bluuebunny/crossref_metadata_2025 huggingface dataset:
A conceptual framework for studying fanatical managers
Authors: Steiner Carol J.
Published: July 2004

This article explicates a conceptual framework that might be used to study how fanatical managers make decisions. It reviews literature on fanatics produced by psychologists, sociologists, cultural theorists, political scientists, theologians, and marketers, and then places their multidisciplinary insights into a management context. It identifies two familiar features of fanatics – intensity and intolerance – but suggests that a third feature – incoherence between thinking, behaviour and goals – might be the conceptual key to understanding fanatical managers, measuring their fanaticism and interpreting their management decision making. This conceptual framework may also assist the chaos, complexity and non‐linear movements in management research as well as practitioners who want an easy‐to‐understand template against which to evaluate their planning, thinking and managerial behaviour.
Management fashions and fads
Authors: Williams Russell
Published: July 2004

This conceptual paper concerns management fashions and fads. It focuses on the way that concepts, techniques and ideas become popular in the marketplace and the role of knowledge entrepreneurs and disseminators in this process. Utilising memetics – the study of memes – the paper demonstrates how some concepts, techniques and ideas prosper in the marketplace, not because of their economic reproductive capacity, but instead because of their interpersonal reproductive capacity. Knowledge entrepreneurs and disseminators (gurus and consultants) might in this light be cast as “evil Svengalis”, bringing forth contagious concepts that serve nobody except themselves. In other words, managers are somehow preyed upon, duped and tricked by gurus and consultants unleashing the latest designer mind management virus. A closer look at the institutional context into which concepts, techniques and ideas are forwarded, as well as the selection process for them, suggests however a more complex relationship exists between managers and consultants. Indeed, in this relationship, managers are likely to play an important part in the consumption of fashions and fads.
How the West was won: using VDX to redevelop cooperative document delivery services in Western Australia
Authors: Burrows Toby , McDonald Carolyn , Archibald Dan
Published: July 2004

The Western Australian Group of University Librarians (WAGUL) has a long history of successful collaborative ventures. A well‐established cooperative interlending agreement is one notable venture that has operated successfully for over 20 years. To further enhance this service, WAGUL decided to participate in the national local interlending and document delivery administration system (LIDDAS) project with the objective of implementing an automated system, using the VDX software, to manage document delivery activity. Since 2002, VDX has been used for the transmission of requests and documents between the WAGUL member libraries. The success of this project has largely been the result of the four libraries working together to share expertise and problem‐solving. This article discusses the process of working collaboratively across institutions ‐ and its benefits and difficulties – in the context of implementing an automated document delivery system.
License to Deny? Publisher restrictions on document delivery from e‐licensed journals
Authors: Wiley Lynn N.
Published: July 2004

The licensing of electronic journals is affecting interlibrary loan and document delivery services. This article reports on a survey done in 2003 at 13 large research libraries on how licensing affects both the lending and borrowing operations at those libraries. A brief history on copyright legislation and guidelines as they relate to ILL are provided as background on how licenses can undermine the copyright support libraries have needed to provide the services users require. ILL data is presented to illustrate that the volume of use per title is not what publishers may imagine. The shift to leasing electronic titles and therefore the requirements that underlie licensing are still relatively new; the article recommends that libraries take every opportunity to converse and negotiate with publishers as access evolves.
Collection coherence and digital abundance: enhancing the effectiveness of document supply
Authors: Genoni Paul , Jones Margaret
Published: July 2004

This article commences with an overview of the changes to library cooperative activity and how these might affect document supply operations. It looks at the increasing emphasis on using ICTs to locate and transfer items, and the corresponding reduction in the importance of ownership and collections. It suggests this is eroding the previous belief in collection coherence and leading to a reduction in efforts to build collections cooperatively between libraries. It argues that libraries have now entered the era of the ‘post‐modern’ collection, and suggests the impact this might have on document supply activity, particularly between consortium members. It concludes with a study of the consortium activities of one academic library, at Murdoch University in Western Australia, in order to illustrate these points.
Interlending and document supply: a review of recent literature – 49
Authors: McGrath Mike
Published: July 2004

Reviews the recent literature in document supply. Looking in particular at e books and journals, resource sharing, scholarly communication, unmediated delivery and pricing.
Work‐family conflict in a southern European country
Authors: Pilar de Luis Carnicer María , Martínez Sánchez Angel , Pérez Pérez Manuela , José Vela Jiménez María
Published: July 2004

Shows the results of a survey about the antecedents of work‐family conflict in a sample of Spanish employees. Analyses and discusses the influence of job‐related and non‐related factors. The results indicate that both groups of factors are antecedents of work‐family conflict. Even though gender is not a significant variable to explain work‐family conflict, the empirical study found differences at the time to explain the antecedents of men and women's work‐family conflict. A few family‐domain and work‐domain perceptions had a strong influence on work‐family conflict such as the gender roles, importance of family, job flexibility and job mental and physical requirements. Some of these perceptions suggest the influence of a culture where traditional gender roles still prevail and family as an institution is very strong. Functional mobility and educational level are also antecedents of work‐family conflict. However, job category level, marital status, and social benefits do not have any influence on work‐family conflict in the multivariate analysis, but the bivariate analysis showed that they have indeed an influence on the work‐family conflict according to the hypotheses developed in the research framework.
Human resource professionals' perceptions of team interviews
Authors: Camp Richaurd , Schulz Eric , Vielhaber Mary , Wagner‐Marsh Fraya
Published: July 2004

