Jose Bessa

Racial influence on the prevalence of prostate carcinoma in Brazilian volunteers

PURPOSE To investigate the prevalence of prostate carcinoma in a sample of volunteers known to have a large proportion of Bantu African ancestors, and the performance of total PSA (tPSA), PSA density (PSAD) and free-to-total PSA ratio (f/tPSA) on the diagnosis. MATERIALS AND METHODS A total of 473 volunteers (range: 40 - 79 years) were screened for prostate carcinoma. Those with tPSA >2 ng/ml and/or abnormal digital rectal examination were submitted to a transrectal ultrasound-directed biopsy (10 cores). The volunteers were classified as White, Mulatto or Black according to physical characteristics and to ancestors race reference. The following variable number of tandem repeats (VNTR) were analyzed in the blood of 120 volunteers without cancer and in 27 patients with prostate cancer: D4S43, PAH, F13A1, APOB and vW-1. RESULTS The biopsies performed in 121 volunteers revealed cancer in 27 (5.7% of 473). The proportions of cancer in White, Mulatto and Black were respectively: 0.6% (1/148), 6.7% (6/90) and 8.5% (20/235) (p = 0.006). The VNTRs analysis revealed heterogeneity in White, Mulatto and Black anthropologic phenotypes with the following admixture of Caucasian, African and Amerindian gene lineages: 67.5 +/- 8%, 20.8 +/- 8%, 11.7 +/- 7%; 54.8 +/- 9%, 36.3 +/- 5%, 8.9 +/- 7%; and, 45.3 +/- 3%, 45.9 +/- 4%, 8.8 +/-7%. Such a mixture was 50.5 +/- 9%, 49 +/- 8% and 0.5 +/- 4% in volunteers bearing cancer, and 59.1 +/- 7%, 31.7 +/- 8% and 9.2 +/- 5% in those without cancer. The sensitivity and specificity of tPSA at cut-off levels of 2, 2.5 and 4 ng/ml for volunteers with tPSA </= 10 ng/ml were respectively: 100% and 6,6%, 100% and 36,6%, 69,2% and 62,2%. PSAD at a cut-off level of 0.08 or 0.10, and f/tPSA at a cut-off level of 20% were able to increase significantly tPSA specificity without loss on sensitivity. CONCLUSIONS The tumor prevalence was higher in Non-White than in White phenotype. The association of tPSA at a cut-off level of 2.5 ng/ml with a PSAD of 0.08 or a f/tPSA of 20% for biopsy indication deserves further investigations as an alternative to tPSA cut-off level of 4 ng/ml.

Voiding dysfunction in patients with neuromyelitis optica spectrum disorders.

We assessed the lower urinary tract symptoms (LUTS) and urodynamic findings in patients with neuromyelitis optica spectrum disorders (NMO‐SD), a recently defined neurological disease.

Evaluation of Models to Estimate Percent Time Spent Following on Two-Lane Highways

AbstractFour analytical models to estimate percent time spent following (PTSF) on two-lane highways were tested with data from 16 sites in Brazil. Besides percent following, the models are based on...

RASTREAMENTO DO ADENOCARCINOMA PROSTÁTICO EM VOLUNTÁRIOS DE UMA REGIÃO DA BAHIA: RESULTADOS PRELIMINARES

The objective of the study was to assess the prevalence of the prostate adenocarcinoma in volunteers, between 40 and 80 years of age, from a northeastern region of Brazil. All volunteers were submitted to a digital rectal examination and total PSA blood level determination. A total of 499 men were evaluated. Prostatic biopsy guided by transrectal ultrasound (5 cores/ lobe) was indicated to those with PSA higher than 2ng/ml and/or prostatic changes on the DRE. Biopsies were carried out in 120 of 135 men that filled those criteria. Prostate adenocarcinoma was found in 24 volunteers corresponding to 5.1% of the sample. Such prevalence seems higher than that reported for men living in the southeastern area of the country. Differences might be a consequence of racial or environmental factors, but it is not possible to rule out other factors such as a methodological bias.

