bluuebunny/crossref_metadata_2025 huggingface dataset:
Twigs on the tree of life? Neutral and selective models for integrating macroevolutionary patterns with microevolutionary processes in the analysis of asexuality
Authors: SCHWANDER TANJA , CRESPI BERNARD J.
Published: November 2008

Neutral models characterize evolutionary or ecological patterns expected in the absence of specific causal processes, such as natural selection or ecological interactions. In this study, we describe and evaluate three neutral models that can, in principle, help to explain the apparent 'twigginess' of asexual lineages on phylogenetic trees without involving the negative consequences predicted for the absence of recombination and genetic exchange between individuals. Previously, such phylogenetic twiggyness of asexual lineages has been uncritically interpreted as evidence that asexuality is associated with elevated extinction rates and thus represents an evolutionary dead end. Our first model uses simple phylogenetic simulations to illustrate that, with sexual reproduction as the ancestral state, low transition rates to stable asexuality, or low rates of ascertained ‘speciation’ in asexuals, can generate twiggy distributions of asexuality, in the absence of high extinction rates for asexual lineages. The second model, developed by Janko et al. (2008), shows that a dynamic equilibrium between origins and neutral losses of asexuals can, under some conditions, generate a relatively low mean age of asexual lineages. The third model posits that the risk of extinction for asexual lineages may be higher than that of sexuals simply because asexuals inhabit higher latitudes or altitudes, and not due to effects of their reproductive systems. Such neutral models are useful in that they allow quantitative evaluation of whether empirical data, such as phylogenetic and phylogeographic patterns of sex and asexuality, indeed support the idea that asexually reproducing lineages persist over shorter evolutionary periods than sexual lineages, due to such processes as mutation accumulation, slower rates of adaptive evolution, or relatively lower levels of genetic variability.
The biogeography of Miniopterus bats (Chiroptera: Miniopteridae) from the Comoro Archipelago inferred from mitochondrial DNA
Authors: WEYENETH NICOLE , GOODMAN STEVEN M. , STANLEY WILLIAM T. , RUEDI MANUEL
Published: November 2008

The endemic fauna of the Comoro Archipelago is composed of a mixture of taxa originating from Africa and Madagascar. Bats are the only native land dwelling mammals on this archipelago, but the biogeographical origins for the vast majority of species within this group are ambiguous. We report here genetic analyses based on two mitochondrial DNA markers to infer the origin of Comorian bats belonging to a reputed species complex of Miniopterus that is further distributed across Africa and Madagascar. Phylogenetic reconstructions show that east African M. minor are not closely related to the insular Miniopterus of Madagascar and the Comoros (Grande Comore and Anjouan). The latter cluster into two distinct, monophyletic clades (Clade 1 and Clade 2). Representatives of these clades occur sympatrically both on the Comoros and on Madagascar, and are distinguished by a large genetic distance (K2P: 9.9% for cytochrome b). No haplotypes are shared between any islands, suggesting the absence of contemporary gene flow. Populations of the widespread Clade 1 are furthermore characterized by a significant inter‐island structure (ΦCT = 0.249), and by high haplotype and nucleotide diversities (h = 0.90–0.98, π = 0.04–0.06). Demographic analyses of Clade 1 suggest secondary contact between two distinct phylogroups (Subclade 1 A and 1B) that reached Grande Comore and Anjouan, and a large, stable population with a long evolutionary history on Madagascar. These results and the current distribution of related lineages suggest that the Comoros were colonized independently at least two or three times by ancestors from Madagascar.
Sequencing over 13 000 expressed sequence tags from six subtractive cDNA libraries of wild and modern wheats following slow drought stress
Authors: ERGEN NESLIHAN Z. , BUDAK HIKMET
Published: November 2008

A deeper understanding of the drought response and genetic improvement of the cultivated crops for better tolerance requires attention because of the complexity of the drought response syndrome and the loss of genetic diversity during domestication. We initially screened about 200 wild emmer wheat genotypes and then focused on 26 of these lines, which led to the selection of two genotypes with contrasting responses to water deficiency. Six subtractive cDNA libraries were constructed, and over 13 000 expressed sequence tags (ESTs) were sequenced using leaf and root tissues of wild emmer wheat genotypes TR39477 (tolerant) and TTD‐22 (sensitive), and modern wheat variety Kiziltan drought stressed for 7 d. Clustering and assembly of ESTs resulted in 2376 unique sequences (1159 without hypothetical proteins and no hits), 75% of which were represented only once. At this level of EST sampling, each tissue shared a very low percentage of transcripts (13–26%). The data obtained indicated that the genotypes shared common elements of drought stress as well as distinctly differential expression patterns that might be illustrative of their contrasting ability to tolerate water deficiencies. The new EST data generated here provide a highly diverse and rich source for gene discovery in wheat and other grasses.
Good Samaritan liver donor in pediatric transplantation
Authors: Jean‐Bernard Otte
Published: November 2008

Abstract:  We report a case of anonymous liver transplantation from adult to child.
Cytomegalovirus encephalitis/retinitis in allogeneic haematopoietic stem cell transplant recipient treated successfully with combination of cidofovir and foscarnet
Authors: Hubacek Petr , Keslova Petra , Formankova Renata , Pochop Pavel , Cinek Ondrej , Zajac Miroslav , Lochmanova Jana , Stary Jan , Sedlacek Petr
Published: November 2008

