Single-Site Video Endoscopic Inguinal Lymphadenectomy: Initial Report

Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization.o TEXTO COMPLETO DESTE ARTIGO, ESTARÁ DISPONÍVEL À PARTIR DE AGOSTO DE 2015.25460761

Extraperitoneal endoscopic radical prostatectomy: How steep is the learning curve? Overheads on the personal evolution technique in 5-years experience

Objective: Prospectively investigate endoscopic extra peritoneal radical prostatectomy (EERP) learning curve impact on outcomes. Materials and methods: In a 5 year period (2004-2008) 270 patients underwent 5-6 ports laparoscopic radical prostatectomy at a referral center in Brazil. The initial 70 cases learning curve protocol included low body mass index patients with low volume, low grade prostate cancer. After that there were no criteria to exclude laparoscopic surgery. The patients were analyzed in two groups: Group 1, first 70 patients (30 transperitoneal and 40 extra peritoneal)-learning curve and Group 2, last 200 patients - EERP only. Surgical and outcome parameters were compared through Student's t test and Fisher's Exact Test. Results: The mean age was 65 years (+/- 8.2) and comparing Groups 1 and 2, mean operative time was 300 (+/- 190) versus 180 (+/- 100) minutes, blood loss 330 (+/- 210) versus 210 (+/- 180) mL, hospital stay 3 (2 to 5) versus 2 (1 to 3) days, positive surgical margins 15% versus 10%, erection sufficient to penetration in previous potent patients 73.3% versus 75%, respectively with no difference between groups. Overall, 78% of patients referred no previous impotence with groups' equivalence. Severe urinary incontinence, transfusion and complications rates were higher in group 1 (p<0.05): 10% versus 2%, 12% versus 2.25% and 30% versus 12.5%, respectively. Peritoneum perforation occurred in 40% and conversion to open surgery was not required. Nerve sparing procedure was applied in 85%. In 3.5-years mean follow-up 90% of patients were free of PSA recurrence with no difference between groups. Conclusion: Severe urinary incontinence, transfusion and complications rates are related to learning curve which is continuous, although a significant improvement is pragmatic after 70 cases. An intensive mentored training program should be considered to minimize the learning outlays. (C) 2009 AEU. Published by Elsevier Espana, S.L. All rights reserved.34759860

P-I class metalloproteinase from Bothrops moojeni venom is a post-proline cleaving peptidase with kininogenase activity: Insights into substrate selectivity and kinetic behavior

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Snake venom metalloproteinases (SVMPs) belonging to P-I class are able to hydrolyze extracellular matrix proteins and coagulation factors triggering local and systemic reactions by multiple molecular mechanisms that are not fully understood. BmooMP alpha-I, a P-I class SMVP from Bothrops moojeni venom, was active upon neuro- and vaso-active peptides including angiotensin I, bradykinin, neurotensin, oxytocin and substance P. Interestingly, BmooMPa-I showed a strong bias towards hydrolysis after proline residues, which is unusual for most of characterized peptidases. Moreover, the enzyme showed kininogenase activity similar to that observed in plasma and cells by kallikrein. FRET peptide assays indicated a relative promiscuity at its S-2-S '(2) subsites, with proline determining the scissile bond. This unusual post-proline cleaving activity was confirmed by the efficient hydrolysis of the synthetic combinatorial library MCA-GXXPXXQ-EDDnp, described as resistant for canonical peptidases, only after Pro residues. Structural analysis of the tripeptide LPL complexed with BmooMP alpha-I, generated by molecular dynamics simulations, assisted in defining the subsites and provided the structural basis for subsite preferences such as the restriction of basic residues at the S-2 subsite due to repulsive electrostatic effects and the steric impediment for large aliphatic or aromatic side chains at the Si subsite. These new functional and structural findings provided a further understanding of the molecular mechanisms governing the physiological effects of this important class of enzymes in envenomation process. (c) 2014 Elsevier B.V. All rights reserved.18443545552Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [FAPESP-2012/50191-4

Sclerotherapy of hydroceles and spermatoceles with alcohol: results and effects on the semen analysis

PURPOSE: To evaluate the success rates of sclerotherapy of the tunica vaginalis with alcohol for the treatment of hydroceles and/or spermatoceles, as well as, evaluation of pain, formation of hematomas, infection and its effects in spermatogenesis . MATERIALS AND METHODS: A total of 69 patients, with offsprings and diagnosis of hydrocele and/or spermatocele, were treated during the period from April 2003 to June 2007. Semen analysis was obtained from patients who were able to provide us with samples. The sclerotherapy with alcohol at 99.5% was undertaken as outpatient procedure. RESULTS: The average volume drained pre-sclerotherapy was 279.82 mL (27 to 1145). The median follow-up was 43 months (9 to 80). A total of 114 procedures were performed on 84 units, with an average of 1.35 procedures / unit and an overall success rate of 97.62%. Of the 69 patients, 7 (10.14%) reported minor pain immediately after the procedure, 3 (4.35%) moderate pain and 2 (2.89%) intense pain. Post-Sclerotherapy spermograms revealed reduction of the parameters regarding: concentration, motility and morphology up to 6 months post procedure , with return to normal parameters 12th months after procedure. CONCLUSIONS: Sclerotherapy of hydroceles and spermatoceles with 99.5% alcohol is an efficient procedure that can be perormed without difficulties, cost-effectiveness, with few side effects and which may be performed in patients who wish fertility