1664 IMPACT OF DETRUSOR SPHINCTER DYSSYNERGIA ON CLINICAL AND URODYNAMIC PARAMETERS OF PATIENTS WITH NEUROMYELITIS OPTICA

INTRODUCTION AND OBJECTIVES: Detrusor external sphincter dyssynergia (DESD) is a cause of elevated vesical pressures and may increase the risk of renal deterioration. Neuromyelitis Optica (NMO) is a newly defined demyelinating autoimmune disease of the central nervous system that affects the spinal cord and was formerly considered a severe form of multiple sclerosis. The purpose of this study was to evaluate the impact of DESD in patients with NMO. METHODS: We prospectively evaluated 30 patients (23 women and 7 men) with a mean age of 41.1 13.5 years (range 13 to 70) and mean duration of disease of 33.8 30.8 months (range 3 to 135). All patients had an established diagnosis of NMO based on stringent criteria and were invited to participate irrespective of the presence of LUTS. Urinary symptoms were evaluated with the International Prostatic Symptom Score (IPSS) and neurological impairment with the Expanded Disability Status Scale (EDSS). All patients underwent videourodynamics and upper urinary tract sonography. We compared clinical and urodynamic parameters based on the presence of DESD. RESULTS: A total of 18 (60.0%) patients had DESD. Compared to patients without DESD (Table), patients with sphincteric dyssynergia had worse urinary symptoms and neurological impairment but no differences in terms of age and disease duration. In terms of urodynamic parameters, those with DESD had greater detrusor pressure at maximal flow (PdetQmax), decreased voided volume and increased postvoid residual volume. Other parameters were not different between the two groups. Upper urinary tract changes were not found in any patient. CONCLUSIONS: DESD is present in most patients with NMO and is associated with worse neurological impairment and urinary symptoms. Despite the increased detrusor pressures observed in patients with DESD, no patients had upper urinary tract damage. Ongoing evaluation of NMO patients will be important to identify those with this newly defined neurological condition who are at risk of upper urinary tract damage.

600 VOIDING DYSFUNCTION IN PATIENTS WITH DOWN SYNDROME

CALADO, A.A.; MACEDO A.J.; NETTO, J.M.B.; FILHO, M.G.; BARROSO, U.J.IBJU-231-09-Cross-cultural adaptation of the Dysfunctional Voiding Score Symptom (DVSS) Questionnaire for Brazilian Children. Int Braz J Urol, 2010. FARHAT,W; BAGLI, D.J; CAPOLICCGIO, G. et.al.,. The dysfunctional voiding scoring system: quantitative standartization of dysfunctional voiding symptions in children. J Uro , Baltimore, v.164, n. 3, pt.2, p.1011-5, set. 2000. KUPFERMAN, J.C.; DRUSCHEL, C.M.; KUPCHIK, G.S. Increased prevalence of renal and urinary tract anomalies in children with Down syndrome. Pediatrics, 124(4), 615-2, Oct, 2009. MERCER, E.S.; BROECKER, B.; SMITH, E.A.et al. Urological manifestations of Down syndrome. J Urol,171(3):1250-3, Mar, 2004. NEVEUS, T.; VON GOTARD, A.; HOEBEKE, P. et al. The stardartization of terminology of lower urinary tract function in children Committee of the International Children s Continence. The Journal of Urology,Vol,314-324,July, 2006. VAZ, G.T.; VASCONCELOS, M.M.A.; OLIVEIRA, E.A.; et.al,. Prevalence of Lower Urinary Tract Symptoms in School-age Children. Pediatr Nephrol. 2011 Oct 4. WEIJERMAN, M.E ; WINTER, J.P. The care of children with Down syndrome. Eur J Pediatr. 2010 December; 169(12): 1445–1452 YANG, P.Y.; MENG, N.H.; CHOU, E.C. Voiding dysfunctions in children with mental retardation.Neurourol Urodyn. 2010 Sep;29(7):1272-5. DVSS inversely correlates with age in both sexes although slightly more marked for boys (r=0.4268, 95% CI, -0.6987 to -0.04722) (p=0.0297), than for girls (r=0.2809, 95% CI 0.5083 to -0.01675) (p=0.0378). LUTD was more prevalent in females despite no significant difference (Female 32.7% and male 22.2%) (Figure 2, 3, 4 and 5).