bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultraflex stents for the management of airway complications in lung transplant recipients
Authors: CHHAJED Prashant N. , MALOUF Monique A. , TAMM Michael , GLANVILLE Allan R.
Published: March 2003

Objective:  We present our experience with the use of the Ultraflex (nitinol) stents in the management of airway complications in lung transplant (LT) recipients.

Methodology:  Nine LT recipients underwent insertion of uncovered Ultraflex stents. Mean change in FEV1, duration to formation of granulation tissue and follow‐up post‐stent insertion were compared with results obtained in LT recipients who had undergone Gianturco stent (n = 10) and Wallstent insertion (n = 16).

Results:  Mean improvement in FEV1 after insertion of Gianturco, Wallstent and Ultraflex stents was 670 ± 591 mL, 613 ± 221 mL and 522 ± 391 mL, respectively. No patient with an Ultraflex stent developed mucus plugging or stenosis at stent extremity at a follow up of 263 ± 278 days. The mean and median duration to stenosis at stent extremity for patients with Gianturco stents was 102 ± 85 days and 73 days, respectively, compared with 132 ± 87 days and 142 days, respectively, for patients with Wallstents. Stricture formation in the middle of the Ultraflex stent occurred bilaterally, at the level of anastomosis in one patient in whom stent placement was undertaken in the presence of inflammation. Stent migration in one patient was related to undersizing of the stent diameter relative to the airway diameter. A larger diameter relative stent was subsequently inserted successfully.

Conclusion:  Ultraflex stents appear to have fewer long‐term complications when used in the management of airway complications following LT.
Some current approaches to the evolution of plant–herbivore interactions
Authors: Futuyma Douglas J.
Published: March 2003

‘Coevolution’ between plants and herbivorous arthropods has several meanings: cospeciation, reciprocal adaptation, and a history of ‘escape‐and‐radiation’. Few well documented examples of each are known. Most evolutionary research on insect‐plant interactions concerns the adaptations of insects to plants or of plants to insects, but little of it expressly addresses reciprocal adaptation. Modern phylogenetic research confirms that host associations in many clades of specialized insects are evolutionarily conservative. An example from leaf beetles (Ophraella) is presented, in which the historical conservatism of host shifts is mirrored by patterns of paucity of genetic variation in the ability to use novel hosts. In several species of Ophraella, genetic variation was more often discerned in responses to plants closely related to the insect’s normal host plant than to more distantly related plants. Thus availability of genetic variation might bias the evolution of host shifts, and account for the phylogenetic pattern. The difficult problem of showing that chemical and other resistance features of plants evolved for their defensive function is slowly yielding to investigation. One difficulty is that most insect herbivores are thought to be usually too rare to impose appreciable selection. Insects collectively could exert quite strong selection on resistance characters if these characters have genetically correlated effects across many species of herbivores (i.e., if selection were ‘diffuse’). Surprisingly, the little available evidence does not suggest that pervasive genetic correlations are common. I conclude that more, and more multidisciplinary, research is needed to understand the evolution of plant resistance and defense.
Natural hybridization between Pseudostellaria davidii and Pseudostellaria palibiniana (Caryophyllaceae)
Authors: Choi Kyung , Kim Jung Sung , Pak Jae‐Hong
Published: March 2003

This is a report of a natural hybrid between Pseudostellaria davidii and Pseudostellaria palibiniana. Mulitivariate analysis with 19 morphological characters demonstrated that an unidentified taxon was intermediate between P. davidii and P. palibiniana. Somatic chromosome numbers of these three taxa were all identical (2n = 32). Pollen sterility was only found in the unidentified taxon. Twelve 10‐mer primers produced 18 species‐specific random amplified polymorphic DNA markers, eight for P. davidii and 10 for P. palibiniana, and all of the 18 markers also appeared in the unidentified taxon. Based on these data, this new taxon should be considered as a natural hybrid between P. davidii and P. palibiniana.
Size and architectural traits as ontogenetic determinants of fitness in a phenotypically plastic annual weed (Amaranthus albus)
Authors: Cheplick Gregory P.
Published: March 2003

Abstract Plasticity of size and architectural traits, and their importance to reproductive fitness, were estimated in relation to nutrient availability in the annual Amaranthus albus. Seeds from seven field‐collected genotypes were used to rear a first generation under uniform conditions. Seed families (inbred lines) from four first‐generation plants per genotype were used to rear a second generation in a glasshouse for 10 weeks. Nine plants per family were regularly fertilized, while nine others were unfertilized. Size was estimated at 5, 8, and 10 weeks; architectural traits were recorded at 8 weeks (no. branches) and 10 weeks (no. branches and branch length). Fitness was assessed by the number of seeds per plant. Because traits were intercorrelated, size‐scaled architectural traits were generated and allometric analyses performed. Genetic variation was analyzed for the second generation among inbred lines of the original genotypes, and among families within each genotype. For fertilized and unfertilized groups, early size (volume occupied at 5 weeks) and branch length per mass were significant determinants of fitness. The number of branches per size explained a smaller proportion of the variance in fitness. Genotype by treatment interaction was apparent for some traits, indicating genetic variation for plasticity, but plasticity of size did not change over ontogeny. Significant effects of genotype on size and architectural traits, and fitness, were detected mostly in the unfertilized group. Thus, selection is most likely to differentiate among genotypes in nutrient‐poor environments. Lengthening of multiple branches increases seed output throughout the season, and genotypes with longer branches per unit mass have a selective advantage. Because early size is correlated with seed output, ontogenetic plasticity in response to improved soil resources allows opportunistic increases in fitness.
Placental transfer of IgG subclasses in a Japanese population
Authors: Hashira Shintaro , Okitsu‐Negishi Shoko , Yoshino Kazuya
Published: March 2003

Abstract Background: Maternal immunoglobulin G (IgG), transferred across the placenta to the fetus during intrauterine life, is an important component of the neonatal immunological defence mechanisms against infection. There is controversy with respect to differences in placental transfer of the different IgG subclasses, and no definite data are available on a Japanese population. Therefore, we investigated placental transfer of IgG subclasses in a Japanese population.

