Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal sh... more Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.
Purpose : Complications are the chief concern of patients and physicians when considering spine s... more Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs...
Low-grade gliomas (LGG) comprise nearly 15-20 % of all central nervous system glial tumors. Sever... more Low-grade gliomas (LGG) comprise nearly 15-20 % of all central nervous system glial tumors. Several factors have been recognized as playing role in LGG malignant transformation (MT). A breakthrough analysis of a multidisciplinary group pointed that temozolomide may play a role in MT of LGGs. We analyzed the prevalence of MT in LGG patients submitted to adjuvant therapy (AT). We analyzed the medical charts of 43 patients with LGG submitted to surgery or biopsy and attending at Hospital do Servidor Público Estadual de São Paulo (São Paulo, Brazil), consecutively diagnosed from 1995 to 2013. 43 patients (24 women and 19 men) were evaluated, with mean age of 45.3 years. According to histology, 30 were astrocytomas (70 %), 12 (27 %) were oligodendrogliomas, and 1 (3 %) were mixed glioma. Mean follow-up time was 4.2 years with the standard deviation of 2.1. Twenty-eight patients did not receive adjuvant therapy and 15 received adjuvant therapy. From 43 patients with complete follow-up, 21 (48 %) experienced malignant transformation. Among such patients, nine were users of AT. Forty-eight percent of patients presented MT, being 60 % in the AT group and 42.8 % without AT. Our analysis revealed a high prevalence of MT in patients undergoing AT, higher than in patients without AT.
Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is consid... more Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is considered a benign condition. Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, dementia and/or urinary incontinence added to dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure. We describe an experience of a conservative treatment of subdural hematoma based in the physiopathology and ability to control the pressure in programmable valves. The adjustment of programmable valves in the treatment of INPH allow us the therapeutic control of hydrocephalus and an important tool to manage complications, especially overshunting and undershunting.
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia an... more Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the tr...
idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfu... more idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.
OBJECT Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephal... more OBJECT Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. METHODS Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded. RESULTS Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. CONCLUSIONS The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.
O xantoastrocitoma pleomórfico é uma neoplasia rara, classificada como grau II ou III pela Orga... more O xantoastrocitoma pleomórfico é uma neoplasia rara, classificada como grau II ou III pela Organização Mundial da Saúde, a depender do aspecto histopatológico. Descrevemos dois casos de portadores de xantoastrocitoma pleomórfico, cujo tratamento escolhido foi cirúrgico. A associação com quimioterapia foi realizada em um dos pacientes. Haja vista a baixa freqüência desse tipo de neoplasia, torna-se fundamental a realização de novos estudos para o desenvolvimento de protocolos de tratamento que vislumbrem a diminuição da taxa de recidivas. ABSTRACT Pleomorphic xanthoastrocytoma: report of two cases Pleomorphic xanthoastrocytoma is a rare neoplasia which presents a high cellular pleomorphism, enabling recurrence and malignant transformation. It is classified by the World Health Organization as a grade II or III tumor, depending on the histopathological appearance. Here we present two cases of pleomorphic xanthoastrocytoma treated surgically. Association with chemotherapy was applied in one of them. Considering the low frequency of this kind of neoplasm, it must accomplish new studies to develop treatment protocols that aim to decrease recurrence rates. Original recebido em agosto de 2007 Aceito para publicação em março 2008 Figura 4 -Aspecto histopatológico (caso 2).
In the past, prostate cancer (PC) could only be detected clinically, and delayed diagnosis of loc... more In the past, prostate cancer (PC) could only be detected clinically, and delayed diagnosis of locally advanced or metastatic disease at presentation was common. Prostate-specific antigen testing and magnetic resonance imaging led to PC detection in a much earlier stage. However, controversy about the best treatment for locally advanced PC remains. Recent refinements in surgery and radiation therapy have improved outcomes, but no comparative study has yet conclusively determined superiority of one option over the other. In this review, we present the most recent evidence about the role of radical prostatectomy for locally advanced PC treatment from a surgeon's perspective.
