bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory morbidity and lung function in two Aboriginal communities in Western Australia
Authors: VERHEIJDEN Marieke W. , TON Anja , JAMES Alan L. , WOOD Marianne , MUSK A. William
Published: March 2003

Objective: To examine differences in the rates of respiratory symptoms, asthma and levels of lung function in two remote Aboriginal communities.

Methodology: Respiratory symptoms, smoking history, skin prick test responses to common allergens, serum IgE, lung function, airway responsiveness to methacholine and white blood cell counts were compared in two Aboriginal communities, one from the central desert (n = 84) and another from the tropical north (n = 209) of Western Australia.

Results: Compared with the tropical community, chest tightness and dyspnoea were more frequent and forced expiratory volume in 1 s and forced vital capacity were lower in the desert community, despite similar levels of wheeze, doctor‐diagnosed asthma and skin prick test responses and lower levels of airway responsiveness and smoking. The total white cell and neutrophil counts were greater in the desert community. Serum IgE was very high and similar in both communities.

Conclusions: Our findings show a low prevalence of asthma in children, a high prevalence of respiratory symptoms and low levels of lung function in remote Aboriginal communities. The greater prevalence of respiratory morbidity in the desert community was not explained by diagnosed asthma, airway hyperresponsiveness or cigarette smoking. The role of infection requires further investigation. The results suggest that the lower lung function observed in Aboriginal communities (compared with non‐Aboriginal communities) results at least partly from environmental factors.
Molecular phylogeny and floral fragrances of male euglossine bee‐pollinated orchids: A study of Stanhopea (Orchidaceae)
Authors: Williams Norris H. , Whitten W. Mark
Published: March 2003

A molecular phylogeny was estimated for 23 species of the genus Stanhopea and its sister taxon the monotypic Embreea (Orchidaceae) using the internally transcribed spacer regions‐1 and ‐2 (ITS). We compared the molecular phylogeny with data on floral fragrances and pollination biology. In a few instances, the fragrance data reflected the molecular phylogeny of some of the species groups, but for the most part, fragrance data were homoplasious and not reliable indicators of phylogeny as determined from the independently derived molecular data set.
Molecular systematics ofLiliumand allied genera (Liliaceae): phylogenetic relationships amongLiliumand related genera based on therbcLandmatKgene sequence data
Authors: Hayashi1 Kazuhiko , Kawano2 Shoichi
Published: March 2003

Coding regions of therbcLandmatKgenes of cpDNA were sequenced to analyze phylogenetic relationships of the family Liliaceaesensu stricto, including the major 16 genera of Medeoloideae and Lilioideae of the Liliaceae, in reference to several genera such asScoliopus, Uvularia, Disporum, andTrilliumused as outgoups. The results were congruent with the taxonomic concept of Liliaceaesensu strictorecently proposed byTamura (1998). The inter‐ and infrageneric relationships in the genusLiliumand allied taxa were then analyzed based upon therbcLandmatKgene sequencing data, usingMedeolaandErythroniumas outgroups. TherbcLgene has evolved more slowly thanmatKand its phylogenetic resolution has been poor as a result of the low base substitution rates; whereas thematKgene has shown a much higher base substitution: 104 variable sites (including 80 informative sites) out of 1641 base pairs were detected. In addition, a remarkably high number of indels, i.e. 19 insertion/deletion events, were detected in thematKgene, which provided us with new evidence for structural changes of this gene within the genusLiliumand allied taxa. Phylogenetic analyses based on the majority rule of the sequence data ofmatKgene revealed that the genusLiliumconsists of three different major clades, including taxa that were placed into different sections by earlier taxonomic treatments, and thus the results of molecular systematic analysis was not congruent with sectional delimitations of the genusLiliumbased on the morphological characters.Nomocharis pardanthinaandNomocharis saluenensiswere ingroup taxa ofLilium.Notholirion, Cardiocrinum, andFritillariaturned out to be sister groups toLilium. An evaluation of the morphological and life‐history characteristics was also attempted in light of the molecular phylogeny.
Genetic diversity and genetic structure of populations of Ranunculus japonicus Thunb. (Ranunculaceae)
Authors:   Syamsuardi, Okada Hiroshi
Published: March 2003

Abstract In order to clarify the genetic diversity and population structure of Ranunculus japonicus, allozymic analysis was conducted on 60 populations in southwestern Japan. Considerable genetic variati ons were detected among the populations of R. japonicus. The genetic diversities within species (Hes = 0.215) and within populations (Hep = 0.172) were slightly higher than those of other perennial herbs with widespread distribution and outcrossing plants. Significantly higher values of fixation index were detected in some populations, which might have arisen from restricted mating partners. The majority of genetic variation (approx. 80%) resided within a population and a moderate level of genetic differentiation (GST = 0.203) was observed among populations. The FST value (0.203) suggests the existence of a substantial population structure in this species. The highly significant correlation between geographic distance and FST values indicates that isolation by distance has played an important role in the construction of the genetic structure of this species.
Vaccines and therapeutics against influenza virus infections
Authors: Saito Takehiko , Tashiro Masato
Published: March 2003

Abstract

Background
: Vaccination prior to epidemic season is the best measure to control influenza virus infection; however, there are several issues to be considered regarding influenza vaccines in Japan. In the present review, current issues regarding influenza vaccine in Japan are described, as well as the future prospects of vaccine development. As well as vaccination, anti‐influenza agents such as amantadine are now available in Japan. Furthermore, neuraminidase inhibitors are expected to appear in the market in near future. These anti‐influenza agents represent new options for influenza control.

