bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual reality ureteroscopy simulator as a valid tool for assessing endourological skills
Authors: MATSUMOTO EDWARD D , PACE KENNETH T , D’A HONEY R JOHN
Published: July 2006

Aim:  Virtual reality (VR) simulators are now commercially available for various surgical skills training. The Uro Mentor VR Ureteroscopy Simulator by Symbionix is one system that may revolutionize the way we assess and teach surgical residents. Surgical educators may no longer have to depend on the operating room as the sole venue for teaching residents technical skills. We validated performance on this new system with previously developed assessment tools and compared it to performance on a high fidelity ureteroscopy bench model.

Methods:  Urology residents (n = 16) were assessed on their ability to perform cystoscopy, guidewire insertion, semirigid ureteroscopy and basket extraction of a distal ureteric stone on the VR simulator. A blinded examiner assessed subject performance using a checklist, global rating scale and a pass/fail rating. In addition, computer‐generated parameters including time to complete task, scope and instrument trauma and the number of attempts to insert a guidewire were analysed. Performance on the VR simulator was compared to performance on a high fidelity ureteroscopy bench model.

Results:  Senior residents (n = 8) scored significantly higher on their global rating scale (29.4 ± 2.5 vs 20.8 ± 0.9, P = 0.005), checklist (19.1 ± 1.1 vs 15.2 ± 0.9, P = 0.02), pass/fail rating (χ2 = 7.3, P = 0.007) and required less time to complete the task (352.9 ± 55.7 s vs 576.8 ± 67.4 s., P = 0.02) than the junior residents (n = 8) on the VR simulator. Junior residents also had a significantly higher incidence of scope trauma (4 vs 0.6, P = 0.02). No significant differences were noted in instrument trauma and the number of attempts to insert the guidewire. Global rating scale performance on the VR simulator correlated well to performance on the high fidelity ureteroscopy bench model (r = 0.7, P = 0.002) as did time to complete task (r = 0.7, P = 0.004).

Conclusions:  The Uro Mentor VR Ureteroscopy Simulator is a useful tool in assessing resident endourological skills. Performance on the VR simulator is comparable to a validated high fidelity ureteroscopy bench model. Future studies will assess the utility of VR simulators in surgical skills training.
Effect of a ‘centralized intensive education system’ for clean intermittent self‐catheterization in patients with voiding dysfunction who start catheterization for the first time
Authors: OH SEUNG‐JUNE , KU JA HYEON , LIM SEUNG HWA , JEON HWANG GYUN , SON HWANCHEOL
Published: July 2006

Background:  This study evaluated the effects of a ‘centralized intensive education system’ (CIES) in terms of acquiring a proper clean intermittent self‐catheterization (CISC) technique by patients with voiding dysfunction.

Methods:  Between March 2002 and March 2003, we prospectively and consecutively enrolled 132 hospitalized patients who learnt and started CISC for the first time due to voiding dysfunction. Patients were enrolled either of two groups (the CIES group vs the ‘individualized ward education system’[IWES] group) at the time of the urologic consultation for voiding dysfunction. Out of 132 patients who enrolled in the study, 112 (45 males and 67 females, mean age 57.3 with a range of 18–81) were included in the primary analyses. The questionnaire was applied immediately before discharge.

Results:  There were similar patient demographics and clinical parameters for the CIES (n = 62) and the IWES groups (n = 50). Of 10 items including the methodology of CISC, six items discriminated significantly in favor of the CIES (P < 0.05). The patient satisfaction with CISC education was significantly different for the two groups in terms of response to the questionnaire. The CIES group was found to be more satisfied with the education received than the IWES group (P < 0.05). Moreover, the number of trials to gain confidence to perform CISC in CIES group was significantly fewer than that of IWES group (P < 0.001).

Conclusion:  Our results demonstrate that CIES might be a superior training program for the patients with voiding dysfunction to acquire a proper CISC technique to the conventional IWES.
Prostate‐specific antigen adjusted for the transition zone volume as a second screening test: A prospective study of 248 cases
Authors: KANG SEOK‐HO , BAE JAE‐HYUN , PARK HONG‐SEOK , YOON DUCK‐KI , MOON DU‐GEON , KIM JE‐JONG , CHEON JUN
Published: July 2006

Aim:  This study was conducted to verify the effectiveness of prostate‐specific antigen adjusted for the transition zone volume (PSATZ), and its availability as a second screening test for prostate cancer detection.

Materials and methods:  Total prostate‐specific antigen (PSA) and free PSA was measured in male patients who visited our outpatient department for voiding difficulty or screening for prostate cancer. Patients who had an intermediate PSA level between 4.0 and 10.0 ng/mL, with an apparently normal prostate on a digital rectal examination, were enrolled. PSATZ, free‐to‐total PSA ratio (F/T ratio) and PSA density (PSAD) were calculated and statistical comparisons between biopsy‐positive (cancer) and biopsy‐negative patients (benign) were conducted.