Abstract:  We report an 18‐yr‐old female patient with repeated CMV reactivations after HSCT treated by several pre‐emptive courses of virostatic therapy. Seven months after HSCT, she developed CMV encephalitis/retinitis. Initial therapy with GCV and hyperimmune globulin failed, and later on GCV‐resistant strain was detected. Continual increase of CMV DNA in peripheral blood led us to combined therapy with CDV and FCV, which was successful and free of severe renal toxicity. To our best knowlegde, this is the first reported case of successful CMV treatment with a combination of CDV and FCV.
Inter‐ and intraspecific sequence variations of the chloroplast genome in wild and cultivated Raphanus
Authors: Yamagishi H. , Terachi T. , Ozaki A. , Ishibashi A.
Published: November 2008

To assess the differentiation of the chloroplast genome in wild and cultivated species of Raphanus, nucleotide sequence polymorphisms were investigated for approximately 2 kbp ranging from trnL (UAA) to psbG in R. raphanistrum and R. sativus. Eighteen plants of wild species, 10 Japanese wild radish plants (R. sativus), and 31 cultivated plants were used for sequence analysis. Intraspecific variations of the chloroplast genome were present both in wild and cultivated Raphanus. All three genes investigated (trnL, trnF and ndhJ) contained nucleotide substitutions within the genus. Whereas, larger numbers of mutations were observed in the intergenic regions. Using the detected variations, the 59 radish plants were classified into 11 haplotypes, seven of which were unique to wild species. Among the haplotypes, one type corresponded completely with the Ogura male sterile cytoplasm. All the cultivated radishes belonged to one of four types, of which three were also observed in Japanese wild radish. The haplotypes were classified into four groups by cluster analysis, and the distribution in the dendrogram confirmed that cultivated radish has multiple origins. On the other hand, the seven haplotypes uniquely observed in R. raphanistrum were considered as useful materials to provide genetic diversity of cytoplasm for breeding of cultivated radishes.
Maternal mortality over the last decade: A changing pattern of death due to alarming rise in hepatitis in the latter five‐year period
Authors: Rana Ashma , Pradhan Neelam , Manandhar Bekha , Bitsta Kesang Diki , Adhikari Silu , Gurung Geeta , Amatya Archana
Published: November 2008

Aims:  To study the causes of maternal mortality in two consecutive five year periods over a decade (1997–2001/2002–2006) in a university hospital.

Method:  A maternal mortality over 10 years (1997–2006) was analyzed prospectively from the Obstetrics/Gynecology Department of Tribhuvan University Teaching Hospital.

Results:  The maternal mortality ratio of 267.5/100 000 live births was affected by 83 (41 [49.3%] direct, 36 [43.3%] indirect and six [7.2%] non‐obstetric) maternal deaths in 31 021 live births. Direct cause was led by infections (n = 23, 27.7%): 15 septic abortions (two [2.4%] spontaneous and 13 [15.6%] induced; seven of these occurred in 1997–2001); along with seven (8.6%) cases of puerperal sepsis; a case of antenatal septic shock; and a case of hemolysis, elevated liver enzyme levels, and low platelet count syndrome. There were eight (9.8%) cases of obstetric hemorrhage (six post‐partum hemorrhage; two abortions); eclampsia (n = 2); severe pregnancy‐induced hypertension with hemolysis, elevated liver enzyme levels, and low platelet count syndrome (n = 1); and cesarean complications included one from anesthesia and another surgical, which was included under post‐partum hemorrhage. There were two cases of pulmonary embolism and four unexplainable deaths. Indirect causes included infective hepatitis (n = 19, 22.8%) (13 of these occurred in the more recent 5‐year period [2002–2006]), followed by heart disease (n = 6), tuberculosis (n = 5, 6%), anemia (n = 3, 3.6%) and a case each of meningitis, chronic renal failure and diarrhea. Six non‐obstetric deaths occurred: one from a road traffic accident; and five due to suicidal (n = 1) and accidental (n = 4) burns.

Conclusion:  Maternal mortality over a period of a decade in an institutional setting exhibited induced septic abortion as the main cause of maternal death during the first five years of the study period (1997–2001). In the second five years of the study period (2002–2006) an alarming rise in infective hepatitis became the main cause of maternal death.
Ecophysiological differences of betaproteobacterial populations in two hydrochemically distinct compartments of a subtropical lagoon
Authors: Alonso Cecilia , Zeder Michael , Piccini Claudia , Conde Daniel , Pernthaler Jakob
Published: November 2008

We studied the population sizes and substrate incorporation patterns of three phylogenetic groups of Betaproteobacteria in a coastal subtropical lagoon that is characterized by a sharp transition from humic freshwater to turbid brackish water. Various cellular processes were addressed by short‐term incubations with four radiolabelled compounds and microautoradiographic assessment of substrate incorporation. Group‐specific differences in the abundances and the respective physiological state of the three populations were observed upon transfer from the humic‐rich compartment to the main body of the lagoon (estimated at 1–2 days). Members of the clade B of Polynucleobacter (PnecB) experienced only an insignificant change in cell numbers, but displayed a general metabolic downshift, carbon metabolism (glucose incorporation) being most affected. By contrast, bacteria from the closely related Polynucleobacter C clade (PnecC) clearly differed in total abundances and in the numbers of DNA‐synthesizing or glucose incorporating cells. At the same time, PnecC bacteria maintained comparable levels of protein synthesis (leucine uptake) in both lagoon compartments, and the proportion of cells incorporating N‐acetylglucosamine was even higher in the main body of the lagoon. Members of the R‐BT lineage showed little changes in cell numbers, DNA synthesis and carbon metabolism. Altogether, the observed patterns of substrate metabolism suggest that different bacterial populations in the lagoon undergo specific physiological adjustments in response to changing environmental conditions.
Species‐sorting may explain an apparent minimal effect of immigration on freshwater bacterial community dynamics
Authors: Jones Stuart E. , McMahon Katherine D.
Published: November 2008

