Search PubMed⌕ Search

Biomedical subjects

Valdemar Ortiz

Publications and source records attributed to Valdemar Ortiz.

At least 19 recordsLinked to original sources
PubMed2006

Could a rural lifestyle decrease the prevalence of erectile dysfunction?

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) in a specific population and explore potential correlates with lifestyle. SUBJECTS AND METHODS: This prospective observational study, covering a population of a very small rural town, included 2000 men aged > or = 20 years from a total population of 121 831 (51% female and 49% male). The International Index of Erectile Function was completed by each of the 2000 men at their homes over a 1-year period. Another questionnaire assessing socio-economic status and health-related determinants of ED were also completed. RESULTS: All 2000 men completed the questionnaires; overall, only 34 reported ED (1.7%). The frequency of mild, mild to moderate, moderate and severe ED was 12%, 29%, 20% and 38%, respectively. Significantly more men aged > 51 years had ED than those aged <41 years (0.05% and 0.45%, respectively; P < 0.001). There was no difference in ED with salary levels. CONCLUSION: The prevalence of ED in this particular rural population of Brazil was very low, at only 1.7%. Although ED increases with age, this association was not apparent for all age groups. It seems that several others factors, e.g. lifestyle, culture and diet, could be important for the onset of ED.

Adult↗
PubMed2006

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 < 0.0001). In contrast, there was no difference before and after the treatment in the placebo group (from 17.0 +/- 3.1 to 17.7 +/- 5.6, P > 0.05). In the KRG group, 20 patients (66.6%), reported improved erection, significant in the global efficacy question (P < 0.01); in the placebo group there was no significance. Scores on questions 2 (rigidity), 3 (penetration), 4 and 5 (maintenance), were significantly higher for KRG than those for the placebo when those questions were answered after 12 weeks of each treatment (P < 0.01). When the score in the KRG group was compared to the placebo group after the treatment, there was a significant improvement in total score (IIEF-5 score) in questions 3 and 5 for the KRG-treated group (P < 0.001 and P < 0.0001, respectively). The levels of serum testosterone, prolactine and cholesterol after the treatment were not statistically significant different between the KRG and the placebo group (P > 0.05). CONCLUSION: Our data show that KRG can be an effective alternative to the invasive approaches for treating male ED.

Adult↗
PubMed2006

Sperm nuclear DNA fragmentation in adolescents with varicocele.

OBJECTIVE: To verify if sperm from adolescents with varicocele have an increased rate of DNA fragmentation when compared with adolescents without varicocele. DESIGN: Controlled prospective study. SETTING: Patients in an academic research environment. PATIENT(S): Adolescent patients with a clinical diagnosed bilateral varicocele, grades II and III, and adolescent patients without a varicocele. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rate of sperm DNA fragmentation as assessed by the Comet assay, graded as class I (no DNA fragmentation), II (little DNA fragmentation), III (meaningful DNA fragmentation), or IV (high DNA fragmentation). RESULT(S): A higher percentage of cells with no DNA fragmentation (class I) was found in the nonvaricocele group (47.62 +/- 7.69) when compared with the varicocele group (27.52 +/- 10.73). A higher percentage of sperm with class III and class IV DNA fragmentation was found in the varicocele group (20.43 +/- 8.97, and 19.57 +/- 10.68) when compared with the nonvaricocele group (11.38 +/- 5.55, and 5.71 +/- 2.35). CONCLUSION(S): Although standard semen analysis showed no difference between the groups, adolescents with varicocele have an increase in sperm nuclear DNA fragmentation. Thus, DNA fragmentation evaluation could be important in deciding treatment options for adolescent patients.

Adolescent↗
PubMed2006

Renoduodenal fistula after renal tumor ablation with radiofrequency.

PURPOSE: To report a renoduodenal fistula after renal tumor ablation with radiofrequency (RFA). METHODS: A 1-inch right anterior renal cell carcinoma was subjected to percutaneous RFA under sedation. We used a 14-gauge probe guided by ultrasonographic images in real time. RESULTS: On the fifth day the computerized tomography with double contrasts showed a fistula between the pelvis and the duodenum. CONCLUSIONS: A major concern regarding this approach relates to the anterior renal tumor and the guided images during the procedure. To our knowledge, there has never been any report of renoduodenal fistula after RFA.

Adult↗
PubMed2006

Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study.

