bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-Related Quality of Life in Lung Transplant Candidates and Recipients
Authors: Stavem Knut , Bjørtuft Øystein , Lund May Brit , Kongshaug Kirsten , Geiran Odd , Boe Jacob
Published: April 2003

Background: Studies on the health-related quality of life in lung transplantation have used general questionnaires, although lung-specific instruments might be more sensitive to small differences. Objectives: To compare the health-related quality of life of lung transplant recipients with lung transplant candidates, using lung-specific and general instruments, and to assess the reliability and validity of these questionnaires. Methods: The study is a cross-sectional postal survey of 31 lung transplant recipients and 15 candidates, using the following outcome measures: St. George’s Respiratory Questionnaire (SGRQ), a lung-specific health status instrument; the Short Form 36 (SF-36), a general measure, and the Hospital Anxiety and Depression scale (HAD). Results: The SGRQ showed a significantly better score (p < 0.05) for transplant recipients in the impacts and activity dimensions and the total score than for candidates. SF-36 scores showed a similar improvement in all subscales of the SF-36 except bodily pain. Cronbach’s α for all dimensions of the SGRQ, SF-36, and HAD were 0.77–0.95. Conclusions: Patients surviving lung transplantations can expect a considerable improvement in most dimensions of health-related quality of life. This finding was consistent using both lung-specific and general measures. The reliability of the questionnaires was acceptable. The associations between scales support the validity of the questionnaires in this setting.
Equivalence of Two Steroid-Containing Inhalers: Easyhaler Multidose Powder Inhaler Compared with Conventional Aerosol with Large-Volume Spacer
Authors: Koskela T. , Hedman J. , Ekroos H. , Kauppinen R. , Leinonen M. , Silvasti M. , Tukiainen H.
Published: April 2003

Background and Objectives: An equivalence study was conducted in which the efficacy and safety of a daily dose of 800 μg of beclomethasone diproprionate administered via a multidose powder inhaler, Easyhaler, and via a metered-dose inhaler (MDI) with a large-volume spacer were compared in adult, newly diagnosed, steroid-naive asthmatic patients. Acceptability of the medications was also compared. Methods: One hundred and forty-four patients were recruited into the double-blind, double-dummy, randomised, parallel-group multicentre study. The study treatment period was 8 weeks. It was preceded by a 2-week run-in period. Morning and evening peak expiratory flow (PEF), numbers of inhalations of a sympathomimetic and asthma symptoms were recorded daily. Spirometry and histamine challenge were performed, and health-related quality of life and morning serum cortisol levels measured during control visits. Results: Criteria indicating treatment equivalence were met. The mean of the primary outcome variable, morning PEF, increased significantly, from 426 to 461 litres/min in the Easyhaler group and from 436 to 467 litres/min in the MDI+spacer group. Similar improvements between groups were also seen in relation to all secondary variables. Changes in serum cortisol levels were minor. In 6 out of 10 questions about device acceptability, the majority of patients rated Easyhaler as better than the MDI+spacer combination. Conclusion: It was concluded that the devices tested were equivalent in terms of efficacy and safety.
Hard Metal Alveolitis Accompanied by Rheumatoid Arthritis
Authors: Hahtola Paula A. , Järvenpää Ritva E. , Lounatmaa Kari , Mattila Jorma J. , Rantala Immo , Uitti Jukka A. , Sutinen Seppo
Published: April 2003

Hard metal lung diseases (HML) are rare, and complex to diagnose. We describe the case of a patient with allergic alveolitis accompanied by rheumatoid arthritis. A sharpener of hard metal by trade, our patient was a 45-year-old, nonsmoking Caucasian female who experienced symptoms of cough and phlegm, and dyspnea on exertion. Preliminary lung findings were inspiratory rales in both basal areas, decreased diffusion capacity and a radiological picture resembling sarcoidosis. A high-resolution computed tomography scan indicated patchy alveolitis as well. An open lung biopsy revealed non-necrotizing granulomas consisting of epitheloid cells and surrounded by lymphocytes, plasma cells and a few eosinophils. These cells also occupied the thickened alveolar interstitium. Macrophages in the alveolar spaces, some of them multinuclear, contained dust particles. Hard metal alveolitis is clinically well known and, in this patient, has been described histologically. After the patient had quit working with hard metal and following corticosteroid therapy, pulmonary symptoms and signs were relieved. During this recovery period, however, she contracted rheumatoid arthritis.
Unilateral Hilar Lymphadenopathy of Sarcoidosis or Sarcoid Reaction Compressing the Trunk of the Right Pulmonary Artery
Authors: Honda Takayuki , Hayasaka Muneharu , Hachiya Tsutomu , Kubo Keishi , Ohashi Masahiko
Published: April 2003

A case of sarcoidosis or sarcoid reaction with a rare manifestation of unilateral lymphadenopathy compressing the trunk of the right pulmonary artery is presented. A 71-year-old woman was admitted for evaluation of a left hilar mass. Chest CT scans showed a mass invading the right pulmonary artery. A frozen section obtained following open lung biopsy showed lymph node tissue largely replaced by noncaseous granulomas indicating sarcoidosis or sarcoid reaction. Old uveitis was compatible with sarcoidosis, and no malignancy was evident. These findings suggested sarcoidosis, however, other evidence of sarcoidosis was not obtained.
Fatigue Associated with Obstructive Sleep Apnea in a Patient with Sarcoidosis
Authors: Drent Marjolein , Verbraecken J. , van der Grinten C. , Wouters E.
Published: April 2003