Conclusions
: Vaccination and antiviral agents are a major armamentarium against influenza infections. Thus, exploratory studies on novel forms of vaccine and anti‐influenza drugs should help to prepare against pandemics that must emerge in near future.
Influenza surveillance system of Japan and acute encephalitis and encephalopathy in the influenza season
Authors: Okabe Nobuhiko , Yamashita Kazuyo , Inouye Kiyosu Taniguchi and Sakae
Published: March 2003

Abstract Aim: To understand the situation of influenza epidemics and neurologic complications during the influenza season in Japan.

Methods
: The influenza surveillance system in Japan was reviewed and the data on influenza/influenza‐like illness and neurologic complications, such as acute encephalitis/encephalopathy, were evaluated.

Results
: From the data of the National Epidemiological Surveillance of Infectious Diseases (NESID), an increase in clinically diagnosed encephalitis/encephalopathy was clearly noted recently. Most cases reported were acute encephalitis/encephalitis. The number of cases of Reye’s syndrome reported was stable and low in number, since the time of the recommendation of not using aspirin for pediatric febrile disease, particularly for influenza‐like illness, in Japan. These acute encephalitis/encephalopathy cases were not correlated clearly with clinically diagnosed influenza patients before the 1997/98 influenza season from the surveillance data, although several case reports have shown a relationship.

Conclusions
: It is clarified from the NESID that neurologic complications such as acute encephalitis/ encephalopathy, apart from Reye’s syndrome, have occurred associated with influenza virus infection, especially among young children. Further investigation should be necessary to find the pathogenesis of this serious complication of influenza virus infection and whether this is unique in Japan, due to unclarified factor/factors, or whether it has not been recognized in other countries.
Risk factors for nutritional rickets among children in Kuwait
Authors: Molla Abdul Majid , Badawi Mona H , Al‐Yaish Suhad , Sharma Prem , El‐Salam Randa Salah
Published: March 2003

Abstract Aim: To assess the risk factors for nutritional rickets among children in Kuwait.

Methods
: One hundred and three children with rickets and 102 control children matched for age and socioethnic characteristics were recruited over a 2 year period (January 1995 to January 1997) in Al‐Adan Hospital in Kuwait. Diagnosis was made on clinical, radiologic and biochemical parameters. A specially designed questionnaire was administered by one of the investigators to both mothers of patients and mothers of control subjects to assess the role of social, nutritional and other related factors in the pathogenesis of nutritional rickets. Biochemical investigations included estimation of hemoglobin, serum calcium, serum phosphorus, serum alkaline phosphatase and serum 25‐hydroxy vitamin D.

Results
: The mean birthweights of rickets patients and control subjects were 3.20~0.46 and 3.19~0.45 kg, respectively. At the time of diagnosis, bodyweights of the patients and controls were 9.36~1.50 and 10.15~2.10 kg, respectively. Heights at the time of diagnosis were 73.58 and 77.24 cm for the patients and the controls, respectively. Mean hemoglobin, serum calcium and serum phosphate were significantly lower in the patients compared with the controls. Alkaline phosphatase was higher among the patients (P<0.0001). The mean serum 25‐hydroxy vitamin D level of the patients was 26.5 nmol/L, compared with 83.5 nmol/L in the controls. The mean age of starting semisolid feeds for the patients was 8.12 months, compared with 5.7 months in the controls. The nutritional quality of semisolid feeds was adequate among 71.6% of the controls as opposed to 13.6% of the patients.

Conclusion
: Nutritional rickets is a multifactorial condition. However, several factors seem to make important contributions. Among these, lack of exposure to sunlight, prolonged breast feeding without supplementation and inadequate weaning practices are important. Maternal education is important as it can influence all of the above factors.
Can zinc deficiency be used as a marker for the diagnosis of celiac disease in Turkish children with short stature?
Authors: Altuntaş Buket , Filik Bülent , Ensari Arzu , Zorlu Pelin , Teziç Tahsin
Published: March 2003

Abstract

Background
: It is generally accepted that celiac disease (CD) must always be considered when dealing with growth failure in children. Therefore, it is important to develop screening tests for detecting patients that need an intestinal biopsy. The aim of the present study was to investigate the value of plasma zinc levels for the diagnosis of monosymptomatic CD in short‐statured children.

Methods
: Fourty‐nine children with a short stature and 34 healthy controls were investigated. Plasma zinc levels were assayed by atomic absorption spectrophotometry in short‐statured children and controls. All patients with short stature underwent endoscopic small intestinal biopsy.

Results
: Duodenal mucosal histopathology was normal in 25 children. Low plasma zinc values were observed in 54.2% of patients with CD, 32.0% of patients with idiopathic short stature and 14.8% of controls. The mean values of plasma zinc levels were not significantly different among the three groups. Sensitivity, specificity and the positive and negative predictive values for plasma zinc were 45.8, 76.0, 64.7 and 59.4%, respectively.

Conclusions
: These results indicate that zinc deficiency is an important problem in CD children with short stature; however, plasma zinc levels are not useful as a screening test for selecting patients for jejunal biopsy.
Evaluation of growth hormone secretion after completion of therapy
Authors: Gökşen Damla , Çoker Mahmut , Özkayin Neşe , Darcan Şükran
Published: March 2003

Abstract

Background
: Growth hormone (GH) reserve in young adults previously diagnosed as having GH insufficiency, who were treated with human (h)GH replacement in childhood needs confirmation in adulthood.

