bluuebunny/crossref_metadata_2025 huggingface dataset:
Epithelial‐mesenchymal transitions in the developing heart of the dogfish (Scyliorhinus canicula). A scanning electron microscopic study
Authors: Macías D. , Pérez‐Pomares J. M. , García‐Garrido L. , Mu·oz‐Chápuli R.
Published: March 2003

An epithelial‐mesenchymal transition is involved in two main morphogenetic events of cardiac morphogenesis, namely the differentiation of the valvuloseptal tissue from the endocardial endothelium, and the formation of subepicardial mesenchyme from the epicardial mesothelium. We have proposed that the dogfish (Scyliorhinus canicula) is a suitable model for the study of basic processes of cardiac morphogenesis in vertebrates, since the heart of this primitive fish probably outlines the original bauplan of the vertebrate heart. In order to study in this model the endocardial and epicardial epithelial‐mesenchymal transition under scanning electron microscopy, we have used a technique of paraffin‐embedding, partial sectioning, dewaxing and critical‐point drying. Our results showed: 1) A centrifugal pattern of epicardial development from the atrioventricular groove to the sinus venosus and conus arteriosus; 2) A close spatial and temporal relationship between the endocardial and epicardial epithelial‐mesenchymal transition, although the transformation of the endocardium starts earlier and ends later the epicardial transformation; 3) A complex arrangement of the fibrous extracellular matrix which is established prior to the migration of the mesenchymal cells. Subepicardial, but not subendothelial mesenchymal cells, coalesce in unicellular or pluricellular ring‐like structures that probably are related to the origin of the cardiac vessels.
Cell surface glycoconjugates in the olfactory system of lungfish Protopterus annectens Owen
Authors: Franceschini Valeria , Lazzari Maurizio , Ciani Franco
Published: March 2003

Franceschini, V. Lazzari, M. and Ciani, F. 2000. Cell surface glycoconjugates in the olfactory system of lungfish Protopterus annectens Owen. —Acta Zoologica (Stockholm) 81: 131–137

Lectin binding was performed on the olfactory system of lungfish Protopterus annectens to identify specific glycoconjugates on the cell surface of olfactory receptor cells. The lectin histochemical patterns and the Western blot analysis indicate that the receptor cells of the olfactory mucosa are characterized by high density of α‐N‐acetyl‐
d‐galactosamine residues on the saccharidic chains of the surface glycoproteins. Other lectins display a regional pattern between the regions of the olfactory bulbs. This different histochemical lectin pattern might be due to a different regional segregation of the olfactory projections. On the other hand it could allow the identification of an area corresponding to the accessory olfactory bulb of terrestrial vertebrates in the ventrolateral region of Protopterus olfactory bulb. The presence in the dipnoan olfactory system of a vomeronasal organ homologous to the organ in amphibians is discussed. Moreover, the selective lectin binding on the surface of primary olfactory neurones suggests that specific cell surface glycoproteins may have a role in the axonal growth due to the continuous cycle of proliferation and the death of olfactory receptor cells.
Circulatory organs of abdominal appendages in primitive insects (Hexapoda: Archaeognatha, Zygentoma and Ephemeroptera)
Authors: Gereben‐Krenn Barbara‐Amina , Pass Günther
Published: March 2003

The abdominal circulatory organs and the haemolymph supply of the terminal filament and the cerci were investigated in a total of nine species (serial semithin sections, TEM, in vivo observations).

In all investigated species, the dorsal vessel features a bidirectional flow. In the 10th abdominal segment, there is an intracardiac valve preventing flow in the anterior direction. The posterior portion of the dorsal vessel differs significantly from the anterior portion in design and wall structure. Pumping actions and frequencies do not correspond with each other in the two portions.

Vessels supply haemolymph to the long terminal appendages. The terminal filament vessel is connected to the dorsal vessel, the two cercal vessels originate from a transverse septum at the base of the terminal filament. All taxa show the same flow pattern through the caudal appendages. Ephemeroptera have a unique spherical body at the posterior end of the dorsal vessel functioning as a backflow valve.

The results indicate that the plesiomorphic state of the circulatory organs in the abdomen of primitive insects differ distinctly from that of higher insects which serve as bases for generalized schemes common to entomological textbooks.
Phylogenetic analysis of the pearlfish tribe Carapini (Pisces: Carapidae)
Authors: Parmentier E. , Castillo G. , Chardon M. , Vandewalle P.
Published: March 2003

Fishes of the tribe Carapini (Encheliophis and Carapus) share a noteworthy peculiarity: they shelter in holothurian echinoderms or bivalve hosts. Some species are considered parasitic, others commensal. This study focuses on the phylogeny of the tribe, using two other Carapidae species as an outgroup (Snyderidia canina and Onuxodon fowleri). Insofar as possible, the selected anatomical and behavioural characters where chosen in an ecomorphological perspective, as features that could be responses to various lifestyle‐related constraints. Our character selection also took into account the fact that some features are (presumably) linked. Such features were grouped together as a single trait to avoid their overvaluation.