Many patients with sarcoidosis suffer from persistent constitutional symptoms such as fatigue and general weakness, even though physiological measures of disease activity returned within normal limits. The following case report demonstrates a sarcoidosis patient with recurring fatigue caused by an obstructive sleep apnea syndrome developed during the course of the disease.
Feedback-Controlled Negative Pressure Ventilation in Patients with Stable Severe Hypercapnic Chronic Obstructive Pulmonary Disease
Authors: Kössler W. , Lahrmann H. , Brath H. , Wei T. , Frank W. , Wild M. , Zwick H. , Wanke T.
Published: April 2003

Background: In recent studies, the efficacy of intermittent rest of the inspiratory muscles as an option of treating patients with severe chronic obstructive pulmonary disease (COPD) has become questionable. Objective: The aim of our study was to analyze the effects of feedback-controlled intermittent negative pressure ventilation (INPV) on stable, but severely hypercapnic COPD patients. Methods: 21 clinically stable, hypercapnic patients with severe COPD underwent INPV with chest shells for 3 weeks, 6 h a day. The INPV sessions were optimized by a visual biofeedback system, which enabled control over the decrease in diaphragmatic activity. Respiratory muscle (RM) function parameters, lung function parameters, blood gases and exercise capacity were analyzed. Results: In the end, 19 patients concluded INPV treatment. They had PaO2 of 56.5 ± 11.8 mm Hg, PaCO2 of 50.2±2.7 mm Hg (mean ± SD) and FEV1 of 27.8 ± 4.3% predicted before treatment. There was no statistically significant change in lung function parameters, RM function parameters, physical performance and level of dyspnea after 3 weeks of INPV. Conclusion: We conclude that intermittent RM rest induced by INPV can relax inspiratory muscles in most patients with stable severe COPD, but fails to improve RM function and exercise capacity.
Microvascular Invasion in Prostate Cancer: Prognostic Significance in Patients Treated by Radical Prostatectomy for Clinically Localized Carcinoma
Authors: van den Ouden Dies , Kranse Ries , Hop Wim C.J. , van der Kwast Theo H. , Schröder Fritz H.
Published: April 2003

Objective: To investigate the clinical significance of vascular invasion in prostate cancer patients treated by radical prostatectomy for clinically localized and locally advanced disease. Materials and Methods: Vascular invasion was determined during a routine work-up of radical prostatectomy specimens of 273 patients who underwent surgery for prostatic carcinoma. The correlation with other pathological variables was investigated. The prognostic influence for clinical progression, local recurrence, distant metastases, biochemical progression, overall survival and cancer-specific survival was determined. Results: Vascular invasion was present in 33 patients (12%). Vascular invasion correlated significantly with capsular perforation, seminal vesicle invasion, positive margins of resection, perineural invasion, high grade, and pathological stage. Vascular invasion was a significant prognostic factor for clinical progression (p < 0.001), local recurrence (p = 0.007), distant metastases (p < 0.001), biochemical progression (p < 0.001), overall survival (p = 0.02), and cancer-specific survival (p < 0.001). Multivariate analysis, adjusting for capsular perforation, high grade, and positive margins of resection, showed that vascular invasion was associated with a 2.5-fold increased risk for clinical progression. This relative risk was 2.3 for biochemical progression, and 2.7 for cancer-specific survival. Conclusion: Vascular invasion is a very important pathological variable for progression and survival, and must be evaluated on a routine basis during the work-up of radical prostatectomy specimens.
Simultaneously Occurring Abdominal Aortic Aneurysm and Invasive Transitional Cell Carcinoma of the Bladder and Their Synchronous Management
Authors: Barbalias G.A. , Liatsikos E.N. , Yarmenitis S. , Maroulis I. , Tsolakis I.
Published: April 2003

We report the case of a 70-year-old man who presented with an abdominal aortic aneurysm and invasive transitional cell carcinoma of the bladder. Synchronous surgical treatment was deemed necessary because of the iliac extension of the aneurysm. Radical cystectomy preceded the repair of the abdominal aortoiliac aneurysm and the bilateral cutaneous ureterostomy.
Malignant Mesodermal Mixed Tumor of the Ureter
Authors: Hashimoto Yoshihiro , Iwase Yutaka , Mogami Tohru , Tsugaya Masayuki , Kohri Kenjiro
Published: April 2003

Malignant mesodermal mixed tumor comprised of epithelial and nonepithelial components is rarely encountered in the urological field. Only 6 cases of malignant mesodermal mixed tumor of the ureter have previously been reported in the literature. We recently encountered a 7th case of malignant mesodermal mixed tumor of the ureter and describe the case in detail. The etiology of malignant mesodermal mixed tumor is also discussed.
High-Flow Priapism Leading to the Diagnosis of Lung Cancer
Authors: Greschner† M. , Krautschick A. , Alken P.
Published: April 2003

We report on a patient with spontaneous high-flow priapism. Magnetic resonance imaging showed a sacral tumor. Prior to tumor surgery, signs of lung cancer were found on chest X-ray. The diagnosis was confirmed by bronchoscopy. Priapism in this case can be explained either as a paraneoplastic symptom or as an isolated manifestation of cauda compression. Both are very uncommon reasons for priapism.
Erectile Dysfunction due to Single Vessel Failure: Diagnosis and Surgical Treatment
Authors: Andresen Reimer , Wegner Hartmut E.H. , Banzer Dietrich
Published: April 2003

We report on the successful surgical treatment of venous single vessel disease in a patient presenting with erectile dysfunction. We stress the necessity of accurate diagnostic workup which enables the identification of rare cases that can be cured surgically.
Isolated Fibrinoid Vasculitis in Renal Angiomyolipoma
Authors: Val-Bernal J. Fernando , Hernando Mercedes
Published: April 2003

