bluuebunny/crossref_metadata_2025 huggingface dataset:
24-Hour versus 48-Hour Occlusion in Patch Testing
Authors: Ale S. Iris , Maibach Howard I.
Published: July 2004

Background: Routine patch testing is usually performed with 2-day occlusion. Yet, shortening the application period, without diminishing diagnostic accuracy, would benefit patients. Previous studies document that differences in application time may produce variable results. Objective: Our objective was to determine whether 1-day application elicits similar results to 2-day application in diagnostic patch testing. Methods: Simultaneous duplicate patch test series were applied to the opposite sides of the upper back on 250 consecutive patients, using the TRUE test system. One set of allergens was removed after 24 and the other after 48 h. Results: A total of 221 positive reactions were observed either after 24 or 48 h of occlusion in 113 (46%) patients. Of these, 190 were concordant, i.e. positive, after 24 and 48 h of occlusion, and 31 were discordant. Twenty-nine of the discordant reactions were observed only after 48 h of occlusion and 2 only after 24 h of occlusion. Of the 27 (19%) patients with discordant patch test reactions, the allergen was deemed to be of definite present or past relevance in 16 (6% of the total and 14% of all patients with positive reactions). Conclusion: These data confirm that the overall concordance of results after 24 and 48 h of application is high. However, clinically relevant allergens would have been missed in 16 patients if only the 24-hour occlusion test was performed. In the light of these results, we consider that the standard 48-hour application remains appropriate for diagnostic patch testing.
Bladder Outlet Obstruction in Women: Difficulties in the Diagnosis
Authors: Klijer Robert , Bar Krzysztof , Białek Waldemar
Published: July 2004

Objective: To identify the difficulties in diagnosing bladder outlet obstruction in women. Material and Methods: 53 women with a mean age of 37.2 (range 16–70) with chronic lower urinary tract symptoms and no neurogenic or organic diseases were examined. The prevalent symptoms were frequency (96%), urgency (92%) and nocturia (75%), and the mean duration of symptoms was 3.8 years. After pressure-flow studies and voiding cystourethrography were conducted, patients either underwent bladder neck or urethral incisions based on their diagnosis. These patients were subsequently subjected to follow-up uroflow studies. Results: Abnormal uroflow curves were observed in 19 of 53 women. In 10 of them (52.6%), bladder outlet obstruction based on pressure-flow results was confirmed. Voiding cystourethrography results from these 19 women confirmed that 17 patients had bladder neck obstruction, while the remaining 2 had urethral obstruction. 16 of 19 were treated endoscopically, with 14 patients undergoing bladder neck incisions through the 5- and 7-o’clock positions and 2 patients having a distal urethral incision through the 12-o’clock position. In all of these 16 cases, there were both a statistical increase in the maximum flow rate (Qmax) as well as an improvement in the flow curves. Symptomatic improvement was observed in 12 of the 16 women subjected to surgical intervention. Conclusion: Bladder outlet obstruction exists in women with lower urinary tract symptoms. Pressure-flow studies and voiding cystourethrography are reliable modalities for confirming bladder outlet obstruction. Bladder outlet obstruction can be functionally or structurally caused.
Long-Term Results of Anderson-Hynes Pyeloplasty in 180 Adults in the Era of Endourologic Procedures
Authors: Göğüş Çağatay , Karamürsel Tamer , Tokatli Zafer , Yaman Önder , Özdiler Erol , Göğüş Orhan
Published: July 2004

Introduction: The aim of the present study wasto evaluate the long-term results of adult open pyeloplasties performed by the Anderson-Hynes technique in the era of new endourologic procedures. Materials and Methods: The medical records of 180 adult patients who underwent Anderson-Hynes pyeloplasty with a diagnosis of ureteropelvic junction (UPJ) obstruction, were retrospectively reviewed. Pre- and postoperative results were compared with clinical, radiologic and radionuclide studies. The mean age of the patients was 33.2 (16–65) years. The minimum clinical follow-up time was 12 months and the mean time from the operation was 9.4 years (between 1 and 17 years). Results: Success was defined as resolution of symptoms and decrease in pyelocaliceal volume and calicectasis. The overall success rate was 91.1%. The success rate was between 93.1 and 100% in patients with grades I–III and 62.5% in patients with grade IV hydronephrosis and contribute to renal function less than 25%. The pyelocaliceal volume returned to normal in 39 (21.7%) patients, significantly decreased in 82 (45.5%), and the flow of contrast media from renal pelvis to ureter improved in 43 (23.9%) and did not change or increased in 16 (8.9%). The failure happened in the first 3 months in 57% of patients and in long-term follow-up in 43% of patients. Conclusion: Despite newer endoscopic techniques, Anderson-Hynes pyeloplasty, with an over 90% success rate remains the gold standard in the treatment of primary UPJ obstruction.
A Novel Antireflux Technique Using an Intussuscepted Ileal Segment
Authors: Tsuchiya Norihiko , Sato Kazunari , Satoh Shiguru , Ohyama Chikara , Shimoda Naotake , Habuchi Tomonori , Kato Tetsuro
Published: July 2004

