bluuebunny/crossref_metadata_2025 huggingface dataset:
Second Surgery for Recurrent Pilocytic Astrocytoma in Children
Authors: Bowers Daniel C. , Krause Timothy P. , Aronson Leslie J. , Barzi Afsaneh , Burger Peter C. , Carson Benjamin S. , Weingart Jon D. , Wharam Moody D. , Melhem Elias R. , Cohen Kenneth J.
Published: April 2003

Pilocytic astrocytoma (PA) is the most common childhood brain tumor. In cases where the tumor progresses or recurs following primary surgical resection, the appropriate treatment is unclear. Options include chemotherapy, radiation therapy, surgical resection or a combination thereof. To analyze the utility of further surgery, we performed a retrospective, single-institution review of pediatric patients with recurrent PAs from 1990 to 1999 who were treated with a second surgical resection. Patients were excluded if they received adjuvant chemotherapy or radiation therapy. Twenty cases were identified. Tumor locations included: cerebral hemisphere (3), cerebellum (7), optic pathway/hypothalamus (5), thalamus (1) and brainstem (4). The indication for 4 surgeries included an enlarging tumor-associated cyst. At second surgery, 10 of 20 patients had a gross total resection (GTR), 2 a near total resection (NTR), and the remaining 8 patients had a subtotal resection (STR). No patients have died. Two of 10 tumors after GTR, 0 of 2 tumors after NTR, and 7 of 8 tumors after STR had second recurrence/progression at a mean of 15 months (range 4–33 months) following second surgery. The remaining 11 patients are recurrence/progression-free at a mean of 40.7 months (range 19–119 months). Surgery for tumors or midline structures rarely resulted in a GTR (1 of 10 cases). Surgery for tumors located in the cerebral hemispheres or cerebellum resulted in GTR or NTR in all cases and can result in long periods of progression-free survival without further adjuvant treatment.
Hyperthermic Enhancement of the Apoptotic and Antiproliferative Activities of Paclitaxel
Authors: Othman Timothy , Goto Shinji , Lee Jeong-Beom , Taimura Akihiro , Matsumoto Takaaki , Kosaka Mitsuo
Published: April 2003

The antineoplastic agent paclitaxel (PTX), a microtubule-stabilizing agent, is known to arrest cell cycle progression and induce apoptosis. Mild hyperthermia (HT) also disrupts the microtubule system and triggers apoptosis. We therefore investigated whether concurrent exposure of murine breast cancer cells to 10 µmol/l PTX and 43°C HT will promote improved anticancer effects. To do this, we exposed FM3A murine cancer cells to: (1) 10 µmol/l PTX for 1 h at 37°C followed by exposure at 43°C HT for 1 h; (2) 10 µmol/l PTX at 37°C for 2 h; (3) 37°C for 1 h followed by 43°C HT for 1 h, and (4) untreated cells at 37°C for 2 h which served as the control. Treatment No. 1 resulted in an enhanced cell cycle arrest, apoptosis and cytotoxicity. Exposure to 43°C HT alone or 10 µmol/l PTX alone induced lesser apoptosis and cytotoxicity than the two treatments concurrently applied. The apoptotic cell death occurred in a time-dependent manner as follows: (1) concurrently applied 43°C HT and 10 µmol/l PTX (5.6 ± 0.5, 16.5 ± 2 and 27.6 ± 1%); (2) 43°C HT alone (4.3 ± 1, 6.6 ± 0.3 and 12.7 ± 1%) and (3) 10 µmol/l PTX alone (4.4 ± 0.3, 8.6 ± 1 and 12.8 ± 1%) at 1, 6 and 24 h postexposure respectively compared to control of 2.0%. These data indicate that while both HT and PTX can individually induce apoptosis and antiproliferation in FM3A cancer cells, they may offer synergistic benefits when used concurrently.
A Rational Approach to the Selection of Useful Drugs for Clinical Practice
Authors: Spector Reynold , Vesell Elliot S.
Published: April 2003

Confusion exists concerning optimal selection of drugs for clinical practice. Many reasons contribute to this confusion which derives from various sources including industry, the FDA and often less than ideal education of physicians in clinical pharmacology during medical school and thereafter. This presentation does not focus on allocating blame for the current unsatisfactory situation, but rather offers a solution to improve drug therapy. Our educational solution consists of a paradigm for rational drug therapy, specifically a checklist of eight criteria for physicians to review before prescribing drugs. Such a review would facilitate better estimation by physicians of risk/benefit ratios involving new, often expensive and, in some cases, questionably effective and safe drugs.
Antioxidant Potential of a Novel Tetrapeptide Derivative in Isoproterenol-Induced Myocardial Necrosis in Rats
Authors: Manikandan Panchatcharam , Sumitra Miriyala , Kumar Dilly Ashok , Gayathri Chandrasekar , Arutselvan Natarajan , Manohar Bhakthavatsalam Murali , Puvanakrishnan Rengarajulu
Published: April 2003

