bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipid parameters in childhood cirrhosis and chronic liver disease
Authors: SelimoĞlu Mukadder AyŞe , AydoĞdu Sema , YaĞci Rasit Vural
Published: March 2003

Background
: Alterations in lipid metabolism are well defined in liver disease. As there has not been an ample amount of work published regarding this topic in children, especially about apolipoprotein A‐I (apo A‐I) and apolipoprotein B (apo B), theoretical knowledge depends on adult studies. In this study, we investigated serum lipid parameters of children with chronic liver disease and cirrhosis.

Methods
: Serum triglyceride, cholesterol, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL), plasma apo A‐I and apo B levels of 82 children with chronic liver disease, 41 of whom had cirrhosis as well, were investigated. Twenty healthy children were selected as controls.

Results
: While mean serum triglyceride and cholesterol levels were not different in chronic hepatitis, cirrhosis and healthy children, mean apo B level of cirrhotic group was higher than that of the control group (P < 0.05). Mean LDL and HDL values of children with chronic hepatitis were lower and mean apo B value was higher than those of the control group (P < 0.05, P < 0.05 and P < 0.001, respectively). Apolipoprotein A‐I level was lower in cholestatic cirrhotic children than non‐cholestatic children (P < 0.05). No statistical difference was detected in lipid parameters of children with or without malnutrition (P > 0.05). The mean HDL value of Child−Pugh B group was significantly lower when compared to Child−Pugh A group (P < 0.05). The mean apo A‐I value of Child−Pugh A group was higher than those of Child−Pugh B and C groups (P < 0.05 and P < 0.001).

Conclusion
: Consequently, we found that among lipid parameters apo A‐I was the most affected parameter in liver injury. Whether apo A‐I level can be used as a prognostic criterion in childhood cirrhosis may require further study.
Relationship of three types of parent–child interaction in depressed and non‐depressed mothers and their children’s mental development at 13 months
Authors: Foss Lynne A. , Hirose Taiko , Barnard Kathryn E.
Published: March 2003

The purpose of the study was to examine mother–child interactions at 1 year of life within three contexts: feeding, attachment behaviors, and maternal vocal joint attention (play), between groups of depressed or non‐depressed mothers, and to examine the relationship between these three contexts and the child’s mental developmental index (MDI). Half of the 36 mother–infant dyads had depressed mothers. There were no significant differences in the feeding interactions, attachment, or joint attention found between the depressed and non‐depressed groups. Securely attached children had a higher MDI score than insecurely attached children, however, the correlation between feeding interaction score and MDI was not significant. Maternal vocal joint attention was significantly correlated with the MDI for non‐depressed mothers but not for depressed mothers. These results are not consistent with the prior literature, and the discussion focused on possible explanation for these findings.
An integrated approach to symptom management
Authors: Larson Patricia J. , Uchinuno Atsuko , Izumi Shigeko , Kawano Ayako , Takemoto Akiko , Shigeno Miyuki , Yamamoto Masumi , Shibata Shuko
Published: March 2003

Symptom management is a challenging experience for patients, families and health‐care professionals. When a person has a symptom that is troublesome and not being properly managed they may become so focused on that symptom that they cannot enjoy a good quality of life. Nurses know symptoms that are problematic for patients are usually problematic for nurses as well; however, not every nurse knows how to effectively manage patients’ symptoms. In response to these challenges, we propose an Integrated Approach to Symptom Management (IASM) that can be used for a variety of patient populations in an effective, efficient and consistent manner. The focus of the IASM is on the patient and is designed to be used by nurses to promote patient self‐care symptom management abilities.
Improving pain management by nurses: A pilot Peer Intervention Program
Authors: Edwards Helen E. , Nash Robyn E. , Yates Patsy M. , Walsh Anne M. , Fentiman Belinda J. , McDowell Jan K. , Skerman Helen M. , Najman Jake M.
Published: March 2003

AbstractSignificant pain continues to be reported by many hospitalized patients despite the numerous and varied educational programs developed and implemented to improve pain management. A theoretically based Peer Intervention Program was designed from a predictive model to address nurses' beliefs, attitudes, subjective norms, self‐efficacy, perceived control and intentions in the management of pain with p.r.n. (as required) narcotic analgesia.

The pilot study of this program utilized a quasi‐experimental pre‐post test design with a patient intervention, nurse and patient intervention and control conditions consisting of 24, 18 and 19 nurses, respectively. One week after the intervention, significant differences were found between the nurse and patient condition and the two other conditions in beliefs, self‐efficacy, perceived control, positive trend in attitudes, subjective norms and intentions. The most positive aspects of the program were supportive interactive discussions with peers and an awareness and understanding of beliefs and attitudes and their roles in behavior.
Professional identity of Japanese nurses: Bonding into nursing
Authors: Gregg Misuzu F. , Magilvy Joan K.
Published: March 2003

AbstractThe purpose of this study was to explore the process of establishing the professional identity of Japanese nurses. Following a grounded theory design, data were generated by interviews, multisite participant observations and theoretical memos. Eighteen Japanese nurses who were selected by theoretical sampling were formally interviewed. Data were analyzed using methods of constant comparative analysis.

