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Biochemical Relapse in Low-risk Prostate Cancer Treated with Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy 前列腺癌根治术和双侧盆腔淋巴结切除术治疗低风险前列腺癌症的生化复发
Pub Date : 2022-09-01 DOI: 10.1055/s-0042-1748182
Cristina Dominguez-Bellini, J. Ramos, L. Becerra, R. Varela
Introduction For low-risk prostate cancer (PCa), curative treatment with radical prostatectomy (RP) can be performed, reporting a biochemical relapse-free survival rate (bRFS) at 5 and 7 years of 90.1% and 88.3%, respectively. Prostatic specific antigen (PSA), pathological stage (pT), and positive margins (R1) are significant predictors of biochemical relapse (BR). Even though pelvic lymphadenectomy is not recommended during RP, in the literature, it is performed in 34% of these patients, finding 0.37% of positive lymph nodes (N1). In this study, we aim to evaluate the 10-year bRFS in patients with low-risk PCa who underwent RP and extended pelvic lymph node dissection (ePLND). Methodology All low-risk patients who underwent RP plus bilateral ePLND at the National Cancer Institute of Colombia between 2006 and 2019 were reviewed. Biochemical relapse was defined as 2 consecutive increasing levels of PSA > 0.2 ng/mL. A descriptive analysis was performed using the STATA 15 software (Stata Corp., College Station, TX, USA), and the Kaplan-Meier curves and uni and multivariate Cox proportional hazard models were used for the survival outcome analysis. The related regression coefficients were used for the hazard ratio (HR), and, for all comparisons, a two-sided p-value ˂ 0.05 was used to define statistical significance. Results Two hundred and two patients met the study criteria. The 10-year bRFS for the general population was 82.5%, statistically related to stage pT3 (p = 0.047), higher Gleason grade group (GG) (p ≤ 0.001), and R1 (p ≤ 0.001), but not with N1. A total of 3.9% of the patients had N1; of these, 75% had R1, 25% GG2, and 37% GG3. Among the N0 (non-lymph node metástasis in prostate cáncer) patients, 31% of the patients had R1, 41% GG2, and 13% GG3. Conclusions Our bRFS was 82.5% in low-risk patients who underwent RP and ePLND. With higher pT, GG, and presence of R1, the probability of BR increased. Those with pN1 (pathologicaly confirmed positive lymph nodes) were not associated with bRFS, with a pN1 detection rate of 3.9%. Details: In low-risk PCa, curative treatment with RP can be performed, reporting a bRFS rate at 5 and 7 years of 90.1% and 88.3%, respectively. Despite the fact that pelvic lymphadenectomy is not recommended during RP in clinical guidelines, in the literature, it is performed in 34% of these patients, finding 0.37% of N1. In this study, we report the 10-year bRFS in patients with low-risk PCa who underwent surgery.
介绍 对于低风险前列腺癌症(PCa),可以进行根治性前列腺切除术(RP)的治疗,报告5年和7年的生物化学无复发生存率(bRFS)分别为90.1%和88.3%。前列腺特异性抗原(PSA)、病理分期(pT)和阳性边缘(R1)是生化复发(BR)的重要预测因素。尽管RP期间不建议进行盆腔淋巴结切除术,但在文献中,34%的患者进行了盆腔淋巴结清扫术,发现0.37%的淋巴结阳性(N1)。在这项研究中,我们旨在评估接受RP和扩展性盆腔淋巴结清扫(ePLND)的低风险前列腺癌患者的10年bRFS。方法论 对2006年至2019年间在哥伦比亚国家癌症研究所接受RP加双侧ePLND的所有低风险患者进行了回顾。生化复发定义为PSA水平连续2次升高 > 0.2 ng/mL。使用STATA 15软件(STATA Corp.,College Station,TX,USA)进行描述性分析,并使用Kaplan-Meier曲线和单因素和多因素Cox比例风险模型进行生存结果分析。相关回归系数用于危险比(HR),对于所有比较,使用双侧p值0.05来定义统计显著性。后果 222名患者符合研究标准。普通人群的10年bRFS为82.5%,与pT3期统计学相关(p = 0.047),高格里森分级组(GG)(p≤0.001)和R1(p≤001),但与N1无关。共有3.9%的患者患有N1;其中75%具有R1,25%具有GG2,37%具有GG3。在N0(前列腺癌中的非淋巴结转移)患者中,31%的患者具有R1、41%的GG2和13%的GG3。结论 在接受RP和ePLND的低风险患者中,我们的bRFS为82.5%。随着较高的pT、GG和R1的存在,BR的概率增加。pN1(病理证实为阳性淋巴结)患者与bRFS无关,pN1检测率为3.9%。详细信息: 在低风险前列腺癌中,可以使用RP进行治疗,据报道,5年和7年的bRFS发生率分别为90.1%和88.3%。尽管临床指南中不建议在RP期间进行盆腔淋巴结清扫,但在文献中,34%的患者进行了盆腔淋巴结切除术,发现N1为0.37%。在这项研究中,我们报告了接受手术的低风险前列腺癌患者的10年bRFS。
