The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits

Objective To histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka first stage urethroplasty. Materials and Methods A urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the penile urethra. The urethral defect was corrected by applying buccal mucosa fenestrated graft through two cruciform incisions in the distal portions of its longitudinal axis. The animals were sacrificed at 2, 4, 8 and 12 weeks post surgery and their genitals were subjected to clinical and histological assessment. Results The buccal mucosa fenestrated graft showed complete uptake in all groups, with keratinization squamous metaplasia and mucosal proliferation of the fenestrated areas. The fenestrated graft area represented an increase in length of 25% in length in relation to the original standard graft. Conclusions The fenestrated buccal mucosa graft presented total integration to the adjacent epithelia with re-epithelization of the incision areas of the graft (fenestrations) and no significant inflammatory or scarring reactions when compared to other mucosa transplanted areas; therefore its application is viable in cases of extensive urethral defect whenever the donating area might be insufficient.Federal University of São Paulo Departament of Urology (PO, HB, AR, UBjr, VO, AMjr) Department of Pathology (RD)UNIFESP, Departament of Urology (PO, HB, AR, UBjr, VO, AMjr) Department of Pathology (RD)SciEL

Classification of brain tumor extracts by high resolution ¹H MRS using partial least squares discriminant analysis

High resolution proton nuclear magnetic resonance spectroscopy (¹H MRS) can be used to detect biochemical changes in vitro caused by distinct pathologies. It can reveal distinct metabolic profiles of brain tumors although the accurate analysis and classification of different spectra remains a challenge. In this study, the pattern recognition method partial least squares discriminant analysis (PLS-DA) was used to classify 11.7 T ¹H MRS spectra of brain tissue extracts from patients with brain tumors into four classes (high-grade neuroglial, low-grade neuroglial, non-neuroglial, and metastasis) and a group of control brain tissue. PLS-DA revealed 9 metabolites as the most important in group differentiation: γ-aminobutyric acid, acetoacetate, alanine, creatine, glutamate/glutamine, glycine, myo-inositol, N-acetylaspartate, and choline compounds. Leave-one-out cross-validation showed that PLS-DA was efficient in group characterization. The metabolic patterns detected can be explained on the basis of previous multimodal studies of tumor metabolism and are consistent with neoplastic cell abnormalities possibly related to high turnover, resistance to apoptosis, osmotic stress and tumor tendency to use alternative energetic pathways such as glycolysis and ketogenesis.14916

Walking vocation and familiarity with the poor: Lima Barreto’s walks through Rio de Janeiro’s downtown

Through an incursion into the past from an ethnographic perspective, our goal is to reconstitute anthropologically relevant aspects of the experiences of the writer Afonso Henriques de Lima Barreto (1881-1921) in the city of Rio de Janeiro. We will take a close look at the relations between city dwellers and at these between city dwellers and urban spaces, taking into account what emerges from the chronicles of this author. In this context, we will also address issues arising from the social and racial discrimination suffered by Lima Barreto, with emphasis on how they occurred in interactions in urban life.Através de uma incursão no passado numa perspectiva etnográfica, pretende-se reconstituir aspectos antropologicamente relevantes das vivências do escritor Afonso Henriques de Lima Barreto (1881-1921) na cidade do Rio de Janeiro. Lançaremos um olhar atento às relações entre os citadinos e destes com os espaços urbanos, com base naquilo que emerge das crônicas do autor em questão. Nesse âmbito, também abordaremos aspectos decorrentes das discriminações sociais e raciais sofridas por Lima Barreto, com ênfase na forma como ocorreram em interações na vida urbana

The heritage modernity in conflict and mediation as meeting with other

O estudo desvela as forças do continuum processo da modernidade que acabam por influenciar as ações dos indivíduos, levando as inter-relações humanas a uma lógica de competição e instrumentalidade. Este cenário cientificista dedicado ao espetáculo do livre mercado causa consequências ameaçadoras aos laços sociais, pois, distancia os sujeitos da reflexão necessária para construção da subjetividade, afastando-os da responsabilidade moral com o outro. Fazendo uso da teoria psicanalítica de Lebrun, podem ser compreendidas as influências da modernidade nos indivíduos, as quais alteraram o ponto referencial do social, o que, por sua vez, silencia a autoridade patriarcal e desarma a intervenção necessária para inserir os sujeitos na linguagem social. A falta do “Não!” patriarcal – representação fálica – impede a construção da subjetividade, como resultado, os indivíduos não conseguem sustentar seus laços sociais – devido à falta de sensibilidade –, descambando, primeiramente, nos conflitos familiares, posteriormente nos conflitos sociais. Diante desta problemática, a mediação de conflitos pode ser observada como uma oportunidade de romper com o ciclo de conflitualidade, eis que, por suas características, entende o conflito como possibilidade da diferença e, ainda, busca o reencontro dos relacionamentos através da sensibilidade, estabelecendo o amor como condutor do laço social, iniciado no seio familiar e, a posteriori, na sociedade.This study aims to reveal the forces of the continuum process of modernity which ends up influencing people’s acts leading the human  interrelationship toward a logic of competition and instrumentality. This scientistic scenario dedicated to the free market spectacle causes consequences to the social bonds, thus distances the subjects from reflection, which is necessary for construction of subjectivity, moving them away from the moral responsibility to one another. Considering the psychoanalytic theory of Lebrun, the influences of modernity in individuals who changed the social reference point can be understood, which in turn mutes patriarchal authority and disarms the required intervention to insert the subjects into social language. The lack of patriarchal saying “No!” - phallic representation - prevents the construction of subjectivity, as a result, individuals cannot sustain their social bonds (due to lack of sensitivity), slipping in family conflicts first and socials ones later. Faced with this problem, conflict mediation can be seen as an opportunity to break the cycle of conflict once its characteristics understand the conflict as a possibility of difference and also seeks the reunion of relationships through sensitivity, setting love as conductor of the social bond, initiated within the family and, subsequently, in the society

