Mechanisms predisposing penile fracture and long-term outcomes on erectile and voiding functions

Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients’ status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4%) were confirmed, mean age was 34.5 years (range: 18–60), mean follow-up 59.3 months (range 9–155). Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%), followed by penile manipulation (6 patients, 14.3%), and homosexual intercourse (4 patients, 9.5%). “Woman on top” was the most common heterosexual position ( = 14, 50%), followed by “doggy style” (=8, 28.6%). Four patients (9.5%) maintained the cause unclear. Six (14.3%) patients had urethral injury and two (4.8%) had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. “Woman on top” was the potentially riskiest sexual position (50%). Immediate surgical treatment warrants long-term very low morbidity2014sem informaçã

Influence of chest wall on lung mechanics during inspiration.

RATIONALE: The interaction between lungs and chest wall influences lung volume, that determines lung history during respiration cycle. In this study, the influence of chest wall mechanics on respiratory system is assessed by the evaluation of inspiration pressure-volume curve (PV curve) under three different situations: closed-chest, open-chest and isolated lung. The PV curve parameters in each situation allow us to further understand the role played by different chest wall elements in the respiratory function. Methods: Twenty-four male Wistar rats (236 ± 29 g) were used. The animals were weighted and then anesthetized with xylazine 2% (0,5mL/kg) and ketamine 10% (0,9mL/kg), exsanguinated and later tracheostomized with a\ud metallic cannula (14 gauge). The cannula was connected to an automatic small animal insufflator. This setup was connected to a pressure transducer (32 samples/s). The 24 animals were randomly separated in three groups: (i) closed chest, (ii) open chest and (iii) isolated lung. The rats were insufflated with 20mL quasi-statically (constant speed of 0,1mL/s). Insufflated volume and measured pressure data were kept and PV curves were obtained for all animals. The PV curves were fitted (non-linear least squares) against the sigmoid equation (1) to obtain the sigmoid equation parameters (a,b,c,d). Elastance measurements were obtained from linear regression of pressure/volume measurements in a 0,8s interval before and after the calculated point. Results: The parameters a, b and c showed no significant change, but the parameter d showed a significant variation among the three groups. The initial elastance also varied between open and closed chest, indicating the need of a higher pressure for the lung expansion, as can be seen in Table 1. Table 1: Mean and Standard Deviation of parameters obtained for each protocol. Protocol: Closed Chest – a (mL) -0.35±0.33; b (mL) 13.93±0.89; c (cm H2O) 21.28±2.37; d (cm H2O) 6.17±0.84; r²** (%) 99.4±0.14; Initial Elastance* (cm H2)/mL) 12.72±6.66; Weight (g) 232.33±5.72. Open Chest - a (mL) 0.01±0.28; b (mL) 14.79±0.54; c (cm H2O) 19.47±1.41; d (cm H2O) 3.50±0.28; r²** (%) 98.8±0.34; Initial Elastance* (cm H2)/mL) 28.68±2.36; Weight (g) 217.33±7.97. Isolated Lung - a (mL) -0.09±0.46; b (mL) 14.22±0.75; c (cm H2O) 21.76±1.43; d (cm H2O) 4.24±0.50; r²** (%) 98.9±0.19; Initial Elastance* (cm H2)/mL) 7.13±8.85; Weight (g) 224.33±16.66. * Elastance measures in the 0-0,1 mL range. ** Goodness of sigmoid fit versus measured data Conclusion: A supporting effect of the chest wall was observed at the initial moments of inspiration, observed as a higher initial elastance in open chest situations than in closed chest situations (p=0,00001). The similar initial elastance for the isolated lung and closed chest may be explained by the specific method used for the isolated lung experiment. As the isolated lung is supported by the trachea vertically, the weight of the tissue may have a similar effect of the residual negative pressure in the thorax, responsible for maintaining the residual volume.CNPqFAPES

Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra((R))) in the treatment of erectile dysfunction in Brazilian and Mexican men