Methods
: A total of 228 matched pairs of cord and maternal serum samples (20–42 weeks gestation) were assayed for each IgG subclass by an enzyme‐linked immunosorbent assay.

Results
: The mean values and hierarchy of cord/maternal concentration ratios of IgG subclasses at 40 weeks gestation were as follows: IgGl(1.47)>IgG3(1.17)=IgG4(1.15)>IgG2(0.80). The cord/maternal concentration ratios of all IgG subclasses were positively correlated to gestational age. The mean ratios for IgG1 and IgG4 nearly reached a plateau at 39 and 37 weeks gestation, respectively, while those for IgG2 and IgG3 increased until 41 weeks gestation. The ratios of all IgG subclasses for full‐term deliveries were reciprocally correlated to the respective maternal IgG subclass serum levels.

Conclusions
: The results suggest that although all four IgG subclasses are actively transferred across the placenta, the efficiency of their transfer ranks in the order IgGl >IgG3=IgG4>IgG2. The different results as to placental transfer of IgG subclasses in the literature might be due, at least in part, to different maternal IgG subclass serum levels in the populations studied.
Congenital muscular torticollis: Early and intensive treatment is critical. A prospective study
Authors: Celayir Ayşenur Cerrah
Published: March 2003

Abstract Background: Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of this outcome, such as treatment duration and exercise frequency. The aim of the present study was to define factors related to treatment duration, to compare different frequencies and intensities of home treatment programs and their effect on the speed of recovery.

Methods
: The present study was a prospective study of 45 infants (26 male, 19 female) with congenital muscular torticollis referred to the pediatric surgical outpatient during a 1 year period. Following a standardized initial assessment, parents were taught our intensive home treatment protocol, consisting of passive stretching exercises repeated every 3 h.

Results
: The mean age at initial assessment was 38.6 days (range 15–120 days). Mean treatment duration was found to be 3.2~1.3 months. All patients were treated by use of our intensive protocol of passive stretching exercises (100% success). No surgery was necessary.

Conclusions
: In patients with early treated congenital muscular torticollis, there is no place for surgical treatment. This group of patients can be successfully treated using an intensive protocol of passive stretching exercises. In addition, this treatment protocol has a very short treatment duration compared with other standardized protocols. A successful outcome depends primarily on good cooperation with the parents, especially in developing countries.
Systolic and diastolic function in children with chronic renal failure
Authors: Atalay Semra , Ekim Mesiha , Tutar H. Ercan , Koçak Gülendam , Bakkalo˘glu Sevcan , Tümer Necmiye
Published: March 2003

Background
: Cardiovascular complications are the most frequent cause of death in patients with end‐stage renal failure (ESRF). We aimed to investigate systolic and diastolic functions in children with ESRF.

Methods
: Thirty‐nine children with ESRF (17 on continuous ambulatory peritoneal dialysis (CAPD), eight on hemodialysis and 14 on predialysis) were examined to assess systolic and diastolic functions by echocardiography and ultrasound Doppler. Left ventricular systolic and diastolic functions were measured both in patients and age‐matched healthy controls (n = 20) and the indices of cardiac performance were compared.

Results
: Increased left ventricular mass index (LVMI) and decreased volume/mass ratio with normal systolic left ventricular function was found in patients, as compared with controls. Left ventricular diastolic dysfunction was observed in dialysis patients. In most of these patients, left ventricular isovolumic relaxation time was prolonged, except in CAPD patients. The peak of late diastolic flow (A) velocities were increased with a reduction of the early diastolic flow velovity (E) – the E/A ratio. The E velocities were unchanged in all patients as compared with controls. Our data indicated an abnormality of myocardial relaxation in patients with ESRF. We found no relationship between E/A ratio and LVMI. Among three groups of patients, the LVMI and diastolic abnormalities were highest in the hemodialysis group indicative of poor control of hypervolemia and hypertension.

Conclusions
: The technique of CAPD has some advantages as a renal replacement therapy for preserving cardiac functions as compared with hemodialysis. However, it must be remembered that patients with hemodialysis have features that effects cardiac status, such as higher volume load and higher afterload (hypertension).
Molecular analysis of syndromic congenital heart disease using short tandem repeat markers and semiquantitative polymerase chain reaction method
Authors: Shi Yi‐Ru , Hsieh Kai‐Sheng , Wu Jer‐Yuarn , Lee Cheng‐Chun , Tsai Chang‐Hai , Tsai Fuu‐Jen
Published: March 2003

Background
: Velo‐cardiofacial syndrome (VCFS) and DiGeorge syndrome (DGS) are developmental disorders characterized by craniofacial anomalies and conotruncal heart defects. Many of them have hemizygous deletions within chromosome 22q11.2, suggesting that haploinsufficiency in this region are responsible for their etiologies.