Long distance atmospheric transport of bacterial cells is often implied as a driver of the apparent cosmopolitan distribution of bacterial taxa. Surprisingly, efforts to measure immigration in bacterial communities are rare. An 8‐week time series of within‐lake bacterial community composition and atmospheric deposition rates and composition were used to estimate the influence of immigration on bacterial community dynamics in two north temperate lakes. Characterization of bacterial community dynamics using automated ribosomal intergenic spacer analysis suggested moderate overlap in composition between the lakes and atmospherically deposited cells. However, taxa that appeared to be delivered by atmospheric deposition had a relatively minor influence on lake bacterial community dynamics. The weak influence of immigrating bacterial taxa suggests that a species‐sorting concept best describes aquatic bacterial metacommunity dynamics.
VESICAL CALCULUS IN NORFOLK
Authors: Thomas J. M. Ridley
Published: November 2008

1. No longer can Norfolk be considered an area where vesical calculus is common.

2. Vesical calculus in children, once very common, has now become very rare.

3. The disappearance coincides with the rise in the standard of living, and quite noticeably with the change to mixed farming in a county which was formerly grain‐ producing. This agricultural change took place between the years 1916 and 1925.

4. Rationing of foodstuffs has, if anything, still further diminished the incidence

5. At the present time approximately only 10 per cent. of patients with vesical calculi do not have an organic lesion in the urinary tract predisposing to the formation of calculus.
THE URINARY CITRATE EXCRETION IN PATIENTS WITH RENAL CALCULI
Authors: Conway Nancy S. , Maitland A. Ian L. , Rennie J. Basil
Published: November 2008

It has been suggested that an important factor in the formation of renal calculi is a deficiency of citrate excretion by the kidney. This we have failed to confirm and consider rather that any gross diminution of urinary citrate is due simply to infection of the urinary tract. The proof of this is as follows:‐

1. In seven patients with calculi and a sterile tract the average citrate content of the urine was comparable with that found in controls.

2. Seven patients with calculi, associated with infection, were all found to have less citrate in their urine than normals.

3. Experiments in vitro confirmed that in this latter group citrate was destroyed particularly by E. colz, although with Kosers medium this splitting action was not detectable.
SIMULTANEOUS BILATERAL URETEROCOLIC ANASTOMOSIS
Authors: Hickey B. B.
Published: November 2008

A method of simultaneous bilateral ureterocolic anastomosis based on that devised by Davalos is described, and a short account is given of four patients on whom it was employed satisfactorily.
Genito‐urinary Complications of Brucellosis
Authors: IBRAHIM A. I. A. , AWAD R. , SHETIY S. D. , SAAD M. , BILAL N. E.
Published: November 2008

Summary— Twelve cases of genito‐urinary complications of brucellosis are presented. Ten patients had epididymo‐orchitis, 1 presented with right hydronephrosis and 1 with haematuria and dysuria. The 10 cases of epididymo‐orchitis were compared with 15 cases of acute non‐specific epididymo‐orchitis. The former were of longer duration and were not associated with lower urinary tract symptoms; almost all of these patients had ingested unpasteurised milk. Non‐specific epididymo‐orchitis had a more acute onset, shorter duration and was associated more frequently with pyuria, lower urinary tract symptoms, higher leucocyte counts and insignificant brucella titres.

The distinction between these two types of epididymo‐orchitis is essential, since the treatments are entirely different.
The Limited Usefulness of External Beam Radiotherapy in the Control of Superficial Bladder Cancer
Authors: Sawczuk I. S. , Olsson C. A. , White R. deVere
Published: November 2008

Summary— Thirty‐seven patients with superficial bladder cancer (Ta, T1) who failed local control were treated with external beam radiotherapy: 22 received full dose radiotherapy without interval cystoscopic monitoring and 15 followed a protocol in an attempt to select a subgroup of radiosensitive tumours. Both the unselected and protocol treated patients demonstrated the limited usefulness of external beam radiotherapy in the treatment of superficial bladder cancer.
Congenital Ureteric Valve Associated with Renal Dysgenesis
Authors: POURMAND G. , KAMALIAN N. , SOHRABVAND F.
Published: November 2008

The first case of congenital ureteric valve was presented by Wolffer in 1887. Since then only 29 cases have been reported (Sant et al., 1985). Twelve were associated with congenital abnormalities such as complete and incomplete duplication of the kidney, horseshoe kidney and posterior urethral valves. We report a patient with a congenital ureteric valve and renal dysgenesis.
Intravesical Migration of Lippes Loop with Stone Formation
Authors: SASIDHARAN K. , CHALLY R.
Published: November 2008

The migration of intra‐uterine devices into the bladder with the formation of stone occurs rarely (Woods and Wise, 1980). We record an example.
Long‐term Follow‐up of lntravesical Epodyl Therapy for Superficial Bladder Cancer
Authors: MUFTI G. R. , VIRDI J. S. , HALL M. H.
Published: November 2008