Scientific research originating from Brazil appears to be rising in several medical fields. Resea... more Scientific research originating from Brazil appears to be rising in several medical fields. Research results are often presented at scientific meetings before publication in peer-reviewed journals. We investigated the publication rate of Brazilian studies presented in American Urological Association (AUA) meetings and compared with the rate of publication of Brazilian oncological studies presented at the American Society of Clinical Oncology (ASCO) meetings. a hand search of 12,454 abstracts presented at aua meetings 2001-2007 was conducted. abstracts for which at least two-thirds of institutions were from brazil were considered as brazilian. final publication was searched in pubmed and lilacs databases. oncological abstracts were also hand searched in the asco meetings proceedings in the same years. There was no significant temporal trend in the proportion of AUA studies originating from Brazil along those 7 years. A total of 195 abstracts (1.57%) were from Brazil. One hundred (51.3%) abstracts were published in full, and the estimated 5-year publication rate was 48.2%. There was a progressive increase in publication rates for studies categorized as video, poster, and podium presentations. Considering abstracts presented in years 2001-2005, urologic publication rate was significantly higher than for abstracts presented at the ASCO meeting. Our results suggest that the Brazilian contribution to AUA meetings is at a plateau and that the Brazilian literature contribution is greater in urology than in oncology. Efforts must be invested towards raising this plateau and understanding qualitative aspects of the urology scientific output from Brazil.
A Litíase urinária representa uma complicação urológica pouco comum no alotransplante renal, a in... more A Litíase urinária representa uma complicação urológica pouco comum no alotransplante renal, a incidência varia de 0,02 a 3,4% 1, 2, 3, 4, 5, 6 . A maioria desses casos são considerados formações de novo, são cálculos que se formam no rim transplantado no pós-operatório tardio 6, . Não obstante, existem alguns relatos sugerindo que os cálculos são mais freqüentemente transferidos juntamente com os rins, do que se imaginava previamente 8,11 . Pelas peculiaridades dos receptores renais, o quadro clínico da litíase renal geralmente é atípico. Em razão disso pode ocorrer retardo no diagnóstico 4, 11 , além da possibilidade do quadro clínico ser confundido com episódios de rejeição aguda 9 . Várias estratégias terapêuticas tem sido propostas para a resolução da litíase no enxerto renal. Entretanto, não há uma padronização de conduta a ser seguida, isto provavelmente, se deve ao número escasso de casos 9, 12, 13, 14 . O objetivo deste trabalho é apresentar a experiência da Divisão de Urologia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com o diagnóstico e com a conduta a litíase urinária no alotransplante renal.
hemi-ablation of the prostate gland has been suggested as an alternative therapy in unilateral tu... more hemi-ablation of the prostate gland has been suggested as an alternative therapy in unilateral tumors. 12 Thus, correctly identifying tumor laterality (uni or bilaterality) via TRUSBX is an important factor in determining the selection of hemi-ablation, although recent studies also suggest that TRUSBX tends to underestimate tumor laterality. As a result of these discrepancies findings, we compared the Gleason score and tumor laterality determined from RP and TRUSBX. Some factors that could cause a discrepancy in results between the two procedures were also evaluated. This study is also particularly important because it includes a population (Brazilian men) that is typically understudied.