Methods
: Nine patients (seven males, two females; two empty cella, one hypoplasia of the hypophysis and six with idiopathic GH deficiency) diagnosed as having GH insufficiency by the insulin tolerance test (ITT) and dopamine stimulation test in childhood (mean age 12.8±2.6 years) were retested at completion of linear growth (mean age 21.0±3.0 years), 4.6±1.6 years after discontinuation of hGH therapy.

Results
: At the initial diagnosis, seven had complete and two had partial GH deficiency. At diagnosis, the mean peak GH response to ITT and dopamine was 4.8±4.08 and 3.4±2.9 mU/L, respectively. At retesting, the mean GH response to ITT and dopamine stimulation was 3.5±2.5 and 3.3±3.1 mU/L, respectively (P=0.91 and 0.96, respectively). During hGH therapy, mean height velocity increased from 3.5±1.9 cm/year at diagnosis to 9.9±3.64 cm/year during the first year (P=0.002). One of nine children diagnosed as having GH insufficiency who was treated with hGH replacement had normal growth hormone secretion at completion of linear growth.

Conclusions
: All GH‐insufficient children should be retested after completion of their hGH treatment and linear growth to identify those who are truly GH insufficient and who may benefit from GH therapy in adulthood.
Re‐treatment for immune globulin‐resistant Kawasaki disease: A comparative study of additional immune globulin and steroid pulse therapy
Authors: Hashino Kanoko , Ishii Masahiro , Iemura Motofumi , Akagi Teiji , Kato Hirohisa
Published: March 2003

Abstract
 

Background
: We compared the efficacy and safety of additional intravenous immune globulin (IVIG) therapy with steroid pulse therapy in patients with IVIG‐resistant Kawasaki disease.

Methods: Two‐hundred and sixty‐two consecutive patients had been treated with a single dose of IVIG (2 g/kg) and aspirin (30 mg/kg per day). Thirty‐five patients (13.4%) were not clinical responders to the initial IVIG treatment. They received an additional IVIG treatment (1 g/kg) within 48 h after the initial treatment. Seventeen patients (6.5%) did not respond to the additional IVIG treatment. We randomly divided these patients into two groups: group 1 consisted of eight patients who were treated with a single additional dose of IVIG (1 g/kg), while group 2 consisted of nine patients who were treated with steroid pulse therapy.

Results
: The IVIG‐resistant patients had a high incidence of coronary artery lesions (CAL; 48.6%). Five patients (62.5%) in group 1 had CAL, including two patients who each had a giant aneurysm and three patients who each had a small aneurysm. Seven patients (77.8%) in group 2 had CAL, including two patients who each had a giant aneurysm, two patients who each had a small coronary aneurysm and three patients who each showed transient dilatation during steroid pulse therapy. There was no significant difference in the incidence of CAL between the two groups. The duration of high fever in group 2 (1.4±0.7 days) was significantly shorter than in group 1 (4.8±3.4 days; P<0.05). The medical costs for the treatment of patients in group 2 (¥113 012±22 084) were significantly lower than those for group 1 (¥144 194±12 914; P<0.05).

Conclusions
: Steroid pulse therapy may be useful in the treatment of patients with IVIG‐resistant Kawasaki disease who experience prolonged fever. However, transient dilatation of the coronary artery is observed during steroid pulse therapy, so careful echocardiographic examination should be performed for those patients receiving steroid pulse therapy for the sake of early detection of coronary artery abnormalities.
Glomerulopathy with mesangial IgM deposits: Long‐term follow up of 64 children
Authors: Zeis Petros M , Kavazarakis Emmanuel , Nakopoulou Lydia , Moustaki Maria , Messaritaki Anna , Zeis Marios P , Nicolaidou Polyxeni
Published: March 2003

Abstract
 

Background
: The aim of the present study was to investigate to what extent IgM nephropathy in children with minimal change nephrotic syndrome (MCNS) and diffuse mesangial hypercellularity (DMH) evolves to focal segmental glomerulosclerosis (FSGS).

Methods
: Tissues from renal biopsies were examined by light microscopy (LM), immunofluorescence (IF) and, in four cases, by electron microscopy (EM). From a total of 352 nephrotic children, 121 had renal biopsy results as steroid dependent or resistant. A diagnostic renal biopsy was also perfomed in 331 children with non‐nephrotic proteinuria and/or hematuria. A second renal biopsy was performed in 16 children whose renal function was impaired during the follow up. The clinical course of IgM‐positive children was compared with that of IgM‐negative children.

Results
: Of the 121 nephrotic children with renal biopsy, 85 were MCNS. Twenty were IF positive mainly for IgM, six of whom (30%) presented evolution to FSGS, while of the remaining 65 IF‐negative children, only three (4.6%) presented evolution to FSGS. Of the total 331 children with non‐nephrotic proteinuria and/or hematuria, 139 were diagnosed as IgA–IgG nephropathy, 44 had positive IF for IgM and 148 were IF negative. Of the 44 children IF positive for IgM, seven (15.9%) presented evolution to FSGS, while none of the 148 IF‐negative children presented evolution to FSGS. The follow‐up time for all children ranged from 1 to 14 years.

Conclusions
: Of IgM nephropathy patients with MCNS and DMH, a significant percentage develop impaired renal function, due to the evolution of FSGS, as revealed by repeat biopsy during long‐term follow up.
Treatment of pneumothorax in newborns: Use of venous catheter versus chest tube
Authors: Arda ·Irfan Serdar , Gürakan Berkan , Al·Iefendioğlu Didem , Tüzün Meriç
Published: March 2003

Background
: The traditional treatment for pneumothorax is tube thoracostomy. Chest tube placement often involves complications, particularly in newborns. The aim of this study is to introduce the method of air drainage with venous catheter and to compare two different methods, chest tube placement and venous catheter insertion, in the treatment of pneumothorax in newborns.

