Repositório RCAAP

O presente número de Millenium, não é, tão só, mais um número da revista. Com este n.º 50 comemora-se a saída constante, sucessiva e continuada das diferentes e consecutivas edições deste periódico, em conformidade com a sua periodicidade, que foi sendo diversa ao longo do tempo. Simultaneamente, celebram-se as suas duas décadas de existência, marcando este quinquagésimo número os 20 anos de publicação consecutiva, em continuum ininterrupto, da revista. E se 20 anos é muito tempo para a vida, também é muito tempo para a permanência e presença durável e real de uma publicação periódica. Muitas foram as transformações, as mudanças e mutações que Millenium sofreu ao longo deste tempo. Talvez por isso, talvez porque a passagem do tempo tudo transfigura, vivemos mais um período de metamorfose na revista. Por isso também, este número marca o fim de mais um ciclo em Millenium. De facto, por razões de ordem estritamente pessoal e particular, aliadas a poderosos motivos familiares, entretanto supervenientes, que obrigam a uma forte e extensa reestruturação na vida familiar, aqui tomada no sentido de família alargada, entendi que não estavam reunidas as necessárias condições para poder continuar a dirigir a revista, e, por isso, a meu pedido, solicitei a minha substituição como diretora da publicação.

A Escola Superior de Educação (ESEV) do Instituto Politécnico de Viseu, através do seu Departamento de Ciências da Linguagem, em colaboração com o TOPUS - Grupo de Pesquisa sobre Espaço, Literatura e outras Artes, constituído, na sua fundação, por investigadores brasileiros das universidades federais do Triângulo Mineiro, Brasília, Uberlândia e Goiás, organizou, nos dias 25, 26 e 27 de setembro de 2014, a II Jornada Internacional de Estudos sobre o Espaço Literário (JOEEL). Participaram nesta jornada professores e investigadores do ensino superior de Portugal e do Brasil que trabalham sobre a articulação do Espaço com a Literatura e com a Arte, docentes dos vários níveis de ensino interessados na reflexão e na discussão sobre esta temática, estudantes do ensino superior e, ainda, público com interesse nos temas em estudo.

Introduction: Ureteropelvic junction obstruction (UPJO) is the most common congenital cause of upper urinary tract obstruction in children. Our objective is to report our experience concerning the first 20 laparoscopic pyeloplasties. Material and methods: Retrospective study including twenty children with diagnosis of UPJO that underwent laparoscopic pyeloplasty by a single surgeon, at our Hospital, between November 2010 and December 2014, with at least one year of follow-up. Success was defined as absence of conversion, resolution of symptoms and radiologic criteria improvement. Results: Median age at surgery was 9.5 years (range between 10 months and 17 years-old). Intrinsic obstruction was found in 7 cases, extrinsic obstruction in 12 cases and one case with both situations. Median operative time was 235 minutes (range between 165-275 minutes), with need for conversion in 2 cases (10%).  Median hospital stay was 2 days (range between 2-5 days. Four patients (20%) had early postoperative complications and two cases (10%) needed surgical revision during follow-up. Median follow-up time was 33 months (range between 12-60 months). In follow-up, all but two patients were asymptomatic. There was radiologic improvement of hydronephrosis in all patients but one, although he had non-obstructive pattern in renographic drainage. Conclusion: Our results are similar to those found in literature, with success rates comparable to open pyeloplasty with advantages of minimally invasive surgery.