This study examines human resource (HR) professionals' perceptions of the outcomes, process dynamics and affect toward team interviews. Results indicate HR professionals with experience conducting team interviews have significantly more positive views than HR professionals without experience. Additionally, African Americans, compared to Caucasians, expressed a significantly more positive view of the process dynamics of team interviews. Results indicate HR professionals were more positive about participating in team interviews as an interviewer than as an interviewee.
Satisfaction with performance appraisal systems
Authors: Cook Jill , Crossman Alf
Published: July 2004

This study examines the inter‐relationship between a person's role as appraisee and/or appraiser in a performance appraisal system (PAS) and level of satisfaction expressed with the system. It builds on earlier US studies which found that being an appraiser and, therefore, also an appraisee increased a person's satisfaction level compared with those who were appraisees only. Data were gathered from 382 respondents to examine three aspects of organisational justice which are known to influence satisfaction with PASs. The results indicate no intrinsic difference in satisfaction level linked to role in administering a PAS and that the source of satisfaction and/or dissatisfaction with the PAS was not equally attributable to all aspects of organisational justice.
Community pharmacies under pressure: issues of deregulation and competition
Authors: Schmidt Ruth A. , Pioch Elke A.
Published: July 2004

As providers of emergency medication, expert advice and specialist healthcare services, retail pharmacies are central to their neighbourhoods. Traditionally, recognition of this vital contribution to the community has been reflected in special protective measures at the macro level, making the pharmacy sector one of the most highly regulated within the UK retail industry. However, recent deregulation measures in relation to all aspects of the services marketing mix, namely products, price, place, promotion, physical evidence, people and processes, have made for a dynamic competitive climate with increasing pressures on the livelihood of small‐ to medium‐sized enterprises. Strategies for success are discussed.
Drivers for dynamic brief development in construction
Authors: Othman Ayman A.E. , Hassan Tarek M. , Pasquire Christine L.
Published: July 2004

Confining the development of the project brief to a certain stage hinders the interaction between the client and the designer. In addition, it inhibits the incorporation of the influential internal and external factors that may affect the project. In spite of the frequently adverse impact of change orders on project cost, time and quality, literature review and case studies showed that client organisations continue to use change orders to achieve their expectations and enhance their projects' performance principally because current construction management process instills an expectation that, change after a specified point is somehow outside the project brief rather than part of the ongoing development of that brief. This paper introduces the concept of dynamic brief development (DBD), a process that facilitates client satisfaction, meets the need to adapt to the brief developing factors for the benefit of the project and fulfils the desire to manage project change orders. In this paper, the need, aims and principles of the concept of DBD are explained and the factors driving brief development are identified. In addition, the rationale behind each factor is given and the case study sampling method is described.
Impacts of CAD on design realization
Authors: De Lapp James A. , Ford David N. , Bryant John A. , Horlen Joe
Published: July 2004

Complete and accurate design is critical for construction project success. Manifesting design intent in the constructed facility depends on coordinated design documents that are developed through design realization. This process evolves design intent from architects and engineers to contractors, through the production and review of shop drawings and other submittals. Information technology has been promoted as a tool to improve this process, but is not being fully utilized for this purpose. A case study investigates the impacts of computed aided design (CAD) on design realization. Comparative analysis between shop drawings prepared by hand and those done with CAD quantify notes, corrections and information transfer errors. Results support the hypothesis that utilizing CAD can improve design accuracy and lower project costs. Barriers to wider adoption, implications for practice and further research are discussed.
Relationship between TQM and innovation: an empirical study
Authors: Singh Prakash J. , Smith Alan J.R.
Published: July 2004

It is generally acknowledged that organisations need to be innovative in order to survive and prosper. Some advocates of total quality management (TQM) have suggested that it provides the necessary platform for inculcating innovation in organisations. Intuitively, TQM components involving sound and effective practices on leadership, customer focus, relations with suppliers, employee inter‐relationships, information/communication systems and management of processes and products do appear to enable organisations develop culture of innovation. A robust TQM‐innovation relationship appears to be conceptually plausible, but little empirical evidence has so far been offered to support this proposition. In this paper, this relationship is explored. Empirical data were taken from a survey of 418 Australian manufacturing organisations. Structural equation modelling technique was used for statistical analysis. Results show that there is insufficient statistical evidence to suggest that TQM is related to innovation. There could well be a more complex relationship between these concepts.
Exploring the relationship between knowledge management practices and innovation performance
Authors: Gloet Marianne , Terziovski Milé
Published: July 2004