Methods
: We treated 72 newborn patients with pneumothorax over a 4‐year period in neonatal intensive care units at two different medical centers. We randomly divided the patients into two groups. In group I, we treated the patients with chest tube placement technique. We used 18‐gauge venous catheter connected to an underwater system to drain air in group II patients. The duration of the procedure, the period of time that the chest tube or catheter was left in place, and the complications associated with the two different procedures were statistically compared.

Results
: The time required to perform the venous catheter procedure was significantly shorter than that for chest tube placement (P < 0.05). The duration of the device in place was also significantly shorter in group II than group I (P < 0.05). Only two minor complications were recorded in patients who underwent venous catheter placement, and this group’s complication rate was significantly lower than the rate in the chest tube group (P < 0.05).

Conclusion
: Insertion of a venous catheter is a safe alternative to chest tube placement as a method of draining air from newborn patients with pneumothorax. This is an easy and quick bedside procedure and is particularly useful for newborn patients that require immediate air drainage.
Serological levels of zinc, copper and iron elements among Giardia lamblia infected children in Turkey
Authors: Ertan Pelin , Yereli Kor , Kurt Özgür , BalcioĞlu I Cüneyt , OnaĞ Ali
Published: March 2003

Background
: Giardiasis, an intestinal protozoan

infection caused by Giardia lamblia, is common in Turkey, especially among children aged between 2‐ and 14‐years‐old. Effects of giardiasis on serological levels of zinc, copper and iron elements were assessed in this study.

Methods
: A total of 45 children, aged between 2‐ and 14‐years‐old, who were admitted to the Pediatrics Department of Celal Bayar University Medical School with gastrointestinal complaints and diagnosed as having giardiasis by stool examinations in the Parasitology Department, were enrolled as the study group (SG). The control group (CG) consisted of 45 age‐matched healthy children. Serological levels of zinc, copper and iron were measured by atomic absorption spectrophotometer in all samples.

Results
: As a result of the study, serum zinc levels were 67.43 ± 17.72 µg/dL and 145.20 ± 9.13 µg/dL, copper levels were 198.45 ± 39.14 µg/dL and 150 ± 21.14 µg/dL and iron levels were 87.98 ± 18.31 µg/dL and 160.45 ± 45.40 µg/dL, in SG and CG, respectively. When compared separately as SG and CG, there was a statistically significant difference between the serological levels of all these elements.

Conclusion
: These results revealed that giardiasis increased the serological levels of copper, like other infectious agents. However, zinc and iron levels decreased during giardiasis due to malabsorption.
Betaine and homocysteine concentrations in foods
Authors: Sakamoto Akiko , Nishimura Yutaka , Ono Hiroaki , Sakura Nobuo
Published: March 2003

Background
: Betaine (Bet) supplementation is an effective strategy for dietary treatment of homocystinuria. However,previous reports on diet therapy have only examined methionine (Met) and cystine concentrations, but not those of Bet and homocysteine(Hcy) in food items. We set up a hypothesis that there are some food items, which contain a small amount of Met, but a great amountof Hcy and Bet.

Methods
: We measured Bet and Hcy concentrations in 58 food items, which were regarded as containing low Met.

Results
: Products of wheat flour are rich in Bet. The amount of Bet in food items investigated in this study is muchsmaller than the dose used to treat homocystinuria patients. Vegetables contained little Hcy, however sprouted beans and sprouted alfalfaseeds contained ample Hcy.

Conclusion
: Patients with homocystinuria do not have to be too concerned about Hcy in food items because the amountis small. Therefore, we encourage homocystinuria patients to continue a low Met diet therapy without anxiety of Hcy and Bet, and if necessary,Bet will be supplemented.
The importance of first‐time parent groups for new parents
Authors: Hanna Barbara A. , Edgecombe Gay , Jackson Carol A. , Newman Susan
Published: March 2003

Abstract First‐time parent groups are offered to all new parents in Victoria, Australia through the Maternal and Child Health Service, which is funded by state and local governments. Parents who join a group attend a series of eight sessions that emphasize parenting skills, relationship development and social support in order to increase confidence and skills in parenting. The present paper highlights the importance of first‐time parent groups, claiming that these groups serve an important social support and health function amid a climate of early discharge policies and changing family structures. Although there are a number of challenges to the successful running of groups, it is argued that first‐time parents benefit from participating in these groups in a number of ways: by developing social networks, gaining self confidence, and through access to relevant information on child health and parenting. Research indicates that first‐time parent groups provide lasting benefits not only for families, but also for society as a whole. Maternal and child health nurses play a key role in facilitating groups for first‐time parents.
Squamous cell carcinoma of the renal pelvis with inferior vena caval extension
Authors: Kimura Takahiro , Kiyota Hiroshi , Asano Koji , Madarame Jun , Yoshino Yasumasa , Miki Kenta , Abe Kazuhiro , Hasegawa Taro , Ohishi Yukihiko
Published: March 2003

Background
: We report here on a third case of squamous cell carcinoma (SCC) of the renal pelvis extending to the inferior vena cava.

Methods/Results
: A 48‐year‐old man was diagnosed with an advanced left renal pelvic tumor on computed tomography. He had undergone extracorporeal shock wave lithotripsy for left staghorn calculi 10 years ago. An inferior vena cavagram showed tumor thrombus extending to the inferior vena cava. Percutaneous left renal biopsy revealed SCC. The patient received three courses of combination chemotherapy with cisplatin, bleomycin and etoposide. However, 1 month after the last course of chemotherapy, he died of cancer progress.