Methods
: To effectively understand the molecular basis for the chromosomal deletions, a semiquantitative fluores­cent polymerase chain reaction (PCR) method using 11 highly polymorphic markers located in 22q11.2 to perform genotyping analysis on 10 probands (five VCFS and five DGS) and their unaffected relatives were designed.

Results
: Two VCFS and four DGS patients have a 3‐Mb deletion; the other DGS patient has a 1.5‐Mb deletion and a cross‐over occurs in the same interval at the other allele.

Conclusion
: This results supports that the specific regions in 22q11.2 are susceptible to rearrangement and the deletions might be the genetic etiology of these syndromes. Most important of all, the new method, semiquantitative fluorescent PCR, is an effective method for detecting chromosomal microdeletions and has the following features: (i) the cost is inexpensive; (ii) the testing time is short; and (iii) the result is accurate.
Brain evoked potentials of 3‐D auditory stimuli
Authors: Yamamori Hiroyuki , Okubo Osami , Harada Kensuke
Published: March 2003

Background
: For evaluation of spatial cognitive function, we studied the brain evoked potentials (EP) of 3‐D auditory stimuli in regard to the change of latencies in normal subjects aged 1−21 years and compared them with patients who have mental retardation (MR).

Methods
: A total of 144 normal subjects and 67 patients with MR were tested. The EP were elicited by 1000 Hz fixed and enlarged tones with Doppler effect randomly presented. No specific task was imposed in relation to the auditory stimuli. Electroencephalograms were recorded at the Fpz, Fz, Cz, Pz and Oz scalp locations (10−20 system), referenced to linked earlobes. The 64 responses of EP were averaged. The EP were measured from the difference in waveform by subtracting the EP of the fixed tone stimuli from that of the enlarged tone stimuli.

Results
: The waveforms of EP consisted of the components P0, N1, P1, N2 and P2. These components (P0, N1, P1, N2 and P2) in the EP gradually shortened with increasing age in children. About 30% of patients with MR showed more prolonged latencies than normal subjects.

Conclusions
: These results suggest that these components indicated auditory kinetic evoked potentials. This developmental change could be related to maturational phenomena regarding spatial cognitive function. The EP of 3‐D auditory stimuli may be used in children to evaluate the development of spatial cognitive function.
Alpha interferon and lamivudine combination therapy for chronic hepatitis B in children
Authors: SelimoĞlu Mukadder AyŞe , AydoĞdu Sema , Ünal Fatih , ZeytinoĞlu AyŞin , Yüce Gül , YaĞci RaŞit Vural
Published: March 2003

Background
: Lamivudine is a new alternative therapeutic agent for chronic hepatitis B, in which alpha interferon (IFN‐α) monotherapy is not successful enough. Published reports have revealed no satisfactory data on IFN‐α and lamivudine combination therapy in children. The aim of this study is to investigate the efficacy and safety of this combination therapy in children with chronic hepatitis B.

Methods
: Children with chronic hepatitis B were given either IFN‐α and lamuvidine (group 1, n = 47) or IFN‐α alone (group 2, n = 30). Alpha interferon was administered as 5 million U/m2 s.c., thrice a week for 6 months and lamivudine 4 mg/kg per day p.o., maximum 100 mg, for 1 year. Clinical examination was performed; blood cell counts and serum alanine aminotransferase (ALT) and amylase were studied at each visit. At the third, sixth and twelfth month, serological markers were determined.

Results
: End of therapy response was achieved in 19 (40.4%) patients in group 1 and in 14 (46.7%) children in group 2 (P > 0.05). In group 1, pretreatment serum ALT and hepatic activity index (HAI) were statistically higher in children who responded to therapy (P < 0.005). In group 2, mean serum ALT was higher and hepatitis B virus (HBV) DNA was lower in responders. Sustained response rate was 40.4 versus 43.3% in two groups.

Conclusion
: The response rate of IFN‐α and lamivudine combination therapy in children with chronic hepatitis B was similar to that of IFN‐α monotherapy. High ALT level and HAI, rather than low HBV‐DNA level were found to be important predictors of response.
Childhood idiopathic nephrotic syndrome in Turkey
Authors:   ZELAL BİRCAN, Yavuz Yilmaz Alev , Katar Selahattin , Vitrinel Ayça , Yildirim Mehmet
Published: March 2003

Background
: It has been reported that there are racial and regional differences in peak incidence age, histopathological features and response to steroid therapy in childhood idiopathic nephrotic syndrome.

Methods
: One hundred and thirty‐eight patients with a diagnosis of idiopathic nephrotic syndrome, followed up in 1994−2000, were assessed retrospectively. The aim of this study was to assess the patients’ response pattern to steroid therapy, to determine whether the duration of the initial steroid therapy alters the steroid response pattern of the disease and to assess renal biopsy results.

Results
: One hundred and fourteen patients who initially received only steroid therapy and were followed up regularly were classified according to response pattern. Of the 114 patients, 30 children had an initial response, 25 children had infrequent relapse, 19 had frequent relapse, 25 had steroid dependence and 15 children had steroid resistance. The 99 patients with steroid responsive nephrotic syndrome were divided into two groups with respect to duration of the initial steroid therapy. There was no statistically significant difference between standard and short therapy groups with respect to the steroid response patterns. Percutaneous renal biopsy was performed in 43 of the 138 patients. Mesengioproliferative glomerulonephritis was the most common histopathological lesion, followed by membranoproliferative glomerulonephritis. The proportions of membranous glomerulonephritis, focal segmental glomerulosclerosis and minimal change nephrotic syndrome were low in our group.