Six categories emerged from the data: (i) learning from working experiences; (ii) recognizing the value of nursing; (iii) establishing one's own philosophy of nursing; (iv) gaining influence from education; (v) having a commitment to nursing and (vi) integrating a nurse into self. The core category, ‘bonding into nursing’, incorporated the relationship between and among all categories and explained the process of establishing the professional identity of Japanese nurses. ‘Bonding into nursing’ was described as an initial substantive theory, which is defined as the process by which each nurse established her/his professional identity as a nurse.
Mesoblastic nephroma in adulthood: A case report
Authors: Shiraishi Koji , Yamamoto Mitsutaka , Gondo Toshikazu , Shirataki Satoshi , Naito Katsusuke
Published: March 2003

Background
: Mesoblastic nephroma is an uncommon renal tumor of infancy and rarely occurs in adults. We report an adult case of mesoblastic nephroma.

Methods
: A 50‐year‐old woman was found incidentally to have a right renal mass by abdominal ultrasonography. Computed tomography and magnetic resonance imaging revealed a heterogeneous tumor and angiography showed a mixture of hypervascularity and hypovascularity. Right radical nephrectomy was performed.

Results
: The tumor was an encapsulated yellowish solid mass. Microscopically, the tumor was composed of spindle cell proliferation. Atypia and mitoses were not identified. Among the tumor cells, there were tubular arranged epithelial elements.

Conclusion
: The patient was free of recurrence 14 months postoperatively. Mesoblastic nephroma is classified as a benign tumor but recurrence and malignant formation of this tumor have been reported so regular postoperative follow up is required.
Significance of hematoma size for evaluating the grade of blunt renal trauma
Authors: Ichigi Yasuhisa , Takaki Norito , Nakamura Koji , Sato Shinji , Kato Akira , Matsuo Yoshitomo , Kudo Sho , Masaki Zenjiro
Published: March 2003

Abstract
Background
: The hematoma size relative to the body size was measured on computed tomography films using a personal computer system in order to define whether that parameter is useful for decision‐making in the management of blunt renal trauma.

Methods
: From 1982 to 1997, 33 patients with intermediate or severe grade blunt renal trauma were retrospectively divided into three groups: group 1, managed conservatively without transcatheter embolization; group 2, managed by bedrest after selective transcatheter embolization; and group 3, managed operatively. In these three groups, the hematoma area (H) and the ratio of hematoma area to body area on CT (H/B) were measured and the chronological changes of the H/B in groups 1 and 2 were studied.

Results
: The H and H/B of group 3 were significantly larger than those of group 1. The H/B was more clearly distinguished for each group compared with the H alone. Well‐preserved kidney integrity, despite the presence of a large hematoma in group 2, allowed the conservative treatment following transcatheter embolization of the bleeding site. The H/B of all group 1 patients gradually decreased and on the 40th or 50th day after injury they reached a level equivalent to the ratio of contra‐lateral normal kidney area to body area.

Conclusion
: The ratio of hematoma area to body area on CT was very useful in evaluating the grade of blunt renal trauma. In conservative treatment for blunt renal trauma changes of the hematoma size is a useful indicator for management.
Diagnostic usefulness of endorectal magnetic resonance imaging with dynamic contrast‐enhancement in patients with localized prostate cancer: Mapping studies with biopsy specimens
Authors: Tanaka Nobumichi , Samma Shoji , Joko Masanori , Akiyama Tatsuya , Takewa Megumi , Kitano Satoru , Okajima Eigoro
Published: March 2003

Background
: New diagnostic criteria for dynamic magnetic resonance (MR) imaging in prostate cancer are presented. The diagnostic usefulness of endorectal MR imaging with dynamic contrast‐enhancement in localized prostate cancer and the validity of these criteria were evaluated.

Methods
: Eighteen untreated patients who were suspected of localized prostate cancer were included in the study. They received endorectal dynamic MR imaging before systematic sextant needle biopsy. First, a mapping study with the findings of MR images and histopathology of biopsy specimens was performed in eight patients out of 18 to compare the difference in T2‐weighted images with the endorectal coil and the body coil in the same individuals. Second, another mapping study was performed in all 18 patients by analyzing the findings of endorectal dynamic MR images. For the diagnosis of prostate cancer in MR imaging, we offered diagnostic criteria from our experience in addition to those in plain T2‐weighted images from the literature.

Results
: The overall diagnostic rates of endorectal dynamic MR imaging were 88.9% in accuracy, 100% in sensitivity, and 81.8% in specificity. In the comparison of the endorectal and body coils in T2‐weighted images in eight patients, there was no difference in the diagnostic rates except for one more histopathologic false positive portion in endorectal MR imaging. In the second mapping study in 18 patients, the diagnostic rates were 92.6% in accuracy, 88.9% in sensitivity and 93.3% in specificity. Endorectal dynamic imaging raised the diagnostic sensitivity from 77.8 to 88.9%.