Conclusion
: This is the third case of SCC of the renal pelvis extending to the inferior vena cava in the world.
Primary squamous cell carcinoma of the prostate
Authors: Okada Eiichiro , Kamizaki Hitonori
Published: March 2003

Abstract
Background
: Primary squamous cell carcinoma (SCC) is an uncommon tumor of the prostate gland. A 65‐year old man complained of obstructive symptoms.

Methods/Results
: Transrectal palpation and diagnostic imaging indicated an ordinary adenocarcinoma, although serum prostate‐specific antigen (PSA) was normal. Biopsy specimens revealed SCC with the serum SCC antigen elevated. The patient was treated with pelvic irradiation and systemic administration of cis‐platinum and peplomycin, which resulted in shrinkage of the cancer.

Conclusion
: No evidence of recurrence has been seen for 18 months.
Immunohistochemical expression of P‐glycoprotein in the rat urinary bladder and the effect of verapamil on intravesical chemotherapy
Authors: Hashimoto Hiroshi , Tokumitsu Masayuki , Saga Yuji , Okuyama Mitsuhiko , Yachiku Sunao
Published: March 2003

Abstract Background: The expression of P‐glycoprotein (Pgp) is thought to be common in bladder epithelium and the multidrug resistance mediated by Pgp must be considered to improve the efficacy of chemotherapy for bladder tumors.

Methods: The expression of Pgp in normal and tumor tissue of the rat urinary bladder was first examined immunohistochemically. The effect of verapamil, an expected modulator of Pgp, on intravesical chemotherapy of the rats was then investigated.

Results: Pgp was immunohistochemically detected in normal epithelium and in tumor tissue of the rat urinary bladder. In those normal and tumor‐bearing bladders, verapamil promoted the uptake of intravesically instilled pirarubicin, but the efflux of intracellular accumulated pirarubicin was observed subsequently in both conditions with and without verapamil. The drug concentration decreased more rapidly in the verapamil group than in the control group.

Conclusions: Verapamil is thought to be useful in promoting uptake of intravesically instilled pirarubicin, but it did not appear to be so efficient at limiting the efflux of intracellular accumulated pirarubicin.
Cyst‐associated renal cell carcinoma: Clinicopathologic characteristics and evaluation of prognosis in 27 cases
Authors: Onishi Tetsuro , Oishi Yukihiko , Goto Hirokazu , Tomita Masayuki , Abe Kazuhiro , Sugaya Shingo
Published: March 2003

Background:

No consistent clinicopathologic characteristics of cyst‐associated renal cell carcinoma (CRCC) have previously been determined.

Methods:

In total, 768 patients with renal cell carcinoma (RCC) underwent radical or partial nephrectomy. Renal cell carcinoma was classified as CRCC in 27 of these patients (3.5%, subdivided into RCC originating in a cyst and cystic RCC), clear‐cell RCC in 662 patients (86.2%), chromophobe cell renal carcinoma in 36 patients (4.7%) and papillary RCC in 43 patients (5.6%) according to the criteria of the World Health Organization.

Results:

The pathologic stage and nuclear grade were usually lower in those with CRCC (low stage/low grade; 89%/96%) or chromophobe cell renal carcinoma (low stage/low grade; 89%/80%) than in those with clear‐cell RCC (low stage/low grade; 59%/65%) or papillary RCC (low stage/low grade; 53%/69%). Of the 27 CRCC patients, only 19 (70%) could be diagnosed through preoperative imaging studies. Patients with CRCC showed a favorable prognosis (survival rate: 95% at 1 year, 89.7% at 3 years and 84.4% thereafter) and, especially among the patients with RCC originating in a cyst, no cancer‐related death was observed. Comparing the survival among four types of RCC, a favorable outcome was observed in cases of CRCC or chromophobe cell renal carcinoma compared with clear‐cell RCC or papillary RCC (clear vs chromophobe: P = 0.002; chromophobe vs papillary: P = 0.019; clear vs cyst‐associated: P = 0.001; papillary vs cyst‐associated: P = 0.00079).

Conclusions:

In cases of CRCC, the disease was usually detected at lower stages and grades and therefore the prognosis was better than in cases of other types of RCC. Preoperative diagnosis of this disease was very difficult, especially in cases of RCC originating in a cyst.
Treatment of androgen‐independent prostate cancer with dexamethasone: A prospective study in stage D2 patients
Authors: Saika Takashi , Kusaka Nobuyuki , Tsushima Tomoyasu , Yamato Toyoko , Ohashi Teruhisa , Suyama Bunzo , Arata Ryoji , Nasu Yasutomo , Kumon Hiromi ,   Okayama Urological Cancer Collaborating Group (OUCCG)
Published: March 2003

Purpose:

In order to evaluate the efficacy of dexamethasone in the treatment of Japanese men with androgen‐independent prostate cancer, a prospective study was conducted using prostate‐specific antigen (PSA) as a primary end‐point.

Methods:

Nineteen Japanese men with stage D2 androgen‐independent prostate cancer were registered and treatment was started. After ruling out anti‐androgen withdrawal syndrome, they were treated with dexamethasone (1.5 mg daily). Patients were monitored for PSA, symptoms, radiologic response, survival rate, time to disease progression, time to treatment failure and complications.