OBJECTIVE: To report a series of children with lower urinary tract dysfunction (LUTD) whose urge syndrome was treated by electrical stimulation, and their voiding dysfunction by biofeedback; none of the children were using anticholinergic drugs during treatment. PATIENTS AND METHODS: In all, 36 children who presented with symptoms of urinary urgency and/or daily incontinence completed the treatment and were prospectively evaluated. The mean (range) follow-up was 13.8 (4-24) months, and their mean age 7 (3-14) years, 17 children were aged <5 years. The children were divided into two groups: group 1, with urge syndrome treated with superficial parasacral electrical stimulation, and group 2, with voiding dysfunction, treated with biofeedback. RESULTS: In group 1, the mean (range) number of electrical stimulation sessions was 13.1 (4-20). Of the 19 children treated, 12 had a complete clinical improvement, six a significant improvement, and one a mild improvement. In group 2, the mean (range) number of biofeedback sessions was 6 (4-14). Of the 17 children treated, there was complete improvement of symptoms in 10, significant improvement in two and mild improvement in five. Six children who had no resolution of symptoms after biofeedback had salvage therapy with electrical stimulation, after which four had complete improvement of symptoms, and two a 90% and 40% improvement, respectively. Taking the two groups together, after treatment, four children developed isolated episodes of urinary tract infection. Of 21 children with nocturnal enuresis, bed-wetting continued in 13 (62%) after treatment. CONCLUSION: In this short-term follow-up, the nonpharmacological treatment of voiding dysfunction using biofeedback, and of urge syndrome by electrical stimulation, was effective for treating LUTD in children.

Adolescent↗
PubMed2005

[Effect of allopurinol on rat testicles morphology, submitted to ischaemia for spermatic cord torsion followed by reperfusion].

PURPOSE: In this investigation has been studied the effect of the allopurinol on the reperfusion injury phenomenon in testicles of rats. METHODS: Eighty adults Wistar rats were divided in 4 groups: sham without allopurinol, sham with allopurinol, right testicular torsion for one hour without allopurinol and right testicular torsion for one hour with allopurinol. Bilateral orchiectomy was performed 60 days of the experiment and the testis were processed for optical microscopy, and examined to asses the seminiferous ducts and the spermatogenic cells. RESULTS: There was significant atrophy and histological damage of the right testis. CONCLUSION: Allopurinol did not protected the testis against the effects of the reperfusion injury.

Allopurinol↗
PubMed2005

Urinary hyaluronan as a marker for the presence of residual transitional cell carcinoma of the urinary bladder.

OBJECTIVE: The purpose of this report is to evaluate the value of urinary hyaluronan (HA) as a maker of residual transitional cell carcinoma (TCC). PATIENTS AND METHODS: Urine samples were collected from 83 patients hospitalized for transurethral resection (TUR). Patient ages ranged from 36 to 86 years. Samples were taken both before and after surgery. HA analysis was performed using an "ELISA-like" fluorometric assay. RESULTS: Patients were divided into two groups: a control group whose previous diagnosis was negative for tumors (n=22) and another with positive diagnosis for tumors (n=61) which was further sub-divided into with and without residual tumor. After the second procedure 47 individuals did not display residual tumor, whereas 14 (23%) did. The average HA in the control group was 8.3 microg/L pre- and 7.1 post-operatively, hence, no change occurred (p=0.471). In the group with TCC patients, the HA dropped from 885.5 microg/L to 215.3 microg/L with residual tumors and from 234.3 microg/L to 11.2 microg/L for those without residual tumor. Using a cut-off value of 20 microg/L, the sensitivity to detect residual tumor is 92.9% and specificity is 83%. CONCLUSION: HA in addition to being one of the best markers for the initial evaluation of bladder carcinoma can be used to determine the presence of a residual tumor. This is associated with poor prognosis.

Adult↗
PubMed2005

Histomorphometry of penile smooth muscle fiber in severe erectile dysfunction.

CONTEXT AND OBJECTIVE: Smooth muscle fiber has fundamental importance in erection. Alterations in its function or quantity may be associated with erectile dysfunction. The study objective was to assess the proportion of penile smooth muscle fiber in patients with severe erectile dysfunction. DESIGN AND SETTING: Clinical study, in the Sexual Dysfunction Group, Universidade Federal de São Paulo (Unifesp), and in the Anatomy Laboratory, Universidade Estadual do Rio de Janeiro (UERJ). METHODS: Twenty patients with severe erectile dysfunction were selected to form two groups of ten patients: one with normal arterial flow (age range: 44 to 78 years) and the other with altered arterial flow (age range: 38 to 67 years). These groups were compared with a group formed by ten cadavers aged 18 to 25 years that were presumed to have been potent. Quantification of the smooth muscle fibers was done by means of an immunohistochemical study. RESULTS: The proportion of smooth muscle fiber found was 41.15% for the control group. The patients with erectile dysfunction and normal arterial flow presented 27.24% and those with altered arterial flow presented 25.74%; 19 patients presented at least one chronic disease or risk factor for erectile dysfunction, with prominence for diabetes mellitus, systemic arterial hypertension and smoking. CONCLUSION: Among patients with severe erectile dysfunction, the arterial flow on its own does not present interference in the proportion of smooth muscle fiber. The diminution of the proportion of smooth muscle fiber may result from chronic diseases and vascular risk factors.