Summary— The records of 111 patients with multiple superficial grade 1–2 transitional cell tumours of the bladder treated with intravesical Epodyl and followed up for a mean period of 6.4 years were retrospectively analysed. The study showed that 65% of patients responded completely after 12 weekly instillations and 46% of these remained continuously free of disease for 5 years. An initial complete response to therapy and lower pathological grade seemed to indicate a long‐term successful response to treatment. In patients who failed to respond by 1 year, further therapy was of no benefit. Clearance of bladder disease by 1 year carried a 14% risk of subsequent tumour invasion by 5 years. This risk increased to 75% in those who failed to respond by 1 year.
Extravascular Absorption of Irrigating Fluid during TURP. The Role of Transmural Bladder Pressure as the Driving Pressure Gradient
Authors: HULTÉN J. O. , SUNDSTRÖM G. S.
Published: November 2008

Summary— The critical intravesical pressure range for extravascular absorption of irrigating fluid (EVA) during transurethral resection of the prostate (TURP) is determined by the pressure in the perivesical tissue. This means that the transmural bladder pressure (detrusor pressure), calculated by deducting perivesical pressure from intravesical pressure during cystometry, is the pressure gradient behind EVA. The transmural pressure in 6 patients undergoing TURP has been studied both before and during epidural anaesthesia, using both conventional medium‐fast fill cystometry and “free‐flow” cystometry through the resectoscope. Epidural block does not influence the transmural pressure response on filling the bladder and neither does the type of infusion. A positive transmural pressure, and thereby a pressure gradient for EVA, exists already during the very early phase of bladder filling. Incomplete perforation of the prostatic capsule and clotting, as well as the accumulation of irrigating fluid in the perivesical tissue, probably moderate the rate of absorption.
Comparison of Catheter Surface Morphologies
Authors: COX AVERIL J.
Published: November 2008

Summary— The surface morphologies of different generic types of Foley catheter have been investigated using scanning electron microscopy (SEM). The characteristic features of each material are illustrated and it is shown that distinct differences exist between the inner and outer surfaces of latex‐based catheters; these differences are attributed to the methods of manufacture. The possible relations between morphology and performance in situ are discussed.
Buried Penis. A Novel Approach
Authors: WOLLIN M. , DUFFY P. G. , MALONE P. S. , RANSLEY P. G.
Published: November 2008

Summary— Buried penis is a congenital abnormality in which the phallus is concealed within the subcutaneous tissue. The corporal bodies and glans have developed normally. A deficiency of penile shaft skin in association with abnormal mobility of the skin gives rise to the phenotypic appearance. The skin defect may be related to an abnormal attachment of dartos muscle during embryogenesis. Correction of this condition requires separation of these abnormal muscular attachments and provision of skin coverage of the penile shaft. It is imperative not to circumcise the patient as this will worsen the skin deficiency. We describe a novel technique for correcting buried penis performed on 12 patients at the Great Ormond Street Hospital for Sick Children. A satisfactory cosmetic result was obtained in all patients.
Validation of a Self‐administered Urological Questionnaire
Authors: BRITTON J. P. , DOWELL A. C. , WHELAN P.
Published: November 2008

Summary— Self‐administered questionnaires are widely used in clinical practice and as an aid to research. However, their reliability as a means of eliciting symptoms of urological disease has not been established.

A questionnaire designed to elicit symptoms of urological disease was validated in 120 patients (36 out‐patients, 27 in‐patients and 57 community patients). All found the questionnaire acceptable and the completion rate was 99%. Only 3 of 648 answers were changed on the test‐retest analysis. Consistency, as assessed by a comparison of responses by clinician and patient, was satisfactory in 11 of 15 questions relating to urological symptoms and the questionnaire successfully identified a high risk group of patients from the community requiring further urological evaluation.

The need to include results of a preliminary validation study when reporting results obtained by a self‐administered questionnaire is emphasised.
Pyelo‐intestino‐cutaneous Conduit in the Treatment of Renal Carcinoma of Solitary Kidneys
Authors: HAAPIAINEN R. K. , LINDELL O. I. , RANNIKKO S. A. S.
Published: November 2008

Summary— A pyelo‐intestino‐cutaneous conduit, either by colonic or ileal segment, was used successfully in 4 patients with urothelial carcinoma affecting a solitary kidney. Primary healing was good but involved the risk of stricture formation. During the follow‐up period (10–48 months), repeated endoscopic check‐ups were easily performed through the conduit, enabling coagulation of recurrent tumour growth. Two patients are still alive and well; 2 are dead.
Transurethral Ureterorenoscopic Lithotripsy and Retrieval of Ureteric Calculi under Local Anaesthesia and Sedation
Authors: CHAN P. S. F. , FENN J. , LI A. K. C.
Published: November 2008

Summary— Under strict indications, ureterorenoscopic (URS) lithotripsy was used to treat ureteric calculi in 61 patients under local anaesthesia and sedation in a 2‐year period ending November 1988. Assessments of success and discomfort of the procedure were made. Stone retrieval was accomplished in 48 patients (78% success rate) and a mean pain score of 6 was recorded in a scale from 0 to 10. It was concluded that performing URS under local anaesthesia is an acceptable alternative.
Voiding Patterns in Men Evaluated by a Questionnaire Survey
Authors: SOMMER P. , NIELSEN K. K. , BAUER T. , KRISTENSEN E. S. , HERMANN G. G. , STEVEN K. , NORDLING J.
Published: November 2008