Results:

Prostate‐specific antigen levels decreased in nine patients (50.0%); five (27.8%) showed a 50% or greater decrease and two (11.1%) showed an 80% or greater decrease. For the nine patients, the mean duration of PSA response was 7.3 months and the median duration was 2.1 months (range, 1.2–27.5+). Bone pain, which was noted in 13 patients at study entry, improved in seven patients (53.8%). Of nine patients who had serial radiographic examinations with bone scan, three (33%) showed partial response, two (22%) were stable and four (44%) showed disease progression. Treatment was well tolerated, except for one patient who suffered a severe pulmonary infection.

Conclusion:

Dexamethasone decreased PSA levels and produced subjective symptomatic improvement in the patients with stage D2 androgen‐independent prostate cancer.
Apoptotic cell death and Smad4 expression in transitional cell carcinoma of the renal pelvis and ureter
Authors: Kong Chuize , Zhang Xianghua , Takenaka Ikumasa
Published: March 2003

Abstract Purpose: To investigate the frequency of apoptosis and the expression of Smad4 protein as well as their roles in transitional cell carcinoma (TCC) of the renal pelvis and ureter.

Methods: Apoptosis was detected by using terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP‐biotin nick end labeling (TUNEL) technique in 34 formalin‐fixed and paraffin‐embedded specimens of renal pelvic and ureteral TCC. The expression of Smad4 was immunohistochemically studied.

Results: The incidence of apoptosis ranged from 1.10 to 3.75% with a median of 2.50% in TCC of the renal pelvis and ureter. The incidence of apoptosis was noted to be closely related to histologic grade but not to pathologic stage of the cancer. The expression of Smad4 was detected in six of 34 cases (17.6%). Regarding subcellular distribution, Smad4 protein was localized both in cytoplasm and nucleus of the cancer cells. In comparing the incidence of apoptosis with the expression of Smad4, no significant associations were seen between them. The expression of Smad4 was not related to the tumor grade nor stage of the cancer.

Conclusions: The present study demonstrated close association of the incidence of apoptosis with the tumor grade of TCC of the renal pelvis and ureter. Significance of Smad4 expression was not noted in the study. It suggests that apoptotic cell death may play an important role in the tumor progression of renal pelvic and ureteral TCC.
Radical prostatectomy: Time trends, morbidity and quality of life
Authors: Arai Yoichi
Published: March 2003

Abstract In recent years, increased screening for prostate cancer, primarily with prostate‐specific antigen testing, has led to an apparent increase in the incidence of prostate cancer and resulted in a shift to an earlier patient age and tumor stage at diagnosis. From the early 1980s, there have been great advances in surgical technique. In the 1990s, radical prostatectomy gained popularity among Japanese urologists. Time trends and morbidity of contemporary anatomical radical prostatectomy in Japan are reported here. In addition, the quality of life in men undergoing radical prostatectomy is discussed.
Induction of apoptosis by cyclooxygenase‐2 inhibitors in prostate cancer cell lines
Authors: Kamijo Toshiyuki , Sato Toshikazu , Nagatomi Yutaka , Kitamura Tadaichi
Published: March 2003

Abstract Prostaglandins are thought to play an important role in the proliferation of prostate cancer and are highly expressed in prostate cancer tissue. Cyclooxygenase‐2 (COX‐2), or prostaglandin endoperoxide synthase, is a key enzyme in the conversion of arachidonic acid into prostaglandin. In several cancers, COX‐2 contributes to the proliferation and metastasis of cancer cells. To assess the role of COX‐2 in prostate cancer, we investigated whether the inhibition of COX‐2 affected the proliferation of prostate cancer cells. The human prostate cancer cell lines, LNCaP and PC 3, and a normal prostate stromal cell line (PrSC) were treated with COX‐2 inhibitors NS 398 and Etodolac. The proliferation rate of the cell lines was examined using 3(4,5‐dimethylethiazoly 1‐2‐) 2,5‐diphonyl tetrazolium bromide (MTT) assays. A DNA fragmentation assay was also used for proof of apoptosis. COX‐2 inhibitors could suppress the proliferation of LNCaP and PC 3 cells. In contrast, PrSC was not affected by COX‐2 inhibitors. These suppressive effects occurred in a time‐ and dose‐dependent manner. One of mechanisms responsible for cell death was apoptosis. COX‐2 seems to play a significant role in the progression of prostate cancer. COX‐2 may be a therapeutic target for prostate cancer. Since COX‐2 inhibitors suppress proliferation and induce apoptosis in prostate cancer cells, and have no effect in normal prostate stromal cells, COX‐2 inhibitors will be useful for the treatment of prostate cancer.
Adenoid cystic carcinoma of the prostate: A case report with immunohistochemical and in situ hybridization staining for prostate‐specific antigen
Authors: Minei Sadatsugu , Hachiya Takahiko , Ishida Hajime , Okada Kiyoki
Published: March 2003

Abstract A 43‐year‐old man with urinary outlet obstruction was referred to our hospital. A digital rectal examination revealed an elastic hard prostate. The serum prostate‐specific antigen (PSA), serum prostatic acid phosphate and γ‐seminoprotein levels were found to be within the normal range, and transrectal ultrasound sonography provided normal findings. The patient underwent a subcapsular prostatectomy under a diagnosis of benign prostatic hyperplasia. Histopathologically, the lesion was diagnosed as an adenoid cystic carcinoma of the prostate. Because a further examination revealed a pathologic extension into the urinary bladder, a radical cystoprostatectomy was performed. The expression of PSA protein and PSA mRNA was studied by means of immunohistochemistry and an in situ hybridization technique. The adenoid cystic carcinoma in the patient did not show any positive signs for PSA protein or PSA mRNA.
Body mass index for chronic hemodialysis patients: Stable hemodialysis and mortality
Authors: Aoyagi Teiichiro , Naka Hidekatsu , Miyaji Keisuke , Hayakawa Kunihiro , Ishikawa Hiromichi , Hata Makoto
Published: March 2003