The process of innovation depends heavily on knowledge, and the management of knowledge and human capital should be an essential element of running any type of business. Recent research indicates that organisations are not consistent in their approach to knowledge management (KM), with KM approaches being driven predominantly within an information technology (IT) or humanist framework, with little if any overlap. This paper explores the relationship between KM approaches and innovation performance through a preliminary study focusing on the manufacturing industry. The most significant implication that has emerged from the study is that managers in manufacturing firms should place more emphasis on human resource management (HRM) practices when developing innovation strategies for product and process innovations. The study shows that KM contributes to innovation performance when a simultaneous approach of “soft HRM practices” and “hard IT practices” are implemented.
Managing change and innovation in IT implementation process
Authors: Bartoli Annie , Hermel Philippe
Published: July 2004

After the prophetic messages about the contributions of information technologies (IT) on firms, we face warning signals on the unavoidable need for change management, and the perverse side effects of IT improvements when they are not integrated within a strategic and managerial framework. The analysis of practices concerning the introduction of IT in organisations shows that often, the context and the process are neglected; as for the content, it is centred on tools rather than on the needs to be satisfied. A managerial typology of barriers to change that differentiates risks of strategic or structural nature, and cultural or behavioural nature, explains the lack of quality in operations. In order better to manage the implications of IT evolution, i.e. their downstream incidences, it is necessary to have steered upstream in defining the objectives, analysing the needs, taking into account the socio‐ organisational context, and the implication of actors.
Flexibility in the P2 domain of the HIV‐1 Gag polyprotein
Authors: Newman John L. , Butcher Eric W. , Patel Dipti T. , Mikhaylenko Yelena , Summers Michael F.
Published: July 2004

The HIV‐1 Gag polyprotein contains a segment called p2, located between the capsid (CA) and nucleocapsid (NC) domains, that is essential for ordered virus assembly and infectivity. We subcloned, overexpressed, and purified a 156‐residue polypeptide that contains the C‐terminal capsid subdomain (CACTD) through the NC domain of Gag (CACTD‐p2‐NC, Gag residues 276–431) for NMR relaxation and sedimentation equilibrium (SE) studies. The CACTD and NC domains are folded as expected, but residues of the p2 segment, and the adjoining thirteen C‐terminal residues of CACTD and thirteen N‐terminal residues of NC, are flexible. Backbone NMR chemical shifts of these 40 residues deviate slightly from random coil values and indicate a small propensity toward an α‐helical conformation. The presence of a transient coil‐to‐helix equilibrium may explain the unusual and necessarily slow proteolysis rate of the CA‐p2 junction. CACTD‐p2‐NC forms dimers and self‐associates with an equilibrium constant (Kd = 1.78 ± 0.5 μM) similar to that observed for the intact capsid protein (Kd = 2.94 ± 0.8 μM), suggesting that Gag self‐association is not significantly influence by the P2 domain.
Modeling and simulation of the human δ opioid receptor
Authors: Aburi Mahalaxmi , Smith Paul E.
Published: July 2004

A model for the human δ opioid receptor has been generated via sequence alignment, structure building using the crystal structure of bovine rhodopsin as a template, and refinement by molecular dynamics simulation. The model building suggested that, in addition to the previously postulated interaction between D128 and Y308, an internal salt bridge also exists between residues D128 and R192, both of which are conserved in all the opioid receptors. The model and salt bridge were then shown to be stable during a 20‐nsec simulation in a lipid bilayer. It is therefore proposed that both of these interactions play a role in stabilizing the inactive state of the receptor. The model is also used in an effort to rationalize many of the mutational studies performed on δ opioid receptors, and to suggest a plausible explanation for the differences between known δ opioid agonists and antagonists.
A mobile loop order–disorder transition modulates the speed of chaperonin cycling
Authors: Shewmaker Frank , Kerner Michael J. , Hayer‐Hartl Manajit , Klein Gracjana , Georgopoulos Costa , Landry Samuel J.
Published: July 2004

Molecular machines order and disorder polypeptides as they form and dissolve large intermolecular interfaces, but the biological significance of coupled ordering and binding has been established in few, if any, macromolecular systems. The ordering and binding of GroES co‐chaperonin mobile loops accompany an ATP‐dependent conformational change in the GroEL chaperonin that promotes client protein folding. Following ATP hydrolysis, disordering of the mobile loops accompanies co‐chaperonin dissociation, reversal of the GroEL conformational change, and release of the client protein. “High‐affinity” GroEL mutants were identified by their compatibility with “low‐affinity” co‐chaperonin mutants and incompatibility with high‐affinity co‐chaperonin mutants. Analysis of binding kinetics using the intrinsic fluorescence of tryptophan‐containing co‐chaperonin variants revealed that excessive affinity causes the chaperonin to stall in a conformation that forms in the presence of ATP. Destabilizing the β‐hairpins formed by the mobile loops restores the normal rate of dissociation. Thus, the free energy of mobile‐loop ordering and disordering acts like the inertia of an engine's flywheel by modulating the speed of chaperonin conformational changes.
Our experience with 23 consecutive patients on gemcitabine/carboplatin chemotherapy for treatment of metastasized transitional cell carcinoma of the urothelium
Authors: HOSCHKE BERND , MAY MATTHIAS , SEEHAFER MATTHIAS , HELKE CHRISTIAN
Published: July 2004

Abstract  Aim:  To evaluate the activity and toxicity of gemcitabine plus carboplatin in patients with metastatic transitional cell carcinoma (TCC) of the urothelium.

