Luiz Gonzaga de Freitas Filho

Sacral ratio and fecal continence in children with anorectal malformations

To evaluate the sacral ratio (SR) in patients with an anorectal malformation (ARM) and verify whether it has predictive value for fecal continence.

Glycine reduces tissue lipid peroxidation in hypoxia-reoxygenation-induced necrotizing enterocolitis in rats

PURPOSE To assess the protective effect of glycine in an experimental model of Neonatal Necrotizing Enterocolitis (NEC). METHODS Fifty (50) neonatal Wistar rats, from a litter of six female rats and weighing 4 to 6 grams, were used. Five animals were cannibalized and the 45 remaining were distributed into three groups: the G1 normal control group (n=12); the G2 Group (n=16), of animals that underwent hypoxia-reoxygenation (HR); the G3 Group of animals (n=17) that underwent HR following a 5% intraperitoneal glycine infusion. The animals underwent hypoxia in a CO2 chamber receiving an air flow of 100% CO2 for 5 minutes and reoxygenation receiving an O2 flow at 100% for 5 minutes. One centimeter long small bowel and colon segments were prepared for histological analysis. The rest of the bowel was removed in a block and frozen at minus 80 degrees C for homogenization and determination of tissue malondialdehyde (MDA). Tissue lesions were classified as Grade 0 to Grade 5, according to the level of damaged mucosa. RESULTS The animals in Group G1 had levels of small bowel and colon lesion significantly smaller as compared to the animals in Groups G2 and G3. The G2 group had mean MDA values significantly higher than the animals in the G1 (p = .015) and G3 (p=0.021) groups. MDA values did not differ significantly (p = 0.992) for the animals in groups G1 and G3. CONCLUSION Glycine reduces tissue MDA levels (a measurement of lipid peroxidation) following HR in neonatal rats.

Effects of repeated extracorporeal shock wave in urinary biochemical markers of rats

PURPOSE To access the effect of repeated extracorporeal shock wave (ESW) on urinary biochemical markers METHODS 20 rats were assigned for ESW (Direx Tripter X1(R) - 14 KV) to one of two groups: G1 (n=10) one ESW; G2 (n=10) two ESWs within a 14-day interval. Within the twenty-four hour period before and after the application of shock waves, the animals were placed in metabolic cages for 24 hour urine collection. The ph, creatinine, sodium, potassium, chlorides, calcium, magnesium, phosphorus, oxalates, alkaline phosphatase and citrates were measured. Twenty-four hours after the material was collected for urinary determination, the animals underwent nephrectomy of the kidney submitted to the ESW applications and were, then, sacrificed. The kidneys were processed for histopathological examination. RESULTS Small variations in the biochemical markers were found in both groups, with no significant differences between the values obtained either prior to or following the ESW applications, except for citrate and alkaline phosphatase. Citraturia decreased significantly in group 2, following the second ESWL application (24.8 +/- 3.0 mg/day after the first ESWL vs. 15.3 +/- 2.2 mg/day after the second ESWL; p < 0.05). Alkaline phosphatase increased significantly following ESWL in group I (0.57 +/- 0.02 vs. 0.79 +/- 0.04 micromol/mg creatinine; p < 0.01) and also in group 2 (0.69 +/- 0.05 vs. 0.83 +/- 0.03 micromol/mg creatinine; p < 0.05). Glomerular, interstitial and sub-capsular hemorrhage with perivascular edema was found in the animals in both groups studied. CONCLUSIONS A significant increase in urinary alkaline phosphatase was found in both groups studied, suggesting a proximal tubule lesion. In the group of rats undergoing more than one ESWL application, a smaller urinary citrate excretion was noticed, which may be a factor contributing for the formation of new calculi.

Acellular human glans extracellular matrix as a scaffold for tissue engineering: in vitro cell support and biocompatibility

ABSTRACT Objectives: Diseases of the genitourinary tract can lead to significant damage. Current reconstructive techniques are limited by tissue availability and compatibility. This study aims to assess if the decellularized human glans can be used as a biomaterial for penile reconstruction. Materials and Methods: Samples of the glans matrices were descellularized. We evaluate the presence of collagen type I and III, and elastic fibers. Biocompatibility assays were performed to assess the cytotoxic and non-cytotoxic interactions between the acellular matrix and 3T3 cells. The matrices were seeded with mesenchymal stem cells and were assessed for viability and integration of these cells. Biomechanical tests in native tissue, descellularized matrix and seeded matrix were performed to characterize their biomechanical properties. Results: The tissue architecture of the decellularized matrix of human glans was preserved as well as the maintenance of the biomechanical and biological properties. The analyzes of glans seeded with mesenchymal stem cells revealed the integration of these cells to the matrices, and its viability during two weeks “in vitro”. Conclusion: The decellularization process did not alter the biological and biomechanical characteristics of the human glans. When these matrices were seeded they were able to maintain the cells integrity and vitality.

Ectopic opening of the vas deferens into a Müllerian duct cyst.

