Marco Aurélio de Freitas Rodrigues

Evaluation of the influence of polymorphic variants CYP1A1 2B, CYP1B1 2, CYP3A4 1B, GSTM1 0, and GSTT1 0 in prostate cancer.

BACKGROUND/OBJECTIVE Genetic polymorphisms in cytochrome P-450 (CYPs) and glutathione S-transferase (GSTs) genes can influence the appearance of tumors by the formation of new enzymes with altered activities. In the present study, 5 polymorphic variants were examined in 154 patients with prostate carcinoma and in 154 controls. MATERIALS AND METHODS DNA analysis was carried out through PCR-based methods. The statistical methods used were odds ratio and confidence interval (95% CI), χ(2), Fisher, and Mann-Whitney. RESULTS The study showed absence of association for CYP1A1 2B, CYP1B1 2, GSTM1 0, and GSTT1 0. The statistical analysis implied a positive association of variant CYP3A4 1B for prostate cancer. The combined analysis of CYP1A1 2B, CYP1B1 2, and CYP3A4 1B genotypes showed positive association. The analysis of histopathologic parameters detected statistically significant differences for Gleason score and biochemistry recurrence risk. The presence of the GSTT1 0 genotype in red meat consumers increased the risk for this disease. CONCLUSION Some polymorphic variants analyzed can influence the development and the progression of prostate cancer.

Comparison between PSA density, free PSA percentage and PSA density in the transition zone in the detection of prostate cancer in patients with serum PSA between 4 and 10 ng/ml

OBJECTIVE Compare the capacity of the PSA density (PSAD), Free PSA percentage (%FPSA) and PSA transition zone density (PSATZ) in improving the sensitivity and specificity of the PSA to detect prostate cancer (PCa) in men with a PSA between 4 and 10 ng/mL. MATERIALS AND METHODS One hundred and forty five men with PSA between 4 and 10 ng/mL were prospectively studied. Blood collection for the total PSA and free PSA was performed as well as transrectal ultra-sound with prostate biopsy and measurement of the total prostate volume (TPV) and transition zone volume (TZV). Patients with initial negative biopsy were followed and the prostate biopsy was repeated in those that presented PSA increase. The capacity of the PSAD, %FPSA and PSADTZ in improving the sensitivity and specificity pf the PSA test to the detection of the PCa was assessed by univariate and multivariate analyses and through the ROC curve. RESULTS Of the 145 patients, 38 (26.2%) had PCa and in 107 (73.8%) a benign prostate disease was diagnosed. No difference among the PSAD, %FPSA and PSADTZ was found. The multivariate analysis showed that the PSADTZ, %FPSA, TZV and age were those more powerful and highly significant PCa predictors. CONCLUSION The determination of %FPSA and PSAD can allow a better discrimination between PCa and benign disease that the isolated use of PSA. The combination of PSADTZ, %FPSA, TZV and age promote a high accuracy for PCa detection.

Influence of sling material on inflammation and collagen deposit in an animal model

Aim:  Compare inflammation and collagen production induced by four sling materials in female rats.

Use of cadaveric fascia lata to correct grade IV cystocele

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation.

Polymorphisms in the AR and PSA Genes as Markers of Susceptibility and Aggressiveness in Prostate Cancer

ABSTRACT The study of genes involved in androgen pathway can contribute to a better knowledge of prostate cancer. Our aim was to examine if polymorphisms in prostate-specific antigen (PSA) and androgen receptor (AR) genes were involved in prostate cancer risk and aggressiveness. Genotypes were determined by PCR-RFLP (PSA) or using a 377 ABI DNA Sequencer (AR). PSA(G/G) genotype (OR = 1.78, 95% CI = 1.06–2.99) and AR short CAG repeats (OR = 1.89, 95% CI = 1.21–2.96) increased risk for prostate cancer and were related with tumor aggressiveness. About 38.3% of tumors showed microsatellite instability. In conclusion, polymorphisms in these genes may be indicated as potential biomarkers for prostate cancer.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20% of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fishers exact test, and multivariate analysis was performed by logistic regression with alpha = 5%. RESULTS Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53%) patients having urethral hypermobility and 61 (47%) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6%) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