A novel surgical technique of antireflux with an ileal conduit for urinary diversion is presented with our early results. The mid 8-cm portion of an isolated terminal ileum is intussuscepted. After skeletonization of the mesenterial vasculature, 3 rows of 4 mattress seromuscular silk sutures are placed on the ileum. By tying the sutures successively, the ileum is intussuscepted and the resultant nipple is secured simultaneously between its outer and inner layers. The outer nipple layer and the recipient ileal layer are further fixed as a whole by placing 3 rows of metal staples. The nipple base is secured by interrupted silk sutures and the mesenterial defect is closed. This technique was applied to 30 patients undergoing rectosigmoidal bladder procedure, a modified ileocecal rectal bladder, in which the antireflux conduit was interposed between the ureters and the rectosigmoidal pouch. Ureteral reflux was observed in none of the patients during a mean follow-up period of 29.9 months. Of the 60 renal units, 53 (88.3%) had normal pyelography and 7 (12.7%) showed mild hydronephrosis at 3–6 months postoperatively. This antireflux technique is simple and reliable, and can be applied to other urinary diversion/reconstruction surgeries, such as the continent reservoir, orthotopic neobladder, and/or bladder augmentation.
Standard versus Hydrophilic Catheterization in the Adjuvant Treatment of Patients with Superficial Bladder Cancer
Authors: Cindolo Luca , Palmieri Emiliano A. , Autorino Riccardo , Salzano Luigi , Altieri Vincenzo
Published: July 2004

Introduction: The aim of the present study is to compare a hydrophilic catheter to the standard polyvinyl chloride catheter with regard to bacteriological safety and overall comfort in patients undergoing intravesical immuno- or chemotherapy for bladder cancer. Materials and Methods: One hundred patients (80 males, 20 females; median age 65.8 years, range 48–79 years) eligible for intravesical prophylaxis of superficial bladder cancer recurrences were randomized to receive intravesical therapy using a standard catheter (group A, n = 50) or a hydrophilic catheter (group B, n = 50). Urinalysis and urine culture were performed 2 days after catheterization. Comfort during catheterization was assessed by a 5-point visual analogue scale at the end of the first four instillations. Results: Urinary tract infection (UTI) was detected in 7.4% of catheterizations in group A, whereas it occurred in 3.5% of catheterizations in group B (p < 0.01). Escherichia coli was the most frequent pathogen regardless of the device used. At the end of each of the first four instillations, the mean score for discomfort was significantly higher in group A than in group B (p < 0.001), although catheterization was progressively better tolerated regardless of the device used (both p < 0.005). None of the patients were found to be suffering from orchitis, epididymitis or gross haematuria. Conclusion: Hydrophilic catheters may be used safely and are well tolerated by patients undergoing intravesical immuno- or chemotherapy. The hydrophilic catheter was associated with a significantly lower occurrence of UTI and higher acceptability compared to the standard device. These data should be considered with regard to patient compliance with intravesical therapy.
Fine-Needle Aspiration Cytology of the Testis: Can It Be a Single Diagnostic Modality in Azoospermia?
Authors: Srivastava A. , Raghavendran M. , Jain M. , Gupta S. , Chaudhary H.
Published: July 2004

Purpose: The aim of this study was to determine whether fine-needle aspiration cytology (FNAC) of testis alone is sufficient to diagnose testicular function and whether follicle-stimulating hormone (FSH) estimation can be safely eliminated from the evaluation protocol of the azoospermic subject. Materials and Methods: We studied 46 adult azoospermic males who were infertile for more than 2 years following marriage. Hormonal profile was done in all. Later all 46 patients were subjected to bilateral FNAC of the testes. The cytological findings were correlated with histological findings. Results: We found 95.65% agreement between FNAC and testicular biopsy. Though serum FSH estimation was done in all patients in this series, in none of the cases did it affect overall management. Conclusion: FNAC is a quick, safe and minimally invasive modality. Following a well-performed semen analysis in an azoospermic subject, it appears that FNAC may be the only investigation needed. It provides a reliable diagnosis in patients with either obstructive or non-obstructive azoospermia. Routine estimation of FSH can be omitted from the investigative protocol in these patients.
Effect of Sildenafil Citrate on Retinal Functions: Preliminary Report on Humphrey Visual Field Analysis
Authors: Öner Hakan F. , Aslan Güven , Kurtulan Erkan , Uçar Tolga , Saatçi Osman A. , Esen Adil A.
Published: July 2004

Objective: To assess the effect of sildenafil citrate treatment on visual field analysis (VFA) in patients using sildenafil citrate for erectile dysfunction. Materials and Methods: In this prospective study on 18 male volunteers with erectile dysfunction, bilateral VFA was performed using the Humphrey 30-2 central standard threshold test. White-on-white (W/W) and blue-on-yellow (B/Y) protocols were used prior to treatment (baseline VFA) and after treatment (repeat VFA) with sildenafil citrate. W/W and B/Y baseline VFA and repeat VFA mean deviations (MD) were compared. Results: The baseline MD for W/W and B/Y protocols were –1.34 ± 1.8 and –2.59 ± 2.1 dB, respectively, whereas the mean repeat MD for W/W and B/Y protocols were –1.79 ± 2.21 and –2.83 ± 3.31 dB, respectively. There was no statistically significant difference between W/W and B/Y baseline and repeat VFA with respect to MD (p > 0.05). Conclusion: Sildenafil citrate causes no significant changes in Humphrey VFA in patients with erectile dysfunction.
Relation between Erectile Dysfunction and Urinary Incontinence after Nerve-Sparing and Non-Nerve-Sparing Radical Prostatectomy
Authors: Tsujimura Akira , Matsumiya Kiyomi , Miyagawa Yasushi , Takaha Natsuki , Nishimura Kazuo , Nonomura Norio , Mori Naoki , Hara Tsuneo , Yamaguchi Seiji , Takahara Shiro , Okuyama Akihiko
Published: July 2004