Renal angiomyolipoma is a tumor composed of a mixture of thick-walled blood vessels, smooth muscle, and mature adipose tissue. It may present as a single unilateral lesion or as a multifocal uni- or bilateral neoplasm. The histologic spectrum of angiomyolipoma is wide but as far as we know intratumoral fibrinoid vasculitis has not been described in the tumor. This is the first report of isolated intratumoral fibrinoid vasculitis observed in two nodules of a unilateral multifocal renal angiomyolipoma. The vasculitis arose in a hypertensive 62-year-old woman who presented with a history of dull right flank and low back pain of 3 months’ duration. There were no signs of generalized disease. Immunophenotyping of the vascular cellular infiltrate disclosed abundant T lymphocytes, significant numbers of histiocytes, and absence of B lymphocytes. The diagnosis of isolated intratumoral arteritis depends on the exclusion of systemic disease. It is important to distinguish cases like this one to avoid misdiagnosis and to prevent unnecessary treatment.
Locally Recurrent Paratesticular Rhabdomyosarcoma Treated with Surgery and Radiotherapy
Authors: Kırkalı Ziya , Tüzel Emre , Alanyalı Hilmi , Özkal Sermin
Published: April 2003

Paratesticular rhabdomyosarcoma is a highly malignant neoplasm and is exceedingly rare in adults. Thus, its biological behavior is unclear and there is no standard established treatment. The prognosis of recurrent paratesticular rhabdomyosarcoma is dismal in the elderly. Herein we describe a case of locally recurrent paratesticular rhabdomyosarcoma in a 68-year-old patient treated with surgery and radiotherapy.
Presence of Mucosal Change in the Urinary Bladder in Nonhematuric Patients with Long-Term Exposure and/or Accumulating High-Dose Cyclophosphamide
Authors: Kimura Motohiko , Tomita Yoshihiko , Morishita Hideo , Takahashi Kota
Published: April 2003

Objective: Cyclophosphamide (CPA)-induced hemorrhagic cystitis is sometimes difficult to manage. We investigated the mucosal changes in patients subjected to CPA therapy in relation to the duration and accumulating dose of CPA. Methods: Fifteen patients, all of whom were receiving CPA, were studied. Investigation of the dose and duration of CPA administration, urinalysis and cystoscopy was performed. Results: The total doses of CPA administered ranged from 2.5 to 237.0 g, and the duration of administration ranged from 4 to 130 months. Four patients with hematuria (micro or macro) showed various degrees of mucosal hyperemia and telangiectasia. Of 11 patients without microhematuria, 6 patients also revealed mucosal changes distinctive of CPA-induced hemorrhagic cystitis. CPA-induced cystitis with no hematuria insidiously progressed in the patients who received CPA orally at a total dose of more than 40 g and/or for longer than 36 months. Conclusion: Early mucosal lesion of the urinary bladder, which will most likely be followed by CPA-induced hemorrhagic cystitis, may develop prior to the appearance of microscopic hematuria. Periodic prophylactic cystoscopy is recommend in patients receiving CPA.
Reappraisal of the Quantity and Nature of Renal Calcifications and Mineral Metabolism in the Magnesium-Deficient Rat
Authors: Schmiedl A. , Schwille P.O. , Bergé B. , Markovic M. , Dvorak O.
Published: April 2003

There is an urgent need for drugs capable of inhibiting renal calcifications, nephrocalcinosis and stones included, in humans. Current anticalcification medication is based mainly on alkalinization of the metabolism using potassium-containing citrate alone, despite the fact that calcium stone patients suffer marginally from both magnesium and potassium deficiency. We investigated the anticalcification efficacy of oral potassium citrate versus the combined administration of this drug and magnesium citrate in the magnesium-deficient rat developing corticomedullary nephrocalcinosis and luminal microliths in the long term. Among other things we employed specific stains for calcium and oxalate, light microscopy and element analysis for renal tissue and calcifications, respectively. In addition, minerals in renal tissue, urine and plasma were determined, as well as the state of extracellular calcium homeostasis. Magnesium deficiency caused pure calcium phosphate tissue deposits, containing no magnesium, but no deposition of calcium oxalate in the tubular lumen; tissue magnesium, calcium and phosphorus were increased, and there was marked potassium wastage via urine; despite mild hypercalcemia other signs of hyperparathyroidism were not found. Alkalinization with the two kinds of medication evoked an increase in urinary pH, citrate, and potassium; however, potassium citrate alone tended to aggravate renal concretions, whereas the combination of this drug with magnesium citrate completely prevented concretions. It was concluded that: (1) magnesium deficiency-induced calcifications are oxalate-free and are not sensitive to mobilization by alkalinization with potassium citrate, which might explain the failure of the drug to prevent stone recurrence in clinical stone patients, and (2) the combination of potassium citrate and magnesium citrate, which shows enormous anticalcification efficacy, deserves high priority in clinical trials aimed at evaluating strategies for the prevention of stones.
Solitary Cutaneous Metastasis of Superficial Bladder Cancer
Authors: Saito Seiichi
Published: April 2003

Cutaneous metastases from bladder cancer are an uncommon finding. We present a patient with superficial bladder cancer whose first manifestation of disseminated disease was a solitary cutaneous metastasis of the scrotum.
Use of a Vertical Rectus abdominis Myocutaneous Flap in Bilateral Groin Dissection for Recurrent Carcinoma of the Penis
Authors: Brierly R.D. , Pereira J.A. , Arnstein P.M.
Published: April 2003