Two consecutive cases of ectopic opening of the vas deferens into Müllerian duct cysts are presented, with descriptions of the presentation, physical examination, radiographic and ultrasonographic images, surgical findings and treatment undertaken. In both cases, ablation of the cyst and ligature of the vas deferens was the technique employed. Both patients are currently well, with normal urinary flow and no urinary tract infections, 3 years after surgery. Ectopic opening of the vas deferens into Müllerian duct cysts is a rare entity but should always be considered when a child presents with purulent urinary discharge and abdominal tumor. Surgery is the only treatment recommended.

GASTROCYSTOPLASTY AND CHRONIC RENAL FAILURE: AN ACID-BASE METABOLISM STUDY

PURPOSE To verify in an experimental model whether gastrocystoplasty may protect patients with chronic renal failure from acid loading associated acidosis a wedge-shaped portion of the middle stomach was used to improve bladder capacity in animals with chronic renal failure. MATERIALS AND METHODS An experimental model was used to study 112 adult female Wistar rats (EPM-1) weighing between 156 and 259 gm. The animals were randomly assigned to groups, including 41 controls, 24 undergoing five-sixths nephrectomy to create chronic renal failure, 26 undergoing gastrocystoplasty and 21 undergoing gastrocystoplasty and five-sixths nephrectomy to create renal failure. To provide an acid overload a 5% NH(4)Cl diet was administered to a subgroup of each group. Two months after surgery 24-hour urine was collected, and volume and pH were measured as well as the amount of bicarbonate, ammonium, titratable acidity and chloride. The animals were then exsanguinated through an abdominal aorta puncture. The blood was used for blood gas analysis and to measure sodium, potassium, chloride, ionized calcium and creatinine. RESULTS When undergoing an acid overload, the animals with gastrocystoplasty had no acidosis since acid radicals were eliminating in the urine as NH(4)Cl. When given the same acid overload, metabolic acidosis developed in the animals with gastrocystoplasty and chronic renal failure. CONCLUSIONS Gastrocystoplasty protected healthy rats from acidosis when they were given an acid overload but failed to protect the rats with chronic renal failure under the same conditions.

Spinal lipoma associated with urethral duplication

Urethral duplication is a rare anomaly with varied clinical manifestations such as urinary tract infections, serous discharge from sinus, outflow obstruction and urinary incontinence. A spinal cord lipoma is fat within the normally positioned spinal cord without any skin or bony abnormalities. Most commonly these rare lesions are usually present at birth with an obvious lumbosacral mass. Spinal cord compression can cause numbness and tingling, weakness, difficulty, incontinence and stiffness of the extremities. We describe an interesting case of spinal lipoma associated with urethral duplication.

High-flow priapism and urinary retention

Priapism, considered a medical emergency, is a relatively uncommon condition.1 Patients presenting with priapism require immediate intervention in an attempt to relieve those with ischemic priapism as promptly as possible. High flow priapism, the outcome of an exaggerated arterial flow into the cavernous artery, is not always an emergency and it can be at first treated only by observation.1,2 Both types of priapism can be distinguished by gas determination of the blood drawn from the cavernous bodies.3 We report on the case of a child with arterial priapism presenting with urinary retention, which led us to intervene by applying superselective arterial embolization.

Bladder acontratility after hypospadia repair

Hinman and Bauman brought attention to an entity that causes unilateral or bilateral hydronephrosis, vesicoureteral reflux, and trabeculated or irregular bladder walls. First referred to as non-neurogenic neurogenic bladder, the disease is a detrusor hyperactivity that patients try to suppress by increasing the activity of the external sphincter. Later the entity became known as Hinman Syndrome. The name was first improperly used, not discriminated, for different voiding dysfunction conditions which led the International Childrens Continence Society to reserve the name “Hinman Syndrome” only for more severe cases, of relevant consequences for the patients renal function. Voiding dysfunctions, particularly in the presence of a vesicosphincterian dyssynergia, may develop into hydronephrosis and renal insufficiency if inadequately treated, in which case being referred to as Hinman syndrome. We present the case of a boy who developed full detrusor acontractility after undergoing a distal hypospadias repair, with no mechanical cause associated. As he was treated early by means of an appendicovesicostomy the development of hydronephrosis and of renal insufficiency that characterize Hinman Syndrome was possibly prevented. Material and methods

Cobb's collar and chronic renal failure

Cobbs collar is a membranous stricture of the bulbar urethra, often underestimated and non-diagnosed. Dewan presented evidence of a common morphological diagnosis for patients presenting with congenital obstructive posterior urethral membrane. The term COPUM (Congenital obstructive posterior urethral membrane) has been suggested in that two distinct pathologies should be distinguished. In boys with a COPUM, the obstructing membrane is just distal to the external sphincter and reinforced by folds extending down from the verumontanum, which when split resemble the valve obstruction suggested by Young. The COPUM is probably due to persistence of the attachment of the verumontanum to the anterior wall of the posterior urethra. Cobb described a congenital narrowing of the bulbar urethra that probably represents an embryological process different from that of the COPUM. Cobbs collar is most likely due to a partially persistent urogenital membrane. We report the case of a child with Cobbs collar having had, in other Service, endoscopic fulguration as if being treated for posterior urethral valve. When undergoing cystoscopy, the obstructive ring was found to be fully intact as if never treated before. The child evolved into chronic renal failure.