Penile prosthesis implantation in an academic institution in Latin America

PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45% had diabetes, 25.9% had previously undergone radical prostatectomy (RP), and 64% had hypertension. Exchange was performed in 5.7% for fracture, inadequate size, or extrusion. A total of 24.5% of men had immediate postoperative pain, 7.9% had local infection, and 8.6% had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64%) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2%) had sexual intercourse one to two times per week. One hundred twenty patients (86.3%) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications

Prognostic value of the percentage of positive fragments in biopsies from patients with localized prostate cancer

OBJECTIVE: To assess the prognostic value of the percentage of positive fragments (PPF) in biopsies from patients with localized prostate cancer (PCa) undergoing radical prostatectomy. MATERIALS AND METHODS: During the period from March 1991 to November 2000, 440 patients were selected. Cases receiving neoadjuvant or adjuvant hormone therapy, or adjuvant radiotherapy, were excluded, as were cases presenting Gleason scores higher than 6 at biopsy. PPF was defined as the total number of fragments divided by the total number of biopsy fragments times 100. This variable was initially divided into categories from 0 to 25%, 25.1% to 50%, 50.1 to 75% and 75% to 100%. During the postoperative period, patients were assessed every 2 months for 1 year, then every 6 months for 5 years, and then yearly. Biochemical recurrence was defined as serum PSA higher than or equal to 0.4 ng/mL. Median follow-up was 60 months. RESULTS: One hundred and nine (24.8%) of the 440 patients under study had biochemical recurrence. In the univariate analysis, PPF significantly influenced disease-free survival (log-rank, p < 0.001), and patients with PPF between 75 and 100% presented a risk of a biochemical recurrence of the disease 3 times higher than patients with PPF between 0 and 25% (p < 0.001). After the Cox regression analysis, both serum PSA (p = 0.001) and PPF (p < 0.001) showed to be independent predictive factors for disease-free survival following surgery. CONCLUSION: PPF measurement in biopsy is a simple and practical method, which should be routinely used as a predictive factor for biochemical recurrence in patients with PCa presenting Gleason scores between 2 and 6.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Division of UrologyUNIFESP, EPM, Division of UrologySciEL

Structural Blocks as Flood Control in Brazilian Pantanal

The Pantanal basin formation and evolution are not well known and explained. This work brings new information showing the structural control over the physical environment of the Pantanal, one of the most important regions all around the world due to its biodiversity. We used different data sets from remote sensing data, the first set is a corrected SRTM (shuttle radar topographic mission) altimetric data and the second is a map of the major lineaments of Pantanal extracted from photointerpretation of satellite images. Both sets were confronted with the official borderlines of Pantanal and to other two limits defined by phytogeography and remote sensing images. It is possible to show that there is a good match between the internal limits of Pantanal and the interpreted lineaments. The altitudes decrease from N to S and from E to W and the slope analysis shows that this declivity is not homogeneous on these directions. The height difference between adjacent blocks is about 3 or 4 meters. Moreover, different regions have different mean altitudes and slope, although the slope inside each block is homogeneous. Considering Pantanal as a Cenozoic active basin, this paper proposes that the neotectonic controls these blocks and so the water flow in the basin, which in turn controls the fauna and flora of the region

Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction

Aim: To examine the treatment efficacy of Korean Red Ginseng (KRG) in impotent men with erectile dysfunction (ED). Methods: A total of 60 patients presenting mild or mild to moderate ED were enrolled in a double-blind, placebo-controlled study in which the efficacies of KRG and a placebo were compared. the patients received either 1 000 mg (3 times daily) of KRG or a placebo. Results: the five-item version of the International Index of Erectile Function (IIEF-5) score after the treatment was significantly higher in the KRG group compared with that before the treatment (from 16.4 +/- 2.9 to 21.0 +/- 6.3, P 0.05). in the KRG group, 20 patients (66.6%), reported improved erection, significant in the global efficacy question (P 0.05). Conclusion: Our data show that KRG can be an effective alternative to the invasive approaches for treating male ED.Univ São Paulo, Div Urol Clin, Sector Sexual Med, São Paulo, BrazilUniversidade Federal de São Paulo, Discipline Urol, São Paulo, BrazilUniversidade Federal de São Paulo, Discipline Urol, São Paulo, BrazilWeb of Scienc

Acute scrotum

O escroto agudo, caracterizado pela presença de dor local intensa, edema e alteração da consistência das estruturas da bolsa testicular, constitui uma urgência urológica e corresponde a 0,5% dos atendimentos nos serviços de emergência. As causas mais freqüentes de escroto agudo são os processos inflamatórios locais (orquiepididimites) e vasculares isquêmicos (torção testicular), cujo diagnóstico diferencial nem sempre é feito de forma simples. Nesse sentido, dois exames podem evidenciar as alterações locais, incluindo o fluxo sanguíneo: o ultrassom Doppler e a cintilografia escrotal. A ultrassonografia com Doppler do escroto constitui exame pouco invasivo, de custo acessível, alta disponibilidade, rápida execução e elevada sensibilidade (cerca de 90%) e especificidade (99%). Por outro lado, a cintilografia escrotal permite definir com precisão a irrigação dos testículos, porém demanda maior tempo e não é disponível na maioria dos serviços. Quando com esses recursos propedêuticos o diagnóstico final permanece incerto, a exploração cirúrgica é indicada e deve ser realizada sem demora, de modo a permitir a preservação testicular nos casos de torção do cordão.Acute scrotum always represents a clinical emergency and is seen in 0,5% of patients attending acute care units. The main cause of acute scrotum are inflammatory conditions of the testis or epididymis and testicular torsion. Based on clinical evaluation the differential diagnosis between these two conditions can be challenging. In order to proper evaluate patients with acute scrotum we can resort to Doppler ultrasound or scrotal scintigraphy that have the ability to depict local anomalies or decreased blood flow. The Doppler ultrasound is a less invasive test, performed quickly and with low costs, easily available and with a high sensitivity (around 90%) and specificity (about 99%). On the other hand scrotal scintigraphy allows for precise depiction of testicular blood irrigation but is a slow procedure and less available in the clinical setting. When the proper diagnosis can not be made safely with the aforementioned tests, immediate surgical exploration must be performed in order to avoid definitive testicular loss associated to spermatic cord torsion

