bluuebunny/crossref_metadata_2025 huggingface dataset:
Formoterol and Salmeterol in Partially Reversible Chronic Obstructive Pulmonary Disease: A Crossover, Placebo-Controlled Comparison of Onset and Duration of Action
Authors: Çelik Gülfem , Kayacan Oya , Beder Sumru , Durmaz Gülten
Published: April 2003

Background: In contrast to the well-known activity profile in asthma, the precise efficacy and optimum dose schedules of long-acting β2-agonists in chronic obstructive pulmonary disease (COPD) are not clear. Objective: In this study, we aimed to compare the onset and the duration of action of a single inhalation of formoterol and salmeterol in COPD patients having partially reversible airway obstruction. Methods: In a double-blind, randomized, crossover and placebo-controlled study design, the respiratory functions of 22 patients (mean age 57.3 ± 5.4 years) having mild to severe COPD (5 mild, 8 moderate and 9 severe) and partially reversible airway obstruction [mean baseline reversibility of forced expiratory volume in 1 s (FEV1) 19.3 ± 3.1%] were evaluated after inhalation of 12 μg formoterol and 50 μg salmeterol. Results: Regarding the onset of bronchodilator action, the mean absolute increase of 0.20 liters in FEV1 10 min after inhalation of formoterol was significantly higher than baseline and that of placebo (0.04 liters), whereas that of salmeterol (0.11 liters) did not reach statistical significance. At 20 min, both formoterol (0.25 liters) and salmeterol (0.20 liters) produced a significant increase in FEV1 compared with baseline and with that of placebo (0.04 liters). The peak bronchodilator effects occurring at 60 and 120 min following formoterol (0.39 liters) and salmeterol (0.40 liters) inhalation, respectively, were significantly higher than the corresponding levels of placebo (0.02 and –0.12 liters, respectively). Concerning the duration of action, the 12-hour values of both formoterol (0.25 liters) and salmeterol (0.22 liters) were significantly higher than that of placebo (–0.12 liters). The area under the curve values of FEV1 of formoterol (3.5 ± 1.3 l·h) and salmeterol (3.2 ± 1.2 l·h) averaged over 12 h were comparable and higher than placebo values (1.2 ± 0.5 l·h). After formoterol inhalation 2 patients experienced tremor and 1 had palpitation; 1 tremor and 1 headache attack were noted after salmeterol. For the pharmacologically predictable side effects, there was no difference between the drugs. Conclusions: In conclusion, this study revealed that a single dose of 12 μg formoterol and 50 μg salmeterol provided comparable bronchodilation within 12 h and had tolerable side effects in patients with mild to severe COPD having partially reversible airway obstruction.
Limited Additive Value of Pleural Fluid Carcinoembryonic Antigen Level in Malignant Pleural Effusion
Authors: Riantawan Pratheep , Sangsayan Piamlarp , Bangpattanasiri Kittima , Rojanaraweewong Prapant
Published: April 2003

Objective: To assess the additive value of pleural fluid carcinoembryonic antigen (CEA.PF) level in the diagnosis of malignant pleural effusion. Methods: Thoracentesis and closed pleural biopsy were performed in consecutive patients with pleural effusions. CEA.PF, cell analysis, and biochemical, cytopathologic and microbiologic studies were carried out. Further diagnostic interventions were undertaken if initial tests were inconclusive. Results: A total of 176 patients were evaluated. The effusions proved malignant in 78 patients (44%). Benign etiologies were diagnosed in 89 cases, comprising 51 tuberculous pleurisies, 12 empyemas, 26 others. The cause was unknown in 9 patients. Median (range) in ng/ml of CEA.PF were 233 (1–12,500) in malignant vs. 2.5 (0.3–9) in tuberculosis, 1.4 (0.1–2) in transudates, 19.4 (0.6–312) in empyemas, p < 0.001. Receiver operating characteristic curve identified 10 ng/ml as the best cut-off for CEA.PF, yielding a sensitivity of 0.77, a specificity of 0.94, a positive and negative predictive value of 0.92 and 0.82, respectively. Among the 78 patients with malignant effusions, CEA.PF was elevated but initial cytopathologic study was nondiagnostic in 14 patients (18%). Prompted by the raised CEA.PF, further diagnostic interventions were undertaken and secured the diagnosis of malignancy in all of these 14 patients. Conclusions: CEA.PF level adds limited value on cytopathologic study in the diagnosis of malignant pleural effusions. It potentially identifies 18% of patients with malignant effusions who require further investigations despite negative initial cytopathologic study.
Non-Pulmonary Effects Induced by the Addition of Formoterol to Budesonide Therapy in Patients with Mild or Moderate Persistent Asthma
Authors: Centanni S. , Carlucci P. , Santus P. , Boveri B. , Tarricone D. , Fiorentini C. , Lombardi F. , Cazzola M.
Published: April 2003

