Browsing by Author "Silva-Ramos, M."
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- Toxina botulínica: aplicações terapêuticas na criança com disfunções miccionaisPublication . Silva-Ramos, M.Introdução e objectivo da revisão: Classicamente o tratamento das disfunções vesico-uretrais em crianças baseia-se nos antimuscarínicos, alfabloqueantes e no cateterismo vesical intermitente. Quando esta terapêutica falha, ou por pouca eficácia ou por efeitos adversos, é necessário recorrer a cirurgias agressivas como a enterocistoplastia de aumento. As injecções de toxina botulinica (TXB) no detrusor e no esfíncter foram recentemente introduzidas no tratamento destes casos refractários ao tratamento conservador. Realizamos uma revisão da literatura focada no tratamento da disfunção vesico-uretral com TXB na criança Observações: Encontramos apenas 14 artigos publicados sobre o uso de TXB especificamente na disfunção vesico-uretral pediátrica. Sendo estes referentes a 10 diferentes séries de pacientes. Sete séries incluíam apenas doentes com disfunção neurogénica e apenas dois contemplavam a aplicação de toxina no esfíncter. A aplicação de TXB no detrusor aumentou significativamente a capacidade vesical e diminuiu a pressão máxima do detrusor na grande maioria dos doentes, tornando-os continentes. A injecção de TXB no esfíncter diminuiu significativamente o resíduo pós-miccional, a pressão do detrusor que provoca perdas e aumentou o fluxo urinário, embora seja por vezes necessário injecções mensais até atingir o resultado pretendido. Conclusões: A TXB parece ser uma boa alternativa ao tratamento cirúrgico da hiperactividade do detrusor na população pediátrica. O uso de TXB no esfíncter em doentes com disfunção miccional parece promissor, no entanto mais estudos são necessários para avaliar qual o melhor método de administração, dose e a sua eficácia a longo prazo.
- Urinary ATP may be a dynamic biomarker of detrusor overactivity in women with overactive bladder syndromePublication . Silva-Ramos, M.; Silva, I.; Oliveira, O.; Ferreira, S.; Reis, M.; Oliveira, J.; Correia-de-Sá, P.Background Nowadays, there is a considerable bulk of evidence showing that ATP has a prominent role in the regulation of human urinary bladder function and in the pathophysiology of detrusor overactivity. ATP mediates nonadrenergic-noncholinergic detrusor contractions in overactive bladders. In vitro studies have demonstrated that uroepithelial cells and cholinergic nerves from overactive human bladder samples (OAB) release more ATP than controls. Here, we compared the urinary ATP concentration in samples collected non-invasively from OAB women with detrusor overactivity and age-matched controls. Methods Patients with neurologic diseases, history of malignancy, urinary tract infections or renal impairment (creatinine clearance <70 ml/min) were excluded. All patients completed a 3-day voiding diary, a 24 h urine collection and blood sampling to evaluate creatinine clearance. Urine samples collected during voluntary voids were immediately freeze-preserved for ATP determination by the luciferin-luciferase bioluminescence assay; for comparison purposes, samples were also tested for urinary nerve growth factor (NGF) by ELISA. Results The urinary content of ATP, but not of NGF, normalized to patients’ urine creatinine levels (ATP/Cr) or urinary volume (ATP.Vol) were significantly (P<0.05) higher in OAB women with detrusor overactivity (n = 34) than in healthy controls (n = 30). Significant differences between the two groups were still observed by boosting urinary ATP/Cr content after water intake, but these were not detected for NGF/Cr. In OAB patients, urinary ATP/Cr levels correlated inversely with mean voided volumes determined in a 3-day voiding diary. Conclusion A high area under the receiver operator characteristics (ROC) curve (0.741; 95% CI 0.62–0.86; P<0.001) is consistent with urinary ATP/Cr being a highly sensitive dynamic biomarker for assessing detrusor overactivity in women with OAB syndrome.
- What about vaginal extraction of the kidney? results of an online surveyPublication . Cabral, J.; Braga, I.; Branco, F.; Cavadas, V.; Fraga, A.; Silva-Ramos, M.PURPOSE: We aimed to characterize surgeons opinion about the vaginal extraction of the kidney after transperitoneal laparoscopic nephrectomy. Matherial and Methods: A 9-item questionnaire was published online (Survey Monkey TM) and publicized via email to a multidisciplinary pool of surgeons in Portugal. Data was collected and statistical analysis was performed using IBM SPSS Statistics, Version 21.0. RESULTS: Three hundred and fifty nine inquiries were sent, 154 surgeons completed the questionnaires (response rate of 43.0%). Fifty five point eight percent of the participants would choose the transvaginal approach for themselves or for a close relative. The most stated arguments were a better cosmesis (29.0%) expectancy of lower post operative pain (26.0%) and lower rate of incisional hernias (23.0%). Defenders of the transabdominal procedure justified with an expectancy of lower complication rate (39%), namely impairment of sexual function and fertility (22%). The female gender and the familiarity with transvaginal surgery were the stronger predictors of the option for this approach (70.6% vs 48.5%; p=0,016 and 85.3% vs 46.6%; p <0.001 respectively). CONCLUSIONS: Contrasting with similar surveys published on transvaginal NOTES, the vaginal specimen extraction after conventional laparoscopic nephrectomy was fairly accepted by the inquired surgeons.