Mário Oliveira

Head-to-head comparison of two online nomograms for prostate biopsy outcome prediction

Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b

LITTER SIZE, AGE-RELATED MEMORY IMPAIRMENTS, AND MICROGLIAL CHANGES IN RAT DENTATE GYRUS: STEREOLOGICAL ANALYSIS AND THREE DIMENSIONAL MORPHOMETRY

It has been demonstrated that rat litter size affects the immune cell response, but it is not known whether the long-term effects aggravate age-related memory impairments or microglial-associated changes. To that end, we raised sedentary Wistar rats that were first suckled in small or large litters (6 or 12pups/dam, respectively), then separated into groups of 2-3 rats from the 21st post-natal day to study end. At 4months (young adult) or 23months (aged), all individual rats were submitted to spatial memory and object identity recognition tests, and then sacrificed. Brain sections were immunolabeled with anti-IBA-1 antibodies to selectively identify microglia/macrophages. Microglial morphological changes in the molecular layer of the dentate gyrus were estimated based on three-dimensional reconstructions. The cell number and laminar distribution in the dentate gyrus was estimated with the stereological optical fractionator method. We found that, compared to young rat groups, aged rats from large litters showed significant increases in the number of microglia in all layers of the dentate gyrus. Compared to the microglia in all other groups, microglia in aged individuals from large litters showed a significantly higher degree of tree volume expansion, branch base diameter thickening, and cell soma enlargement. These morphological changes were correlated with an increase in the number of microglia in the molecular layer. Young adult individuals from small litters exhibited preserved intact object identity recognition memory and all other groups showed reduced performance in both spatial and object identity recognition tasks. We found that, in large litters, brain development was, on average, associated with permanent changes in the innate immune system in the brain, with a significant impact on the microglial homeostasis of aged rats.

The road to real zero ischemia for partial nephrectomy.

PURPOSE To evaluate our initial outcomes of retroperitoneal partial nephrectomy (RPN) performed by off-clamp excision. PATIENTS AND METHODS Between January 2011 and October 2102, patients with T1 posterior renal masses or in the renal convexity were selected for RPN with the intent of performing the modified zero ischemia technique. Patient characteristics, operative details, complications, and long-term outcomes were analyzed. RESULTS There were 19 patients included (mean age 60 years, range 37-81 years; body mass index 27.8 kg/m(2), range 25-34 kg/m(2)). Mean tumor size was 35 mm (20-50 mm), and preoperative aspects and dimensions used for an anatomical (PADUA) classification score was 9 (7-11). Surgical time was 182 minutes (110-255 min), and the series warm ischemia time was 4.9 minutes (0-28 min). The off-clamp procedure was performed in 15 (79%) patients. Mean estimated blood losses (EBL) were 414 mL (100-1600 mL). Transfusion was necessary in two cases, while one reoperation and one conversion to open surgery were needed. Mean hospital stay was 4.5 days (range 3-11). One (5.3%) case of positive margins was reported. Serum creatinine levels varied from 86 to 94 μmol/L (preoperative and 6-month follow-up). Considering the learning curve of the technique, separate analysis of the initial 9 and last 10 cases revealed that while tumor characteristics remained comparable (size 33 vs 37 mm; PADUA score 8.8 vs 9.2), no clamping was performed in the later cases with decreased EBL (544 vs 297 mL), surgical time (207 vs 159 min), and shorter hospital stay (5 vs 4 days). CONCLUSION Our preliminary results on off-clamp RPN are promising and may pave the way for a real zero ischemia nephron-sparing surgery. Larger and randomized studies should follow in to confirm our initial results.

Abordaje combinado para la nefrectomía parcial en lesiones renales complejas

OBJECTIVE To develop a combined surgical approach (laparoscopic and open) that allows an increased vascular control and decreased ischemia time, maintaining the advantages of pure laparoscopic partial nephrectomy (LPN). MATERIAL AND METHODS During the laparoscopic phase, dissection of the kidney and its pedicle is achieved. Then, an open approach is initiated through a mini-laparotomy, with the kidney being brought to the incision, improving the identification and exposition of the tumors. Following tumor identification by ultrasound, exeresis of the lesion is performed with or without vascular clamping. RESULTS Through this approach we performed the excision of complex lesions in 6 patients. Mean surgical time was 192 minutes (range 180-210) and mean warm ischemia time was 13 minutes (0-22), with a mean blood loss of 267 mL (100-500). Average pre and postoperative glomerular filtration rate was 51.5 (28-90) and 48.8 mL/min/1.73 m(2) (19-90), respectively. In one patient, suture repair of the pelvicaliceal system was needed, with no other perioperative morbidities being reported. CONCLUSIONS This combined approach is a minimally invasive surgical alternative, reproducible and safe which preserves the virtues of pure LPN. It allows a better control of the vascular pedicle, reducing the risk of hemorrhage and the warm ischemia time. This technique may be either considered in the treatment of renal masses with indication for partial nephrectomy but of complex laparoscopic approach or as a surgical approach in the early learning curve of the LPN.

Renal Sinus Hemangioma Simulating a Complex Cyst

Renal sinus hemangiomas are extremely rare and little is known about these benign mesenchymal tumors. We report a case of a suspected complex renal cyst. Ultrasonography, computed tomography and magnetic resonance were unable to rule out malignancy. The patient underwent nephrectomy, and histology revealed a renal sinus hemangioma without relation to parenchyma. Based on this case we discuss this infrequent pathology.

Ascitis post-histerectomía: retraso en el diagnóstico

Artículo disponible en www.actasurologicas.info DESCRIPCIÓN DEL CASO Mujer de 35 años enviada para histerectomía total de emergencia por hemorragia puerperal tras una cesárea urgente por rotura prematura de la bolsa de las aguas (35 semanas). La paciente recibió el alta hospitalaria el día 8 del postoperatorio, en buen estado clínico y asintomática. Volvió a ingresar 6 días después, con dolor y distensión abdominales e hipertermia. La paciente no presentaba otras molestias importantes (tampoco urinarias). El abdomen estaba distendido y la prueba de la onda de líquido era positiva para ascitis, pero no había signos de irritación peritoneal. Las concentraciones de creatinina en el líquido ascítico estaban muy aumentadas. La tomografía computarizada (TC) abdominal y pélvica reveló la presencia de una cantidad enorme de líquido abdominal, sin alteraciones renales o ureterales. Sin embargo, la fase cistográfica puso de manifiesto un escape en la pared posterior de la vejiga. Se remitió a la paciente para laparotomía exploradora. Se evacuaron más de 10 litros de urinoma intraperitoneal. El tratamiento consistió en enterólisis y limpieza peritoneal, seguidos de cistorrafia, colocación de un catéteter doble J y sondaje vesical. Se administraron los antibióticos adecuados con arreglo al cultivo del líquido ascítico. La evolución posquirúrgica fue favorable. La evaluación a los 3 meses, el análisis y la TC fueron normales.