Summary— A questionnaire on obstructive and irritative voiding symptoms was sent to 572 men aged between 20 and 79 years, selected at random from the National Register; 337 questionnaires were completed. None of the responders had consulted a doctor because of voiding symptoms. There was a significant increase in voiding symptoms and in the obstructive, irritative and total symptom scores between the fifth and sixth decades, whereas the increases in the other decades were small. Only the prevalence of terminal dribbling was uniform. The prevalence of single obstructive and irritative voiding symptoms in men aged 60 to 79 years without subjective prostatism was the same as in patients admitted with prostatism, although most of the men had milder symptoms. Only nocturia and urge incontinence were more prevalent in patients admitted with prostatism. About 20% of men in the oldest decades had symptoms equal in severity to those found in men undergoing prostatectomy; 29% and 11% of men in the seventh decade had nocturia twice and 3 times or more respectively; 19% complained of urge incontinence. More information on possible treatment is needed.
Assessment of the Poorly Contractile or Acontractile Bladder in the Older Male in the Absence of Neuropathy
Authors: McINERNEY P. D. , ROBINSON L. Q. , WESTON P. M. T. , COX R. , STEPHENSON T. P.
Published: November 2008

Summary— Up to 30% of patients who undergo prostatectomy are left with residual symptoms. Most have persistent detrusor instability, but some have poorly contractile or acontractile bladders. Over a 2‐year period, 42 neurologically normal patients were shown to have a hypocontractile or acontractile bladder on urodynamic testing; 27 had undergone outflow tract surgery. Four patients who were totally incontinent had undergone at least 2 transurethral resections. The remainder had severe frequency, urgency and nocturia. Urodynamically, all but 7 patients with poor compliance had normal filling cystometrograms, all but 8 had residual urine volumes less than 100 ml, and 26 had less than 5 ml. Thus their symptoms are difficult to explain. Apart from the insertion of an artificial sphincter in those with total incontinence, treatment did not improve any of these patients.
Influence of Retinoids on Bladder Cancer Growth as Detected by Primary Tissue Culture
Authors: SAWCZUK I. S. , OLSSON C. A. , MERTZ J. R.
Published: November 2008

Summary— The ability of the retinoid compounds, all‐trans and 13‐cis, to inhibit the growth of bladder tumour cells was investigated in primary tissue culture. A significant decrease in tumour growth was evident in 9 human bladder cancer patients. Since retinoid compounds are able to delay the progression or induction of tumours in primary tissue culture, their trial use as intravesical agents may be warranted.
A New Self‐retaining Intraurethral Device: An Alternative to an Indwelling Catheter in Patients with Urinary Retention due to Infravesical Obstruction
Authors: NISSENKORN I. , RICHTER S.
Published: November 2008

Summary— A new self‐retaining intraurethral catheter, designed as an alternative to an indwelling catheter, has been used in 14 patients. It was left in place for 2 to 18 weeks; 11 of the 14 patients were able to void freely, were continent and had neither residual urine nor urinary tract infection. This device may be used instead of an indwelling Foley catheter in patients with retention due to infravesical obstruction and may be an alternative to prostatectomy in patients who are at high risk for surgery.
Local Hyperthermia of the Prostate Gland for the Treatment of Benign Prostatic Hypertrophy and Urinary Retention
Authors: LINDNER A. , BRAF Z. , LEV A. , GOLOMB J. , LEIB Z. , SIEGEL Y. , SERVADIO C.
Published: November 2008

Summary— Local hyperthermia of the prostate was used to treat 72 patients who had an indwelling catheter because of urinary retention caused by benign prostatic hypertrophy. One month after completion of treatment 50% of patients were able to dispense with the catheter and 1 year later 40% remained catheter‐free. The best results were achieved in patients who underwent 6 to 10 treatment sessions in conjunction with cyproterone acetate 50 mg tid administered during the treatment period only.
The Scrotoscope. A New Instrument for Examining the Scrotal Contents
Authors: SHAFIK A.
Published: November 2008

Summary— A new instrument (the scrotoscope) is described. It was used in the diagnosis of questionable masses in the testis, epididymis and spermatic cord in 49 patients. Scrotal examination and testicular biopsy were performed in 31 infertile patients by means of the scrotoscope, together with pampiniform plexus venography in 1 patient and vasography in 2. Scrotoscopy allows the surgeon to view, study and treat intrascrotal lesions.
Single Urine Sample Diagnosis. A New Concept in Stone Analysis
Authors: BOWSHER W. G. , CROCKER P. , RAMSAY J. W. A. , WHITFIELD H. N.
Published: November 2008

Summary— A method of single urine sample crystal diagnosis after extracorporeal Shockwave lithotripsy (ESWL) is described.
Treatment of Lymphocele Associated with Renal Transplant
Authors: NICHOLSON M. L. , VEITCH P. S.
Published: November 2008

Summary— A new method of operative drainage of lymphoceles following renal transplantation is described. The technique involves intraperitoneal marsupialisation of the lymphocele cavity followed by insertion of a Tenckhoff peritoneal dialysis catheter to splint open the peritoneal window and act as an internal drain.
Prostate Tumour Markers as an Aid in the Staging of Prostatic Cancer
Authors: HAAPIAINEN R. K. , PERMI E. J. , RANNIKKO S. A. S. , VOUTILAINEN P. E. J. , LIEWENDAHL K. , STENMAN U.‐H. , ALFTHAN O. S.
Published: November 2008

