasias da Bexiga Urinária/genética , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de RestriçãoRESUMO
OBJECTIVES: Postgastrectomy iron deficiency anemia has a variable prevalence and occurs in 20-50% of patients. Food fortification reports examining ferrous glycinate chelate have shown that it can be 2.5-3.4 times more bioavailable than ferrous sulfate, with minimal gastrointestinal symptoms. The present study was designed as a controlled experimental study including 18 gastrectomized patients with iron deficiency anemia to compare the effects of ferrous sulfate and ferrous glycinate chelate in the treatment of anemia and to evaluate the presence of side effects. METHODS: Patients were divided in two groups: group 1 received ferrous sulfate (200 mg twice a day, corresponding to 80 mg of elemental iron) and group 2 received ferrous glycinate chelate (250 mg/d, corresponding to 50 mg of elemental iron) for 4 mo. Laboratory measurements were performed at baseline and after 2 and 4 mo. RESULTS: Group 1 showed an apparent recovery in laboratory parameters, with increases in medium corpuscular hemoglobin (P = 0.02), serum iron (P = 0.02), and ferritin (P = 0.04), and a decrease in transferrin (P = 0.002) after 4 mo. Individualized analysis showed that only one patient using ferrous sulfate had anemia at the end of the study in contrast to six patients using ferrous glycinate. In addition, ferritin levels increased above 20 microg/L at the end of the study in seven patients using ferrous sulfate in contrast to one patient using ferrous glycinate. CONCLUSION: Patients with iron deficiency anemia after gastrectomy treated with ferrous sulfate had better results in hematologic laboratory parameters than those who used ferrous glycinate chelate.
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Anemia Ferropriva/tratamento farmacológico , Compostos Ferrosos/farmacocinética , Gastrectomia/efeitos adversos , Glicina/análogos & derivados , Quelantes de Ferro/farmacocinética , Idoso , Disponibilidade Biológica , Feminino , Ferritinas/sangue , Compostos Ferrosos/uso terapêutico , Glicina/farmacocinética , Glicina/uso terapêutico , Hemoglobinas/metabolismo , Humanos , Absorção Intestinal , Ferro/sangue , Quelantes de Ferro/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Resultado do TratamentoRESUMO
Introduction: Squamous cell carcinoma of the penis is a rare disease in the developed world but common in underdeveloped countries. We have evaluated the prognostic factors related to penile carcinoma and assessed the outcome of patients regarding the lymph node status at two institutions. Materials and methods: Between January 1990 and December 2003, 87 patients with a clinical diagnosis of penile carcinoma had been treated at Instituto de Cancer de Londrina and Universidade Estadual de Londrina and were retrospectively reviewed. Patients who were followed for more than 18 months or until death due to penile cancer were evaluated for prognostic factors. Overall survival was calculated according to lymph node status. Results: Overall survival according to lymph node status at presentation, showed a poor outcome for patients with palpable lymph nodes compared with those with clinically negative lymph node (2-year survival of 20 and 68 respectively, p < 0.0005). The same was observed in those who presented delayed lymphadenopathy compared with patients who persisted N0 during follow-up time (2-year-survival of 28 and 90 respectively, p < 0.0005). Forty eight patients were assessed for prognostic factors. Histological grade and pathological stage were all statistically significant at univariate analysis regarding disease-free survival. Conclusion: Patients with positive lymph node had a poor overall survival regardless whether or not an immediate or a delayed lymphadenectomy had been performed. Histological grade and pathological stage were the only variables statistically significant at univariate analysis with respect to disease-free survival.
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Humanos , Masculino , Neoplasias dos Genitais Masculinos , Neoplasias Penianas , LinfonodosRESUMO
AIM: Compare inflammation and collagen production induced by four sling materials in female rats. METHODS: Adult female rats (n=144) were submitted to a urinary incontinence model and neutering. After four weeks they were randomized in 5 groups: Sham; autologous sling; Marlex; swine intestinal submucosa (SIS), and polypropylene mesh (TVT). Animals were killed at 7, 30 and 90 days. The inflammatory infiltrated area was rated from 0 to 3 (0=area smaller than 25%, 1=between 25% and 50%, 2 between 50% and 75%, and 3 for areas greater than 75%). The presence of granuloma and necrosis was noted. Penetration in the vesical wall was evaluated employing a system of scores from 0 to 3. The amount of collagen I and III, and the total was assessed using the Picro-Sirius staining technique. RESULTS: The Sham group presented lower inflammatory parameters at 7 days. On the 30th day, the autologous fascia presented inflammatory reactions similar to the Sham group, and lower than the remaining groups. The synthetic materials demonstrated greater inflammatory reactions at 60 days. No differences between groups were observed other than those concerning collagen production, except at 60 days, when TVT and SIS differed from Fascia and Sham in the production of collagen III. CONCLUSION: Autologous fascia produced less inflammatory reaction and collagen. TVT and Marlex caused more intense and longer-lasting inflammatory reaction with greater visceral penetration. When TVT was used, this process resulted in a higher quantity of collagen III. The presence of SIS, although presenting a less intense inflammatory reaction than the synthetics, also caused greater collagen III production at 60 days.