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引用次数: 0
Radical Nephrectomy in Renal Cell Carcinoma with Venous Tumoral Thrombus: Long-term Outcomes and Overall Survival 肾细胞癌合并静脉肿瘤性血栓的根治性肾切除术:长期疗效和总生存率
Pub Date : 2022-09-01 DOI: 10.1055/s-0042-1748871
Aysa Vanessa Mosquera, Catalina Barco-Castillo, D. Camacho, J. Corrêa, R. Varela, Danilo Citarella, M. Cabrera
Objective To describe the five-year overall survival (OS) and perioperative morbidity of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) treated through radical nephrectomy and thrombectomy. Materials and Methods We evaluated a cohort of 530 patients with a diagnosis of RCC from January 2009 to December 2019, and found VTT in 42 of them; these 42 patients composed the study sample. The patients were stratified according to the Neves Thrombus Classification (NTC). The baseline and perioperative characteristics, as well as the follow-up, were described. The Kaplan-Meier curve and its respective Cox regression were applied to present the 5-year OS and the OS stratified by the NTC. Results The average age of the sample was of 63.19 ± 10.7 years, and there were no differences regarding gender. In total, VTT was present in 7.9% of the patients. According to the NTC, 30.9% of the cases corresponded to level I, 21.4%, to level II, 26.1%, to level III, and 21.4%, to level IV. The 5-year OS was of 88%. For level-I and level-II patients, the 5-year OS was of 100%, and of only 38% among level-IV patients. Complications, mostly minor, occurred in 57% of the cases. Conclusions Radical nephrectomy with thrombectomy is a morbid procedure; however, most complications are minor, and the five-year mortality is null for patients in NTC levels I and II, and low for levels III and IV, and it may be even lower in level-III patients when standardizing transesophageal echocardiogram intraoperatively and routinary extracorporeal bypass. Thus, we recommend considering this surgery as the first-line management in patients with RCC and VTT.
目的探讨肾细胞癌(RCC)合并静脉肿瘤血栓(VTT)行根治性肾切除术和取栓术治疗的5年总生存期(OS)和围手术期发病率。研究人员对2009年1月至2019年12月诊断为RCC的530例患者进行了队列评估,其中42例发现VTT;这42名患者组成了研究样本。根据Neves血栓分类(NTC)对患者进行分层。描述了基线和围手术期特征以及随访。应用Kaplan-Meier曲线及其相应的Cox回归来表示5年OS和NTC分层OS。结果患者平均年龄为63.19±10.7岁,性别差异无统计学意义。总的来说,7.9%的患者存在VTT。根据NTC, 30.9%的病例为I级,21.4%为II级,26.1%为III级,21.4%为IV级。5年OS为88%。对于i级和ii级患者,5年OS为100%,而iv级患者仅为38%。57%的病例发生并发症,多数为轻微并发症。结论根治性肾切除术合并血栓切除术是一种病态的手术;然而,大多数并发症是轻微的,NTC I级和II级患者的5年死亡率为零,III级和IV级患者的5年死亡率较低,III级患者的5年死亡率在规范术中经食管超声心动图和常规体外搭桥时可能更低。因此,我们建议考虑将此手术作为RCC和VTT患者的一线治疗。
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引用次数: 0
Manejo del cáncer de próstata oligometastásico: Una perspectiva del radioterapeuta 少转移性前列腺癌的管理:放射治疗师的观点
Pub Date : 2022-06-01 DOI: 10.1055/s-0042-1750016
J. C. Galvis
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引用次数: 0
Disfunción eréctil en personas con VIH – Revisión de alcance 艾滋病毒感染者的勃起功能障碍-范围回顾
Pub Date : 2022-06-01 DOI: 10.1055/s-0042-1743205
Isabella Lince-Rivera, Mauricio Medina-Rico, Eduardo Nuñez-Rodriguez, Mónica Maria Medina F., H. López-Ramos