A novel tetrapeptide derivative Boc-Lys(Boc)-Arg-Asp-Ser(tbu)-OtBu (PEP1261) has been tested in vivo in isoproterenol (ISO) hydrochloride (HCl)-induced myocardial necrosis in rats. ISO·HCl induces myocardial necrosis in rats which is accompanied by the distinct increase in heart weight, marked electrocardiographic changes, increase in the levels of serum marker enzymes and lipid peroxides and decrease in the levels of antioxidants. PEP1261 (5 mg/kg body weight i.p.) pre- and post-treatment effectively decreases serum marker enzyme levels, while the electrocardiographic changes get restored towards normalcy. PEP1261 also inhibits the action of the free radicals toxicity by increasing the levels of antioxidants and histological studies confirm the above findings. This study shows that PEP1261 could serve as an excellent cardioprotective agent possessing membrane-stabilizing action.
Preliminary Evidence for Herpes labialis Recurrence following Experimentally Induced Disgust
Authors: Buske-Kirschbaum Angelika , Geiben Andrea , Wermke Cornelia , Pirke Karl-Martin , Hellhammer Dirk
Published: April 2003

Background: After primary orofacial infection with the herpes simplex virus (type 1, HSV-1), up to 40% of HSV seropositive subjects suffer recurrent herpes infections which are characterized by painful erosions of the involved skin mainly around the lips (herpes labialis). Besides various other factors, there is growing evidence suggesting that psychosocial factors might trigger HSV. The present study was designed to investigate modulation of recurrent HSV infection by experimentally induced emotional distress. Methods: Among patients with herpes labialis (n = 91), subjects who showed recurrent HSV infection (>5 acute infections/year) and who reported to suffer from HSV symptoms exclusively after confrontation with dirty dishes, i.e. dirty plates or dirty glasses were selected by standardized interview. Subjects (n = 20) were randomly assigned to two treatment groups. The experimental group (n = 10) was first exposed to 5 slides showing dirty glasses and subsequently to the glasses previously presented on the slides in vivo. The control group (n = 10) was exposed to neutral slides and neutral objects. In order to determine the proportion of leukocyte subpopulations and concentrations of tumor necrosis factor α (TNF-α), blood samples were collected 15 min before as well as 40 min and 48 h after stimulus presentation. Saliva cortisol was obtained 45, 20, 15 and 1 min before and 1, 10, 20 and 30 min after stimulus confrontation. Results: Medical examination of the volunteers 48 h after the experiment indicated that four experimental subjects showed HSV-1 symptoms while not a single herpetic infection could be determined in the control subjects (p = 0.033). Moreover, significantly elevated concentrations of TNF-α were observed in the experimental, but not in the control group. No significant alterations of the number of leukocyte subpopulations were found 30 min or 48 h after stimulus presentation. Further, cortisol concentrations were found to be unchanged after the treatment. Conclusions: The present findings suggest that experimentally induced emotional stress such as disgust may be associated with reactivation of HSV.
Assessment of Psychological Distress in the Setting of Medical Disease
Authors: Fava Giovanni A. , Mangelli Lara , Ruini Chiara
Published: April 2003

The biopsychosocial model of disease has recently been depicted as the basis for a renewed emphasis on the multiaxial diagnostic system of the DSM-IV. The authors challenge this stance, underscoring the clinical inadequacies of the DSM-IV in the setting of medical disease, particularly the chapters concerned with somatoform disorders and psychological factors affecting medical conditions. Diagnostic criteria which are based on the clinical insights derived from psychosomatic research in the past decades may offer new opportunities to psychosomatic medicine and consultation-liaison psychiatry. The development of the Diagnostic Criteria for Psychosomatic Research (DCPR), encompassing alexithymia, type A behavior, irritable mood, demoralization, disease phobia, thanatophobia, health anxiety, illness denial, functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction, is described. Preliminary results obtained with the combination of DSM and DCPR criteria appear to be promising.
The Growing Commercial Value of the Male Body: A Longitudinal Survey of Advertising in Women’s Magazines
Authors: Pope Jr. Harrison G. , Olivardia Roberto , Borowiecki III John J. , Cohane Geoffrey H.
Published: April 2003

Background: With the advances of feminism, men have gradually relinquished their once-exclusive ‘masculine’ roles as fighters and breadwinners. In response to this change, the male body may have gained in relative importance as one of the few surviving marks of masculinity. We hypothesized that these trends might be quantified by using a commercial measure such as advertising. Methods: We examined the proportion of exposed male and female bodies portrayed in advertisements between 1958 and 1998 in two leading American women’s magazines. Results: In both magazines, the proportion of undressed women in the advertisements has changed little over the last 40 years, whereas the proportion of undressed men has increased dramatically, especially since the early 1980s. Conclusions: Trends in commercial advertising offer tentative support for the hypothesis that the male body is increasing in importance as a mark of masculinity – at least as judged from the actions of advertisers seeking to influence women’s attitudes.
Sexual Dysfunction in Male Psychiatric Outpatients: Validity of the Massachusetts General Hospital Sexual Functioning Questionnaire
Authors: Labbate Lawrence A. , Lare Sandra B.
Published: April 2003

Background: The purpose of this study was to determine the frequency of sexual dysfunction in male outpatients with concomitant psychiatric and medical conditions and to establish the validity of the Massachusetts General Hospital Sexual Function Questionnaire (MGH). Methods: Male VA outpatients were given two sexual function questionnaires, a 36-item Changes in Sexual Functioning Questionnaire (CSFQ) and the 5-item MGH. Medical records were evaluated for diagnosis, medications and illnesses that might affect sexual functioning. Results: Among 100 outpatient respondents, the CSFQ showed that 90% and the MGH showed that 77% experienced sexual dysfunction. Forty percent of patients reported total absence of sexual function. Good concurrent validity was established between the MGH and CSFQ. Conclusions: Sexual dysfunction is highly prevalent in psychiatric outpatients. The MGH is a valid clinical measure to determine sexual dysfunction.
Moisturisers for Psoriatic Skin –Do Gross Morphological Differences Matter?
Authors: Kynemund L. , Jemec G.B.E. , Wulf H.C.
Published: April 2003