A 12-week, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of flexible-dose sildenafil citrate (Viagra((R))) treatment (25, 50 or 100 mg) in Brazilian and Mexican men with erectile dysfunction (ED) of broad-spectrum etiology. Efficacy was assessed on the basis of responses to the 15-item International Index of Erectile Function (IIEF) questionnaire, completed at baseline and after 12 weeks of treatment. At end point, mean scores for all IIEF domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were significantly (P < 0.0001) higher in the sildenafil group (n = 109) than in the placebo group (n = 105). These findings confirm the significant increases in frequency of penetration and frequency of maintained erections reported previously. Sildenafil treatment was well tolerated. the most common adverse events were headache and flushing. in conclusion, sildenafil is a well-tolerated and effective treatment for ED of broad-spectrum etiology in Latin American men.Hosp Albert Einstein, BR-01250000 São Paulo, BrazilTorre Hosp Angeles del Pedregal, Consultorio 827, MexicoFac Ciencias Med Santa Casa, Porto Alegre, RS, BrazilHosp Clin Cuiritiba, Curitiba, Parana, BrazilUniv Estadual Campinas, Fac Ciencias Med, Campinas, SP, BrazilClin Rio Claro, Rio Claro, SP, BrazilUniv Estadual Rio de Janeiro, Fac Med, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilHosp Servidor Publ Estadual, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Analise critica da captação de orgãos para transplante na organização de procura de orgãos da Universidade Estadual de Campinas-SP

Orientador : Ubirajara FerreiraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A partir da década de 60, com o uso de imunossupressores mais eficazes e a definição do conceito de morte encefálica, os transplantes de órgãos tornaram-se rotina em alguns hospitais. Todavia, foi a comercialização da ciclosporina, na década de 80, que realmente deu um impulso jamais visto aos transplantes. No entanto, não existe transplante sem órgão doado e estes podem advir de doadores cadáveres e vivos. O transplante com órgão de cadáver deve ser o preferido: não mutila uma pessoa hígida e os índices de sobrevida do enxerto, seja de cadáver ou de vivo, são praticamente similares. Porém, órgãos de cadáveres são muito escassos, principalmente em alguns países, como é o caso do Brasil. Com o objetivo de avaliar o porquê da escassez de órgãos, realizou-se um trabalho prospectivo na Organização de Procura de Órgãos da Universidade Estadual de Campinas, que abrange uma população estimada de seis milhões e seiscentos mil habitantes, distribuídos em 127 cidades. Durante os anos de 1994 a 1999 foram notificados 865 potenciais doadores. Deste total, 321 tornaram-se doadores efetivos e 973 transplantes foram realizados, divididos entre rim, fígado, coração e córneas. Os motivos para a não viabilização dos outros potenciais doadores durante estes seis anos foram: recusa familiar - 28% das famílias se recusaram a doar; parada cardíaca antes do diagnóstico de morte encefálica - 17% dos potenciais doadores; descarte dos órgãos pelas equipes transplantadoras - 11% dos potenciais doadores; sorologia positiva - 5% do total de potenciais doadores; boa evolução neurológica - 2% dos potenciais doadores. A média das taxas de potenciais doadores por milhão de habitantes por ano, avaliando os anos de1994 a 1999, foi de 21,8, bem abaixo das taxas estimadas na literatura, que variam de 40 a 100 potenciais doadores por milhão de habitantes por ano. Conclui-se que a escassez de órgãos para transplante na Organização de Procura de Órgãos da Universidade Estadual de Campinas se deve ao baixo número de potenciais doadores notificados, recusa familiar, parada cardíaca antes do diagnóstico de morte encefálica e descarte do potencial doador pelas equipes transplantadorasAbstract: From the 60's on, with the use of more effective immunosuppressive drugs and afier a definition of conception on brain death, organ transplantation have become a common practice at some hospitais. Though it was commercialization of ciclosporine in the 80's that strongly stimulated transplantation. Nevertheless, there cannot be transplantation once there is no donated organ and such organs may be either from living or deceased donors. Undoubtfully, transplantation with organs from deceased donors is preferred for two reasons: it does not take mutilation of a healthy patient and also the graft survival rates, either from living or deceased donors, are practically the same. Organs from deceased donors are fairly scarce, mainly in some countries like Brazil. A prospective study has been done at Organ Procurement Organization at State University of Campinas. In order to estimate the reason for scarcity of organs. OPO/UNICAMP embraces an estimated population of six million and six hundred thousand inhabitants, scattered in 127 cities. Eight hundred, sixty five potential donors were notified from 1994 to 1999, from which, 321 have become effective donors and 973 transplants have been accomplished, among kidney, liver, heart and cornea. The reasons for the non-viability of the remaining potential donors, during these six years, have been the following: family refusal - 28% of families refused to donate; 17% of the potential donors had a cardiac arrest prior to brain death diagnosis, discard of organs by transplant teams - 11% of potential donors, sore positive - 5% of the potential donors, good neurological evolution - 2% of potential donors. The average rates of potentialdonors per million or inhabitants a year, evaluating the years form 1994 to 1999, was 21.8, which is far lower than the ones rated in literature, ranging frem 40 to 100 potential donors per million inhabitants a year. We can conclude from the figures above, that scarcity of organs for transplantation at Organ PrecurementOrganization at State University of Campinas is due to a low number of notified potential donors, family refusal, cardiac arrest prior to brain death diagnosis and discard of potential donors by transplantation teamsMestradoCirurgiaMestre em Cirurgia Medic