We present a 42-year-old man requiring bilateral groin dissection for recurrent squamous cell carcinoma of the penis. Tissue cover was obtained using a pedicled vertical rectus abdominis myocutaneous flap. This case is made interesting by the use of a unilateral flap to cover a large bilateral lower abdominal tissue defect, enabling minimal weakening of the abdominal wall, primary skin closure, and allowing early mobilization and hospital discharge.
11-Deoxycorticosterone-Producing Adrenocortical Carcinoma
Authors: Egoshi Ken-ichi , Masai Motoyuki , Nagao Koichi , Ito Haruo
Published: April 2003

A woman presented with a history of weight loss and muscle weakness. A laboratory test revealed hypokalemia and elevation of plasma 11-deoxycorticosterone (DOC). CT showed a left adrenal mass. A left adrenalectomy was performed. The histological and immunohistochemical diagnosis showed a DOC-producing adrenocortical carcinoma. This cancer is very rare; only 10 cases including the present case have appeared in the literature.
Sarcomatoid Carcinoma of the Urinary Bladder: 3 Case Reports
Authors: Sejima Takehiro , Miyagawa Ikuo
Published: April 2003

Three cases of sarcomatoid carcinoma of the urinary bladder are considered. The patients were 2 males, aged 68 and 81 years, and a 79-year-old female. Transurethral resection of the bladder tumor (TUR-BT) and consecutive radical cystectomy were performed in all patients. Local progression of bladder tumors just after TUR-BT was recognized in the 2 younger patients, each of whom died due to recurrence after radical cystectomy. Because of the extremely aggressive malignant potential of sarcomatoid carcinomas, the indications for TUR-BT should be carefully assessed and suitable therapeutic strategies should be examined further.
Patterns of Metastasis in Muscle-Invasive Bladder Cancer (pT2–4): An Autopsy Study on 367 Patients
Authors: Wallmeroth Andreas , Wagner Urs , Moch Holger , Gasser Thomas C. , Sauter Guido , Mihatsch Michael J.
Published: April 2003

Background: Metastatic status is an essential determinant of prognosis of patients with muscle-invasive bladder cancer treated by cystectomy, and preoperative metastases detection is crucial for treatment selection in these patients. To better understand the metastatic behavior of bladder tumors, autopsies of patients with muscle-invasive bladder carcinomas (pT2–4) were evaluated. Methods: Protocols and histologic sections from autopsies of 367 patients with pT2–4 bladder cancer were reviewed. Results: Metastases were found in 251 of 367 patients (68%). The most frequent sites of metastases were regional lymph nodes (90%), liver (47%), lung (45%), bone (32%), peritoneum (19%), pleura (16%), kidney (14%), adrenal gland (14%), and the intestine (13%). There was no difference in the frequency and location of metastases between 308 transitional cell carcinomas and 38 squamous cell carcinomas. The frequency of metastases increased with local tumor extension (patients with cystectomy: pT2, 36%; pT3a, 45%; pT3b, 69%; pT4, 79%; p < 0.0001). For all pT classifications, the frequency of metastases was slightly higher in patients treated by cystectomy (metastases in 45% of 29 pT2 and 89% of 28 pT4 tumors) than in patients without cystectomy (36% of pT2 and 79% of pT4 tumors). Conclusions: These results argue against relevant clinical differences between histologic tumor types. The high frequency of metastases in patients having undergone cystectomy indicates that metastasis often occurs before the time of diagnosis. This emphasizes the need for a better prediction of the metastatic capability of these tumors at the time of diagnosis.
Interstitial Laser Coagulation in Benign Prostatic Hyperplasia: A Critical Evaluation after 2 Years of Follow-Up
Authors: Krautschick A.W. , Köhrmann K.U. , Henkel T.O. , Michel M.S. , Alken P.
Published: April 2003

Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction who underwent interstitial laser coagulation (ILC) of the prostate. We evaluated the safety and efficacy of ILC with respect to relief of symptoms and bladder outlet obstruction. In addition to the critical evaluation of our clinical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, including prostate size, number of sticks per prostate volume and type of application. A total of 59 patients were treated with the Nd-YAG laser (mediLas fibertom) between April 1993 and December 1996. At the time of reevaluation, 47 patients had completed a follow-up of up to 24 months. A perineal approach was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% were high-risk patients in accordance with the ASA score (ASA III). The efficacy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in accordance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volume reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A significant improvement in all voiding parameters (flow rate, residual volume), including the symptom score, was observed. Pdet decreased from an average of 90 cm H2O preoperatively to 42 cm H2O postoperatively after 24 weeks and the mean reduction in prostate volume was 14 cm3. Interestingly, it was noted that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed and the improvement in objective and subjective parameters. In view of the low morbidity outcome, especially in high-risk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia.
Malignant Fibrous Histiocytoma of the Epididymis
Authors: Ikinger Uwe , Westrich Martin , Bersch Wolf , Böttinger Klaus
Published: April 2003

A 54-year-old patient was found to have a painless ca. 1.5 cm diameter tumor in the region of the right epipidymis. The right testis was exposed from a scrotal incision. The final pathology surprisingly showed malignant fibrous histiocytoma (MFH) of the epipidymis and the patient subsequently underwent radical inguinal orchiectomy. Complete metastatic screening was normal. Postoperatively, 60 Gy external beam radiation was administered. At the least follow-up (6 years), there were no recurrences or metastases. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.
Spontaneous Subcapsular Renal Haemorrhage Presenting with Pleuritic Chest Pain
Authors: Nayak N. , Anderson J.B. , Channer K.S.
Published: April 2003