Results:  Of 248 patients, 51 (20.6%) had prostate cancer and 197 (79.4%) had benign prostatic hyperplasia (BPH) on pathologic examination. Mean PSA, PSAD, F/T ratio and PSATZ were 7.48 ± 1.77 ng/mL, 0.23 ± 0.09 ng/mL per mL, 0.14 ± 0.08 and 0.71 ± 0.44 ng/mL per mL in patients with prostate cancer and 6.59 ± 1.60 ng/mL, 0.16 ± 0.07 ng/mL per mL, 0.21 ± 0.11 and 0.36 ± 0.30 ng/mL per mL in patients with benign, respectively. Receiver operating characteristics (ROC) curve analysis demonstrated that PSATZ predicted the biopsy outcome better than F/T ratio. With a cut‐off value of 0.37 ng/mL per mL, PSATZ had a sensitivity of 74.5% and a specificity of 72.6% for predicting prostate cancer. The maximal cut‐off value that preserves 100% of sensitivity was 0.2, and at this cut‐off value, 16.1% of unnecessary biopsies could be reduced.

Conclusions:  Prostate‐specific antigen adjusted for the transition zone volume may be more useful than other strategies in detecting prostate cancer in patients with intermediate PSA levels of 4.0–10.0 ng/mL. It can be used as a second screening test to reduce unnecessary biopsy.
Clinical significance of urinary white blood cell count and serum C‐reactive protein level for detection of non‐palpable prostate cancer
Authors: KATO TOMONORI , SUZUKI HIROYOSHI , KOMIYA AKIRA , IMAMOTO TAKASHI , NAYA YUKIO , TOBE TOYOFUSA , ICHIKAWA TOMOHIKO
Published: July 2006

Aim:  The clinical significance of the urinary white blood cell (U‐WBC) count and serum C‐reactive protein (CRP) level was evaluated in an effort to improve the efficiency of prostate biopsies.

Methods:  We enrolled 228 consecutive patients with serum prostate‐specific antigen (PSA) ranging from 3.0 to 20.0 ng/mL, normal digital rectal examination findings, and who underwent prostate biopsies between January 2001 and August 2004. Of these, 157 patients had histologically confirmed benign prostatic disease and the remaining 71 patients had prostate cancer. Patients with a pretreatment U‐WBC count ≤3 or >3/high power field were defined as non‐pyuria and pyuria, respectively. The patients were also separated into two groups based on the serum CRP level prior to biopsy. Several clinical factors were compared among these subgroups.

Results:  Inflammation was histologically detected at rates of 58.1% and 34.1% in the pyuria and non‐pyuria groups, respectively (P = 0.0014). The rates of cancer detection were significantly lower in the pyuria, than in the non‐pyuria group (P = 0.0384). The cancer detection rates did not significantly differ according to serum CRP levels prior to biopsy.

Conclusion:  The U‐WBC count appears to be a reliable indicator of minute prostatic inflammation. The serum PSA level was elevated in patients with asymptomatic prostatitis. Counting U‐WBC is a simple, convenient and non‐invasive method that should be valuable part of routine urological examinations.
Significance of electrostimulation in detecting neurovascular bundle during radical prostatectomy
Authors: TSUJIMURA AKIRA , MIYAGAWA YASUSHI , TAKAO TETSUYA , MATSUMIYA KIYOMI , NAKAYAMA MASASHI , TSUJIMOTO YUICHIRO , TAKAHA NATSUKI , NISHIMURA KAZUO , NONOMURA NORIO , TAKADA TSUYOSHI , FUJIOKA HIDEKI , KUROKAWA KOHEI , AOZASA KATSUYUKI , OKUYAMA AKIHIKO
Published: July 2006

Objective:  The reported rate of erectile dysfunction after nerve‐sparing prostatectomy varies according to physicians. Because exact preservation of the neurovascular bundle (NVB) solely depends on the judgment of the physician, he or she should try to correctly identify the NVB and also avoid neurophysiologic injury of the NVB during the procedure. The purpose of the present study is to assess the status of the NVB preservation by physician’s judgment at the operation, the changes in intracavernous pressure related to intraoperative electrical stimulation and postoperative histopathological examination.

Patients and Methods:  Thirty‐eight patients who underwent nerve‐sparing radical prostatectomy judged by intraoperative electrical stimulation of the NVB were included in this study. Bilateral, unilateral and non‐nerve‐sparing procedures were performed in 18, 17, and 3 cases, respectively. The NVB preservation evaluated by intraoperative physician’s judgment was compared to that evaluated by postoperative histopathological examination. Furthermore, the NVB preservation evaluated by intraoperative electrical stimulation was compared to that by physician’s judgment and postoperative histopathological examination.

Results:  For 68 of 76 NVB (89.5%), intraoperative subjective judgment and histopathological assessment were identical. For 66 of 76 NVB (86.8%), electrical stimulation findings and the physician’s judgments were identical, and for 70 of 76 NVB (92.1%), electrical stimulation findings and histopathological findings were identical.

Conclusion:  Even if physicians are convinced of a successful nerve‐sparing procedure, there are some cases in which the NVB is not preserved accurately or neurophysiological damage is suffered. Therefore, intraoperative electrical stimulation of the NVB as well as the cavernosal nerve is very useful in evaluation of NVB preservation.
Comparison of 25 and 75 mg/day naftopidil for lower urinary tract symptoms associated with benign prostatic hyperplasia: A prospective, randomized controlled study
Authors: YOKOYAMA TERUHIKO , KUMON HIROMI , NASU YOSHITSUGU , TAKAMOTO HITOSHI , WATANABE TOYOHIKO
Published: July 2006

Background:  The present study investigated the efficacy, safety, and utility of starting an α1d‐selective antagonist, naftopidil, at 75 or 25 mg/day in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).