Studies suggest that moisturisers have a beneficial effect on psoriasis, and their use in preventive or adjuvant dermatological therapy is therefore of considerable clinical interest, although no classification of these products exists to guide their use. We have previously suggested a classification based on the ability of moisturisers to induce mechanical changes in normal skin. In psoriasis patients obvious objective differences exist between plaques and clinically uninvolved skin. This study was undertaken to investigate if these differences influence the mechanical response to moisturisers. Skin mechanics distension and hysteresis, Dermaflex® as well as capacitance Corneometer 812 CM® and moisturiser absorption were measured on psoriasis plaques and adjacent clinically uninvolved skin of 17 psoriasis patients. Three commonly available moisturisers, a barrier cream and a gel were tested. Baseline distensibility and capacitance were significantly lower for plaques (p < 0.0001), and all moisturisers increased distensibility in both lesions and adjacent skin. Hysteresis was generally affected to a greater degree by Locobase®. The gel caused greater increases in hysteresis outside plaques. Capacitance was significantly increased in plaques, except for areas treated with Locobase, while only Decubal® appeared to cause significant increases in uninvolved skin. Locobase showed better absorption in plaques than in control areas. No objective differences were found in the effects of moisturisers between psoriatic plaques and adjacent clinically uninvolved skin, suggesting that the significant clinical differences between lesional and paralesional skin do not influence the efficacy of moisturisers.
Influence of Piroxicam: Hydroxypropyl-Beta-Cyclodextrin Complexation on the in vitro Permeation and Skin Retention of Piroxicam
Authors: Doliwa A. , Santoyo S. , Ygartua P.
Published: April 2003

The interactions between piroxicam (Px) and hydroxypropyl-β-cyclodextrin (HPβCD) were thoroughly investigated both in solution and the solid state. The solubility studies have demonstrated the formation of a Px:HPβCD inclusion complex with 1:1 stoichiometry. The addition of propylene glycol to the medium produced less stable complexes, revealing the fact of this co-solvent probably acting as a competing agent. Equimolecular Px:HPβCD solid systems were prepared using the co-precipitation method and then fully characterized by X-ray diffractometry, infrared spectra and differential scanning calorimetry. A topical gel formulation containing Px, as inclusion complex with HPβCD, was developed in order to study the influence of Px complexation on its release rate and skin percutaneous permeation. The formation of Px:HPβCD complexes did not increase either Px release from the vehicle or its skin permeation. However, Px complexation with HPβCD allowed the incorporation of a higher quantity of Px into the gel, which resulted in a considerable increase in the Px released and permeated. Skin pretreatment with different HPβCD solutions, followed by the application of control gel, showed no enhancing capacity. The amount of Px retained in the skin, after pretreatment experiments, was found to be very similar to that obtained without skin pretreatment and was observed to be related to flux values through the skin.
Chemoprevention of Skin Cancer through Natural Agents
Authors: Gupta Sanjay , Mukhtar Hasan
Published: April 2003

To reduce the occurrence of skin cancers, the use of sunscreens and wearing protective clothing while in the sun are emphasized. These are important strategies, but sadly these efforts are only partially effective. Thus, the development of novel strategies to reduce the occurrence of skin cancer is a highly desirable goal. One attractive approach is through chemoprevention which is the use of naturally occurring agents or synthetic compounds to prevent the occurrence and subsequent development of cancer. The ideal chemopreventive agent(s) for use for prevention of skin cancer must be available in its active form with none or minimal toxicity and a known mechanism of action. A wide range of synthetic and naturally occurring agents have been identified as a rich source of skin cancer chemopreventive agents. For a variety of reasons, there is a greater emphasis on the use of naturally occurring compounds for skin cancer chemoprevention, and many such agents have found a place in skin care products. This review focuses on the use of naturally occurring agents present in the diet and beverages consumed by humans for the chemoprevention of skin cancer.
New Developments in Photoprotection of Human Skin
Authors: Krutmann Jean
Published: April 2003

Because of increased leasure time, the growing popularity of staying outdoors and of holidays in the sun, it has become more and more important to study the molecular and photobiological effects that ultraviolet (UV) radiation exerts on human skin. Information obtained from these studies is being used to constantly improve the quality of sunscreen preparations containing organic and inorganic filters. It is also fostering the development of antioxidants and active agents that can be used in combination with or in addition to UV filters to provide better photoprotection for human skin. In addition, these studies provide novel test models which allow to prove or disprove the efficacy of a given sunscreen preparation for biological endpoints that differ from the sunburn reaction and are of direct relevance for photocarcinogenesis and photoaging. In this review, two examples are given to illustrate this development: (1) the use of topically applied DNA repair enzymes to prevent UVB-radiation-induced damage and (2) the development of a novel assay that is based on the detection of UVA-radiation-induced mutations in mitochondrial DNA and can be used to study the efficacy of protective measures against photoaging of human skin.
Pemphigus – Paradigm of Autoantibody-Mediated Autoimmunity
Authors: Hertl Michael , Veldman Christian
Published: April 2003

