RESUMO
Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.
Assuntos
Corpos Estranhos , Perfuração Intestinal , Ureter , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Ureter/diagnóstico por imagem , Ureter/cirurgia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgiaRESUMO
ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.
Assuntos
Humanos , Ureter/cirurgia , Ureter/diagnóstico por imagem , Corpos Estranhos/cirurgia , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Perfuração Intestinal , Bexiga Urinária/cirurgia , Bexiga Urinária/diagnóstico por imagemRESUMO
INTRODUCTION: Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. MATERIALS AND METHODS: Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2 ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. RESULTS: Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and pathologic factors predicting progression-free survival at 5 years, prostate weight; preoperative PSA; Gleason score; pathologic stage; tumor volume; PSMs; capsular and perineural invasion were correlated with BCR. At multivariate analysis, only Gleason score and percentage of tumor volume correlated as significant independent predictors of BCR. CONCLUSION: At univariate analysis, presence, number and location of PSMs have consistent correlation with BCR after RRP, but at follow-up BCR occurred only in 37.8% of patients with PSMs. However at multivariate analysis, the significant risk factors for BCR were percentage of tumor volume (p = 0.022) and Gleason score (p < 0.005) in the surgical specimen. Angiolymphatic invasion and Gleason score were significantly correlated with CR.
Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasia Residual , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga TumoralRESUMO
Introduction Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate ...
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Intervalo Livre de Doença , Análise Multivariada , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasia Residual , Recidiva Local de Neoplasia/patologia , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga TumoralRESUMO
Apesar dos bem estabelecidos parâmetros clínicos, cirúrgicos e anatomopatológicos utilizados na atualidade para podermos predizer a evolução para recidiva bioquímica do adenocarcinoma da próstata, após seu tratamento cirúrgico, sobretudo quando da presença de margens cirúrgicas positivas, análises imunoistoquímicas tem se revelado importantes ferramentas para apoiar a indicação de tratamentos adjuvantes precocemente ou não com base na expressão de determinados marcadores que sinalizam a agressividade do tumor. O iNOS (sintase do óxido nítrico induzível) sintetiza óxido nítrico (NO) que tem importante papel no crescimento tumoral e na angiogênese, como também influencia a citotoxicidade de macrófagos e a imunosupressão induzida pelo tumor, sendo um marcador muito encontrado em células do adenocarcinoma da próstata diferenciando este de tecido benigno. A COX-2 que tem produção estimulada pelo NO, também tem sido associada a diversas neoplasias por sua ação angiogênica e no processo da inflamação, sendo estudada como via alvo terapêutico. O GLUT1 é um ativo transportador de glicose expressado em tecidos normais e expresso em altos níveis em numerosos tumores, sendo um marcador intrínseco e mediador de hipóxia reduzindo a fosforilação oxidativa e agindo na via de sinalização oxigênio-dependente através do fator de hipóxia induzida (HIF-1). A Nitrotirosina é um produto da nitração da tirosina mediado por espécies reativas do nitrogênio, tais como o ânion peroxinitrito e o dióxido de nitrogênio, sendo detectado em condições patológicas como em neoplasias sendo considerado marcador de estresse oxidativo dependente de NO. Os objetivos deste trabalho foram avaliar as expressões desses marcadores em espécimes cirúrgicos de próstatas com adenocarcinoma e avaliar suas relações com o prognóstico pós-prostatectomia radical em pacientes com margens cirúrgicas positivas, fator este considerado na literatura como significativo para recidiva bioquímica. Foram analisados...
In spite of the well-established clinical, surgical and anatomopathological parameters currently used to allow us to predict the evolution to biochemical recurrence of adenocarcinoma of the prostate, after its surgical treatment, especially when in the presence of positive surgical margins, immunohistochemical tests have become very important tools to support the indication of adjuvant therapies, either precociously or not, based on the expression of certain markers that signalize the tumors aggressiveness. The iNOS (inducible nitric oxide synthase) synthesizes nitric oxide (NO) which plays an important role in the tumors growth and in the angiogenesis, affecting as well the macrophages cytotoxicity and the tumor-induced immunosuppression, being a marker very commonly found in prostate adenocarcinoma cells, thus differentiating this from a benign hyperplasia. The COX-2, which production is stimulated by the NO, has also been associated to various neoplasias due to its angiogenic action and to its influence on the inflammation process as well, being then studied as a therapeutic target via. The GLUT1 is an active glucose transporter expressed in normal tissues and expressed at high levels in numerous tumors, playing the role as intrinsic and mediator hypoxia marker, reducing oxidative phosphorylation and acting on the oxygen-dependent signalizing via through hypoxia inducible factor (HIF-1). Nitrotyrosine is a product of tyrosine nitration mediated by reactive nitrogen species such as peroxynitrite anion and nitrogen dioxide, being detected in pathological conditions such as in neoplasias, thus being considered a marker of NO-dependent oxidative stress. The objectives of this work were to evaluate the expressions of those markers in surgical specimens of prostates with adenocarcinoma, as well as to evaluate their relation with prognosis after radical prostatectomy in patients with positive surgical margins, factor which has been considered...