Objetivo Exponer los factores que han sido asociados al desarrollo de disfunción eréctil (DE) en las personas con virus de la inmunodeficiencia humana (VIH) y cuál es la prevalencia de la disfunción eréctil en esta población. Métodos Se realizó una revisión de alcance utilizando las siguientes bases de datos: MEDLINE, CENTRAL, Embase, Scopus, Lilacs, y Psycinfo. Los artículos incluidos debían tener cualquier información relacionada con la DE en personas con VIH, su prevalencia, y posibles factores asociados. Se filtraron un total de 2.726 artículos por título y resumen, y, de estos, se seleccionaron 22 referencias para revisión de texto completo y análisis. Resultados Se encontró que las personas con VIH tienen una mayor probabilidad de presentar DE en comparación con las personas sin VIH. Algunos estudios han establecido una asociación entre la DE y trastornos psicológicos o factores orgánicos, como la lipodistrofia, la hipertensión arterial, la hipercolesterolemia, la diabetes mellitus, la depresión, la ansiedad, y el hipogonadismo. La ingesta de terapia antirretroviral (TARV), más específicamente los inhibidores de la proteasa, sigue siendo cuestionada como causante de DE en pacientes con VIH. Conclusiones Ante un paciente con diagnóstico de VIH, se debe ahondar sobre DE con el fin de recomendar e iniciar conductas terapéuticas que aseguren un mejoramiento en su calidad de vida.
目的揭示与人类免疫缺陷病毒(HIV)患者勃起功能障碍(ED)发展相关的因素,以及该人群勃起功能障碍的患病率。方法使用以下数据库进行范围审查:Medline、Central、Embase、Scopus、Lilacs和Psycinfo。所包括的文章必须包含与艾滋病毒感染者、其流行率和可能的相关因素有关的任何信息。按标题和摘要共筛选了2726篇文章,其中选择了22篇参考文献进行全文审查和分析。结果发现,与没有艾滋病毒的人相比,感染艾滋病毒的人更有可能出现这种情况。一些研究已经建立了DE与心理障碍或器官因素之间的联系,如脂肪营养不良、高血压、高胆固醇血症、糖尿病、抑郁、焦虑和性腺功能减退。抗逆转录病毒疗法(ARV),更具体地说是蛋白酶抑制剂的摄入,作为艾滋病毒患者发生DE的原因,仍然受到质疑。结论对于确诊为艾滋病毒的患者,应深入研究,以建议和开始治疗行为,以确保其生活质量的提高。
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引用次数: 0
Metabolomic Profile in Patients with Malignant Disturbances of the Prostate: An Experimental Approach 前列腺恶性紊乱患者的代谢组学特征:一种实验方法
Pub Date : 2022-06-01 DOI: 10.1055/s-0042-1744253
H. García-Perdomo, Leidy Vanessa Mena Ramirez, J. Wist, Adalberto Sanchez
Purpose To identify metabolites in humans that can be associated with the presence of malignant disturbances of the prostate. Methods In the present study, we selected male patients aged between 46 and 82 years who were considered at risk of prostate cancer due to elevated levels of prostate-specific antigen (PSA) or abnormal results on the digital rectal examination. All selected patients came from two university hospitals (Hospital Universitario del Valle and Clínica Rafael Uribe Uribe) and were divided into 2 groups: cancer (12 patients) and non-cancer (20 patients). Cancer was confirmed by histology, and none of the patients underwent any previous treatment. Standard protocols were applied to all the collected blood samples. The resulting plasma samples were kept at -80°C, and a profile of each one was acquired by nuclear magnetic resonance (NMR) using established experiments. Multivariate analyses were applied to this dataset, first to establish the quality of the data and identify outliers, and then, to model the data. Results We included 12 patients with cancer and 20 without it. Two patients were excluded due to contamination with ethanol. The remaining ones were used to build an Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) model (including 15 non-cancer and 10 cancer patients), with acceptable discrimination (Q2 = 0.33). This model highlighted the role of lactate and lipids, with a positive association of these two metabolites and prostate cancer. Conclusions The primary discriminative metabolites between patients with and without prostate cancer were lactate and lipids. These might be the most reliable biomarkers to trace the development of cancer in the prostate.