Objective: The present study was designed to assess the non-pulmonary effects of a 2-week treatment with the addition of formoterol to budesonide therapy in 10 patients with mild or moderate asthma. Methods: Each patient was invited to perform a screening visit which included spirometry before and after inhalation of 12 μg formoterol with a metered dose inhaler (MDI), measurement of arterial blood pressure, baseline electrocardiography and 24-hour Holter monitoring, and a test for evaluating upper limb tremor. Patients then began bronchodilating therapy with 12 μg formoterol MDI and 400 μg budesonide Turbuhaler b.i.d. Each patient was also given a peak flowmeter and a diary in which he had to record the morning and evening values measured before taking inhaled drugs. Two weeks later, the patients repeated the same examinations; the diary card was returned 2 months after the beginning of the study. Results: Adding formoterol to budesonide therapy caused a significant improvement in lung function, but neither induced any statistically significant effect on mean heart rate, nor altered the circadian rhythm of autonomic regulation nor elicited significant alterations in cardiac morphology. However, the evaluation of upper limb tremor revealed a statistically significant increase (p = 0.02). Conclusions: This study shows that adding the recommended dose of formoterol to an inhaled corticosteroid therapy does not induce significant cardiac undesirable effects, although tremor, surely due to stimulation of β2 receptors of the skeletal muscles, may sometimes be a limiting effect.
Laparoscopic and Laparotomic Cholecystectomy: A Randomized Trial Comparing Postoperative Respiratory Function
Authors: Mimica Ž. , Biočić M. , Bačić A. , Banović I. , Tocilj J. , Radonić V. , Ilić N. , Petričević A.
Published: April 2003

Background: The fact that pulmonary complications occur in 20–60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period. Objective: The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal. Patients and Methods: A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation. Results: Six hours postoperatively, the values of ventilation parameters decreased on average by 40–50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy. Conclusions: Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.
Isolated Azygos Continuation of the Inferior Vena cava in the Elderly
Authors: Fernandes Ritabelle , Israel Robert H.
Published: April 2003

A 70-year-old woman with the isolated anomaly of azygos continuation of the inferior vena cava is presented. The interest in this anomaly lies in its presentation as a mediastinal mass on the chest roentgenogram. This article reviews the embryogenesis and the diagnostic testing of this venous anomaly.
Diagnosis and Treatment of Cystic Fibrosis
Authors: Koch Christian , Høiby Niels
Published: April 2003

This review discusses some diagnostic aspects of cystic fibrosis (CF) including direct mutational analysis. Treatment of major disease manifestations is discussed in more detail with an emphasis on lung disease, in particular chronic infection with Pseudomonas aeruginosa which is responsible for the majority of excess morbidity and mortality. Centralised care and aggressive antimicrobial treatment have led to increased life expectancy and this may be even further increased by the demonstration that chronic P. aeruginosa infection may be prevented, or at least postponed for many years in a majority of patients. Adjunct treatment such as the use of local and systemic anti-inflammatory agents and inhalation of human recombinant DNase are also briefly touched upon. It is emphasised that important questions concerning the link(s) between the mutated gene and lung disease are still missing but that current research raises hope of a more causal treatment in the near future.
Small Cell Lung Carcinoma Presenting as Acute Cardiovascular Collapse due to Tumour Cell Embolisation
Authors: Wong C.H. , Suvarna S.K. , Ciulli F. , Leggett R.J.E.
Published: April 2003

We present a case of small cell lung carcinoma causing acute cardiovascular collapse due to pulmonary tumour emboli. Although pulmonary tumour emboli may complicate a number of malignancies, this is rarely seen in cases of carcinoma of the bronchus. Patients suffering with pulmonary tumour emboli often have previous symptoms, and show progressive dyspnoea. To our knowledge there have been no reports of tumour emboli presenting acutely without any previous history of symptoms.
A System for Microscope-Assisted Guided Interventions
Authors: King A.P. , Edwards P.J. , Maurer Jr. C.R. , de Cunha D.A. , Hawkes D.J. , Hill D.L.G. , Gaston R.P. , Fenlon M.R. , Strong A.J. , Chandler C.L. , Richards A. , Gleeson M.J.
Published: April 2003

We present a system for surgical navigation using stereo overlays in the operating microscope aligned to the operative scene. This augmented reality system provides 3D information about nearby structures and offers a significant advancement over pointer-based guidance, which provides only the location of one point and requires the surgeon to look away from the operative scene. With a previous version of this system, we demonstrated feasibility, but it became clear that to achieve convincing guidance through the magnified microscope view, a very high alignment accuracy was required. We have made progress with several aspects of the system, including automated calibration, error simulation, bone-implanted fiducials and a dental attachment for tracking. We have performed experiments to establish the visual display parameters required to perceive overlaid structures beneath the operative surface. Easy perception of real and virtual structures with the correct transparency has been demonstrated in a laboratory and through the microscope. The result is a system with a predicted accuracy of 0.9 mm and phantom errors of 0.5 mm. In clinical practice errors are 0.5–1.5 mm, rising to 2–4 mm when brain deformation occurs.
Do Microelectrode Techniques Increase Accuracy or Decrease Risks in Pallidotomy and Deep Brain Stimulation?
Authors: Hariz Marwan I. , Fodstad Harald
Published: April 2003