Introduction: We investigated the status of erectile function and urinary continence after radical prostatectomy to investigate a possible relation between them and then determined whether the status of postoperative urinary continence affected erectile function. Patients and Methods: Seventy-six patients who had no symptoms of erectile dysfunction or urinary incontinence preoperatively were included in this study. The postoperative status of erectile function and urinary continence was investigated using a self-reported patient questionnaire. Results: Thirteen of 27 patients (48.1%) who underwent nerve-sparing procedures maintained erectile function, while 7 of 49 patients (14.2%) who underwent non-nerve-sparing procedures maintained it postoperatively. None of the 27 patients in the nerve-sparing procedure group reported incontinence, whereas 3 of the 49 patients (6.1%) who underwent non-nerve-sparing procedures reported moderate incontinence. However, no significant correlation between the International Index of Erectile Function-5 score and the Incontinence Impact Questionnaire score was seen. Conclusion: No relation between the status of urinary continence and erectile function was shown, regardless of the nerve-sparing nature of the prostatectomy.
E-Cadherin Expression in Prostate Adenocarcinomas in Chinese and Its Pathological Correlates
Authors: Hsu Yen-Shen , Wang Jyh-Seng , Wu Tony T.
Published: July 2004

Introduction: We examined the E-cadherin expression in prostate adenocarcinomas in Chinese to correlate this immunohistochemical marker with histopathological features. Materials and Methods: Primary adenocarcinomas from 122 radical prostatectomy specimens were stained using anti-E-cadherin (HECD-1) antibody. The association of E-cadherin expression with serum prostate-specific antigen (PSA), pathological stage and Gleason score was assessed by Kendall’s tau-b test. Results: Aberrant E-cadherin expression was identified in 79 tumors (64.8%). Abnormal E-cadherin expression did not correlate to serum PSA (p = 0.802), tumor stage (p = 0.684) and Gleason score (p = 0.385). Conclusions: The frequency of aberrant E-cadherin expression was higher in prostate adenocarcinomas of Chinese as compared to that reported in Caucasians. No association with pathological stage, Gleason score and serum PSA was identified.
p53 Gene Codon 72 Polymorphism but Not Tumor Necrosis Factor-α Gene Is Associated with Prostate Cancer
Authors: Wu Hsi-Chin , Chang Chao-Hsiang , Chen Huey-Yi , Tsai Fuu-Jen , Tsai Jeffery J.P. , Chen Wen-Chi
Published: July 2004

Objective: A polymorphism of gene p53 codon 72 is associated with various cancer formations. Tumor necrosis factor-α (TNF-α) one of the cytokines secreted by macrophages in response to inflammation and is also related to cancer formation. We aimed to evaluate the association between prostate cancer and the polymorphisms of the TNF-α gene promoter –308 and p53 gene codon 72. Patients and Methods: In our study, a normal control group of 126 healthy people and 96 patients with prostate cancer were examined. The polymorphism (G/A) of TNF-α gene was detected by polymerase chain reaction (PCR)-based restriction analysis (Nco I endonuclease) and the polymorphism of p53 gene was detected by two PCRs (one for proline and one for arginine form). Results: There was a significant difference in the distribution of codon 72 polymorphism the p53 gene between prostate cancer patients and the normal controls (p < 0.001). The proline form of p53 gene codon 72 was significantly higher than the arginine form, with an odds ratio of 2.606 (95% CI = 1.052–6.455). This difference was also revealed in the tumor staging (p = 0.035) as the proline form was significantly higher in the metastasis group of prostate cancer. There were no statistical differences in the distribution of –308 polymorphism of the TNF-α gene between cancer patients and the control subjects (p = 1.0). Conclusion: Prostate cancer appears to be associated with the p53 gene codon 72 polymorphisms, but not with the TNF-α gene. The proline form of p53 gene codon 72 might be a more significant risk factor for the development of metastasis than the arginine form.
All-Trans Retinoic Acid and Interferon-α for Treatment of Human Renal Cell Carcinoma Multicellular Tumor Spheroids
Authors: Rohde Detlef , Brkovic Drasko , Hönig d’Orville Inga
Published: July 2004

Introduction: Conventional preclinical investigations have strongly recommended to combine interferon-α (IFN-α) with 13-cis retinoic acid (13-cRA, isotretinoin) for treatment of renal cell carcinoma (RCC). However, a recent randomized controlled trial on the drug combination ultimately failed to demonstrate an increased tumor-specific survival of patients with metastatic RCC (MRCC). All-trans retinoic acid (ATRA, tretinoin) was suggested to provide stronger antineoplastic properties than 13-cRA in different other tumors. Materials and Methods: The present study aimed to compare ATRA with 13-cRA (0.1, 1, 10, 100 nM) alone or in combination with IFN-α (5, 400, 5,000, 25,000, 250,000 IU/ml) or 5-fluorouracil (5-FU; 0.1, 1, 10, 100 µg/ml). Multicellular tumor spheroids of human RCC cells (SN12C) were treated in order to facilitate the predictions of the model system. Results: ATRA decreased the mean volume of SN12C spheroids 10–20% more than 13-cRA. Both retinoids led to a super-additive growth inhibition in combination with IFN-α, but not with 5-FU. However, in this scenario the superior effect of ATRA compared to 13-cRA, although statistically significant, was not impressive (<10%). Conclusions: ATRA provides a slightly stronger direct antineoplastic effect on human renal cancer cells than 13-cRA, and acts synergistically with IFN-α. However, ATRA, if at all, does not seem to be more suitable for treatment of patients with MRCC than 13-cRA.
Does Radical Nephrectomy with Immunochemotherapy Have Any Superiority over Embolization Alone in Metastatic Renal Cell Carcinoma?
Authors: Demirci Deniz , Tatlışen Atila , Ekmekçioğlu Oğuz , Özcan Nevzat , Kaya Reşat
Published: July 2004