意图 鉴定人类体内可能与前列腺恶性病变相关的代谢产物。方法 在本研究中,我们选择了年龄在46岁至82岁之间的男性患者,他们因前列腺特异性抗原(PSA)水平升高或直肠指检结果异常而被认为有患前列腺癌症的风险。所有入选的患者均来自两所大学医院(瓦莱大学医院和Clínica Rafael Uribe Uribe),并分为两组:癌症(12名患者)和非癌症(20名患者)。癌症经组织学证实,无一例患者接受过任何治疗。标准方案适用于所有采集的血液样本。所得血浆样品保持在-80°C,并使用既定实验通过核磁共振(NMR)获得每种血浆样品的图谱。将多变量分析应用于该数据集,首先确定数据的质量并识别异常值,然后对数据进行建模。后果 我们纳入了12名癌症患者和20名非癌症患者。两名患者因乙醇污染而被排除在外。剩下的用于建立潜在结构判别分析(OPLS-DA)的正交投影模型(包括15名非癌症患者和10名癌症患者),具有可接受的判别(Q2 = 0.33)。该模型强调了乳酸盐和脂质的作用,这两种代谢产物与前列腺癌症呈正相关。结论 癌症患者和非前列腺患者之间的主要鉴别代谢产物是乳酸盐和脂质。这些可能是追踪前列腺癌症发展最可靠的生物标志物。
{"title":"Metabolomic Profile in Patients with Malignant Disturbances of the Prostate: An Experimental Approach","authors":"H. García-Perdomo, Leidy Vanessa Mena Ramirez, J. Wist, Adalberto Sanchez","doi":"10.1055/s-0042-1744253","DOIUrl":"https://doi.org/10.1055/s-0042-1744253","url":null,"abstract":"\u0000 Purpose To identify metabolites in humans that can be associated with the presence of malignant disturbances of the prostate.\u0000 Methods In the present study, we selected male patients aged between 46 and 82 years who were considered at risk of prostate cancer due to elevated levels of prostate-specific antigen (PSA) or abnormal results on the digital rectal examination. All selected patients came from two university hospitals (Hospital Universitario del Valle and Clínica Rafael Uribe Uribe) and were divided into 2 groups: cancer (12 patients) and non-cancer (20 patients). Cancer was confirmed by histology, and none of the patients underwent any previous treatment. Standard protocols were applied to all the collected blood samples. The resulting plasma samples were kept at -80°C, and a profile of each one was acquired by nuclear magnetic resonance (NMR) using established experiments. Multivariate analyses were applied to this dataset, first to establish the quality of the data and identify outliers, and then, to model the data.\u0000 Results We included 12 patients with cancer and 20 without it. Two patients were excluded due to contamination with ethanol. The remaining ones were used to build an Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) model (including 15 non-cancer and 10 cancer patients), with acceptable discrimination (Q2 = 0.33). This model highlighted the role of lactate and lipids, with a positive association of these two metabolites and prostate cancer.\u0000 Conclusions The primary discriminative metabolites between patients with and without prostate cancer were lactate and lipids. These might be the most reliable biomarkers to trace the development of cancer in the prostate.","PeriodicalId":38070,"journal":{"name":"Urologia Colombiana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42743095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alto porcentaje de ausencia de reflejo bulbocavernoso en pacientes neurológicamente sanos con disfunción vesical 神经健康膀胱功能障碍患者球海绵状反射缺失率高
