bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression in chronic haemodialysed patients
Authors: CHEN YONG‐SHING , WU SAN‐CHIANG , WANG SHIANG‐YAW , JAW BIH‐SHAW
Published: May 2003

SUMMARY:  From April 2000 to April 2001, a total of 108 chronic stable haemodialysed patients (34 males aged 57.76 ± 12.68 years under haemodialysis treatment for 31.41 ± 24.71 months and 74 females aged 54.99 ± 12.87 years under haemodialysis for 41.47 ± 33.47 months) were studied for signs of clinical depression. Depression was measured by using ‘The Taiwanese Depression Questionnaire (TDQ)’. After analysing various possible factors, we chose to study three dimensions: affective change, somatic complaint and cognitive disturbance. Thirty‐six (33.4%) of the patients were found to have TDQ scores above 19; our cut‐off value. Diabetic patients were also found to have higher depression scores and affective change scores than those without diabetes. The elderly suffered more from somatic complaints, and patients without jobs also tended to have higher depression scores. We compared the nutrition indexes and uraemic toxin removal indexes of those with higher depression scores (score ≥19) with those with normal scores (score <19), and we found no differences between the two groups. We found that an underlying disease and job status were the major differences found in the two groups. Therefore, our findings suggest that the depression found in our chronic haemodialysed patients was not a result of the physical conditions, but a result of psychosocial problems indicating a need for psychosocial support for these patients.
Antibiotics induce apoptosis of human peritoneal mesothelial cells
Authors: FANG CHENG‐CHUNG , YEN CHUNG‐JEN , TSAI TUN‐JUN , CHEN RUEY‐HWA , LEE PO‐HUANG , TOMINO YASUHIKO
Published: May 2003

SUMMARY:  The peritoneal mesothelial cell is a critical component of the peritoneal membrane. The intraperitoneal use of several antibiotics to treat bacterial peritonitis is current clinical practice. Our previous study showed that cephalothin (CPL) and cefotaxime (CFT) have cytotoxic effects on human peritoneal mesothelial cells (HPMC), however, the exact mechanism of cytotoxicity has not been elucidated. In the present study, flow cytometry, TdT‐mediated dUTP nick‐end labelling (TUNEL) staining and electron microscopy were used to detect the apoptosis of HPMCs. Immunofluorescent staining was used to evaluate the cytochrome c distribution pattern. Western blotting was used to assess apoptotic signalling proteins. We found that CPL (0.5 mg/mL) and CFT (1 mg/mL) induced apoptosis of HPMCs, whereas cefazolin (0.5 mg/mL) and ceftriaxone (0.5 mg/mL) failed to induce apoptosis of HPMCs. While the DNA content of CFT‐ or CPL‐treated cells was reduced, as determined by flow cytometry, cefazolin and ceftriaxone had no such effect. The CFT‐ or CPL‐treated cells displayed the features of apoptosis both under the electron microscope and by using TUNEL staining. However, cefazolin and ceftriaxone produced the same result as the medium controls. Furthermore, CFT and CPL increased the expression of Bax and p53, and caused the translocation of cytochrome c from the mitochondria to the cytoplasm. The HPMC treated by CFT but not by CPL induced the cleavage of procaspase‐3 to form active caspase‐3. In conclusion, cefotaxime and cephalothin induce apoptosis of HPMCs in vitro. Signal transduction may be through the mitochondrial pathway.
Unruptured intracranial aneurysms in haemodialysis patients
Authors: NAKATANI TATSUYA , NAGANUMA TOSHIHIDE , UCHIDA JUNJI , MASUDA CHIKAYOSHI , WADA SEIJI , SUGIMURA TAKESHI , SUGIMURA KAZUNOBU
Published: May 2003

SUMMARY:  While the mortality rate of subarachnoid haemorrhage is very high in haemodialysis (HD) patients, the prevalence of unruptured intracranial aneurysms in HD patients has not yet been elucidated. We performed cerebral magnetic resonance angiography (MRA) on 123 HD patients who did not have symptomatic cerebrovascular disease, and on 52 control subjects. On the basis of these images, the prevalence of unruptured intracranial aneurysms was evaluated. Unruptured aneurysms were found in three HD patients (2.4%). There were no aneurysms found in the healthy control group. There was no significant difference in the prevalence of unruptured aneurysms between HD patients and healthy controls. Therefore, the incidence of intracranial aneurysms is not associated with chronic renal failure.
Interferon‐γ induces macrophage migration inhibitory factor synthesis and secretion by tubular epithelial cells
Authors: RICE EDWINA K , NIKOLIC‐PATERSON DAVID J , HILL PRUDENCE A , METZ CHRISTINE N , BUCALA RICHARD , ATKINS ROBERT C , TESCH GREG H
Published: May 2003

SUMMARY:  Macrophage migration inhibitory factor (MIF) promotes macrophage accumulation and leucocyte activation during inflammation. Macrophage migration inhibitory factor is upregulated in intrinsic renal cells in many types of kidney diseases, and has a pathogenic role in rat crescentic nephritis. However, little is known about the factors that regulate the production and secretion of MIF in kidney cells. In this study, we evaluated whether interferon‐gamma (IFN‐γ), a cytokine implicated in the development of kidney disease and a potent inducer of MIF production in macrophages, could promote MIF synthesis and secretion from renal tubular epithelial cells. Northern blot analysis detected constitutive expression of MIF mRNA in rat tubular epithelial cells (NRK52E), which increased twofold after a 6‐h stimulation with IFN‐γ. Macrophage migration inhibitory factor protein was found only in the cytoplasm of NRK52E cells. Following IFN‐γ stimulation, intracellular MIF in NRK52E cells was rapidly secreted with a maximal reduction of 50% after 20 min, which returned to normal levels after 2–4 h. Rapid secretion of MIF in response to IFN‐γ was also seen in rat mesangial cells. These findings indicate that IFN‐γ induces rapid secretion of MIF by tubular epithelial cells, and suggest that this may be an important mechanism leading to inflammatory cell accumulation and activation during kidney disease.
Unenhanced helical computed tomography in the evaluation of acute flank pain
Authors: AHMAD NAZIM ALI , ATHER MOHAMMAD HAMMAD , REES JEFFREY
Published: May 2003