Pemphigus encompasses a group of life-threatening autoimmune blistering diseases due to a loss of adhesion between keratinocytes, called acantholysis, which is caused by autoantibodies (AAb) against intercellular adhesion structures of epidermal keratinocytes. In pemphigus vulgaris (PV), the blisters are located in the suprabasal layer whereas in pemphigus foliaceus (PF), a clinically less severe disease, the blisters occur within the upper layers of the epidermis. In PV and PF, the AAb target the extracellular portions of desmoglein 3 (Dsg3) and Dsg1, respectively. AAb production in PV and PF is polyclonal and most AAb are of the IgG4 subclass in acute onset or active disease while patients in remission have mainly AAb of the IgG1 subtype. Evidence for the pathogenicity of these circulating AAb is provided by the observations that (1) the activity of pemphigus correlates with AAb titers, (2) newborns of mothers with active pemphigus temporarily exhibit blisters due to the transplacentar transfer of maternal AAb and (3) pemphigus-like lesions are induced in neonatal mice by transfer of IgG from PV patients. Clinically, pemphigus is characterized by extensive cutaneous blisters and erosions of the mucous membranes (PV). Patients with untreated pemphigus are prone to infections, loss of body fluids and proteins and to weight loss due to painful oral and esophageal erosions. The major therapeutic strategy in pemphigus is chronic immunosuppressive therapy with glucocorticosteroids in combination with immunosuppressive adjuvants.
Radiosurgery in Lesional Epilepsy: Brain Tumors
Authors: Schröttner O. , Eder H.G. , Unger F. , Feichtinger K. , Pendl G.
Published: April 2003

The purpose of this study was to examine the effects of different doses of radiation to the brain tissue immediately adjacent to tumors which were associated with epilepsy. From April 1992 to December 1995, 26 patients with medically intractable tumor epilepsy (mean duration 6.9 years, range: 1–27 years) have been treated with Gamma Knife radiosurgery (GKRS). Clinical and imaging controls were available for 24 patients with a mean follow-up of 2.25 years (range: 1–4.4 years). Tumor control had been achieved in all patients. The patients were divided into two groups according to the volume of tissue outside the tumor which had received 10 Gy or more. This volume was assessed by measuring the ratio of the tumor and the ratio of the volume within the isodose containing 10 Gy (10G/Tum ratio). 54 percent of all the 24 patients achieved an excellent result according to the Engel classification (class I or II). The patients were divided into two groups. In group I were 12 patients, and the 10G/Tum ratio was 3 or less. In group II there were 12 patients and the 10G/Tum ratio was more than 3. In group I the mean value for the 10G/Tum ratio was 2 (range 0.86 to 2.9). In group II the mean value of the ratio was 11.1 (range 3.13 to 63.2). In group I only 42% of patients achieved an excellent result compared with 66% in group II. Moreover, the location of the tumor had an effect on the results, in that temporal tumors were associated with excellent results in 64% of cases as opposed to 40% in extratemporal tumors. Finally, if the epilepsy had lasted for 2.5 years or less there were excellent results in 70% of patients, as opposed to 43% excellent results for patients who had suffered epilepsy for more than 2.5 years.
Complete Androgen Blockade versus Chemical Castration in Advanced Prostatic Cancer: Analysis of an Italian Multicentre Study
Authors: Bono A.V. , DiSilverio F. , Robustelli della Cuna G. , Benvenuti C. , Brausi M. , Ferrari P. , Gibba A. , Galli L. , Members of the Italian Leuprorelin Group and
Published: April 2003

Objectives: In spite of a great amount of data, the hormonal treatment of advanced prostatic carcinoma (CaP) still remains controversial. As a relevant amount of dihydrotestosterone is present within the prostate tissue after castration, complete androgen blockade (CAB), with inhibition of the activity of both testicular and adrenal androgens, has been advocated as up-front treatment of advanced CaP. However, many controlled studies have failed to demonstrate a benefit for CAB in comparison with simple surgical or chemical castration. The present study was performed to bring additional data for a worldwide meta-analysis of all phase III trials comparing castration and CAB. Methods: This is a centrally controlled phase III study in which chemical castration with leuprorelin acetate depot was compared with leuprorelin plus flutamide in stage C and D CaP. Two hundred and forty-one eligible and evaluable patients with histologically proven CaP were recruited for the study (120 treated with castration and 121 with CAB). The diagnostic and staging workup consisted of blood chemistry, general condition assessment, prostate-specific antigen (PSA), abdominal sonography and computed tomography scan, and whole-body isotopic bone scan. End points of the study were survival, time to treatment failure, and time to progression. The patients were followed every 6 months with PSA and sonography. Results: At a cut-off analysis performed in December 1996, when the mean follow-up period was 43.7 ± (SD) 24.1 months, no statistical differences in terms of time to treatment failure, time to progression, and death rate could be detected. Also considering the common risk factors, such as basal PSA, haemoglobin, alkaline phosphatase, and Gleason score, the outcome did not show any clear advantage for CAB. Conclusions: This study appears to confirm that the advantages of first-line CAB in CaP are at best marginal. The final analysis will be performed when the follow-up period has reached 5 years, but it seems unlikely that the present results will change.
Leuprorelin Three-Month Depot in the Treatment of Advanced and Metastatic Prostate Cancer: Long-Term Follow-Up Results
Authors: Jocham Dieter
Published: April 2003