Systematic Review And Meta-analysis Of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy.

Abstract Purpose: We performed a systemic review with meta-analysis to compare tubeless vs conventional percutaneous nephrolithotomy (PCNL) and assess the effectiveness and safety of this innovative procedure. Materials and Methods: A systematic review of PUBMED, EMBASE, LILACS, and Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared tubeless PCNL vs conventional PCNL. The analyzed outcomes were stone-free rate, pain assessment, analgesic medication requirements, operative time, hospitalization time, blood loss, and complications. Results: A total of 10 RCTs were identified that reported 621 patients. Seven studies analyzed stone-free rates. Meta-analysis of the data resulted in no difference between tubeless and conventional PCNL. Operative time, blood transfusion, hemoglobin drop and postoperative fever did not differ between the groups. Meta-analysis of length of hospitalization and prolonged urinary drainage was analyzed and favored the tubeless PCNL group. Conclusions: Tubeless PCNL is a safe and effective procedure with a stone clearance rate comparable to that of conventional PCNL. Tubeless PCNL presented a shorter hospital stay and less postoperative urinary leakage. Pain reduction and minimization of analgesic requirements also were demonstrated

Vascular Modifications Of The Clitoris Induced By Topic Nitric Oxide Donor Gel--preliminary Study.

The clitoral blood flow increase is dependent of nitric oxide (NO) and it occurs due to sexual arousal. Female sexual disorder mechanisms are poorly understood and NO therapeutic role in this scenario is to be determined. To assess topic NO donor S-nitrosoglutationa (GSNO) gel-100 µM effect on clitoral blood flow in healthy women. Forty healthy women were double-blinded randomized for Group 1, GSNO gel, n=20 and Group 2, placebo gel, n=20. All patients underwent Doppler ultrasound test in the clitoral artery. Hemodynamic analysis consisted of: systolic peak speed, diastolic speed, and vase resistance rate. Ten random patients were analyzed regarding sexual function after two double-blinded placebo and NO donor gel periods of 30 days. To consider female sexual dysfunction treatment through local NO-dependent pathway. Mean age was 31 years (20-39) and mean female sexual function index score 31.5 (26-34). Group 1: The mean and standard deviation baseline and 15 minutes after the application of the GSNO gel systolic (11.7±2.1 cm/second to 15.9±2.4 cm/second) and diastolic speeds (2.7±0.3 cm/second to 4.2±0.4 cm/second) and resistance (0.71±0.04 to 1.38±0.06) were significantly increased (P=0.002) (P=0.043), and (P=0.005), respectively. No local or systemic adverse effect was observed in women or in their sexual partners and the sexual function presented a slightly insignificant improvement (P=0.065), although eight of 10 women could subjectively identify the GSNO gel as the preferred and most pleasant between both tried. Group 2 presented no significant differences at baseline and 15 minutes after the application of the placebo gel, P>0.05. The topic GSNO gel increased significantly the clitoral blood flow and could be considered therapeutically in selected cases of female sexual dysfunction warranting further investigation.8484-

[definition And Epidemiology Of Androgen Disorder Of Aging Male (adam)].

32 Suppl 11-