Objectives: The purpose of this study was to determine the value of unenhanced helical computed tomography (UHCT) in the diagnosis of acute flank pain at our institution.

Methods: Two hundred and thirty‐three consecutive UHCT examinations, performed for suspected renal/ureteral colic between July 2000 and August 2001 were reviewed, along with pertinent medical records.

Results: Ureteral calculi were identified in 148 (64%) examinations, evidence of recent passage of calculi was found in 10 (4%) and no calculi were found in 75 (32%). Thirty‐two of the conservatively managed patients were excluded for inadequate follow‐up. In the remaining 201 patients, sensitivity of UHCT in diagnosing calculi was 99% and specificity was 98%, while the positive predictive value was 99% and negative positive predictive value was 98%. Overall, an alternative or additional diagnosis was established in 28 (12%) patients. Upon diagnosis of ureterolithiasis on UHCT, none of the patients required additional imaging studies for confirmation.

Conclusion: UHCT is a highly sensitive imaging modality for the detection of urinary tract calculi and obstruction.
Clear cell adenocarcinoma of the male urethra
Authors: GöĞUŞ ÇAĞATAY , BALTACI SüMER , ORHAN DICLEHAN , YAMAN ÖNDER
Published: May 2003

We present a rare case of clear cell adenocarcinoma of the male urethra. These tumors are usually presented with hematuria, obstructive voiding symptoms or urinary retention. Histologically, they display tubulocystic, tubular, papillary or diffuse patterns with clear and hobnail cells. The present case of this rare disease emphasizes the aggressive nature of urethral clear cell adenocarcinoma in males.
Prevalence of elevated serum prostate‐specific antigen in rural Nigeria
Authors: UKOLI FLORA , OSIME USIFO , AKEREYENI FOLASADE , OKUNZUWA OSAZUWA , KITTLES RICK , ADAMS‐CAMPBELL LUCILE
Published: May 2003

Background: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians.

Methods: Rural Nigerian men, 40 years and older, were screened by serum prostate‐specific antigen (PSA) and digital rectal examination (DRE) and those with PSA ≥ 4 ng/mL and/or abnormal DRE were referred for prostate biopsy.

Results: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were ≥ 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA ≥ 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men ≥ 80 years. The rate was 13 (15.7%) for men ≥ 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one‐third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men ≥ 80 years. The proportion of men with PSA ≥ 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men ≥ 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side‐effects of the procedure or diagnosis of cancer.

Conclusion: The proportion of men with PSA ≥ 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African‐American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.
Testicular metastasis from squamous cell carcinoma of the lung
Authors: UCHIDA KOHSUKE , KURIMURA YUICHIRO , MIYAKE MASAFUMI , ANDO MASAKATSU , TANAKA TOSHIAKI , SASAO TAKUMI , SANO MASATO , YOSHIOKA MIGAKU , YAMAGUCHI YASUHIRO
Published: May 2003

We present a case of squamous cell carcinoma of the testis that metastasized from lung cancer. The patient, who had received left pneumonectomy 2 years earlier for squamous cell carcinoma (SCC) of the lung, developed pulmonary metastasis, which was treated with chemotherapy. Although the recurrence regressed after treatment, the testicular tumor progressed gradually. Left radical orchiectomy was performed. Pathological examination revealed metastatic SCC. Testicular metastasis from lung cancer is a very rare disease.
A study to detect Helicobacter pylori in fresh and archival specimens from patients with interstitial cystitis, using amplification methods
Authors: Agarwal M. , Dixon R.A.
Published: May 2003

OBJECTIVES

To detect Helicobacter pylori DNA in fresh and paraffin‐embedded bladder biopsy specimens, and thus determine any possible role in interstitial cystitis (IC).

MATERIALS AND METHODS

Thirty‐three bladder biopsy samples were examined from patients with IC (29 paraffin‐embedded and four freshly frozen) diagnosed according to National Institute of Diabetes, Digestive and Kidney Disease criteria. The positive control was a gastric biopsy sample from a patient with a known gastric ulcer caused by H. pylori infection.

RESULTS

The anticipated polymerase chain reaction product size of 109 base pairs was obtained with the positive control, whereas none of the other biopsy samples (paraffin embedded or fresh) showed positive amplification specific for H. pylori.

CONCLUSIONS

As there was no H. pylori DNA in any of the samples from patients with IC, it is an unlikely candidate in the pathogenesis of IC.
Fibrin as an inducer of fibrosis in the tunica albuginea of the rat: a new animal model of Peyronie's disease
Authors: Davila H.H. , Ferrini M.G. , Rajfer J. , Gonzalez‐Cadavid N.F.
Published: May 2003

OBJECTIVES

To investigate the role of fibrin in inducing fibrosis in the tunica albuginea (TA) of the rat penis, to develop a new animal model for Peyronie's disease (PD).