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Biomarcadores Tumorais , Neoplasias da Próstata/diagnóstico , Prognóstico , Prostatectomia , PróstataRESUMO
Introducción: la revascularización miocárdica quirúrgica (RVMQ) incompleta es un factor determinante en la reaparición precoz de angina y determina una menor sobrevida para los pacientes. Objetivo: el objetivo del presente trabajo es evaluar la eficacia perfusional de la terapia angiogénica celular con células derivadas de la médula ósea (CMO) autólogas por inyección directa intramiocárdica complementaria a la RVMQ convencional. Material y método: la evaluación perfusional luego de la cirugía se realiza a los tres, seis y 12 meses mediante SPECT y ecocardiograma Doppler Tisular-Strain (DTI-Strain). Resultados: en esta comunicación preliminar (precedida por ocho casos pilotos) se reportan resultados de cuatro pacientes (dos casos y dos controles) que completaron el seguimiento al tercer mes, teniendo todos oclusión crónica de coronaria derecha (CD) sin recanalización, fracción de eyección del ventrículo izquierdo (FEVI) media de 50%. En los territorios de la descendente posterior (DP) y posterolateral (PL) de CD se inyectó un promedio de 5,7 x 106 células CD34+ autólogas en un volumen promedio de 5 ml por territorio. En el control perfusional con SPECT al tercer mes de los casos se registró un incremento perfusional en los territorios inyectados de aproximadamente 10%. En los controles, los sectores miocárdicos no revascularizados tuvieron un decremento perfusional en promedio de 3%. En el DTI-Strain se observó mejoría de los valores en todas las muestras estudiadas en el caso con FEVI conservada, y peoría en el caso con FEVI en rango inferior. La terapia celular angiogénica con CMO autólogas por vía intramiocárdica tiene beneficios prefusionales, es una técnica factible y segura complementaria al tratamiento quirúrgico.
Summary Introduction: incomplete surgical myocardial revascularization is a determining factor for early flare of subsequent angina which results in lower patient survival. Objective: the present study aims to evaluate the perfusional efficacy of cell angiogenic therapy, using autologic bone-marrow derived stem cells, by means of direct intramyocardial injections, as a complementary therapy when combined with myocardial surgical revascularization. Method: perfusional assessment subsequent to surgery is performed after three, six and twelve months with Single Photon Emission Computed Tomography (SPECT) and DTI-Strain. Results: the present preliminary communication/notice (preceded by eight pilot cases) reports results obtained in four patients (two cases and two controls), completed follow-up in the third month, all of which evidenced chronic right coronary (RC) occlusion with no reversal, 50% average left ventricle ejection fraction. An average of 5.7 x 106 CD34+ autologic cells was injected into the descending posterior and posterolateral territory. The average injection volume was 5 ml per territory. Upon SPECT perfusional control in the third month, a 10% perfusional increase was detected in the injected territories. As to the control cases, nonrevascularized myocardial sectors evidenced a perfusional decrease of 3%, on average. DTI-Strain showed values improvement for all samples studied in the case of the preserved left ventricle ejection fraction (LVEF), and worsening in the LVEF lower range. Angiogenic cell therapy by intramyocardial autologic bone-marrow stem cells implies perfusional benefits. It is a feasible and safe technique to complement surgical treatment.