Methods:  In this prospective comparative study, the subjects comprised 153 patients with LUTS associated with BPH. Patients were randomized to receive either 25 mg/day (Group LD) or 75 mg/day (Group HD) of naftopidil for 4 weeks. The lower urinary tract disease symptom score (LUTDSS), the International Prostate Symptom Score (IPSS), the Quality of life assessment index, the maximum flow rate (Qmax), and the residual urine volume were compared between the groups.

Results:  In both groups, the LUTDSS and the IPSS were significantly improved at the endpoint and no significant intergroup differences were identified. However, the improvement in the Qmax was significantly better for Group HD than for Group LD. The overall efficacy did not differ significantly between the groups. The degree of improvement in voiding symptoms and LUTDSS among patients with moderate symptoms was significantly greater for Group HD than for Group LD. The frequency of adverse reactions did not differ significantly between the groups.

Conclusions:  Starting administration at 75 mg/day rather than 25mg/day is helpful for LUTS associated with BPH for patients with moderate symptoms, particularly in improving voiding symptoms. The 75 mg/day administration was considered to be a recommendable therapeutic dose in some patients.
Effect of prostate manipulation on the serum levels of complexed prostate‐specific antigen and total prostate‐specific antigen
Authors: LONG RONAN , GIRI SUBHASIS , DIVER SEAN , DUDDY LORNA , MCKEOWN DECLAN , MORAN KEVIN
Published: July 2006

Background:  Recently there has been considerable interest in complexed prostate‐specific antigen (cPSA) as an alternative to total PSA (tPSA). Data regarding the variations of cPSA are limited. We performed a prospective study using different forms of prostate manipulation to demonstrate and compare variations between cPSA and tPSA.

Methods:  The study included 113 men, 34 of whom had a digital rectal examination, 28 had a flexible cystoscopy, 17 had a rigid cystoscopy, 21 had a prostate biopsy, and 13 underwent a transurethral resection of the prostate (TURP). Blood samples were taken before and after manipulation for measurement of tPSA and cPSA.

Results:  There was a statistically significant difference in the cPSA and tPSA before and after manipulation, with the exception of cystoscopy. On review of the data, it was clear that not all changes were clinically significant. The mean differences were greater for tPSA than for cPSA for all procedures. This was most apparent following prostate biopsy and TURP. Regression analysis also showed that cPSA and tPSA were affected differently by prostate manipulation.

Conclusion:  Our results demonstrate that cPSA is less prone to variations when compared to tPSA.
Maximum tumor diameter is a simple and valuable index associated with the local extent of disease in clinically localized prostate cancer
Authors: MIZUNO RYUICHI , NAKASHIMA JUN , MUKAI MAKIO , OOKITA HAJIME , NAKAGAWA KEN , OYA MOTOTSUGU , OHIGASHI TAKASHI , MARUMO KEN , MURAI MASARU
Published: July 2006

Background:  The present study was undertaken to investigate the association of pathological features, including the total tumor volume (TTV), maximum tumor area (MTA), and maximum tumor diameter (MTD), with the local extent of disease in clinically localized prostate cancer.

Methods:  Serial whole sections of the prostate from 164 patients who underwent radical prostatectomy for localized prostate cancer were investigated. The correlations between the indicators of tumor size, including the TTV, MTA, and MTD, and other pathological parameters were evaluated.

Results:  The MTD, MTA, and TTV were significantly correlated with each other. Multivariate stepwise logistic regression analysis indicated that the Gleason score, perineural invasion, microvascular invasion, and MTD were significant independent parameters associated with extraprostatic disease.

Conclusion:  The histological tumor grade, perineural invasion, microvascular invasion, and tumor size were correlated with the local extent of disease. The MTD, a simple, easy, and inexpensive parameter, is a more significant pathological feature associated with the local extent of disease than the MTA or TTV.
Fournier’s gangrene: Report of thirty‐three cases and a review of the literature
Authors: TAHMAZ LUTFI , ERDEMIR FIKRET , KIBAR YUSUF , COSAR AHMET , YALCÝN ORHAN
Published: July 2006

Background:  Fournier’s gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease.

Methods:  Thirty‐three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient’s age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad‐spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split‐thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20–50 mL daily) and broad‐spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients’ scrotum and penis were covered with their own new scrotal skin.

Results:  The mean age of the patients was 53.9 ± 9.56 years (range = 23–71). The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 ± 10.459 (range = 14–54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I.

Conclusions:  Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad‐spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.
Comparison of the effects of percutaneous and intraduodenal administration of oxybutynin on bladder contraction and salivation in rabbits
Authors: KONTANI HITOSHI , HAMAMOTO TETSUKAZU , TAKEUCHI SUNAO , NOMURA YUKARI , SAWANISHI HIROYUKI , SAITO HARUO
Published: July 2006

Aim:  As only a few basic animal experiments have assessed the usefulness of percutaneous application of oxybutynin, we compared the effects of percutaneous application and intraduodenal injection of oxybutynin on urinary bladder contraction accompanied by micturition in conscious rabbits and salivation in anesthetized rabbits.

Methods:  Bladder contractions were induced by continuous infusion of saline (2 mL/min) into the bladder. Salivary secretion was induced by pilocarpine (0.1 mg/kg, i.v.). Oxybutynin was administered at 15 mg/animal, and the plasma concentrations of oxybutynin and N‐desethyloxybutynin were measured by high‐performance liquid chromatography to clarify the effective concentration.