Urethral duplication II-A Y type with rectal urethra: ASTRA approach and tunica vaginalis flap for first stage repair

INTRODUCTION: Urethral duplication is a rare congenital anomaly affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. We present a patient with urethral duplication in which the orthotopic urethra was patent in the penile segment but atresic in the bulbar and prostatic segment. The patient had urinary flow from the rectum and the ectopic urethra could be well identified by anal examination. MATERIALS AND METHODS: Age at surgery was 13 months. The procedure consisted of an ASTRA (anterior sagittal trans-ano-rectal) approach for dividing the urethra and rectum and was successful to move the urethra up to the perineal area. The rectum was reconstructed and the patient placed into a lithotomy position. A urethral catheter inserted in the penile urethra oriented us were the atresic urethra in bulbar area started. The scrotum was opened in the middle and the distance between the two urethral stumps proximal and distal defined the extension of no urethral tissue that consisted of 5 cm. We opened the right scrotal space and a tunica vaginalis flap was obtained and attached to the bulbar tissue for a two-stage urethroplasty strategy. RESULTS: Patient had a nice healing and the tunica vaginalis was nicely incorporated to the adjacent tissue, having the two urethral stumps well delineated. CONCLUSIONS: ASTRA approach in combination with a two-stage urethroplasty with tunica vaginalis dorsal flap proved to be an excellent combination for a rare case of urethral Y duplication having the main urethra into the rectum.Universidade Federal de São Paulo (UNIFESP) Department of UrologyUNIFESP, Department of UrologySciEL

Elective appendicovesicostomy in association with monfort abdominoplasty in the treatment of prune belly syndrome

OBJECTIVE: To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty to avoid urinary tract infection (UTI) and renal damage in the post-operative follow-up of patients with prune belly syndrome. MATERIALS AND METHODS: We followed 4 patients operated in our institution (UNIFESP) (Monfort, orchidopexy and Mitrofanoff) and compared them to 2 patients treated similarly, but without an appendicovesicostomy, in a second institution (UFBA). We evaluated postoperative clinical complications, UTI and preservation of renal parenchyma. Patients were followed as outpatients with urinalysis, ultrasonography (US) and occasionally with renal scintigraphy. RESULTS: Mean follow-up was 23.5 months. Immediate post-operative course was uneventful. We observed that only one patient with the Mitrofanoff channel persisted with UTI, while the 2 patients used as controls persisted with recurrent pyelonephritis (> 2 UTI year). CONCLUSION: Our data suggest that no morbidity was added by the appendicovesicostomy to immediate postoperative surgical recovery and that this procedure may have a beneficial effect in reducing postoperative UTI events and their consequences by reducing the postvoid residuals in the early abdominoplasty follow-up. However, we recognize that the series is small and only a longer follow-up with a larger number of patients will allow us to confirm our suppositions. We could not make any statistically significant assumptions regarding differences in renal preservation due to the same limitations.Federal University of São Paulo Division of UrologyFederal University of Bahia Division of UrologyUNIFESP, Division of UrologySciEL

Histopathological evaluation of urethroplasty with dorsal buccal mucosa: an experimental study in rabbits

PURPOSE: Buccal mucosa is a widely accepted tissue for urethroplasty. The exact healing and tissue integration process, mainly the histological characteristics of dorsal buccal mucosa graft urethroplasty when used dorsally to reconstruct the urethral plate has not previously been assessed, and thus we developed an experimental model to address this question. MATERIALS AND METHODS: In 12 New Zealand rabbits (weight 2.5 kg) we surgically created a dorsal penile urethral defect. A buccal mucosa graft was sutured to the corpora and tunica albuginea, and the ventral urethra anastomosed to this new urethral plate. The animals were divided in three groups and sacrificed 1, 3 and 6 weeks after surgery (groups 1, 2 and 3). A retrograde urethrogram was obtained at autopsy in the last group and the penis analyzed histologically with hematoxylin-eosin and Masson's staining. RESULTS: The urethrograms showed no evidence of fistula or stricture. In group 1 the histopathological analysis showed submucosal lymph-mononuclear inflammatory edema, numerous eosinophils and squamous epithelium integrated into the adjacent urothelium. In group 2 there was no evidence of an inflammatory response but rather complete subepithelial hyaline healing, which was more marked in group 3. CONCLUSION: Healing of buccal mucosa grafts to reconstruct the urethral plate can be achieved by total integration of the squamous epithelium with the urothelium, maintaining the original histological properties of the graft with no fibrosis or retraction.Federal University of São Paulo Divisions of UrologyFederal University of São PauloUNIFESP, Divisions of UrologyUNIFESPSciEL