MATERIALS AND METHODS

The TA of rats (five per group per period) were injected with either saline, fibrin, transforming growth factor‐β1 (TGF‐β1) or TGF‐β1 plus fibrin; the rats were killed at 1, 3, and 6 weeks after injection. Images were analysed quantitatively from tissue sections stained for collagen (Masson trichrome), fibrin (Verhoeff's stain) and elastin (Hart's stain), and immunostained for TGF‐β1, inducible nitric oxide synthase (iNOS), heme oxygenase 1 (HO1), α‐smooth muscle actin (ASMA), apoptosis (TUNEL) and plasminogen activator inhibitor (PAI). Collagen fibre organization was characterized by electron microscopy. Human PD plaque tissue and normal human TA were assayed for fibrin by immunohistochemistry in nine samples.

RESULTS

At 1 week after injection of fibrin into the rat TA, only oedema was present; at 3 weeks, the oedema developed into a characteristic fibrotic PD‐like plaque. The injection of TGF‐β1 into the TA also induced oedema in the TA at 1 and 3 weeks but there was very little evidence of a recognisable plaque at either time. Injection with TGF‐β1 plus fibrin resulted in oedema at 1 week but at 3 weeks there was a smaller plaque than with fibrin only. At 6 weeks the induced plaques in the fibrin‐only and fibrin + TGF‐β1 groups persisted, and were comparable with those elicited at this time by TGF‐β1 alone. The control animals showed no pathology at any of the sample times. At 3 weeks the PD plaque induced by injection with fibrin alone had not only greater expression of TGF‐β1 than the TA of the animals receiving TGF‐β1 alone, but also greater levels of other markers of fibrosis, e.g. HO1 (reactive oxygen species), ASMA (presence of myofibroblasts), apoptosis, and PAI (inhibitor of fibrinolysis). iNOS, a known antifibrotic agent, was also increased. In human PD plaque tissue, fibrin was detected by immunohistochemistry in all nine specimens.

CONCLUSIONS

These results suggest that fibrin, when introduced into the TA of the rat penis, acts as a potential profibrotic protein, possibly via the local release of TGF‐β1, and induces a plaque not only histologically similar to that induced by TGF‐β1 but to that of the human condition. Because fibrin can extravasate from the blood into the human TA after an injury to the TA, and because fibrin persists in the plaque tissue, we hypothesise that fibrin may play a key role in the pathogenesis of human PD.
Current practice in the management of vasectomy reversal and unobstructive azoospermia in Merseyside & North Wales: a questionnaire‐based survey
Authors: Wood S. , Montazeri N. , Sajjad Y. , Troup S. , Kingsland C.R. , Lewis‐Jones D.I.
Published: May 2003

OBJECTIVE

To investigate the current incidence of vasectomy reversal procedures, the techniques used and which practitioners use them.

PATIENTS AND METHODS

Using a questionnaire, 130 general surgeons and urologists practising in Merseyside and North Wales were surveyed.

RESULTS

The response rate was 74%, with 24 urological surgeons and 14 general surgeons undertaking vasectomy reversal. Annually, urological surgeons carried out significantly more procedures than did general surgeons, at 8.5 and 5.3 (P = 0.029), respectively. They were also more likely to use double‐layer closure and microsurgical techniques, whilst significantly less likely to use stents. Urologists reported significantly greater patency rates, at 76% and 52% (P = 0.017), respectively, with no significant differences in subsequent pregnancy rates (30% vs 25%). Only one practitioner checked tubal patency in the female partner before vasectomy reversal.

CONCLUSIONS

The use of vasectomy reversal is a cost‐effective treatment for men wanting paternity after vasectomy. The technique used by the clinician and proper audit of the results require close attention; it would also appear to be obvious that all the partners of men seeking a vasectomy reversal should have their fertility status established before reversal, something that is clearly not done at present.
The results of 15 years of consistent strategy in treating antenatally suspected pelvi‐ureteric junction obstruction
Authors: Thorup J. , Jokela R. , Cortes D. , Nielsen O.H.
Published: May 2003

OBJECTIVE

To determine how to select patients for surgery among those with antenatally detected pelvi‐ureteric junction (PUJ) obstruction.

PATIENTS AND METHODS

The study comprised 100 consecutive children with antenatally detected suspected unilateral PUJ obstruction and a normal contralateral kidney. The correct diagnosis was made using postnatal ultrasonography, intravenous urography and renal scintigraphy, the last also being used for the follow‐up.

RESULTS

Four patients had poor function in the hydronephrotic kidney, treated in three by nephrectomy; 61 had normal function in the hydronephrotic kidney, with 49 followed for 1–10 years with no change in kidney function and no symptoms. Twelve patients in this group had later surgery (at 0.7–8 years old) because of pyelonephritis (four), pain and/or renal functional impairment (eight, three of whom had normal function afterward). Thirty‐five patients had moderately impaired function of the hydronephrotic kidney; 29 had primary surgery at a median age of 4 months. The median hydronephrotic renal function increased from 32% before to 42% after surgery, with 15 kidneys having normal function. In one other patient the kidney was lost before surgery. Five other patients were initially treated conservatively and the hydronephrotic renal function increased from 32% to 35% at the 1‐year follow‐up, significantly less than in the surgical group. The overall operative complication rate was 4%.