This methodology enabled commensals to be separated from parasites, the former belonging to Carapus and the latter to Encheliophis. Carapus species reflect in their morphology the constraints imposed by a diet of hard, mobile, elusive prey, showing predator‐type features: a strong dentition, a wide mouth opening, a robust food intake apparatus. On the other hand, the endoparasitic Encheliophis species show a generally weaker buccal apparatus and narrow mouth opening, in relation to the different constraints of their lifestyle where the diet constraints are less pronounced: they eat body parts of their host. Changes in both generic diagnoses are proposed and three species are transferred from Encheliophis to Carapus.
Scale morphogenesis and ultrastructure of dermis during embryonic development in the alligator (Alligator mississippiensis, Crocodilia, Reptilia)
Authors: Alibardi L. , Thompson M. B.
Published: March 2003

Formation of scales in different body regions of embryonic alligators is described using light and electron microscopy. Transformation of the skin surface to produce scales takes place between stages 19 and 23, after which the shape of scales is complete over most of the embryonic surface. Scalation is not synchronous; different regions develop scales at different rates. Initially scales are formed on the back and dorsal side of the proximal tail and appear as undulations of the epidermis which form symmetrical (bumps) or asymmetrical (serrated) scale anlagen. No dermal condensations are apparent beneath the epidermis, although in some areas of the skin (belly, limbs) mesenchymal cells are more numerous within the bumps than in other areas. At stage 21, scalation has spread to the neck and belly but is absent or poorly developed over most areas of the flank, gular, jaw, limb and head regions. Grooves form between the outer edges of adjacent scales or interbump regions. A superficial denser dermis and a reticulated deep subdermis are visible in many scales from stage 21. The dermis forms a superficial loose and a deep dense layer from stage 22. Both loose and deep dermis, and sometimes the deep reticulate subdermis, move towards the surface to form the dermal core of scales, although the mechanism of this movement is not known. Bundles of collagen fibrils, with almost no elastic fibrils, are progressively deposited, especially in the denser dermis. At stage 22, the flank, gular and proximal areas of limbs form scales, but the head, jaw, distal limbs and digits still lack scales. The digits become scaled at stage 23 when scalation is well advanced in the other regions. By stage 24 most of the body is scaled and subsequent scale modifications occur only by growth. Five main types of scales are recognized by their shape: symmetrical scutes, asymmetrical scutes, overlapping scutes, tuberculate scales, and elevated asymmetrical scutes (tail verticils). Pigmentation, mainly due to epidermal melanocytes, is visible at embryonic stage 23 and progresses through stages 24 and 25.
The wing vestiture of the non‐ditrysian Lepidoptera (Insecta). Comparative morphology and phylogenetic implications
Authors: Simonsen Thomas J.
Published: March 2003

The ultrastructure of the dorsal forewing vestiture in exemplars of all family group taxa of non‐ditrysian Lepidoptera is examined, and the evolutionary implications at family level and above are discussed. Wing‐scale terminology is reviewed. Three different types of bilayer wing‐scale covering are recognized; only a few groups have a single‐layer wing‐scale covering. The general scale arrangement is random, but a few taxa have clustered scale arrangements and scattered heteroneurans have scales arranged in transverse rows. Cross ribs are present in all taxa, but only as vestiges in eriocraniid cover scales. Ridge dimorphism is widespread in Neolepidoptera. Surprisingly, ridges and cross ribs on the adwing scale surface are of general occurrence in Neopseustidae and Hepialidae, and are even found on parts of the ground scales of many other Neolepidoptera. Morphological evidence strongly indicates that the fused wing‐scale types found in non‐Coelolepidan Lepidoptera and Neolepidoptera are independently evolved, as evidenced from the presence of vestigial perforations. Absence of perforations is not infallible evidence that a scale is solid. Microtrichia are independently reduced in a number of taxa and probably re‐evolved in at least higher nepticulids. Wing vestiture and scale characters indicate that Tischerioidea may be the sister group of Ditrysia.
Microscopic anatomy and ultrastructure of the digestive system ofNatatolana obtusata(Vanhöffen, 1914) (Crustacea, Isopoda)
Authors: Storch V , Strus J , Brandt A
Published: March 2003

The scavenging cirolanid isopodNatatolana obtusatawas caught using primarily meat‐baited traps at a station in the Weddell Sea at Kap Norvegica. The hindguts of most specimens were densely stuffed with meat from the traps. The anatomy and the ultrastructure of different sections of the digestive system are described. The large and extremely expandable mouth opens into a short oesophagus which extends posteriorly into a small stomach. Lateralia and primary filter can be observed directly when the mouth opening is widened to its extreme. The anterior hindgut is extremely variable in its lumen and very distensible, depending on the nutritional condition. The cuticle of the hindgut is colonized by fungi. The length of the midgut glands varies with the nutritional conditions. Morphology and anatomy of the digestive system ofNatatolana obtusataare discussed with the background of the lifestyle of the species and compared with other taxa.
Open stone surgery in children: is it justified in the era of minimally invasive therapies?
Authors: Zargooshi Javaad
Published: March 2003

Objective To review experience with open surgery for paediatric urolithiasis during a 10‐year period.

Patients and methods The hospital records of patients up to 13 years old and treated between 1990 and 2000 for stones were reviewed; there were 310 patients (98 girls and 212 boys, aged 9 months to 13 years, mean 6.8 years).