Pub Date : 2022-06-01 DOI: 10.1055/s-0042-1743509
Berenice Alcaraz-Contreras, Guadalupe Guerrero-Reyes, A. Gutiérrez-González, Ricardo Hernández-Velázquez, David Fernando Taboada-Lozano, Rigoberto Pallares-Méndez
Introducción y Objetivo El reflejo bulbocavernoso (RBCV) se ha observado ausente incluso en pacientes neurológicamente sanos. Los trastornos funcionales del piso pélvico deben incluir su evaluación.Nuestro objetivo primario fue evaluar la prevalencia de ausencia de RBCV en pacientes sanos. El objetivo secundario fue observar la afectación del RBCV en presencia de otras comorbilidades cómo enfermedad neurológica y diabetes mellitus tipo 2. Métodos Estudio descriptivo y retrospectivo, en el que se revisaron mil expedientes clínicos de pacientes sometidos a estudio urodinámico a quienes se les realizó exploración mecánica del RBCV como parte de una exploración rutinaria. Se realizó estadística descriptiva para las variables cuantitativas y cualitativas utilizando la prueba tde Student y la de chi cuadrado, respectivamente. Se consideraron estadísticamente significativos valores de p < 0,05. Resultados La muestra tenía una media de edad de 59,84 años (desviación estándar [DE]: ± 14,13 años), y contenía 36,19% de mujeres y 21,13% de hombres sin enfermedad neurológica y RBCV ausente. Se observó mayor ausencia de RBCV en pacientes con presencia de enfermedad neurológica en comparación con pacientes neurológicamente sanos: 21,6% versus 10,6%, respectivamente (p < 0,0001); además, se observó una ausencia importante de RBCV en presencia de diabetes mellitus en comparación con pacientes no diabéticos: 30.8% versus 18.8%, respectivamente (p < 0,0001). No se observaron diferencias al comparar grupos con respecto a disfunción vesical. Conclusión La ausencia de RBCV no es exclusiva de una enfermedad neurológica con repercusión de síntomas del tracto urinario inferior, y la proporción de pacientes neurológicamente sanos con ausencia de RBCV no es despreciable. No se encontró una diferencia significativa en los grupos con ausencia de RBCV con respecto a disfunción vesical.
介绍和目的即使在神经系统健康的患者中也观察到球春季反射(RBCV)缺失。盆底功能紊乱应包括其评估。我们的主要目标是评估健康患者缺乏RBCV的患病率。次要目的是观察在其他合并症(如神经系统疾病和2型糖尿病)的情况下RBCV的影响。方法:描述性和回顾性研究,回顾了1000份接受尿动力学研究的患者的临床档案,这些患者接受了RBCV机械扫描,作为常规扫描的一部分。分别使用TDE学生测试和卡方测试对定量和定性变量进行描述性统计。p值被认为具有统计学意义<-0.05。结果样本平均年龄为59.84岁(标准差[SD]:'14.13岁),其中36.19%的女性和21.13%的男性没有神经系统疾病和缺乏RBCV。与神经系统健康患者相比,神经系统疾病患者的RBCV缺乏率更高:分别为21.6%和10.6%(P<0.0001);此外,与非糖尿病患者相比,糖尿病患者的RBCV明显缺乏:分别为30.8%和18.8%(p<0.0001)。在比较各组膀胱功能障碍方面没有观察到差异。结论RBCV缺乏并不仅仅是一种神经系统疾病,会影响下尿路症状,神经系统健康的RBCV缺乏患者的比例不容忽视。与膀胱功能障碍相比,没有RBCV的组没有发现显着差异。
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引用次数: 0
Ionizing Radiation Exposure in Children with Vesicoureteral Reflux: Should We Be Alarmed? 儿童膀胱输尿管反流的电离辐射暴露:我们应该警惕吗?