Methods:  Twenty‐three consecutive patients (from February 1999 to January 2002) with metastatic TCC and no prior chemotherapy were referred to our institution. Each patient was treated with gemcitabine (1000 mg/m2) on Days 1 and 8 and carboplatin (area under curve, 4.5) on Day 1. Cycles were repeated every 21 days until tumor progression or severe toxicity was seen, or for a maximum of six cycles. Median age of the patients was 68 years (range 47–82). The median Eastern Cooperative Oncology Group (ECOG) performance score was one and the median creatinine clearance rate was 56 mL/min (range 31–94).

Results:  The overall response rate was 60.8%, with five of the 23 patients achieving a complete response, and nine showing a partial response. Median time to tumor progression (TTP) was 7.8 months, with a median survival of 15.4 months and a 1‐year survival probability of 56%. Most of the complications from toxicity were hematological.

Conclusions:  Gemcitabine plus carboplatin is active in the treatment of metastatic urothelial cancer in those patients new to chemotherapy and has an acceptable safety profile. The potential clinical benefit of this novel combination in the treatment of transitional cell carcinoma warrants further testing in Phase III studies.
Urethral ‘recurrence’ found 14 years after radical cystectomy
Authors: SORSCHER STEVEN , ISLAM REZWAN , MASON ALBERT
Published: July 2004

Abstract  We report a case of transitional cell urethral cancer diagnosed 14 years after radical cystectomy. Traditionally, in the postcystectomy setting, these cancers have been referred to as ‘recurrences’. We review the biological models for the oncogenesis of these cancers and propose that they are typically a result of a field cancerization effect, rather than being derived from the same clone responsible for the original urothelial tumor.
Spontaneous expulsion of a bullet via the urethra
Authors: KILIÇ DALOKAY , KILINÇ FERHAT , EZER ALI , GUVEL SEZGIN
Published: July 2004

Abstract  The rare clinical occurrence of the spontaneous passage of bullet which was not found during an operation after a gunshot wound to the bladder in a 28‐year‐old man is described.
Laparoscopic pyelolithotomy – A technique for the management of stones in the ectopic pelvic kidney
Authors: KAMAT NAGESH , KHANDELWAL PANKAJ
Published: July 2004

Abstract  We present our preliminary experience with the technique of laparoscopic pyelolithotomy for ectopic pelvic kidney calculi. This surgery has low morbidity and is ideally suited for the ectopic pelvic kidney with a laterally or anteriorly directed pelvis.
Hydronephrosis due to ureteral endometriosis treated by transperitoneal laparoscopic ureterolysis
Authors: WATANABE YUICHI , OZAWA HIDEO , UEMATSU KATSUTOSHI , KAWASAKI KENSUKE , NISHI HIDEYUKI , KOBASHI YUJI
Published: July 2004

Abstract  Ureteral obstruction secondary to endometriosis is relatively uncommon. We present a 43‐year‐old multiparous woman who suffered from periodic left loin pain in the terminal period of her menstruation. Excretory urogram demonstrated left hydronephrosis and hydroureter and obstruction of the lower left ureter just inferior to the left sacroiliac joint without urolithiasis. An enhanced computed tomography scan showed soft tissue density mass around the left ureter at the level of the stenosis. She underwent transperitoneal laparoscopic ureterolysis and adhesiotomy of the left ureter under the diagnosis of ureteral endometriosis. Because blueberry spots were clearly observed on the pelvic brim, the fibrous tissue surrounded the ureter was removed with peritoneal bleeding spots. Histological examination of the surrounding tissue confirmed the ectopic endometriosis. Even though retroperitoneoscopy is frequently used for ureteral lesion, transperitoneal laparoscopy has an advantage for resection of ectopic endometriosis surrounding the ureter.
Clinical parameters that predict histology of postchemotherapy retroperitoneal lymph node mass in testicular cancer
Authors: ONOZAWA MIZUKI , KAWAI KOJI , YAMAMOTO TAKAHIRO , HINOTSU SHIRO , TSUKAMOTO SADAMU , HATTORI KAZUNORI , MIYANAGA NAOTO , SHIMAZUI TORU , AKAZA HIDEYUKI
Published: July 2004

Abstract  Background:  Since the advent of cisplatin‐based chemotherapy, the majority of metastatic testicular cancers can be cured by chemotherapy followed by retroperitoneal lymph node dissection (RPLND). However, postchemotherapy RPLND confers no therapeutic benefit if the residual mass contains no viable cells. Therefore, to determine which parameters predict a patient's likelihood of having only necrosis in the residual mass, we retrospectively analyzed clinical parameters of patients who underwent postchemotherapy RPLND.

Methods:  Data from 27 patients with metastatic testicular cancer were analyzed. The histology of the primary tumor was seminoma in 11 cases and non‐seminoma in 16 cases. All of the patients with non‐seminoma showed a normalization of tumor markers after chemotherapy. Analysis of clinical parameters included data for the initial histology, pretreatment tumor marker levels, postchemotherapy retroperitoneal mass size, and the histology of the dissected RPLNs.