Results The commonest symptoms were renal‐ureteric colic (26.7%), gross haematuria (19%), urinary retention (16.7%), and abdominal and/or flank pain (13.2%). Because of poverty and the resultant inability to pay medical fees, 19 children presented very late with pyonephrosis (resembling peritonitis in nine) and obstructive renal atrophy in 23. In 18 other patients the delay was caused by the disappearance of pain. Delayed presentation was the most important factor in developing complications from the stone. The stones were in the calyces in 15 patients, the pelvis in 113, the ureter in 56, the bladder in 71, the urethra in 17 and in a combination of sites in 38. The mean (range, median) stone size was 27 (9–75, 22) mm; 80 (25.8%) were complete staghorn stones. Indications for open surgery were a complex stone burden (62%), ESWL failure (14.5%), need for nephrectomy (1.9%), anatomical abnormalities (2.2%), and unavailability of minimally invasive alternatives (19%). All of the nephrectomized patients underwent unilateral stone removal and contralateral nephrectomy. For parents, the cost and reliability of the result were more important than other considerations, e.g. having a large or small incision. The overall stone‐free rate at discharge was 95.4% (100% for single stones). In five cases (1.6%) a repeat open procedure was needed. The mean (range, median) hospital stay was 4 (1–13, 3) days.

Conclusions Arguments against open surgery for urolithiasis in adults should not be extrapolated to children, in whom open surgery is safe and effective. In Iran and many ‘developing’ countries, open surgery is less expensive, more effective, more dependable, and more easily available than minimally invasive alternatives. At least in such countries it deserves to be among the first‐line therapies for paediatric urolithiasis, and urologists in less‐developed countries should not decline to offer open surgery because it is almost obsolete in developed countries. Delayed presentation (through poverty and/or unawareness) contributes significantly to the morbidity of urolithiasis.
The rho/rho‐kinase pathway is involved in the progression of testicular germ cell tumour
Authors: Kamai T. , Arai K. , Sumi S. , Tsujii T. , Honda M. , Yamanishi T. , Yoshida K.‐I.
Published: March 2003

Objective To clarify the role of one of the downstream effectors of Rho (Rho‐kinase) in testicular germ cell tumour (GCT) by quantifying mRNA expression for Rho‐kinase in patients with this disease.

Materials and methods The mRNA levels of the RhoA and Rho‐kinase genes were analysed in surgical specimens of testicular GCT tissues from 57 consecutive Japanese patients, and in the corresponding non‐tumour tissue originating from the same patient, using the polymerase chain reaction after reverse transcription. The expression levels of these genes were compared between the tissues and the relationship between their expression levels evaluated within tumours and with tumour stage. The difference in the expression levels of the mRNAs of RhoA and Rho‐kinase genes were also assessed between tumours that were seminoma only and mixed tumours of seminoma and nonseminoma.

Results RhoA and Rho‐kinase mRNAs were more abundant in tumour tissue than in non‐tumour tissue (P < 0.01 and < 0.05, respectively). High RhoA and Rho‐kinase mRNA expressions were related to tumour stage (P < 0.05 and < 0.01, respectively). The mRNA levels of RhoA and Rho‐kinase in mixed tumours were higher than in tumours with seminoma only (P < 0.01 and < 0.05, respectively). There was a positive relationship between expression levels of mRNAs of RhoA and Rho‐kinase in tumour tissues (P < 0.001).

Conclusions These findings suggest that the RhoA/Rho‐kinase pathway is involved in the progression of testicular GCT. This pathway might be a molecular target for new treatment strategies for this disease.
Sleep and night‐time behaviour of enuretics and non‐enuretics
Authors: Nevéus T. , Läckgren G. , Stenberg A. , Tuvemo T. , Hetta J.
Published: March 2003

Objective

To investigate connections between nocturnal enuresis and sleep factors such as the subjective depth of sleep and classical parasomnias.

Patients, subjects and methods

One hundred school children aged 6–10 years answered a questionnaire, with their parents, and the same questions were asked of a group of 29 children of the same age suffering from severe nocturnal enuresis.

Results

There were significant differences in arousability, with the enuretic group being ‘deep sleepers’, and in the prevalence of onset insomnia, nightmares, interrupted sleep and bedtime struggles, which were all less common among the enuretics. The prevalence of classical parasomnias did not differ between the groups.

Conclusion

A high arousal threshold is one of the pathogenetic factors underlying nocturnal enuresis and we propose that this group of therapy‐resistant enuretic children might not only sleep more deeply than their nonenuretic peers, but perhaps have ‘better’ sleep.
An Italian epidemiological multicentre study of nocturnal enuresis
Authors: Chiozza M.L. , Bernardinelli L. , Caione P. , Del Gado R. , Ferrara P. , Giorgi P.L. , Montomoli C. , Rottoli A. , Vertucci P.
Published: March 2003

Objective

To estimate the prevalence of enuresis in schoolchildren in Italy.

Subjects and methods

The Italian Club of Nocturnal Enuresis promoted a prevalence study of nocturnal enuresis using a self‐administered questionnaire in seven cities in Northern, Central and Southern Italy. The association between enuresis and potential risk factors, e.g. a family history of enuresis, stress, socio‐economic status and abnormal diurnal voiding habits, was investigated. The perceived impact on the child and on the family was also evaluated. A random‐cluster sampling scheme was used to obtain a sample of primary and secondary schoolchildren from each city. One primary school and one secondary school for each socio‐economic level was sampled in each city, giving a total of 42 schools surveyed; 9086 children were covered by the survey. In a cluster sampling method, the variance of prevalence is divided into two components, binomial and extra‐binomial variability. Both the DSM III and DSM IV definitions of enuresis were used because at present, there is no consensus on the diagnostic criteria.