Results:  The intercontraction interval (ICI) was prolonged from 0.5 h after intraduodenal injection of oxybutynin, and this effect continued for 2 h. The ICI prolongation after percutaneous application of oxybutynin appeared at 2 h and continued throughout the 6‐h experimental period. The saliva secretion induced by pilocarpine was inhibited to almost the same level by oxybutynin 3 h after intraduodenal injection and 6 h after percutaneous application. However, the sum of the plasma concentrations of oxybutynin and N‐desethyloxybutynin rose steeply to a very high level within 20 min after oral administration instead of intraduodenal injection and decreased within 3 h to about half of the level evident 6 h after percutaneous application.

Conclusion:  We confirmed that percutaneous application of oxybutynin caused long‐lasting ICI prolongation in our rabbit model, as compared with that after intraduodenal injection, and produced weaker inhibitory effects on saliva secretion because it did not cause steep elevation of the plasma concentration.
Spironolactone with ACE inhibitor is effective in gross hematuria caused by nephroptosis
Authors: TOJO AKIHIRO , ONOZATO MARISTELA LIKA , ASABA KENSUKE , FUJITA TOSHIRO
Published: July 2006

Abstract  Gross hematuria caused by nephroptosis is difficult to treat and sometimes requires surgical treatment. We experienced a case of a 64‐year‐old woman with gross hematuria due to nephroptosis and glomerular thin basement membrane that showed remission of hematuria with the blockade of the renin‐angiotensin‐aldosterone system with an angiotensin‐converting enzyme inhibitor and spironolactone.
Large renal aneurysm successfully treated by percutaneous embolization using detachable steel coils
Authors: ISHIZUKA OSAMU , TAKAYAMA FUMIYOSHI , SONE SHUSUKE
Published: July 2006

Abstract  A 71‐year‐old man was referred to our hospital because of hematuria. A computed tomography scan showed a huge aneurysm (43 × 32 × 30 mm) in the right kidney. The patient was treated successfully with transcatheter arterial embolization (TAE) using detachable steel coils. At present, 1 year after TAE, the patient has no hematuria and hypertension. To our knowledge, this case is the second largest aneurysm treated successfully by TAE.
Laparoscopic excision of a ureteral diverticulum
Authors: LI JIAN‐RI , CHIU KUN‐YUAN , LIN HSUI‐MIN , CHENG CHEN‐LI , YANG CHI‐REI , HUNG SIU‐WAN
Published: July 2006

Abstract  Ureteral diverticula are a rare anomaly of the ureteral structure and were reported as case reports in the literature. We report an acquired ureteral diverticulum that was managed with laparoscopic resection. The clinical presentation is demonstrated and the follow‐up image is illustrated. The laparoscopic application could be expanded to this area.
Possibility of spontaneous seeding of transitional cell carcinoma of the ureter in renal tubules: Another mechanism of transitional cell carcinoma dissemination
Authors: FONG CHAU‐JYE , CHEN TOAN , HSIEH DAR‐SHIH , YEN CHUNG‐YANG , CHEN HONG‐I
Published: July 2006

Abstract  Cancer cell seeding inside the urinary tract always has been considered one possible mechanism of the multicentric origin of transitional cell carcinoma (TCC). However, there is still no direct clinical evidence to prove that the natural seeding of TCC is a real event. To our knowledge, we report the first case of spontaneous seeding of TCC of the ureter in the renal tubules of a hydronephrotic kidney. The TCC nature of the intratubular tumor cells has been confirmed by the morphological appearance of them after hematoxylin and eosin staining and positive p53 immunohistochemical staining.
Primary renal inflammatory malignant fibrous histiocytoma: A diagnostic challenge
Authors: SINGH SHRAWAN K , MANDAL ARUP K , AGARWAL MAYANK MOHAN , DAS ASHIM
Published: July 2006

Abstract  Renal inflammatory malignant fibrous histiocytoma (MFH) is an extremely rare lesion and is a great masquerader of common benign renal inflammatory lesions, especially xanthogranulomatous pyelonephritis (XGPN). The clinical presentation of mass with fever and peripheral leucocytosis (marked at times), and marked inflammatory, predominantly neutrophilic, infiltrate obscuring the malignant cells on histopathology, can lead to delay in the diagnosis of this poor prognostic malignant tumor. We present the case of a patient who underwent radical nephrectomy with a clinical diagnosis of renal malignancy, but histopathology showing XGPN. The patient showed an initial clinical response, only to recur two times, ultimately leading to a histological and immunohistochemical diagnosis of inflammatory MFH. The diagnosis, histology, therapeutic options and prognosis of this rare lesion are discussed.
Bladder wall injury consequent to total hip replacement: Delayed presentation
Authors: KALDENBACH ULRICH , ROTH STEPHAN
Published: July 2006

Abstract  Bladder injury, although rare, may be traumatic or iatrogenic. We report a patient with greatly delayed presentation of bladder injury after a total hip replacement.
Invasive micropapillary carcinoma of the urinary bladder: An immunohistochemical study of neoplastic and stromal cells
Authors: KURODA NAOTO , TAMURA MASATO , OHARA MASAHIKO , HIROUCHI TAKASHI , MIZUNO KEIKO , MIYAZAKI ERIKO
Published: July 2006