Pub Date : 2022-06-01 DOI: 10.1055/s-0041-1740591
Nicolás Fernández, L. Villarraga, Julián Chavarriaga, J. Prada, Valeria Restrepo, Jaime Pérez
Objectives Ionizing radiation imaging is commonly used for diagnosis and follow up in children with vesicoureteral reflux (VUR). We aim to measure the effective dose (mSv) in patients with VUR. Methods We reviewed our electronic database of patients under 8-years-old with VUR. Primary endpoint was to calculate the effective radiation dose (ED). Absolute frequencies and percentages were reported for global qualitative variables. This study conducted a logistic regression model to calculate the odds ratio for radiation exposure. Analysis was performed using STATA version 14.0 (StataCorp LLC, College Station, TX, EEUU). Results A total of 140 patients were found, 97 were assessed for eligibility. We included 59 patients in the final analysis. Mean age was 20 ± 17.9 months, 66% were females. Most cases of VUR were bilateral (44%) and high grade (93.4%). The lowest number of studies per patient was two, with a minimum radiation of 5.7 mSv. The highest radiation was estimated at 20.7 mSv corresponding to a total of five studies. Logistic regression showed that highest grades of VUR and age of first UTI episode were associated with higher ED (OR, 1.7; 95% CI, 0.87-3.31), (OR 1.02; 95% CI 0.97-1.07) respectively. A mean ED for children with VUR was estimated of 5.5 ± 3 mSv/year. Conclusion In our study, the children with VUR were exposed to 5.5 mSv/year without counting the natural background radiation, which is alarming, and we believe should raise awareness worldwide in how we are unnecessarily diagnosing indolent VUR cases and following patients.
目标 电离辐射成像通常用于儿童膀胱输尿管反流(VUR)的诊断和随访。我们的目的是测量VUR患者的有效剂量(mSv)。方法 我们回顾了8岁以下VUR患者的电子数据库。主要终点是计算有效辐射剂量(ED)。报告了全球定性变量的绝对频率和百分比。本研究采用逻辑回归模型计算辐射暴露的比值比。使用STATA 14.0版(StataCorp LLC,College Station,TX,EEUU)进行分析。后果 共发现140名患者,其中97人接受了资格评估。我们将59名患者纳入最终分析。平均年龄为20±17.9个月,女性占66%。大多数VUR病例为双侧(44%)和高级别(93.4%)。每位患者的最低研究次数为两次,最低辐射量为5.7 mSv。最高辐射量估计为20.7 mSv,相当于总共五项研究。Logistic回归显示,VUR的最高级别和首次UTI发作的年龄分别与较高的ED相关(OR,1.7;95%CI,0.87-3.31),(OR 1.02;95%CI 0.97-1.07)。VUR儿童的平均ED估计为5.5±3 mSv/年。结论 在我们的研究中,VUR儿童在不计算自然背景辐射的情况下暴露于5.5 mSv/年,这令人担忧,我们认为应该提高全世界对我们如何不必要地诊断惰性VUR病例和跟踪患者的认识。
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引用次数: 0
Gender Dysphoria Publication Trends: A Bibliometric Analysis between 1900 and 2018 性别阅读障碍的出版趋势:1900年至2018年的文献计量分析
Pub Date : 2022-06-01 DOI: 10.1055/s-0041-1730319
N. Fernández, L. Zuluaga, Gabriela París, María Juana Norato, J. Silva, Jaime Pérez
Objective Research on gender dysphoria (GD) has been growing over the last decades with increasing interest in understanding and characterizing the causal relationships between psychological, genetics, hormonal, and sociocultural factors. Changes and acceptance of this condition as non-pathologic have led to significant changes in general perspective and its management over time. Our objective is to carry out a bibliometric analysis to know the publication trends and quality of evidence related to gender dysphoria. Methods A systematic search and critical review of the literature was carried out between January 1900 and December 2018 to perform a bibliometric analysis. Research was done in the following databases: OVID, PubMed, EMBASE, Scopus, Web of Science and Google Scholar. The medical subject headings (MeSh) terms used were: gender dysphoria; and surgery and psychology. The results were plotted using the VOSviewer version 1.6.8. Statistical analyses were performed with the IBM SPSS, Version 25.0. Results A total of 1,239 manuscripts were identified, out of which 1,041 were selected. The average number of cited times per year per manuscript is 1.84 (interquartile range [IQR] 0-2.33). The average impact index was 47.8 (IQR 20-111.6). The median of total citations per manuscript was 3 (IQR 0-33.1), and the highest number of citations per manuscript was 484. Most publications focus on the psychological aspects of GD, and there is a significant amount of manuscripts related to social and anthropological issues. Most articles have a low level of scientific evidence. Conclusion There is a great amount of published literature on GD; however, there is a significant level of disagreement in many respects on this topic. Regarding surgical gender-affirmation, there is a lack of information supported by high level of evidence to uphold the emerging expansion of medical practices.