Results

Completed questionnaires were received from 7012 children, an overall response rate of 77.2%. Those aged 6–14 years were analysed, restricting the sample to 6892 children. There were 250 enuretic children using the DSM III definition of enuresis and 112 using the DSM IV definition. The overall prevalence was 3.8% and showed a decreasing trend with increasing age. Bedwetting was more frequent in boys than in girls. The prevalence of enuresis was higher when the child was from a family of low socio‐economic status despite the child’s age group. The logistic analysis showed that familiality, stress, birthweight, age of attaining diurnal continence, soiling and, for girls, menstruation, were statistically significant variables and thus contributed to predicting the probability of bedwetting, confirming the findings of previous studies. There was a large difference in prevalence using the two DSM definitions; a high percentage of DSM III enuretic children had more than two wet nights per week.

Conclusion

It is important that a consensus about the ‘working definitions’ of enuresis is reached to avoid bias in the recruitment step, to carry out comparable epidemiological studies and to obtain adequate therapeutic responses.
Immunohistochemical analysis of Ki‐67 antigen and Bcl‐2 protein expression in prostate cancer: effect of neoadjuvant hormonal therapy
Authors: Tsuji  , Murakami  , Kanayama  , Sano  , Kagawa
Published: March 2003

Objective

 To determine differences in the immunohistochemical (IHC) expression of Bcl‐2 protein and Ki‐67 antigen in patients with prostatic cancer who underwent radical prostatectomy with or without neo‐adjuvant hormonal therapy.

Materials and methods

 Ki‐67 antigen and Bcl‐2 protein were detected by IHC using MIB‐1 and Bcl‐2 antibodies in prostatectomy specimens from 28 patients who received hormonal therapy before surgery (group 1) and 51 patients who did not (group 2).

Results

 In group 2, the mean MIB‐1 index increased with increasing grade of tumour, from 11.6% in low‐grade to 24.7% in high‐grade tumours (P=0.002). Bcl‐2 expression did not correlate with either tumour grade or stage. In group 1, there were no correlations between Bcl‐2 expression or MIB‐1 index and tumour grade or stage. More tumours in group 1 were Bcl‐2‐positive (16 of 28, 57%) than were tumours in group 2 (11 of 51, 22%; P=0.003). The mean (sd) MIB‐1 index of tumours in group 2 [15.6 (14.4)%], was significantly greater than that of tumours in group 2 [6.8 (7.5)%; P=0.004].

Conclusions

 These results indicate that Bcl‐2 positivity is increased by androgen ablation therapy and conversely, that the proliferative activity of cancer cells is significantly reduced. The expression of Bcl‐2 protein may play a role in the ability of prostate cancer cells to survive in an androgen‐deprived environment.
Excision of residual masses of metastatic germ cell tumours after chemotherapy: the role of extraperitoneal surgical approaches
Authors: Christmas  , Doherty  , Rustin  , Seckl  , Newlands
Published: March 2003

Objective

 To evaluate the efficacy and safety of extra‐peritoneal surgical approaches for the removal of residual masses of metastatic germ cell tumours in men after chemotherapy.

Patients and methods

 A series of 75 men (median age 32 years) with metastatic germ cell tumours of testicular (n=63) or extragonadal (n=12) origin, who had been treated with an intensive course of platinum‐based chemotherapy, were found to have residual tumour masses. Extraperitoneal surgical approaches were used on 80 occasions to excise these masses. A thoraco‐abdominal extraperitoneal approach (n=71) was used for large masses and those with intrathoracic metastases while smaller retroperitoneal masses were removed through 12th rib (n=5) or Rutherford‐Morrison (n=4) extraperitoneal approaches.

Results

 Complete macroscopic clearance of residual masses within the thorax and retroperitoneum was achieved in all cases. The median blood loss was 0.8 L and the median in‐patient stay was 7 days. Complications included chest infection in four cases. Two patients died about 4 weeks after surgery, one from septic pericarditis and another after an epileptic fit secondary to brain metastases. Eleven patients have developed tumour recurrence, five of whom have died from disseminated disease. Hence the survival rate and disease‐free survival rate are 91% and 83%, respectively, with a median follow‐up of 22 months.

Conclusions

 The thoraco‐abdominal extraperitoneal surgical approach for retroperitoneal lymph node dissection after chemotherapy for testicular cancer is safe and has some advantages over anterior approaches, allowing synchronous removal of intrathoracic disease, improved access to nodes above and behind the renal vessels and more rapid post‐operative recovery.
Characterization and modulation of transitional cell carcinoma cell lines with acquired multidrug resistance
Authors: Yu  , Chang  , Ma
Published: March 2003

Objectives

 To characterize in vitro drug‐induced multidrug resistance (MDR) in transitional cell carcinoma (TCC) cell lines, and to elucidate the possible mechanisms of acquired MDR and their modulation.

Materials and methods

Two drug‐resistant cell lines, TCC8702/A1000 (adriamycin 1000 ng/mL) and TCC8803/A200 (adriamycin 200 ng/mL), were established after long‐term adriamycin treatment for at least 16 months. Their biological characteristics, including growth morphology, doubling time and cell cycle, were analysed. The drug‐resistance pattern to various anticancer drugs was measured using a microplate cytotoxicity assay. The modulation of drug sensitivity by calcium‐channel blockers and protein kinase C inhibitor was assessed among the different cancer cell lines.