reperfusão.A RCR diminuiu após 120 minutos de isquemia retornando a níveis semelhantes ao control... more reperfusão.A RCR diminuiu após 120 minutos de isquemia retornando a níveis semelhantes ao controle após a reperfusão. Conclusão: A CHE foi sensível para indicar a lesão isquêmica, sugerindo irreversibilidade da lesão. Já a RCR foi mais sensível no sentido de detectar a reversibilidade da lesão isquêmica após a reperfusão. DESCRITORES: Colinesterase. Função mitocondrial.Transplante de fígado.Isquemia. Reperfusão. Tiraboschi RB, Domingos ALA, Reis RB, Bovo TB, Suaid HJ, Cologna AJ, Martins ACP. Adrenalectomia laparoscópica: análise de 11 pacientes. Acta Cir Bras [serial online] 2003 vol 18 suppl 5. Disponível em www.scielo.br/acb RESUMO -Objetivo: Analisar a experiência inicial da Divisão de Urologia do HCFMRP-USP na adrenalectomia transperitoneal videolaparoscópica. Métodos: Análise retrospectiva de 11 casos de adrenalectomia transperitoneal laparoscópica realizados de fevereiro de 1999 a março de 2003 sendo 3 em homens( 27%) e 8 em mulheres (73%), idade média de 40,2 ± 13,1 anos. Os pacientes apresentavam os diagnósticos seguintes: adenoma -5, síndrome de Cushing -3, feocromocitoma -1, hiperaldestorismo -1 e síndrome de Carney -1. Resultados: A cirurgia foi bilateral em 05 pacientes (45,4%) e unilateral em 06 pacientes (54,6 %), destes 04 à direita (36,4%) e 02 à esquerda (18,2%). O tempo médio de internação foi de 3,6 ± 1,1 dias, o tempo médio de cirurgia foi de 220,5 ± 103,7 minutos e a taxa de conversão foi de 18,2%. Conclusão: Os resultados apresentados são similares aos relatados pela literatura, demonstrando que a adrenalectomia videolaparoscópia pode ser realizada de maneira segura e eficiente com benefícios: tempo cirúrgico aceitável, rápida recuperação pós-operatória e alta precoce. DESCRITORES: Adrenalectomia, laparoscopia. Adenoma da adrenal. Cushing. Conn. Carey. surgical approach. Journal of Tiraboschi RB, Domingos ALA, Reis RB, Bovo TB, Suaid HJ, Cologna AJ, Martins ACP. Laparoscopic adrenalectomy -analysis of 11 patients. Acta Cir Bras [serial online] 2003 vol 18 suppl 5. Available in www.scielo.br/acb ABSTRACT -Objective:
Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal sh... more Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.
Purpose : Complications are the chief concern of patients and physicians when considering spine s... more Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs...
Low-grade gliomas (LGG) comprise nearly 15-20 % of all central nervous system glial tumors. Sever... more Low-grade gliomas (LGG) comprise nearly 15-20 % of all central nervous system glial tumors. Several factors have been recognized as playing role in LGG malignant transformation (MT). A breakthrough analysis of a multidisciplinary group pointed that temozolomide may play a role in MT of LGGs. We analyzed the prevalence of MT in LGG patients submitted to adjuvant therapy (AT). We analyzed the medical charts of 43 patients with LGG submitted to surgery or biopsy and attending at Hospital do Servidor Público Estadual de São Paulo (São Paulo, Brazil), consecutively diagnosed from 1995 to 2013. 43 patients (24 women and 19 men) were evaluated, with mean age of 45.3 years. According to histology, 30 were astrocytomas (70 %), 12 (27 %) were oligodendrogliomas, and 1 (3 %) were mixed glioma. Mean follow-up time was 4.2 years with the standard deviation of 2.1. Twenty-eight patients did not receive adjuvant therapy and 15 received adjuvant therapy. From 43 patients with complete follow-up, 21 (48 %) experienced malignant transformation. Among such patients, nine were users of AT. Forty-eight percent of patients presented MT, being 60 % in the AT group and 42.8 % without AT. Our analysis revealed a high prevalence of MT in patients undergoing AT, higher than in patients without AT.
Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is consid... more Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is considered a benign condition. Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, dementia and/or urinary incontinence added to dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure. We describe an experience of a conservative treatment of subdural hematoma based in the physiopathology and ability to control the pressure in programmable valves. The adjustment of programmable valves in the treatment of INPH allow us the therapeutic control of hydrocephalus and an important tool to manage complications, especially overshunting and undershunting.
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia an... more Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the tr...
idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfu... more idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.
OBJECT Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephal... more OBJECT Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. METHODS Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded. RESULTS Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. CONCLUSIONS The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.