Several recent publications have stated that the use of microelectrode recording (MER) during pallidotomy or deep brain stimulation (DBS) contributes to decreasing risks and side effects of surgery, and that such a technique is a prerequisite for minimizing lesion size and for accurate placement of the stereotactic lesion or the DBS electrode. To evaluate the consistency of these statements, we reviewed hundreds of papers and congress reports on MER- and non-MER-guided procedures published since 1992. This review showed that MER groups published more often than non-MER groups. While side effects of surgery were not uncommon in both groups, the rate of severe complications, such as hematoma, and mortality appeared to be higher when microelectrodes were used, both in ablative surgery and in DBS procedures. Besides, the nonaccurate placement of lesions or DBS electrodes, as assessed on published MRI figures, was not uncommon in MER publications. Lesion volume was, when reported, not different in both techniques. The electrical parameters of stimulation of implanted electrodes in the thalamic ventral intermediate (Vim) nucleus for treatment of tremor were higher in MER-guided surgery. The available literature suggests that MER techniques may increase the risks of surgery without enhancing its accuracy, compared to MRI-based macrostimulation techniques. To date, there is no randomized trial by one and the same group on the use of micro- versus macroelectrodes in surgery for movement disorders. A prerequisite for such a trial in the future must imply that the investigators have an equal nonprejudiced attitude towards, and equal confidence and experience in, either technique. Since such a prerequisite does not exist so far in the functional stereotactic community, a critical and comparative study of the available literature remains the only way to evaluate the pros and cons of either technique, in terms of targeting accuracy and surgical complications.
A Comparison of Surgical Approaches for the Management of Tremor: Radiofrequency Thalamotomy, Gamma Knife Thalamotomy and Thalamic Stimulation
Authors: Niranjan Ajay , Jawahar Ajay , Kondziolka Douglas , Lunsford L. Dade
Published: April 2003

Objective: Between April 1994 and January 1999, 39 stereotactic procedures for patients with intractable tremor were performed at the University of Pittsburgh Medical Center. A retrospective analysis of results of radiosurgical thalamotomy (n = 15), MR-guided stereotactic radiofrequency thalamotomy (n = 13), and deep brain thalamic stimulation (DBS; n = 11) was performed to study relative advantages and risks of these procedures. Methods: All options were discussed with the patients, but radiosurgery usually was performed in elderly patients with concurrent medical problems. Stereotactic thalamotomy and DBS was performed with MR guidance and macrostimulation. For radiosurgery, a median dose of 140 Gy (range 130–150 Gy) was delivered using a single 4-mm collimator. Results: Of the 13 patients who underwent radiofrequency thalamotomy, 5 had immediate complete arrest of tremor, 6 had a significant reduction and 2 had partial reduction. All 11 patients who underwent DBS had excellent control of tremor immediately after the procedure, and in longer-term follow-up 10/11 maintained excellent tremor control. Of the 12 evaluable radiosurgery patients, 10 noted excellent relief and 2 had partial relief. Conclusion: Stereotactic procedures for tremor control are safe and effective. Each procedure has specific advantages and disadvantages that are important for patient selection.
Fractionated Stereotactic Radiosurgery for Treatment of Acoustic Neuromas
Authors: Song Dan Y. , Williams Jeffery A.
Published: April 2003

Background: Microsurgery and single-fraction radiosurgery for acoustic neuromas are associated with high rates of control, but can result in facial palsy and trigeminal neuropathy. To reduce the morbidity of treatment for acoustic neuromas while maintaining efficacy, we explored fractionated stereotactic radiosurgery (FSR). Methods: We reviewed data for 31 acoustic neuromas in 30 patients treated with 25 Gy (linear accelerator) given in 5 consecutive daily fractions. The minimum follow-up was 6 months (6–44 months). The mean tumor volume was 1.1 cm3 (0.1–8.74 cm3). Results: All tumors remain controlled (9 smaller, 22 unchanged). No patient has experienced post-radiosurgery facial motor dysfunction. Two patients developed new trigeminal neuropathy; 2 patients with preexisting trigeminal nerve symptoms had improvement after FSR. Balance improved in 3 patients, was unchanged in 20 and worsened in 7 patients. Of the 12 patients with useful hearing (PTA ≤ 50 dB) prior to treatment, 9 patients retained useful hearing following FSR. Subjectively, of 25 patients with any hearing prior to treatment, 2 had improvement, 10 remained unchanged and 13 had worsening. Conclusions: Short course FSR for acoustic neuromas results in acceptable toxicity and may provide high control of tumors. Longer follow-up is needed to assess outcomes.
The Relationship of Magnetic Source Imaging to Ictal Electrocorticography in a Neuronavigational Workspace
Authors: Gross R.E. , Dean A. , Lewine J. , Chong B. , Jones G. , Funke M. , MacDonald P.
Published: April 2003

Magnetic source imaging (MSI) registers magnetoencephalographic (MEG) activity to a three-dimensional MRI volume. State-of-the-art MSI allows concurrent whole head coverage, but is practically restricted to interictal recording. However, the purpose of the presurgical evaluation of epileptic patients, in which MSI is playing an increasing role, is the elucidation of the ictal epileptogenic focus. The manner in which interictal MSI activity relates to the ictal focus has not yet been adequately examined. To facilitate this analysis, we are developing techniques to precisely coregister MSI to the ictal onset zone as defined by extraoperative intracranial grid/strip monitoring. The neuronavigational workspace is a convenient area in which to precisely coregister these (and other) imaging and physiological data sets.
Optimized Visualization and PCR Reamplification of Differentially Displayed cDNA Bands Detected by Silver Staining in Polyacrylamide Gels as Established in the Model of Dithranol-Treated Keratinocytes
Authors: Böckelmann Raik , Bonnekoh Bernd , Gollnick Harald
Published: April 2003