Adolescent↗
PubMed2005

[Prostate cancer dedifferentiation following antiandrogen therapy: a morphological finding or an increased tumor aggressiveness?].

BACKGROUND: Neoadjuvant androgen deprivation in prostate cancer induces tumor volume regression but does not improve outcome of the patient. A possible explanation for this phenomenon could be an increase of the residual tumor aggressiveness brought about by antiandrogen therapy. The purpose of the present study was to evaluate the frequency of tumor dedifferentiation following androgen blockade in prostate cancer and to determine if the remaining tumor shows signs of increased aggressiveness. METHODS: Thirty patients bearing locally advanced prostate cancer (stages T2c - T3) were submitted to neoadjuvant anti-androgenic therapy during four months followed by radical prostatectomy. Gleason scores from biopsy and surgical specimens were compared. Furthermore, the cell proliferation index was evaluated by immunohistochemistry assay for PCNA, tests with strong nuclear staining were considered positive. The percentage of positive nuclei, counted in 500 cells, was determined in several categories of the Gleason score from surgical specimens. RESULTS: In 11(37%) surgical specimens the Gleason score was equal or lower than that found in the biopsy and in 19 (63%) the total score was higher in the surgical specimens (p<0.05). The median of PCNA expression was 4.5%, 10%, 12% and 14% in Gleason scores 2-4, 5-6,7 and 8-10, respectively (p>0.05). The median of cell proliferation indexes was 9% for glandular or specimen confined tumors and was 17% for extraprostatic tumors (p<0.05). CONCLUSION: The lower Gleason score was found in almost 2/3 of patients submitted to antiandrogen therapy. However, the cell proliferation index measured by PCNA was the same for tumors with lower or higher Gleason scores. It seems that cell dedifferentiation seen after neoadjuvant androgen deprivation represents a mere morphologic phenomenon and not a real increase in tumor aggressiveness.

Aged↗
PubMed2005

The impact of pronuclear orientation to select chromosomally normal embryos.

PURPOSE: To find an effective method to select embryos from ICSI with better chromosomal status when preimplantation-genetic-diagnosis (PGD) is not applied. METHODS: Several morpholological evaluations were done in same embryos. Embryos from ICSI were classified on day 1 according to pronuclear-nucleoli arrangement. On day 3, classification was done according to number, fragmentation, size and shape of cells. In some patients, embryos exhibiting good quality on day 3 (at least six regular blastomeres with cell fragmentation lower than 20%) were also submitted to PGD, irrespective to pronuclear-nucleoli morphology. RESULTS: Forty-two per cent of normally fertilized embryos showed pronuclear-nucleoli-good-morphology; from those, 86% were also classified as good quality on day 3. Good-quality embryos submitted to PGD have shown lower chromosomal abnormality rates when also classified as pronuclear-nucleoli-good-morphology. CONCLUSIONS: Pronuclear-nucleoli morphology seems to be correlated with PGD results. This criterion may prove useful for pre-select embryos with normal chromosomal package when PGD is not applied.

Cell Division↗
PubMed2005

Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermic patients.

OBJECTIVE: To assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa from different types of azoospermia. DESIGN: Retrospective study. SETTING: Academic medical center and private fertility center. PATIENT(S): Two hundred twelve patients underwent 257 ICSI cycles. INTERVENTION(S): Cycles of ICSI were divided into four groups according to the etiology of azoospermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular sperm aspiration and percutaneous epididymal sperm aspiration were the sperm retrieval methods used for ICSI. MAIN OUTCOME MEASURE(S): Fertilization, pregnancy, and miscarriage rates. RESULT(S): Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). CONCLUSION(S): Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal sperm was used compared with testicular sperm.

Abortion, Spontaneous↗
PubMed2005

High kidney stone risk in men working in steel industry at hot temperatures.