Results:  Histological examination of dissected RPLNs showed residual tumor in 27% of seminoma patients and 38% of non‐seminoma patients. In seminoma patients, no viable cells were found in all six patients with pretreatment lactate dehydrogenase (LDH) levels below 7.5 times the upper limit of normal, or in all five of the patients with postchemotherapy RPLNs less than 2.5 cm. In non‐seminoma patients, no viable cells were found in nine of 10 patients with pretreatment alpha‐fetoprotein (AFP) levels less than 2700 ng/mL, or in eight of nine patients with residual mass less than 2.5 cm.

Conclusions:  Both postchemotherapy RPLN mass size and pretreatment tumor marker levels are possible predictors for necrosis of the residual mass in testicular cancer patients.
Histopathological aspects of transitional cell carcinoma of the bladder: Analysis of 20 years experience
Authors: SCIARRA ALESSANDRO , DE MATTEIS ANNA , MARIOTTI GIANNA , VORIA GIUSEPPE , LUCERA ROSSANA , DI SILVERIO FRANCO
Published: July 2004

Abstract  Background:  In this study we used histopathological examinations performed over a 20‐year period to describe the characteristics of newly diagnosed transitional cell carcinoma (TCC) of the bladder in relation to patient age, and to verify changes in the TCC over different periods of observation or in relation to patient age.

Methods:  We reviewed all histopathological examinations performed from January 1979 to December 1998 in patients undergoing surgery who were newly diagnosed with TCC of the bladder. All examinations were performed by the same pathologist and reviewed by two pathologists. In each case analyzed, we evaluated T classification of the tumor, histological grade, size, localization, growth type, multiplicity and carcinoma in situ (CIS).

Results:  The study population included 3113 men and 620 women. The mean patient age was 66.31 ± 10.84 years. A high percentage of Ta (52.2%) and T1 (27.7%) tumors were found. The number of cases observed and, in particular, the percentage of Ta tumors increased significantly and progressively from the first (1979–1983 = 376 cases; Ta = 37.8%) to the last (1994–1998 = 1732 cases; Ta = 56.3%) period of observation (P < 0.001). A significant difference in the distribution of histological grade and T classification in the different age decades was apparent (P < 0.001); in particular, for G1 and Ta tumors there was a trend to decrease, whereas for G3, T1 and T2 tumors there was a tendency to increase with age decades.

Conclusion:  In our analysis, age of patient and the period of examination significantly influenced different pathological characteristics of newly diagnosed TCC of the bladder.
Health‐related quality of life after chemotherapy for advanced germ cell tumors: A comparison of standard‐dose and high‐dose chemotherapy
Authors: MIYAKE HIDEAKI , MURAMAKI MOTOTSUGU , ETO HIROSHI , KAMIDONO SADAO , HARA ISAO
Published: July 2004

Abstract  Background:  The objective of this study was to evaluate the health‐related quality of life (HRQoL) in patients with germ cell tumors who received standard‐dose chemotherapy or high‐dose chemotherapy combined with peripheral blood stem cell transplantation (PBSCT), and to compare the HRQoL of these patients with patients who had undergone surveillance therapy only.

Methods:  Among the 102 patients included in this study, 38 underwent standard‐dose cisplatin‐based combination chemotherapy alone, 24 received high‐dose chemotherapy with PBSCT following standard‐dose chemotherapy, and 40 underwent surveillance monitoring. HRQoL was evaluated using the SF‐36 survey, which contains 36 questions that assess eight quality‐of‐life aspects, including physical functioning, role‐physical functioning, bodily pain, general health, vitality, social functioning, role‐emotional functioning and mental health.

Results:  The follow‐up period of the surveillance group was significantly longer than that of the remaining two groups receiving chemotherapy; however, scale scores were not affected by the duration of follow up in either group. No significant difference was observed in any scale scores between the patients undergoing chemotherapy and those in the surveillance group. In comparison with the general population in the USA, social functioning in both the chemotherapy and surveillance groups was significantly lower, whereas vitality in these two groups was significantly higher. Patients undergoing standard‐dose chemotherapy alone had a significantly higher score for mental health than those undergoing high‐dose chemotherapy. However, there were no significant differences in the remaining seven scores, irrespective of the type of chemotherapy.

Conclusions:  Seven of the eight scale scores of HRQoL were favorable in patients who received chemotherapy or surveillance, and no significant difference was observed between these two groups. Moreover, with the exception of the mental health score, HRQoL was not significantly affected by the type of chemotherapy. Therefore, patients who received chemotherapy, including high‐dose chemotherapy with PBSCT, seem to be generally satisfied with their overall HRQoL.
Impact of adjuvant systemic chemotherapy on postoperative survival in patients with high‐risk urothelial cancer
Authors: SUZUKI SHIN , SHINOHARA NOBUO , HARABAYASHI TORU , SATO SOSHU , ABE TAKASHIGE , KOYANAGI TOMOHIKO
Published: July 2004

Abstract  Background:  The objective of this study was to retrospectively investigate the effectiveness of adjuvant combination chemotherapy for locally advanced urothelial cancer.