Introduction: We evaluated the results and effects of radical nephrectomy followed by immunochemotherapy and embolization alone on the survival of patients with metastatic renal cell carcinoma. Patients and Methods: The study included 20 patients with histologically confirmed renal cell carcinoma. Ten patients were in the combined therapy group and the other 10 patients who were unable to undergo nephrectomy because of poor performance status or unresectable tumor were in the embolization group. Radical nephrectomy was performed on patients with good performance status (WHO criteria 0–1). Immunochemotherapy (interferon alpha 2a and 5-fluorouracil) was started within 1 month after surgery. A dose of 9 × 106 U/day interferon alpha 2a was subcutaneously administered 3 times a week. A dose of 750 mg/m2 5-fluorouracil was administered intravenously during 4 h in the first 5 days of treatment. 5-Fluorouracil therapy was converted to weekly intervals after the first 12 days. Combined therapy was continued for 3 months. Ethanol was used for transarterial embolization. The main renal arteries and parasitic arteries of the tumor were embolized. Results: There were no significant differences in age distribution, sex, affected side, tumor size and T stage between the groups. After completion of the combined therapy, 6 patients showed progression at the first control. Only 1 patient (10 %) had stable disease throughout the 10 months after combined therapy. One patient died of myocardial infarction on the 4th day in the embolization group. While progressive disease within the first 3 months was detected in 6 patients, the other 3 patients (30%) had stable disease for 14, 17 and 55 months, respectively. There was no complete response in any group and no patient was alive (died of renal cell carcinoma) at the time of the analysis of the study data. Whereas the median survival time was 11 months (1–80) (mean ± SE: 22.2 ± 9.1) in the combined group, this time was a median of 1 month (1–74) (mean ± SE: 17.5 ± 8.6) in the embolization group. There was no statistically significant difference in survival time between the groups (p > 0.05). Conclusion: In this preliminary report, the clinical findings in embolization-group patients were definitively worse than the nephrectomy plus immunochemotherapy-group patients. In spite of these differences, combination therapy using radical nephrectomy and immunochemotherapy could not show superiority to embolization alone, especially in terms of survival time.
Investigation on the Histopathological Effects of Thyroidectomy on the Seminiferous Tubules of Immature and Adult Rats
Authors: Oncu Meral , Kavaklı Duygu , Gokcımen Alpaslan , Gulle Kanat , Orhan Hikmet , Karaoz Erdal
Published: July 2004

Introduction: This study aimed to investigate the histopathological effects of thyroidectomy on both immature and adult rat testes. Materials and Methods: Male albino Wistar rats, 4 weeks old and weighing between 45 and 55 g, were used for this study. The experimental groups were as follows: 2-week control group (group I); 2-week thyroidectomy group (group II); 4-week control group (group III); 4-week thyroidectomy group (group IV); 6-week control group (group V), and 6-week thyroidectomy group (group VI). The control groups included both sham-operated and untreated rats. In groups II, IV and VI, total thyroidectomy was performed under ether anesthesia in all rats at 4 weeks of age. The rats were killed in the 2nd, 4th and 6th weeks, respectively, following the thyroidectomy. The testes of each animal were evaluated histologically. Results: In group II, spermatogenesis progressed to meiosis but round spermatids were found to be decreased and pachytene spermatocytes were observed to be increased when compared to group I. Giant pachytene spermatocytes were seen. There were also many degenerated cells of intermediate origin in the seminiferous epithelium. In groups IV and VI, spermatogonia and primary spermatocytes were normal in appearance, but there was widespread degeneration of the other spermatogenic cells. In addition, some closed lumina covered by degenerated and dead cells were observed. In group II, the mean outer diameter, luminal diameter and area occupied by seminiferous epithelium decreased by 19.74, 32.18, and 28.12%, respectively. In group IV, these data decreased by 23.9, 16.52, and 48.5%, respectively, and in group VI, by 21.10, 19.76 and 40.29%, respectively, when compared with the control groups. These data were statistically significant (p < 0.001). Conclusions: Thyroid hormones could have a marked influence on the seminiferous tubules of both immature and adult rats, and their permanent lack results in a depression in seminiferous tubule growth as shown by the reduced outer and luminal diameters and area occupied by the seminiferous epithelium, which could give rise to degenerative changes in the spermatogenic cells of thyroidectomized rats. In addition, all these changes could also result from both the inability of Sertoli cells to support spermatogenic cells and the diminished levels of GH and FSH.
Expression Patterns of Cyclins D1, E and Cyclin-Dependent Kinase Inhibitors p21(Waf1/Cip1) and p27(Kip1) in Urothelial Carcinoma: Correlation with Other Cell-Cycle-Related Proteins (Rb, p53, Ki-67 and PCNA) and Clinicopathological Features
Authors: Ioachim E. , Michael M. , Stavropoulos N.E. , Kitsiou E. , Hastazeris K. , Salmas M. , Stefanaki S. , Agnantis N.J.
Published: July 2004