Conclusions
: Our study group is similar to one reported from Saudi Arabia with respect to the steroid response pattern and to Saudi Arabian and Nigerian reports with respect to the histopathology. Although it has been reported that short initial steroid therapy was followed by a higher rate of relapses, there was no statistically significant difference between standard and short therapy groups with respect to the relapse rate in our study group.
Following the forsaken: A procedural description of a problem‐based learning program in a school of nursing studies
Authors: Biley Francis C. , Smith Keri L.
Published: March 2003

Abstract This paper reports the findings of one stage in an ongoing project to evaluate, from the students’ perspectives, a student‐centered problem‐based learning (PBL) program in a School of Nursing Studies. We begin by making a comparison between teacher‐centered education and religious devotion, and liken PBL to a congregation without a priest. A topographical account of the setting follows, describing the typical activities and events that characterize the program. Throughout the course of this account, a number of issues arise: the role of the facilitator, group dynamics, mutual responsibility and motivation for learning. These are touched on briefly, but we do not attempt to make a substantive theoretical contribution. Despite the widespread popularity of PBL in nursing schools, there have been few empirical studies conducted and, consequently, the adoption of PBL in nursing has been dependent upon the research of the very different discipline of medicine and medical education.
Health Care Reforms in Aged Care in Australia
Authors: McMillan Margaret ,   (Developed in Collaboration with I Frean, A Cadd and I Stein)
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Nurses' use of restraints and their attitudes toward restraint use and the elderly in an acute care setting
Authors: Myers Helen , Nikoletti Sue , Hill Andrew
Published: March 2003

Abstract A descriptive correlation study was conducted in an acute‐care hospital to explore the relationship between nurses' use of restraints and their attitudes toward restraint use and the elderly. A total of 201 nurses returned a questionnaire that collected demographic information and included two research instruments: (i) Perceptions of Restraint Use Questionnaire and (ii) Attitudes toward the Aged Semantic Differential. Results showed slightly positive attitudes towards the elderly and toward the use of restraints, although there was no correlation between scores on the two scales. Furthermore, nurses' attitudes did not predict their self‐reported use of restraints.
Fever management practises: What pediatric nurses say
Authors: Edwards Helen E. , Courtney Mary D. , Wilson Jennifer E. , Monaghan Sarah J. , Walsh Anne M.
Published: March 2003

Abstract Pediatric nurses manage fevers in hospitalized children daily: a complex practise. The present study identified varied decision‐making criteria and inconsistent practise influenced by many external variables. Nurses perform comprehensive assessments in order to make informed decisions. However, factors influencing their practise include medical orders, the temperament of the child, a history of febrile convulsions, parental requests, colleagues and ward norms. Nurses have a ‘temperature’ at which they consider a child febrile (37.2–39.0°C) and many reported a ‘temperature’ at which they administered antipyretics (37.5–39.0°C). Antipyretics were administered to febrile children for pain relief, irritability, at the request of parents and to settle a child for the night. Administration was reported to be higher during the day and evening shifts, at medication rounds and when the ward was busy. At night, nurses were reluctant to wake a sleeping febrile child, preferring to observe them instead. Recommendations to promote consistent fever management practises are included.
Mental health professionals’ attitudes to drugs and substance abuse
Authors: Pinikahana Jaya , Happell Brenda , Carta Bill
Published: March 2003

Abstract The purpose of the present study was to investigate the mental health professionals’ attitudes to drug and substance abuse in Victoria, Australia. The drug‐ and alcohol‐related attitudes of clinicians were examined in order to develop a relevant training curriculum for clinicians. A questionnaire on knowledge, skills, attitudes and practises was distributed to mental health clinicians (n = 378) in Victoria. One hundred and seventy‐three clinicians returned the questionnaire, giving an overall response rate of 46%. The survey results show that the attitude of mental health professionals to drug and substance abuse is generally a positive one. The majority of respondents held positive views on treatment interventions and they are optimistic that drug and alcohol dependence are treatable illnesses. A positive and more optimistic attitude towards treatment interventions should enable health professionals, particularly nurses, to provide the necessary care for those in need of medical care.
Reliability and validity of the Inventory of Functional Status after Childbirth when used in an Australian population
Authors: McVeigh Carol , Chaboyer Wendy
Published: March 2003

Abstract This study presents the results of reliability and validity testing of the Inventory of Functional Status after Childbirth (IFSAC) when used in an Australian sample. Data were obtained from a culturally diverse group of 173 women residing in a regional city in New South Wales, Australia. Participants could read and write English, delivered healthy infants between 37 and 42 weeks gestation and experienced normal pregnancies, labors, and deliveries. The inventory and its five scales were assessed for reliability using Cronbach's coefficient α and construct validity using item‐total correlation matrices. While three of the IFSAC scales performed well, two were problematic in this Australian population. With modification and updating, the clinical utility of IFSAC may be more fully realized.
Knowledge level and coping strategies according to coagulation levels in older persons with atrial fibrillation
Authors: St‐Louis Lyne , Robichaud‐Ekstrand Sylvie
Published: March 2003