Conclusion
: The data demonstrated the validity of this diagnostic criteria and the diagnostic usefulness of endorectal dynamic MR imaging in localized prostate cancer.
Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University
Authors: HOSHI SENJI , ORIKASA SEIICHI , YOSHIKAWA KAZUYUKI , SATO KATSUKO , TOYODA SEIICHI , SAITOH SEIICHI , SATOH MAKOTO , OHYAMA CHIKARA , NAMIMA TAKASHIGE , KAWAMURA SADAFUMI , SUZUKI KEN‐ICHI
Published: March 2003

Background: Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer.

Methods: Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole‐layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space.

Results: Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down‐staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post‐neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico‐ureteral reflux.

Conclusions: Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.
Proteoglycan core protein in human urine and its possible role on calcium oxalate urolithiasis
Authors: Yoshimura Kazuhiro , Miyake Osamu , Tsujihata Masao , Yoshioka Toshiaki , Yamaguchi Seiji , Koide Takuo , Takahara Shiro , Okuyama Akihiko
Published: March 2003

Background
: There are only a few papers reporting on the role of proteoglycan core protein in calcium oxalate stone formation. The present study was carried out to investigate the role of core protein of proteoglycan in human urine on calcium oxalate (CaOx) crystallization.

Methods
: Proteoglycans were collected from whole human urine. The covalently bound glycosaminoglycans (GAG) of proteoglycans were then digested by GAG lyase. The inhibitory activity on CaOx crystal growth in vitro was measured before and after enzyme digestion of proteoglycans. Sodium dodecylsulfate–polyacrylamide gel electrophoresis (SDS‐PAGE) of the core protein of proteoglycans and the analysis of amino acid sequence were performed.

Results
: The core protein showed significant inhibitory activity on CaOx crystal growth, which scarcely changed when compared with that of proteoglycans before enzyme digestion. The SDS‐PAGE revealed that the core protein was a single unit with a molecular weight of 26 kDa and amino acid sequencing demonstrated high homology to interalpha‐trypsin inhibitor (ITI) light chain (bikunin) with Kunitz inhibitor domain as a core protein.

Conclusions
: The results suggested that human urine contains proteoglycans and a major part of them is ITI light chain (bikunin). The Kunitz inhibitor domain, a core protein of bikunin, has significant inhibitory activity on CaOx crystallization without GAG bound covalently to the core protein.
Expression of protein tyrosine phosphatase PTP‐RL10 and its isoform in the mouse testis
Authors: Tokuchi Hiromu , Higashitsuji Hiroaki , Nishiyama Hiroyuki , Nonoguchi Kohsuke , Nagao Toshikazu , Xue Jing‐Hui , Itoh Katsuhiko , Ogawa Osamu , Fujita Jun
Published: March 2003

Background
: The cytoplasmic‐type protein tyrosine phosphatase PTP‐RL10/PTPD1/PTP2E contains an ezrin‐like domain and associates with the c‐Src protein tyrosine kinase. Because tyrosine phosphorylation regulated by protein tyrosine kinases and phosphatases is involved in activation, migration, differentiation and proliferation of various cell types, the expression of PTP‐RL10 and c‐src in the mouse testis was investigated.

Methods
: Testes of wild‐type mice and W/Wv mutant mice that lack germ cells were analyzed by northern blotting, in situ hybridization histochemistry and reverse transcriptase–polymerase chain reaction for the expression of PTP‐RL10, its isoform PTP‐RL10b and c‐src. Expression in the Sertoli cell lines, TM4 and TAMA26 was also analyzed.

Results
: PTP‐RL10 transcripts of 5.7 kb and 2.9 kb in size were detected in the testis. In situ hybridization histochemistry demonstrated that the 5.7 kb transcripts were expressed in pachytene spermatocytes and somatic cells including Sertoli cells, in which c‐src transcripts were detected. The 2.9 kb transcript encoded a novel isoform, PTP‐RL10b, that has the catalytic domain but not the domains that associate with c‐Src. PTP‐RL10b was expressed mainly in the testicular somatic cells. TM4 and TAMA26 cells were found to co‐express PTP‐RL10, PTP‐RL10b and c‐src transcripts.

Conclusion
: PTP‐RL10 and its isoform are expressed in the Sertoli cells and are suggested to play roles in spermatogenesis by interacting with c‐Src and/or other protein(s).
Why the flexible cystoscope has not yet been widely introduced?: A questionnaire to Japanese urologists
Authors: Yoshimura Rikio , Wada Seiji , Kishimoto Taketoshi
Published: March 2003

Background
: The flexible cystoscope has not been as widely accepted in the field of urology as in other fields. The results of this investigation provided implications for determining the reasons for the under‐use of flexible cystoscopy as well as for the drawbacks of the flexible cystoscope.

Methods
: We performed an investigation by sending a questionnaire to urologists asking them to compare the flexible cystoscope with the rigid cystoscope in order to determine why use of the former lags behind that of the latter.

Results
: We received answers from 420 urologists. We classified the urologist into four groups according to their years of experience. We also classified patients, for whom flexible cystoscopy was carried out, into four groups. The majority of the urologists in all groups thought that the flexible cystoscope provided a small field of vision and rough images. Urologists thought that the flexible cystoscope was inferior to the rigid cystoscope in terms of manipulability in biopsy. However, doctors who examined many patients using flexible cystoscopy believed that it was advantageous in terms of decreasing the patients’ pain and they have experienced no problem in clinical practice.