Introduction: The expression pattern of cyclins D1 and E, as well as cyclin-dependent kinase inhibitors p21(Wa1/Cip1) and p27(Kip1) and their relationship to tumour behaviour and patients’ prognosis was examined in 142 urothelial cell carcinomas. The expression of these proteins was also analyzed along with other cell-cycle-related proteins such as: p53, pRb and the proliferation-associated indices Ki-67 and proliferating cell nuclear antigen (PCNA). Patients and Methods: These molecule markers were localized immunochemically using the monoclonal antibodies anti-cyclin D1 (DCS-6), anti-cyclin E (13A3), anti-p21 (4D10), and anti-p27 (1B4) in 142 patients with urothelial cell carcinoma. Results: Focal positivity (<10% of tumour cells) or the absence of cyclin D1 immunostaining was observed in 105/142 (73.9%) of the tumours. Cyclin D1 expression was correlated with tumour grade and stage as well as with the existence of in situ component. In addition, cyclin D1 expression was positively correlated with p21(Waf1/Cip1) and p27(Kip1) and inversely with the Ki-67 score. Focal positivity (<20% of tumour cells) or the absence of cyclin E immunoreactivity was observed in 105/142 (73.9%) in all cases. Cyclin E expression was correlated with tumour stage. A positive relationship between cyclin E expression and the two associated proliferating indices Ki-67 and PCNA, as well as with p53 and p27(Kip1) proteins expression was noted. Absence or focal positivity (<5% of tumour cells) of p21(Waf1/Cip1) was detected in 88/142 (62%) of the carcinomas. p21(Waf1/Cip1) expression was correlated with tumour grade and stage. A positive relationship of its expression cyclin D1, cyclin E, p27 and pRb expression was observed. Absence or focal immunostaining (<20% of tumour cells) of p27 protein was detected in 55/141 (39%) in all cases. p27(Kip1) expression was correlated with tumour grade as well as with cyclins D1 and E. The prognostic significance of cyclins D1, E and cyclin-dependent kinase inhibitors p21(Waf1/Cip1), p27(Kip1) in determining the risk of recurrence and progression with both univariate (log rank test) and multivariate (Cox regression) methods of analysis showed no statistically significance differences. Conclusion: These findings suggest that the level of the cell cycle regulators studied does not seem to have a clinical value in terms of predicting the risk of early recurrence and progression. In addition the interrelationship probably means their contribution to the regulation of cell growth through different pathways in bladder carcinogenesis.
Acetylcholine Release from Urinary Bladder Smooth Muscles of Non-Insulin-Dependent Diabetic Rats
Authors: Miyamae Koichi , Yoshida Masaki , Inadome Akito , Murakami Shigetaka , Otani Masayuki , Iwashita Hitoshi , Masunaga Koichi , Ueda Shoichi
Published: July 2004

Introduction: To investigate the mechanism of voiding dysfunction in non-insulin-dependent diabetes mellitus, we attempted to measure the acetylcholine (ACh) release using an in vivo microdialysis technique and measuring the detrusor pressure after electrical field stimulation (EFS) of the pelvic nerve. Materials and Methods: Eight- and 32-week-old female Goto-Kakizaki (GK) rats (non-insulin-dependent diabetes mellitus model) and age-matched female Wistar rats (controls) were used in this study. The pelvic nerve was exposed on a bipolar platinum electrode to EFS, and a cannula was inserted into the bladder to measure the detrusor pressure. The microdialysis probe was inserted into the bladder wall and was connected to a microinfusion syringe pump. Dialysate was constantly perfused, collected in a microtube, and then injected into the ACh assay system. Histological examinations were performed by staining with hematoxylin and eosin and S-100 immunohistochemical staining in bladder preparations of both GK and control rats. Results: In 8-week-old rats, both detrusor pressures and amounts of ACh release of GK rats were not significantly different from those of control rats. In 32-week-old rats, both detrusor pressures and ACh releases were only significantly increased at 5 and 10 Hz of EFS. In the histological study, the number of nerve fibers or bundles of 32-week-old GK rats was significantly decreased as compared with control rats. Conclusion: The present data suggest that the decrease in EFS-induced ACh release in GK rats, which may be caused by the decreased number of nerve fibers, may contribute to the decrease in bladder contractions.
Mixed Germ Cell Tumor after Bilateral Orchidopexy in Persistent Müllerian Duct Syndrome with Transverse Testicular Ectopia
Authors: Manassero Francesca , Cuttano Maria Giuseppa , Morelli Girolamo , Salinitri Giuseppe , Spurio Michela , Selli Cesare
Published: July 2004

The persistent müllerian duct syndrome is characterized by the retention of müllerian derivatives (fallopian tubes, uterus) in patients otherwise normally virilized, usually with cryptorchidism or an inguinal hernia. Very rarely, this syndrome is associated with transverse testicular ectopia , which designates the condition when both testes descend through the same inguinal canal into the same scrotal sac. We report on a patient with both conditions, who had T1N2M0 scrotal mixed germ cell tumor of the testis (teratoma and embryonal carcinoma), 18 years after bilateral orchidopexy. The literature concerning this uncommon association is reviewed.
Late Recurrence of Clinical Stage I Seminoma of the Testis after 12 Years despite Adjuvant Infradiaphragmatic Irradiation
Authors: Tavolini Ivan Matteo , Mazzariol Chiara , Dal Bianco Massimo , Bassi Pierfrancesco
Published: July 2004

A patient treated with prophylactic infradiaphragmatic radiation therapy for clinical stage I left testicular pure seminoma developed a large mass of the chest wall 12 years after primary treatment. An incisional biopsy confirmed pure seminoma. After chemotherapy, surgical removal of the residual mass and second-line chemoradiation therapy for persistent seminoma, the patient had a vertebral relapse. He died of progression 24 months after the first relapse despite further therapy.
Condylomata acuminata of the Neovagina in a HIV-Seropositive Male-to-Female Transsexual
Authors: Liguori Giovanni , Trombetta Carlo , Bucci Stefano , De Seta Francesco , De Santo Davide , Siracusano Salvatore , Belgrano Emanuele
Published: July 2004