Abstract Body mass index (BMI) is used as a reference for weight control programs in the general population and in morbidity and mortality studies in diabetes patients. However, the implications of BMI in chronic hemodialysis patients is unclear. We studied the BMI of chronic hemodialysis patients, focusing on problems encountered during outpatient hemodialysis therapy and on 2‐year mortality. Outpatients with chronic hemodialysis (n = 258; 144 men, 114 women) were divided into four groups: (i) patients with stable hemodialysis; (ii) patients with marked hypotension requiring catecholamine infusion during hemodialysis; (iii) patients with excessive interdialysis weight gain requiring occasional additional hemodialysis; and (iv) patients with troublesome hemodialysis due to other causes. The statistical differences between the average BMI among these groups were evaluated, and were subdivided into sex, age and the duration of hemodialysis history. The 2‐year mortality rates of these patients were also studied according to their BMI. In patients under 60 years of age, those with excessive interdialysis weight gain had statistically larger BMI (23.2; n = 35) compared to patients with good hemodialysis control (20.1; n = 178), regardless of gender and hemodialysis history. The mortality rate was at a minimum at approximately 20 BMI in patients under 60 years of age. However, lower BMI was associated with a greater mortality rate in patients 60 years or over. For chronic hemodialysis patients, the BMI associated with stable hemodialysis and minimum mortality is approximately 20, in those under 60 years of age. The BMI of aged hemodialysis patients should be considered separately in morbidity and mortality studies.
Prognostic significance of platelet‐derived endothelial cell growth factor/thymidine phosphorylase expression in stage pT1 G3 bladder cancer
Authors: Li Shengwen , Nomata Koichiro , Sawase Kenji , Noguchi Mitsuru , Kanda Shigeru , Kanetake Hiroshi
Published: March 2003

Abstract Background: The management of patients with pT1 G3 bladder cancer remains controversial because of the high incidence of recurrence with muscle invasion. Thymidine phosphorylase (dThdPase) is identical to platelet‐derived endothelial cell growth factor (PD‐ECGF) and has angiogenic activity. The aim of this study was to determine whether the expression of PD‐ECGF/dThdPase in bladder cancer tissue was associated with tumor progression and recurrence in patients with pT1 G3 bladder cancer.

Methods: Fifteen patients who were pathologically diagnosed as having pT1 G3 transitional cell carcinoma of the bladder were treated with transurethral resection. Sections of paraffin‐embedded bladder tissue were immunohistochemically stained with either mAb654–1, a monoclonal antibody against human PD‐ECGF or anti‐CD34 monoclonal antibody, respectively. When more than 10% of tumor cells were positively stained with mAb654–1, this section was defined as positive in this study.

Results: Eight of 15 sections from patients with pT1 G3 bladder cancer (53%) were positive with PD‐ECGF/dThdPase. During follow up, patients in the negative group had no disease progression and only two patients had local recurrence. In contrast, seven of eight positives had recurrence (P < 0.05) and progression was also observed in four recurrent patients. However, there was no statistical relationship between PD‐ECGF and CD34 expression in any of the patients.

Conclusion: The expression of PD‐ECGF/dThdPase appears to be an important prognostic factor of pT1 G3 bladder cancer and did not show any significant relationship between PD‐ECGF/dThdPase expression and vascular density.
Urinary transforming growth factor‐β1 levels correlate with bladder outlet obstruction
Authors: Monga Manoj , Gabal‐Shehab Lamia L , Stein Paul
Published: March 2003

Abstract Background: Urinary transforming growth factor‐β1 (TGF‐β1) levels have been shown to correlate with elevated intrapelvic pressure associated with ureteropelvic junction obstruction. Other studies have evaluated urinary TGF‐β1 levels in prostate cancer. This study tests the hypothesis that urinary TGF‐β1 levels might correlate with objective measures of bladder outlet obstruction (BOO).

Methods: Twenty‐three men (age: 46–85 years) with lower urinary tract symptoms underwent urodynamic studies consisting of non‐invasive uroflowmetry, cystometrogram and voiding pressure flow studies. Patients were classified as obstructed (n = 17) or not obstructed (n = 6) based on Abrams‐Griffith nomograms. Urinary TGF‐β1 was extracted from an aliquot of urine obtained at the time of bladder catheterization for urodynamic studies. Urinary TGF‐β1 levels were then determined by enzyme‐linked immunosorbent assay (ELISA).

Results: There was a strong correlation between urinary TGF‐β1 levels and the presence of obstruction by Abrams‐Griffith nomogram criteria (P = 0.025). Urinary TGF‐β1 levels were significantly higher in men with obstruction (0.039 ± 0.011 pg/mL) than in men without obstruction (0.029 ± 0.009 pg/mL; P = 0.036).

Conclusion: Urinary TGF‐β1 levels correlate with objective measures of BOO. Further study is needed to test the utility of urinary TGF‐β1 as a non‐invasive diagnostic tool for BOO.
Identification of muscarinic receptor subtypes of cultured smooth muscle cells and tissue of human bladder body
Authors: Kiwamoto Hiro , Ma Fu‐Hai , Higashira Hanae , Park Yung‐Chol , Kurita Takashi
Published: March 2003

Abstract Background: Muscarinic receptor subtypes of cultured smooth muscle cells from the human bladder body were investigated by the receptor binding assay method. The result was compared with that obtained from the human bladder body tissue to confirm whether the receptor subtypes of the cells are not changed after several passages of cell culture.