Abstract The present study examined the knowledge level and the coping strategies of older persons with atrial fibrillation, who were on oral anticoagulant therapy. The relationship among knowledge level, problem and affective‐oriented coping strategies, and the level of anticoagulant effectiveness were examined. We also compared differences between subjects who were within a therapeutic range for International Normalized Ratio levels with those who were not. The research design was descriptive and correlational. One hundred older persons completed the Jaloweic Coping Scale (a knowledge questionnaire) and socio‐demographic, contextual and clinical characteristic questions. The findings suggested that the knowledge levels were low (53%), and problem‐oriented coping strategies were most often used (32.62%) compared to affective‐oriented coping strategies (18.96%). Other than praying and putting one's trust in God (P = 0.05), it appeared that no other significant coping strategies differentiated the subjects regarding their level of anticoagulant effectiveness. It is recommended that further examination of the reasons for older persons’ low knowledge level, in regard to their oral anticoagulant therapy, occurs and that use of problem‐oriented coping strategies, to improve self‐care measures, be encouraged.
Suppression of default apoptosis in androgen‐dependent cells by testosterone‐mediated bcl‐2 expression
Authors: OHIGASHI TAKASHI , UENO MUNEHISA , IIDA MASAHIRO , HIRATA RISA , NAKANOMA TAKASHI , DEGUCHI NOBUHIRO
Published: March 2003

Background: The significance of apoptosis with regard to the development and progression of androgen‐dependent cells has not been clearly understood. In the present study we investigated the expression of the bcl‐2 proto‐oncogene after androgen deprivation and its role in cell growth in an androgen‐dependent cell line.

Methods: We used SC2G, an androgen‐dependent mouse mammary carcinoma cell line cloned from Shionogi carcinoma 115 (SC115). The expression of bcl‐2 mRNA and protein in SC2G cells was measured by reverse transcription–polymerase chain reaction and western blotting, respectively. We also investigated the effects of antisense oligodeoxynucleotides (ODN) complementary to strategic sites in the mouse bcl‐2 gene in SC2G cells.

Results: When SC2G cells were cultured in serum‐free medium, the number of viable cells was significantly larger among cells with testosterone than those without testosterone after 3 days. Apoptosis was demonstrated in approximately 30% of positive‐staining nuclei in SC2G cells cultured in testosterone‐free medium. The levels of bcl‐2 mRNA and protein in SC2G cells started to decrease after testosterone withdrawal. The cell density of SC2G cells decreased after 4 days culture with antisense ODN when compared with cells cultured in the presence of sense control.

Conclusions: These data indicate that bcl‐2 proto‐oncogene inhibits the self‐programmed apoptosis of androgen‐dependent cells, suggesting the possibility of an antisense therapy for hormone‐refractory prostate cancer, which is reported to express high levels of Bcl‐2 protein.
Prognostic significance of tumor grade for renal cell carcinoma
Authors: Onodera Yasutada , Matsuda Nobuyasu , Ohta Michiya , Goto Ryuta , Fujii Nobukatsu , Yamada Yasuyo , Ikeuchi Takao , Kai Yoshio
Published: March 2003

Background: The natural history and prognosis of renal cell carcinoma cannot be predicted. Based on the Japanese classification system, the value of nuclear grade were assessed as a possible prognostic factor for renal cell carcinomas.

Methods: In this retrospective study of 116 patients with renal cell carcinoma, radical nephrectomy was performed. Survival rates were calculated using the Kaplan–Meier method and multivariate analysis was performed using Cox’s proportional hazard model.

Results: Distribution by stage and grade in the population of renal cell carcinomas was as follows: pT1 in 13 cases (11.3%), pT2 in 65 cases (56.5%), pT3 in 36 cases (31.3%) and pT4 in one case (0. 9%) and grade 1, 28 (24.1%), grade 2, 69 (59.5%) and grade 3, 16 (13.8%). Three cases could not be determined because of pre‐operative embolization of the renal cell carcinomas. Nuclear grade was correlated with stage (P= 0.0002), the presence of perirenal fat involvement (P= 0.003) and metastases (P= 0.007). A significant difference in survival was found between grades 1 and 3 (P= 0.0001) and grades 2 and 3 (P= 0.0001), respectively. Survival was significantly correlated with sex (P= 0.0125), tumor size (P= 0.0001), the presence of lymph node metastasis (P= 0.0001), renal vein involvement (P= 0.0001), perirenal fat involvement (P= 0.002) or distant metastasis (P= 0.0001). The multivariate analysis showed that the occurrence of tumor grade (P= 0.0006) or distant metastasis were independent prognostic values.

Conclusion: The observations lead us to conclude that the nuclear grade according to the Japanese classification system appears to be of reliable prognostic value for renal cell carcinomas.
Two cases of perineal ectopic testis
Authors: Ku Ja‐Hyeon , Jeon Youn‐Soo , Lee Nam‐Kyu , Kim Min‐Eui , Park Young‐Ho
Published: March 2003

Purpose
: Perineal ectopic testis is seen very rarely and here we report on two patients with perineal ectopic testis.

Methods/Results
: We experienced two cases of perineal ectopic testis on which orchiopexies to the corresponding hemiscrotums were performed.

Conclusions
: On surgical exploration, the gubernaculum testes were found to lie fixed to the perineum.
Effect of ethyl icosapentate on urinary calcium and oxalate excretion
Authors: Konya Eiji , Tsuji Hidenori , Umekawa Tohru , Kurita Takashi , Iguchi Masanori
Published: March 2003

Background: The effect of ethyl icosapentate (EPA‐E) on urinary calcium and oxalic acid excretion was examined to evaluate whether EPA‐E is useful in the prevention of calcium‐containing urinary stones.

Methods: For 6 months, urine was measured daily from 40 calcium‐containing urinary stone producers at an outpatient clinic, before and after the administration of 1800 mg/day EPA‐E. The urine was measured for volume, urea nitrogen, creatinine, calcium, magnesium, phosphorus, uric acid, oxalic acid and citric acid. Serum total cholesterol and triglyceride were also measured.