Conclusions
: Lack of experience in using the flexible cystoscope appears to be the main reason for the negative impression it generates. The flexible cystoscope can be routinely used in place of the rigid counterpart for urological investigations and it is recommended that it be used more widely for the benefit of the patients.
Metachronous bilateral torsion of the testicular appendices
Authors: Monga Manoj , Scarpero Harriette Miles , Ortenberg Joseph
Published: March 2003

Background
: Torsion of the appendix testis is a common cause of scrotal pain in children and a common cause for surgical exploration of the pediatric scrotum. The first case of metachronous bilateral torsion of the testicular appendices managed by a non‐operative approach is reported.

Methods/Results
: A case report and a computer‐assisted review of the literature are presented. Physical findings of a tender, mobile mass over the anterior surface of the testis characterize the presentation. Doppler findings of normal blood flow to the testes with increased flow to the adjacent appendix testis can be utilized as an adjunct to diagnosis. Ultrasonographic findings of a pedunculated mass with a central hypoechoic area at the superior aspect of the testis support the diagnosis. Accurate non‐operative diagnosis of torsion of the appendix testis permits successful conservative management with non‐steroidal anti‐inflammatory agents.

Conclusions
: Improvements in ultrasonographic and Doppler imaging of torsion of the appendix testis have facilitated the diagnosis of this entity and decreased the need for surgical exploration of the scrotum.
Modified extravesical ureterocystoneostomy of the kidney transplant allograft with completely duplicated ureters
Authors: Nakatani Tatsuya , Uchida Junji , Kim Taku , Yamamoto Keisuke , Kishomoto Taketoshi
Published: March 2003

Background: The technique of ureterocystoneostomy for completely duplicated ureters has not yet been established. We report on a case of a living‐related transplant recipient who successfully received his mother's kidney having completely duplicated ureters.

Methods/Results: The recipient was a 33‐year‐old male patient introduced to hemodialysis due to focal glomerulosclerosis. The donor was his 60‐year‐old mother having left completely duplicated ureters. We adopted the modified extravesical ureterocystoneostomy technique. Postoperative drip infusion pyelography and voiding cystography of the recipient showed no evidence of urinary tract obstruction or vesicoureteral reflux.

Conclusions: We conclude that this technique is suitable for the transplantation of the kidney with complete ureteral duplication.
Characteristics of pediatric urolithiasis in south‐east Anatolia
Authors: Ece Aydin , Özdemir Enver , Gürkan Fuat , Dokucu Ali Ihsan , Akdeniz Osman
Published: March 2003

AbstractBackground: Urolithiasis is endemic in Turkey and characteristics of urolithiasis vary in different regions of the world. The aim of the present study was to evaluate the etiological and clinical characteristics and course of pediatric urolithiasis in south‐east Turkey.

Methods: The study population consisted of 81 children (52 girls) with urolithiasis at a mean age of 6.2 ± 4.2 years who were followed up for 1–32 months.

Results: Metabolic disorders, anatomical defects and infection stones were found to be the etiological factor in 34.6, 29.6 and 22.2% of patients, respectively, while 13.6% of patients were considered idiopathic. Of all patients, 28.4% were admitted with acute renal failure (ARF) and 72.8% had urinary tract infection. Recurrence was seen in 19.8% of patients at presentation. The localization of the stone was found to be in the upper urinary tract, the lower urinary tract or both in 65.4, 14.8% and 17.3% of patients, respectively. Patients with multiple and bilateral stones had a higher risk for ARF than the others. The risk for chronic renal failure was significantly higher in children with multiple, bilateral or recurrent stones and with ARF at presentation.

Conclusions: Early diagnosis and management of renal stones and urinary tract infections is necessary to prevent the development of ARF or chronic renal failure and to improve the quality of a patient’s life.
Pre‐emptive renal transplantation in children
Authors: Harada Hiroshi , Seki Toshimori , Nonomura Katsuya , Chikaraishi Tatsuya , Takeuchi Ichiro , Morita Ken , Usuki Tomoaki , Watarai Yoshihiko , Togashi Masaki , Hirano Tetsuo , Koyanagi Tomohiko
Published: March 2003

AbstractBackground:Renal transplantation is a definitive therapeutic modality in end‐stage renal disease (ESRD). Most ESRD patients in Japan experience dialysis prior to renal transplantation. The present study was undertaken to examine the usefulness of pre‐emptive renal transplantation (PET).

Methods:Between 1987 and 1998, 255 renal transplantations were carried out by the authors. Among those consecutive cases, 10 were cases of PET. In nine pediatric cases, demographics, graft and patient survival, height growth and benefits from successful transplantation were studied and compared with age‐matched dialyzed transplantation controls.

Results:All transplantation was living‐related. There was a disparity of causes of ESRD between the two groups. In PET, acquired renal deterioration due to a congenital lower urinary tract disorder was the major cause. Graft and patient prognosis was favorable in both groups. Growth retardation in PET patients under 15 years of age was significantly less apparent at the time of transplantation and after 3 years compared to the control. The benefits from transplantation were different in the two groups. Most PET patients felt an improvement of their physical condition; however, all of the control patients felt that the major boon was the freedom from the restriction of the daily diet and time for dialysis.