Results

Both MDR sublines had lower growth rates, lower saturation densities and higher nuclear/cytoplasmic ratios than the parent cell lines. DNA staining and cell cycle analysis revealed that both TCC8702/A1000 and TCC8803/A200 cells had a decreased S‐phase fraction and the TCC8803/A200 cells a changed stem line; both sublines showed increased expression of membranous glycoprotein gp‐170. The cytoplasmic content of glutathione and glucose‐6‐phosphate dehydrogenase were not related to the MDR development in the sublines. The drug‐resistance index of TCC8702/A1000 to adriamycin was 121‐fold higher than the native cell line and TCC8803/A200 was 189‐fold higher. TCC8803/A200 also had a broader MDR to cisplatin, vinblastine and vincristine. Calcium‐channel blockers (verapamil, quinidine) and protein kinase C inhibitors (tamoxifen) inhibited gp‐170 activity and slowed the drug‐efflux pump, with the acquired‐MDR cells subsequently accumulating anticancer drugs. A calcium antagonist‐based combination of modulators all presented synergistic cytotoxic enhancement of the anticancer drugs. Parent TCC cell lines had a poorer response to modulator treatment than their MDR sublines.

Conclusion

Different MDR mechanisms and subsequent modulator responses exist between native and acquired drug resistance in TCC cells. Acquired MDR seems strongly related to increased gp‐170 expression and responds well to calcium antagonists. This phenomenon may be applicable in clinical conditions.
Prostate specific antigen velocity as a measure of the natural history of prostate cancer: defining a ‘rapid riser’ subset
Authors: Nam  , Klotz  , Jewett  , Danjoux  , Trachtenberg
Published: March 2003

Objective

 To study the rate of change in prostate specific antigen (PSA velocity) in patients with prostate cancer initially managed by ‘watchful waiting’.

Patients and methods

 Serial PSA levels were determined in 141 patients with prostate cancer confirmed by biopsy, who were initially managed expectantly and enrolled between May 1990 and December 1995. Sixty‐seven patients eventually underwent surgery (mean age 59 years) because they chose it (the decision for surgery was not based on PSA velocity). A cohort of 74 patients remained on ‘watchful waiting’ (mean age 69 years). Linear regression and logarithmic transformations were used to segregate those patients who showed a rapid rise, defined as a>50% rise in PSA per year (or a doubling time of <2 years) and designated ‘rapid risers’.

Results

 An initial analysis based on a minimum of two PSA values showed that 31% were rapid risers. Only 15% of patients with more than three serial PSA determinations over ≥6 months showed a rapid rise in PSA level. There was no advantage of log‐linear analysis over linear regression models.

Conclusion

 Three serial PSA determinations over ≥6 months in patients with clinically localized prostate cancer identifies a subset (15%) of patients with a rapidly rising PSA level. Shorter PSA surveillance with fewer PSA values may falsely identify patients with rapid rises in PSA level. However, further follow‐up is required to determine if a rapid rise in PSA level identifies a subset of patients with an aggressive biological phenotype who are either still curable or who have already progressed to incurability through metastatic disease.
Expression of E‐cadherin in primary prostate cancer: correlation with clinical features
Authors: Kuczyk  , Serth  , Machtens  , Bokemeyer  , Bathke  , Stief  , Jonas
Published: March 2003

Objective

 To correlate the immunohistochemically detected loss of E‐cadherin expression with patient age, clinical and biological variables, and to investigate the prognostic value of these variables for the relapse‐free and overall survival of patients with different stages of newly diagnosed prostate cancer.

Patients and methods

 Sixty‐seven patients (median age 63 years, range 48–78) undergoing radical prostatectomy for the treatment of primary prostate cancer were assessed to determine whether age, tumour stage, histological grading, serum levels of prostate specific antigen and prostatic acid phosphatase, regional lymph node status and E‐cadherin expression were prognostic factors for relapse‐free and overall survival.

Results

 With a median (range) follow‐up of 54 (3–193) months, there was no independent prognostic value of decreased E‐cadherin expression for the long‐term or recurrence‐free survival of patients, using a threshold value of 40% for the relative amount of positively stained tumour cells, or for any other threshold value calculated (25%, 60% or 75%). However, comparing a follow‐up of 16 months in patients with <40% positivity and 46 months in patients with ≥40% positivity, those patients retaining E‐cadherin expression had a significantly longer recurrence‐free interval after radical prostatectomy (P<0.01).

Conclusion

 The value of E‐cadherin expression as an additional independent prognostic variable for patients with primary prostate cancer is questionable.
Free‐to‐total prostate‐specific antigen (PSA) ratio improves the specificity for detecting prostate cancer in patients with prostatism and intermediate PSA levels
Authors: Recker  , Kwiatkowski  , Piironen  , Pettersson  , Goepel  , Tscholl
Published: March 2003

Objective

 To investigate the clinical significance of the free‐to‐total prostate‐specific antigen (PSA) ratio in improving the specificity of PSA measurement for detecting prostate cancer within the diagnostic intermediate range (4–10 ng/mL total PSA) in patients referred for the treatment of urinary symptoms.

Patients and methods

 Serum samples were obtained from 333 consecutive patients with obstructive and irritative urinary symptoms. Of these men, 114 had total PSA levels of 4–10 ng/mL; 22 had prostate cancer (group 1) and 71 had benign prostatic hyperplasia (BPH, group 2). Group 3 consisted of 21 patients with BPH and a chronic indwelling catheter. The concentrations of free and total PSA (ProStatusTM, Wallac Oy, Turku, Finland) and PSA complexed to α‐1‐antichymotrypsin were measured and the free‐to‐total PSA ratio calculated. All patients under 70 years of age or with suspicious findings on digital rectal examination or transrectal ultrasonography underwent ultrasound‐guided sextant prostate biopsies. Of the 114 patients, 105 (92%) underwent transurethral resection of the prostate and six (5%) radical retropubic prostatectomy.