Abstract  A 66‐year‐old man complained of hematuria. A cystoscopy revealed a non‐papillary tumor and radical cystectomy was performed. Macroscopically, an ulcerative lesion was observed. Microscopically, the neoplasm showed a mixture of urothelial carcinoma, squamous cell carcinoma and micropapillary carcinoma. Immunohistochemically, micropapillary carcinoma cells were positive for cytokeratins 7 and 20, carcinoembryonic antigen and CA125. Additionally, myofibroblasts were distributed in a chicken‐wire pattern in the stroma of micropapillary carcinoma. Subsequently, the patient died of carcinoma 1 year after the onset of symptoms. Our results support the previous hypothesis that bladder micropapillary carcinoma runs an aggressive clinical course and suggest that micropapillary carcinoma may show the glandular differentiation of urothelial carcinoma and show the stromal reaction by myofibroblasts resembling that of carcinoma in other anatomic sites.
Occipital condyle syndrome guiding diagnosis to metastatic prostate cancer
Authors: MARTINEZ SALAMANCA JUAN IGNACIO , MURRIETA CONCEPCION , JARA JOSE , MUNOZ‐BLANCO JOSE LUIS , ALVAREZ FEDERICO , DE VILLORIA JUAN GUZMAN , HERNANDEZ CARLOS
Published: July 2006

Abstract  Occipital condyle syndrome (OCS) results from a unilateral occipital pain associated with an ipsilateral paresis of the 12th cranial nerve (hypoglossal), and is typically caused by metastasis of the skull base. OCS diagnosis occurred, in all cases described in the published literature, when metastatic prostate cancer (MPC) was previously known. We present a case of a patient whose initial manifestation of MPC was OCS. The patient was treated with complete hormonal blockade and non‐steroidal anti‐inflammatory drugs as opposed to locoregional radiotherapy applied in other cases. After 18 month follow‐up, the patient had a complete neurological and biochemical response.
Advanced prostate cancer with extremely low prostate‐specific antigen value at diagnosis: An example of high dose hook effect
Authors: AKAMATSU SHUSUKE , TSUKAZAKI HIDEKI , INOUE KOUJI , NISHIO YASUNORI
Published: July 2006

Abstract  A 67‐year‐old man presented with a lower abdominal mass. Radiographic examination revealed a huge mass filling the entire pelvis. Although prostate‐specific antigen (PSA) was 1.4 ng/ml, percutaneous needle biopsy revealed adenocarcinoma compatible with prostate cancer, which stained positive for PSA. Hormone therapy was initiated and 1 month later his PSA was as high as 2713 ng/ml, although the mass had decreased in size. High dose hook effect was suspected and hormone therapy was continued. PSA is presently under control and below 0.1 ng/ml. When prostate cancer with very high PSA is suspected and the PSA value is unexpectedly low hook effect should be considered and PSA should be re‐analyzed.
Pseudo‐clitoromegaly associated with congenital prepubic sinus
Authors: HAYASE MASA , KOJIMA YOSHIYUKI , HAYASHI YUTARO , MARUYAMA TETSUJI , SASAKI SHOICHI , KOHRI KENJIRO
Published: July 2006

Abstract  We operated on a 12‐year‐old girl who had clitoromegaly and a sinus on the midline prepubic area congenitally. The prepubic sinus appeared to point to the clitoris on the preoperative magnetic resonance image, but the relation between the sinus and clitoromegaly was unclear. Gray‐brown discharge was emitted at the site of dissection between the prepuce and clitoris and the size of the clitoris became normal. The sinus was excised, revealing a tract 1.5 cm long that extended to the retropubic sinus, and ended in a fibrous tract that was linked to the clitoris. This suggested pseudo‐hypertrophy because of the discharge collected in the end of the prepubic sinus.
Fertility‐preserving treatment for patients with malignant germ cell tumors of the ovary
Authors: Nishio Shin , Ushijima Kimio , Fukui Akimasa , Fujiyoshi Naoki , Kawano Kouichiro , Komai Kan , Ota Shunichiro , Fujiyoshi Keizo , Kamura Toshiharu
Published: July 2006

Aim:  The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO).

Methods:  A case study analysis was performed on patients with MGCTO treated at Kurume University Hospital between 1986 and 2004. Thirty‐five patients were included in the study, 14 with immature teratoma, 11 with dysgerminoma, eight with endodermal sinus tumor, and two with mixed germ cell tumor. Twenty‐three patients had International Federation of Gynecology and Obstetrics stage I (Ia, 11; Ib, 2; Ic, 10), one had stage II, seven had stage III, and four had stage IV disease.

Results:  Five patients with stage III or IV disease received radical surgery. Thirty patients underwent conservative surgery. As the adjuvant treatment, 30 patients received chemotherapy, while five patients did not receive any chemotherapy. The overall survival rate was 97.1%. One patient died of the disease. She was 13 years old with a stage IV endodermal sinus tumor. Twelve have attempted conception, and eight have achieved at least one pregnancy (66.7%).

Conclusions:  Irrespective of the stage of the disease, conservative surgery and adjuvant chemotherapy for MGCTO can achieve a favorable outcome in terms of survival and fertility.
Metabolic disorders in patients with recent gestational diabetes mellitus
Authors: Eroglu Derya , Zeyneloglu Hulusi B.
Published: July 2006

Aim:  To determine metabolic disorders in patients with recent gestational diabetes mellitus (GDM) compared with controls.

Methods:  Thirty‐six patients with recent GDM and treated with a diabetic diet only, and 33 controls with normal pregnancies, were included in the study. An oral glucose tolerance test, with corresponding insulin and hormone levels, was performed; the homeostatic model assessment scores were calculated to estimate insulin resistance; prevalence of polycystic ovarian morphology on ultrasound scan was assessed; and results were recorded 10–15 months after delivery.