The differential display of cDNA species defined by a combination of so-called anchored and arbitrary primers has been acknowledged as a powerful complex strategy to identify differences in gene expression, and depends in its original version, inaugurated by P. Liang and A.B. Pardee in 1992, on the use of radioactive-labelled nucleotides. As a non-radioactive methodological alternative, we established the use of polyesterfilm-backed 10% polyacrylamide gels for horizontal differential-display electrophoresis under non-denaturing conditions, with subsequent detection of cDNA bands by an optimized, semi-automated silver staining omitting any fixation step. Polyacrylamide gel slices carrying the silvered cDNA species of interest were cut out, chopped, squashed and incubated in an ammonium acetate/EDTA solution at 37°C overnight under vigorous shaking. This procedure resulted in a 70% average success rate for subsequent PCR reamplification with regard to the number of cDNAs harvested from the differential-display gel. Novel sequence data of three cDNA clones are communicated, which under these methodological conditions were selected to be up- or down-regulated, respectively, by antipsoriatic dithranol in cultured HaCaT keratinocytes.
Effects of Diisopropylamine Dichloroacetate on Proliferation and Differentiation of Normal Human Keratinocytes in vitro
Authors: Kitamura Nobuo , Ota Yukiko , Mimura Kunio
Published: April 2003

We found that diisopropylamine dichloroacetate (DADA), known as a vasodilator, enhanced growth of keratinocytes in 4 days culture at 1–30 μg/ml, and such promoting effects of cell proliferation were reconfirmed by measuring DNA synthesis using [3H]thymidine incorporation. On the other hand, this substance enhanced synthesis of keratin K1, a potent marker of differentiation in keratinocytes, at 1–100 μg/ml in low calcium (0.1 mM) or high calcium medium (1.25 mM). Moreover, the formation of cornified envelope, another potent marker of differentiation in keratinocytes, was also promoted by DADA at a concentration of 0.1–10 mM which includes valid concentration of DADA for the enhancement of keratin K1 formation (1–100 μg/ml: 0.05–0.5 mM DADA). These results indicate that DADA has a double function, enhancement of both proliferation and differentiation of cells, which could be linked to the turnover of skin epidermis. Furthermore, in order to analyze the effect of DADA on keratinocytes, we examined the effects of each component of this substance, diisopropylamine (DIA) and dichloroacetate (DCA), on keratinocytes. As the result of these investigations, evidence was found that DCA was effective on enhancement of cell growth, but DIA was ineffective. Moreover, we found that DCA was effective on keratinocyte differentiation by evaluating the enhancement of a differentiation marker, formation of cornified envelopes, within 10 mM, while DIA was not effective. Therefore, we concluded that only DCA was an active component of the DADA molecule for the proliferation and the differentiation of keratinocytes in vitro.
The Pretreatment Effect of Chemical Skin Penetration Enhancers in Transdermal Drug Delivery Using Iontophoresis
Authors: Choi Eung Ho , Lee Seung Hun , Ahn Sung Ku , Hwang Sang Min
Published: April 2003

The transdermal drug delivery (TDD) system has largely been divided into physical, biochemical and chemical methods. Recently, combinations of these methods were introduced for more effective delivery with less side effects. We performed this study to identify the effectiveness and mechanism of TDD using the physical method, ‘iontophoresis’, plus the chemical method, ‘pretreatment with chemical enhancer’. The action sites of chemical enhancers in the stratum corneum (SC) were observed by electron microscope. We also studied whether this combined method synergistically impaired the skin barrier. To confirm the synergistic effect on skin penetration by this combined method, we measured the blood glucose level after insulin iontophoresis following a chemical enhancer pretreatment in rabbits. The results were that (1) dilatation of the intercellular lipid layers of the SC and lacunae was prominent in pretreatment with chemical enhancers inducing high transepidermal water loss (TEWL); (2) the skin barrier impairment, with repeated treatments showing an increased TEWL and also epidermal proliferation, was increased with the chemical enhancers that showed a high TEWL immediately after treatment; (3) the combination of chemical enhancer pretreatment and iontophoresis showed no synergistic impairment of the skin barrier, and (4) the chemical enhancer pretreatment with greater impairment of the skin barrier could increase the delivery of insulin by iontophoresis. The results showed that a combination of chemical enhancer pretreatment and iontophoresis could deliver drugs more effectively than iontophoresis alone. Our proposed theory is that iontophoretic drug delivery may be easier through the dilated intercellular spaces of the SC which have a lower electrical impedance following the chemical enhancer pretreatment. Because the effect and the side effects in the combination are decided by the chemical enhancer rather than iontophoresis, the development of proper chemical enhancers is important in future plans.
Lack of Efficacy of Topical Capsaicin in Serotonin-Induced Itch1
Authors: Weisshaar Elke , Ziethen Beate , Gollnick Harald
Published: April 2003