Introduction: Urorectal fistulas (URF) are a devastating complication of pelvic tumor treatment and a significant surgical challenge. Despite its increasing incidence associated with an increasing use of different forms of non-surgical treatment of pelvic tumours, urorectal fistula remains rare. Given the improbability of spontaneous closure, surgical correction becomes necessary in almost all cases. Despite the existence of various surgical techniques, rates of failure / recurrence are usually high, particularly in radiation fistulas. In this study the authors describe their experience in the treatment of URF resulting from pelvic tumor treatment. Methods: Between October 2008 and February 2015, 12 male patients were identified with URF treated in our institutions. A review of medical records of patients, including age, symptoms, comorbidity, diagnostic approach, type and fistula etiology, type of surgical reconstruction, follow-up and results was performed. Non-neoplastic / inflammatory fistula patients were excluded from the study. Results: We identified and treated 12 patients. One patient with fistula secondary to anterior resection of the rectum developed lymph node and liver metastases 4 months after the diagnosis of urorectal fistula and was consequently excluded from surgical treatment and study. The mean age of patients was 68 years (53-78). Nine patients developed URF after prostate cancer therapy: Two after low-dose brachytherapy combined with external beam radiation therapy; five after retropubic radical prostatectomy, with adjuvant radiation therapy in one; one after low-dose brachytherapy followed by transurethral resection of prostate; and one after high intensity focal ultrasound and radiation therapy. In two patients, the fistula resulted from surgical treatment of rectal carcinoma, associated with radiation therapy in one of them. In all patients with fecal and urinary diversion was performed by means of colostomy and suprapubic catheterization or urethral catheterization during the waiting period for surgical reconstruction. No spontaneous closure of URF occurred in any patient. Eleven patients underwent surgical reconstruction. Perineal approach was exclusively used in seven patients. In four patients, an abdominoperineal approach was employed. Effective fistula closure was reported in six patients after the first surgical attempt. Two patients required a second surgery, while one patient required three surgical procedures to achieve a successful result. Surgical failure occurred in two patients, which at present do not wish any additional reconstructive attempt. These two patients and one patient, in whom the reconstruction was effective, yet remain with colostomy. The mean follow-up was 25.5 months (3-75). Conclusion: URF are an uncommon but serious complication of treatment of pelvic tumors, usually associated with debilitating morbidity and loss of quality of life. Although a surgical reconstruction can be extremely difficult, in most cases it is possible to have a successful outcome by either a perineal or abdominoperineal approach and the use of interposing tissue when indicated.

Objectives: To evaluate urinary stone composition in our institution, its gender and age, including variations and the evolution in the last 7 years. Material and Methods: The authors reviewed all urinary stone analysis performed since January 2009 to September 2015 in our hospital – Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal. Patients were stratified by gender, age and stone composition analyzing the evolution of stone composition in different years. The stone analysis method was infrared spectroscopy. Results: From 302 valid stone analysis reports, 55,3% were female and 44,7% were male patients. Mean patient age was 51±14 years old. A total of 7 different mineral components were identified. 51,6% (n=156) of all the stones had Calcium Oxalate, 41% (n=124) had Calcium Phosphate (33% of Apatite form), 37,7% (n=114) had Uric Acid, 22,1% (n=67) had Ammonium Urate, 9,6% (n=29) had Magnesium Ammonium Phosphate, 6,3% (n=19) had Sodium Urate, and 1,3% (n=4) had Cystine in its composition. Only 30,4% of stones had a single chemical compound. Of these 56% were pure stones of Calcium Oxalate, and 31% were pure stone of Uric Acid. The most frequent mixed stone was Calcium Oxalate + Calcium Phosphate (Apatite) followed by Uric Acid + Ammonium Urate comprehending 45% and 27% of all mixed stones respectively. Related to the ethology we divided stones into 3 groups, pure non-infection, pure infection, and mixed with component of infection, and the prevalence was 37,7%, 4,3% and 57,9% respectively. The distribution between genders was similar and the highest difference was in the Ammonium Urate compound with 28% prevalence in male and 17% in women. (p=0,379)
Patients after 50 years old had more prevalence of Uric Acid component accounting for 49% of their stones.(p<0,001) . Along the 7 years of study we identified a significant reduction in the prevalence of mixed stones with component of infection, gradually decreasing from 89,6% in 2009 to 27% in 2015. Conclusions: Calcium Oxalate calculus were the most prevalent, but this difference was not as important as in other studies worldwide. This study highlights the importance of the development of National and European database to report all regional stone composition variations.

Introduction and Objectives Penile prosthesis implantation is a common, well‐established treatment for correcting medical refractory erectile dysfunction. Although more invasive than some of the other currently available therapies, PP surgery has the advantages of high patient satisfaction rates. The aim of this study was to evaluate the surgical results and patient satisfaction after implantation of PP in 25 patients treated at the University Hospital of Coimbra (CHUC). Material and MethodsWe evaluated 25 patients with erectile dysfunction who underwent implantation of PP, inflatable and semi‐rigid, between November 2000 and November 2013. The information was obtained from medical records and telephone interviews and encompassed clinical severity, comorbidity, etiology, PP type, surgical complications, need for reintervention and degree of patient satisfaction. Results88% of patients had severe ED. The main etiologies reported were: multifactorial (46.4%), atherogenic (24%) and neurologic (16%). Most devices implanted were inflatable prostheses (84%). In 80% of the cases there were no complications reported; the rate of re‐intervention was 20%. There were a high percentage of satisfied / very satisfied patients (65%). Discussion/ConclusionPP surgery remains an excellent alternative in restoring erectile function in patients whose medical therapies have failed. Despite its invasive nature, the implementation of PP has proven to be associated with a low rate of complications and a high degree of patient satisfaction.