Results:  Waist : hip ratio and fasting cholesterol and triglyceride levels were significantly higher in women with recent GDM; high‐density lipoprotein cholesterol did not differ between groups. Fasting, 1‐h and 2‐h plasma glucose levels were significantly higher in the GDM group; no statistically significant difference was found between groups regarding fasting insulin levels, 1‐h and 2‐h insulin response, and homeostatic model assessment scores. Serum hormone levels did not differ between groups. The prevalence of polycystic ovarian morphology was greater in women with GDM. There was no difference in any metabolic parameter between women in the GDM group with polycystic ovaries and those with normal ovaries.

Conclusions:  We found a higher prevalence of polycystic ovarian morphology in women with GDM than in controls. Among women with recent GDM, higher waist : hip ratios and fasting plasma glucose and triglyceride levels may indicate metabolic syndrome. In women with recent GDM managed by diet only, insulin resistance may not be detected in the short term.
Prospective study of non‐closure or closure of the peritoneum at cesarean delivery in 124 women: Impact of prior peritoneal closure at primary cesarean on the interval time between first cesarean section and the next pregnancy and significant adhesion at second cesarean
Authors: Komoto Yoshiko , Shimoya Koichiro , Shimizu Takashi , Kimura Tadashi , Hayashi Shusaku , Temma‐Asano Kumiko , Kanagawa Takeshi , Fukuda Hirotsugu , Murata Yuji
Published: July 2006

Aim:  The aim of this study was to evaluate the effect of non‐closure of the peritoneum at cesarean delivery on postoperative complications and the interval time to the next pregnancy, and to investigate the incidence of adhesion following cesarean and the association between adhesion formation and peritoneal closure.

Methods:  One hundred and twenty four women scheduled for cesarean section were randomized to either closure of both the visceral and parietal peritoneum (C‐group, n = 70) or non‐closure (NC‐group, n = 54). At repeated cesarean, the levels and extent of adhesion, operating time, and any complications were examined.

Results:  There was no difference in the incidence of postoperative complications at the first cesarean section. The operating time of the C‐group was significantly longer than that of the NC‐group. The frequency of analgesic use was significantly higher in the C‐group. The time interval from cesarean section to the next pregnancy in the NC‐group was significantly shorter than that in the C‐group. There are no significant differences between the rates of complications in the C‐group and the NC‐group at repeated cesarean. The incidence of adhesion in the C‐group was significantly higher than that in the NC‐group (P < 0.05). The mean total operating time and the mean interval time for skin incision to delivery in the C‐group were significantly longer than those in the NC‐group (P < 0.05 and P < 0.001, respectively) at repeated cesarean section.

Conclusions:  Non‐closure of the peritoneum at cesarean delivery appears to have no adverse effect on postoperative recovery, it also decreases the number of analgesic doses and shortens the operating time and may be more desirable in achieving a next pregnancy. The present study demonstrated that surgical peritoneal closure resulted in more advanced adhesion formation. The practice of non‐closure of the peritoneum should be performed at cesarean.
Significance of CD44v6 expression in gynecologic malignancies
Authors: Hong Soon Cheol , Song Jae Yun , Lee Jae Kwan , Lee Nak Woo , Kim Sun Haeng , Yeom Bom Woo , Lee Kyu Wan
Published: July 2006

Aim:  Variants of CD44 have been proposed to be important in cancer invasion and metastasis. The purpose of this study was to evaluate the diagnostic and prognostic value of CD44v6 expression in gynecologic malignancies.

Methods:  Immunohistochemistry was used to determine the expression of CD44v6 in samples from a series of 65 cases of early cervical cancer, 76 cases of endometrial samples and 57 cases of serous epithelial ovarian tumors. We analyzed the expression of CD44v6 and correlated the findings with clinicopathological factors.

Results:  In the cervical series, CD44v6 was detected in 60 cases of cervical cancer (92.3%). The immunoreactivity was decreased when stromal invasion reached a depth of more than 5 mm (P < 0.05). However, it was not correlated with other clinicopathological factors. In the endometrial series, CD44v6 was detected in one endometrial hyperplasia (6.7%) and in 24 endometrial cancers (100%), while it was not detected in the proliferative endometrium (P < 0.05). Immunoreactivity was decreased in grade 2 and 3 endometrial cancers compared with grade 1 (P < 0.05). In the ovarian series, CD44v6 was not detected in the benign tumors, but it was detected in four borderline malignancies (27%) and 12 carcinomas (40%). Immunoreactivity was not correlated with clinicopathological factors of ovarian cancer.

Conclusion:  CD44v6 may be involved in stromal invasion of early squamous cervical carcinomas and in the cellular differentiation of endometrial cancer. In addition, it may be useful for early diagnosis of endometrial cancer.
Small bowel perforation from a thermal burn caused by contact with the end of a laparoscope during ovarian cystectomy
Authors: Ito Masayuki , Harada Tasuku , Yamauchi Nobuhiro , Tsudo Toshiyuki , Mizuta Masayoshi , Terakawa Naoki
Published: July 2006