OBJECTIVES: To study the incidence of urinary lithiasis and metabolic alterations among male employees from a steel industry who were exposed to high temperatures in the work environment. METHODS: A retrospective cross-sectional study was performed and consisted of two stages. First, the incidence of urolithiasis among the industry's 10,326 employees was assessed. These employees were divided into two group's: group 1 (n = 1289) consisted of the hot-area workers (temperature greater than 45 degrees C) and group 2 (n = 9037) consisted of those working in areas at room temperature. In the second stage, 59 workers without urolithiasis who underwent a metabolic evaluation were divided into two group's: group 3 (n = 34) consisted of hot-area workers and group 4 (n = 25) consisted of those working in areas at room temperature. Evaluations were made of calcium, creatinine, and uric acid in serum; in the 24-hour urine samples, we assessed the volume, calcium, uric acid, citrate, and oxalate. RESULTS: Of the 10,326 workers, 181 (1.75%) had presented with at least one episode of urinary stones. Of these, 103 were among the hot-area workers (8.0%) and 78 among the room-temperature workers (0.9%; P <0.001). The metabolic evaluation showed that the hot-area group (group 3), compared with the room-temperature group (group 4), presented more frequently with hypocitraturia (55.8% versus 28%, P = 0.03) and low urinary volume (79.4% versus 48%, P = 0.01). CONCLUSIONS: Workers exposed to high temperatures presented with a ninefold risk of lithiasis. Hypocitraturia and low urine volumes were the metabolic alterations observed.

Adult↗
PubMed2005

The Boatman's knot: a single knot for renal-vein ligation during laparoscopic nephrectomy: description of technique and evaluation of feasibility and safety.

BACKGROUND AND PURPOSE: The endovascular stapler is the standard of care for renal-vein ligation during nephrectomy, but recently, some reports have addressed the need for lowering the costs in the operating room. The authors describe the first use of "boatman's knot" in renal-vein ligation during laparoscopic nephrectomy and tests of its safety and feasibility. MATERIALS AND METHODS: Sixteen bilateral laparoscopic nephrectomies were performed in female pigs. On the right side, the renal vein was ligated with the boatman's knot, and on the left side, the vein was ligated with conventional intracorporeal technique. The knots were performed by the same surgeon at initial laparoscopic training. The time required to tie the knots was measured. After bilateral nephrectomy, a midline incision was created, and the bursting pressure of the knots was measured with a manometer by saline infusion into the vena cava. RESULTS: The average knot-completion time was 45 seconds (range 30-50 seconds), and the average time needed to carry out the conventional suture was 202.5 seconds (range 186-228 seconds). After renal-vein transection, there was complete hemostasis in all cases. The mean bursting pressure was 179.9 mm Hg (range 126-304 mm Hg). In five cases, the rupture site was in a lumbar vein previously sutured, while in three cases, the rupture happened in the vena cava itself. CONCLUSION: The boatman's knot is feasible, safe, easy to learn, and faster than conventional intracorporeal suturing. This technique may replace the endovascular stapler. However, its clinical applicability remains to be determined.

Animals↗
PubMed2005

The Macedo-Malone antegrade continence enema procedure: early experience.

PURPOSE: The successful treatment of fecal incontinence can dramatically improve the quality of life of affected children. The introduction of the Malone antegrade continence enema provides the opportunity to manage previously resistant cases. However, using the to create this catheterizable channel is not always possible, and the duration of these antegrade enemas is a source of concern for the patients. We describe a new approach to create left continent colonic access to shorten the duration of these enemas, and report the experience gained from the first 9 cases managed at our institution. MATERIALS AND METHODS: During a 5-year period 9 patients underwent a Macedo-Malone antegrade continence enema at our institution. Incontinence was associated with myelomeningocele in 7 patients and anorectal malformation in 2. The antegrade continence enema procedure is begun by isolating a 2 cm flap in a tenia on the left colon (spleen flexure). A 12Fr silicone Foley catheter is placed on the mucosal surface of the flap to allow tubularization of the plate with interrupted polyglycolic acid 3-zero transverse sutures, creating an efferent tubular conduit. Antegrade colonic washouts were started 2 weeks after surgery with saline solution or tap water in all patients. RESULTS: Followup of our 9 cases ranged from 8 to 33 months (average 20.7). Enema volume varied from 250 to 800 ml, with administration taking from 45 to 60 minutes, and colonic evacuation occurred within 30 to 60 minutes of enema administration. Of the 9 patients 8 were completely continent and 1 was partially continent. Four patients experienced difficulty with catheterization initially because of stenosis of the stomal track. The affected stomas were dilated, which was successful in 1 case. Three patients subsequently required stomal revision. CONCLUSIONS: The Macedo-Malone procedure is a relatively straightforward operative approach providing an effective washout technique that is acceptable to parents and children.

