Guilherme Barreiro

Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction

OBJECTIVE Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO. MATERIALS AND METHODS Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm. RESULTS Forty-two patients, mean age 64.8 +/- 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 +/- 3.2 mL. Achieved IPPs values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75.1 - 99.2) and 50 % specificity (28.2 - 71.8). CONCLUSION IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.

Aspirin inhibits serine phosphorylation of insulin receptor substrate 1 in growth hormone treated animals

In this study, we demonstrate that pretreatment with aspirin inhibits GH‐induced insulin resistance. GH was observed to lead to serine phosphorylation of IRS‐1, a phenomenon which was reversed by aspirin in liver, muscle and WAT in parallel with a reduction in JNK activity. In addition, our data show an impairment of insulin activation in the IR/IRS/PI(3)kinase pathway and a reduction in IRS‐1 protein levels in rats treated with GH, which was also reversed in the animals pretreated with aspirin. Overall, these results provide new insights into the mechanism of GH‐induced insulin resistance.

A Novel Intraurethral Device Diagnostic Index to Classify Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Objectives. Using a urethral device at the fossa navicularis, bladder pressure during voiding can be estimated by a minimal invasive technique. This study purposes a new diagnostic index for patients with lower urinary tract symptoms (LUTSs). Methods. Fifty one patients presenting with LUTSs were submitted to a conventional urodynamic and a minimal invasive study. The results obtained through the urethral device and invasive classic urodynamics were compared. The existing bladder outlet obstruction index (BOOI) equation that classifies men with LUTSs was modified to allow minimal invasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the new equation for classifying obstruction was then tested in this group of men. Results. The modified equation identified men with obstruction with a positive predictive value of 68% and a negative predictive value of 70%, with an overall accuracy of 70%. Conclusions. The proposed equation can accurately classify over 70% of men without resorting to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the surgical treatment of men with LUTSs.

Arteriovesical fistula as a complication of a gunshot wound to the pelvis: Treatment dilemma

Abstract:  The case is reported of an arteriovesical fistula after a gunshot wound to the pelvis in a 29‐year‐old man. It developed 20 days after an exploratory laparotomy with primary suture of the bladder. The patient presented with intermittent gross hematuria and diagnosis was made through cystoscopy and arteriogram. Treatment was initially performed through open embolization. Re‐treatment with endovascular procedures was twice necessary. Further evolution led to complete recovery from symptoms after an open procedure. Virtually all forms of treatment were tried and the resolution was finally achieved after more than 7 months.

Mucinous adenocarcinoma associated with chronic suppurative hidradenitis: Report of a case and review of the literature.

Highlights • Mucinous adenocarcinoma associated with suppurative hidradenitis is extremely rare.• Magnetic resonance imaging findings help in the diagnosis of mucinous adenocarcinoma.• The surgery is highly complex, and even in a tertiary hospital, complications may occur.

Retrospective analysis of 70 patients who underwent post-bariatric abdominoplasty with neo-omphaloplasty

Introduction: With the increasing surgical treatment of obesity, a new group of patients is being attended by plastic surgeons: those with large flaccid skin following weight loss. For patients treated with conventional or open bariatric surgery, vertical, anchor-line, or inverted “T” abdominoplasty has been widely used to improve the abdominal contour. In this study, abdominoplasty was associated with umbilical amputation followed by neo-omphaloplasty. Methods: Seventy patients with stable weight for at least 18 months underwent surgery at the UNICAMP Plastic Surgery Outpatient Clinic, from March 2011 to April 2013. In all patients, anchor-line abdominoplasty with excision of the original navel was executed, together with the surgical specimen and preparation of neo-umbilicus, through bilateral dermal-fat flaps. A retrospective analysis of medical records and photographic archives was performed. Results: The 70 patients were predominantly female (91%) and white (83%) with a mean age of 40 years. After a wait time of approximately 16 months, they were subjected to anchor-line abdominoplasty associated with neo-omphaloplasty, which lasted an average of 2 hours. There were post-operative complications in 29.85% of the patients, including small dehiscence, unsightly, enlarged, or hypertrophic scars, keloid, seroma, relevant dermo-fatty excesses, and wound infection. The neo-umbilicus obtained from the surgery is very similar to the original umbilicus. We did not observe necrosis, stenosis, morphological distortions, or bad positioning. Conclusion: This technique has made it possible to obtain an umbilicus with a natural look, is easy to perform, and shortens operating time.