Objectives: To determine median survival time, median time to tumor progression and maintenance of testosterone suppression (i.e. ≤50 ng/dl) during long-term treatment with subcutaneous injections of leuprorelin acetate 3-month depot (LAD-3M). In Germany 62 patients with advanced prostate cancer participated in a prospective, randomized, multicenter phase II trial as part of a European study. Of these, 37 patients entered the follow-up study. Methods: Standard clinical investigations and methods were employed in the study. Results: Twenty-five of the 62 (40.3%) patients died during the course of the study. No death had a causal relationship with the study drug. Median survival time, median time to tumor progression and median period of progression-free survival were 1,149 (3.1 years), 1,015 (2.8 years) and 680 days (1.9 years), respectively. Adequate suppression of testosterone serum levels to the castration range was confirmed. Objective and subjective response as well as the safety profile were comparable to previously published results with LAD-3M, LAD-1M and other LHRH analogues. Conclusions: The results of this follow-up study confirm long-term efficacy and safety of LAD-3M for treatment in advanced prostate cancer. LAD-3M is a suitable alternative to the established shorter-acting LHRH-a depot formulations.
Local Recurrent Cancer after Radical Prostatectomy and Incontinence
Authors: Grein Ulrich , Meyer Wolfgang W.
Published: April 2003

Objective: The artificial sphincter AMS AS 800 is the treatment of choice in postprostatectomy urinary incontinence. However, when the incontinence is combined with a local tumour recurrence, the insertion of an artificial sphincter may pose a problem. Tumour mainly localised at the site of the anastomosis could cause problems with the insertion of the cuff. It is also questionable whether this elaborate and expensive operation is appropriate in patients with a progressive carcinoma. Materials and Methods: The charts of 220 patients who received a bulbar artificial sphincter between 1986 and 1996 were reviewed. Five patients were selected who suffered from simultaneous urinary incontinence and local recurrence of prostate cancer. The follow-up of these patients was between 18 and 70 months. Results: In all 5 patients the implantation of the artificial sphincter at the bulbous urethra could be performed without any complications. All patients were continent during follow-up. Two changes of the cuff were necessary due to tissue shrinkage of the urethra below the cuff. One patient, 2 years after local excision of recurrent prostate cancer, was found, during implantation, to have a macroscopically inconspicuous though histologically tumour-infiltrated area. In the follow-up 5 years after the implantation his prosthesis is still working well. Conclusions: Even with local recurrence of prostatic carcinoma after radical prostatectomy, the patients’ prognosis ‘quo ad vitam’ is not bad. The follow-up of patients proves that they profit from implantation of an artificial sphincter in terms of better quality of life. Sphincter-related complications are not more frequent than in comparable groups of patients without local recurrence.
Percutaneous Sclerotization of Simple Renal Cysts with 95% Ethanol Followed by 24–48 h Drainage with Nephrostomy Tube
Authors: De Dominicis C. , Ciccariello M. , Peris F. , Di Crosta G. , Sciobica F. , Zuccalà A. , Iori F.
Published: April 2003

Aim of the Study: We propose some technique devices for treating simple renal cysts with percutaneous puncture (PCN) to reduce recurrences. Materials and Methods: Between January 1995 and December 1998, a series of 42 patients, 13 females and 29 males, ranging in age between 49 and 73 were treated for symptomatic kidney cystic disease. The cysts varied between 7.4 and 13.6 cm in diameter and from 100 to 570 cm3 in volume. This technique consists of echo-guided emptying of the cyst, and slowly inserting a quantity of pure 95% ethanol, equivalent to about 1/3 of the cyst volume, into the cavity. This acts as a sclerosant agent on the cyst walls. The protocol of this technique also includes positioning a curled drainage catheter, for 24–48 h, in suction, to ensure a correct collapse of the cyst walls and to avoid cyst recurrence. Results: Of the 42 patients treated, only 4 did not complete the protocol. In 3 cases, the patients were not able to stand the procedure because of intense pain during cyst filling with alcohol. The other patient had intracystic hemorrhage. The results were evaluated by ultrasonography at 7 days post-operatively and then at 1, 3, 6, 9 and 12 months later. There was a further follow-up lasting from 12 to 36 months. Of 38 patients treated, 29 (76%) did not have any recurrence. 8 patients (21%) developed a small liquid layer of 3–4 cm, which did not enlarge in subsequent check-ups. We observed a recurrence, which spontaneously reduced in volume, only in 1 patient. Conclusions: This procedure was simple to apply in an out-patient setting and used low-cost materials which are easily obtained. Moreover, the results appear to confirm the validity of this technique.
Porcine Urinary Tract as a Training Model for Ureteroscopy
Authors: Strohmaier Walter Ludwig , Giese Andreas
Published: April 2003

