Small renal masses in Latin-American population : Characteristics and prognostic factors for survival, recurrence and metastasis - A multi-institutional study from LARCG database

To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine

Kidney transplantation

O transplante renal apresenta-se hoje como a melhor forma de terapia da insuficiência renal terminal em pacientes selecionados. São abordados os avanços nos campos das IndIcações, seleção e estabilização clínica dos doadores, conservaçã? dos órgãos a serem transplantados, imunossupressão, e técnicas cirúrgicas, os quais vIeram a alterar favoravelmente os resultados dos transplantes renais nas últimas décadas.Kidney transplantation stands as the bestform ofrenal replacement therapy in selected patients with end-stage renal disease. The article covers advances m the fields of indications. selection and management of the donors, organ preservatlOn, IInmunosupressiono and surgical techniques whichfavorably altered the results ofkidney transplantation over the last decades

Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients

Introduction: Contrast induced nephropathy (CIN) is one of the complications of the use of intravascular contrast agents, being defined as a reduction of the glomerular filtration rate caused by the iodinated contrast. Most CIN data derive from the cardiovascular literature, which identified as the most consistent risk factors pre-existing chronic renal insufficiency and diabetes mellitus. However, these studies limit their conclusions to a more specific patient population. Computerized tomography as a cause of CIN has been studied less often. Objective: To report on the incidence of computerized tomography contrast induced nephropathy (CIN) in an inpatient population of a tertiary general hospital, identifying potentially avoidable risk factors. Methods: We performed a prospective cohort study with inpatients admitted at a tertiary hospital requiring contrast-induced CT. The primary outcome was the development of CIN, measure by the alteration of serum creatinine or glomerular filtration rate in 48 or 72 hours. Through clinical interview, we verified possible risk factors and preventive measures instituted by the medical team and their association with development of CIN. Results: Of a total of 410 patients, 35 (8.5%) developed CIN. There was a positive correlation between CIN and the presence of diabetes mellitus (OR = 2.15; 95%CI 1.35-4.06; p = 0.02), heart failure (OR = 2.23; 95%CI 1.18-8.8; p = 0.022), and renal failure (OR = 3.36; 95%CI 1.57- 7.17; p = 0.002) Conclusion: Incidence of CIN varies according to the population. Diabetes mellitus, heart failure and renal failure were independent risk factors for the development of CT-associated CIN. Further studies are needed to better understand and treat CT-associated CIN

Increased Tissue Factor Expression is an Independent Predictor of Mortality in Clear Cell Carcinoma of the Kidney

Purpose Increased expression of tissue factor (TF), a primary initiator of the extrinsic coagulation pathway, has been associated with a worse prognosis in a variety of solid tumors. We report for the first time the correlation of the immunohistochemical expression of tissue factor with clinical and pathological outcomes in clear cell carcinomas of the kidney. Materials and Methods immunohistochemical expression of tissue factor was evaluated in 58 paraffin-embedded samples of clear cell carcinomas of the kidney treated at the same university hospital, that was correlated with clinical and pathological variables and with overall survival. Results high intensity tissue factor expression (TF area > 10µm2) was observed in 22.4% of the tumors (13 patients), and was an important predictor of overall mortality, both in univariate and multivariate analysis (p < 0.05). Median overall survival for both groups was 66 months; 78.2 months for patients in the group of lower TF expression and 27.5 months for patients in the group of higher TF expression (log rank p < 0.001). The hazard ratio for mortality was 9.7 (CI 3.7-25.6) for tumors with increased TF expression. Conclusions Increased immunohistochemical expression of TF was an important independent predictor of mortality in a contemporary cohort of patients with clear cell carcinoma of the kidney. Further studies are necessary to define the role of TF in clinical practice

Sjuksköterskors erfarenheter av palliativ vård : En litteraturöversikt

Bakgrund: Palliativ vård syftar till att främja livskvalitet hos patienter. Sjuksköterskor har ansvar att vårda utifrån patienters unika behov, begär och önskningar. Därför är det väsentligt med kommunikation för att samla in data angående den unika patienten. Patienter uttrycker att få bevara värdighet, integritet och få vara självbestämmande som väsentligt inom palliativ vård. Syfte: Att skapa en översikt av sjuksköterskors erfarenheter av palliativ vård. Metod: En allmän litteraturöversikt har genomförts där åtta kvalitativa artiklar och tre kvantitativa artiklar har analyserats.  Resultat: Enligt sjuksköterskors erfarenheter hade kommunikation en viktig del i palliativ vård. Genom att kommunicera med patienter kunde en datainsamling ske, där patienters behov och önskningar kunde belysas. Sjuksköterskor erfor även ett stort ansvar att bevara patienters värdighet. Sjuksköterskor hade ett ansvar att ha kunskap inom palliativ vård för att kunna ge en adekvat vård. Tidsbrist var något som sjuksköterskor ansåg som ett hinder inom palliativ vård, då utsattes sjuksköterskor för svåra prioriteringar. Slutsats: Sjuksköterskor erfor ett stort ansvar vid palliativ vård. Ett ansvar att utgå från patienters egna behov och önskningar. Genom kommunikation kunde dessa behov och önskningar identifieras. Nyckelord: Allmän litteraturöversikt, erfarenhet, palliativ vård, sjuksköterskor

Existe associação entre antiinflamatórios não-esteróides e nefropatia induzida por contraste? = Is there association between non-steroidal anti-inflammatory drugs and contrast media-induced nephropathy?

Objetivos: revisar a literatura médica sobre a possibilidade de existir associação entre uso de antiinflamatórios não esteróides e aumento na incidência da nefropatia induzida por contraste. Fonte de dados: busca de artigos na base de dados PubMed/Medline. Síntese dos dados: a investigação demonstrou não haver nenhum estudo observacional ou ensaio clínico que sustente a existência de associação entre uso de AINES e nefropatia induzida por contraste. Existem apenas relatos anedóticos em meio a artigos de revisão, que incluem os antiinflamatórios não esteróides como drogas nefrotóxicas. Revisando os mecanismos de lesão renal induzida pelo uso de meios de contrate e pelos antiinflamatórios não esteróides, não parece haver razão para acreditar em um sincronismo que leve a lesão renal. Conclusões: faltam evidências, na literatura médica indexada, que sustentem a afirmação de que os antiinflamatórios não esteróides seriam fator de risco para o desenvolvimento de nefropatia induzida por contrast

Análise da expressão imuno-histoquímica do fator tecidual no carcinoma gástrico: correlações com prognóstico e sobrevida.

RESUMO Objetivo: estudar a expressão do fator tecidual (FT) e sua correlação com o prognostico e sobrevida em pacientes com carcinoma gástrico. Métodos: verificamos a expressão imuno-histoquímica do FT em 50 espécimes de adenocarcinomas gástricos de pacientes submetidos a tratamento cirúrgico com intenção curativa. A intensidade da sua expressão foi comparada com dados clínicos e patológicos, estadiamento TNM, fatores prognósticos e sobrevida. Resultados: houve expressão do FT em todos os tumores; a intensidade de expressão do FT não foi associada com estágio TNM, variáveis clínicas ou patológicas ou sobrevida geral. Conclusão: este estudo mostra que o FT tem uma expressão elevada em carcinoma gástrico, mas que este não é útil como marcador de prognóstico