Capsaicin (CAP) has been demonstrated to be an effective topical inhibitor of cutaneous vasodilatation, pain and pruritus induced by a variety of chemical and physical stimuli. In a previous study, we showed a significantly inhibitory effect of topical CAP treatment on histamine-induced itch and cutaneous vascular reactions in healthy subjects compared to atopic eczema patients. As serotonin is proposed to play a pathophysiological role in some types of pruritus (e.g. uremic and hepatic pruritus) and CAP has been described to be successful in hemodialysis-related pruritus, we investigated the antipruritic effect of topical CAP on serotonin-induced reactions in 10 healthy volunteers in comparison to untreated skin (UPS) and placebo substance (vehicle)-treated skin (VS). On the first day, serotonin iontophoresis was performed in untreated skin. One week later, the treatments started, using either CAP 0.05% liniment or a placebo liniment (vehicle) 3 times daily over a 5-day period. On day 6, serotonin was applied by iontophoresis within the pretreated skin. After another 1-week break, the treatments were performed vice versa on the corresponding infrascapular region. Weal and flare areas were planimetrically evaluated. Itch sensations were documentated by the volunteer on a scale over a 24-min follow-up period. The examination also comprised alloknesis, which stands for induction of perifocal sensations by usually non-itching stimuli. In CAP-treated skin, serotonin-induced wheals were significantly larger post-application compared to non-pretreated skin. Wheals were significantly larger in VS than in UPS. Comparison of serotonin-induced flares in the different study arms did not reveal any significant differences. Itch sensations were not significantly reduced by topical CAP application. The areas of alloknesis were smaller in capsaicin-treated skin compared to VS and UPS, but did not reach significant value. In conclusion, topical CAP application is not effective in serotonin-induced itching in healthy volunteers. Serotonin is most unlikely to play a role in the mechanism of action of CAP.
Dithranol in a Cream Preparation: Disperse or Dissolve?
Authors: Prins M. , Swinkels O.Q.J. , Bouwhuis S.A. , de Gast M.J. , Bouwman-Boer Y. , van der Valk P.G.M. , van de Kerkhof P.C.M.
Published: April 2003

In the search for the ideal dithranol cream preparation for short-contact treatment of psoriasis, we investigated the clinical efficacy, side effects and patient appreciation of two dithranol cream preparations (cream A and B) in a double-blind left-right comparing study. Dithranol was dissolved at preparation in cream A and dispersed in cream B. Cream A is known to have a shelf life of 1 year, while cream B has a much shorter shelf life (several months). Ten patients with chronic plaque-type psoriasis were treated during 7 weeks in a short-contact regimen. The clinical efficacy was monitored by scoring of erythema, induration, scaling and involved area (PASI); skin irritation was scored visually, and patient appreciation was evaluated by means of a multiple-choice questionnaire. Dispersion of dithranol in a cream was associated with less irritation and less discoloration of the skin, and its efficacy was comparable with that of the cream in which the dithranol was dissolved. As the dispersed dithranol formulation is easier to be manufactured, its quality will be less depending on the pharmacist’s experience and equipment, and so more reliable. Besides, it will be less expensive to prepare. We advise to use this formulation for short-contact treatment.
Synergistic Activity of Benzoyl Peroxide and Erythromycin
Authors: Burkhart Craig N. , Specht Kathleen , Neckers Doug
Published: April 2003

Background: Benzoyl peroxide (BP) is the most widely used topical agent for acne since its introduction in the 1960s. Concomitant topical treatment of BP and erythromycin is stated to be superior to BP alone. However, no synergistic activity has been found with this combination. Instead, such combination therapies are hypothesized to gain their efficacy by the coupled action of two effective treatments. The antibiotic kills all susceptible bacteria and the BP eliminates the resistant strains. Objective: The purpose was to compare radical production by BP alone and with various antibiotics to determine whether certain antibiotics increase radical formation by BP, as the antibacterial activity of BP may correlate with the amount of radicals it forms. Methods: Polymerization of tetraethylene glycol dimethacrylate was used as a test of BP radical activity. Results: The results suggest that radical activity increases upon addition of certain antibiotics, such as erythromycin, to a solution of BP. Conclusion: Radical activity of BP in tetraethylene glycol dimethacrylate is increased when tested in consort with several antibiotics, such as the macrolides. We propose that the tertiary amines contained on certain antibiotics are responsible for catalysis of BP radical formation. If increased radical formation correlates with enhanced biological effect, then these data reveal the possibility of a biological synergism in mixtures of BP and antibiotics. An understanding of the mechanism of catalysis of BP radical formation by antibiotics may lead to the discovery of improved treatments for acne.
EEMCO Guidance for the in vivo Assessment of Skin Greasiness
Authors: Piérard Gérald E. , Piérard-Franchimont Claudine , Marks R. , Paye M. , Rogiers V.
Published: April 2003

Sebaceous gland activity has four distinct components which are sebum production (a secretion rate function), storage (a volume function), surface output (a delivery rate function) and stratum corneum permeation (an influx rate function). The oily appearance of skin results from an excess of sebum excretion and spreading over the body surface and its interaction with the skin surface. A multi-pronged approach is often useful to assess skin greasiness with precision. The clinical evaluation of skin greasiness and its shiny appearance should be further complemented by quantifying the large pores, follicular plugs and comedones. The sebum amount present at the skin surface can be measured non-invasively using one of several methods based on solvent extraction, cigarette paper pads, photometric assessment, bentonite clay and lipid-sensitive tapes. Quantitative parameters include the sebum casual level, the sebum excretion rate, the sebum replacement time, the instant sebum delivery, the follicular excretion rate, the density in sebum-enriched reservoirs and the sustainable rate of sebum excretion. A series of environmental and biological features influence the data. Hence rigorous methodological designs are mandatory to support claims. As a rule, accuracy of the methods is adversely affected by skin temperature, degree of hydration and surface roughness. An additional confounding factor is the inherent difficulty of collecting the surface lipids without a contribution from the follicular reservoir. A better understanding of factors that alter the sebum amount at the skin surface may well assist in the development of sebosuppressive agents to help the reduction of the skin greasiness and improve acne.
Brain Metastasis as a Sole Recurrence of Prostate Cancer after Total Prostatectomy
Authors: Hayashi Tetsuo , Igarashi Kazumasa , Tanizawa Akiko , Terada Yoko , Sekine Hideaki
Published: April 2003