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Colágeno Tipo III/biossíntese , Granuloma/patologia , Slings Suburetrais , Animais , Bioprótese , Fáscia/transplante , Feminino , Mucosa Intestinal , Modelos Animais , Polipropilenos , Distribuição Aleatória , Ratos , Ratos Wistar , Telas Cirúrgicas , Suínos , Transplante Autólogo , Incontinência Urinária/cirurgiaRESUMO
OBJECTIVE: Compare the capacity of the PSA density (PSAD), Free PSA percentage (%FPSA) and PSA transition zone density (PSATZ) in improving the sensitivity and specificity of the PSA to detect prostate cancer (PCa) in men with a PSA between 4 and 10 ng/mL. MATERIALS AND METHODS: One hundred and forty five men with PSA between 4 and 10 ng/mL were prospectively studied. Blood collection for the total PSA and free PSA was performed as well as transrectal ultra-sound with prostate biopsy and measurement of the total prostate volume (TPV) and transition zone volume (TZV). Patients with initial negative biopsy were followed and the prostate biopsy was repeated in those that presented PSA increase. The capacity of the PSAD, %FPSA and PSADTZ in improving the sensitivity and specificity pf the PSA test to the detection of the PCa was assessed by univariate and multivariate analyses and through the ROC curve. RESULTS: Of the 145 patients, 38 (26.2%) had PCa and in 107 (73.8%) a benign prostate disease was diagnosed. No difference among the PSAD, %FPSA and PSADTZ was found. The multivariate analysis showed that the PSADTZ, %FPSA, TZV and age were those more powerful and highly significant PCa predictors. CONCLUSION: The determination of %FPSA and PSAD can allow a better discrimination between PCa and benign disease that the isolated use of PSA. The combination of PSADTZ, %FPSA, TZV and age promote a high accuracy for PCa detection.
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Adenocarcinoma/diagnóstico , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Idoso , Métodos Epidemiológicos , Humanos , Masculino , Antígeno Prostático Específico/sangue , Valores de ReferênciaRESUMO
OBJECTIVE: Compare the capacity of the PSA density (PSAD), Free PSA percentage ( percentFPSA) and PSA transition zone density (PSATZ) in improving the sensitivity and specificity of the PSA to detect prostate cancer (PCa) in men with a PSA between 4 and 10 ng/mL. MATERIALS AND METHODS: One hundred and forty five men with PSA between 4 and 10 ng/mL were prospectively studied. Blood collection for the total PSA and free PSA was performed as well as transrectal ultra-sound with prostate biopsy and measurement of the total prostate volume (TPV) and transition zone volume (TZV). Patients with initial negative biopsy were followed and the prostate biopsy was repeated in those that presented PSA increase. The capacity of the PSAD, percentFPSA and PSADTZ in improving the sensitivity and specificity pf the PSA test to the detection of the PCa was assessed by univariate and multivariate analyses and through the ROC curve. RESULTS: Of the 145 patients, 38 (26.2 percent) had PCa and in 107 (73.8 percent) a benign prostate disease was diagnosed. No difference among the PSAD, percentFPSA and PSADTZ was found. The multivariate analysis showed that the PSADTZ, percentFPSA, TZV and age were those more powerful and highly significant PCa predictors. CONCLUSION:The determination of percentFPSA and PSAD can allow a better discrimination between PCa and benign disease that the isolated use of PSA. The combination of PSADTZ, percentFPSA, TZV and age promote a high accuracy for PCa detection.
Assuntos
Idoso , Humanos , Masculino , Adenocarcinoma/diagnóstico , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Métodos Epidemiológicos , Antígeno Prostático Específico/sangue , Valores de ReferênciaRESUMO
INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.