O xantoastrocitoma pleomórfico é uma neoplasia rara, classificada como grau II ou III pela Orga... more O xantoastrocitoma pleomórfico é uma neoplasia rara, classificada como grau II ou III pela Organização Mundial da Saúde, a depender do aspecto histopatológico. Descrevemos dois casos de portadores de xantoastrocitoma pleomórfico, cujo tratamento escolhido foi cirúrgico. A associação com quimioterapia foi realizada em um dos pacientes. Haja vista a baixa freqüência desse tipo de neoplasia, torna-se fundamental a realização de novos estudos para o desenvolvimento de protocolos de tratamento que vislumbrem a diminuição da taxa de recidivas. ABSTRACT Pleomorphic xanthoastrocytoma: report of two cases Pleomorphic xanthoastrocytoma is a rare neoplasia which presents a high cellular pleomorphism, enabling recurrence and malignant transformation. It is classified by the World Health Organization as a grade II or III tumor, depending on the histopathological appearance. Here we present two cases of pleomorphic xanthoastrocytoma treated surgically. Association with chemotherapy was applied in one of them. Considering the low frequency of this kind of neoplasm, it must accomplish new studies to develop treatment protocols that aim to decrease recurrence rates. Original recebido em agosto de 2007 Aceito para publicação em março 2008 Figura 4 -Aspecto histopatológico (caso 2).
In the past, prostate cancer (PC) could only be detected clinically, and delayed diagnosis of loc... more In the past, prostate cancer (PC) could only be detected clinically, and delayed diagnosis of locally advanced or metastatic disease at presentation was common. Prostate-specific antigen testing and magnetic resonance imaging led to PC detection in a much earlier stage. However, controversy about the best treatment for locally advanced PC remains. Recent refinements in surgery and radiation therapy have improved outcomes, but no comparative study has yet conclusively determined superiority of one option over the other. In this review, we present the most recent evidence about the role of radical prostatectomy for locally advanced PC treatment from a surgeon's perspective.
Scientific research originating from Brazil appears to be rising in several medical fields. Resea... more Scientific research originating from Brazil appears to be rising in several medical fields. Research results are often presented at scientific meetings before publication in peer-reviewed journals. We investigated the publication rate of Brazilian studies presented in American Urological Association (AUA) meetings and compared with the rate of publication of Brazilian oncological studies presented at the American Society of Clinical Oncology (ASCO) meetings. a hand search of 12,454 abstracts presented at aua meetings 2001-2007 was conducted. abstracts for which at least two-thirds of institutions were from brazil were considered as brazilian. final publication was searched in pubmed and lilacs databases. oncological abstracts were also hand searched in the asco meetings proceedings in the same years. There was no significant temporal trend in the proportion of AUA studies originating from Brazil along those 7 years. A total of 195 abstracts (1.57%) were from Brazil. One hundred (51.3%) abstracts were published in full, and the estimated 5-year publication rate was 48.2%. There was a progressive increase in publication rates for studies categorized as video, poster, and podium presentations. Considering abstracts presented in years 2001-2005, urologic publication rate was significantly higher than for abstracts presented at the ASCO meeting. Our results suggest that the Brazilian contribution to AUA meetings is at a plateau and that the Brazilian literature contribution is greater in urology than in oncology. Efforts must be invested towards raising this plateau and understanding qualitative aspects of the urology scientific output from Brazil.