Methods:  Between 1987 and 1998, 56 patients with locally advanced bladder (n = 27) or upper urinary tract (n = 29) cancer (pathological stage T3, T4 or N1, N2 and M0) were treated by radical cystectomy or radical nephroureterectomy and regional lymphadenectomy. Thirty‐one patients had lymph node‐positive disease and 25 patients did not. Twenty patients underwent adjuvant chemotherapy and 36 patients were observed after surgery. Cox proportional hazards models were used to determine the impact of numerous clinicopathological findings on survival. A subgroup analysis of patients with lymph node‐positive disease was conducted to evaluate disease‐free survival and overall survival rates.

Results:  In this series, the median follow‐up period was 39 months (range, 4–163) after surgery. Disease‐free and overall survival rates of all 56 patients were 45% and 58%, respectively, at 3 years. Only lymph node status was significantly associated with disease‐free and overall survival in the multivariate analyses. In a subgroup analysis of patients with lymph node‐positive disease, 16 patients who underwent adjuvant chemotherapy had superior disease‐free survival compared to 15 patients with no adjuvant chemotherapy (P = 0.0376).

Conclusion:  These findings show that the prognosis of advanced urothelial cancer is significantly associated with nodal status. Furthermore, adjuvant combination chemotherapy has a positive impact on survival in patients with lymph node‐positive disease.
Effectiveness of percent free prostate specific antigen as a predictor of prostate cancer detection on repeat biopsy
Authors: UEMURA HIROJI , NAKAMURA MASAFUMI , HASUMI HISASHI , SUGIURA SHINPEI , FUJINAMI KIYOSHI , MIYOSHI YASUHIDE , YAO MASAHIRO , KUBOTA YOSHINOBU
Published: July 2004

Abstract  Background:  The aim of this study was to identify predictors that can increase the accuracy of detecting prostate cancer on subsequent biopsies.

Methods:  Between 1998 and 2003, a total of 235 men with prostate specific antigen (PSA) levels between 4.0 and 20 ng/mL underwent one or more systematic needle biopsies of the prostate. Of these men, 73 (31.1%) underwent one repeat biopsy and 26 (11.1%) underwent two or more repeat biopsies. We evaluated the results of prostate biopsies in relation to the morbidity of prostate cancer detected on repeat biopsies.

Results:  Of the 73 men who underwent repeat biopsy, 16 (21.9%) had prostate cancer. Twenty‐six men with one negative re‐biopsy underwent two or more repeat biopsies, and five of these patients were found to have early stage prostate cancer. On repeat biopsy, there was a significant difference in percent free PSA between the cancer‐detected group and the no‐cancer‐detected group (P < 0.01). A receiver operating characteristics (ROC) curve gave an optimal cut‐off value for percent free PSA of 11%, demonstrating a significant difference in the cancer detection rate on repeat biopsy (P = 0.0009). Analysis of the data for re‐biopsies showed that cancer‐detected cases showed a raised PSA value and a simultaneously reduced percent free PSA (these differences were statistically significant).

Conclusions:  A low percent free PSA level increased the probability of a positive result in repeat biopsy. An increase in the accuracy of detecting cancer, especially on repeat biopsy, will promote the detection of more early stage prostate cancer.
Single‐blind, randomized controlled study of the clinical and urodynamic effects of an α‐blocker (naftopidil) and phytotherapy (eviprostat) in the treatment of benign prostatic hyperplasia
Authors: YAMANISHI TOMONORI , YASUDA KOSAKU , KAMAI TAKAO , TSUJII TOSHIHIKO , SAKAKIBARA RYUJI , UCHIYAMA TOMOYUKI , YOSHIDA KEN‐ICHIRO
Published: July 2004

Abstract  Aim:  The aim of our study was to examine the efficacy of naftopidil in terms of the international prostate symptom score (IPSS) and urodynamic parameters in the treatment of benign prostatic hyperplasia (BPH). Eviprostat was used as a control to study the efficacy of naftopidil.

Methods:  Forty‐nine patients with BPH (mean age 67.9 ± 7.8 years) were involved in the study. Patients were randomly assigned either to the naftopidil group, which was treated with the α‐blocker naftopidil (50–75 mg daily, 36 patients), or the eviprostat group, which was treated with phytotherapy (six tablets of eviprostat daily, 13 patients).

Results:  The mean total IPSS, the total storage and voiding symptom scores, and the quality of life score decreased significantly (P < 0.0001 for each variable) in the naftopidil group, but not in the eviprostat group. In the naftopidil group, analyses showed significant increases in average and maximum flow rate and bladder capacity at first desire to void (P < 0.001, P = 0.001 and P = 0.024, respectively), and significant decreases in the postvoid residual, the percent of residual and the Abrams–Griffiths number (P = 0.009, P = 0.008 and P = 0.042, respectively). However, in the eviprostat group, no significant changes were noted in terms of these symptomatic and urodynamic parameters. In the pressure/flow study, an improvement in the International Continence Society nomogram grade was noted in 29% of the naftopidil group, but in only 16% of the eviprostat group. Among the 14 patients in the naftopidil group, detrusor overactivity disappeared in 21% and cystometric capacity increased in 36%, but no improvement in detrusor overactivity was noted in the eviprostat group.