Although laparoscopic surgery now replaces many gynecologic laparotomy procedures, serious complications unique to laparoscopy may occur, including vascular or bowel injury. In most cases of bowel injury during laparoscopy, the laparoscopic instruments that cause injury are the trocar, Veress needle, grasping forceps or scissors, electrocoagulator, or laser. We report a rare case of small bowel perforation after a thermal burn caused by contact with the end of the scope during laparoscopic ovarian cystectomy. Burns and perforations of the small bowel during laparoscopy are rare complications preventable by familiarity with the physical properties of the laparoscopic instruments.
Reduction of aquaporin‐8 on fetal membranes under oligohydramnios in mice lacking prostaglandin F2α receptor
Authors: Shioji Mitsunori , Fukuda Hirotsugu , Kanzaki Toru , Wasada Kenshi , Kanagawa Takeshi , Shimoya Koichiro , Mu Junwu , Sugimoto Yukihiko , Murata Yuji
Published: July 2006

Aim: To investigate the association between aquaporin‐8 (AQP‐8: a water channel protein) expression in fetal membranes and oligohydramnios during near‐term and postdate pregnancy, we set up an oligohydramnios model using prostaglandin F2α receptor (FP)‐deficient mice.

Methods: Pregnant FP‐deficient mice from 14 to 21 gestational days (GD) were killed to measure the amniotic fluid volume (AFV), and fetal membranes were collected for the analysis of aquaporin‐8 expression.

Results: The AFV was highest at 14 GD, and was significantly decreased to 28% and 0% at 20 GD and 21 GD, respectively, compared with the volume at 14 GD. Immunohistochemistry and immunoblot analysis showed that aquaporin‐8 was expressed in the basal component of fetal membranes, and that the protein level was significantly decreased to 60% at 20 GD compared with that at 14 GD.

Conclusions: We demonstrated that AQP‐8 expression in the fetal membrane was decreased at post term in FP‐deficient mice. Our findings suggest that aquaporin‐8 in fetal membranes may be involved in the regulation of AFV, especially when oligohydramnios occurs.
Auto‐transplantation of the uterus in the domestic pig (Sus scrofa): Surgical technique and early reperfusion events
Authors: Wranning Caiza Almén , El‐Akouri Randa Racho , Lundmark Cecilia , Dahm‐Kähler Pernilla , Mölne Johan , Enskog Anders , Brännström Mats
Published: July 2006

Aim: To develop a method for auto‐transplantation of the uterus in the pig and to evaluate the early reperfusion events after short‐term cold ischemia.

Methods: The bicornate uterus, with the cervix but without ovaries, was dissected and isolated with its bilateral feeding and draining vessels. The uterine arteries were cannulatedin situand the uterus was flushed with heparinized Ringer Acetate. It was stored at 4°C for 1–2 h during continuous flushing. The uterus was then placed in its original pelvic position and the uterine arteries and veins were anastomosed end‐to‐end to their origin. During approximately 100 min of reperfusion, blood samples and tissue biopsies were taken for monitoring of reperfusion events and detection of ischemia‐reperfusion injuries.

Results: Out of 19 auto‐transplanted pigs, seven were considered well flushed and were kept for cold ischemia. Of these seven, four showed satisfactory reperfusion judged by change in gross appearance and presence of appropriate venous blood flow. Analysis of blood‐gas and metabolite parameters and histology indicated that at least two of these transplants were well reperfused, with no severe ischemia‐reperfusion injuries.

Conclusion: In this first report ever on auto‐transplantation of the pig uterus it is demonstrated that an acceptable reperfusion can be achieved. Furthermore, it is suggested that because of the large total size of the pig uterus with long uterine horns and the small size of the vessels available for re‐anastomosis, the pig is a fairly difficult model for further studies on transplantation of the uterus.
Effect of thread pitch on pull‐out strength of laparoscopic myoma screws
Authors: Tintara Hatern , Aiyarak Pattara , Mitarnun Winyou , Geater Alan
Published: July 2006

Aim:  The purpose of this study was to evaluate the effect of thread‐pitch on pull‐out strength and bending strength of buttress‐thread screws designed for laparoscopic myoma extraction.

Methods:  The ultimate failure load of four 5‐mm diameter buttress‐thread screws with 3‐, 4‐, 5‐, and 6‐mm thread pitch, 40 mm in thread‐length were examined on fresh myoma specimens. The myoma tissue at each traction site was evaluated histologically to determine its density. The critical minimal pull‐out strength based on moderate‐density myoma group was estimated. The bending strength was also determined for each screw.

Results:  A wide range of ultimate failure loads with a mean ± SE of 129.3 ± 5.5 N (range, 30.4–255.7 N) for all screws and tissue densities was recorded. In moderate‐density myomas, the mean ultimate failure loads decreased linearly with increasing thread‐pitch from 3 mm (148.0 ± 9.5 N) to 6 mm (119.8 ± 9.4 N) (test for trend: P < 0.05). Based on the criterion of a minimum pull‐out strength of at least 50 N in not less than 95% of tractions in medium‐density myomas, the 3‐mm and 5‐mm pitch screws were found to have acceptable properties. The 5‐mm pitch screw had less thread‐turn than the 3‐mm pitch for the same thread‐length and would need less application time. The bending strength also decreased with increasing thread pitch from 3 to 5 mm, then became stable at around 15 N.

Conclusions:  The pull‐out strength of soft tissue buttress‐thread screws decreased linearly with increasing thread‐pitch. Thread‐pitch should be considered when designing laparoscopic myoma‐screws.
Mid‐second trimester measurement of fetal nasal bone length in the Japanese population
Authors: Kanagawa Takeshi , Fukuda Hirotsugu , Kinugasa Yukiko , Son Mihyon , Shimoya Koichiro , Murata Yuji , Yokoyama Takuhei , Hashimoto Hiroyuki , Isaka Shigeyuki , Nagamatsu Masaaki
Published: July 2006

Aim:  We carried out a preliminary study to compare the nasal bone length (NBL) and biparietal diameter/NBL (BPD/NBL) ratio between the Japanese and white populations.