Methods: Inhibitory effects of various muscarinic antagonists on the binding of [3H]‐N‐methylscopolamine ([3H]‐NMS) to membrane preparations obtained from cultured smooth muscle cells from the fourth subculture of the human bladder body were compared with those prepared from the human bladder body tissue and cells expressing human muscarinic receptor subtypes.

Results: Binding‐inhibition constants (pKi) for atropine, pirenzepine, methoctramine, 4‐diphenylacetoxy‐N‐methylpiperidine methiodide (4‐DAMP), oxybutynin and propiverine obtained from membrane preparations of cultured smooth muscle cells were 8.91, 6.35, 8.24, 8.53, 7.29 and 5.61, respectively. pKi values of these muscarinic receptor antagonists against the membrane preparation of human bladder body tissue were 9.08, 6.66, 8.05, 8.79, 7.53 and 6.04, respectively. pKi values of cultured smooth muscle cells and tissue from human bladder body were correlated closely with those of insect cells expressing the cloned human M2 receptor subtype.

Conclusion: The binding affinities for various muscarinic receptor antagonists of cultured human smooth muscle cells were maintained through the fourth subculture and it was suggested that the M2 receptor subtype is predominantly expressed in cultured smooth muscle cells of human bladder body as well as in tissue of the human bladder body.
Neurofibromatosis involving the urinary bladder
Authors: Chakravarti Aniruddha , Jones Malcolm Anthony , Simon Jayanthi
Published: March 2003

We present two interesting cases of a 24‐year‐old man and a 14‐year‐old boy, uncle and nephew, with lower urinary tract symptoms, café au lait patches and subcutaneous nodules. Ultrasonography and computed tomography scans showed a large, irregular lobulated soft tissue mass between the bladder and sacrum. Cystoscopy, laparotomy and biopsies revealed neurofibromatosis involving the urinary bladder. No enlargement of the tumor or upper urinary tract obstruction has occurred during the long‐term follow up. We recommend meticulous follow up of patients with giant intrapelvic neurofibromatosis.
A case of pelvic malignant paraganglioma
Authors: TAUE RYUICHI , TAKIGAWA HIROSHI , SINOTOU KENJI , UNO SATOSHI , MORI RYOUJI , TATARA KIYOSHI , SANO TOSHIAKI
Published: March 2003

Abstract We report a rare case of pelvic malignant paraganglioma that was treated with surgery, combination chemotherapy and radiation. A 47‐year‐old man was diagnosed with pelvic malignant paraganglioma that had metastasised to the thoracic vertebrae. The pelvic mass, which was 6 cm in size, was on the posterior side of the bladder and had invaded the prostate, seminal vesicle and bladder neck. We resected the intrapelvic tumor and lymph nodes using cystoprostatectomy. Metastases to bilateral obturator lymph nodes and the right internal iliac lymph node were shown by pathology. Adjuvant therapies included six courses of the combination chemotherapy (cyclophosphamide, vincristine and dacarbazine), and 12 courses of VP‐16 therapy. Radiation therapy was done for metastasis of the thoracic vertebrae. Local recurrence, progression of bone metastasis and new metastasis have not been detected since these treatments. The patient has been clinically stable during 20 months of follow‐up. Chemotherapy of cyclophosphamide, vincristine and dacarbazine and VP‐16 with radiation appears to be effective in treating advanced malignant paraganglioma.
Does transurethral resection of the prostate facilitate detection of clinically significant prostate cancer that is missed with systematic sextant and transition zone biopsies?
Authors: Kitamura Hiroshi , Masumori Naoya , Tanuma Yasushi , Yanase Masahiro , Itoh Naoki , Takahashi Atsushi , Tsukamoto Taiji , Adachi Hideki , Hotta Hiroshi
Published: March 2003

Abstract
Background
: A prospective study was conducted to determine whether transurethral resection of the prostate (TURP) facilitates detection of prostate cancer that is missed with systematic sextant biopsies associated with transition zone (TZ) biopsies.

Methods
: A total of 139 consecutive patients underwent transperineal TZ biopsies of each lobe in addition to a transrectal systematic sextant peripheral zone (PZ) biopsy. Patients whose biopsies were negative for cancer received TURP for relief of lower urinary tract obstruction when indicated.

Results
: Cancer was detected in biopsy specimens of 40 patients. Of these cancers, 18 originated in the PZ alone and 22 were located both in the TZ and the PZ. No cancers were detected in the TZ alone. Of 99 patients who were proven not to have cancer by the biopsies, 18 were indicated for TURP. Five of these patients (28%) had cancer in the resected tissues. All cancers were clinically organ confined and their Gleason sum scores were 2–5. Cancer‐positive chips accounted for less than 10% of all resected specimens. Of the 66 patients with negative biopsies and without indication for TURP, four (6%) were revealed to have an elevation of the serum PSA level during follow up. They were later proven to have cancer by a second biopsy.

Conclusion
: Routine use of TZ biopsy is not warranted for detection of cancer. Transurethral resection of the prostate can detect cancers in patients with negative PZ and TZ biopsies. However, cancers detected by TURP may not always be clinically significant and only four of 66 patients who were not indicated for TURP and received a close follow up were later found to have cancer, although their follow‐up period was short. Thus, it still remains to be elucidated whether TURP is necessary for all patients with negative biopsies of the prostate.