Luiz Carlos de Almeida Rocha

ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Efficacy and Tolerability of Lodenafil Carbonate for Oral Therapy of Erectile Dysfunction: A Phase III Clinical Trial

INTRODUCTION This is a phase III, prospective, randomized, double-blind, placebo-controlled clinical trial on lodenafil carbonate (LC), a novel phosphodiesterase 5 inhibitor developed in Brazil. AIM Expanding information on LC efficacy and safety. MAIN OUTCOME MEASURES International Index of Erectile Function (IIEF) erectile domain, positive answers to the sexual encounter profile (SEP)-2 and SEP-3 questions and incidence of adverse events (AEs). METHODS A total of 350 men with erectile dysfunction (ED) of all degrees were randomized to placebo, LC 40 mg or LC 80 mg and followed for 4 weeks. They completed the IIEF and answered the SEP questions 2 and 3 after each intercourse without and with the use of LC. RESULTS IIEF Erectile Domain scores without and with the use of medication were the following (mean [M] +/- standard deviation [SD]): placebo = 13.9 +/- 5.2 and 14.8 +/- 7.8; LC 40 mg = 13.6 +/- 5.3 and 18.6 +/- 8.0; LC 80 mg = 13.4 +/- 4.9 and 20.6 +/- 7.7 (analysis of variance [ANOVA] P < 0.01). Positive answers to SEP-2 without and with the use of medication were the following (M +/- SD): placebo = 55.3 +/- 43.2% and 52.1 +/- 41.4%; LC 40 mg = 46.4 +/- 44.3% and 63.5 +/- 42.0%; LC 80 mg = 50.2 +/- 40.9% and 80.8 +/- 32.3% (ANOVA P < 0.01). Positive answers to SEP-3 were the following: placebo = 20.2 +/- 32.3% and 29.7 +/- 38.1%; LC 40 mg = 19.6 +/- 34.3% and 50.8 +/- 44.4%; LC 80 mg = 20.8 +/- 33.2% and 66.0 +/- 39.3% (ANOVA P < 0.01). The patients with at least one AE were placebo = 28.7%, LC 40 mg = 40.9%, and LC 80 mg = 49.5%. AEs whose incidence was significantly higher with LC than with placebo included rhinitis, headache, flushing, visual disorder, and dizziness. CONCLUSIONS LC showed a satisfactory efficacy-safety profile for oral therapy of ED.

Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats

OBJECTIVE Microsurgical procedures are currently the gold standard for vasovasostomy with excellent results, but it takes an increased operative time demanding special training and experience in microsurgery. The objective of this study is to reach the same results with reduced operative time. MATERIALS AND METHODS Male adults Wistar rats were divided into 3 groups: I) 20 rats in control group, II) 20 with conventional one-layer microsuture and III) 20 with fibrin glue. After four weeks each rat was left for two weeks with two female rats. RESULTS The fertility rates were 80% in group I, 70% in group II and 65% in group III (p > 0.05). In group II granuloma was found in 75% of the rats, while in group III in 85% (p < 0.05). Anastomosis was considered with patency in 75% and 80% of the rats in groups II and III (p > 0.05). Overall operative time was 41.7 +/- 2.49 and 28.55 +/- 1.14 minutes in groups II and III (p < 0.05) and the time to anastomosis of 24.6 +/- 1.8 and 9.35 +/- 0.78 minutes (p < 0.05), respectively. CONCLUSIONS We can conclude that vasovasostomy with fibrin adhesive has the same results of the conventional microsurgery technique but with a reduced operative time and a simplified procedure.