Summary— Serum acid phosphatase activity (ACP), prostate specific phosphatase (PAP) and prostate specific antigen (PSA) were measured in 100 patients with prostatic cancer. The patients were divided into 4 groups: T1–2 MO, T3–4 MO and M1 patients with ≤10 or > 10 metastatic foci in bone scintigraphy. The mean serum ACP levels were almost identical in the T1–2 MO and T3–4 MO groups and there was no significant difference between the mean PAP values. Significantly higher PSA levels were observed in the MO patients in the extracapsular category compared with those in the intracapsular category. The mean serum levels of all 3 tumour markers were significantly higher in the M1 than in the MO category. PSA seems to be the marker of choice as a diagnostic aid for differentiating between patients with intracapsular and those with extracapsular tumour growth. In prostatic cancer patients with bone metastases these markers were of similar value for staging the disease.
Erythrocyte Stearic to Oleic Acid Ratio in Prostatic Carcinoma
Authors: PERSAD R. A. , GILLATT D. A. , HEINEMANN D. , HABIB N. A. , SMITH P. J. B.
Published: November 2008

Summary— The red cell membrane stearic acid to oleic acid ratio was analysed in 34 men with histologically proven carcinoma of the prostate and distant metastases. This ratio was expressed as the saturation index (SI). A mean SI of 0.97 was found in control patients without evidence of any malignancy whereas all patients with advanced prostatic cancer showed a reduced stearic to oleic acid ratio (mean SI 0.466). Untreated patients had a significantly lower SI (mean 0.36) than those who had responded to hormonal therapy (mean 0.547; P < 0.0001). A drop in SI correlated well with more advanced disease as judged by radiological findings and serum PSA.

It is suggested that red cell membrane SI correlates well with radiological and biochemical markers of advanced prostatic carcinoma and may be used as a marker to assess progress and response to treatment.
Effect of High‐dose Medroxyprogesterone Acetate on Plasma Hormone Levels and Pain Relief in Patients with Advanced Prostatic Cancer
Authors: SASAGAWA I. , SATOMI S.
Published: November 2008

Summary— High‐dose medroxyprogesterone acetate (MPA) was given orally to 7 patients with advanced prostatic cancer and severe pain due to bone metastases; 5 patients had stable and 2 had progressive disease. Pain relief was obtained in 6 patients. Two patients who reported complete relief of pain showed suppressed levels of gonadotrophins after MPA treatment. In the other patients, suppression of plasma gonadotrophin levels was observed before treatment. The plasma levels of prolactin, growth hormone and thyroid stimulating hormone were not affected by MPA. Only 1 patient showed suppression of plasma adrenocortical trophic hormone. The plasma levels of cortisol and dihydroepiandrosterone sulphate were suppressed in 6 patients, but there was no correlation between the suppression and the occurrence of pain relief. These findings suggest that the mechanism of pain relief by high‐dose MPA may be very complicated.
Balloon Dilatation of the Prostate: Technique and Early Results
Authors: KEANE P. F. , CHARIG C. R. , HUDD C. , SHAH P. J. R. , KELLETT M. J. , BOYLE J. , WICKHAM J. E. A. , O'DONOGHUE E. P. N.
Published: November 2008

Summary— Fourteen men with outflow obstruction were treated by balloon dilatation of the prostatic urethra using 25 and 30 mm balloon catheters. Significant improvement in objective measurement of outflow obstruction was noted in only 2 patients.
Experience with Ultrasound Guided Transperineal Prostatic Needle Biopsy 1985–1988
Authors: CLEMENTS R. , GRIFFITHS G. J. , PEELING W. B. , RYAN P. G.
Published: November 2008

Summary— A consecutive series of 143 ultrasound guided biopsies of the prostate have been analysed. In 84 patients, in whom carcinoma was suspected by both digital examination and ultrasound, 49 cancers were confirmed histologically. In 29 patients in whom digital examination suggested cancer but ultrasound was normal, 2 cancers were confirmed. In 20 patients with a normal digital examination but a suspicious ultrasound appearance, no cancers were proven.
Histological Grading of Prostatic Carcinoma in Prostatectomy Specimens: Comparison of Prognostic Accuracy of Five Grading Systems
Authors: GALLEE M. P. W. , TEN KATE F. J. W. , MULDER P. G. H. , BLOM J. H. M. , Van der HEUL R. O.
Published: November 2008

Summary—The prognostic accuracy of 5 histological grading systems (Broders, Anderson, Mostofi, Gleason and Mostofi‐Schroeder) was compared. Grading was performed on 50 prostatectomy specimens by 5 pathologists. The results were averaged so as to reduce the impact of inter‐observer variation. The Cox proportional hazards model was used to estimate the relationship between average grading scores and both time‐to‐recurrence and time‐to‐death by prostatic carcinoma. Age at surgery was considered to be a possible confounding factor and adjusted accordingly. The prognostic impact of the 5 grading systems (related to both recurrence and death caused by prostatic carcinoma) was judged by the likelihood ratio (LR) test score (χ2distributed with 1 df); for time‐to‐recurrence for the Mostofi‐Schroeder score the LR was 6.54 and for the Gleason system it was 1.79. A stepwise procedure demonstrated that the best prognostic performance was reached with the Mostofi‐Schroeder and Broders systems used together (with Mostofi‐Schroeder weighted 1.5 times larger than Broders). For time‐to‐recurrence the median grading result was also used, giving results similar to the mean grading result. For time‐to‐death from prostatic carcinoma the LR test scores for all grading systems were relatively low. In this analysis the outcome of the Gleason system showed a minimum of prognostic ability, whereas the Broders and Mostofi‐Schroeder systems had a reasonable predictive ability. Since the inter‐observer variation of the Mostofi‐Schroeder system was large, the Broders system is preferable. The restrictions and implications of this study are discussed and a brief review of the prognostic importance of grading of prostatic carcinoma is presented.
Fetal Vesicoureteric Reflux
Authors: NAJMALDIN A. , BURGE D. M. , ATWELL J. D.
Published: November 2008