Brain metastasis from prostate cancer is a rare clinical event. We present a case of prostate cancer with a solitary brain metastasis as a sole site of recurrence after total prostatectomy. To our knowledge, this is the third reported case of an isolated brain metastasis from prostate cancer.
Epididymal Metastasis of a Prostatic Carcinoma
Authors: Anastasiadis A.G. , Ebert T. , Gerharz C.-D. , Ackermann R.
Published: April 2003

We report the case of a 73-year-old patient who presented with a local recurrence of a prostatic carcinoma which had metastasized to the right epididymis. The histopathological examination of the resected tissue after transurethral resection of the prostate 8 years before revealed a pluriformal adenocarcinoma of the prostate, but the patient refused any kind of therapy at that time.
Prognostic Significance of p53 Protein Overexpression in Transitional Cell Carcinoma of the Renal Pelvis and Ureter
Authors: Jinza S. , Takano Y. , Iki M. , Noguchi S. , Masuda M.
Published: April 2003

Fifty-three patients with invasive transitional cell carcinoma of the renal pelvis and ureter were studied for p53 protein overexpression by immunohistochemistry. Overexpression of p53 protein was observed in 19 patients (35.8%). There was a significant correlation between overexpression of p53 protein and histologic grade (p < 0.01). However, there was no correlation found between p53 immunoreactivity and pathologic stage. By univariate survival analysis, a significant difference in cumulative survival was observed between stage pT2 and stage pT3 or pT4 tumors (p < 0.05). The difference in survival between patients with p53-positive and negative tumors did not reach statistical significance (0.05 < p < 0.1). Multivariate analysis revealed that pathologic stage had an independent prognostic value (p < 0.05). The independent prognostic value of p53 protein overexpression did not quite reach statistical significance (p = 0.07). p53 protein nuclear overexpression appears to be a relatively weak prognostic indicator for patients with invasive transitional cell carcinoma of the renal pelvis and ureter.
Renal Needle Biopsy along the Retrograde Puncture Line of the Renal Calyx: A New Promising Technique
Authors: Mimata Hiromitsu , Kasagi Yasuhiro , Nasu Nobuyoshi , Nomura Takeo , Matsubara Takanori , Nakagawa Masayuki , Nomura Yoshio
Published: April 2003

The Biopty-gun is a useful tool in conducting percutaneous renal biopsies, but bleeding is still a significant complication. To reduce the rate of severe bleeding complications, we attempted a new method of renal needle biopsy using a retrograde access technique. Retrograde puncture of the renal calyx was performed using the Lawson nephrostomy kit. The 18-gauge needle of the Biopty-gun was inserted along the puncture wire and fired. A 7-french pigtail catheter was retained in the renal pelvis for a few days following the procedure. This biopsy is a promising and safe technique.
Operative Course of Transurethral Resection of the Prostate and Progression of Prostate Cancer
Authors: Trygg Gunnar , Ekengren Jan , Farahmand Bahman Y. , Persson Per-Gunnar , Hahn Robert G.
Published: April 2003

Surgery has the potential to disseminate cancer cells, and we therefore hypothesized that extensive transurethral resections of the prostate (TURP) would be followed by a worse prognosis than minor ones. For this purpose, the association between the extent of surgery, disease progression, and mortality was studied in 138 patients with prostatic cancer who had undergone TURP. The results show that a large bleed (≥275 ml) indicated a slightly increased relative risk of general progression of the cancer (relative risk (RR) = 1.9, 95% confidence interval (CI) = 0.9–4.1) and death (RR = 1.5, CI = 0.6–3.3). Other parameters of extensive surgery, such as the operating time and fluid absorption, were not associated with increased risk. Patients with a medical disease, however, such as hypertension and congestive heart failure, had a significantly higher relative risk of general progression (RR = 2.7, CI = 1.2–6.1) and death from prostatic cancer (RR = 4.6, CI = 2.0–10.7) in addition to an increased relative risk of death from other causes (RR = 3.7, CI = 1.3–10.5). We conclude that concurrent medical disease, but not an extensive TURP, worsened the prognosis of patients with prostatic cancer who underwent TURP.
Idiopathic Partial Thrombosis of the Corpus cavernosum
Authors: Thiel R. , Kahn T. , Vögeli T.A.
Published: April 2003

A case of spontaneous, partial, unilateral thrombosis of the corpus cavernosum is described. A 35-year-old white male presented with a painful mass in the perineum without priapism. Diagnostic evaluation with sonography and magnetic resonance imaging revealed a thrombosis in the left posterior corporal body. Treatment consisted of intravenous heparin followed by prophylactic acetylsalicylic acid. The thrombosis resolved spontaneously over several months without sequelae. Conservative management of this rare disease appears to be possible and safe.
A Müllerian Prostatic Cyst Protruding into the Base of the Urinary Bladder
Authors: Barzilai Menashe , Ginesin Yehoshua
Published: April 2003

The unique appearance of a midline prostatic cyst is reported. The cyst presented as a round-shaped filling defect at the base of the urinary bladder during an intravenous pyelography study. Transabdominal sonography showed the mass to be a midline prostatic cyst. The sonographic features of the mass and its location are the hallmark of a müllerian duct prostatic cyst. Midline prostatic cysts are discussed and the features differentiating müllerian duct cysts from utricle cysts are emphasized.
Late Local and Pulmonary Recurrence of Renal Cell Carcinoma
Authors: Froehner M. , Manseck A. , Lossnitzer A. , Wirth M.P.
Published: April 2003