CONCLUSIONS

With our management programme more than half the patients can avoid surgery in childhood. Although the follow‐up was intense there was moderate and irreversible functional kidney deterioration in 5%. In contrast, after successful reconstructive surgery, only a few follow‐up procedures causing possible discomfort to the child are needed in most. The risk of surgical complications cannot be neglected. The present results are useful for advising parents deciding whether their antenatally detected hydronephrotic child should undergo surgery or not.
Comparison of the relaxant effects of alfuzosin, phentolamine and sildenafil on rabbit isolated corpus cavernosum
Authors: Palea S. , Barras M.
Published: May 2003

OBJECTIVE

To compare the direct relaxant effects of alfuzosin, phentolamine and sildenafil in rabbit isolated corpus cavernosum (CC) pre‐contracted with phenylephrine or KCl.

MATERIALS AND METHODS

Penile erectile tissue was obtained from male New Zealand White rabbits (22–26 weeks old). The CC was cut into longitudinal strips and mounted under 2 g resting tension in 5‐mL jacketed organ baths containing a modified Krebs solution bubbled with 95% O2, 5% CO2 and maintained at 37 °C. Tissue strips were pre‐contracted by 60 mmol/L KCl or 10 µmol/L phenylephrine. After obtaining a stable plateau of contractions, test compounds were added to the organ bath. The relaxant potencies were expressed as the percentage of inhibition of the plateau of contraction induced by 10 µmol/L phenylephrine.

RESULTS

Alfuzosin showed a concentration‐dependent relaxing effect on rabbit CC pre‐contracted by 10 µmol/L phenylephrine, with a mean (sd) pIC50 of 7.64 (0.06). The relaxant effect was unaffected by pre‐incubation with 100 µmol/L Nω‐nitro‐l‐arginine methyl ester (L‐NAME). Phentolamine had a potency similar to alfuzosin, with a pIC50 of 7.44 (0.08). Both alfuzosin and phentolamine were completely ineffective on the plateau of contraction induced by 60 mmol/L KCl. In contrast to alfuzosin, sildenafil was equipotent in relaxing the rabbit CC against each contractile agent, with pIC50 values of 7.25 (0.09) and 7.23 (0.22) with 10 µmol/L phenylephrine and 60 mmol/L KCl, respectively. The relaxant response to sildenafil was partly blocked by pretreatment with 100 µmol/L L‐NAME, with pIC50 values of 7.94 (0.09) and 6.63 (0.32) without and with L‐NAME, respectively. Sildenafil, incubated for 45 min at 10 µmol/L, had no relaxant effect on the resting tension of the preparation or on the concentration‐response curve to phenylephrine.

CONCLUSIONS

The direct relaxant effect of alfuzosin is mediated through α1‐adrenoceptor blockade. The relaxations induced by phentolamine and alfuzosin are independent of nitric oxide, whereas those induced by sildenafil are, at least partly, sensitive to L‐NAME and a selective soluble guanylate cyclase inhibitor, indicating the involvement of nitric oxide and soluble guanylate cyclase. Alfuzosin and phentolamine effectively counteract α1‐adrenoceptor‐mediated contractions of rabbit CC. If valid for human CC, such an effect may contribute to an improved erectile function in patients treated for benign prostatic hyperplasia.
Artificial neural networks in predicting optimum renal stone fragmentation by extracorporeal shock wave lithotripsy: a preliminary study
Authors: Hamid A. , Dwivedi U.S. , Singh T.N. , Gopi Kishore M. , Mahmood M. , Singh H. , Tandon V. , Singh P.B.
Published: May 2003

OBJECTIVE

To assess the ability of artificial neural networks (ANNs) to predict optimum renal stone fragmentation in patients being managed by extracorporeal shock wave lithotripsy (ESWL).

PATIENTS AND METHODS

The study included 82 patients with renal stones who were being treated by ESWL. Data (input and output values) from 60 patients in whom there was optimum fragmentation of stones by ESWL were used for training the ANN. These data mainly included the 24‐h urinary variables, the radiological features of the stone disease and the ESWL settings used. The predictability of the trained ANN was tested on 22 subsequent patients, by supplying the input variables of the 22 patients into the trained ANN and recording the output values (predicted values). After subjecting these patients to ESWL, the actual results (observed values) were recorded. The predicted and the observed values were then compared.

RESULTS

In the 22 patients in whom predictability was tested, the trained ANN predicted optimum fragmentation at ≤ 13 000 shocks/stone (as per study protocol) in 17 and optimum fragmentation at> 13 000 shocks/stone in the other five. In the 17 patients (test set) where the trained ANN had predicted optimum fragmentation at ≤ 13 000 shocks/stone, the optimum fragmentation was at that value, although the predicted and observed values were not identical. The overall correlation between the predicted and the observed values was 75.5% (correlation coefficient 0.7547) in these 17 patients. Of the other five patients, none had optimum fragmentation at < 13 000 shocks/stone, as predicted by the trained ANN, giving complete accuracy for this factor.

CONCLUSION

This was a pilot study, i.e. an initial attempt to use an ANN in this regard, and although there were few patients, such that it is not possible to make final recommendations, the overall predictability was ≈ 75%. An encouraging outcome of the study was that the trained ANN identified patients unlikely to benefit from ESWL. Using a larger dataset and identifying more significant variables, while eliminating inputs with a negative effect, the efficiency and utility of this ANN can probably be enhanced and in future it might be possible to predict stone fragmentation with reasonable accuracy.
Identifying under‐performing surgeons
Authors: Singh R. , Smeeton N. , O'Brien T.S.
Published: May 2003

OBJECTIVE

To estimate the likelihood of poor surgical results being explained by chance rather than under‐performance.