Prevalência de sobrepeso e obesidade em escolares da região de Parelheiros do município de São Paulo Prevalence of overweight and obesity in school children of Parelheiros region in São Paulo city, Brazil

OBJETIVO: Verificar, em uma amostra de escolares de uma região de baixo nível socioeconômico, a prevalência de sobrepeso e obesidade. MÉTODOS: Estudo transversal com uma amostra de 218 crianças selecionadas de modo aleatório, a partir de um universo estimado de 1.500 crianças e adolescentes, com idade entre seis e 14 anos, provenientes de três escolas de ensino fundamental de Parelheiros, São Paulo, sem distinção de sexo ou etnia. Foram excluídas aquelas portadoras de qualquer doença metabólica ou endócrina diagnosticada ou em tratamento. Os indivíduos foram submetidos à avaliação antropométrica, com medida do peso corporal e altura para cálculo do índice de massa corpórea e relação peso/altura. Todas as crianças responderam a um questionário aplicado pelos pesquisadores sobre hábitos alimentares. RESULTADOS: A prevalência de obesos e de portadores de sobrepeso foi respectivamente 14,7 e 16,5%. Entre os alunos obesos e com sobrepeso, o baixo consumo de frutas (10,8 e 10,8%), de verduras e legumes (16,4 e 9,1%) e o alto consumo de doces (72,2 e 78,1%) foram associados ao excesso de peso. A prática esportiva esteve ausente ou escassa nos obesos (81,3%) e portadores de sobrepeso (77,8%). CONCLUSÕES: Os alunos avaliados, embora provenientes de uma região pobre de São Paulo, apresentaram um perfil de transição nutricional, com altas taxas de obesidade e sobrepeso.<br>OBJECTIVE: To establish the prevalence of overweight and obesity in school children from low socioeconomical status. METHODS: This cross sectional study randomly enrolled 218 eighteen students out of 1.500 students with six to 14 years old from three schools located in Parelheiros, São Paulo, Brazil. Children with a diagnosis and or treatment of metabolic or endocrine diseases were excluded. The studied children had an anthropometric evaluation of weight and height, and body mass index was calculated. All children answered a questionnaire about daily food consumption and physical activity. RESULTS: The prevalence of obesity and overweight were respectively 14.7 and 16.5%. Among these students, the low consumption of fruits (10.8 and 10.8%), vegetables (16.3 and 9.1%) and the high consumption of candies (72.2 and 78.1%) were associated with weight excess. Poor physical activities was common among obese (81.3%) and overweight (77.8%) students. CONCLUSIONS: The evaluated students, despite living in a poor region of São Paulo, showed a profile of nutritional transition, with high obesity and overweight rates

Síndrome do desfiladeiro torácico - ressecção de costela cervical por videotoracoscopia Thoracic outlet syndrome - cervical rib resection through videothoracoscopic surgery

A base do tratamento cirúrgico da Síndrome do Desfiladeiro Torácico (SDT) é a ressecção da primeira costela, podendo associar-se à escalenectomia ou ainda à ressecção de costela cervical. Esta última é feita tradicionalmente por meio de um acesso supraclavicular ou mesmo axilar, o qual é tecnicamente mais trabalhoso. Pode ser realizada também por meio de acesso paraescapular. Embora tecnicamente atrativa e associada à menor invasividade e maior segurança, com ótimo resultado estético, a ressecção da primeira costela torácica, por intermédio de cirurgia videoassistida transaxilar ou pela técnica videotoracoscópica, é pouco relatada na literatura, e nenhuma referência foi encontrada sobre ressecção de costela cervical mediante essa técnica. Neste artigo, apresentamos essa inovação cirúrgica realizada com sucesso para ressecção de costela cervical em duas pacientes.<br>The basis of Thoracic Outlet Syndrome (TOS) surgical treatment is the first rib resection and may be associated with scalenectomy or cervical rib resection. The latter is traditionally done through a supraclavicular or axillary access, which is the most technically challenging. It can also be achieved through parascapular access. Although technically attractive and associated with less invasiveness and increased security, with excellent aesthetic results, the first thoracic rib resection via video-assisted transaxillary surgery or videothoracoscopic technique is seldom reported in the literature, and no reference was found on cervical rib resection through this technique. In this article, we introduced this innovation successfully performed for surgical cervical rib resection in two patients