In the PSA era, the incidence of localized prostate cancer has been increasing. This reality requires new therapeutic strategies, in order to give an answer to patients, in whom active surveillance may be indicate but desire more interventionist strategy with minimal side effects and without compromising cancer control. In these cases, focal therapies that include irreversible electroporation may be effective alternative strategies. The irreversible electroporation is an emergent approach on focal treatment of localized PCa. The nonthermal mechanism that preserves the tissue architecture without damaging tissue structures, such as vessels and nerves within the target region, is the main advantage comparatively to other techniques used in focal treatment. The number of clinical studies is reduced and the results still immature.

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Introduction: Paratesticular tumors account for 2% of genitourinary neoplasms. They are benign neoplasms originating from the mesenchymal tissue, of slow and indolent growth, with no definite etiology, and can appear in any tissue composed of smooth muscle. Note the leiomyomas, which are considered a rare neoplasia in this location, so that their diagnosis is often confused with testicular tumors. Clinical Case: The authors present a case of a 56-year-old male patient admitted to the urology outpatient clinic with a large painless mass in the right testis of slow growth and a 3-year evolution. After further examination, he underwent right inguinal orchiectomy. The histopathological analysis and immunohistochemical profile of the surgical specimen showed a mesenchymal neoplasia compatible with atypical Paratesticular Leiomyoma, with borderline behavior and indolent growth. Discussion: This is a rare benign pathology whose etiology is frankly unknown and easily diagnosed as testicular origin. Therefore, this report sets out the objective of introducing this entity into medical knowledge in order to collaborate on future approaches.

Objectives: Assess whether the neutrophil-lymphocyte ratio (RNL) can predict the risk of recurrence and progression of patients with the non–muscle-invasive bladder carcinoma (CBNMI). Material & Methods: It was performed a retrospective analysis of patients diagnosed with CBNMI after a resection of the bladder tumor (RTUV), between January 2013 and December 2014. Patients who had no white blood cell count prior to surgery and patients with synchronous tumors were excluded. It was subsequently performed a multivariate statistical analysis with SPSS 22.0® software, with the following variables: age, gender, time of recurrence or disease progression (in months), NLR, tumor size (≤ 3 or >3cm), multiple tumors, histology and tumor initial grade. Results: The sample consists of 84 patients, 79.8% were males and the average age was 69 years. In 67.9% of the patients the initial tumor histology was pTa and in 77.4% was a low-grade tumor. In 21.4% of patients the tumor was multiple and in 33.3% the tumor was larger than 3 cm. Nineteen-percent of patients had recurrence of tumor and progression was verifyed in 16.4%. Patients with RNL>3.32 presented pT1 as initial tumor histology more often (p=0.018). In a multivariate analysis, the RNL> 3.32 was found to be associated with a higher recurrence or progression of tumor (hazard ratio [HR] = 2.94; 95% CI: 1.27-6.8; p=0012.). Conclusions: In conclusion, this study states that RNL may be an useful predictor of recurrence or progression of tumor in patients with CBNMI, valuable in the clinical decision.

Introduction: Urinary tract infection (UTI) is one of the most frequent infections at community level, presenting higher costs for society and health system. The publication of epidemiological evaluation studies of etiological agents responsible for UTI and its antimicrobial resistance profile is an added value for the elaboration of decision criteria for antibiotic- empirical therapy, serving as well to alert the health professionals for the benefits of a correct antimicrobial prescription. Material and Methods: Cross-sectional epidemiological study, based on the urine cultures performed to external users of the Clinical Pathology Service of Horta Hospital EPER in the year 2016. On the urine cultures considered positive, parameters such as age, sex, type of bacteria and antimicrobial susceptibility profile were study. All records with insufficient data for analysis, as well as all requests for duplicate urine cultures from the same patient within a period of less than 7 days, were excluded from the study. All the data used were provided by the Clinical Pathology Service of the Horta Hospital EPER. Results: Higher prevalence of positive urine cultures in women compared to men. In women, a bi-modal trend with the first peak occurring in the age group of 30 to 39 years, the second (highest) peak in the 70-79 age group. In men, the tendency to increase occurs beginning from the age group of 50 to 59; the frequency of bacteria isolated between sexes were different. The prevalence of Escherichia coli (major responsible for UTI) in women is higher than in men. The second and third most frequent bacteria were Klebsiella p. Pneumoniae and Proteus mirabilis respectively, with higher frequency in man than in woman in both cases; Major frequency of ESBL occurred in man; the study of antimicrobial profile in Escherichia coli strains showed high sensitivity to fosfomycin (>95%) and nitrofurantoin (>95%). Trimethoprim/ sulfamethoxazole and fluoroquinolones showed high resistance (close to 20%). Amoxicillin and amoxicillin/clavulanic acid with much higher resistance when compared to fosfomycin and nitrofurantoin. Excluding cephalothin, there were some heterogeneity in the cephalosporin group, but with sensitivities always higher than 80%. Conclusion: This type of studies helps to determine the guidelines for an empirical antibiotic therapy.