Conclusions:  Naftopidil appears to have been effective in this short‐term treatment of BPH.
Papillary renal cell carcinoma radiographically mimicking massive calcification
Authors: HISASUE SHIN‐ICHI , TAKAGI SEIJI , GOTOUDA YUKO
Published: July 2004

Abstract  A  53‐year‐old  male  was  referred  to  the  Department  of  Urology,  Hokkaido  Kouseiren  Kutchan Kousei Hospital for a left renal mass incidentally found by computed tomography. The tumor was 29 mm in diameter and showed ring‐like calcification and heterogeneous enhancement by the contrast medium. The patient underwent left partial nephrectomy after the diagnosis of left renal cell carcinoma. Contrary to the radiographic finding, there was no palpable calcified lesion in the macroscopic specimen. Histopathologically, the tumor showed features of papillary renal cell carcinoma with massive psammoma bodies which might have been the cause for mimicking radiographic calcification.
Clinical study of bladder cancer: Proteinuria as a predictor of recurrence and efficacy of intravesical bacille Calmette–Guerin therapy
Authors: SATOH AKINORI , HANAWA YASUMASA , NAKAMURA SO
Published: July 2004

Abstract  Aim:  We studied the clinical characteristics of bladder cancer, with special attention to the clinical and pathological variables that affect tumor stage, relapse and efficacy of intravesical therapy.

Methods:  We reviewed the medical records of 152 patients of the Saiseikai Central Hospital who had been diagnosed as having bladder cancer between 1981 and 2001.

Results:  The age of the patients ranged from 24 to 88 years, with a median of 63.5 years. The median follow up was 52.4 months (range, 0.5–259.5 months). There was no difference in the incidence of gross hematuria as a presenting symptom among the patients with invasive cancer, superficial cancer and carcinoma in situ (CIS). However, the incidence of urinary frequency and painful urination did differ significantly between patients. Although patients with invasive cancer had a longer time to hospital visit than those with superficial cancer, this time difference was not statistically significant. Presence of proteinuria, multifocality and intravesical bacille Calmette–Guerin (BCG) therapy were the significant predictors of relapse after transurethral resection (TUR). Presence of proteinuria was shown to adversely affect the efficacy of intravesical BCG therapy. In the BCG‐treated group, 3‐year relapse‐free survival was 78.4% for patients without proteinuria and 40.0% for those with proteinuria; this difference was statistically significant (P = 0.0277).

Conclusions:  Time to hospital visit did not influence the pathological stage of cancer in patients included in the present study. Presence of proteinuria, multifocality and BCG therapy were the significant predictors of relapse after TUR. Presence of proteinuria was shown to adversely affect the efficacy of intravesical BCG therapy. Proteinuria might be helpful in predicting tumor relapse and efficacy of intravesical BCG therapy in clinical settings, along with other markers.
Laparoscopic drainage of nocardial adrenal abscess in an HIV positive patient
Authors: CHONG YEW LAM , GREEN JUSTIN ANTON , TOH KHAI LEE , TAN JAMES K
Published: July 2004

Abstract  We report a rare case of a nocardial adrenal abscess in an HIV patient that underwent the first drainage of adrenal abscess by laparoscopy. Adrenal abscesses are exceedingly rare in adults and prove to be a diagnostic challenge. Laparoscopic adrenal exploration is both a diagnostic and therapeutic modality with low perioperative morbidity that should be considered in the management of indeterminate adrenal masses and abscesses.
Complications of laparoscopic radical cystectomy during the initial experience
Authors: HEMAL ASHOK K , KUMAR RAJEEV , SETH AMLESH , GUPTA NARMADA P
Published: July 2004

Abstract  Aim:  Radical cystectomy is the standard of care for patients with muscle invasive bladder cancer. While open radical cystectomy is now a standard procedure, laparoscopic radical cystectomy is still in its infancy. We performed this surgery laparoscopically in 11 patients and review the procedure specific complications.

Methods:  Beginning in February 1999, 11 patients underwent laparoscopic radical cystectomy at the Department of Urology, All India Institute of Medical Sciences, New Dehli. Urinary diversion was performed by an open‐hand sewn ileal conduit.

Results:  There were three intraoperative complications specifically related to the laparoscopic radical cystectomy. These included injury to the external iliac vein in one patient and a small rectal tear in two. All were repaired with laparoscopic free hand suturing with normal postoperative recovery. Other laparoscopy‐related complications were subcutaneous emphysema in one patient and hypercarbia necessitating conversion to open surgery in a patient who, four weeks after surgery, died of multiple organ failure. One patient had margins positive and received cisplatinum‐based chemotherapy. All patients had normal renal function and preserved upper tracts with no evidence of metastasis at a mean of 18.4 months follow up (range 1–48 months).