Aspectos odontolegais relacionados ao dano estético nos processos julgados pelo TJ/RS

Objetivo: analisar os valores pagos por danos estéticos, morais e materiais nos processos de responsabilidade civil contra o Cirurgião-dentista julgados no Tribunal de Justiça do Estado do Rio Grande do Sul nos anos de 2007 a 2010, identificar no teor dos julgamentos se foi utilizado pelo perito ou juiz o método descritivo na avaliação da alteração estética, bem como destacar a importância de equipará-lo a uma das categorias ou adjetivos referida em uma escala gradual qualificativa de gravidade crescente.Metodologia:Conclusão:Os processos relacionados à responsabilidade profissional do Cirurgião-dentista mostraram uma tendência dos magistrados deferirem mais indenizações por danos morais do que danos materiais, bem como de valorar num patamar quantitativo alto os pedidos por danos estéticos, sendo esses, na média, maior que os danos materiais e morais. De acordo com os julgamentos analisados, não se identificou na valoração dos danos estéticos uma análise objetiva e comparativa. Os parâmetros indicados no método descritivo sempre deverão ser utilizados para mostrar sua característica e importância nas avaliações das alterações estéticas, necessitando para tal atribuir pontos ou porcentagens com escalas numéricas. Foram analisados julgamentos de processos civis envolvendo Cirurgiões-dentistas, baixadas (download) e impressas, por meio de busca eletrônica no site do Tribunal de Justiça do Estado do Rio Grande do Sul do ano de 2007 até o ano de 2010. Utilizou-se na amostra apenas os textos produzidos pelos magistrados, fazendo a análise do inteiro teor somente nos casos em que foram deferidos danos estéticos. Nesses, verificou-se se fora utilizada algum parâmetro qualificativo ou numérico

The 2009 earthquake, magnitude mb 4.8, in the Pantanal Wetlands, west-central Brazil

The main goal of this paper is to characterize the Coxim earthquake occurred in June 15th, 2009 in the Pantanal Basin and to discuss the relationship between its faulting mechanism with the Transbrasiliano Lineament. The earthquake had maximum intensity MM V causing damage in farm houses and was felt in several cities located around, including Campo Grande and Goiânia. The event had an mb 4.8 magnitude and depth was 6 km, i.e., it occurred in the upper crust, within the basement and 5 km below the Cenozoic sedimentary cover. The mechanism, a thrust fault mechanism with lateral motion, was obtained by P-wave first-motion polarities and confirmed by regional waveform modelling. The two nodal planes have orientations (strike/dip) of 300°/55° and 180°/55° and the orientation of the P-axis is approximately NE-SW. The results are similar to the Pantanal earthquake of 1964 with mb 5.4 and NE-SW compressional axis. Both events show that Pantanal Basin is a seismically active area, under compressional stress. The focal mechanism of the 1964 and 2009 events have no nodal plane that could be directly associated with the main SW-NE trending Transbrasiliano system indicating that a direct link of the Transbrasiliano with the seismicity in the Pantanal Basin is improbable

Sensoriamento Remoto na Análise do Alinhamento das Lagoas do Pantanal da Nhecolândia, MS

Among the several kinds of pantanais, the Nhecolândia sub-region deserves prominent role for presenting peculiar landscape. Its main feature is the presence of numerous lakes, which are divided into “baías” and “salinas” (fresh and brackish, respectively). The study aimed to quantify and analyze the orientation and aligning intensity of the major axes of these water ponds, in order to contribute for understanding the formation and functioning of this intriguing and yet unknown region. Firstly, we adopted the object-oriented classification method on Landsat 5 satellite image, TM sensor. Then, we used a specific algorithm for identifying the alignment of the ponds. As results, we recognized 17,631 lakes, 17,050 being baías and 577 salinas. These ponds are aligned in two directions - NE and NW -, which would be associated to the directions of the winds prevailing during the origin of the Nhecolândia lakes.Dentre os diversos pantanais, a sub-região da Nhecolândia merece papel de destaque por apresentar paisagem peculiar. Sua característica principal é a presença de inúmeras lagoas, as quais podem ser divididas em baias e salinas. O trabalho objetivou quantificar e analisar a orientação e intensidade de alinhamento dos eixos maiores dessas lagoas, de modo a contribuir com dados que permitam melhor compreender a formação e o funcionamento ainda poucos conhecidos desta região tão intrigante. Para tanto, primeiramente adotou-se o método de classificação orientada a objeto sobre imagem do satélite Landsat 5, sensor TM. Em seguida, utilizou-se um algoritmo específico para a identificação do alinhamento das lagoas. Como resultado, foram reconhecidas 17.631 lagoas, das quais 17.050 são baías e 577 salinas. Observou-se que as lagoas estão alinhadas em duas direções - NE e NW -, as quais estariam associadas às direções dos ventos atuantes durante a gênese das lagoas Nhecolândia