Análise da cicatrização da bexiga com o uso do extrato aquoso da Orbignya phalerata (babaçu): estudo controlado em ratos

INTRODUCTION: Wound healing is a complex process that deals with different biological and immunological systems and is essential to keep the organism integrity. Three well-defined phases occur: inflammatory, proliferative and maturation. A failure or lengthy phase may result in a delay or absence of it. PURPOSE: The aim of this paper is to analyse comparatively the histological alteration provided by the use of the aqueous extract of Orbignya phalerata, in the healing process of bladder surgical wounds. METHODS: Forty adult, male Wistar rats were used. The experimental procedure consisted of a longitudinal 2cm long bladder incision and single layer interrupted suture of 5-0 poliglactine 910. Post-operatively, the rats were randomly divided into two groups of 20. The substance was not used in the control group. The Orbignya phalerata aqueous solution was used in the study group. The animals were observed and killed three and seven days later. Comparative histological analysis was accomplished between the groups. Resuts: Significant statistical differences were observed in the neo-formation variables (p= 0,001), chronic inflammation (p= 0,002) and fibroblastic proliferation (p= 0,023). Acute inflammation was very evident in the control group. CONCLUSION: The time factor of wound healing showed homogeneity between experimental and control groups, however faster in the experimental one. The Orbignya phalerata had a favoring healing effect in the surgical incision on rats bladder.

Genitourinary paracoccidioidomycosis complicated with urinary outflow obstruction—a report of two cases and a review of the literature

Paracoccidioidomycosis (PCM) is a systemic granulomatous mycosis caused by the fungus Paracoccidioides brasiliensis. Also known as South American blastomycosis and Lutz‐Splendore‐Almeida disease, PCM is endemic in South and Central America, especially in Brazil, Venezuela, Colombia, Ecuador, and Argentina.1 Its chronic form, which accounts for more than 80% of cases, usually affects men between 29 and 60 years old—predominantly rural workers—and it is characterized by polymorphic lesions that may affect any organ, in particular the skin; the lymph nodes; the lungs; the oral, nasal, and gastrointestinal mucosa; the adrenals; and the central nervous system.1 The genitourinary tract is the least commonly involved system in chronic PCM. In the present paper, we describe two cases of genitourinary PCM located in the penis and the prostate that were treated at our institution, and we review the pertinent literature.

Enterocutaneous fistula as a complication of percutaneous nephrolithotomy in patients with previous bariatric surgery: case report and bibliographic review.

OBJECTIVE Enterocutaneous fistula is a rare complication after percutaneous nephrolithotomy. Some situations are risk factors for it to occur, such as horseshoe kidney, retrorenal colon and chronic colonic dilation by several factors, among them late postoperative time after yeyunoileal bypass in morbid obesity treatment. METHODS 35-year-old female patient with a 2.5 cm calculus in the right renal pelvis. Late postoperative time after bariatric surgery using duodenal switch technique, and 55 kg lost till present. She undergone percutaneous nephrolithotomy (PCNL) with two punctures, one in the lower calyx, lost during dilation, and other in the upper calyx through which surgery was successfully carried out. During immediate postoperative time it enteric secretions were observed through the lower chalice puncture. Once the intraperitoneal lesion was removed, decision for conservative treatment was taken with fistula drainage, broadspectrum antibiotic therapy, fasting and total parenteral nutrition. The fistula debt ceased in the 8th postoperative (PO) day, when drain and nephrostomy tube were withdrawn and patient was discharged from the hospital on 10th PO day. On ambulatory follow up the patient is in good conditions. RESULTS One case of enterocutaneous fistula after PNL presented in a patient in late postoperative time after yeyunoileal bypass. She was successfully treated by conservative therapy. Several authors point to chronic colonic distention and to great loss of retroperitoneal fat as causes for the increase of inadvertent colonic punctures in percutaneous renal access. CONCLUSIONS The risk of complications with enterocutaneous fistula is significantly higher during the postoperatory in patients of bariatric surgery than in others.

Retroperitoneal sarcoma-like malakoplakia

. We illustrate an unusual case of extensive retroperitoneal malakoplakia mimicking retroperitoneal sarcoma.A 20-year-old male was admitted in our institution with a 3-month history of back pain, hematuria, lower uri -nary tract symptoms, and weight loss of 12 kg. Past medi-cal history was non-significant. On physical examination, he had a scaphoid abdomen with no palpable masses. DRE showed a normal prostate, with a large palpable mass with undefined limits above the prostate. Laboratory tests revealed serum creatinine of 1.5 mg/dL, PSA of 0.3 mg/dL, negative HIV-ELISA test, positive urine culture for