We present an unusual case of condylomata acuminata arising in the transplanted skin of a neovagina in a male-to-female transsexual. The neovagina had been constructed using a penile and a scrotal skin flap. Resection of the larger condylomata was performed; then all visible lesions were ablated by electrovaporization. Microsocpic examination and DNA hybridization revealed condylomata acuminata due to human papillomavirus type 16, 31, and 33 infection.
Renal Metastasis from Primary Hepatocellular Carcinoma
Authors: Aron Monish , Nair Manju , Hemal A.K.
Published: July 2004

Secondary malignant tumors of the kidney are uncommon. These secondary tumors are usually the result of hematogenous spread from solid or hematologic malignancies. These tumors are almost always discovered at autopsy, with only 40 cases diagnosed prior to death reported in the literature. Primary tumors of the lung, breast and gastrointestinal tract are the most common sources of renal metastases. The occurrence of a renal secondary from a primary hepatocellular carcinoma is the subject of this presentation. To the best of our knowledge, such an occurrence has not been reported previously.
Primary Retroperitoneal Hydatid Cyst with Unusual Clinical Manifestation
Authors: Gürdal Mesut , Kireççi Sinan , Yücebaş Ergin , Karaman M. İhsan
Published: July 2004

Although hydatid disease may affect any organ of the body, there are only a limited number of cases where the primary lesion is in the retroperitoneal region. Since the clinical and laboratory findings are nonspecific, the correct preoperative diagnosis may be difficult. A primary retroperitoneal hydatid cyst that was given a preoperative diagnosis of adrenal mass and treated by adrenalectomy and partial nephrectomy is presented and discussed with the relevant literature.
New Advances on the Functions of Epidermal Growth Factor Receptor and Ceramides in Skin Cell Differentiation, Disorders and Cancers
Authors: Mimeault M. , Bonenfant D. , Batra S.K.
Published: July 2004

Recent advances in understanding of the biological functions of the epidermal growth factor and epidermal growth factor receptor (EGF-EGFR) system and ceramide production for the maintenance of skin integrity and barrier function are reported. In particular, the opposite roles of EGFR and ceramide cascades in epithelial keratinocyte proliferation, migration and terminal differentiation are described. Moreover, the functions of ceramides in the epidermal permeability barrier are reviewed. The alterations in EGFR signaling and ceramide metabolism, which might be involved in the etiopathogenesis of diverse skin disorders and cancers, are described. New progress in understanding of skin organization, which might provide the basis for the design of new transcutaneous drug delivery techniques as well as for the development of new therapies of skin disorders and cancers, are reported.
Using Skin Models to Assess the Effects of a Protection Cream on Skin Barrier Function
Authors: zur Mühlen A. , Klotz A. , Weimans S. , Veeger M. , Thörner B. , Diener B. , Hermann M.
Published: July 2004

Background: There is a basic necessity to understand the mechanisms of the protective effects of emulsions. This would promote the development of protective cosmetics and therefore improve the prevention and treatment of occupational skin diseases. However, for such studies, no reliable skin model is available. Objective: An in vitro skin model test was developed to evaluate the protective mechanism of cosmetic ingredients. Methods: The efficacy of three products was assessed by an in vivo test (Repetitive Occlusive Irritation Test) and then 3-dimensional skin model tests were carried out. Results: In vivo test results demonstrate that the best protection against sodium dodecyl sulphate is offered by a multiple emulsion. In the case of a skin model test, sodium dodecyl sulphate led to cell damage, an increase in pro-inflammatory markers and some barrier lipids. The multiple emulsion increased the content of skin lipids, without inducing irritation or cell death. Conclusion: Skin models react similarly to sodium dodecyl sulphate compared to human skin and therefore they are suitable to study barrier repair after sodium dodecyl sulphate damage. It is likely that the superior protective effect of the multiple emulsion in vivo is based on the increased amount of skin barrier lipids.
Characterization of Transport of Chlorhexidine-Loaded Nanocapsules through Hairless and Wistar Rat Skin
Authors: Lboutounne H. , Faivre V. , Falson F. , Pirot F.
Published: July 2004

Nanocapsules appear a promising approach as a drug system for topical application. However, the transport mechanism of nanocapsule-associated drug through the skin is still being questioned. In the present study, the transport of chlorhexidine-loaded poly(Ε-caprolactone) nanocapsules through full-thickness and stripped hairless rat skin was investigated in static-diffusion cell. The chlorhexidine permeation profiles fitting the Fickian diffusion model showed that the drug encapsulation reduced the percutaneous drug absorption through stripped skin. Possible nanocapsule transport within skin conducts was suggested from the analysis of permeation parameters and confirmed by confocal laser microscopy studies. Furthermore, the chlorhexidine permeation and drug release data were highly correlated, suggesting that the magnitude of percutaneous absorption was controlled by the diffusion across the polymeric carrier. The behavior of nanocapsules at the skin interface was investigated by contact angle and surface tension measurements. The small ‘wetting’ of the nanocapsule on the stratum corneum surface preserved the mechanical integrity of the carrier characterized by a high specific surface at the skin interface. The flexibility of the nanocapsules assured a satisfying bioadhesion to the skin, whereas the rigidity of the carrier limited the molecular ‘spill’ into the skin and controlled the drug delivery to the skin.
The Use of Ozone as an Oxidizing Agent to Evaluate Antioxidant Activities of Natural Substrates
Authors: He Q.C. , Krone K. , Scherl D. , Kotler M. , Tavakkol A.
Published: July 2004