A Litíase urinária representa uma complicação urológica pouco comum no alotransplante renal, a in... more A Litíase urinária representa uma complicação urológica pouco comum no alotransplante renal, a incidência varia de 0,02 a 3,4% 1, 2, 3, 4, 5, 6 . A maioria desses casos são considerados formações de novo, são cálculos que se formam no rim transplantado no pós-operatório tardio 6, . Não obstante, existem alguns relatos sugerindo que os cálculos são mais freqüentemente transferidos juntamente com os rins, do que se imaginava previamente 8,11 . Pelas peculiaridades dos receptores renais, o quadro clínico da litíase renal geralmente é atípico. Em razão disso pode ocorrer retardo no diagnóstico 4, 11 , além da possibilidade do quadro clínico ser confundido com episódios de rejeição aguda 9 . Várias estratégias terapêuticas tem sido propostas para a resolução da litíase no enxerto renal. Entretanto, não há uma padronização de conduta a ser seguida, isto provavelmente, se deve ao número escasso de casos 9, 12, 13, 14 . O objetivo deste trabalho é apresentar a experiência da Divisão de Urologia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com o diagnóstico e com a conduta a litíase urinária no alotransplante renal.
hemi-ablation of the prostate gland has been suggested as an alternative therapy in unilateral tu... more hemi-ablation of the prostate gland has been suggested as an alternative therapy in unilateral tumors. 12 Thus, correctly identifying tumor laterality (uni or bilaterality) via TRUSBX is an important factor in determining the selection of hemi-ablation, although recent studies also suggest that TRUSBX tends to underestimate tumor laterality. As a result of these discrepancies findings, we compared the Gleason score and tumor laterality determined from RP and TRUSBX. Some factors that could cause a discrepancy in results between the two procedures were also evaluated. This study is also particularly important because it includes a population (Brazilian men) that is typically understudied.
reperfusão.A RCR diminuiu após 120 minutos de isquemia retornando a níveis semelhantes ao control... more reperfusão.A RCR diminuiu após 120 minutos de isquemia retornando a níveis semelhantes ao controle após a reperfusão. Conclusão: A CHE foi sensível para indicar a lesão isquêmica, sugerindo irreversibilidade da lesão. Já a RCR foi mais sensível no sentido de detectar a reversibilidade da lesão isquêmica após a reperfusão. DESCRITORES: Colinesterase. Função mitocondrial.Transplante de fígado.Isquemia. Reperfusão. Tiraboschi RB, Domingos ALA, Reis RB, Bovo TB, Suaid HJ, Cologna AJ, Martins ACP. Adrenalectomia laparoscópica: análise de 11 pacientes. Acta Cir Bras [serial online] 2003 vol 18 suppl 5. Disponível em www.scielo.br/acb RESUMO -Objetivo: Analisar a experiência inicial da Divisão de Urologia do HCFMRP-USP na adrenalectomia transperitoneal videolaparoscópica. Métodos: Análise retrospectiva de 11 casos de adrenalectomia transperitoneal laparoscópica realizados de fevereiro de 1999 a março de 2003 sendo 3 em homens( 27%) e 8 em mulheres (73%), idade média de 40,2 ± 13,1 anos. Os pacientes apresentavam os diagnósticos seguintes: adenoma -5, síndrome de Cushing -3, feocromocitoma -1, hiperaldestorismo -1 e síndrome de Carney -1. Resultados: A cirurgia foi bilateral em 05 pacientes (45,4%) e unilateral em 06 pacientes (54,6 %), destes 04 à direita (36,4%) e 02 à esquerda (18,2%). O tempo médio de internação foi de 3,6 ± 1,1 dias, o tempo médio de cirurgia foi de 220,5 ± 103,7 minutos e a taxa de conversão foi de 18,2%. Conclusão: Os resultados apresentados são similares aos relatados pela literatura, demonstrando que a adrenalectomia videolaparoscópia pode ser realizada de maneira segura e eficiente com benefícios: tempo cirúrgico aceitável, rápida recuperação pós-operatória e alta precoce. DESCRITORES: Adrenalectomia, laparoscopia. Adenoma da adrenal. Cushing. Conn. Carey. surgical approach. Journal of Tiraboschi RB, Domingos ALA, Reis RB, Bovo TB, Suaid HJ, Cologna AJ, Martins ACP. Laparoscopic adrenalectomy -analysis of 11 patients. Acta Cir Bras [serial online] 2003 vol 18 suppl 5. Available in www.scielo.br/acb ABSTRACT -Objective:
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