Results: Urinary calcium excretion was not reduced in any of the patients or particular hypercalciuric groups, nor did the level of calcium change. However, nine of the 25 hypercalciuric patients experienced a significant urinary calcium reduction to the normal calciuric level (a reduction of approximately 44%). It is not known why these particular patients experienced a reduction. Urinary oxalic acid did not change, whether hypercalciuria was present or not.

Conclusions: These findings suggest that EPA‐E is not particularly effective in reducing urinary calcium excretion in the hypercalciuric patients, but it needs future investigation because some patients experienced significant urinary calcium reduction.
A simple and reliable monitoring system to confirm the preservation of the cavernous nerves
Authors: Kurokawa Kohei , Suzuki Takanori , Suzuki Kazuhiro , Ito Kazuto , Shimizu Nobuaki , Fukabori Yoshitatsu , Yamanaka Hidetoshi
Published: March 2003

Abstract Background: It is important to establish a procedure with which to confirm the preservation of the cavernous nerves during nerve‐sparing radical surgery. For this purpose, we examined changes in intracavernous pressure (ICP) following electrical stimulation of the neurovascular bundle (NVB) with respect to the continuity of the cavernous nerves.

Methods: Six cases of radical prostatectomy and eight cases of radical cystoprostatectomy were examined. In all cases, prior to prostate removal, electrical stimulation of the site where the NVB was determined to run was performed and the changes in ICP measured. In eight cases, ICP changes were also measured following prostate removal.

Results: Prior to prostate removal, ICP changes could be measured in all 28 sides of 14 cases. These changes were classified into two patterns: stimulation‐related increases of convex waveform (t1) were observed in 24 sides (85.7%); and waveforms with reversed type (t2), which was thought to be an incomplete type t1, were observed in four sides (14.3%). There were no ICP changes following non‐sparing or incomplete sparing of NVB macroanatomically. Of five sides where the NVB was supposedly completely preserved macroanatomically, ICP changes consisted of type t1 on three sides, t2 on one side and type t2 or no change on a single side. All measurements were obtained within 10 min. Neither electrical stimulation nor measurement of ICP caused any adverse effects.

Conclusion: Intraoperative stimulation of the NVB while monitoring ICP changes provides a simple and reliable method of accurately evaluating the preservation of the cavernous nerves.
Collecting duct carcinoma with long survival treated by partial nephrectomy
Authors: Matsumoto Hiroaki , Wada Takashi , Aoki Akihiko , Hoshii Yoshinobu , Takahashi Mutsuo , Aizawa Sigeo , Naito Katsusuke
Published: March 2003

Abstract A case is reported of collecting duct carcinoma of the left kidney treated with partial nephrectomy. A 57‐year‐old woman presented for evaluation of the left renal mass, which was detected by screening ultrasonography. A computed tomography scan and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. The renal tumor biopsy revealed a low‐grade renal cell carcinoma or a tubulopapillary adenoma. Subsequently, left partial nephrectomy was performed. Microscopically, the tumor showed tubulopapillary proliferation with a fibrous capsule. Histochemically, the tumor cells reacted with lectins or antibodies against the collecting duct. Twenty‐four months after partial nephrectomy, the patient is alive and has no distant metastatic lesions. We review the literature on collecting duct carcinoma, in addition to the case of partial nephrectomy.
Calcium phosphate crystal‐associated proteins: α‐2‐HS‐glycoprotein, prothrombin fragment 1 and osteopontin
Authors: Nishio Shunji , Hatanaka Masayuki , Takeda Hajime , Aoki Katsunori , Iseda Tokuhiro , Iwata Hidenobu , Yokoyama Masayoshi
Published: March 2003

Abstract To study the inhibitory effects of calcium phosphate‐associated proteins on calcium oxalate crystallization and urinary concentrations of proteins in people who form stones and healthy controls. From 60 L of urine from healthy men, calcium phosphate‐associated proteins (α‐2‐HS‐glycoprotein, prothrombin fragment 1 and osteopontin) were obtained. The effects of the proteins on calcium oxalate (CaOx) crystallization were studied with a mixed suspension mixed product removal system. To examine urinary concentrations of the proteins, urine samples were collected from 17 healthy subjects and 15 stone formers and analyzed using anion‐exchange chromatography and an enzyme immunoassay. Prothrombin fragment 1 (PTF1) and osteopontin (OPN) had strong inhibitory effects on CaOx crystallization, while α‐2‐HS‐glycoprotein had a mild inhibitory effect. Urinary concentrations of PTF1 and OPN were lower in stone formers than in healthy controls. Low urinary concentrations of PTF1 and OPN might be one of the reasons for stone formation.
Postnatal development of the testis in Japanese children based on observations of undescended testes
Authors: Yuasa Joji , Ito Haruo , Toyama Yoshiro , Yuasa Shigeki , Masai Motoyuki
Published: March 2003

Abstract Background: Little is known about the morphological aspects of the postnatal development of the testis in Japanese children. By investigating the normal development of the testis, clinicians in urology can give better strategies to their patients. In addition, the pattern of development will improve the understanding of the effect of xenoestrogens.