Locally recurrent renal cell carcinoma and multiple pulmonary metastases were successfully resected in a patient 20 years after nephrectomy.
Prognosis of Patients with Prostate Carcinoma Presenting as Nonregional Lymph Node Metastases
Authors: Furuya Yuzo , Akakura Koichiro , Akimoto Susumu , Ito Haruo
Published: April 2003

Objective: The mode of progression in patients with prostate cancer with metastasis to nonregional lymph nodes was examined in order to know whether the site of metastasis effects the prognosis of prostate cancer. Methods: From 1986 to 1995 at the Chiba University Hospital, 205 cases of prostatic cancer with distant metastases were experienced. In 17 of them, nonregional lymph node metastases were observed at the diagnosis, of whom 10 also had bone metastases. Results: There was no statistical difference in prognosis between 17 patients with nonregional lymph node metastases and remaining 188 patients with metastatic prostate cancer. In all patients metastasized to nonregional lymph nodes, serum prostate-specific antigen and/or prostatic acid phosphatase levels were elevated. Anti-androgen therapy was effective in 15 cases and 5-year survival rate was 45.8%. Patients without bone metastases at the initial diagnosis could survive longer than those with metastases to bone (p < 0.05). Conclusions: From these observations, endocrine therapy was effective even in patients with distant lymph node metastases.
Cytogenetic Study in 102 Infertile Men
Authors: Gündüz Gülgün , Lüleci Güven , Baykara Mehmet
Published: April 2003

Chromosomal anomalies may be a reason for male infertility. To find out whether this is true mitotic chromosome studies were performed on 41 males with azoospermia and 61 males with oligozoospermia. A constitutional chromosomal abnormality was diagnosed in 14 (34.1%) azoospermic patients and in 2 (3.3%) oligozoospermic patients. The 47,XXY karyotype was the commonest in the azoospermic group. An overall incidence of 15.7% abnormality indicates that routine chromosome analysis of infertile men should be considered.
Renal Masses Presenting 25 and 50 Years following Blunt Renal Trauma
Authors: Pruthi Raj S. , Issa Muta M. , Kabalin John N. , Terris Martha K.
Published: April 2003

The long-term consequences of blunt renal trauma are not well described. We report on 2 patients with a history of blunt renal trauma who presented with radiographically detected renal masses suspicious for renal tumor. Both patients suffered blows to the kidney during boxing matches followed by flank pain and hematuria. The injuries occurred 25 and 50 years prior to the detection of renal masses. Subsequent nephrectomy and histopathological evaluation revealed benign dystrophic renal tissue. These presentations represent probable long-term sequelae of blunt renal trauma.
Testicular Teratoma with a Unique Mode of Spread and Spontaneous Maturation
Authors: Angell Scott K. , Pruthi Raj , Gill Harcharan
Published: April 2003

Chylous ascites, a rare compliation following retroperitoneal lymph node dissection, has not been reported as a means of spread of testicular cancer. This report describes a unique path of spread of testicular cancer which also appears to spontaneously mature at the metastatic site.
Adrenal Hemorrhage Diagnosed by Ultrasonically-Guided Biopsy
Authors: Ochiai Atsushi , Ukimura Osamu , Tanaka Shigeki , Kojima Munekado
Published: April 2003

Adrenal hemorrhage in adults is an uncommon disease and is usually associated with systemic diseases, trauma or anticoagulation. When adrenal hemorrhage is discovered in chronic course without any suggestive clinical settings, it is difficult to distinguish adrenal hemorrhage correctly before surgical resection. We present a case of adrenal hemorrhage which was incidentally detected as an adrenal mass and was successfully treated in a conservative way based upon histopathological findings obtained by ultrasonically guided biopsy.
Intravesical Instillation of Mitomycin-C in 242 Patients with Superficial Bladder Cancer at High Risk of Recurrence: Long-Term Results
Authors: Hurle R. , Manzetti A. , Losa A. , Micheli E. , Ranieri A. , Chinaglia D. , Lembo A.
Published: April 2003

Objective: The present study evaluated the long-term results of intravesical mitomycin C (MMC) instillation after transurethral resection (TUR) in 242 consecutive patients with superficial bladder cancer at high risk of recurrence (stage Ta, grade 1–3, or stage T1, grade 1 and 2, primary multiple or recurrent tumor). Materials and Methods: 242 patients were treated with weekly instillations of 40 mg MMC for 8 weeks after TUR. Tumor-free patients then followed a maintenance course with monthly instillations for 3 months. Results: Median follow-up of disease-free patients is 43.5 (range 23–112) months. The incidence of first recurrence is 59.5% (144/242 patients) with a median time to first recurrence of 29 months. 95 patients (39.3%) remained disease-free. Three had disease progression as the first event. The risk of recurrence was significantly higher for multifocal tumors (p = 0.0023, hazard ratio 1.79, 95% CI 1.23–2.59). Overall, patients have been followed for a median time of 57 (range 10–114) months. During this period the recurrence rate was 4.9. Eleven more patients had disease progression. The progression rate is 5.8% (14/242), with a mean time to progression of 34 months. At present 209 patients are alive, 6 have died of bladder cancer, 16 of causes unrelated to the disease and 11 (4.5%) have been lost to follow-up. Thus the crude survival rate is 86.4%, disease-specific mortality 2.5%, and non-disease-specific mortality 6.6%. Conclusions: Patients with multiple tumors seem to benefit the least from MMC instillation. Probably recurrent disease could be better prevented with intravesical bacillus Calmette-Guérin.
Prostatic Cancer with Huge Cystic Degeneration
Authors: Tsuji Hidenori , Hashimoto Kiyoshi , Katoh Yoshinari , Iguchi Masamori
Published: April 2003