Results

 Patients in group 1 had significantly lower median free PSA concentrations (0.78 ng/mL vs 1.13 ng/mL, P<0.001) and a lower free‐to‐total PSA ratio (12.1% vs 19.9%, P<0.001) than those in group 2. The differences were similar between group 1 and group 3 (median free PSA in group 3, 1.06 ng/mL, P=0.03, and free‐to‐total PSA ratio 18.7%, P=0.007). There were no significant differences between patients in groups 2 and 3. The free‐to‐total PSA ratio had a higher specificity than total PSA at all sensitivity levels, e.g. a threshold free‐to‐total PSA ratio of 0.20 detected 91% of cancers and spared 48% (group 2) or 46% (group 3) from unnecessary biopsies. The area under the receiver operating characteristic curve for group 1 vs group 2 was 0.56 (total PSA) and 0.78 (free‐to‐total PSA ratio) and for group 1 vs group 3 was 0.56 (total PSA) and 0.81 (free‐to‐total PSA ratio).

Conclusion

 In those patients with extensive symptoms from BPH and requiring surgical treatment, the free‐to‐total PSA ratio improves the specificity for detecting prostate cancer in the diagnostic ‘grey zone’ of 4–10 ng/mL total PSA. This improvement occurred in patients with or without a chronic indwelling catheter for urinary retention.
Penile perfusion and functional scintigraphy:
Authors: Drawz  , Drawz  , Kittner  , Seiter  , Schuemichen
Published: March 2003

Objective

 To determine the effect on penile haemodynamics of vascularization using the Hauri method for the treatment of erectile dysfunction of vascular aetiology, as assessed by penile perfusion and functional scintigraphy.

Patients and methods

 Penile perfusion and functional scintigraphy were performed before and after penile revascularization by the Hauri method in 13 patients. The established method of scintigraphy was carried out using 10 MBq/kg body weight of 99mtechnetium pertechnetate for in vivo labelling of erythrocytes, modified by including an estimate of mean virtual blood inflow rate.

Results

 In 10 of the 13 patients there was a significant increase in the mean virtual blood inflow rate after surgery (P<0.01, Wilcoxon test). In three patients, the inflow rate was lower after surgery than before; Doppler ultrasonography showed an occluded anastomosis in these patients.

Conclusions

 Penile vascularization using the Hauri method provides an objectively demonstrable improvement in penile haemodynamics in man. It is thus a sufficiently therapeutic procedure for treating erectile dysfunction of vascular aetiology and its effect greatly exceeds any ‘psychological influence’.
Terazosin in benign prostatic hyperplasia: effects on blood pressure in normotensive and hypertensive men
Authors: Kirby
Published: March 2003

Objective

 To determine the effects of terazosin on blood pressure and on antihypertensive therapy when used in managing benign prostatic hyperplasia (BPH).

Patients and methods

Safety data from a large, multinational study were analysed retrospectively. Normotensive and hypertensive patients received escalating dosages of terazosin for 10 weeks and were maintained on 5 or 10 mg daily doses for 16 weeks (single‐blind period). After the initial treatment period, only men having sufficient improvements in International Prostate Symptom Score (≥30%) and in peak flow rate (≥10%) were randomly assigned to continue terazosin or to receive placebo for 24 weeks (double‐blind period).

Results

In hypertensive patients, terazosin reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) during the single‐blind period; these clinically significant reductions were maintained in patients receiving terazosin during the double‐blind period. However, in normotensive and controlled hypertensive patients terazosin produced no clinically significant mean changes in SBP or DBP during either study period. Terazosin did not adversely affect patients receiving concomitant antihypertensive medication.

Conclusion

Terazosin is a safe treatment for BPH in normotensive and hypertensive men, including men who are already taking additional antihypertensive drugs.
A conscious‐rabbit model for the long‐term observation of urethral and arterial pressures
Authors: Pouyet  , Briand  , Martin
Published: March 2003

Objective

 To describe and evaluate a new experimental model for the simultaneous measurement of urethral (UP) and arterial (AP) pressures in the conscious rabbit, thereby avoiding the interference of anaesthesia which markedly reduces reflex activity and tone of smooth muscle.

Materials and methods

 Female rabbits were anaesthetized and catheters inserted into the urethra, abdominal aorta, jugular vein and bladder. After recovering from surgery, rabbits were trained to remain static in a sling for a period of 2 h, during which the UP and AP were recorded. The model was validated for short‐ and long‐term stability before the effects of drugs were assessed; UP and AP were recorded for up to 60 min after drug/solvent administration to assess short‐term stability, and long‐term stability was assessed by comparing 60 min control periods between the first and fifth experimental session up to a month apart.

Results

 Over 60 min in the control group, the UP remained steady, whereas the AP only decreased slightly. Recordings were made during five subsequent control periods, with at least 3 days of rest between successive assessments, and the UP and AP remained similar for up to 1 month. During a second phase, the effect of α1‐adrenoceptor agonists on both pressures were evaluated to characterize their functional uroselectivity. De‐glymidodrine and l‐phenylephrine (0.1 mg/kg) were administered intravenously; the UP increased by 18 cmH2O (146%) and 21 cmH2O (173%), respectively, whereas AP increased by 22 mmHg (31%) and 47 mmHg (63%), respectively. At 5 min after administering the drugs, the UP remained higher by 16 cmH2O (121%) with de‐glymidodrine, whereas it had returned to basal values with l‐phenylephrine.