Ozone, the main component of photochemical smog and air pollution, can damage the skin by oxidizing stratum corneum enzymes, lipids and structural proteins. We have developed a rapid screening assay to determine free radical scavenging capacity of various active ingredients that are frequently used in personal care products. Several known antioxidants including vitamin C, vitamin E analog Trolox, walnut seed extract, lipoic acid and ergothioneine inner salt were assayed for their ability to neutralize ozone-induced oxidation of β-phycoerythrin, a fluorescent reporter protein derived from algae. The free radical scavenging capacities of these antioxidants were quantified and compared. The results demonstrate that this assay is a valuable primary screening tool for identifying antioxidant activity of natural or synthetic substrates that can be used in personal care products to protect the uppermost layer of our skin from oxidizing damage induced by O3.
Percutaneous Penetration of Topically Applied Melatonin in a Cream and an Alcoholic Solution
Authors: Fischer T.W. , Greif C. , Fluhr J.W. , Wigger-Alberti W. , Elsner P.
Published: July 2004

In a clinical study, the skin penetration properties of melatonin 0.01% in a cream and 0.01 and 0.03% in a solution were investigated by evaluation of the serum melatonin levels over a 24-hour time course in 15 healthy volunteers. Blood samples for melatonin measurements were taken at 9.00 a.m. before applying the test preparations and 1, 4, 8 and 24 h after application. The measurements were carried out by radioimmunoassay for melatonin. In 15 volunteers, the serum levels of melatonin before application of the topical preparations were between 0.6 and 15.9 pg/ml. After application of the 0.01% melatonin cream, there was a steady increase starting from 9.00 a.m. up to a mean serum value of 9.0 pg/ml at 9.00 a.m. the next day. The solution of 0.01% melatonin also showed an increase, starting from 5.00 p.m., up to a mean melatonin level of 12.7 pg/ml 24 h after application. The solution containing 0.03% melatonin resulted in elevated melatonin levels 1 and 8 h after application. The values were 18.1 and 19.0 pg/ml. The cumulative melatonin values for each preparation were 7.1, 8.6 and 15.7 pg/ml, respectively. This study shows that the strongly lipophilic substance melatonin is able to penetrate through the skin and leads to dose- and galenic-dependent melatonin levels in the blood. No increase of melatonin above the physiological range was observed.
Haloperidol Attenuates β-Amyloid-Induced Calcium Imbalance in Human Fibroblasts
Authors: Palotás A. , Penke B. , Palotás M. , Kenderessy A.Sz. , Kemény L. , Kis E. , Vincze G. , Janka Z. , Kálmán J.
Published: July 2004

Background: Antipsychotics are widely used in the treatment of behavioral and psychological symptoms of dementia. A low frequency of Alzheimer’s disease in patients with schizophrenia is reported, and it has been proposed that antipsychotic medications, such as haloperidol, may be responsible. Disruption of intracellular calcium levels is considered to play a key role in β-amyloid-induced neurotoxicity in Alzheimer’s disease. Haloperidol has also been reported to interact with calcium homeostasis through dopamine-2 and sigma-1 receptors, and other, yet unknown mechanisms. Objective: Therefore, we investigated whether differences in the basal intracellular free calcium levels of cultured cutaneous fibroblasts – cells that do not express dopamine-2 and sigma-1 receptors – derived from sporadic Alzheimer patients and from age-matched control individuals after haloperidol treatment might be present. Methods: Intracellular calcium level was measured in Fura-2AM-loaded human fibroblasts by dual wavelength spectrofluorimetry. Results: Alzheimer cells exhibited significantly lower calcium level as compared to the control cultures. Exposure of fibroblasts to β-amyloid peptide resulted in increased calcium concentration of the control cells, but not of Alzheimer fibroblasts. Co-incubation of cultures with a therapeutic dose of haloperidol blocked the β-amyloid-induced elevation of calcium. Conclusion: This finding indicates that haloperidol efficiently countervails ionic imbalance and suggests that it may serve as a potential agent in alleviating neurotoxic effects of β-amyloid peptide.
Topical Activity of Ascorbic Acid: From in vitro Optimization to in vivo Efficacy
Authors: Raschke T. , Koop U. , Düsing H.-J. , Filbry A. , Sauermann K. , Jaspers S. , Wenck H. , Wittern K.-P.
Published: July 2004

We present here a new cosmetic formula system containing 3% ascorbic acid based on an optimized oil-in-water (O/W) emulsion. This formulation demonstrated a good long-term stability of the active ingredient and also of the emulsion itself. It could be deduced from in vitro release studies that this O/W emulsion enabled a better release of the hydrophilic active agent than an alternative W/O emulsion. By measuring the ultraweak photon emission, which is a well-established parameter for the oxidative stress in the skin, the high in vivo antioxidant capacity of 3% ascorbic acid was demonstrated after 1 week of product application. This placebo-controlled study also proved that ascorbic acid in an O/W cream reduced oxidative stress in human skin significantly better than the derivative sodium ascorbyl-2-phosphate, a more stable vitamin C replacement commonly used in cosmetic formulations. With increasing age, the number of papillae in the epidermal-dermal junction zone in human skin are reduced. This implies a possible consequence of reduced mechanical resistance of the skin and impaired supply of the epidermis with nutrients. In a 1-month placebo-controlled study on 25 human volunteers, a significant increase in the number of dermal papillae after application of the 3% ascorbic acid cream was demonstrated, using a confocal laser scanning microscope. Fine lines and wrinkles are a characteristic sign of aged and especially photo-aged skin. Application of 3% ascorbic acid in a 12-week placebo-controlled usage study indicated a significant reduction of facial wrinkles. Altogether, 3% ascorbic acid in a cosmetic O/W emulsion has been shown to be appropriately stable and to enable a good release of the active agent in vitro as a precondition for a high efficacy in vivo. Application in vivo resulted in a significant reduction of oxidative stress in the skin, an improvement of the epidermal-dermal microstructure and a reduction of fine lines and wrinkles in aged skin. These results were received within a relatively short period of time of product application.
To Induce or Not to Induce Labor: A Macrosomic Dilemma
Authors: Simhayoff Nurit , Sheiner Eyal , Levy Amalia , Hammel Rachel D. , Mazor Moshe , Hallak Mordechai
Published: July 2004