Conclusion:In pediatric renal transplantation, short‐term preceding dialysis does not have a detrimental effect, but PET could benefit ESRD patients by maintaining their quality of life. Moreover, PET minimizes the production of renal dwarfism in prepubertal children. Thus, PET should be taken into consideration in the choice of renal replacement therapy.
Autohemicastration in a man without schizophrenia
Authors: Murota‐Kawano Akiko , Tosaka Akira , Ando Masao
Published: March 2003

Abstract A 52‐year‐old unmarried bag craftsman was admitted to East Tokyo Metropolitan Hospital because of a large scrotal hematoma. He had accidentally hit his right testis against the edge of a desk early the previous morning. He had resected his right testis with scissors to release from severe pain 30 min after the accident. He had sutured the scrotal incision with two stitches of string by himself. At the emergency operation 36 h after the self‐mutilation, we removed a hematoma weighing 283 g and ligated the cut end of the right spermatic cord after adequate debridement. He was diagnosed by a psychiatrist as having slightly low intelligence without psychotic disorder or drug abuse.
Production of parathyroid hormone‐related protein in two new cell lines of renal cell carcinoma
Authors: Ueno Munehisa , Akita Masumi , Ban Shin‐ichi , Ohigashi Takashi , Yanagita Saori , Iida Masahiro , Deguchi Nobuhiro
Published: March 2003

Abstract Background: Hypercalcemia is the most common of all paraneoplastic syndromes and has been reported to appear in up to 20% of patients with renal cell carcinoma (RCC). Humoral hypercalcemia of malignancy is believed to be induced when parathyroid hormone‐related protein (PTHrP) is excessively produced in cancer cells and impairs the homeostasis of serum calcium concentrations.

Methods: Cancer cells were isolated from a surgical specimen and successfully cultured in a monolayer. The present study describes the establishment and characterization of new cell lines of RCC.

Results: Two different cell lines, designated SMRC‐1 and SMRC‐3, were established from human RCC, each of which had been continuously secreting PTHrP in vitro. The patient from whom the SMRC‐3 cells were obtained was shown to have elevated levels of PTHrP and resultant hypercalcemia. Cultured SMRC‐1 was spindle‐shaped in morphology. SMRC‐3 had pleomorphic polygonal shapes and formed typical epithelial monolayers. Both cell types secreted intact, C‐terminal PTHrP and interleukin‐6 in the culture medium. Cellular messenger RNA of PTHrP was analyzed by reverse transcriptase–polymerase chain reaction. The SMRC‐1 cells showed chromosome numbers ranging from 42 to 47 with consistent structural abnormalities of add(4)(q23~25) and add(6)(q13). The chromosomal analysis of SMRC‐3 revealed a modal number of 95 with consistent structural abnormalities of add(1)(p36) and der(1;3)(q10;p10).

Conclusions: These cell lines could be good models for investigating the mechanism of PTHrP production and the relationship between this hormone and hypercalcemia.
Comparison of surgical stress between laparoscopy and open surgery in the field of urology by measurement of humoral mediators
Authors: Miyake Hideaki , Kawabata Gaku , Gotoh Akinobu , Fujisawa Masato , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao , Hara Isao
Published: March 2003

Background: Recently, laparoscopic procedures have become more common in urological surgery, and are suggested to be less stressful compared with open surgery; however, little data on objective evaluation of surgical stress after laparoscopic surgery are available. The objective of this study was to compare surgical stress between laparoscopic and open surgery in the field of urology by measurement of humoral mediators.

Methods: Blood samples were obtained from 25 patients who underwent laparoscopic surgery (laparoscopic radical prostatectomy, 10; retroperitoneoscopic nephrectomy or nephroureterectomy, seven; laparoscopic adrenalectomy, five; and hand‐assisted laparoscopic radical nephrectomy, three) and 10 who underwent open surgery (retropubic radical prostatectomy, four; radical cystectomy, three; and radical nephrectomy, three), 48 h before surgery, during surgery, and 24, 48 and 96 h after surgery. Serum levels of interleukin (IL)‐6, IL‐10 and granulocytic elastase in these samples were measured, and the results were analyzed with respect to several clinical factors.

Results: In both groups, IL‐6 and granulocytic elastase levels increased during surgery and reached maximum levels 24 h after surgery; the increase in granulocytic elastase tended to be prolonged compared with that of IL‐6. Changes in IL‐10 levels in the open surgery group were similar to those of IL‐6 and granulocytic elastase levels, whereas IL‐10 levels in the laparoscopic surgery group reached a maximum level during surgery and then decreased to the same level as at 48 h before surgery, on the first postoperative day. The maximum levels of these three mediators in the laparoscopic surgery group were significantly lower than those in the open surgery group. IL‐6 was closely associated with the interval of fasting and duration of hospitalization after surgery.