METHODS

The 30‐day mortality rates after radical cystectomy for bladder cancer were analysed theoretically. Surgical competence was defined as a mortality rate of 4%, excellence as 2% and under‐performance as 8%, 12%, 20% or 40%. Four scenarios were explored for surgeons of different competence: first, the sample size required to show that a given level of under‐performance is very unlikely to be due to chance; second, the likelihood of two or more consecutive deaths in a series of cases; third, the likelihood of clustering of deaths, defined as two deaths in five or in 10 cases; and last, the likelihood of outstanding surgical results (i.e. no deaths) being achieved in small cohorts by surgeons of differing competence.

RESULTS

For surgeons with a mortality rate of 8%, 12%, 20% or 40%, the sample sizes needed to prove under‐performance are 211, 65, 21 and seven, respectively. For consecutive deaths, 0.4% of excellent, 1.4% of competent and 21% of surgeons with a mortality rate of 12% will experience two or more consecutive deaths in the next 10 cases. For clustered deaths, 1% of excellent, 5% of competent and 23% of seriously under‐performing surgeons (mortality rates ≥ 12%) will experience two deaths in their next 10 cases. Lastly, for the likelihood of outstanding results, only 3.6% of surgeons with an 8% mortality rate and < 1% of surgeons with a mortality rate ≥ 12% will experience no deaths over 40 consecutive cases.

CONCLUSIONS

Very large cohorts are needed to confirm even significant under‐performance. Consecutive deaths are very unlikely events for competent surgeons. Clustered deaths (two deaths in 10 cases) are very unlikely events for excellent surgeons but plausible for competent ones. Analysis of consecutive/clustered deaths is limited by low statistical sensitivity; only up to a quarter of seriously under‐performing surgeons are identified. No deaths in 40 consecutive cases implies competence.
Urodynamics in a rat neurogenic bladder model with a unilateral electrolytic lesion of the basal forebrain
Authors: Shimizu I. , Kawashima K. , Ishii D. , Oka M.
Published: May 2003

Despite the significant clinical problems of bladder dysfunction, specifically affecting the individual's quality of life, our understanding of this disease is limited. The main problem relates to the lack of clinically relevant models. The paper by Shimizu et al. describes the development of a neurogenic bladder model in the rat by an electrolytic unilateral lesion of the right basal forebrain. This model mimics the clinical situation of increased voiding frequency and decreased micturition threshold pressure. The group also uses this model to test the effects of AH‐9700, a potent sigma receptor‐agonist, with some success. The overall develop of clinically relevant models has important implications in future drug development and testing.

OBJECTIVE

To investigate the changes in bladder function in rats with an electrolytic lesion of the right basal forebrain (RBF) and to determine the effects of AH‐9700, a novel sigma receptor ligand, on cystometry in RBF‐lesioned rats.

MATERIALS AND METHODS

A lesion was made electrolytically in the RBF of male Wistar rats. At 7 or 8 days after the lesion or sham surgery, continuous cystometry was performed in awake rats. In addition, contractile responses to electrical field stimulation or carbachol were measured in isolated bladder strips, as were the forebrain contents of acetylcholine, monoamine neurotransmitters and their metabolites.

RESULTS

RBF‐lesioned rats showed a remarkable increase in voiding frequency, with a decrease in voiding threshold pressure but no change in voiding pressure, compared with sham‐operated rats. However, contractile responses in bladder strips isolated from RBF‐lesioned rats were no different from those in strips isolated from sham‐operated rats. In RBF‐lesioned rats, the contents of acetylcholine, dopamine, 4‐dihidroxyphenylacetic acid and homovanillic acid were significantly decreased in the right forebrain. AH‐9700 dose‐dependently decreased the voiding frequency and increased the threshold pressure in RBF‐lesioned rats. Anti‐muscarinic agents (oxybutynin and propiverine) also decreased the voiding frequency, but their effects were less potent than that of AH‐9700.

CONCLUSIONS

The RBF‐lesioned rat may be a useful model for the neurogenic bladder of supraspinal origin. Moreover, AH‐9700 effectively improves bladder dysfunction in this model.
Contralateral adrenal metastasis of renal cell carcinoma: treatment, outcome and a review
Authors: Lau W.K. , Zincke H. , Lohse C.M. , Cheville J.C. , Weaver A.L. , Blute M.L.
Published: May 2003

The group from the Mayo Clinic review their experience with contralateral adrenal metastasis in 11 patients, two with synchronous and nine with metachronous metastases, all being treated by adrenalectomy. Although nine of the 11 patients had died from RCC by the time of review, the authors felt that removal of contralateral adrenal metastasis had a beneficial effect; this sustains the belief that surgical removal of solitary metastases is advisable.

Urologists from London address the concept of surgical variables as being of major importance. We will be hearing more about ‘under performing surgeons’, and I felt that an editorial comment from two European urologists would help to put the article in place for the reader. I can guarantee that further views are on their way about this important topic.

Screening for prostate cancer has occupied many column inches in most urological Journals, and readers are of course aware of the randomized studies being conducted in North America, Europe and elsewhere. Authors from South Africa describe some of the problems associated with developing a screening programme in a less developed part of the world. They show that it can be extremely difficult to induce patients screened for the PSA to attend for their prostate biopsy.

OBJECTIVE

To report the surgical treatment of patients with renal cell carcinoma (RCC) metastatic to the contralateral adrenal gland and compare our experience with previous reports, as such metastases are found in 2.5% of patients with metastatic RCC at autopsy, and the role of resecting metastatic RCC at this site is not well defined.