客观的 在过去的几十年里,随着人们对理解和表征心理、遗传学、激素和社会文化因素之间的因果关系越来越感兴趣,对性别焦虑症(GD)的研究也在增长。随着时间的推移,对这种非病理性疾病的改变和接受导致了总体观点及其管理的重大变化。我们的目标是进行文献计量分析,以了解与性别焦虑症相关的出版趋势和证据质量。方法 在1900年1月至2018年12月期间,对文献进行了系统的检索和评论,以进行文献计量分析。研究在以下数据库中进行:OVID、PubMed、EMBASE、Scopus、Web of Science和Google Scholar。使用的医学主题标题(MeSh)术语有:性别焦虑症;以及外科和心理学。使用VOSviewer 1.6.8版绘制结果。使用IBM SPSS 25.0版进行统计分析。后果 共鉴定了1239份手稿,其中1041份被选中。每份手稿每年的平均被引用次数为1.84次(四分位间距[IQR]0-2.33)。平均影响指数为47.8(IQR20-111.6)。每份手稿的总引用次数中位数为3次(IQR 0-33.1),每份手稿的最高引用次数为484次。大多数出版物都关注GD的心理方面,还有大量与社会和人类学问题有关的手稿。大多数文章的科学证据水平很低。结论 有大量关于GD的已发表文献;然而,在这个问题上,许多方面都存在很大程度的分歧。关于手术性别确认,缺乏有高水平证据支持的信息来支持医疗实践的新扩展。
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引用次数: 0
Quadratus Lumborum Block for Upper Tract Urological Surgery in Pediatric Patients 腰方形块在小儿上尿路外科的应用
Pub Date : 2022-06-01 DOI: 10.1055/s-0042-1743510
C. Hoffmann, A. Harb, L. Woo, J. Hannick
Objective Among regional blocks, the quadratus lumborum fascial plane block (QLB) has been well described, but the description of its use and efficacy for pediatric patients undergoing upper abdominal urologic surgery is limited. We present a case series examining the use of the QLB for postoperative pain management in children undergoing upper tract surgery. Methods From August 2019 to August 2020, through a chart review, we identified 5 patients who had undergone a QLB for upper urinary tract surgery via a flank incision. Posterior QLB was performed after induction of general anesthesia. A single injection of 0.5mL/kg of either 0.25% or 0.5% ropivacaine with 1mcg/kg of clonidine was administered. Patients received fentanyl IV (1 mcg/kg), and acetaminophen IV (15mg/kg) as adjuvants during the operation. Postoperative pain was managed with oral acetaminophen and ibuprofen. Results The average postoperative pain score during the entire admission was 1, with the lowest being 0 and highest, 3. No administration of rescue narcotics was required in the postanesthesia care unit or on the floor. The average length of stay ranged from 0 to 1 day. No complications associated with the regional QLB were identified. Conclusions Our series suggests the QLB may be considered as a regional anesthetic option to minimize narcotic requirements for children undergoing upper abdominal urological surgery via flank incision. Additional studies are needed to compare the efficacy of the QLB versus alternate regional anesthetic blocks for upper tract urological surgery via flank incision in children and to determine effective dosing and use of adjuvants.