Conclusions

 This conscious‐animal model allows the simultaneous measurement of UP and AP in the absence of anaesthesia. It provides a useful means to directly evaluate the effects of a drug on the urogenital and cardiovascular systems, and thereby its functional uroselectivity.
An exploration of screening practices for prostate cancer and the associated community expenditure
Authors: Perkins  , Sanson‐Fisher  , Clarke  , Youman
Published: March 2003

Objectives

 To determine: (i) the prevalence, reasons for, and demographic and psychosocial predictors of prostate cancer screening among a randomly selected sample of men; and (ii) to estimate the community expenditure involved in the screening of asymptomatic men.

Subjects and methods

 A random sample of men aged 40–79 years was selected from the State Electoral Register of New South Wales, Australia, and asked to complete a computer‐assisted telephone interview. The questions determined their demographic characteristics, their subjective health rating compared with others of the same age (5‐point scale), the prevalence and reasons for any screening for prostate cancer (‘ever screened’ and ‘screened within the last 12 months’), whether they had undergone a digital rectal examination (DRE), a blood test for prostate‐specific antigen (PSA) or transrectal ultrasonography (TRUS), and the prevalence of urinary symptoms. Those who had been screened were then asked to nominate the single most important factor in the decision to undergo prostate cancer screening. To estimate community expenditure, the costs for prostate cancer screening were estimated by applying Medicare schedule charges to the screening and subsequent diagnostic tests performed. Two scenarios were developed to estimate costs; the first used guidelines which do not recommend the use of routine screening for all asymptomatic men, and the second was based on guidelines where the routine use of PSA or TRUS as part of a periodic health examination is not recommended, but the use of DRE in asymptomatic men aged 50–70 years is.

Results

 Of the 551 eligible participants, 86% completed the interview; 44% of participants reported that they had ‘ever’ been screened, whilst 23% had been screened in the year before the study. Among those who had been screened, the reason reported most often for screening, apart from symptoms and family history, was the doctor’s recommendation after a medical assessment of their prostate cancer risk status. Screening status was predicted both by the age of the man and his symptom score. As a result, the community expenditure in New South Wales for screening among asymptomatic men was estimated to be A$6.4 million and A$5.2 million for the first and second scenarios, respectively.

Conclusions

 The results of this study suggest that, despite the recommendations of primary bodies that asymptomatic men not be screened for prostate cancer, screening is occurring at a high level and with significant costs to the healthcare system.
Whole‐body potassium and bone mineral density up to 30 years after urinary diversion
Authors: Stein  , Fisch  , Andreas  , Bockisch  , Hohenfellner  , THÜroff
Published: March 2003

Objectives

 To evaluate the long‐term effects of different types of urinary diversion on skeletal bone density and whole‐body potassium content in patients with an early correction of base excess (<−2.5).

Patients and methods

 The early correction of base excess (<−2.5) is one of the principles of the treatment of patients undergoing urinary diversion at our institution. In 27 patients with urinary diversion, bone mineral density (assessed by dual‐photon absorptiometry), whole‐body potassium, electrolyte and creatinine levels were determined, and capillary blood gas analysed. The mean time since surgery was 16.8 years in 16 patients with a rectal reservoir, 20.5 years in six patients with a colonic conduit, 7.8 years in four patients with an ileocaecal pouch and 5 years in one adolescent with an ileal bladder augmentation.

Results

 Bone mineral density was normal in 25 of the 27 patients; no exact measurement was possible in the remaining two. The whole‐body potassium content was reduced in eight of the 27 patients (three with a conduit, two with a rectal reservoir, two with an ileocaecal pouch and one with ileal augmentation). In four of these eight patients the base excess was <−2.5 (−2.7 to −5). Of the other four, two had no regular testing of their base balance and two were obese. The electrolytes were within the normal ranges. None of the patients had hyperchloraemic metabolic acidosis.

Conclusion

 With early correction of the base excess (<−2.5), there was no decrease in bone mineral density and no hyperchloraemic acidosis. There was no significant difference between the different types of urinary diversion. There seems to be a relationship between low base excess and decreased whole‐body potassium.
Bladder tumours detected on screening: results at 7 years
Authors: Mayfield  , Whelan
Published: March 2003

Objective

 To report the outcome at a minimum follow‐up of 7 years of a cohort of tumours that were asymptomatic at presentation and detected in a previous community‐based screening programme (with reduced mortality and progression at 3 years of follow‐up).

Patients and methods

 In the original screening, 2356 men aged ≥60 years had a dipstick test for microscopic haematuria; 474 (20%) had positive results and of these, 317 agreed to further investigation. Twenty‐one were found to have bladder tumours; this was reduced to 17 after pathological review. No tumours were muscle‐invasive at diagnosis. The outcome of this cohort was evaluated at 7 years of follow‐up.

Results

 The patients were grouped on the basis of their original histology. In group A, four patients had no tumour on histological review and none progressed in grade or stage. In group B, eight patients reported to have well differentiated superficial tumours (i.e. G1pTa) had no recorded deaths from cancer or progression to muscle‐invasive disease. In group C, of nine patients with tumours having a potentially worse prognosis (G1–2, ≥pT1, or carcinoma in situ, three died from bladder cancer, two progressed to muscle‐invasive disease (one of whom died from unrelated causes) and two further patients died from unrelated causes.