PATIENTS AND METHODS

We retrospectively identified 11 patients who had surgery for metastatic RCC to the contralateral adrenal gland between October 1978 and April 2001. The patients’ medical records were reviewed for clinical, surgical and pathological features, and the patients’ outcome.

RESULTS

The mean (median, range) age of the patients at primary nephrectomy was 60.9 (64, 43–79) years; all had clear cell (conventional) RCC. Synchronous contralateral adrenal metastasis occurred in two patients. The mean (median, range) time to contralateral adrenal metastasis after primary nephrectomy for the remaining nine patients was 5.2 (6.1, 0.8–9.2) years. All patients were treated with adrenalectomy; there were no perioperative complications or mortality. Seven patients died from RCC at a mean (median, range) of 3.9 (3.7, 0.2–10) years after adrenalectomy for contralateral adrenal metastasis; one died from other causes at 3.4 years, one from an unknown cause at 1.7 years and two were still alive at the last follow‐up.

CONCLUSIONS

The surgical resection of contralateral adrenal metastasis from RCC is safe; although most patients died from RCC, survival may be prolonged in individual patients. Hence, in the era of cytoreductive surgery, the removal of solitary contralateral adrenal metastasis seems to be indicated.
Catheter‐associated urinary tract infections: prevalence of uropathogens and pattern of antimicrobial resistance in a UK hospital (1996–2001)
Authors: Wazait H.D. , Patel H.R.H. , Veer V. , Kelsey M. , Van Der Meulen J.H.P. , Miller R.A. , Emberton M.
Published: May 2003

OBJECTIVE

To assess the change in the bacterial profile and pattern of antibiotic resistance of catheter‐associated urinary tract infections (CAUTIs, the most prevalent form of nosocomial infections) between 1996 and 2001.

MATERIALS AND METHODS

Catheter samples of urine (CSUs) submitted in 1996, 1998 and 2001 (2451, 2460 and 3349 specimens, respectively) were analysed. The distribution of different uropathogens in bacterial CAUTIs and their in vitro antimicrobial resistance was evaluated over the study interval. The likelihood ratio test was used to assess whether there was a linear trend according to calendar year.

RESULTS

Escherichia coli was the most frequently isolated pathogen in all years, but its frequency declined over time (35.6%, 32.5% and 26.6%, respectively). Enterococcus was the second most frequent overall, with a significant increase in frequency with time (11.8%, 15.3% and 22.0%, respectively). There was also a considerable change in resistance patterns to antibiotics. As a result, in 1996, CAUTIs were least often resistant to ciprofloxacin (8.0%) followed by co‐amoxiclav (18.5%) and cephalexin (25.4%). In 2001, CAUTIs were least often resistant to co‐amoxiclav (22.5%), followed by ciprofloxacin (27.2%) and nitrofurantoin (28.8%).

CONCLUSION

The types of organisms associated with CAUTI have changed over the last 5 years in a UK institution, as have the patterns of antibiotic resistance. Currently, the most appropriate agents for the empirical management of CAUTIs seem to be co‐amoxiclav, ciprofloxacin and nitrofurantoin.
The long‐term outcome of bilateral Cohen ureteric reimplantation under a common submucosal tunnel
Authors: Androulakakis P.A. , Stefanidis A.A. , Karamanolakis D.K. , Moutzouris V. , Koussidis G.
Published: May 2003

OBJECTIVE

To analyse the results of bilateral Cohen reimplantation under a common submucosal tunnel, over an 18‐year period.

PATIENTS AND METHODS

We retrospectively examined 102 children (35 boys and 67 girls, median age 5.5 years, range 0.5–13.5) who underwent bilateral antireflux ureteric reimplantation from 1983 to 2000 with a modified Cohen technique, re‐implanting both ureters under a common submucosal tunnel in the mid‐trigonal area, to treat primary vesico‐ureteric reflux (VUR, 99 patients) or obstructive megaureter (three). The mean (range) follow‐up was 10.6 (2–18) years.

RESULTS

The operation was successful in 198 of 204 (97%) ureters. One patient had vesico‐ureteric stenosis in one ureter and was re‐operated successfully. In two ureters in two different patients there was transient stasis after surgery caused by oedema within the tunnel, which gradually resolved. Two ureters in two other patients had reflux after surgery, which resolved spontaneously after 12 and 24 months, respectively. A 6‐month old baby had anuria after surgery because of acute compression of both ureters within a narrow tunnel; this patient was re‐operated, the tunnel widened and the obstruction resolved. None of 82 patients who had reached school age by the time of their last follow‐up showed signs of voiding dysfunction.

CONCLUSIONS

The modified bilateral Cohen reimplantation with both ureters under a common submucosal tunnel offers very good long‐term results in curing VUR or obstructive megaureter. Crossing one ureter upon the other within the tunnel does not predispose to long‐term obstruction. From these results we recommend it as a reliable technique for surgically treating bilateral VUR or obstructive megaureter.
Laparoscopic renal biopsy: a 9‐year experience
Authors: Shetye K.R. , Kavoussi L.R. , Ramakumar S. , Fugita O.E. , Jarrett T.W.
Published: May 2003

Renal biopsy is a frequent procedure in patients with suspected intrinsic renal disease. In some patients the blind percutaneous approach is contraindicated; the authors from Johns Hopkins describe their experience over a 9‐year period using a laparoscopic approach. They found that adequate tissue could be obtained for biopsy in the large majority of cases, and that complications occurred in a tiny minority. Most patients were discharged within 24 h. They indicate the advantages in removing tissue by this method.