Methods: Biopsied testis samples of 68 patients with undescended testes aged between 2 and 21 years were examined by light microscopy. Nineteen patients with normal histology of the bilateral testes were selected for this study. For light microscopy, paraffin sections were stained with hematoxylin and eosin. In addition, using electron microscope, Epon sections stained with lead citrate and uranyl acetate were observed. Semi‐thin sections stained with toluidine blue were also used for light microscopy.

Results: Gonocytes were observed in the testis of the 2‐year‐old boys. Spermatocytes developed by 4 years of age and spermatids developed by 11 years of age. The immature Sertoli–Sertoli ectoplasmic junction was observed as early as 4 years of age, and it was completed by 9 years of age. Mature myoid cells were observed by the age of 13 years. Immature Leydig cells were found at 7 years of age and the cells matured by 13 years of age.

Conclusion: A pattern of postnatal development of the testis in Japanese children was presented.
Changes in cellular immunity during chemotherapy for testicular cancer
Authors: Kubota Yoko , Ohji Hirosi , Itoh Keiichi , Sasagawa Isoji , Nakada Teruhiro
Published: March 2003

Background:

The changes in vivo in immunocyte functions during chemotherapy that is administered in combination with granulocyte colony‐stimulating factor (G‐CSF) in humans have not been fully investigated. This study was designed to examine neutrophil functions and the activities of natural killer (NK) cells, during the administration of chemotherapy and G‐CSF for the treatment of testicular cancer.

Methods:

Seven patients with germ cell tumors at stage IIA, IIB or IIIB, who were treated with bleomycin, etoposide and cisplatin (BEP), were enrolled in the study. Numbers and activities of neutrophils and NK cells were measured at various times during and after the first course of chemotherapy. Neutrophil phagocytosis was quantitated by flow cytometry with fluorescent latex beads. Bactericidal activity was measured in terms of colony‐forming units. The activity of NK cells was measured by monitoring the release of 51Cr.

Results:

After BEP chemotherapy, CD16+ and CD56+ cell counts, and neutrophil granulocyte counts decreased while there were no significant changes in the number of lymphocytes. Phagocytosis by neutrophils was enhanced after administration of G‐CSF. The activity of NK cells was severely impaired after chemotherapy and did not change after administration of G‐CSF.

Conclusions:

After BEP chemotherapy for testicular cancer with G‐CSF, neutrophil function was not at all inferior to those before treatment. Natural killer cell activity was suppressed by the BEP chemotherapy and did not change after administration of G‐CSF.
Case of mediastinal seminoma with testicular microlithiasis
Authors: Sato Koji , Komatsu Kazuto , Maeda Yuji , Ueno Satoru , Koshida Kiyoshi , Namiki Mikio
Published: March 2003

Abstract Testicular microlithiasis is a rare condition in which calcified concretions fill the lumina of the seminiferous tubules. We report the case of a 19‐year‐old Japanese man with mediastinal seminoma, normal testicular physical findings and bilateral testicular microlithiasis seen on ultrasonography. Testicular needle biopsy demonstrated multiple laminated calcifications within the seminiferous tubules without any signals of a viable germ cell tumor. To our knowledge, this is only the sixth reported case of extragonadal germ cell tumor with testicular microlithiasis.
Ureteroarterial fistula controlled by intraluminal ureteral occlusion
Authors: Inoue Takahiro , Hioki Takuichi , Arai Yasuaki , Inaba Yoshitaka , Sugimura Yoshiki
Published: March 2003

Abstract A 73‐year‐old woman underwent a pelvic exenteration for transitional cell carcinoma of the bladder and radiation‐induced rectovaginal fistula. The patient had undergone radical hysterectomy and radiotherapy for cervical cancer 30 years earlier. Fifteen months after the operation, she suffered from ureteroaortic fistula, which was controlled by intraluminal ureteral occlusion using Gianturco coils. During 53 months of follow up, she has been free of hemorrhagic episodes.
Stage specific follow‐up strategy after cystectomy for carcinoma of the bladder
Authors: KURODA MASAO , MEGURO NORIO , MAEDA OSAMU , SAIKI SHIGERU , KINOUCHI TOSHIAKI , USAMI MICHIYUKI , KOTAKE TOSHIHIKO
Published: March 2003

Background
: Follow‐up strategies after cystectomy for carcinoma of the bladder should be determined according to the risk of recurrence, which is stage dependent. We aimed to develop follow‐up protocol for monitoring patients with carcinoma of the bladder for tumor recurrence and diverted urinary tract complications after radical cystectomy.

Methods
:

The records of 351 patients with carcinoma of the bladder who underwent cystectomy between 1979 and 1999 were reviewed for dates and presenting symptoms of local and distant recurrences. The results of imaging studies and blood tests were also reviewed. Based on the division of patients into pathological stages of pT1 and lower, pT2, and pT3 and higher groups, we proposed a new follow‐up schedule for carcinoma of the bladder.

Results
:

The risk of metastasis was related to the pathological stage of the primary tumor. Recurrence developed in 10 of 124 patients (8%) with pT1 or lower, 17 of 101 patients (17%) with pT2, and 55 of 101 patients (54%) with pT3 or higher disease at a median of 11 (range 6–186), 10 (1–40) and 7 (1–76) months, respectively. Recurrences in patients with pT3 or higher were found earlier and more frequently than those with pT2 or lower. Of 82 patients with metastases, 54 initially were symptomatic, and three of pT1 or lower, six of pT2, and 19 of pT3 or higher were asymptomatic. Based on these results we proposed a stage specific follow‐up protocol.