Summary— We present an analysis of 30 patients with fetal vesicoureteric reflux (VUR) from a series of 107 patients with prenatally diagnosed urinary tract anomalies. In 13 patients (Group I) the fetal VUR was the only urinary tract abnormality. In 17 patients (Group 2) the fetal VUR was combined with other urinary tract problems. In 14 of 46 refluxing renal units there was no evidence of upper tract dilatation on a pre‐and post‐natal ultrasound examination. Any infant with postnatal urinary tract dilatation needs full urological investigations, including a micturating cystogram. A normal postnatal ultrasound examination does not exclude fetal VUR.
Prenatally Diagnosed Reflux: a Follow‐up Study
Authors: GORDON A. C. , THOMAS D. F. M. , ARTHUR R. J. , IRVING H. C. , SMITH S. E. W.
Published: November 2008

Summary— This report analyses the characteristics and outcome of 25 infants with vesicoureteric reflux detected prenatally on the basis of dilatation of the fetal urinary tract. Sixteen infants had bilateral reflux—a total of 41 refluxing units.

The high proportion of males (84%) contrasts with clinically presenting reflux, which is dominated by females. Prenatally diagnosed reflux is generally of a higher grade—usually grade IV.

Eight children (32%) had coexistent congenital abnormalities. Chemoprophylaxis was completely effective in 17 children (68%), who remained infection‐free; 3 children (12%) had a single urinary infection and were managed conservatively whilst 5 (20%) experienced 2 or more infections and required reimplantation or vesicostomy. Spontaneous cessation of reflux was observed in 6 (35%) of 17 refluxing ureters reassessed after a mean interval of 2.1 years.

The significance of isotope findings was sometimes difficult to assess but results in 30 refluxing units support the concept that focal renal scarring is usually a consequence of infected reflux in postnatal life.
Results of Surgical Treatment of Severe Vesicoureteric Reflux: Retrospective Study of Reflux Grades 4 and 5
Authors: JANSEN H. , SCHOLTMEIJER R. J.
Published: November 2008

Summary— A series of 80 children underwent surgery in the Sophia Children's Hospital for gross reflux grades 4 and 5. In this retrospective study the success rate for ureteric reimplantation was 90%. Analysis of growth showed that after surgery the children tended to fall within the normal ranges for height and weight. Deterioration in renal function was progressive in 3 children. New renal scars developed in 13% of renal units. Initially non‐refluxing kidneys showed no further deterioration. Moderate hypertension was found in only 4 patients.
Identification of Urinary Stone Composition by Pulsed Dye Laser
Authors: HOLDEN D. , WHITEHURST C. , RAO P. N. , KING T. A. , BLACKLOCK N. J.
Published: November 2008

Summary— Stones were recovered from the urinary tract and their composition determined by X‐ray diffraction before exposure to a pulsed dye laser beam. The resultant fluorescent emissions were recorded using a scanning reticon and they appeared to be specifically related to the composition of each stone.

This technique has a practical application as it may allow identification of the composition of urinary tract stones in vivo, and so indicate the best mode of lithotripsy.
Staghorn Calculi of the Kidney: Classification and Therapy
Authors: SILVERIO F. DI , GALLUCCI M. , ALPI G.
Published: November 2008

Summary— Following the introduction of new techniques, the reclassification of staghorn calculi is indicated in order to establish the most suitable form of treatment.

Of 269 patients with staghorn calculi treated over a 3‐year period, 56% underwent extracorporeal Shockwave lithotripsy (ESWL) monotherapy; 16% required open surgery and the remaining 28% underwent percutaneous nephrolithotripsy (PCNL) with ultrasound in association with ESWL. The latter group has been reviewed, taking into account invasiveness, results, complications and cost effectiveness. A combination of PCNL and ESWL was beneficial in patients in whom percutaneous access through a single tract removed more than 70% of the stone. As a result of these findings, the authors propose a revised classification of staghorn calculi.
Continence after Total Bladder Replacement: Urodynamic Analysis of the Ileal Neobladder
Authors: BACHOR R. , FROHNEBERG D. , MILLER K. , EGGHART G. , HAUTMANN R.
Published: November 2008

Summary— Since April 1986 we have carried out 103 bladder substitutions with the ileal neobladder; 91 of these were performed after radical cystectomy in males (group 1) and 12 after subtotal bladder resection (group 2); 55 patients in group 1 and 8 in group 2 were followed up by long‐term urodynamic investigations and by a questionnaire concerning micturition patterns and continence at home 3 months post‐operatively. The maximum bladder capacity was approximately 770 ml with an absolute intravesical pressure of 23 to 30 cm H2O. Intravesical pressure waves with a mean amplitude of 20 cm H2O were found in 38% of patients in group 1 and 25% in group 2; 61% of these patients were asymptomatic.