Conclusion: Although the present study was based on retrospective and non‐randomized analysis, the findings suggest that serum levels of IL‐6, IL‐10 and granulocytic elastase are useful as objective markers of surgical stress, and that laparoscopic surgery is markedly less stressful than open surgery.
Clinical significance of thymidylate synthase expression in bladder cancer
Authors: Nomura Takeo , Nakagawa Masayuki , Fujita Yoshitsugu , Hanada Toshikatsu , Mimata Hiromitsu , Nomura Yoshio
Published: March 2003

Background : The purpose of the present paper was to investigage the clinical significance of thymidylate synthase (TS) expression in bladder cancer and its association with proliferation markers, such as p53, Ki‐67, and proliferating cell nuclear antigen (PCNA).

Methods : Thymidylate synthase gene expression in 54 patients with bladder cancer was measured by the reverse transcription polymerase chain reaction (RT‐PCR) method using glyceraldehyde‐3‐phosphate dehydrogenase (GAPDH) as an internal standard. The TS expression was also examined immunohistochemically. Immunohistochemical studies of p53, Ki‐67, and PCNA expression were carried out to examine the correlation between TS expression and the expression of proliferation markers in the tumors. Prognostic and clinical outcome factors such as vascular invasion and distant metastasis were also examined along with TS expression.

Results : Twenty‐four patients with invasive bladder cancer had TS levels of 5.07 ± 0.77 (mean ± SE), while 30 patients with superficial bladder cancer had TS levels of 2.28 ± 0.38. There was a significant difference in TS levels between invasive and superficial bladder cancer (P = 0.001). There was a positive correlation between TS expression and each proliferation marker of p53 (r = 0.686, P < 0.01), Ki‐67 (r = 0.715, P < 0.0001) or PCNA expressions (r = 0.670, P < 0.0001) in these patients. Patients with high TS levels (TS ≥ 2.63, the median value) had significantly higher rates of vascular invasion and distant metastasis. Kaplan–Meier analysis demonstrated that patients with high TS levels (TS ≥ 2.63) had unfavorable prognosis compared to patients with low TS levels (TS < 2.63; P = 0.034). Furthermore, patients with high TS staining had a significantly poorer prognosis than those with low staining (P = 0.012).

Conclusion : Determination of level of TS expression may help in the selection of an appropriate treatment for bladder cancer because TS expression influences the biological characteristic of bladder tumor.
Surgical management of urinary incontinence in children with anatomical bladder‐outlet anomalies
Authors: SHIMADA KENJI , MATSUMOTO FUMI , TOHDA AKIRA , HARADA YASUNORI , NAITOH YASUYUKI
Published: March 2003

Background: Pediatric urinary incontinence secondary to anatomical anomalies of the bladder outlet is relatively rare, and there is no consensus on its surgical treatment. We reviewed the clinical courses and surgical management of children with this pathology.

Methods: From 1991 to 2001, we performed bladder neck reconstruction on seven children (three boys and four girls). The mean age at the first intervention was 7 years (range 5–12 years). The underlying diagnosis was bladder exstrophy in two children, pseudoureterocele‐type ectopic ureter in three, bladder neck incompetence from unknown etiology in one boy with hypospadias, and bilateral single ectopic ureter associated with cloacal malformations in one child. Lower urinary tract was evaluated through various imagings, endoscopy, and urodynamic studies.

Results: The methods used to reconstruct the bladder neck was the Young‐Dees‐Leadbetter procedure (performed on four children); the Kropp procedure (two children); and the Pippi‐Salle procedure (one child). Bladder augmentation with intestinal segment was performed on four children; Mitrofanoff continent stoma was created in all patients. Urethral catheterization could not be routinely used in all patients, because of pain, stricture, or complicated urethral anatomy. All patients achieved urinary continence.

Conclusion: The treatment of pediatric urinary incontinence from anatomical anomalies is technically challenging. Depending on the underlying disorders and anatomy, one needs to decide which method of reconstruction to perform. It would be safer to employ simultaneous augmentation and to create catheterizable continent stoma.
Extensive bilateral renal pelvis, ureter and bladder leukoplakia
Authors: Gumus Eyup , Yilmaz Banu , Miroglu Cengiz
Published: March 2003

We are presenting a case of leukoplakia spread to the bilateral renal pelvis, ureter and bladder in a 52‐year‐old woman. We believe this case is important because it involves leukoplakia that is more extensive than in any cases previously cited in the literature. No other possible etiologic cause except a heavy smoking habit was defined. Conservative follow‐up was preferred to aggressive surgery.
Urinary oxalic acid excretion differs after oral loading of rats with various oxalate salts
Authors: HOSSAIN RAYHAN ZUBAIR , OGAWA YOSHIHIDE , MOROZUMI MAKOTO , SUGAYA KIMIO , HATANO TADASHI
Published: March 2003

Background: To compare urinary oxalate excretion after the oral administration of oxalic acid, disodium oxalate, or calcium oxalate in rats.

Methods: Male Wistar rats were divided into four groups of six rats each and were intravenously hydrated with normal saline, and then were administered normal saline (control group), 10 mg of oxalic acid, equimolar disodium oxalate, or equimolar calcium oxalate via a gastrostomy. Urine specimens were collected just before administration and at hourly intervals up to 5 h afterwards. The urinary oxalate, calcium, magnesium and phosphorus levels were measured.