Conclusions
:

A stage‐driven follow‐up strategy for monitoring patients after radical cystectomy can reduce medical expenses while efficiently detecting recurrences and complications.
Utility of immunohistochemical detection of prostate‐specific Ets for the diagnosis of benign and malignant prostatic epithelial lesions
Authors: TSUJIMOTO YUICHI , NONOMURA NORIO , TAKAYAMA HITOSHI , YOMOGIDA KENTARO , NOZAWA MASAHIRO , NISHIMURA KAZUO , OKUYAMA AKIHIKO , NOZAKI MASAMI , AOZASA KATSUYUKI
Published: March 2003

Background
: Human prostate‐specific Ets (hPSE) belongs to the Ets family. It regulates the proliferation, differentiation, and development of prostate epithelial cells. A recent study showed that hPSE can be detected in normal glands but not in cell lines established from prostate cancer (PCA), suggesting a translational disorder of hPSE from mRNA to protein in PCA. Immunohistochemical detection of hPSE could therefore be another method of differential diagnosis of PCA from other proliferative conditions in the prostate.

Methods
:

An immunohistochemical detection of hPSE was carried out on the whole mounted prostatectomy specimen obtained from 19 cases with PCA.

Results
:

Basal and secretory luminar cells showed a diffuse cytoplasmic staining for hPSE in normal glands, hyperplastic glands, and prostate intraepithelial neoplasia lesions. Whereas approximately 30% of PCA lesions showed a negative staining for hPSE, the positive rate for hPSE between PCA and benign glands or prostate intraepithelial neoplasia (PIN), was statistically significant (P < 0.05). Staining intensities in normal glands, hyperplastic glands, and PIN lesions were similar, but generally stronger than those in PCA lesions.

Conclusions
:

Negative immunoreactivity for hPSE strongly suggests malignancy in the prostate glands. Decreased immunoreactivities of glands for hPSE could suggest PCA.
Influence of endometrial thickness and pattern on pregnancy rates in in vitro fertilization‐embryo transfer
Authors:   AYUSTAWATI, Shibahara Hiroaki , Obara Hiromi , Hirano Yuki , Taneichi Akiyo , Suzuki Tatsuya , Takamizawa Satoru , Sato Ikuo
Published: March 2003

Aim
: Our aim was to investigate the role of endometrial thickness and pattern in the pregnancy rate during an in vitro fertilization‐embryo transfer (IVF‐ET) cycle.

Methods
: Records of patients who underwent IVF‐ET at the Jichi Medical School Hospital during May 1995–December 1999 were evaluated retrospectively. Only cycles, in which endometrial thickness and pattern on the day of human chorionic gonadotrophin (HCG) administration were recorded, were analyzed in this study. Endometrial thickness was divided into three categories (A: < 10 mm, B: 10–14 mm, C: > 14 mm), and endometrial pattern was divided into two categories: triple line and non‐triple line. A total of 156 IVF‐ET cycles from 120 patients was evaluated.

Results
: There were no significant differences for both the endometrial thickness and pattern in the pregnancy rate during the IVF‐ET cycle (P > 0.05). Among the study groups, the triple‐line endometrial pattern was found to be 58.7% in group A, 84.0% in group B and 70% in group C. We found that in the triple‐line endometrial pattern, there was a significant difference between group A and group B (P < 0.01). Triple‐line endometrial pattern appeared significantly in younger women (33 ± 5.4 years) than in non‐triple‐line endometrial pattern (36 ± 5.2 years; P = 0.047). The minimum and maximum endometrial thickness where pregnancy occurred was 6.5 mm (two pregnancies) and 19 mm (one pregnancy), respectively.

Conclusion
: Endometrial thickness and pattern have no influence on the pregnancy rates in an IVF‐ET cycle, but patients with triple‐line endometrial pattern and group B endometrial thickness showed a better pregnancy outcome in the IVF‐ET treatment. (Reprod Med Biol 2002; 1: 17–21)
Cadmium‐induced testicular damage in a rat model of subchronic intoxication
Authors: Aoyagi Teiichiro , Ishikawa Hiromichi , Miyaji Keisuke , Hayakawa Kunihiro , Hata Makoto
Published: March 2003

Background: Cadmium (Cd)‐induced testicular damage in relation to spermatogenesis has not been well studied. We studied the mechanism of Cd‐induced testicular damage in a rat model of subchronic intoxication.

Methods:  Male Sprague–Dawley rats were subcutaneously injected with 0.6 mg Cd/kg per day for 6 weeks. The concentration of Cd in urine, serum and testes was measured by using atomic absorption spectrophotometry. Testicular damage was evaluated by counting the spermatogonia (SG) and spermatocytes (SC) on one cut‐surface of five seminiferous tubules in stages VII or VIII of spermatogenesis every week. The location of intratesticular cadmium was determined by using oxine‐fluorescent cytochemistry.

Results: There were no differences in the testes/bodyweight ratio between the study and control groups. The concentration of Cd in the testes increased more than 100‐fold that in serum after week 2, suggesting active testicular Cd accumulation (1–3 mg/g tissue). Cadmium accumulation was detected in SG and SC. The number of SG and SC diminished significantly in the study group (week 2: SG 74%, SC 90%; week 4: SG 47%, SC 75%; week 6: SG 30%, SC 54% of the control, respectively).

Conclusions: Cadmium accumulated in SG and SC, consequently reduced the number of these cells, and disturbed the spermatogenesis in this rat model of subchronic Cd intoxication. Therefore, the number of SG decreased in this rat model of subchronic Cd intoxication. (Reprod Med Biol 2002; 1: 59–63).