Objectives: Endourological procedures as ureteroscopy require an advanced level of skills. To facilitate the training of the proper technique, simulators are helpful. Nonbiological models, useful to learn the basic steps, do not represent the clinical situation in an ideal way. We therefore looked for a biological but nevertheless easily available model. Methods: The complete urinary tract is dissected off the retroperitoneal organ package of freshly slaughtered pigs. Results: The porcine urinary tract model allows for training all aspects of diagnostic and therapeutic ureteroscopy including lithotripsy and stenting in a way which is almost identical to the clinical situation in humans. Conclusions: The porcine urinary tract model is an ideal ex vivo model. Concerning ‘tissue feeling’ and anatomic relations, it is superior to nonbiological simulators. Nevertheless, it is quite easily available and inexpensive. In training courses, we have used it with great success.
Percutaneous Management of Ulcerative Glandular Hypervascularization after Virag-I Operation
Authors: Peşkircioğlu Levent , Tekin M. İlteriş , Boyvat Fatih , Özkardeş Hakan
Published: April 2003

A 42-year old man was admitted with glans ulcer, meatal stenosis, urinary retention and impotence. He had undergone a Virag-I operation because of impotence at another hospital 2 months earlier. The deep dorsal vein was isolated under local anesthesia and blocked by coils and embolized by n-butyl cyanoacrylate in a retrograde fashion. After 2 months, the glans had healed completely. The patient has no further urinary problem and is potent.
Extracorporeal Shock Wave Lithotripsy in Ureteral and Kidney Malformations
Authors: Gallucci Michele , Vincenzoni Andrea , Schettini Manlio , Fortunato Pasquale , Cassanelli Antonella , Zaccara Antonio
Published: April 2003

Introduction: Extracorporeal shock wave lithotripsy (SWL) has long been accepted worldwide in the treatment of kidney stone disease. Upper ureter calculi in ureteral and kidney malformations are rather frequent (10–25%). The aims of this retrospective study were to determine whether malformations might impair fragment expulsion. Material and Methods: From 1986 to 1995, 203 patients with ureteral and kidney malformations were treated and followed up for a minimum of 1 year to a maximum of 9 years. Malformations included: ureteropelvic junction stenosis, horseshoe kidney, renal malrotation, renal ectopia, duplicated ureter, nonobstructive megaureter, medullary sponge kidney and caliceal diverticula. As pretreatment workup, all patients underwent conventional studies prior to SWL treatment: X-rays, renal ultrasound, intravenous pyelography, routine blood tests and urinalysis. All examinations were repeated at regular intervals for the first 6 months. Patients with metabolic disorders were excluded from the study. We also excluded patients with a follow-up of under 1 year. We considered three groups of patients: (1) stone-free patients at plain X-rays and ultrasound; (2) >90% elimination, i.e. stone-free patients at plain X-rays and positive at ultrasound; (3) patients with residual fragments at plain X-rays and ultrasound. Results: 96 (55%) patients were in group 1 (stone free), 40 (19%) were in group 2 (>90% elimination) and 67 (26%) were in group 3 (residual). Residual stones were more frequent in patients with medullary sponge kidney (82%). In patients with renal ectopia the residual stone rate accounted for only 13% of cases. Conclusions: There is evidence that SWL should always be offered to patients with ureteral and kidney malformations. These patients should however be considered at high risk for recurrences and so they need to be carefully followed up.
Paraganglioma and Adrenal Pheochromocytoma Presenting Simultaneously in an Elderly Female
Authors: Xenos Eleftherios S. , Padilla Pedro , Partap Prabha , Mogerman Donald
Published: April 2003

Paragangliomas are chromaffin tissue tumors arising in an extra-adrenal location. It is quite rare to find a paraganglioma concurrently with a pheochromocytoma. We report a patient who underwent resection of a retroperitoneal mass that was characterized pathologically as a malignant paraganglioma. An incidental finding was a microscopic pheochromocytoma in the ipsilateral adrenal gland.
Concealed Penis:Rare Complication of Circumcision
Authors: Esen A. Adil , Aslan Güven , Kazımoğlu Hatem , Arslan Deniz , Çelebi İlhan
Published: April 2003

A man presented with a concealed penis which developed after circumcision. In addition to anatomic variations in penile skin attachment and obesity, circumcision is an iatrogenic cause in the etiology of a concealed penis. Although it is a frequent and simple operation, it may lead to uncommon complications due to a lack of experience and poor technique.
Spontaneous Regression of Hepatic Metastases after Nephrectomy and Metastasectomy of Renal Cell Carcinoma
Authors: Wyczółkowski Marek , Klima Włodzimierz , Bieda Witold , Walas Krystyna
Published: April 2003

We report a case of clear cell carcinoma of the kidney with multifocal metastases to the lymph nodes, vagina and liver. Spontaneous regression of liver metastasis has been described after nephrectomy. Surgical management of primary and metastatic tumors should be considered in all patients with renal cell carcinoma.
Optimal Starting Time for Flutamide to Prevent Disease Flare in Prostate Cancer Patients Treated with a Gonadotropin-Releasing Hormone Agonist
Authors: Tsushima Tomoyasu , Nasu Yasutomo , Saika Takashi , Maki Yoshio , Noda Masatoshi , Suyama Bunzo , Yamato Toyoko , Kumon Hiromi
Published: April 2003