Authors from Varanasi, India describe how artificial neural networks were used in an attempt to predict optimum renal stone fragmentation in patients undergoing ESWL. They were encouraged by the findings in what was essentially a pilot study, and felt that with a larger data set, the value of their network system could be enhanced.

OBJECTIVES

To present our experience and outcome of consecutive laparoscopic renal biopsy over a 9‐year period, as renal biopsy remains an important diagnostic procedure for evaluating proteinuria, haematuria and renal failure, but when percutaneous biopsy is contraindicated, a laparoscopic biopsy is an attractive option because it is minimally invasive.

PATIENTS AND METHODS

Seventy‐four patients (29 male, 45 female, mean age 45 years, range 3–79) had a laparoscopic renal biopsy taken for various indications, e.g. morbid obesity, solitary kidney, coagulopathy, failed percutaneous biopsy, high location of the kidney and poor visualization with ultrasonography. The kidney was approached via a laparoscopic retroperitoneal route using a two‐port technique, with the patient in the flank position. After identifying the kidney, one to five cortical biopsies were obtained with cup‐biopsy forceps.

RESULTS

Adequate tissue was obtained in 96% of the patients; the mean (range) operative duration was 123 (9–261) min and the estimated blood loss 67 (5–2000) mL. Forty‐three patients were discharged within 24 h. Complications occurred in 10 patients, with significant bleeding in three. One patient died after surgery, secondary to a perforated peptic ulcer while on high‐dose steroid therapy.

CONCLUSION

Laparoscopic renal biopsy is a safe and effective alternative to open renal biopsy for patients in whom percutaneous biopsy is not feasible. It offers the advantage of obtaining cortical biopsies and achieving haemostasis under direct vision. Adequate renal tissue is obtained in most cases. Recovery and convalescence are short for most patients.
Urogynaecological and obstetric issues in women with the exstrophy‐epispadias complex
Authors: Mathews R.I. , Gan M. , Gearhart J.P.
Published: May 2003

The authors from Copenhagen write about their 15‐year consistent strategy in the treatment of antenatally suspected PUJ obstruction. The group deals with this controversial subject in some detail, and they outline data which they feel are helpful for urologists giving advice to parents about the advisability of having the condition treated by operative or conservative means.

The Cohen technique for the treatment of bilateral VUR, using a common submucosal tunnel, over an 18‐year period is described by authors from Athens; they found that the technique offers excellent long‐term results, and that crossing one ureter upon the other within the tunnel does not predispose to obstruction.

OBJECTIVE

To review of the sexual and urogynaecological issues faced by a large cohort of women with the exstrophy‐epispadias complex (EEC).

PATIENTS AND METHODS

The study comprised 83 women and girls with EEC; a confidential survey was mailed to identify their social and sexual concerns. Fifty‐six women had classical bladder exstrophy (CBE), 13 had female epispadias (FE) and 14 had cloacal exstrophy (CE). Data on the initial method of reconstruction and urogynaecological problems were obtained from a review of the hospital records. Information on continence, infection and sexual function was obtained from 34 completed surveys.

RESULTS

The bladder was closed in 51 patients with CBE and 13 with CE. Urinary calculi developed in 10 patients with CBE, two with FE and three with CE. Vaginal and uterine prolapse occurred an earlier age in patients with EEC. Eight women had 13 pregnancies, eight of which resulted in normal healthy children. Overall continence was achieved in 85% of the women surveyed. Urinary tract infections remained a frequent problem for women with EEC; only 27% of respondents indicated that they were infection‐free. Women aged> 18 years (24) who responded indicated that they had appropriate sexual desire; 16 were sexually active and the mean age for commencing sexual activity was 19.9 years. Six patients had dyspareunia and 10 indicated that they had orgasms. However, five additional patients indicated that they had restricted intercourse, as they were dissatisfied with the cosmesis of their external genitalia.

CONCLUSIONS

Sexual and gynaecological issues become increasingly important in patients with EEC as they become adults. Understanding these issues faced by patients with EEC as they mature will permit better counselling of future patients.
Age of ovary determines remaining life expectancy in old ovariectomized mice
Authors: Cargill Shelley L. , Carey James R. , Müller Hans‐Georg , Anderson Gary
Published: May 2003

We investigated the capacity of young ovaries, transplanted into old ovariectomized CBA mice, to improve remaining life expectancy of the hosts. Donor females were sexually mature 2‐month‐olds; recipients were prepubertally ovariectomized at 3 weeks and received transplants at 5, 8 or 11 months of age. Relative to ovariectomized control females, life expectancy at 11 months was increased by 60% in 11‐month recipient females and by 40% relative to intact control females. Only 20% of the 11‐month transplant females died in the 300‐day period following ovarian transplantation, whereas nearly 65% of the ovariectomized control females died during this same period. The 11‐month‐old recipient females resumed oestrus and continued to cycle up to several months beyond the age of control female reproductive senescence. Across the three recipient age groups, transplantation of young ovaries increased life expectancy in proportion to the relative youth of the ovary. Our results relate to recent findings on the gonadal input upon aging in Caenorhabditis elegans and may suggest how the mammalian gonad, including that of humans, could regulate aging and determine longevity.
Cd8+ T–Cell Interaction With Hcv Replicon Cells: Evidence for Both Cytokine– and Cell–Mediated Antiviral Activity
Authors: Liu Chen , Zhu Haizhen , Tu Zhengkun , Xu Yi-Ling , Nelson David R.
Published: May 2003