Introduction: Hemostasis is a central issue in laparoscopic surgery. There are no clear guidelines when it comes to the choice of what energy scissor to use. This study compares the efficiency and security between EnSeal® and LigasureTM in the sealing of arteries and veins in an ex-vivo porcine model. Methods: The instruments were compared with each other with respect to cutting speed and burst pressure (BP) after vessel harvest. The coagulation and cut levels of the generators were set up at a constant level. A group of vessels was sent for histological evaluation with assessment of thermal damage and histological seal. Results: A total of 124 vessels were tested. Overall, LigasureTM was the fastest instrument in all types of vessels and EnSeal® was the slowest. There were no statistically significant differences between the BP, except for the group of medium arteries, where the BP generated by LigasureTM were significantly higher than the ones generated by EnSeal®. In the same group of vessels LigasureTM was the one with the lowest percentage of seal failures. There was no association between the number of seal failures and the size of the vessel. There was, however, an association between the number of seal failures in arteries versus veins, with a larger number of failure in arteries for both instruments, compared to none failure in veins with LigasureTM. Although no statistically significant differences were found between the seals of the two instruments, the one with the highest median sealing length in both arteries and veins is LigasureTM, which theoretically may mean a more reliable sealing. Conclusion: LigasureTM provides the fastest and most reliable seal, with superior BP in medium arteries comparatively to EnSeal®, and greater sealing length median, both in arteries and veins. However, it presented significantly higher thermal damage than EnSeal®.

Introduction: Shortage of high quality donors led to an increasing need of compatible organs: grafts with multiple renal arteries (MRA) are one of the solutions, although being a potential risk factor that can impair outcomes. The aim of this study is to provide a view of our experience with multiple renal arteries grafts in renal transplantation and compare the outcome between multiple renal arteries and single renal artery (SRA) groups. Material and Methods: A retrospective study of 2989 kidney transplants was performed in our department between January 1980 and February 2017: demographic characteristics and outcomes were compared between recipients of grafts with multiple renal arteries (648; 21.7%) and single renal artery (2341; 78.3%). Statistical analysis was done using IBM SPSS Statistics 22: chi-square, independent sample t-test and Kaplan Meier tests were used with a p value of 0.05. Results: Grafts from cadaveric donors occurred in 95.8% of the single renal artery group and 97.4% of multiple renal arteries group. The recipients of multiple renal arteries group had a previous higher time on dialysis (50.3 ± 43.1 vs 46.30 ± 37.5 months, p:0.04), a longer operative time (2.43 ± 0.57 vs 2.28 ± 0.49 hours, p<0.001), a higher cold ischemia time (19h08 ± 6h05 vs 18h34 ± 6h17 hours, p:0.04) and more red blood cell transfusions (1.8 ± 0.8 vs 1.7 ± 0.8 packs, p:0.01) than the recipients of single renal artery kidney recipients. In the multiple renal arteries group, ex-vivo bench surgery techniques, in vivo sequential anastomosis and mixed techniques were used. The different options did not affect the outcomes. The rate of delayed graft function, surgical complications, length of hospital stay, acute and chronic rejections, graft loss, death were not statistically different. The follow-up was not statistically different: multiple renal arteries (8 ± 7.3 years) versus single renal artery (7.7 ± 6.6 years) group (p:0.1). The current state of the patient was not dependent on the number of arteries used. Conclusion: Multiple renal arteries grafts were not a problem in our unit: despite of having a longer operative time, higher cold ischemia time and higher blood transfusions rate, short and long-term outcomes were comparable between groups. At this level, literature results are not consensual: prospective studies are necessary.