Results: Urinary oxalate excretion peaked at 1–2 h after administration of oxalic acid or equimolar disodium oxalate, while administration of calcium oxalate only caused a small increase of urinary oxalate excretion. Cumulative urinary oxalate excretion during 5 h was 1.69 ± 0.10 mg (mean ± SD; 17%), 1.43 ± 0.13 mg (13%), and 0.22 ± 0.03 mg (2%) after the administration of oxalic acid, disodium oxalate, and calcium oxalate, respectively. Urinary calcium excretion showed a decrease in the oxalic acid and disodium oxalate groups, while urinary magnesium or phosphorus excretion did not change significantly.

Conclusion: The upper gastrointestinal tract seems to be the major site of oxalic acid absorption and only free oxalate is absorbed irrespective of whether it is the sodium salt or not. After binding to calcium in the gut, oxalic acid absorption seems to be inhibited in the presence of calcium and this means that calcium oxalate is poorly absorbed (at least in the upper gastrointestinal tract).
Early rheumatoid arthritis: can we predict its outcome?
Authors: Williamson A. A. , McColl G. J.
Published: March 2003

Abstract

The continuing trend towards more aggressive treatment of rheumatoid arthritis (RA) has seen an increasing interest in the early phase of this chronic inflammatory disease. Optimal benefit from present and emerging therapies is limited by our prognostic abilities during this period. The present review attempts to outline first the many methodological issues encountered in studies of early RA, and second the extent to which each major outcome measure can be explained, both by readily available clinical variables and by HLA‐DR genotyping. The evidence supporting the clinical usefulness of genotyping is discussed separately. Based on this information, a clinically appropriate approach to the management of early RA and the identification of patients suitable for experimental therapies is suggested. (Intern Med J 2001; 31: 168–180)
Underuse of beta‐blockers following myocardial infarction: a tale of two cities
Authors: Nicholls S. J. , McElduff P. , Dobson A. J. , Jamrozik K. D. , Hobbs M. S. T. , Leitch J. W.
Published: March 2003

Abstract Aims: To measure factors associated with underuse of beta‐blocker therapy after myocardial infarction (MI).

Methods: The Newcastle and Perth collaborating centres of the World Health Organization (WHO) MONICA project (to MONItor trends and determinants of Cardiovascular disease) systematically evaluated all patients admitted to hospital in their respective regions with possible MI. A total of 1766 patients in Newcastle and 4503 patients in Perth, discharged from hospital after confirmed MI from 1985 to 1993, were studied. Rates of beta‐blocker use before and after hospital discharge were evaluated and correlates of beta‐blocker use determined.

Results: Beta‐blocker use was similar in Newcastle and Perth before MI (21% of patients in each centre). During hospital admission, beta‐blocker therapy was initiated nearly twice as frequently in Perth compared with Newcastle (66 vs 36%, respectively) and more patients were discharged from hospital on beta‐blockers in Perth (68%) than in Newcastle (45%). The main factors associated with underuse of beta‐blockers in multivariate analysis were geographical centre (odds ratio (OR) for Newcastle compared with Perth 0.3; 95% confidence interval (CI) 0.3–0.3), a history of previous MI (OR 0.6, 95% CI 0.5–0.7), admission to hospital in earlier years (OR 0.4, 95% CI 0.3–0.4 for years 1985–87 compared with years 1991–93), diabetes (OR 0.6, 95% CI 0.5–0.8) and the concomitant use of diuretics (OR 0.5, 95% CI 0.4–0.6) and calcium antagonists (OR 0.6, 95% CI 0.5–0.8).

Conclusions: Underuse of beta‐blockers after MI was strongly related to hospital prescribing patterns and not to community use of beta‐blockers. Underuse occurred in patients with diabetes and in patients with left ventricular dysfunction, patients who stand to benefit most from beta‐blocker use following MI. (Intern Med J 2001; 31: 391–396)
Feasibility study of the early detection and treatment of renal disease by mass screening
Authors: Craig J. C. , Barratt A. , Cumming R. , Irwig L. , Salkeld G.
Published: March 2003

Abstract

Aim: To determine whether mass screening for proteinuria may be worthwhile in the detection of early renal disease in Australians.

Methods: A feasibility study was conducted using systematic review, meta‐analysis and cost‐effectiveness methods.

Results: End‐stage renal disease (ESRD) develops in about 1500 Australians each year. Of these, about 1000 are over 50 years of age (an incidence of about 200 per million, per year). Proteinuria, which is present in about 5% of the general population, confers an approximately 15‐fold increased risk for ESRD. Twelve randomized trials of angiotensin‐converting enzyme inhibitors (ACEi), in 1943 patients with varying degrees of renal impairment, hypertension and proteinuria, showed that the risk of developing ESRD can be reduced by about 30% over a 2‐ to 3‐year period. In a general‐practice‐based screening model involving: (i) an opportunistic single dipstick test for protein, (ii) a confirming 24‐h urine test for protein and (iii) commencement of ACEi in appropriate individuals, 20 000 people over 50 years of age would need to be screened to prevent one case of ESRD. To achieve this, approximately 100 people would need to be treated with ACEi for 2 to 3 years, and 1000 would need to have a 24‐h urine protein test (and of these, 700 would be false positives). Such a strategy may save health dollars but some critical research questions are still unanswered. What is an individual’s risk of developing ESRD, given values for proteinuria, blood pressure and renal function? What is the benefit of ACEi in screen‐detected cases, which are at low risk of ESRD? What psychological and physical harm is caused by screening, including the specific renal investigations and treatments that follow on from proteinuria detection?

