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espanolAntecedentes: la incidencia del carcinoma de celulas renales (CCR) esta aumentando a nivel mundial debido al envejecimiento de la poblacion y al uso generalizado de estudios de imagenes. Objetivo: El objetivo de este estudio fue describir las caracteristicas y resultados perioperatorios de la cirugia de CCR en pacientes muy ancianos (PEV), ≥ 75 anos. Metodos: se trata de un estudio comparativo retrospectivo de 3656 pacientes que se sometieron al tratamiento por CCR entre 1990 y 2015 en 28 centros de ocho paises de America Latina. Comparamos las caracteristicas basales, asi como los resultados clinicos y perioperatorios segun los grupos de edad ( Resultados: Hubo 410 pacientes con PEV (11,2%). En el analisis bivariado, VEP tuvo un indice de masa corporal mas bajo (p 2 en 26.3% vs 12.4%, p estadio pT2 (OR 1,63, p = 0,04) se asociaron de forma independiente con complicaciones perioperatorias. Conclusiones: La reseccion quirurgica del CCR fue segura y exitosa en PEV. La edad ≥75 anos se asocio de forma independiente con complicaciones perioperatorias a los 30 dias. Sin embargo, la gran mayoria fueron complicaciones de bajo grado. La edad por si sola no debe orientar la toma de decisiones en estos pacientes, y el tratamiento debe adaptarse de acuerdo con el estado funcional y la gravedad de las comorbilidades. (REV INVEST CLIN.2020; 72 (5): 308-15) EnglishBackground: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups ( Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p 2 in 26.3% vs. 12.4%, p pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Background: Tumor burden and metastatic disease sites are well-established prognostic factors in many malignancies, including metastatic Renal Cell Carcinoma (mRCC). Objective: We aimed to evaluate the impact of bone metastasis (BM) location on clinical outcome of mRCC patients. Methods: This study is a retrospective analysis of 4060 mRCC patients from the Latin American Renal Cancer Group (LARCG) database. Clinico-pathological characteristics, 24-months-survival, overall survival (OS), and BM sites were collected. To estimate the association between BM location and clinical outcomes we used Cox regression method. Results: Out of 4060 patients, 530 (14.5%) had metastatic disease. Among those, we analyzed the fifty-six that had only BM. The median follow-up was 20.8 months (range from 0 to 188 months). Non-spinal BM (NSBM) were identified in 33 (58.9%) patients and spinal BM (SBM) in 23 (41.1%) patients. Median OS was 35 months, and 24-months OS was 76% for patients with NSBM and 46% with SBM (HR: 2.22). In multivariable analysis SBM (HR: 3.08), ASA classification 3-4 (HR: 2.37), non-cc histology (HR: 5.11), and age (HR 1.06) were independent prognostic factors for OS. Conclusions: Our study showed that SBM predicted shorter OS, suggesting that the location of BM may impact the clinical outcome of patients with mRCC.

There is no information about the evolution of robotic programs in public hospitals of Latin-America. To describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date. We conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25–75 centiles (IQR) were estimated. Since 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs. Adoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.

Background/AIMS: Osteoarthritis (OA), the commonest joint disorder, is a leading cause of disability. Symptomatic slow-acting drugs for OA (SYSADOA), particularly glucosamine plus chondroitin sulphate (GS/CS), are effective for symptom relief, protect joint cartilage and delay OA progression, with a good safety profile. D-002, a mixture of beeswax alcohols that inhibits both cyclooxygenase and 5-lipoxygenase activities, has been effective in experimental and clinical OA studies, showing also a chondroprotective effect.OBJECTIVES: To compare the effects of D-002 and GS/SC administered for 12 weeks on OA symptoms.METHODS: Participants were randomized to GS/CS (375/300 mg) or 50?mg D-002 once daily for 12 weeks. Symptoms were assessed by the Western Ontario and McMaster Individual Osteoarthritis Index (WOMAC) and the visual analogy scale (VAS) scores. The primary outcome was the reduction of the total WOMAC score. Secondary outcomes included WOMAC pain, stiffness and function scores, VAS score and rescue medication consumption.RESULTS: Of 60 randomized patients, 59 completed the study. D-002 and GS/SC reduced significantly total WOMAC score (72.1% and 78.5%, respectively), and pain, joint stiffness and physical function scores versus baseline. VAS scores decreased significantly with D-002 (76.6%) and GS/SC (76.8%). The reductions, significant from the second week, were enhanced over the trial. Rescue medications were consumed by 3/30 D-002 and 4/30 GS/SC patients. No differences between groups were found. Treatments were well tolerated.CONCLUSIONS: D-002 (50 mg/day) administered for 12 weeks was safe and comparable to GS/SC for alleviating OA symptoms (pain, stiffness, and functional limitation) (RPCEC00000180).

OBJECTIVE To prove that the thermal energy of CO2 lasers, when applied on the fistula, pyogenic sac, and septic bone in cases of osteomyelitis, creates an aseptic area, diminishes relapses, and promotes healing in those patients treated. SUMMARY BACKGROUND DATA CO2 laser surgery, whether used in a focused or unfocused manner, has been incorporated into surgical procedures because of its incisive, coagulating, and antiseptic properties. These forms and characteristics are especially useful in the treatment of chronic osteomyelitis. METHODS The authors recorded their experiences with 80 patients (10-75 years) with different types of chronic osteomyelitis. Classical surgical procedures were performed incorporating the CO2 laser beam. RESULTS Of the 80 patients, 45 healed with a single application combined with sequestrectomy implant removal, etc. Twenty-two patients needed up to three sessions to heal. Twelve patients did not heal, 1 asked for an amputation, and 3 were unavailable for follow-up procedures. We did not evaluate antibiotics prescribed, or cultures taken, due to the multiplicity of drugs used by chronic osteomyelitis patients with disease progression, and the various permutations and combinations of germs involved. CONCLUSIONS Although CO2 laser beam surgery cannot replace classic surgical procedures in osteomyelitis, it is an important adjunctive tool that helps enhance surgical effects and assists in the healing process.