The interaction between the host immune response and infected hepatocytes plays a central role in the pathogenesis of hepatitis C virus (HCV). The lack of a suitable animal or in vitro model has hindered our understanding of the host T–cell/HCV interaction. Our aim was to develop an in vitro model to study the mechanisms of HCV–specific T–cell–mediated antiviral and cytolytic function. The HCV replicon was HLA typed and lymphocytes were obtained from an HLA class I–matched subject. CD8+ T cells were expanded with 2 HCV–specific/HLA–restricted peptides for NS3. Lymphocyte preparations were cocultured with HCV replicon (FCA1) and control (Huh7) cells labeled with 51Cr. After a 48–hour incubation, the cells were harvested for RNA extraction. Standard blocking assays were performed in the presence of anti–interferon gamma (IFN–γ), anti–tumor necrosis factor α (TNF–α), and anti–FasL. Cytolytic activity was measured by 51Cr release. HCV replicon cells express homozygous HLA–A11 alleles and present HCV nonstructural proteins. HCV–specific expansion of CD8+ cells led to a 10–fold decrease in HCV replication by Northern blot analysis and 21% specific lysis of FCA1 cells (compared with 2% of control Huh7 cells). Twenty percent of this antiviral activity was independent of T–cell binding, suggesting cytokine–mediated antiviral activity. The CD8+ antiviral effect was markedly reduced by blocking either IFN–γ or FasL but was unaffected by blocking TNF–α. In conclusion, HCV–specific CD8+ cells inhibit viral RNA replication by cytokine–mediated and direct cytolytic effects. This T–cell/HCV subgenomic replicon system represents a model for the investigation of CD8 cell interaction with HCV–infected hepatocytes.
Viral Dynamics and Response Differences in Hcv–Infected African American and White Patients Treated With Ifn and Ribavirin
Authors: Layden-Almer Jennifer E. , Ribeiro Ruy M. , Wiley Thelma , Perelson Alan S. , Layden Thomas J.
Published: May 2003

Studies have suggested that African American patients infected with hepatitis C virus (HCV) do not respond as well to treatment with interferon (IFN) as white patients. Here we analyzed the difference in the viral kinetic response between genotype 1 HCV–infected African American patients (n = 19) and white patients (n = 16). Patients were treated with 10 mIU IFN–α2b daily with or without ribavirin for 1 month followed by 3 mIU IFN–α2b 3 times a week with ribavirin. The kinetic parameters (ε, treatment effectiveness at inhibiting virion production; δ, loss rate of virus–producing cells; c, clearance rate of free virions; τ, delay until viral decline starts) were estimated from the viral load decay profiles using a previously described mathematical model. Differences in early kinetic parameters and viral negativity frequencies at weeks 4, 12, and 48 were compared. Ribavirin did not appear to enhance any of the viral kinetic parameters, although this may have been due to the high dose of IFN used. African American patients exhibited significantly (P = .005) lower drug effectiveness (88.6% vs. 98.2%) compared with white patients, accounting for a 0.8 log lower HCV RNA decrease in the first 24 hours of treatment. Significant differences (P = .006) were also noted for δ. There was no correlation between any of the viral kinetic parameters and either age, body mass index (BMI), or genotype 1 subtype. No patient achieved viral negativity at weeks 4, 12, or 48 without an ε greater than 90%. The mean viral decline and viral negativity rates were statistically different between the two races; however, when controlling for treatment effectiveness, these differences were no longer apparent. In conclusion, the failure of IFN response in African American patients infected with genotype 1 HCV is in part due to an impaired ability to inhibit viral production.
The Kidney Plays A Major Role in the Hyperammonemia Seen After Simulated or Actual Gi Bleeding in Patients With Cirrhosis
Authors: Olde Damink Steven W.M. , Jalan Rajiv , Deutz Nicolaas E.P. , Redhead Doris N. , Dejong Cornelis H.C. , Hynd Paula , Jalan Rosy A. , Hayes Peter C. , Soeters Peter B.
Published: May 2003

Upper gastrointestinal (UGI) bleeding in cirrhosis is associated with enhanced ammoniagenesis, the site of which is thought to be the colon. The aims of this study were to evaluate interorgan metabolism of ammonia following an UGI bleed in patients with cirrhosis. Study 1: UGI bleed was simulated in 8 patients with cirrhosis and a transjugular intrahepatic portasystemic stent–shunt (TIPSS) by intragastric infusion of an amino acid solution that mimics the hemoglobin molecule. We sampled blood from the femoral artery and a femoral, renal, portal, and hepatic vein for 4 hours during the simulated bleed and measured plasma flows across these organs. Study 2: In 9 cirrhotic patients with an acute UGI bleed that underwent TIPSS insertion, blood was sampled from an artery and a hepatic, renal, and portal vein, and plasma flows were measured. Study 1: During the simulated bleed, arterial concentrations of ammonia increased significantly (P = .002). There was no change in ammonia production from the portal drained viscera, but renal ammonia production increased 6–fold (P = .008). In contrast to an unchanged ammonia removal by the liver, a significant increase in muscle ammonia removal was observed. Study 2: In patients with an acute UGI bleed, ammonia was only produced by the kidneys (572 [184] nmol/kg bw/min) and not by the splanchnic area (-121 [87] nmol/kg bw/min). In conclusion, enhanced renal ammonia release has an important role in the hyperammonemia that follows an UGI bleed in patients with cirrhosis. During this hyperammonemic state, muscle is the major site of ammonia removal.