Cavernosal abscess is an uncommon condition. It can be idiopathic or with an underlying cause. Surgical drainage and systemic antibiotics remain the first line of treatment regarding long-term sequelae. The authors report a rare case of a 51-year-old man with a bilateral cavernosal abscess with no underlying cause. The patient was treated with surgical drainage and systemic antibiotics. Culture of pus was positive for Staphylococcus aureus. There were no sequelae at six-month follow-up.

Introduction: Chronic kidney disease is a prevalent disorder, with a significant number of late stage patients, which only options are renal replacement therapy and transplantation. Kidney transplantation is associated with higher quality of life and lower mortality. The increasing gap between the demand for kidneys and its availability for transplantation has prompted the research and development of an alternative source to the conventional brain dead donors, the donors after cardiac death. The latter need preservation techniques in order to offer similar functional results. In the present article, we proposed to review the recent evidence about the role of extracorporeal membrane oxygenation as preservation technique in the harvesting of kidneys from donors after circulatory death. Material and Methods: A literature research was conducted in PubMed/MEDLINE, using the following expressions: “kidney transplantation”; “non-heart-beating donor”; “donation after cardiac death”; “extracorporeal membrane oxygenation”; “abdominal normothermic perfusion”. Based on the selected articles, it was performed a non-systematic review, summarizing the recent evidence about the role of extracorporeal membrane oxygenation as preservation technique in the harvesting of kidneys from donors after circulatory death. Results: The evidence suggests that extracorporeal membrane oxygenation is better than the other preservation techniques used in donors after cardiac death, as it has been associated to improved renal allograft outcomes. Regarding the conventional deceased donors, the brain dead, this technique allows similar results, particularly when compared with expanded criteria donors. Discussion: Organ preservation through extracorporeal membrane oxygenation in cardiac death donors has favorable functional results and, for this reason, may contribute to increase the pool of donors. The logistical challenges of the technique restrict its implementation. Conclusion: In the long-term, should be created conditions so that extracorporeal membrane oxygenation in donors after cardiac death may be widely implemented, increasing the number of kidneys obtained for transplantation.

Introduction: Obesity is an increasingly common disease in patients with end-stage chronic kidney disease candidates for renal transplantation. It is an important factor that should be addressed in the period before renal transplantation. The aim of this study is to evaluate the impact of pretransplantation body mass index (BMI) in graft and recipient outcomes. Material and Methods: An observational retrospective analysis of 913 kidney transplantations was performed between September 2010 and May 2017. Recipients were categorized in groups: obesity (group 1), overweight (group 2) and normal BMI (group 3). A preoperative protocol was used: recipient and donor characteristics, perioperative data, graft and patient survival were evaluated. The software used was IBM SPSS Statistics 23: p value of < 0.05 was considered statiscally significant. Results: Overweight was observed in 36.2% and obesity in 12.3%. In groups 1 and 2, there was a higher prevalence of type II diabetes mellitus compared with group 3 (17.9%, 16.4%, 6.6%, respectively, p < 0.001). Recipient creatinine serum levels at first and third months were also statistically different. Both groups 1 and 2 showed higher surgery duration and postoperative length of stay. It was noticed a lower immediate diuresis rate in group 1 (63.2%) and in group 2 (80.4%), p < 0.0001. Perioperative complications were more prevalent in groups 1 and 2, especially lymphocele formation (21.4% and 7.7%, respectively, versus 3.6%) and wound dehiscence (21.4% and 5.8%, respectively, versus 1.2%), p < 0.05. No statistically differences were seen in graft and patient survival. Conclusion: Pretransplantation weight is important in renal transplantation: worse renal function in the first and third months, longer surgery duration and postoperative length of stay, higher delayed graft function rate and a higher prevalence of lymphocele formation and wound dehiscence were noticed in both non-normal weight groups. However, obese and overweight groups showed similar survival and long-term outcome comparing with normal BMI recipients.