Résumé Introduction: la revascularisation myocardique chirurgicale (RVMQ) incomplète est un facteur primordial à la réapparition précoce d’angine et détermine une survie raccourcie des patients. Objectif: le but de ce travail est d’évaluer l’efficacité de perfusion de la thérapie angiogénique cellulaire avec des cellules extraites de la moelle osseuse (CMO) autologues par injection directe intra-myocardique complémentaire à la RVMQ conventionnelle. Matériel et méthode: l’évaluation de la perfusion post-chirurgicale est faite trois, six et douze mois après avec SPECT et échocardiogramme Doppler Tisular-Strain (DTI-Strain). Résultats: dans cette communication préalable, précédée de huit cas pilotes, on reporte les résultats de quatre patients (deux cas et deux contrôles) ayant complété le suivi au bout de trois mois et présentant tous occlusion chronique de coronaire droite (CD) sans recanalisation, fraction d’éjection du ventricule gauche (FEVG) moyenne de 50%. Dans les territoires de la descendante postérieure (DP) et postéro latérale (PL) de CD on a injecté une moyenne de 5,7 x 106 cellules CD34+autologues dans un volume moyen de 5 ml par territoire. Lors du contrôle de perfusion avec SPECT des cas au troisième mois, on a repéré une hausse de perfusion dans les territoires injectés de 10% environ, les secteurs myocardiques non revascularisés ayant subi une décroissance perfusionnelle de 3% environ. Au DTI-Strain, on a observé une amélioration des valeurs dans tous les échantillons prélevés au cas de FEVG conservée et aggravation au cas avec FEVG à rang inférieur. La thérapie cellulaire angiogénique avec CMO autologues par voie intra-myocardique a des bénéfices de perfusion, est une technique faisable et sûre complémentaire au traitement chirurgical.
Resumo Introdução: a revascularização cirúrgica incompleta do miocárdio (RVCM) é um fator determinante no reaparecimento precoce da angina que implica uma sobrevida menor para os pacientes. Objetivo: o objetivo deste trabalho é avaliar a eficácia perfusional da terapia angiogênica celular com células autólogas obtidas da medula óssea por injeção direta intra-miocárdica como complemento a RVCM tradicional. Material e método: a avaliação perfusional pós-cirurgia é feita aos três, seis e doze meses usando SPECT e ecocardiograma Doppler Tisular-Strain (DTI-Strain). Resultados: nesta comunicação preliminar, (depois de oito casos piloto) relatamos os resultados de quatro pacientes (dois casos e dois controles) que terminaram o seguimento no terceiro mês, todos com oclusão crônica de coronária direita (CD) sem recanalizaçao com fração de ejeção do ventrículo esquerdo (FEVE) média de 50%. Na região do ramo descendente posterior (DP) e póstero-lateral (PL) da CD, injetaram-se uma média de 5,7 x 106 células CD34+ autólogas em um volume médio de 5 ml por região. No controle perfusional dos casos, realizado no terceiro mês, foi registrado um aumento da perfusão nas regiões injetadas de aproximadamente 10%. Nos controles, os setores do miocárdio não revascularizados apresentaram uma redução média da perfusão de 3%. No DTI-Strain foi observada uma melhora dos valores em todas as amostras estudadas no caso com FEVE conservada, e uma piora no caso com FEVE com valor inferior. A terapia celular angiogênica com CMO autólogas por via intra-miocárdica apresenta melhoras da perfusão, é uma técnica viável e segura, complementar ao tratamento cirúrgico.
Assuntos
Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/terapia , Revascularização Miocárdica , Transplante Autólogo , Transplante de CélulasAssuntos
Humanos , Hipersensibilidade , Hipersensibilidade Imediata/fisiopatologia , Eosinófilos/fisiologia , Doenças do Complexo Imune/fisiopatologia , Doenças do Sistema Imunitário/etiologia , Hipersensibilidade Tardia/fisiopatologia , Hipersensibilidade Tardia/classificação , Doenças Autoimunes/etiologia , Doenças Autoimunes/fisiopatologia , Síndrome da Imunodeficiência Adquirida , Síndromes de ImunodeficiênciaRESUMO
The relative contribution of heritable and nonheritable factors to disease expression in BRCA2 mutation carriers is largely unknown. This report describes a familial breast cancer syndrome in a pair of identical female twins. These twins showed an extremely high concordance in their clinical histories; both twins exhibited similar cancer-related risk factors, and developed breast cancer at the same age with the same disease stage and identical histological features. No differences were detected in hormone receptors status, p53, bcl-2, erbB-2 and LI Ki67 expression by immunohistochemistry. A BRCA2 exon 11 protein truncation test showed a lower molecular weight band than the one expected for a normal allele, in both twins. Sequence analysis of DNA showed a 6 bp insertion between nucleotides 4359-4360, which resulted in a premature stop codon at position 1378. The remarkable disease similarity observed in this identical twin pair is in accordance with an important role for heritable factors in disease expression among patients carrying BRCA germline mutations.