The results showed that 85% of patients were continent by day and by night. We attribute this to our operative technique: the ileal loop is folded 4 times in a “W” or “M” shape to achieve complete detubularisation of the bowel and the external urethral sphincter is carefully preserved. Altogether, these data show the ileal neobladder technique to be a reliable and safe method of bladder substitution.
Total Bladder Replacement in the Male and Female Using the lleocolonic Segment (LeBag)
Authors: LIGHT U. K. , MARKS J. L.
Published: November 2008

Summary— A group of 11 patients, 2 female and 9 male, underwent total bladder replacement using the ileocolonic segment (LeBag technique) with anastomosis of the bowel to the urethra. The diagnosis was invasive bladder cancer in 10 patients and severe intractable interstitial cystitis in 1. The surgical technique in the male patients was modified to simplify the procedure. The 2 female patients underwent insertion of an artificial sphincter around the bowel segment for a continence mechanism. One patient died 6 weeks post‐operatively from a severe coagulopathy. Five of the 9 male patients are continent day and night, relying on their own residual sphincter mechanism, but the remaining 4 required insertion of the artificial urinary sphincter to achieve social continence. The surviving female patient is totally continent. All patients have voiding intervals of 4 to 6 h during the day and are thus continent both day and night, but in some cases the artificial sphincter was necessary to achieve this. Loss of the normal bladder‐sphincter reflexes following cystectomy may account for the high incidence of nocturnal incontinence observed in most series. Total bladder replacement is now possible in both male and female patients, thus avoiding an abdominal stoma.
Treatment of Bladder Carcinoma Using a Germ Cell Chemotherapy Protocol
Authors: WILLIAMS GRANT , COLBECK R. A. , CRAWFORD S. M.
Published: November 2008

Summary— Elevated levels of circulating β‐human chorionic gonadotrophin (β‐HCG) are commonly associated with a variety of tumours of germ cell origin. Other carcinomas may possess choriocarcinomatous elements but only rarely have there been reports of transitional cell carcinomas of the bladder associated with raised germ cell tumour markers, possibly because assays are not routinely performed.

We present 3 patients with advanced transitional cell carcinoma of the bladder, 2 with metastatic and 1 with locally invasive disease, who had raised levels of germ cell tumour markers. These patients were therefore treated with combination chemotherapy appropriate to such tumours, with excellent results, as shown by clinical improvement and return to normal of tumour marker levels. Recent reports of the association between bladder carcinoma and ectopic synthesis of β‐HCG are reviewed. It was concluded that the production of β‐HCG is probably not rare, but that when it is found, the adoption of an appropriate chemotherapeutic regime may be successful.
The Intraprostatic Spiral. New Treatment for Urinary Retention
Authors: NIELSEN K. K. , KLARSKOV P. , NORDLING J. , ANDERSEN J. T. , HOLM H. H.
Published: November 2008

Summary— In a series of 45 consecutive patients with acute or chronic urinary retention, 41 were treated by insertion of an intraprostatic spiral using ultrasonic guidance under local anaesthesia. Insertion was successful in 35 patients and in 6 the spiral was inserted endoscopically.

During a follow‐up period of 12 months 8 patients died, all with a functioning spiral. The device was removed in 16 patients; in 6 cases the reasons for removal were related to the spiral and in 10 they were not. The spiral remained in situ in 17 patients and all had satisfactory voiding. This device is a good alternative to an indwelling catheter in patients awaiting prostatic surgery and also in those who are either unfit or unwilling to undergo prostatectomy.
Gamma‐seminoprotein—a New Tumour Marker in Prostatic Cancer?: Results of a Pilot Study
Authors: MAIER U. , SIMAK R.
Published: November 2008

Summary— Serum levels of gamma‐seminoprotein (GSM), prostate specific antigen (PSA) and prostate specific acid phosphatase (PAP) were examined, using enzyme immunoassay, in 250 patients with prostatic disease. The results indicated that the highest specificity was obtained with GSM (94%) and the lowest with PSA (60%). In contrast the highest sensitivity in newly detected carcinomas (n = 41) was obtained with PSA (71%), whereas that of GSM (51%) was comparable to that of PAP (44%). Of 41 patients with newly detected prostatic cancer, 35 (85%) showed a significant increase in at least 1 of the tumour markers. Five of 6 patients whose markers were within normal limits had incidental carcinomas. During follow‐up, PSA was raised in 88%, GSM in 66% and PAP in 55% within 12 months prior to clinical progression. Our results suggest that the determination of GSM may be of value in the serological detection and monitoring of prostatic cancer. These findings must be confirmed by further studies with larger numbers of patients and longer follow‐up.
Low Dose Methptrexate and Doxorubicin in Hormone‐resistant Prostatic Cancer
Authors: SMITH M. F. , LAWSON A. H. , KIRK D. , KAYE S. B.
Published: November 2008

Summary— A group of 24 patients, all of whom had progressive disease following initial hormone therapy for advanced prostatic carcinoma, were given intravenous methotrexate (30 mg/m2) and doxorubicin (15 mg/m2) at 2‐week intervals for a planned 6‐treatment course. Seventeen patients completed the full course. Assessment included “quality of life” criteria, using the subjective assessment of performance status, severity of pain and analgesic consumption. Over half of the patients improved in each of these modalities and 8 (33%) improved in all 3. As toxicity was acceptable, low dose chemotherapy may have a part to play in these patients who present a difficult management problem.
Unilateral Testicular Torsion: Abnormal Histological Findings in the Contralateral Testis—Cause or Effect?
Authors: LAOR E. , FISCH H. , TENNENBAUM S. , SESTERHENN I. , MOSTOFI K. , REID R. E.
Published: November 2008

Summary— A histological review of testicular biopsies of the contralateral testis, obtained at the time of surgical intervention for testicular torsion, was performed in 20 post‐pubertal men.

Contralateral histological abnormalities were found in 12 specimens. The duration of torsion correlated well with the viability of the involved testis but not with the presence of contralateral abnormalities.

The high incidence of contralateral histological abnormalities and their nature suggest that they existed prior to the torsion since they would be unlikely to appear at such an early stage. We believe that some patients who suffer testicular torsion probably have congenital anomalies of both testes. These abnormalities involve testicular parenchyma as well as the suspension system.