The Boomerang Thigh Flap: Optimizing the Donor Site for an Extended Skin Island Flap

Background The anterolateral region of the thigh is one of the most used donor areas for flaps. However, there are cases in which large defects require more than the conventional skin island provided by the anterolateral thigh flap (ALT). For an extended skin island flap, we developed a new boomerang thigh flap (BTF), in which a boomerang design includes perforators from multiple branches of the lateral circumflex femoral artery (LCFA), providing a single‐pedicle, large, reproducible, and reliable flap. We report the anatomical study and the use of the new BTF in a clinical series. Methods We dissected 20 flaps in fresh cadavers to determine the anatomical landmarks, vascular pedicle pattern, perforator distribution, and BTF flap dissection technique. After achieving a reproducible and reliable technique, with primary closure of the donor site based on the pinch test, the BTF was applied for microsurgical reconstructions in the head and neck, lower limb, and upper limb regions. Results The BTF corresponds to a 45° confluence of the ALT and the tensor fascia lata (TFL) elliptical skin islands. It includes the perforators from the transverse/ascending and the descending branches of the LCFA, which conjoined into a single arterial LCFA pedicle in 85% (17) of the cadaver dissections. All the venous branches drained into a single lateral circumflex femoral vein. ALT perforator distribution followed literature descriptions, while TFL perforators were mainly septocutaneous and projected into a virtual rectangle of 6 × 4 cm at the lateral margin of the TFL. Average BTF dimensions were 40 × 8.6 cm. For the clinical cases, flap dimensions and pedicle characteristics were equivalent to the anatomical findings. The BTF was separated into two skin islands in four cases and no major complications were reported. Conclusion The BTF is a reliable, reproducible, and divisible flap that provides extended skin island for reconstruction of large defects.

A New Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap (PIMOC) for Salvage Head and Neck Reconstruction: Anatomic Study and Clinical Application

Well-vascularized composite tissue offers improved outcomes for complex head and neck reconstruction. Patients with vessel-depleted necks and failed reconstructions require alternative reconstructive options. We describe a pedicled internal mammary artery osteomyocutaneous chimeric flap (PIMOC) for salvage head and neck reconstruction. Bilateral dissections of 35 fresh cadavers were performed to study individual tissue components and vascular pedicles to develop the PIMOC technique. The flap was then utilized in a series of patients with vessel-depleted neck anatomy. The PIMOC was dissected bilaterally in all cadavers and there were no statistical differences in vascular pedicle caliber or length with regards to laterality or gender. Five patients subsequently underwent this procedure. The flaps included a vertical rectus abdominis myocutaneous component and a 6th or 7th rib with adjacent muscle and skin to restore bone defects, internal lining, and external coverage. All donor sites were closed primarily. There were no flap losses and all patients gained improvements in facial contour, speech and swallow. Although technically complex, the PIMOC is reproducible and provides a safe and reliable option for salvage head and neck reconstruction. The harvest of the 6th or 7th rib and rectus abdominis muscle renders an acceptable donor site.

Gluteal contour restoration in antiretroviral users and its quality-of-life related impacts: a historical cohort study

Introduction: Since the introduction of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), disease mortality has been dramatically reduced worldwide. One related side effect from the use of these drugs is gluteal lipodystrophy. The aim of this study is to assess the quality-of-life impact of correcting this deformity in HIV patients. Methods: A historical cohort study was conducted between January 2010 and December 2014 with 23 patients, assessing the quality of their lives using the Nottingham Health Profile. A statistical analysis was performed using the McNemar test for related samples. Results: There was a significant difference between preoperative and postoperative response in 19 of the 38 questions. Conclusion: We may say that gluteal reconstruction plays a role in improving quality of life for HIV patients who have been affected by antiretroviral related gluteal lipodystrophy. ■ ABSTRACT

The impact of care actions on the perception of the quality of the Single Health System (SUS), Brazil: a cross-sectional study

Introduction: Non-melanoma skin cancer is the most prevalent cancer in Brazil. Surgical resection is one of the pillars of management, and care actions, such as surgical task forces, are one way to reduce treatment waiting time. Methods: In this research , we conducted a cross-sectional study with 40 patients; 20 of whom were treated by a surgical task force and 20 were controls. Epidemiological data were collected in addition to answers to nine questions related to the quality of the Single Health System (SUS in Portuguese). Results: A significant difference was observed in responses related to the waiting time for surgery in the SUS (p < 0.05). Conclusion: One can observe an improvement in the perception of patients, with regard to the SUS, when included in care actions. ■ ABSTRACT