Objective: Flare-up phenomena, such as an increase in prostate-specific antigen (PSA) and/or deterioration of symptoms, are observed in some patients undergoing gonadotropin-releasing hormone (GnRH) agonist therapy. This study was carried out to determine the optimal time for starting the administration of flutamide to prevent flare-up phenomena. Patients and Methods: Twenty-six patients with prostate cancer and elevated serum levels of PSA were randomly assigned to 5 groups. Group A patients (n = 6) were treated with a subcutaneous injection of 3.75 mg leuprorelin acetate depot alone. Group B, C, D and E patients (5 patients in each group) were treated with 375 mg/day of orally administered flutamide combined with leuprorelin. Flutamide was initiated on the day of leuprorelin injection in group B, and at 1, 2 and 4 weeks before leuprorelin injection in groups C, D and E, respectively. Serum PSA and testosterone levels were measured in each patient. Results: Pretreatment with flutamide increased the serum testosterone level, but the testosterone surge after leuprorelin administration was almost the same in all 5 treatment groups. In patients who had been treated with flutamide in combination with leuprorelin, the mean PSA level did not exceed the pretreatment levels after leuprorelin administration. The rate of decrease in PSA in the group receiving simultaneous administration of flutamide with leuprorelin showed a decline comparable to that during the period before leuprorelin administration in the flutamide pretreatment groups. Conclusion: Simultaneous administration of flutamide with a GnRH agonist is sufficient to prevent flare-up phenomena.
‘Viagra® Effect’ – Influence of Mass Media on Patient Behavior
Authors: Braun M. , Klotz T. , Mathers M.J. , Klingebiel J. , Zumbè J. , Schoenenberger A. , Engelmann U.
Published: April 2003

Introduction: The effects of modern mass media and communication on the public health system are well known. So far however, these different influences of the media have not been objectively evaluated by physician-patient contacts. Patients and Methods: In this study we asked urologists, primary care physicians and internists in private practices in Cologne and a rural area (Erftkreis, Germany) to quantify their weekly contacts with patients suffering from erectile dysfunction (ED). The poll was conducted by four separately mailed questionnaires whereas a double counting was avoided. Between the second and third mailing, an unbelievable public attention was seen following the FDA approval of Viagra® in the United States. When Viagra was available in Germany, a fourth questionnaire was sent (4 months later) to all practitioners (n = 751). Results: During this time span, there was a statistically (p ≤ 0.01; t test) significant increase in weekly physician-patient contacts (WPC; 13.1–19.1 WPC for urologists, 4.4–5.5 WPC for general practitioners/internists) for ED in the region of Cologne-Erftkreis. In the fourth mailing, there was a slight decrease, but overall WPC was still higher compared to the first two mailings (17 WPC for urologists, 5.2 WPC for other specialists). Conclusions: Our investigation shows that urologists are accepted as the competent advisory partners for therapy with Viagra®. This was seen by the higher increase (20.1%) in patient contacts with urologists in comparison to colleagues of other medical disciplines (45.8 vs. 25.7% between mailing 1+2 and 3). In this investigation we were able to demonstrate the effects of mass media on patient behavior.
Use of Sildenafil in Penile Implant Patients
Authors: Mireku-Boateng A.O. , Dennery Morice , Littlejohn Joe
Published: April 2003

Objective: To determine whether Sildenafil use in the patients with penile implants provided additional sexual satisfaction. Material and Methods: 12 patients who had had insertion of inflatable penile implants were given oral Sildenafil in the period following implantation. They were assessed for sexual satisfaction before and after oral Sildenafil use. The assessment was done using questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire. These four questions of the IIEF questionnaire address the domain of satisfaction in male sexual behavior. Each person answered these questions using a scale of 1 (almost never or never) to 5 (almost always or always). The main answer to each question after Sildenafil was compared to the mean answer before. Results: There was a significant increase in the mean answer score to each of these questions. Conclusion: Supplemental Sildenafil can increase the sexual satisfaction of patients with inflatable penile implants.
Nephrogenic Adenoma of the Urinary Bladder: Our Experience and Review of the Literature
Authors: Porcaro Antonio B. , D’Amico Antonio , Ficarra Vincenzo , Balzarro Matteo , Righetti Rita , Martignoni Guido , Cavalleri Stefano , Malossini Gianni
Published: April 2003

Objective: To assess our experience in the treatment and clinical outcome of bladder nephrogenic adenoma (NA) updating and reviewing the literature concerning this issue. Patients and Methods: From September 1976 to June 1999, bladder NA was diagnosed in 8 patients: 6 men and 2 women with a 3:1 male ratio, aged 26–80 (mean 58.3) years. Follow-up ranged from 4 to 194 (mean 93.5) months. Results: NA was associated with transitional cell carcinoma in 3 cases. Predisposing factors were assessed in all patients. Previous surgery of the lower urinary tract was detected in 5 cases: ureterocystoneostomy in 2, partial cystectomy in 1, repair of vesicouterine fistula in 1, and multiple urethroplasties in 1. Previous endoscopic treatments were carried out in 2 patients, transurethral resection of the prostate in 1 and repeated transurethral resection of the vesicle in the other. A history of intravesical instillation of bacillus Calmette-Guérin was assessed in 1 case. Patients complained of irritative voiding symptoms in 6 cases and hematuria in 2. Endoscopically, the lesions appeared polypoid and multifocal in 5 patients, and flat and single in 3. The lesions were removed endoscopically, providing relief of symptoms in all cases. Histopathology assessed the diagnosis of nephrogenic adenoma, detecting focal atypic cells in 1 case only. Five patients (63%) relapsed 2–24 months after management. Recurrences were also treated endoscopically. Conclusions: Clinical and endoscopic features of bladder NA are not specific, simulating urothelial carcinoma or chronic cystitis. Endoscopic management allows accurate histological diagnosis and provides long-lasting relief of symptoms. NA needs careful and long-term follow-up, because of the high risk of recurrences and the potential neoplastic degeneration of the metaplastic urothelium.
A Tool for Self-Dilatation of Distal Urethral Strictures
Authors: Ubrig Burkhard , Hofmockel Georg
Published: April 2003