Introduction: Our objective was to evaluate success and complication rates of different techniques of transvaginal correction for apical prolapse using native tissues. Material and Methods: Retrospective study of 41 transvaginal apical prolapse repair using native tissues, performed by the Urogynecology Department of a tertiary hospital, from January 2013 to June 2018. Results: In our sample, mean age was 66 years; all women were multiparous and 95.1% were postmenopausal. Regarding past surgical history 47.5% had a previous hysterectomy and 17.5% an anterior, 10.0% a posterior and 7.5% an apical prolapse repair. On clinical examination, in addition to apical prolapse, 24.4% presented prolapse of the anterior compartment, 4.9% of the posterior compartment and 53.7% of both. Surgical apical prolapse correction was performed with transvaginal uterosacral ligament suspension in 22.0% of cases, sacrospinous ligament fixation in 68.3% and iliococcygeus fixation in 9.8%. At the same surgical session, 39.0% underwent vaginal hysterectomy (with anterior and posterior colporrhaphy in 7/16, anterior repair in 4/16 and posterior repair in 3/16 cases), 7.3% had anterior compartment repair, 2.4% posterior compartment repair and in 36.6% both compartments were repaired. During the perioperative period there were no reported complications. Therapeutic success was observed in 82.9%. Clinical apical prolapse recurrence occurred in 17.1% and 4.9% had recurrence of other types of prolapse. It was reported a case of urge incontinence and two cases of fistulas. In 34.1%, these complications occurred in the first 6 months after surgery. There was no statistically significant difference concerning either the success or the occurrence of complications between the three different techniques of apical prolapse repair. Conclusions: The use of native tissues to correct apical prolapse was an effective and safe method with low morbidity. In this study all of the techniques of apical repair were equally effective suggesting that surgeon’s experience must be considered when deciding which procedure to perform.

Introduction: Although the risk of urethral trauma while treating bladder stones is worrisome, evidence about the best treatment approach is scarce. The aim of this study is to compare the safety and efficacy of transurethral cystolithotomy and percutaneous suprapubic cystolithotomy in adults´ bladder lithiasis treatment. Methods: We retrospectively evaluated 120 patients (January 2012 to December 2017) who were surgically treated for bladder lithiasis with percutaneous suprapubic cystolithotomy (n= 20) and transurethral cystolithotomy (n= 100). Age, gender, calculi size, surgery duration, hospital stay, post-operative infections, haematuria, pain and urethral strictures were evaluated. Previous diagnosis of benign prostate hyperplasia and urethral strictures were also considered. Results: Both groups were homogeneous according to the pre-operative variables evaluated, including calculi dimensions and simultaneous diagnosis. Median surgery time in percutaneous suprapubic cystolithotomy and transurethral cystolithotomy were 65 and 58 minutes, respectively (p= 0.043). Pain and haematuria were similar in both groups. Median hospital stay was 2.0 days in both groups. Median follow-up time was 13 months. In the transurethral cystolithotomy, three patients (3%) developed urethral stricture while none of the patients treated with PSC developed urethral strictures during the follow-up (p= 0.435). Discussion: Percutaneous suprapubic cystolithotomy theoretically offers an advantage over transurethral cystolithotomy in terms of urethral trauma, although we did not observe a significant difference. However, it deserves to be considered, especially in patients with known urethral strictures that may hinder transurethral access. Further prospective studies with more patients may however confirm these theoretical advantages.

Devido à grande proximidade dos SPN com a órbita, SNC e outras estruturas, o cirurgião deve estar bem familiarizado com a anatomia nasossinusal. Foi efectuado um estudo retrospectivo de 150 TC-SPN realizadas no nosso centro, durante 2015. 75 exames preencheram os critérios de inclusão. Foi realizada análise de variáveis demográficas e anatómicas. A idade média foi 48 anos. Observámos agenésia do seio frontal em 6% dos lados avaliados e hipoplasia em 15%, defeito da lâmina papirácea (LP) em 11%, deiscência da artéria etmoidal anterior em 29%, célula Onodi em 16%, exposição do nervo óptico em 28% e exposição da artéria carótida interna em 19%, entre outras variáveis avaliadas. A altura média da lamela lateral foi maior no sexo masculino. O sexo feminino correlacionou-se com hipoplasia do seio maxilar e LP medializada. Uma avaliação cuidada da TC-SPN é essencial para alcançar melhores resultados cirúrgicos e menores taxas de complicação.

  O transplante pancreático representa uma alternativa cirúrgica para o tratamento de casos selecionados de doentes diabéticos, com o objetivo de evitar as complicações sistémicas da doença. A abordagem mais frequente é o transplante pancreático-renal simultâneo, em que o pâncreas é geralmente posicionado intra-peritonealmente na região pélvica direita. Vários métodos de imagem são usados para a avaliação do enxerto parenquimatoso, a anatomia vascular e a drenagem entérica. A compreensão do procedimento cirúrgico, das técnicas utilizadas e da anatomia pós-procedimento é fundamental à medida que o número destes casos aumenta. O radiologista deve também conhecer as possíveis complicações associadas e a sua aparência imagiológica, com a finalidade de preservar a máxima função do enxerto.