Background and objectives Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system.Design, setting, participants, & measurements A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+).Results The combination of APD$6-9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD$6-9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD$9-15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD$9-15 mm alone. The LR+ for surgery for diffuse caliectasis and APD$6-9 mm was higher than for APD$6-9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD$9-15 mm and diffuse caliectasis than APD$9-15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD$6-9 mm or $9-15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05).Conclusions These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.
Introduction:Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for evaluation of nodal involvement in patients with penile cancer and nonpalpable lymph nodes. Nevertheless, SLNB is not used in a regular basis due to the lack of studies that adequately characterize the performance of this procedure. The purpose of this study was to evaluate the diagnostic performance of SLNB in patients with infiltrative penile carcinoma without palpable inguinal lymph nodes in a Colombian population.Materials and Methods:This is a retrospective observational study of 89 patients diagnosed with infiltrative penile squamous cell carcinoma with nonpalpable inguinal lymph nodes. These patients underwent partial or complete penectomy, along with SLNB, between 2008 and 2017. Those individuals with a positive SLNB underwent inguinal lymphadenectomy, while those with a negative SLNB were followed on a quarterly basis with a physical examination and imaging to assess relapse. Statistical analysis was done using the STATA 14 software. A contingency table was made to calculate sensitivity, specificity, positive predictive value, negative predictive value, and exactitude, each one with its own confidence interval (CI) of 95%.Results:There was an average follow-up of 31.4 months, and all 89 patients were evaluated; most primary tumors were T2 (55%), followed by T1 (37%), all of which were subclassified as T1b and T3 (8%). Tumours were most frequently located in the glans (43%). All patients were classified as cN0 and underwent SLNB. Sixty-one patients (69%) tested negative in the SLNB, four of whom (6%) presented with lymph node relapse. On the other hand, 28 patients (31%) tested positive in the SLNB and consequently underwent inguinal lymphadenectomy, seven of whom had negative lymph nodeinvolvement (25% false positives). According to the results, the sensitivity was 84% (95% CI, 65.3–93.6) and the specificity was 89% (95% CI, 79.4–94.7), with a false-negative rate of 6.5%.Conclusions:The SLNB using radiotracer can be a useful method for lymph node staging in patients with penile cancer and nonpalpable lymph nodes when performed in experienced centers.
Introducción La obesidad afecta diversos aspectos físicos, psicológicos y sociales. Recientemente se ha comenzado a estudiar su relación con la función sexual y el efecto de las intervenciones dirigidas a reducir el peso. Objetivo Describir los cambios inducidos por la cirugía bariátrica en la función sexual en un grupo de pacientes obesos. Métodos Estudio observacional prospectivo de pacientes con obesidad mórbida, intervenidos con cirugía bariátrica. Se evaluó la función sexual en hombres con el cuestionario abreviado de función sexual (SHIM) y la encuesta de autoestima y relaciones (SEAR), y en mujeres con el Índice de función sexual femenina (IFSF). La calidad de vida se evaluó con el cuestionario SF-12. Se utilizaron pruebas estadísticas no paramétricas. Resultados Se incluyeron 19 pacientes, 13 mujeres con un promedio de edad de 45,3 años (22–59) y 6 hombres con un promedio de 41 años (36–54). El seguimiento promedio fue de 19 meses (13,1–25,9). Para el IFSF, todos los dominios demostraron mejoría, aunque la variable deseo fue la única en la que se obtuvo una diferencia estadísticamente significativa (p = 0.027). Los puntajes obtenidos con la escala SHIM, demuestran disminución en la severidad de la disfunción eréctil de 16,8 (8–21) a 22,16 (18–25) (p = 0,059). En calidad de vida, tanto mujeres como hombres reportaron un incremento estadísticamente significativo (p = 0.036 y p = 0.002, respectivamente). Conclusiones La cirugía bariátrica tiene un impacto altamente favorable en la calidad de vida y cambios positivos en todos los dominios de la función sexual de hombres y mujeres. Es posible que esos cambios se vean influidos por variables físicas y psicosociales que deben medirse con investigaciones futuras.
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