We propose the use of a catheter stopper with a smooth tip as a tool for the dilatation of distal urethral strictures. This allows for self-dilatation by the patient himself or by non-professionals involved in daily care at regular intervals. The method was successfully used in 2 patients.
Morbidity and Discomfort of Ten-Core Biopsy of the Prostate Evaluated by Questionnaire
Authors: Manseck A. , Guhr K. , Froehner M. , Hakenberg O.W. , Wirth M.P.
Published: April 2003

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature.
Mitochondrial Energy Metabolism in Very Premature Neonates
Authors: Wenchich László , Zeman Jiří , Hansíková Hana , Plavka Richard , Sperl Wolfgang , Houštěk Josef
Published: April 2003

The activity, amount and protein composition of pyruvate dehydrogenase (PDH) and respiratory chain complexes were studied in muscle mitochondria obtained postmortally from 6 neonates with a gestational age of 23–29 weeks. The activities of PDH and respiratory chain complex III and IV and citrate synthase were significantly lower in comparison with control children aged 0.5–2 and 2–20 years. Protein analyses revealed a parallel decrease in the content of PDH, respiratory chain complexes and their subunits in the cases analyzed. The observed immaturity of the mitochondrial energy-providing system suggests that significant development of mitochondrial energy metabolism occurs during the last 3 months of prenatal development. The metabolic disturbances of mitochondrial energy conversion associated with the low functional capacity and content of PDH and respiratory chain complexes may play an important role in the morbidity of very premature neonates.
Microdeletion 4p16.3 in three unrelated patients with Wolf-Hirschhorn syndrome
Authors: Dufke A. , Seidel J. , Schöning M. , Döbler-Neumann M. , Kelbova C. , Liehr T. , Beensen V. , Backsch C. , Klein-Vogler U. , Enders H.
Published: April 2003

Wolf-Hirschhorn syndrome (WHS) is a multiple malformation syndrome caused by partial monosomy of 4p16.3. Pitt-Rogers-Danks syndrome, first thought to be a distinct entity, is a similar condition associated with a microdeletion overlapping the WHS critical region. In this paper we evaluate three WHS patients showing a microdeletion of 4p and remarkable development with respect to the clinical spectrum of WHS.
Nondisjunction in trisomy 21: Origin and mechanisms
Authors: Petersen M.B. , Mikkelsen M.
Published: April 2003

Chromosomal aneuploidy is a fundamental characteristic of the human species. In this review we summarize the knowledge about the origin and mechanisms of nondisjunction in human trisomy 21 that has accumulated during the last decade by using DNA polymorphism analysis. The first molecular correlate of nondisjunction in humans is altered recombination, meiosis I errors being associated with reduced recombination and maternal meiosis II errors with increased recombination between the nondisjoined chromosomes. Thus, virtually all maternal meiotic errors of chromosome 21 seem to be initiated in meiosis I. Advanced maternal age remains the only well documented risk factor for maternal meiotic nondisjunction, but there is, however, still a surprising lack of understanding of the basic mechanisms behind the maternal age effect.
Susceptibility genes: GSTM1 and GSTM3 as genetic risk factors in bladder cancer
Authors: Schnakenberg E. , Breuer R. , Werdin R. , Dreikorn K. , Schloot W.
Published: April 2003

Glutathione S-transferase (GST, E.C. 2.5.1.18) comprises a family of isoenzymes that play a key role in the detoxification of such exogenous substrates as xenobiotics, environmental substances, and carcinogenic compounds. At least five mammalian GST gene families have been identified to be polymorphic, and mutations or deletions of these genes contribute to the predisposition for several diseases, including cancer. The gene cluster of GSTM1–GSTM5 has been reported to be localized on chromosome 1p and spans a length of nearly 100 kb. One mutation of the GSTM3 gene generates a recognition site for the transcription factor yin yang 1. As a result of this mutation, the expression of GSTM3 can be influenced. The mutated GSTM3 gene has been reported to be involved in increased susceptibility for the development of cancer, but no information is available concerning its role in bladder cancer. We have identified patients with a heterozygous GSTM3 geno- type who carry a significantly increased risk for the development of bladder cancer. Here we report that the mutation of intron 6 of GSTM3 increases the risk for bladder cancer (odds ratio: 2.31; 95% confidence interval [CI], 1.79–2.82). We developed a procedure to identify heterozygous or homozygous carriers of the GSTM1 alleles. Heterozygous carriers of the GSTM1 null genotype have a significantly elevated risk of developing bladder cancer. We calculated an odds ratio of 3.54 (95% CI, 2.99–4.11) for this genotype. These observations lead to the assumption that the lack of detoxification by glutathione conjugation predispose to bladder cancer when at least one of two alleles is affected. Furthermore, individuals presenting the homozygous wild type of GSTM1 and GSTM3 are significantly protected against bladder cancer.