We present an unusual case of spontaneous renal subcapsular haematoma in a normal kidney presenting with pleuritic chest pain and mimicking pulmonary embolism. The literature suggests that the majority of these cases occur in association with renal tumours and that the diagnosis can best be made by computed tomographic scanning. Treatment is expectant but because of the high incidence of tumours, nephrectomy is usually necessary.
Surgical Treatment of Penile Carcinoma: Our Experience from 1976 to 1997
Authors: Ficarra Vincenzo , D’Amico Antonio , Cavalleri Stefano , Zanon Giovanni , Mofferdin Alessandro , Schiavone Dionisio , Malossini Gianni , Mobilio Gaetano
Published: April 2003

Objective: The purpose of this work is to evaluate our experience with the surgical treatment of penile squamous carcinoma, analyzing the therapeutic results in terms of local recurrence rates, survival and mortality rates. Material and Methods: From 1976 to 1997, 47 patients were treated at our institution for carcinoma of penis. Treatment of primary tumor was conservative in 8 patients (17%). Partial penectomy was performed in 30 patients (63.8%); total penectomy in 5 (10.7%) and emasculation in 4 (8.5%). Pathological stage was pTis in 2 cases (4.2%), pT1 in 20 (42.6%), pT2 in 21 (44.7%) and pT3 in 4 (8.5%). The tumor was clinically overstaged in 13 patients (27.7%) and understaged in 4 (8.5%). Bilateral inguinal lymphadenectomy was performed only in 4 patients clinically N+ (pN2) and in 3 clinically N0 (pN0). Results: Local recurrence rate was 43% in the patients with pT1 stage tumor treated conservatively. No local recurrence was observed after penectomy. 19 patients (40.4%) are alive and disease-free; 17 patients (36.2%) died of the tumor and 11 patients (23.4%) died of other causes but disease-free. Mean follow-up is 69.43 months. The overall 5-year survival rate was 34%. Conclusion: Partial penectomy gives better results than conservative treatment in the local management of the T1 stage tumor. Survival and mortality rates are related to both pathological and histological stages. The high mortality rate observed in the pT2 stage tumors in our experience might be related to the fact that in this stage an inguinal lymphadenectomy was not performed as a rule.
Profile of Placental Alkaline Phosphatase Expression in Human Malignancies: Effect of Tumour Cell Activation on Alkaline Phosphatase Expression
Authors: Dabare A.A.N.P.M. , Nouri A.M.E. , Cannell H. , Moss T. , Nigam A.K. , Oliver R.T.D.
Published: April 2003

Cellular alkaline phosphatases (ALP) are increasingly recognised as important markers for monitoring tumour cell behaviour in human malignancies. Colorimetric, flow-cytometric, and immunocytochemical assays were employed to assess the influence of activation on expression of cellular ALP in human tumour cell lines. The results showed the following: (1) Testis tumour biopsies (16/16) unlike bladder (0/14) and head and neck (0/16) tumours showed positive staining for ALP, particularly the placental type, i.e. PLAP, although this was not always present on all the cells of non-seminoma biopsies. (2) The intensity of ALP expression differed widely in tumour cell lines. Based on biochemical analysis, the profile of ALP fell into two categories: (a) low expressing (MW 70 kD, placental type ALP) like Hep2 and KB lines, and (b) those expressing both low and high molecular (MW 95 kD) bands like testis lines Tera II and Ep2102. In all cases treatment of tumour cell lysates with heat prior to biochemical analysis showed the disappearance of the higher and sharpening of the lower molecular weight ALP band. (3) Exposure of tumour cells to epidermal growth factor (EGF) expressing EGF receptor led to a decreased ALP expression by as much as 54% as assessed by biochemical or flow-cytometric techniques. These data demonstrated that testis tumour tissues and cell lines expressed ALP which were different from others. The data also showed that exposure of tumour cell lines expressing EGFr to EGF resulted in suppression of ALP expression. These observations are consistent with the notion that EGFr and PLAP expression may be taken as a marker of proliferation and differentiation in human malignancies, respectively.
Management of Staghorn Calculus: Analysis of Combination Therapy and Open Surgery
Authors: Goel Mahesh C. , Ahlawat Rajesh , Bhandari Mahendra
Published: April 2003

Objective: To assess the role of primary open surgery versus the recommended combination approach (percutaneous and lithotripsy) to treat staghorn calculi in a developing country. Patients and Methods: Available records (n = 91) of patients with staghorn managed during the last 4 years were retrieved. Patients were placed in two groups, open surgery and combination group, according to the primary procedure chosen by the patient. Demographic data in two groups was comparable in most of the respects except that renal failure patients were more in the combination group. Stone clearance, major residue, auxiliary procedures, morbidity, hospital stay and the cost were studied in the two groups for comparison. Results: Complete clearance could be obtained in 66 and 59% with open and combination method respectively. Major residue (>16 mm2) was present in 21% of open and 38% of the combination group. In patients with primary stone burden <900 mm2, the total clearance rates were 66 and 60% in open and combination group, respectively. Total clearance was not affected by caliceal dilatation, total stone burden, pelvic and caliceal bulk separately or their ratio, as arrived by logistic regression analysis. The incidence of haematuria in the combination group was marginally higher, probably due to more renal failure patients in this group. Hospital stay in the two groups was comparable (13.0 days in combination vs. 12.1 days for open). The cost of treatment with combination group was significantly higher. Conclusion: Open surgery for staghorn is still an economically viable option for difficult stone disease, specially in a developing country, with comparable efficacy, favourable morbidity and hospital stay.
Life-Threatening Spontaneous Retroperitoneal Bleeding: A Rare Complication of Oral Anticoagulation
Authors: Casella Roberto , Staedele Harald , von Weymarn Alexander , Stoffel Flavio , Bongartz Georg , Gasser Thomas C.
Published: April 2003

In a patient on oral anticoagulation with sudden onset of loin pain, the possibility of spontaneous bleeding in the retroperitoneum must be considered in the differential diagnosis of renal colic. This rare pathology can be life-threatening, and rapid diagnosis with ultrasound and computerized tomography of the abdomen must be made. If the patient is hemodynamically stable, a conservative approach is justified. Otherwise, emergency nephrectomy may be needed. As patients become older and indications for anticoagulant therapy become more common, we will probably have to face more of these rare bleeding complications in the future. We report such a case.
The Correlation of p53 Protein Overexpression and p53 Antibodies in Serum of Patients with Transitional Cell Carcinoma of the Urinary Bladder
Authors: Wunderlich H. , Hindermann W. , Hüller M. , Reichelt O. , Werner W. , Schubert J. , Kosmehl H.
Published: April 2003

Background: Mutations of p53 gene were demonstrated in many solid tumors with varying frequency. We analyzed the relationship between p53 protein expression in bladder cancer tissue, p53 autoantibodies in serum and the clinical course of 32 patients with and 10 patients without transitional cell carcinoma of the urinary bladder. Materials and Methods: In the 32 patients studied, bladder cancer was diagnosed as pTaG1–2 in 8 cases, pT1G2 in 6, pT1G3 in 7, pT2G2–3 in 7, pT3G2–3 in 3 and pT4 in 1 patient. Anti-p53 antibodies were detected by an enzyme-linked immunosorbent assay. Immunohistochemical staining was performed using a standardized alkaline phosphatase monoclonal anti-alkaline phosphatase method. To prove the statistical significance of tumor grading and staging, the Kruskal-Wallis test was applied (p < 0.01). The mean follow-up was 26 months. Results: We found 12.5% p53 autoantibody-positive sera without a statistically significant correlation with tumor grade (p = 0.0569) and category (p = 0.612). Three of 4 patients who had p53 autoantibody-positive sera died within 9 months. All of these sera-positive patients had p53 protein-positive tumor tissue. Control sera were all negative for p53 autoantibodies. Conclusion: This study shows a strong relationship between p53 protein overexpression and the occurrence of p53 autoantibody in bladder cancer. The expression of p53 autoantibodies seems to be an event in cases of bladder cancer with an unfavorable tumor-specific outcome. Because of the small number of cases and the short follow-up time, further quantitative studies will hopefully demonstrate whether this might be of prognostic importance.
Outcome of Augmentation Sigmoidocystoplasty in Children with Neurogenic Bladder
Authors: Arikan Nihat , Türkölmez Kadir , Budak Mehmet , Gogus Orhan
Published: April 2003

Purpose: The role of augmentation cystoplasty in the neuropathic bladder has been well determined since clean intermittent self-catheterization (CISC) has been accepted as a treatment modality in voiding dysfunction. We present our clinical experience with sigmoid augmentation cystoplasty in children with neurogenic bladder disorder. Material and Methods: From 1991 to 1997 sigmoid augmentation cystoplasty with modified clam technique was performed in 18 cases with neuropathic bladder pathologies. In 4 cases, ureteroneocystostomy was performed, 2 of whom were bilateral. Age range of these patients was 5–17 years (mean 10.3 years) and follow-up period was from 16 to 70 months (mean 41 months). Results: Pyuria was detected in 10 cases and 2 of them were symptomatic. Clinical acidosis was detected in only 1 case. Fifteen cases (83%) were continent by using CISC with 4–6 hourly and detrusor pressure lower than 30 cm water at maximal bladder capacity. Conclusion: In children with neurogenic bladder pathologies refractory to conservative management, augmentation cystoplasty with CISC is an effective treatment modality in protecting the upper urinary tract and preventing incontinence.
A Case of Metastatic Malignant Melanoma Presenting with Hematuria
Authors: Demirkesen Oktay , Yaycioglu Ozgur , Uygun Nesrin , Demir Gokhan , Yalcin Veli
Published: April 2003

We report a case of metastatic malignant melanoma that presented with macroscopic hematuria and lower urinary tract symptoms. Effective palliation of urinary tract symptoms was achieved with transurethral resection of metastatic lesions in the bladder. However, the patient was lost due to widespread disease despite systemic therapy. Solitary or multiple dark blue-black nodular or vegetating lesions encountered during cystoscopy should raise the suspicion of metastasis of malignant melanoma and be investigated accordingly.
Nephron-Sparing Surgery in a Case of Giant Renal Hydatid Cyst
Authors: Singh S.K. , Yadav Subhash , Srivastava Prajay , Sharma S.K.
Published: April 2003

We report a case of a centrally located giant renal hydatid cyst managed successfully by excision of the cyst alone and preserving the renal parenchyma after clamping the main renal artery. Follow-up IVP showed good function.
Nephrogenic Adenoma of the Bladder after Intravesical Bacillus Calmette-Guérin Treatment
Authors: Kilciler Mete , Tan Özgür , Özgök Yaşar , Tahmaz Lütfi , Deveci Salih , Erduran Doğan
Published: April 2003

A 60-year-old female patient was subjected to transurethral resection of transitional cell carcinoma of the bladder and was given intravesical bacillus Calmette-Guérin treatment for 6 weeks. The control cytoscopy performed after 6 months revealed a polypoid lesion at the trigon and the lesion was resected. The pathological examination of the specimen showed no evidence of cancer but the presence of a metaplastic lesion that was nephrogenic adenoma.
Myelodysplastic Syndrome with Clonal Eosinophilia Accompanied by Eosinophilic Pulmonary Interstitial Infiltration
Authors: Kuroda Junya , Kimura Shinya , Akaogi Teruaki , Hayashi Hideo , Yamano Takeshi , Sasai Yuri , Horiike Shigeo , Taniwaki Masafumi , Abe Tatsuo , Kobayashi Yutaka , Kondo Motoharu
Published: April 2003

We report a case of de novo myelodysplastic syndrome with clonal eosinophilia (MDS-Eo) and eosinophilic pulmonary interstitial infiltration, confirmed by autopsy. Cytogenetic study using Giemsa banding identified 47,XY,+1,der(1;7)(q10;p10),+8 in the marrow cells. Simple Giemsa staining revealed the same chromosomal aberration in metaphase spreads with eosinophilic granules, indicating the clonal proliferation of eosinophils. To our knowledge, our case is the 6th reported case of MDS-Eo with cytogenetically confirmed clonal eosinophilia, and the first autopsy of MDS-Eo. A review of the literature combined with our findings suggests that this type of chromosomal aberration might be involved in the as yet unknown pathogenesis of MDS-Eo.
The Cellular Immune System of Patients with Acute Leukemia and Severe Chemotherapy-Induced Leukopenia: Characterization of T Lymphocyte Subsets Responsive to IL-16 and IL-17
Authors: Bruserud Øystein , von Volkman Hilde Løland , Ulvestad Elling
Published: April 2003

The aim of the present study was to characterize the effects of IL-16 and IL-17 on CD4+ and CD8+ T cell responses in patients with acute leukemia and severe chemotherapy-induced leukopenia. We investigated (1) the function of cytokines as growth factors for preactivated monoclonal T cell populations which had been prepared by long-term in vitro culture, and (2) the ability of cytokines to modulate anti-CD3-stimulated proliferation of polyclonal, nonexpanded T cells. A subset of CD4+ and CD8+ clones could utilize IL-16 and IL-17 as growth factors after previous mitogenic activation, but for the CD4+ subset IL-16 responses were significantly higher than IL-17 responses. Cytokine-dependent proliferation was higher for the CD4+ than for the CD8+ clones in the presence of both IL-16 and IL-17. The effects of IL-16/IL-17 were modulated by the presence of exogenous IL-2 and IL-4. The IL-16-responsive CD8+ clones seemed to represent a minor subset expressing the phenotype CD4lowCD8high. The anti-CD3-stimulated polyclonal responses were generally lower for the cytopenic patients than for healthy individuals, and this decreased responsiveness was probably caused by a combination of quantitative T cell defects and suboptimal accessory cell costimulation. Although IL-16 and IL-17 could function as growth factors for a large subset of our T cell clones, both cytokines had either no or only minor effects on the polyclonal T cell responses for cytopenic patients (e.g. only weak enhancement of anti-CD3 and anti-CD3+anti-CD28 responses, no alteration of the cytokine responsiveness profile after anti-CD3 stimulation). We conclude that both IL-16 and IL-17 are potentially immunostimulatory cytokines in patients with acute leukemia and chemotherapy-induced leukopenia, but the final effects of IL-16/IL-17 on proliferative T cell responses are modulated by local immunoregulatory networks.
Therapeutic Efficacy of Recombinant Interferon-Alpha in Polycythaemia vera
Authors: Öztürk Ahmet , Günay Alp , Üskent Necdet
Published: April 2003

The therapeutic efficacy of recombinant interferon-α (rIFN-α) has been evaluated in 7 patients with polycythaemia vera (PV), diagnosed according to the criteria of the Polycythemia Vera Study Group. Six complete responses and one partial response were achieved. Pruritus significantly improved in 80% (4/5) of the cases. Recombinant interferon-α had to be discontinued in 1 patient because of grade 3–4 nephrotoxicity according to WHO criteria. rIFN-α therapy significantly decreased the phlebotomy requirements and improved the mean corpuscular volume, erythrocyte and platelet counts, pruritus complaints and the degree of splenomegaly (p < 0.05). rIFN-α seems to be an effective treatment modality for the myeloproliferation of PV and pruritus complaints.
Regulation of Both Erythroid and Megakaryocytic Differentiation of a Human Leukemia Cell Line, UT-7
Authors: Miura Yasusada , Kirito Keita , Komatsu Norio
Published: April 2003

UT-7 is a human megakaryoblastic leukemia cell line with absolute dependence on interleukin-3, granulocyte-macrophage colony-stimulating factor (GM-CSF), or erythropoietin (EPO) for growth and survival. Among its sublines, UT-7/GM, which remains undifferentiated in the presence of GM-CSF, has a bipotency showing differentiation into erythroid or megakaryocytic cell lineages in the presence of EPO or thrombopoietin (TPO), respectively. To investigate the mechanism underlying determination of cell differentiation, we investigated the role of signal transducers and activators of transcription (STAT) in EPO-induced erythroid differentiation. UT-7 cells grow in response to GM-CSF and EPO but do not differentiate into mature cells. UT-7/GM cells grow in response to GM-CSF and differentiate into erythroid cells by EPO. In UT-7 cells, both GM-CSF and EPO induced the activation of Stat1α, Stat3 and Stat5. In UT-7/GM cells, EPO activated Stat5 alone, although the activation of Stat1α, Stat3, and Stat5 was induced by GM-CSF or TPO. In addition, GM-CSF inhibited EPO-induced erythroid differentiation and concomitantly activated Stat1α and Stat3 in UT-7/GM cells even in the presence of EPO. Further we transfected Stat1α, Stat3 cDNA or both into UT-7/GM cells. Hemoglobin-positive cells were decreased in the stable transfectants stimulated with EPO. These results indicate that Stat1α and Stat3 have an inhibitory effect on the EPO-induced erythroid differentiation, and more complicated combination of transcription factors may play an important role in the decision of cell differentiation.
Effect of Discontinuing Prophylaxis with Norfloxacin in Patients with Hematologic Malignancies and Severe Neutropenia
Authors: Martino R. , Subira M. , Altés A. , López R. , Sureda A. , Domingo-Albós A. , Pericas R. , Brunet S.
Published: April 2003

The use of fluorinated quinolones for prophylaxis of infections in neutropenic cancer patients has led to a reduction of infections with gram-negative enteric bacilli, but there is concern about the emergence of antibiotic-resistant enterobacterial infections and a rise of gram-positive bacteremias. Due to these concerns, in mid-1995 the use of prophylactic norfloxacin was discontinued in our unit. In order to evaluate the impact of this measure on the infectious morbidity in our unit, 91 severe neutropenic episodes in 58 patients with hematologic malignancies who did not receive norfloxacin prophylaxis (NO group) were closely matched to 91 episodes in 60 patients who received norfloxacin prophylaxis (NORFLO group). There were no differences in the incidence of febrile neutropenia, fever of unknown origin or bacteremia during the first febrile episode. There was a trend for a higher rate of coagulase-negative staphylococcal bacteremia in the NORFLO group (5 vs. 11 cases in the NO and NORFLO groups, respectively, p = NS). Enterobacterial bloodstream infections were more frequent in the NO group (13 vs. 2 cases, respectively, p = 0.01), especially Escherichia coli (9 vs. 1 case, respectively, p = 0.01). Twelve of 13 enterobacterial isolates in the NO group were sensitive to the fluoroquinolones vs. 0/2 in the NORFLO group (p = 0.07). We conclude that the abrupt discontinuation of norfloxacin prophylaxis in our ward led to a rapid increase in the rate of fluoroquinolone-susceptible enterobacterial infections, with a scarce impact on infectious morbidity. This suggests that the selection of resistant flora in an inpatient ward by prophylactic antimicrobials may be reversible following the discontinuation of the prophylactic agent(s).
Heme Arginate Therapy forBeta Thalassemia:In vitro versus in vivo Effects
Authors: Rund Deborah , Fibach Eitan , Goldfarb Ada , Friedberg Aviva , Rachmilewitz Eliezer
Published: April 2003

Hemin has a profound effect on erythroid cell maturation and promotes fetal hemoglobin synthesis in vitro. In β-thalassemia, increasing fetal hemoglobin levels can ameliorate the anemia. We administered heme arginate, a novel stable form of hemin, to 4 patients with thalassemia intermedia and studied the in vitro versus in vivo effects. In erythroid cultures, there was a marked rise in total hemoglobin and hemoglobin F. In vivo, 3 of 4 patients had a rise in hemoglobin levels (from 0.4 to 1.1 g%), which was statistically significant in 1 patient. There were no serious adverse effects. Heme arginate may be useful in the treatment of thalassemia intermedia.
Determination of Hematopoietic Stem Cells in Peripheral Blood by an Automated Hematology Analyzer (SE-9000)
Authors: Takekawa Katsuhiro , Yamane Takahisa , Hino Masayuki , Tatsumi Noriyuki
Published: April 2003

We evaluated the usefulness of an automated hematology analyzer (SE-9000) for the identification and counting of peripheral blood stem cells (PBSCs). The samples tested were from 14 patients with hematological malignancies. Peripheral blood samples were collected from the subjects before and after a course of chemotherapy. From the leukapheresis sample, CD34+ cells, assumed to be hematopoietic stem cells, were obtained with an immunomagnetic cell separator. The CD34+ cells obtained accumulated in the gate corresponding to low recurrent frequencies of the automated hematology analyzer. This gate shows results of the ‘immature information’ (IMI) channel. Software for detection of only the cells that accumulated in this gate was therefore developed. With this trial program, the regression coefficient between the percentage of leukocytes from the blood samples that were CD34+ and the percentage of such leukocytes that appeared on the IMI channel was 0.79. With this analyzer, the number of PBSC could be counted in about 80 s. The identification and counting of cells picked up by the IMI channel should be clinically useful for the monitoring of changes in PBSC after chemotherapy for mobilization.
Some Aspects of Morphological and Dysplastic Changes of the Bone Marrow in Malignant Lymphoma
Authors: Jakovleva Kristina , Everaus Hele
Published: April 2003

Cytological and histological study of the bone marrow of 33 patients with malignant lymphoma was performed to evaluate (1) the occurrence of secondary myelodysplastic changes, (2) the cell lines involved and (3) whether secondary myelodysplastic changes were similar or different for non-Hodgkin’s lymphoma (NHL) and Hodgkin’s disease (HD). Different changes in erythro-, granulo- and megakaryopoiesis were revealed. Granulo- and erythropoiesis were disturbed more frequently. Morphological changes of the erythroid series, megaloblastoid maturation of the nucleus and multinuclearity, were seen more often in NHL patients. Cells of the granulocytic series demonstrated different changes: hypogranulation and hypersegmentation in NHL, hypergranulation and Döhle’s bodies in HD. No remarkable dysplastic changes of megakaryopoiesis were demonstrated.
Thrombotic Thrombocytopenic Purpura Complicating Chronic Myelogenous Leukemia Treated with Interferon-α
Authors: Rachmani Rita , Avigdor Abraham , Youkla Mona , Raanani Pia , Zilber Moshe , Ravid Mordchai , Ben-Bassat Isaac
Published: April 2003

Two patients with chronic myelogenous leukemia are described in whom thrombotic thrombocytopenic purpura (TTP) developed following treatment by interferon-α. In one of the patients, a lymphoblastic transformation was diagnosed concomitantly. Prompt institution of plasmapheresis, steroids and vincristine resulted in complete resolution. In the hitherto reported case of TTP complicating interferon-α treated chronic myelogenous leukemia, the course was fatal.