Conclusions: Given available data, screening middle‐aged and older Australians for proteinuria and treating some with ACEi is, at best, a promising primary prevention strategy for preventing ESRD. However, a large population‐based cohort study, with nested trial of ACEi, is still required to evaluate whether this model of screening for renal disease does more harm than good.(Intern Med J 2002; 32: 6–14)
The Problem with Doctors
Authors: Macdonald G.
Published: March 2003

By C. Brand (ed.). Middle Park: Little C Books, 2001. 180 pp. Price $A24.95 (Paperback). ISBN 0646‐40692‐2
Audit of the management of suspected giant cell arteritis in a large teaching hospital
Authors: Dalbeth N. , Lynch N. , McLean L. , McQueen F. , Zwi J.
Published: March 2003

Background : The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high‐dose corticosteroids may be associated with significant morbidity, including osteo­porosis.

Aim: To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital.

Methods: We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteo­porosis prophylaxis.

Results: The mean waiting time for biopsy for all patients was 5.6 days (range 0−42 days). This
time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate.

Conclusions: There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis. (Intern Med J 2002; 32: 315−319)
Resource allocation and bioethics: the Patti Hearst dilemma
Authors: Duggan J. M.
Published: March 2003

Abstract

Medicine has entered an era of high technology, accompanied by expensive investigation and management. Simultaneously, there is increasing recognition of the gap between the costs of medical technology and society's willingness to pay. It is debatable whether medicine recognizes that it is a hostage in thrall to the medical‐industrial complex or whether it has wittingly entered the compact to pursue the high‐cost, high‐technology course. The situation is reminiscent of the events surrounding the kidnap of Patti Hearst − a wealthy heiress who was much later arrested with the gang of robbers. Whether she was hostage or willing accomplice still remains obscure. It is necessary that a body, such as the Cochrane Collaboration, pursues these issues in medicine. (Intern Med J 2003; 33: 127−130)
Allelopathic activity of Mexican sunflower [Tithonia diversifolia (Hemsl.) A. Gray] in soil under natural field conditions and different moisture conditions
Authors: Tongma Suthep , Kobayashi Katsuichiro , Usui Kenji
Published: March 2003

The allelopathic activity of Mexican sunflower [Tithonia diversifolia (Hemsl.) A. Gray] in soil under natural field conditions and the effect of water stress on the growth and allelopathic activity of this plant were investigated. Seed germination, shoot growth and root growth of tested plant species in soil collected from a field where Mexican sunflower had been grown for 5 years were less than those in soil from an area without the plant. Growth of young leaves, mature leaves, senescent leaves, stem and roots of Mexican sunflower was reduced with decrease in soil moisture level. The allelopathic activity of water extracts (per dry weight of starting material) from each part of the plants grown at low soil moisture levels was greater than that of the water extracts from the same part of the plants grown at high soil moisture levels. The allelopathic activity was found in the soil from the pots previously planted with Mexican sunflower to a similar extent (per plant) at different soil moisture levels. These results suggested that, in the field, under water stress conditions, the growth of Mexican sunflower was reduced but the plants contained a greater amount of allelopathic substance(s) per dry weight than in the absence of water stress. It was considered that allelopathic activity of Mexican sunflower in soil was maintained to a similar extent under various soil moisture conditions in natural fields.
Influence of temperature levels and planting time on the sprouting of rhizome‐bud and biomass production of torpedograss (Panicum repens L.) in Okinawa island, southern Japan
Authors: Hossain, Mohammad Amzad , Akamine, Hikaru , Nakamura, Ichiro , Ishimine Yukio , Kuramochi Hitoshi
Published: March 2003

The present study describes the influence of temperature levels and planting time on the sprouting of rhizome‐buds and the biomass production of torpedograss (Panicum repens L.) in the Okinawa prefecture, Japan. Torpedograss planted in each month (1994–95) was grown for 210 days. Sprouting of the rhizome‐bud of torpedograss was 92–96% at the temperature range of 20–35°C in an incubator, and the sprouting was not observed at the extreme low and high temperature of ≤5 and ≥45°C, respectively. The plant showed 40–72% emergence when grown in pots throughout the year in the ambient temperature range of 17–29°C. The percentage emergence was comparatively higher in March to September, and shoots elongated rapidly in the period from April to October when the temperature range of 22–29°C prevailed. Torpedograss‐rhizome sown in the period from January to June obtained significantly higher biomass because higher temperatures prevailed in the following growth period from May to October, as compared with the torpedograss‐rhizome sown in the period of July to December. The plant required higher temperatures for proper growth and development during the period of moderate (70–110 days after planting (DAP)) and fast growth phases (110 DAP to the last harvest).