Adolescent↗
PubMed2005

The tunica vaginalis dorsal graft urethroplasty: experimental study in rabbits.

PURPOSE: We created an experimental model of urethral defect and then repaired it using a tunica vaginalis graft applied on the dorsal surface of the urethra. We studied the histological and radiological characteristics of free tunica vaginalis graft urethroplasty. MATERIALS AND METHODS: In 20 New Zealand rabbits a dorsal urethral defect was created by excising a portion of the dorsal urethral surface. The tunica vaginalis graft was placed dorsally over the corpora cavernosa and tied with 4 interrupted sutures. The mucosal margin of the urethral defect was sutured to the graft using 6-zero polydioxanone sutures in continuous fashion. The animals were divided into 4 equal groups and were sacrificed 14 days, and 4, 8 and 12 weeks after surgery, respectively. A retrograde urethrogram was done at autopsy. The penis was sent for histological analysis and an experienced pathologist evaluated the severity of acute and chronic inflammation, foreign body reaction and scar formation. RESULTS: There were no deaths related to the procedure and no intraoperative complications. All rabbits voided spontaneously after surgery. Retrograde urethrograms showed no fistula or stricture. As time after surgery increased, the signs of inflammation response disappeared, and the orientation of collagen fibrils and smooth muscle fascicles resembled that of a normal urethra. The mesothelial lining of the tunica vaginalis gradually became replaced by a more stratified epithelial lining, similar to the urothelial lining of the native urethra. CONCLUSIONS: In the current study we noted that a tunica vaginalis graft placed dorsally can be a successful urethral substitute in the animal model.

Animals↗
PubMed2005

Does the less aggressive multimodal approach of treating bladder-prostate rhabdomyosarcoma preserve bladder function?

PURPOSE: The treatment of bladder-prostate rhabdomyosarcoma has evolved into multimodal therapy, including chemotherapy, radiotherapy and organ sparing surgery with bladder preservation. We investigated bladder function in children who underwent multimodal therapy at our institution and retained the original bladder for at least 6 months after treatment ended. MATERIALS AND METHODS: We evaluated 8 children with bladder-prostate rhabdomyosarcoma treated at our institution between 1999 and 2003 according to inclusion criteria. All patients underwent history, physical examination and urodynamic study at least 6 months after completion of treatment (range 6 to 39 months). RESULTS: All patients were treated following the same chemotherapy and radiotherapy scheme. Three patients (37.5%) were asymptomatic and had normal urodynamic studies, and 1 had only dysuria (this patient later underwent continent urinary diversion with transverse colon). The 4 remaining patients had urological complaints, and the urodynamic findings were reduced bladder capacity in 4, overactivity plus sensory urgency in 2, sensory urgency only in 1 and suprapubic pain during filling in 1. CONCLUSIONS: Among 8 patients 3 had normal urinary function and 4 had minor tolerable alterations. Cystectomy and urinary diversion were later necessary in only 1 patient due to disabling dysuria. The fact that the original functioning bladder was preserved in 7 of 8 patients suggests the feasibility of multimodal therapy. Long-term followup will still be necessary for definite conclusions, since we recognize that the deleterious effects, mainly of radiotherapy, may take longer to become evident.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Sperm retrieval techniques in rats with suppressed spermatogenesis by experimental cryptorchidism.

OBJECTIVE: Our aim was to assess the suppression of spermatogenesis and sperm retrieval rate after testicular sperm extraction (TESE) or testicular sperm aspiration (TESA) in adult rats with surgically induced cryptorchidism. METHODS: Adult rats were submitted to TESE and TESA procedures after 15 days of induced cryptorchidism. After spermatozoa retrieval, the testicles were extracted, weighed and a morphological analysis by conventional light microscopy was done. The numbers of spermatozoa retrieved in both TESA and TESE were rated and compared. RESULTS: Histological analysis of the testicles revealed Sertoli cell-only syndrome in 60% of the testicles, and maturation arrest in the remaining cryptorchid testicles. Significant differences were seen in the number of spermatozoa retrieved (P < 0.05) between cryptorchidic and control rats. When sperm retrieval techniques were compared, no differences were detected in the number of spermatozoa obtained (P > 0.05). CONCLUSIONS: It seems that a 15 day period of cryptorchidism is enough to induce spermatogenesis disorders. No differences were detected in the number of spermatozoa retrieved in the right or left testicles, irrespective of the testicular pole. Furthermore, and even more importantly, no differences in the retrieval rate were seen between the two techniques.

Animals↗