We assessed the effect of labor induction among parturients carrying macrosomic fetuses on the risk of a cesarean section (CS). The study population consisted of consecutive women with singleton fetuses weighing ≧4,000 g, delivered between 1988 and 1999. A comparison was made between parturients who delivered after labor induction and those who delivered without labor induction. The Mantel-Haenszel procedure was used to obtain the weighted odds ratios while controlling for confounding variables. During the study period, 4,755 women delivered macrosomic newborns in our institution. In 20% of the women (n = 951) labor was induced, while 80% of them (n = 3,804) delivered without labor induction. The women who delivered after labor induction were more likely to be nulliparous (18.0 vs. 10.0%; p < 0.001). In addition, these women had significantly higher rates of gestational diabetes (23.3 vs. 10.7%; p < 0.001), hypertensive disorders (10.1 vs. 5.3%; p < 0.001), hydramnios (17.4 vs. 9.9%; p < 0.001), and oligohydramnios (2.1 vs. 0.2%; p < 0.001). The CS rate was significantly higher among the patients who delivered after labor induction as compared with those in whom labor was not induced (17.8 vs. 11.9%; odds ratio 1.6, 95% confidence interval 1.3–1.9, p < 0.001). Stratified analysis using the Mantel-Haenszel technique was performed to control for confounders such as gestational diabetes, hypertensive disorders, previous CS, hydramnios, oligohydramnios, and nulliparity. None of these variables changed the significant association between induction of labor and CS. The induction of labor among women carrying macrosomic fetuses was found to be an independent risk factor for a CS.
Evaluation of Stroke Volume via Arterial Pulse Pressure Waveforms in Neonatal Lambs
Authors: Kappler Sherri , Milstein Jay M. , Moon-Grady Anita J. , Bennett Stephen H.
Published: July 2004

Arterial pulse waveforms contain information about stroke volume (SV) as an integral of pulsatile flow. SV estimation is accurate in adults with proper pulse pressure measurement technique. It is unclear whether the same methods are suitable in critically ill infants in the neonatal clinical setting where the fidelity of pulse pressure measurements are uncertain. We compared three pulse waveform SV methods with three systolic area SV methods in neonatal lambs in order to identify the most accurate and precise approach. Six newborn lambs were studied. Each lamb had a ligated ductus arteriosus and was instrumented to record high-fidelity pulsatile waveforms of arterial blood pressure using a transducer-tipped catheter and pulsatile flow via calibrated ultrasonic flow probe, respectively. Three steady-state hemodynamic conditions were induced experimentally: control, hypertension via infusion of angiotensin II, and hypotension by phlebotomy. Recordings of a range of SVs were made during a steady state that was interrupted by a transient period of decreasing SV, induced by momentarily increasing preload by pulmonary artery occlusion. Modification of pulse wave pressure measurement conditions, simulating an overdamped fluid-filled catheter system, were achieved by low-pass digital filtering of the original high-fidelity waveforms (high) to an 8-Hz cut-off (medium) and to a 2-Hz cut-off (low). The six SV estimates were then calibrated against flowmeter-derived SV and their accuracy and precision evaluated. Based on 6,479 waveforms, a systolic area method with pulse contour integration was the most accurate and precise. We conclude that neonatal pulse arterial waveforms embed SV information under a wide variety of hemodynamic and pressure waveform measurement conditions, and thus may be of potential clinical value in the assessment of newborn cardiovascular status.
Insulin Tolerance Test Causes Hypokalaemia and Can Provoke Cardiac Arrhythmias
Authors: Binder Gerhard , Bosk Axel , Gass Matthias , Ranke Michael B. , Heidemann Peter H.
Published: July 2004

We report the observation and analysis of a new adverse event during the insulin tolerance test (ITT) and propose additional safety procedures. An 8-year-old girl with growth hormone insufficiency had a cardiac arrest due to ventricular flutter when she was tested for growth hormone deficiency by the ITT. Severe hypokalaemia (K+ 2.6 mmol/l) was observed after resuscitation. Ergometry ECG revealed catecholaminergic polymorphic ventricular tachycardia, a hereditary arrhythmogenic disease. Consecutive measurements of serum potassium during ITT in 29 short children (21 boys) with growth failure revealed a mean decrease of serum potassium by 1.1 ± 0.4 mmol/l with the nadir at 30 min after the insulin bolus. Hypokalaemia (serum potassium <3.5 mmol/l) occurred in all but one child; severe hypokalaemia (serum potassium <2.9 mmol/l) was measured in every third child. This observation indicates that acute hypokalaemia which is induced by insulin and catecholamine excess occurs frequently in ITT. The case shows that the combination of acute hypokalaemia and the adrenergic counterregulation in ITT is a strong trigger of cardiac arrhythmias, which can become life-threatening if the child has an arrhythmogenic disease. Therefore, we recommend ECG monitoring during ITT to enhance the detection of cardiac arrhythmias. In addition, in the case of a comatose child during ITT the determination of the glucose and potassium level as well as adequate treatment are necessary.