Conclusions:  Though there were three complications specific to the laparoscopic radical cystectomy, none necessitated a conversion to open surgery or hampered the overall outcome. Absence of local recurrence or metastatic disease at four years of follow up suggests that the procedure is oncologically valid. Laparoscopic radical cystectomy is a new procedure and it is important to critically analyze the complications in order to reduce their occurrence and allow the development of a better technique.
Determining the contribution of asphyxia to brain damage in the neonate
Authors: Low James A.
Published: July 2004

Studies in the research laboratory have demonstrated the complex relationship between fetal and newborn asphyxia and brain damage, a balance between the degree, duration and nature of the asphyxia and the quality of the cardiovascular compensatory response. Clinical studies would support the contention that the human fetus and newborn behave in a similar manner. An accurate diagnosis of asphyxia requires a blood gas and acid base assessment. The clinical classification of fetal asphyxia is based on a measure of metabolic acidosis to confirm that fetal asphyxia has occurred and the expression of neonatal encephalopathy and other organ system complications to express the severity of the asphyxia. The prevalence of fetal asphyxia at delivery is at term, 25 per 1000 live births of whom 15% are moderate or severe; and in the preterm, 73 per 1000 live births of whom 50% are moderate or severe. It remains to be determined how often the asphyxia recognized at delivery may have been present before the onset of labor. There is a growing body of indirect and direct evidence to support the contention that antepartum fetal asphyxia is important in the occurrence of brain damage. Although much of the brain damage observed in the newborn reflects events that occurred before delivery, newborn asphyxia and hypotension, particularly in the preterm newborn, may contribute to the brain damage accounting for deficits in surviving children
Surgical repair of genital fistulae
Authors: Naru Tahira , Rizvi Javed H. , Talati Jamsheer
Published: July 2004

Objective:  Genital fistula is one of the serious childbirth injuries that can occur among women in the developing countries. Complex fistulae still represent a challenging management problem. We report our experience of managing genital fistulae at the Aga Khan University Hospital (AKUH), Karachi, Pakistan.

Methods:  Eighty‐seven women with genital fistulae were managed between January 1988 and December 2002. Sixty‐eight cases were urogenital and 19 were rectovaginal fistulae. Three women had concomitant urogenital and rectovaginal fistulae. The position of patients for surgery and the route of repair were individualized according to the appropriate access to the fistulae.

Results:  Of the 68 cases of urogenital fistulae, 54 were successfully repaired at first attempt. Three patients were cured at second repair. A success rate of 83.8% was achieved. Four patient with ureterosigmoid anastomosis and seven patients who were lost to follow‐up, were considered as failures. All of the 19 rectovaginal fistulae (100%) closed after single repair.

Conclusion:  With an experienced uro‐gynecologic team using conventional approach and meticulous repair, a high percentage of patients with genital fistulae can be rendered dry and continent.
Hormone replacement therapy and breast cancer risk in Kyushu University Hospital: Supporting the Women's Health Initiative study
Authors: Nozaki Masahiro , Koera Keiko , Nagata Hideaki , Nakano Hitoo
Published: July 2004

Aim:  The influence of hormone replacement therapy (HRT) on breast cancer has not been clarified in Japan, however the Women's Health Initiative (WHI) trial recently showed breast cancer risk according to use of estrogen plus progestin. We assessed retrospectively the incidence of breast cancer in postmenopausal women who received HRT at our outpatients clinic.

Methods:  Among the patients registered at the postmenopausal clinic in Kyushu University Hospital from 1990 to 2003, 917 women who received HRT (estrogen plus progestin, 507 patients; estrogen only, 410 patients) after informed consent were examined by mammography or breast ultrasound tomography.

Results:  Breast cancer occurred in nine patients: five patients who received estrogen plus progestin and four who received estrogen only. Four of five the patients who used estrogen plus progestin received HRT for more than 5 years.

Conclusion:  Breast cancer risk in patients who used estrogen plus progestin for more than 5 years seemed to be higher than those who used it for less than 5 years. This tendency is similar to the results of the WHI. In addition, breast cancer incidence in patients treated with HRT in our clinic seemed to be higher than the incidence in average Japanese women. Therefore, patients need to be given sufficient information before undergoing HRT.
Rapidly growing leiomyoma in a postmenopausal woman
Authors: Okamoto Takako , Koshiyama Masafumi , Yamamoto Keiko
Published: July 2004

We present here a case of a rapidly growing leiomyoma occurring after menopause. The tumor weighed 4329 g, suggesting the rapid accumulation of ‘hyaline fibrosis’. A small amount of proliferative activity was detected as evidenced by Ki‐67 antigen immunoreactivity.
Fasting or two‐hour postprandial plasma glucose levels in early months of pregnancy as screening tools for gestational diabetes mellitus developing in later months of pregnancy
Authors: Bhattacharya Sudhindra Mohan
Published: July 2004

Purpose:  The present study was done to find out whether the fasting or 2‐hour postprandial plasma glucose (PPPG) levels in early months of pregnancy can be used as screening tools for gestational diabetes mellitus (GDM) developing in later months of pregnancy.

Basic procedure:  Fasting and 2‐hour PPPG levels were measured in the early months of pregnancy in 246 women attending the antenatal clinic of the author. All of the women underwent glucose challenge tests with 50 grams of glucose at 24–28 weeks and if the value exceeded 140 mg%, a three‐hour oral glucose tolerance test (OGTT) with 100 grams of glucose was performed to diagnose GDM.

Main findings:  The present study found that the incidence of GDM was 10.5% in the third trimester. Statistical analysis did not show any correlation between fasting and the PPPG values in the early months and GDM in later months of pregnancy.

Conclusion:  Fasting or PPPG values cannot be used as efficient screening tools for GDM developing in the later months of pregnancy.