客观的 在区域块中,腰方筋膜平面块(QLB)已被很好地描述,但对其在接受上腹部泌尿外科手术的儿童患者中的使用和疗效的描述有限。我们提出了一系列病例,研究QLB在接受上呼吸道手术的儿童术后疼痛管理中的应用。方法 从2019年8月到2020年8月,通过图表回顾,我们确定了5名通过侧翼切口接受QLB上尿路手术的患者。全麻诱导后进行后QLB。单次注射0.5mL/kg 0.25%或0.5%罗哌卡因和1mcg/kg可乐定。患者在手术期间接受芬太尼静脉注射(1 mcg/kg)和对乙酰氨基酚静脉注射(15mg/kg)作为佐剂。术后疼痛采用口服对乙酰氨基酚和布洛芬治疗。后果 整个入院期间的平均术后疼痛评分为1,最低为0,最高为3。麻醉后护理室或地板上不需要使用救援麻醉剂。平均住院时间为0至1天。未发现与区域QLB相关的并发症。结论 我们的系列研究表明,QLB可以被视为一种区域麻醉选择,以最大限度地减少通过侧面切口接受上腹部泌尿外科手术的儿童的麻醉需求。需要进行更多的研究,以比较QLB与替代区域麻醉块在儿童侧切口上尿路外科手术中的疗效,并确定佐剂的有效剂量和使用。
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引用次数: 0
Comparación de la costo-efectividad de la nefrolitotomía percutánea y de la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 a 30 mm en Colombia 哥伦比亚20至30'01mm肾结石患者经皮肾镜取石术和柔性钬激光逆行肾镜取石术的成本-效果比较
Pub Date : 2022-05-18 DOI: 10.1055/s-0042-1759624
H. Lopez, Silvia Riveros, A. Diaz, Diana Maria Chaparro, G. Monroy
Resumen Introducción y Objetivo  Con el advenimiento de nuevas tecnologías, vienen controversias respecto al espectro de sus aplicaciones. El costo derivado de estas tecnologías juega un papel muy importante en el momento de la toma de decisiones terapéuticas. Es por esto que consideramos relevante estimar la costo-efectividad de la nefrolitotomía percutánea comparada con la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm en Colombia. Materiales y Métodos  Por medio de la construcción de un modelo de árbol de decisión usando el programa Treeage (TreeAge Software, LLC, Williamstown, MA, EE.UU.), se realizó una comparación entre la nefrolitotomía percutánea y la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm. La perspectiva fue la del tercer pagador, y se incluyeron los costos directos. Las cifras fueron expresadas en pesos colombianos de 2018. La mejoría clínica, definida como el paciente libre de cálculos, fue la unidad de resultado. Se hizo una extracción de datos de efectividad y seguridad por medio de una revisión sistemática de la literatura. La razón de costo-efectividad incremental fue calculada. Resultados  El modelo final indica que la nefrolitotomía percutánea puede ser considerada como la alternativa más costo-efectiva. Los hallazgos fueron sensibles a la probabilidad de mejoría clínica de la nefrolitotomía percutánea. Conclusión  Teniendo en cuenta las variables económicas, los supuestos del modelo y desde la perspectiva del tercer pagador, la nefrolitotomía percutánea para el tratamiento de pacientes con cálculos renales de 20 mm a 30 mm es costo-efectiva en nuestro país. Estos hallazgos fueron sensibles a los costos y a la efectividad de los procedimientos quirúrgicos.
本研究的目的是分析在不同的研究领域中,在不同的研究领域中,在不同的研究领域中,在不同的研究领域中,在不同的研究领域中,在不同的研究领域中,在不同的研究领域中。这些技术的成本在治疗决策中起着非常重要的作用。因此,我们认为评估经皮肾碎石切开术与灵活逆行holmio激光肾碎石切开术在哥伦比亚20 - 30 mm肾结石患者中的成本效益是相关的。建筑材料和方法通过使用决策树模型方案Treeage Treeage软件,LLC (Williamstown, MA,),比较了nefrolitotomía percutánea灵活与钬激光在逆行性和nefrolitotomía litiasis患者肾20毫米至30毫米。从第三个付款人的角度来看,直接费用也包括在内。这些数字以2018年哥伦比亚比索表示。临床改善,定义为无结石患者,是结果的单位。通过系统的文献综述,提取有效性和安全性数据。计算增量成本效益比。结果表明,经皮肾石切开术是最具成本效益的选择。这些结果对经皮肾石切开术临床改善的可能性很敏感。结论:经皮肾石切开术治疗20 - 30毫米肾结石患者在我国具有成本效益,考虑到经济变量、模型假设和第三付款人的观点。这些发现对手术的成本和效果是敏感的。
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引用次数: 0
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Urologia Colombiana
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