This report details a case of prostatic cancer associated with cystic degeneration. A cystic mass may occur in the pelvis for various reasons. A congenital cyst is associated with an abnormality in the paramesonephric (müllerian) duct or mesonephric (wolffian) duct. An acquired cyst can be classified into three main types, retention, malignant and parasitic, however a cyst accompanying prostatic cancer is rare. In this particular case the size of the cyst under imaging was approximately 15 cm in diameter; this makes it one of the largest among those previously reported.
An Unusual Case of Ureteral Ectopia in the Seminal Vesicle: Diagnosis and Surgical Management
Authors: Jones Jon , Dahms Stefan E. , Fichtner Jan , Hohenfellner Markus , Thüroff Joachim W.
Published: April 2003

We report the case of a young man who presented with numerous episodes of ipsilateral epididymitis. Selected imaging studies with consideration of urogenital embryology lead to the rare diagnosis of a dysplastic kidney with ureteral ectopia in the seminal vesicle. After nephroureterectomy and vesiculectomy, convalescence was uneventful. No specific symptoms, equivocal diagnostic findings and the small number of patients limit the surgical experience in diseases of the seminal vesicle. Suprainguinal extravesical extirpation, however, appears to be an excellent operative approach in cases of unilateral seminal vesicle cysts.
Vesicocolonic Fistula Four Years after Augmentation Colocystoplasty
Authors: Gofrit O.N. , Pode D. , Landau E.H.
Published: April 2003

An 8-year-old girl was born with crossed fused renal ectopia and neurogenic bladder due to sacral agenesis. Due to progressive upper tract deterioration and incontinence despite clean intermittent catheterization and pharmacotherapy with anticholinergic agents, the patient underwent augmentation colocystoplasty at the age of 4 years. Four years after surgery the girl was readmitted because of persistent febrile urinary tract infection, persistent metabolic acidosis, and intermittent watery diarrhea. A cystogram revealed a fistula between the dome of the augmented bladder and the transverse colon. The fistula was successfully resected. The presence of enterovesical fistula should always be suspected in a patient with augmented bladder who have late onset of urinary tract infection, metabolic acidosis, and diarrhea.
Unusual Semi-Spheric Perivesical Calcification after Pelvic Radiotherapy
Authors: Froehner Michael , Hakenberg Oliver W. , Manseck Andreas , Oehlschlaeger Sven , Wirth Manfred P.
Published: April 2003

An uncommon case with semi-spheric perivesical calcification after pelvic radiotherapy is reported and the possible pathogenesis of this phenomenon is discussed.
Infected Congenital Urethral Diverticulum in an Adult Male
Authors: Monish A. , Rajeev T.P. , Dorairajan L.N. , Gupta N.P.
Published: April 2003

Congenital anterior urethral diverticulum is a rare anomaly. The majority present in infancy with urinary obstruction. Those who present beyond infancy do so on account of recurrent urinary tract infection or dribbling. We present a case of congenital anterior urethral diverticulum manifesting in adulthood with suppuration in the diverticulum.
Can Sensitivity of Voided Urinary Cytology or Bladder Wash Cytology Be Improved by the Use of Different Urinary Portions?
Authors: Mungan N. Aydin , Kulacoglu Sezer , Basar Murat , Sahin Mehmet , Witjes J. Alfred
Published: April 2003

Objective: To improve sensitivity by using different portions of voided urine cytology (VUC) and bladder wash material cytology (BWC). Materials and Methods: 52 patients with biopsy-proven superficial transitional cell carcinoma (TCC) of the bladder were studied. Voided urine specimens were divided into a first stream, mid-stream and terminal stream. Bladder wash material was also divided into a first portion, mid-portion and last portion. All portions were investigated for cytology abnormalities. Results: Sensitivity for the detection of malignant cells was 34.6, 38.5 and 38.5% for the first, mid- and terminal stream of VUC and 34.6, 38.5 and 34.6% for the first, mid- and last portion of BWC, respectively. The sensitivity of VUC was 20–25% for grade I, 30–40% for grade II, and 50–75% for grade III tumors, respectively. The sensitivity of BWC was 25% for grade I, 35–45% for grade II, and 33–50% for grade III tumors, respectively. There was no statistical significant difference for sensitivities between either grades (p = 0.06) or portions or streams (p = 0.3) of VUC and BWC. Conclusions: In this small group of patients, we did not find any significant difference, but we found highest sensitivity in grade III tumors with the terminal portion of the voided urine when compared to other portions of VUC. Therefore, we believe that further study in a large series is necessary to investigate this approach of differentiated BWC and especially VUC.
Penile Epithelioid Sarcoma
Authors: Yaman Önder , Bozlu Murat , Heper Aylin Okçu , Tulunay Özden , Anafarta Kadri , Göğüş Orhan
Published: April 2003

Epitheloid sarcoma is a rare mesenchymal neoplasm. We had the opportunity to report a case of epithelioid sarcoma of the penis.