Conclusion

 This cohort of patients represents a unique group, in that all had superficial disease at the time of diagnosis. The outcome at 3 years was excellent, but in the subsequent 4 years many patients had progression of their cancer. All patients who developed invasive disease were in group C; as their disease was identified at a superficial stage it may have been amenable to aggressive early management not usually associated with such grade and stage.
Buccal mucosal grafts in the treatment of ureteric lesions
Authors: Naude
Published: March 2003

Objective

To devise a procedure capable of curing complicated ureteric strictures and replacing segments of lost ureter, without the long‐term infective complications of bowel interposition or the surgical magnitude of autotransplantation.

Patients and methods

Four patients with complicated strictures and one with segmental ureteric loss were treated by buccal mucosal patch grafts and an omental wrap. One patient with segmental ureteric loss was treated by interposition of a tubularized buccal mucosal graft.

Results

Ureteric patency was established and maintained in all patients, there were no complications and urine was sterile in all patients at follow‐up.

Conclusion

In a few patients, buccal mucosal patch graft repair has proved capable of maintaining patency and good urinary drainage in patients with complicated ureteric strictures. Segmental ureteric loss has been replaced in one patient by a patch graft and in another by tubularized graft interposition.
Hypospadias repair by skin flaps: a comparison of onlay preputial island flaps with either Mathieu’s meatal‐based or Duckett’s tubularized preputial flaps
Authors: Ghali
Published: March 2003

Objectives

To evaluate the success of different skin flaps in the one‐stage correction of primary hypospadias, with particular emphasis on comparing onlay preputial island flaps with Mathieu’s meatal‐based and Duckett’s preputial tubularized flaps.

Patients and methods

During a 12‐year period, 418 patients underwent single‐stage primary hypospadias repair using skin flaps, carried out by one surgeon. The surgical techniques used included Mathieu’s repair in 216 (52%), Duckett’s in 148 (35%), onlay preputial flaps in 42 (10%) and the Mustarde flap procedure in 12 (3%). The surgical results were reviewed, assessing complications and the functional and cosmetic outcome.

Results

At a mean follow‐up of 23 months the initial overall complication rate for flap procedures was 22%; however, after a mean of 1.4 procedures, the final success rate was 95%. The complication rate was significantly (P<0.05) higher in patients with a proximal urethral meatus, with severe chordee or in repairs involving transection of the urethral plate. However, the complication rates were not significantly different when the patients underwent repair when aged <2 years or >2 years. Despite no significant difference in overall complication rates, onlay procedures tended to be used in more severe hypospadias than was Mathieu’s repair. Duckett’s repair caused a significantly higher overall complication rate as fistulae, strictures, meatal stenoses and tubular abnormalities than did onlay procedures. The use of double‐faced preputial island flaps resulted in an inferior cosmetic appearance than the use of single‐faced flaps, but the overall complication rates did not differ significantly between these techniques.

Conclusions

Hypospadias repair using skin flaps offered a reliable and durable outcome. However, complication rates were greater in patients with severe hypospadias and with techniques requiring transection of the urethral plate. The onlay preputial island‐flap technique was more widely applicable than was Mathieu’s repair and had a lower complication rate than Duckett’s procedure.
Papillary renal cell carcinoma: clinicopathological characteristics and evaluation of prognosis in 42 patients
Authors: Onishi  , Ohishi  , Goto  , Suzuki  , Miyazawa
Published: March 2003

Objective

To determine the clinicopathological characteristics of histologically defined papillary renal cell carcinoma (RCC) in relation to prognosis.

Patients and methods

In total, 768 patients with RCC underwent nephrectomy at our university hospital between 1957 and 1995. RCC was classified into clear‐cell carcinoma in 689 patients (89.7%, no follow‐up in 14), chromophobe cell carcinoma in 36 (4.7%, no follow‐up in two) and papillary RCC in 43 (5.6%, no follow‐up in one). In the present study, the 42 patients with papillary RCC who underwent nephrectomy and were followed up were those in whom the clinicopathological features of the papillary RCC were assessed. Factors assessed were the presence or absence of foam‐cell infiltration, occurrence of bleeding and/or necrosis, presence or absence of a pseudocapsule, mixed occurrence with clear‐cell carcinoma, presence or absence of solid variants, cytoplasmic appearance (basophilic vs eosinophilic cells), stage, nuclear grade of malignancy, and angiographic appearance in relation to prognosis. The prognosis was also compared among patients with clear‐cell, chromophobe cell and papillary RCC.

Results

The prognosis was significantly better in patients with foam‐cell infiltration (P=0.03), with a pseudocapsule (P=0.07), with no solid variants (P=0.001) and with basophilic cells (P<0.001). There were also significant differences in survival between patients with low‐stage (1+2) and high‐stage (3+4) disease (P=0.003), and among grades 1–3 (grade 1 vs 2, P=0.05; grade 1 vs 3, P<0.001, grade 2 vs 3, P=0.006). Furthermore, the prognosis in patients with papillary RCC was worse than in those with chromophobe cell carcinoma (P=0.02), but there was no significant difference in survival between patients with papillary RCC and those with clear‐cell carcinoma.

Conclusion

The clinicopathological features (e.g. the presence or absence of foam cells, of a pseudocapsule and of solid variants, cytoplasmic appearance, and the stage and nuclear grade of malignancy) are important prognostic factors for patients with papillary RCC. Furthermore, the prognosis in patients with papillary RCC is similar to those with clear‐cell carcinoma.