An experimental model for the study of drug effects on cutaneous healing

PURPOSE Immunosuppressive agents are known to interfere with the healing of surgical wounds. The increasing use of these drugs warrants a better understanding of their effects on wound healing. The aim of this study was to develop an experimental model that would allow for a reliable and rapid assessment of drug effects on cutaneous wound healing. METHODS Thirty syngeneic Lewis rats underwent surgical incision on their dorsal region, in the presence or absence of a three-week regimen of immunosuppressant drug therapy (i.e., cyclosporin, azathioprine, and prednisone). Surgical site tissue was collected at intervals over 21 days after surgery and analyzed for cell number and collagen fiber content. Both of these quantitative assessments were performed using digital image capture with the Image Pro Plus 4.5 software. RESULTS Computerized histomorphometric analyses revealed an apparent inhibition of cellular responses and collagen fiber production in drug-treated animals compared to control animals. CONCLUSION The experimental model was reproducible, easy to perform, and allowed for quantitative histological evaluations. It may be useful for the study of surgical healing in the presence of other drug classes.

Evaluation of seminal citrate level by 1H nuclear magnetic resonance spectroscopy in men with spinal cord injury

Study design:A case–control evaluating seminal citrate in patients with spinal cord injury (SCI).Objective:Several studies have shown neurological prostatic dysfunction in patients with SCI, as confirmed by low levels of seminal prostate-specific antigen (PSA), which is used as a parameter of gland activity. However, seminal citrate, produced almost exclusively by the prostate, could also be used as a marker of prostate function. Thus, the objective of this study was to determine whether SCI causes any changes in seminal citrate concentration and to compare the results obtained for patients and healthy men (controls).Setting:The study was carried out in Brazil.Methods:We studied 30 men with SCI aged on average 37.77±10.04 years and 30 controls aged on average 38.03±10.06 years. Blood and semen samples were collected after 3 days of abstinence from ejaculation. Fifteen minutes after collection, semen was stored in liquid nitrogen and the samples were submitted to 1H nuclear magnetic resonance (1H NMR). Serum was stored at a controlled temperature of −70 to −79 °C and later used for the determination of testosterone, prolactin and total PSA using an AxSYM instrument and Abbott reagents.Results:The median concentration of seminal citrate was significantly lower in patients than in controls (521.65 versus 858.30 mg per 100 ml, P<0.001).Conclusions:Patients with SCI have a significant reduction of seminal citrate as a consequence of neurological dysfunction of the prostate.

Evaluation of seminal zinc levels by atomic absorption in men with spinal cord injury

Study design:A case–control study evaluating seminal zinc level in spinal cord injury (SCI) patients.Objectives:Patients with SCI have neurological prostate dysfunction. There are only some indications in the literature that seminal zinc level may be lower in these patients. Seminal zinc is mainly produced by the prostate and, therefore, can be considered to be a marker of prostate function. The objective of the present study was to determine whether SCI can induce changes in seminal zinc levels and to compare the results with those obtained for normal men (controls).Setting:The study was carried out in Brazil.Methods:A total of 24 men with SCI (mean age±s.d. 36.25±10.24 years) and 24 controls (mean age±s.d. 36.50±10.31 years) were studied. Blood and semen were collected after 3 days of abstinence from ejaculation. Semen was left at room temperature for 15 min, stored in liquid nitrogen, and lyophilized. Seminal zinc was determined by atomic absorption. Blood was stored at a controlled temperature of – 70 to −79 °C and later used for the determination of testosterone, prolactin and total prostate-specific antigen using an AxSYM apparatus and Abbott reagents.Results:Mean seminal zinc concentration was 85.20 mg l−1 for the patients, a lower value than that obtained for the controls (147.16 mg l−1) (P=0.0035).Conclusion:Patients with SCI have a significant reduction of seminal zinc.

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula.

PURPOSE The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. MATERIALS AND METHODS A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. RESULTS The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts.