bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant antiangiogenic therapy with tamoxifen does not impair gastrointestinal anastomotic repair in the rat
Authors: McNamara D. A. , Walsh T. N. , Kay E. , Bouchier‐Hayes David J.
Published: December 2004

Introduction  Antiangiogenic therapy has the potential to moderate tumour and micrometastatic growth. Its use in the perioperative period is attractive but its potential to compromise wound and anastomotic healing is a cause for concern. Tamoxifen is antiangiogenic but also favourably modifies some aspects of wound healing. We hypothesised that tamoxifen would not adversely affect skin wound and gut anastomotic healing.

Methods  A previously established model of tamoxifen, administered orally at antiangiogenic doses (20 mg/ml arachais oil/day), was used. Animals received two days pretreatment prior to laparotomy and small bowel anastomosis. Treatment was continued until completion of the study. The principal outcome measures are survival, macroscopic wound and anastomotic healing, anastomotic bursting pressure and PVA sponge granuloma hydroxyproline (OHP) content.

Results  Tamoxifen treated animals had fewer complications of skin wound healing than controls (4.5%vs. 19.5%; χ2 4.65, 1 d.f., P < 0.05). There was no significant difference in adhesion formation or macroscopic complications of anastomotic healing. Anastomotic bursting pressure was greater in tamoxifen treated animals at postoperative day 3 (39 ± 4.4 vs. 22.5 ± 3.5 mmHg; P < 0.01) and equal to that of controls on postoperative day 5 (144.4 ± 9.4 vs. 127.3 ± 10.9 mmHg; P = ns). Tamoxifen treated animals weighed significantly less than placebo controls from postoperative day 3 with no difference in mortality between groups (χ2 = 0.06, 1df, P = ns). PVA sponge granuloma OHP content on day 7 was higher in tamoxifen‐treated animals (2.93 ± 0.4 vs. 1.4 ± 0.4 mg OHP/mg dry sponge weight; P = 0.03).

Conclusion  Antiangiogenic therapy with tamoxifen has no demonstrable adverse effects on wound or anastomotic repair and its perioperative use is compatible with successful early surgical outcomes.
Quality of life before and after proctocolectomy and IPAA in patients with ulcerative proctocolitis – a prospective study
Authors: Berndtsson I. , Öresland T.
Published: December 2004

Objective  The principal aim of the present investigation was to study the general QoL and disease‐specific adjustment before, and one‐year after, operation with an ileal pouch anal‐anastomosis (IPAA) in a consecutive series of patients with ulcerative colitis (UC).

Patients and method  Eleven patients were medically treated and 31 patients underwent colectomy with ileostomy. The patients were interviewed before the IPAA operation and again one‐year after closure of the covering loop ileostomy. General quality of life was estimated with a Swedish instrument (according to Kajandi, score range 16–96) and a VA‐scale. The instrument for disease‐specific adjustment contained specific questions with five factors (score range 34–204). Open questions about quality of life were used to identify areas of concern, which were not included in the other instruments. Postoperative function was described in terms of a functional score (score range 0–15).

Results  The results of the general quality of life assessments did not differ significantly when comparing pre‐operative to postoperative values. Disease‐specific adjustment showed that the medically treated patients had a score of 162; interquartile range (IQR) 145–176. The patients with ileostomy scored 164; IQR 141–180. Postoperatively there was a statistically significant improvement in both groups to 189 (IQR 172–199), an increase of 15%. The open questions revealed restrictions in daily life for both patient groups pre‐operatively with improvements after IPAA. The median grading of functional outcome according to the score system was 2. The most frequent problems were: patients who had occasional bowel movements at night, 40%; intermittent perianal soreness, 51%; antidiarrhoeal medication use, 61%.

Conclusion  General QoL did not change after IPAA. The bowel‐specific adjustment in most factors improved in the majority of patients after IPAA. However, half of the IPAA patients had occasional bowel movements at night perianal soreness, and used antidiarrhoeal medication.
Surgery for carcinoid tumours of the lower gastrointestinal tract
Authors: Goede A. C. , Winslet M. C.
Published: December 2004

Introduction  Carcinoid tumours are rare neoplasms that originate from neuroendocrine cells of the primitive gastrointestinal tract. Mid‐ and hind‐gut tumours comprise the majority of these rare tumours. With many recent advances in medical treatment the role and importance of surgery and the surgeon needs to be assessed.

Method  A Medline, Pubmed and Embase databases search was undertaken. All relevant articles were cross‐referenced.

Results and conclusions  Incidental findings of carcinoid tumours should be treated at initial surgery whilst elective surgery and further management should be undertaken in specialist centres by a multidisciplinary team. Asymptomatic patients have a better prognosis than those with symptoms. In advanced cases surgery combined with chemotherapy and liver resection is appropriate. The outlook for the majority of cases is good.
Results following conservative lateral sphincteromy for the treatment of chronic anal fissures
Authors: Garcea G. , Sutton C. , Mansoori S. , Lloyd T. , Thomas M.
Published: December 2004

Introduction  Lateral sphincterotomy is now the standard surgical treatment for fissure‐in‐ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate.

Materials and methods  A total of 65 patients undergoing conservative lateral sphincterotomy under a single operator between January 1996 and January 2002 were reviewed. Specific questions were asked regarding overall success of the operation, leakage of fluid, faeces or flatus and recurrence of fissure symptoms. Supplemental data was obtained from a retrospective analysis of the patients' case notes to ascertain demographics, length of hospital stay and complication rate.

Results  Sixty of 65 patients responded to our postal questionnaire. The male to female ratio was 1 : 1 and the mean age 40.3 years of age. No complications were recorded and 97% of patients had achieved fissure healing by the time of their out‐patient follow‐up (mean 6.9 weeks). Two patients reported new incontinence following their procedure; one patient experienced incontinence of fluid and flatus (1.7%) and the remaining patient complained of incontinence to flatus only. No patients experienced incontinence of faeces. Eleven patients experienced persistent symptoms of pain and bleeding but only 6 of these patients required treatment from their general practitioner which consisted of stool softeners and topical analgesia. No patients required re‐operation.

Conclusion  A conservative division of the internal anal sphincter results in adequate fissure healing and a much lower incontinence rate than that previously recorded in the literature for more traditional divisions of the internal anal sphincter.
Screening the average risk population for colorectal cancer: the Israeli experience 1985–97
Authors: Niv Yaron
Published: December 2004

Introduction  Five prospective, controlled trials of CRC screening, 4 of them randomized, using the Hemoccult test in large populations, have been reported from Europe and USA. In all the series stage shifting was documented, and mortality from CRC was reduced by 12–33%. In comparison with this large experience, the Israeli screening programs in the average risk population are very modest, started as case findings and expanded to nation‐wide recommendation for FOBT in 1999. In this study the Israeli experience between 1985 and 1997 was documented.

Methods  Medline search of the last 22 years for screening programs in Israel was performed, as well as personal contact with all the Israeli investigators. Reports to the Israeli Cancer Association (ICA) were collected, reviewed and summarized.

Results  Since 1985 8 papers about faecal occult blood test (FOBT) and 5 papers about flexible sigmoidoscopy (SIG) screening in average risk population have been published. 35 685 people have been screened, 110 cases of CRC and 546 cases of adenoma were found. The yield of SIG was 4 times that of FOBT for CRC. In addition, since 1990 80 084 people were screened according to the reports to the ICA. Five hundred and six cases of CRC and 2714 cases of adenoma were found. In the only prospective, controlled study, CRC incidence and mortality were significantly decreased in participants of a FOBT screening program, an effect lasting 11 years. Refusers were more likely to be male, of Asia‐Africa decent, smokers, and consumer of more coffee and less tea or dairy food.

Conclusion  FOBT may protect against CRC for prolonged periods. Individuals who refuse FOBT have significantly higher CRC incidence and mortality rates than those who accept testing. The Israeli experience, thus small, supports a comprehensive screening campaign for early detection of CRC in Israel.
A study of the complications and pelvic visceral function after restorative proctocolectomy and W pouch construction
Authors: Fowler A. L. , Turner B. N. , Thomson W. H.
Published: December 2004

Objective Aspects of ileal pouch surgery remain controversial. The authors' single practice experience of 107 operations illustrates many of them. It was hoped that its study would contribute usefully to the debate.

Patients and methods Details of all 107 restorative proctocolectomies carried out since the operation was started in Gloucester in 1984 until the study period ended have been kept prospectively. All patients had proctectomy by mesorectal dissection, and 106 had W pouch restoration. Four suffered functional failure requiring reversion to ileostomy and three patients have died. The remaining 99 were sent a questionnaire concerning pelvic visceral function and evidence of pouchitis. Records of all but one of the patients have been reviewed.

Results Surgical morbidity was low with neither chronic pelvic sepsis, pouch related fistula, pouch haemorrhage nor pouch ischaemia. Mucosectomised patients had similar bowel control to the stapled group. The policy change from routine to selective protective ileostomy proved satisfactory. W pouch function was found to be comparable to that reported from major J pouch series, although anti‐diarrhoeal usage was reduced, and was not influenced by either gender, age or time since surgery.

Conclusion None of the following reasonably intuitive assumptions seem supported by our findings: that mesorectal excision necessarily poses a greater danger to pelvic visceral function than close rectal dissection, that the greater capacity of W pouches will be reflected in markedly less frequency, that mucosectomy would impair anal control, or that a defunctioning ileostomy is a mandatory precaution. Pouch frequency is less if wind can be passed separately; otherwise functional outcome seems determined by other, non‐technical, factors.
Recent randomised trials in colorectal disease
Authors: Chopada A. , Taylor I.
Published: December 2004

Progress in colorectal surgery over the last few years is evident by the growing number of randomised controlled trials reported. We have scrutinised such trials reported over the last year across the entire spectrum of colorectal disease and have presented the significant findings in this trials report.
Obstructed defecation
Authors: D'Hoore A. , Penninckx F.
Published: December 2004

Background In the last decade our understanding of pelvic floor function and dysfunction has improved significantly. A more rational diagnostic and therapeutic approach is now possible for the group of patients with constipation due to obstructed defecation (OD).

Methods The review is based on a literature search using the PubMed database focusing mainly on recent literature addressing the subject.

Results Obstructed defecation occurs in about 7% of the adult population. Different pathophysiological mechanisms, either functional or anatomical, eventually lead to OD. Different tests (defecography, balloon evacuation test, manometry, electromyography, colonic transit time measurementmanometry) play an important role to quantify the problem. These tests are not without problems as abnormal results are also found in asymptomatic controls. Also, there is poor agreement between different tests and a poor correlation with symptomatology. Thus, for most syndromes conservative treatment including biofeedback is appropriate. Surgery can yield excellent results in selected cases.

Conclusion Validation of scoring systems and quantitative tests is still needed. More uniform and strict criteria for anismus should be applied to make therapeutic approaches comparable. Appropriate selection of patients for surgery is the key to success.
The incidence and causes of permanent stoma after anterior resection
Authors: Bailey C. M. H. , Wheeler J. M. D. , Birks M. , Farouk R.
Published: December 2004

Aims Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this.

Methods All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively.

Results Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5–6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01).

Conclusion Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre‐operatively.
Continuous real‐time ambulatory urodynamic monitoring in infants and young children using infrared telemetry
Authors: Yeung C.K.
Published: December 2004

Objective

To assess the feasibility of continuous real‐time ambulatory bladder monitoring in infants and young children using a specially developed ambulatory urodynamic data logger with built‐in infrared telemetric on‐line facilities.

Patients and methods

Twenty‐nine infants and young children (mean age 3.9 years, range 7 weeks to 9.5 years) with various types of bladder dysfunction underwent urodynamic studies performed using an ambulatory urodynamic recorder with a specially developed integral transmitter that converts digital pressure signals to modulated infrared waves (935 nm). A receiver mounted on the ceiling of the room receives the signals emitted from the recorder. During the investigation, the infant can conduct normal activities, be totally mobile and be accompanied by the mother undisturbed in a private cubicle. The urodynamicist in the next room can observe all the patient’s activities through a one‐way mirror while continuous real‐time on‐line pressure signal displays are recorded and monitored using a computer, with event markers placed as necessary. For security, the data recorded during ambulatory investigation are stored in the internal memory of the ambulatory recorder.

Results

All 29 infants and young children completed the urodynamic studies using the new system; the results were satisfactory and reliable, with no data lost during ambulatory recording. The results obtained using infrared telemetry were not significantly different from conventional natural‐filling urodynamic studies performed with a cabled on‐line urodynamic recorder.

Conclusion

The infrared telemetry system provides a reliable and effective way of performing continuous real‐time ambulatory urodynamic monitoring in infants and young children. With the development of more powerful telemetric data transmission technologies, such a method could be extended in the near future to a truly ambulatory urodynamic recording with real‐time on‐line facilities, either at home or in the clinic, both for adults and for children.
Regular dilatation is unnecessary after tubularized incised‐plate hypospadias repair
Authors: Lorenzo A.J. , Snodgrass W.T.
Published: December 2004

ObjectiveTo determine if patients who undergo tubularized incised‐plate (TIP) urethroplasty need regular dilatation to prevent neourethral strictures or meatal stenosis.

Patients and methodsThe follow‐up of two consecutive series of patients who underwent primary TIP hypospadias repair by one surgeon was reviewed. The first 72 patients (group 1) had periodic neourethral calibrations for 1 year after repair, while the next 62 patients (group 2) had no routine dilatation, except for six patients (10%) in whom the meatus appeared to be small. Urethroscopy was performed in both groups at the time of fistula repair, skin revisions or during anaesthesia for unrelated procedures.

ResultsThere was no evidence of scarring in group 1; one case of meatal stenosis and one neourethral stricture were detected in group 2. The difference in outcome was not statistically significant (P = 0.4). Overall, the incidence of meatal stenosis was low (0.7%) and comparable with most recent series in which postoperative calibration was not used routinely.

ConclusionDilatation of the neourethra is unnecessary after TIP urethroplasty. Calibration or uroflowmetry 6 months after surgery may be useful to detect subclinical obstruction.
Gene amplification and overexpression of HER2 in renal cell carcinoma
Authors: Latif Z. , Watters A.D. , Bartlett J.M.S. , Underwood M.A. , Aitchison M.
Published: December 2004

Objective To determine the frequency of HER2 genetic abnormalities in renal cell carcinoma (RCC) and hence assess the potential suitability of Herceptin™ immunotherapy.

Patients and methods Tumours from 27 patients with RCC were assessed; all patients had undergone nephrectomy. Benign renal tissue from the nephrectomy specimens was studied in seven patients. Gene amplification was assessed using fluorescent in‐situ hybridization, and protein over‐expression using immunohistochemistry.

Results Twenty‐four patients had clear cell renal carcinoma, two had papillary renal carcinoma and one a sarcomatoid variant carcinoma. There was no HER2 amplification in the tumours or the benign renal tissue. Polysomy 17 was detected in 11 of 27 tumours (41%) and increased HER2 copy number in seven (26%). Both polysomy 17 and increased HER2 copy number were absent in the benign renal tissue. Three tumours (11%) and six of the seven benign renal tissue samples over‐expressed the HER2 protein.

Conclusions
HER2 amplification is absent and protein over‐expression uncommon in RCC. This casts doubt on the suitability of Herceptin™ in the treatment of RCC.
Gubernacular development in Müllerian inhibiting substance receptor‐deficient mice
Authors: Bartlett J.E. , Lee S.M.Y. , Mishina Y. , Behringer R.R. , Yang N. , Wolf J. , Temelcos C. , Hutson J.M.
Published: December 2004

Objective To determine, in mice with disrupted Müllerian inhibiting substance (MIS) receptor genes, whether MIS affects gubernacular development; MIS causes Müllerian duct regression and is proposed to be involved in the first stage of testicular descent, because gubernacular development is abnormal in humans with persistent Müllerian duct syndrome.

Materials and methods Ten wild‐type, 11 heterozygotic and 12 homozygotic mice for MIS receptor mutations were killed at 17.5 or 18.5 days after conception or at birth, to provide serial sagittal sections of the pelvis. The amount of cremaster muscle, mitotic bodies in the gubernacular bulb, and gubernacular size were quantified by computer analysis (four mice/group).

Results Müllerian ducts were present in the homozygous mutants, partially present in the heterozygotes and absent in the wild‐type controls. All mice had descended testes. The cremaster muscle was significantly less developed in homozygous mutants than in wild‐type controls (P < 0.001) and heterozygotes (P < 0.01) at birth. The mitotic index between the gubernacula of all groups was indistinguishable. There was no statistical difference in gubernacular area amongst the groups. Poor cremaster muscle development in homozygous mutants gave the muscle a loose mesenchymal appearance.

Conclusions Although there was an observable effect on cremaster muscle development in these mutant mice, gubernacular development and testicular descent were otherwise normal, and thus there must be other reasons for the observed differences in humans with persistent Müllerian duct syndrome.
Calyx to parenchyma ratio in pelvi‐ureteric junction obstruction
Authors: Imaji R. , Dewan P.A.
Published: December 2004

Objective To review the ultrasonography of patients who had undergone pyeloplasty for pelvi‐ureteric junction (PUJ) obstruction, and document the changes in calyceal distension and parenchymal thickness after pyeloplasty, to attempt to establish an additional prognostic indicator.

Patients and methods Fifty‐eight patients who underwent pyeloplasty for PUJ obstruction were assessed retrospectively. Pre‐ and postoperative ultrasonograms were analysed for both pyelocaliectasis, graded according to the Society for Fetal Urology criteria, and the ratio of the depth of calyces to the thickness of the parenchyma (C/P ratio). Patients underwent nuclear medicine renography before and 3 months after pyeloplasty. The results were analysed using the paired t‐test, Kruskal–Wallis test, Spearman's correlation coefficient by rank test and the Mann‐Whitney U‐test.

Results There was no significant difference in hydronephrosis grade before and after surgery (P < 0.05) but there was a significant difference in the C/P ratios (P < 0.01). There was no correlation between C/P ratios and the results of diuresis renography.

Conclusion Hydronephrosis as measured by an estimate of pelvic volume is an insensitive marker of improvement after pyeloplasty. Reduced calyceal distension correlates well with other favourable prognostic indicators. Therefore, the C/P ratio may be an additional indicator of the appropriateness of surgical intervention, and should be the subject of further study.
Management of severe hypospadias using Glassberg's modification of the Duckett repair
Authors: MacGillivray D. , Shankar K.R. , Rickwood A.M.K.
Published: December 2004

Objective  To assess the effectiveness of Glassberg's modification of Duckett's technique in the surgical correction of severe hypospadias.

Patients and methods  The case notes of 24 boys who underwent hypospadias repair using this technique were reviewed, noting the severity of the lesion, the method of repair and the clinical outcome.

Results  One operation was required in 14 (58%) of patients; complications requiring further surgery occurred in 10 boys (42%).

Conclusion  This technique allows a single‐stage procedure when otherwise a two‐stage procedure would be necessary.
A single‐centre long‐term outcome analysis of artificial urinary sphincter placement in children
Authors: Hafez A.T. , McLorie G. , Bägli D. , Khoury A.
Published: December 2004

Objective To retrospectively evaluate the outcome of artificial urinary sphincter (AUS) placement in 79 children, with a mean follow‐up of 12.5 years.

Patients and methods A total of 89 children had an AUS placed between 1977 and 1994; complete data were obtained for 79 (63 boys and 16 girls). The indication for AUS placement was urinary incontinence caused by sphincteric deficiency with a stable bladder. Before and after surgery, all patients underwent ultrasonography, voiding cysto‐urethrography and urodynamics. Logistic regression was used to assess the factors influencing the outcome.

Results The mean (range) age at surgery was 11.7 (3–18) years. The cause of incontinence was a neuropathic bladder in 74 patients and bladder exstrophy in five. At a mean (range) follow‐up of 12.5 (5–22) years, 63 of 79 patients (80%) had an intact AUS. The AUS was removed in 16 patients (20%) because of erosion at a mean (range) of 5.6 (1–11) years after insertion; there were 0.035 revisions per patient‐year. Of 63 patients with an AUS in place, 57 (90%) are completely dry and 36 (57%) are using clean intermittent catheterization. Thirteen patients (20%) developed bladder instability during the follow‐up, which was managed by anticholinergics in eight, spinal cord de‐tethering in three and enterocystoplasty in two. Hydronephrosis occurred in 12 of 126 renal units (10%) that improved after enterocystoplasty or anticholinergics. The overall 10‐year survival of the AUS was 79% (78% for early models and 80% for the AMS800); the survival was not affected by age, sex, model, previous bladder neck surgery, augmentation cystoplasty or intermittent catheterization. Bladder exstrophy was associated with lower AUS survival, as four of the five patients affected had the AUS removed secondary to erosion (P = 0.014).

Conclusion In children the AUS has a 79% 10‐year survival and gives a 90% continence rate. Bladder instability after AUS placement can be managed with anticholinergics or enterocystoplasty. The AUS is not a justifiable treatment option for patients with bladder exstrophy.
Allogeneic whole‐cell vaccine: a phase I/II study in men with hormone‐refractory prostate cancer
Authors: Eaton J.D. , Perry M.J.A. , Nicholson S. , Guckian M. , Russell N. , Whelan M. , Kirby R.S.
Published: December 2004

Objective To establish the safety and toxicity of an allogeneic human tumour cell vaccine in patients with hormone‐refractory prostate cancer, and to determine any biochemical, immunological or clinical response to vaccination.

Patients and methods Sixty patients with hormone‐refractory prostate cancer were recruited and randomly allocated into four equal groups. Three cell lines (from a bank of four) were administered initially every 2 weeks and then monthly, in conjunction with the immunostimulant Mycobacterium vaccae (SRL‐172), each group receiving a different combination of the four cell lines. The patients' serum prostate‐specific antigen (PSA) levels were monitored regularly, and the immune response to the vaccine measured using nonspecific intracellular cytokines and specific humoral and cell‐mediated assays.

Results The vaccine was safe and well tolerated with no major side‐effects. Whilst several patients had a decline in PSA from the entry level, there was no significant decrease that could be attributed solely to the vaccine. However, the immunological data were more encouraging, with several patients from each arm of the trial having an increase in cytokine production, increases in specific antibodies and evidence of T‐cell proliferation in response to the vaccinations.

Conclusion The failure of the vaccine to produce a PSA response in the patients in the trial is not surprising considering the stage of the disease. The high PSA levels on entry indicate that the burden of disease was probably high and thus this was an extremely challenging group of patients in which to try and elicit a response through immunotherapy. However, the immunological evidence of a response to the vaccine was encouraging and suggests that further exploration of immunotherapy in less advanced disease may yield more encouraging clinical responses.
Spongioplasty and separation of the corpora cavernosa for hypospadias repair
Authors: Dodat H. , Landry J.‐L. , Szwarc C. , Culem S. , Murat F.‐J. , Dubois R.
Published: December 2004

Objective

To describe a surgical method (a modified Duplay technique), and its results, for hypospadias repair, developed to avoid the common complication of fistula.

Patients and methods

The urethroplasty was modified so that it no longer comprises a simple approximation of the urethral plate with no dissection. The inferior surface of the corpora cavernosa is exposed as far as the lateral border and to the end of the glans, allowing tension‐ free suturing of urethral tissues, with a lengthening effect of the intermediate plane. This corrects chordee and especially the ‘bucket‐handle’ glans, and protects the reconstructed urethra and proximal urethra. The study included 51 children who had their hypospadias repaired over a 9‐month period (mean age at surgery 20.6 months, range 1–11 years); 14 had coronal, three anterior penile juxta‐coronal, 23 anterior penile, four medium penile, five posterior and two penoscrotal hypospadias.

Results

All children were followed and no fistula was apparent in any with anterior hypospadias; two fistulae occurred after repair of the posterior form. The risk of fistula is therefore reduced (two in 51).

Conclusion

This technical modification can be used to treat all forms of distal hypospadias (glanular, glanulo‐preputial, and anterior penile). It was also used for several cases of more severe hypospadias. These good results must be confirmed in a larger series of patients.
Detection of telomerase status by semiquantitative and in situ assays, and by real‐time reverse transcription‐polymerase chain reaction (telomerase reverse transcriptase) assay in bladder carcinomas
Authors: Longchampt E. , Lebret T. , Molinie V. , Bieche I. , Botto H. , Lidereau R.
Published: December 2004

Objective

To investigate whether telomerase activity could be used as a diagnostic and/or prognostic marker of bladder carcinoma, by assessing telomerase activity using semiquantitative and in situ methods, and quantifying telomerase reverse transcriptase (hTERT) mRNA expression in a series of bladder carcinomas.

Material and methods

Telomerase activity was detected by the telomeric repeat amplification protocol (TRAP) assay using a telomerase polymerase chain reaction (PCR) enzyme‐linked immunosorbent assay (ELISA) kit on a series of 29 bladder carcinomas and on three normal bladder samples. hTERT mRNA levels were quantified using real‐time quantitative reverse transcription (RT)‐PCR. For the in situ detection of telomerase activity, the same telomerase PCR ELISA kit was used and applied to frozen‐tissue sections only for discordant cases between telomerase activity and hTERT mRNA status.

Results

Telomerase activity was positive in 15 of the 29 bladder carcinomas (52%) and negative for the three normal bladder samples. hTERT was detected and quantified in all tumour samples, with major differences in hTERT values. None of the three normal bladder samples had quantifiable hTERT mRNA, giving complete sensitivity and specificity for the method in diagnosing bladder carcinoma. Comparing the results of RT‐PCR and TRAP assay showed a significant association between the enzyme activity and levels of hTERT mRNA expression, with only five discordant cases, most of them being TRAP‐negative and hTERT‐positive. Among these cases the in situ results of telomerase activity were concordant with hTERT mRNA levels by RT‐PCR and not with TRAP assay results, as nuclear fluorescence of malignant epithelial cells. The semiquantitative evaluation of positive cell numbers showed a heterogeneity of telomerase activity within the tumour tissue. There was a significant correlation between RT‐PCR and histopathological variables (grade and stage), and a significant correlation between TRAP assay results and histopathological grade.

Conclusion

Detecting hTERT mRNA by RT‐PCR seems to be a promising method, with a much better sensitivity than the TRAP assay in diagnosing bladder carcinomas, and a better correlation with histopathological variables. False‐negative cases on the TRAP assay are explained by the heterogeneity of telomerase activity within tumour cells. Thus evaluating hTERT gene expression levels could be used as a marker of malignant progression, useful in the early diagnosis and follow‐up of bladder carcinomas.
Retroperitoneal laparoscopic vs open partial nephroureterectomy in children
Authors: El‐Ghoneimi A. , Farhat W. , Bolduc S. , Bagli D. , McLorie G. , Khoury A.
Published: December 2004

Objectives

To compare the results of retroperitoneal laparoscopic with open partial nephroureterectomy.

Patients and methods

Laparoscopic retroperitoneal partial nephroureterectomy was undertaken in 15 children (13 upper and two lower poles; median age at the time of surgery 61 months, range 5–212). A three‐trocar retroperitoneal approach was used. The polar vessels were identified and either coagulated or clipped before transecting the parenchyma using a harmonic scalpel. An additional 13 consecutive children underwent similar procedures (11 upper and two lower poles) by conventional open surgery (median age at surgery 16 months, range 1.5–72).

Results

One patient in the laparoscopy group required conversion to open surgery because of a peritoneal tear and was excluded from the analysis. The mean (range) operative duration was 146 (50–180) and 152 (75–240) min for the open surgery and laparoscopy groups, respectively. The blood loss was minimal (< 20 mL) in both groups. The mean (range) hospital stay was 1.4 (1–3) and 3.9 (3–5) days for the laparoscopy and open groups, respectively (P < 0.001). Eight patients were discharged on the day after the laparoscopic procedure. In addition, of those patients in the laparoscopy group who had a lower‐pole partial nephrectomy, one had a urinoma after surgery.

Conclusion

Laparoscopic retroperitoneal partial nephrectomy is a safe and feasible procedure in children. It requires a similar operative duration to that of an open procedure. The main advantage to the laparoscopic approach is that it significantly decreases the hospital stay compared with that after an open procedure.
The use of cell salvage during radical retropubic prostatectomy: does it influence cancer recurrence?
Authors: Davis M. , Sofer M. , Gomez‐Marin O. , Bruck D. , Soloway M.S.
Published: December 2004

Objective

To assess whether there is a difference in the biochemical recurrence rate in patients who had radical retropubic prostatectomy (RRP) with or without cell salvage transfusion.

Patients and methods

The records of 769 consecutive patients undergoing RRP between 1992 and 1998 were retrospectively reviewed. Patients having adjuvant hormonal treatment, postoperative external beam radiotherapy, or a follow‐up of < 1 year were excluded from the analysis. The remaining 408 patients were categorized into three groups: 87 who received cell‐salvaged blood using a commercial cell saver; 264 receiving only autologous transfusion; and 57 with no transfusion. Disease recurrence was defined as a prostate‐specific antigen (PSA) level of> 0.2 ng/mL. Bivariate and multivariate logistic regression analyses were used to assess and compare the risk of cancer recurrence in the three groups. Covariates used in the multivariate analyses included Gleason score, preoperative PSA level, seminal vesicle involvement and surgical margins.

Results

The mean (range) follow‐up was 40.2  (12–104) months; there were no significant differences among the groups in initial PSA level and Gleason score. In the multivariate logistic regression analysis, the initial PSA, Gleason score, seminal vesicle involvement and surgical margins, but not transfusion group, were independent predictors of recurrence.

Conclusion

Cell salvage during RRP does not influence the recurrence of prostate cancer. Cell salvage is a safe method of transfusion during RRP.
The correlation between preoperative voiding mechanism and surgical outcome of the tension‐free vaginal tape procedure, with reference to quality of life
Authors: Wang A.C. , Chen M.‐C.
Published: December 2004

Objectives

To determine whether the surgical outcome of the tension‐free vaginal tape (TVT) procedure differs in patients with dysfunctional voiding (DV) or normal voiding.

Patients and methods

The voiding mechanism and surgical efficacy of the TVT procedure were analysed retrospectively by reviewing the charts of 79 consecutive women treated over 2 years. Based on their initial voiding mechanism, the patients were divided into two groups, with or without DV. The King's Health Questionnaire was used to evaluate the women's quality of life both before and 1 year after surgery.

Results

The change in free maximum urinary flow rate (Qmax) after surgery differed significantly between the groups (P = 0.001). Moreover, both before and after surgery, the free Qmax was significantly lower (P = 0.019 and 0.001, respectively), and the detrusor pressure at Qmax (both P < 0.001) and urethral resistance (P = 0.036 and 0.027, respectively) significantly higher in the group with DV. The subjective outcome measure showed that the cure rates were not significantly different in the two groups (P = 0.173), but the objective outcome measure showed a significant difference (P = 0.025). Analysis of the total scores for all domains showed that significantly more women improved by> 25% in the group without than in those with DV (P = 0.016).

Conclusions

The objective cure rate of the group without DV undergoing the TVT procedure was significantly higher than in those with DV. In addition, subjective measures assessed by the disease‐specific quality‐of‐life questionnaire indicated that the group without DV had a better quality of life than those with DV.
Long‐term results of orthotopic neobladder reconstruction after radical cystectomy
Authors: Kulkarni J.N. , Pramesh C.S. , Rathi S. , Pantvaidya G.H.
Published: December 2004

Objective

To assess, in a retrospective study, the long‐term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle‐invasive bladder cancer.

Patients and methods

Data were retrieved for all patients with muscle‐invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long‐term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded.

Results

In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow‐up was 73 (36–144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero‐enteric and vesico‐urethral strictures (9% each). Most patients had daytime (89%) and night‐time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH2O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty‐four patients had recurrence of disease, of whom 20 died.

Conclusions

Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates.
Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease
Authors: Prieto Castro R.M. , Leva Vallejo M.E. , Regueiro Lopez J.C. , Anglada Curado F.J. , Alvarez Kindelan J. , Requena Tapia M.J.
Published: December 2004

Objective

To assess the effectiveness of the combination of colchicine and vitamin E (which has anti‐fibrotic, anti‐mitotic and anti‐inflammatory effects) in modifying the early stages of Peyronie's disease, by evaluating pain relief, correction of deformities and plaque size.

Patients and methods

In all, 45 patients were divided into two groups and treated from January 1998 to November 2001. Their mean (range) age was 53.4 (40–62) years, the time from onset of the disease < 6 months and they had penile deformity of < 30°; no patient had erectile dysfunction. Twenty‐two patients were given ibuprofen 400 mg/day for 6 months, whilst 23 received a combination of vitamin E 600 mg/day plus colchicine 1 mg every 12 h. Pain, plaque size and penile deformity were assessed at 6 months.

Results

There were no statistically significant differences between the groups at baseline in age, time from onset of the disease until the initial evaluation or plaque size. Although the proportion of patients reporting pain relief was higher amongst those receiving colchicine plus vitamin E (91% vs 68%) this was not significantly different, but differences in plaque size and penile curvature were significant.

Conclusions

The use of colchicine plus vitamin E during the early stages of Peyronie's disease (time from onset < 6 months) in patients with penile curvature of < 30° and no erectile dysfunction is an effective and well‐tolerated way to stabilize the disease. A more extensive study is needed, comparing these results with other oral therapies.
Penile epithelioid sarcoma and the case for a histopathological diagnosis in Peyronie's disease
Authors: Usta M.F. , Adams D.M. , Zhang J.‐W. , Davis R. , Hellstrom W.J.G.
Published: December 2004

Objectives

To devise a set of clinical criteria that would identify which penile abnormality could be malignant and warrant biopsy, between Peyronie's disease (a pathological fibrosis involving the tunica albuginea of the penis) and epithelioid sarcoma (ES) of the penis (a rare malignant condition which can resemble Peyronie's disease in clinical presentation).

Patients and methods

The pathology reports and histological slides of men with Peyronie's disease who underwent penile biopsy were reviewed for ES. The medical charts of suspicious cases were then reviewed by a pathologist, unaware of the origin, for consistencies in signs, symptoms and clinical findings. These consistencies were then to be used to develop criteria for biopsy. Thirty‐two men underwent penile biopsy from 1992 to 2001.

Results

Because there were no actual cases of ES, a specific set of criteria for ES could not be established. A review of previously published cases was then used for comparison with the present patients.

Conclusions

Many of the previously reported cases included signs and symptoms of urethral narrowing or compression, causing lower urinary tract symptoms. In addition, the penile nodule size was reported to progressively enlarge over time. Because of the high prevalence of Peyronie's disease and low prevalence of ES, biopsy of every penile nodule is not judicious. However, signs and symptoms of urethral obstruction, and a progressively growing and persistently painful nodule should suggest a possible malignancy and warrant biopsy.
Cell‐surface matrix proteins and sialic acids in cell‐crystal adhesion; the effect of crystal binding on the viability of human CAKI‐1 renal epithelial cells
Authors: Kramer G. , Steiner G.E. , Prinz‐Kashani M. , Bursa B. , Marberger M.
Published: December 2004

Objective

To investigate the role of sialic acids and cellular matrix proteins as crystal‐binding molecules in human calcium‐oxalate nephrolithiasis.

Materials and methods

The well‐defined human renal cancer cell line CAKI‐1 was used a standard cell culture system. After enzymatic digestion of various cell surface molecules, the binding of α2,6 (Sambucus nigra, SN‐) and α2,3 (Maackia amurensis, MA)‐specific lectins to CAKI‐1 cells was analysed. Simultaneously, the effect on adhesion and release of calcium oxalate monohydrate crystals was investigated (eight replicates). The effect of crystal adhesion on cell viability was assessed using Trypan blue exclusion (five replicates).

Results

Neuraminidase decreased MA‐lectin binding of CAKI‐1 cells by 39% (P < 0.05) but elevated SN‐lectin binding by 812% (P < 0.05). Simultaneously, crystal binding to CAKI‐1 cells was increased by 28% (P > 0.05). Pretreatment with collagenase type I, trypsin and dispase II reduced crystal‐binding by 61–74% (P < 0.05) with no effect on sialic acid‐specific lectin‐binding. However, only collagenase type I and dispase (ratio 4 : 1) were also able to release crystals from their receptor‐binding sites (P < 0.05). An increase in the number of cell surface‐bound crystals correlated significantly with a decrease in cell viability (P < 0.05).

Conclusions

α2,3‐linked sialic acids protect cells from crystal‐binding. Much greater SN‐lectin binding associated with only moderately increased crystal binding argues against α2,6‐linked sialic acids as a main target structure of crystals. In contrast, collagen type I, type IV and/or fibronectin seem to be potent crystal‐binding molecules on human renal epithelial cells, with collagen type I involved in a potential second step of crystal–cell interaction.
Differences in biopsy features between prostate cancers located in the transition and peripheral zone
Authors: Augustin H. , Erbersdobler A. , Graefen M. , Jaekel T. , Haese A. , Huland H. , Hammerer P.G.
Published: December 2004

Objective

To identify the zonal location of prostate cancers before surgery, by analysing the mapping of ultrasonography‐guided systematic sextant biopsies for differences between cancers located in the transition zone (TZ) and peripheral zone (PZ); and to compare the correlation between Gleason scores of needle biopsies and those of radical prostatectomy (RP) specimens.

Patients and methods

In all, 186 patients with TZ (46) and PZ cancers (140) underwent ultrasonography‐guided systematic sextant biopsy and RP at the same institution. The clinical and pathological characteristics, and the anatomical location of positive biopsies, were determined and compared using t‐tests and chi‐square tests. Differences between Gleason scores of needle biopsies and those of RP specimens were evaluated and compared by Cohen κ testing.

Results

TZ cancers had a significantly lower rate of positive biopsies in the middle (63% vs 80%) and base (50% vs 80%) of the prostate than had PZ cancers. Positive biopsies were exclusively obtained from the apex in 19.6% of TZ and 5% of PZ cancers (P = 0.002). There was exact agreement between Gleason scores of needle biopsies and those of RP specimens in 15.2% of TZ (κ = 0.02) and 55% of PZ cancers (κ = 0.25), respectively.

Conclusion

Compared with PZ cancers, TZ cancers had a different anatomical pattern of positive biopsies, with lower rates in the middle and base of the prostate. The finding of positive biopsies exclusively in the apex favoured prostate cancer located in the TZ. Furthermore, the correlation between needle biopsy Gleason scores and those of the RP specimens was clearly lower in TZ cancers.