Methods:  Three hundred and fifty nine (359) singleton fetuses of healthy Japanese couples were examined from June 2004 to October 2005. NBL was measured by the strict midsagittal section. The reference range of NBL was established from cross‐sectional data between 15 and 25 weeks’ gestation.

Results:  The success rate of obtaining reliable NBL was 93% (333/356). There were 330 fetuses (93%) available for constructing a reference range from the population. The median NBL increased from 3.2 mm at 15 weeks’ to 7.6 mm at 25 weeks’ gestation. The median of BPD/NBL ratio was 9.01.

Conclusions:  We demonstrated that NBL was significantly shorter and BPD/NBL was significantly greater in the Japanese population than those in the white and black populations.
Whitening effect of a dermocosmetic formulation: a randomized double‐blind controlled study on melasma
Authors: Thirion L. , Piérard‐Franchimont C. , Piérard G.E.
Published: July 2006

Synopsis

Melasma is an endocrine‐mediated facial hypermelanosis with epidermal and occasionally dermal components. We tested in a randomized double‐blind design the effect of a whitening formulation (Thiospot intensive®) on this skin disorder. The product containing ethyl linoleate, thioctic acid, octadecenedioic acid, lactic acid and ethylhexyl methoxycinnamate was applied twice daily for 3 months by 20 young women. Another control group of seven women received a non‐skin lightening formulation. Clinical assessments were made at 1‐month intervals. In addition, objective measurements of the hypermelanosis were performed using narrow‐band reflectance spectrophotometry, image analysis of video‐recorded ultraviolet light reflection (ULEV method) and photodensitometry of the corneomelametry test. A significant lightening effect was evidenced beginning the second month of treatment with the whitening formulation. No significant effect was observed with the control product.
Expression and function of neurotrophins and their receptors in human melanocytes
Authors: Marconi A. , Panza M. C. , Bonnet‐Duquennoy M. , Lazou K. , Kurfurst R. , Truzzi F. , Lotti R. , De Santis G. , Dumas M. , Bonté F. , Pincelli C.
Published: July 2006

Synopsis

Melanocytes and cells of the nervous system are of common ectodermal origin and neurotrophins (NT) have been shown to be released by human keratinocytes. We investigated the expression and function of NT [nerve growth factor (NGF), brain‐derived neurotrophic factor (BDNF), NT‐3, NT‐4/‐5] and their receptors in human melanocytes. Human melanocytes produce all NT in different amounts, whereas they only release NT‐4. NT‐4 release is downregulated, whereas NT‐3 is upregulated by ultraviolet (UVB) irradiation. Melanocytes treated with phorbol 12‐myristate 13‐acetate (PMA) express TrkA and TrkB, but not TrkC. NT fail to stimulate melanocyte proliferation, whereas they stimulate the synthesis of tyrosinase and tyrosinase‐related protein‐1 (TRP‐1). Finally, NT‐3, NT‐4 and NGF increase melanin production. Taken together, these results demonstrate an intriguing interaction between melanocytes and the nervous system. We speculate that NT could be considered the target of therapy for disorders of skin pigmentation.
New antiaxillary odour deodorant made with antimicrobial Ag‐zeolite (silver‐exchanged zeolite)
Authors: Nakane T. , Gomyo H. , Sasaki I. , Kimoto Y. , Hanzawa N. , Teshima Y. , Namba T.
Published: July 2006

Synopsis

The causative substances for axillary osmidrosis, which are often found in apocrine sweat, are the decomposed/denatured products of short‐chain fatty acid and other biological metabolite compounds produced by axillary‐resident bacteria. Conventional underarm deodorants suppress the process of odour production mostly by the following mechanism: (1) suppression of perspiration, (2) reduction in numbers of resident bacteria, (3) deodorization and (4) masking. The most important and effective method to reduce odour is to suppress the growth of resident bacteria with antimicrobials, which have several drawbacks, especially in their safety aspect. To solve these problems, we focused on Ag‐zeolite (silver‐exchanged zeolite) that hold stable Ag, an inorganic bactericidal agent, in its structure, and therefore, poses less risk in safety. Its bactericidal effect on skin‐resident bacteria was found to be excellent and comparable with that of triclosan, a most frequently used organic antimicrobial in this product category. The dose–response study of Ag‐zeolite powder spray (0–40 w/w%) using 39 volunteers revealed that 5–40 w/w% Ag‐zeolite could show a sufficient antimicrobial effect against skin‐resident bacteria. The comparison study using 0.2 w/w% triclosan as the control and 10 w/w% Ag‐zeolite indicated that: (1) one application of the powder spray containing 10 w/w% Ag‐zeolite could show a sufficient antimicrobial effect against the resident bacteria and its effect continued for 24 h, (2) a powder spray containing 0.2 w/w% triclosan was unable to show a sufficient antimicrobial effect, and (3) no adverse event was observed. These studies show that Ag‐zeolite has a superior antimicrobial ability that is rarely found in conventional antimicrobials used in deodorant products and a strong antiaxillary odour deodorant ability because of its long‐lasting effect. During clinical study, patch tests with humans and other clinical studies of this product showed no adverse events related to the treatment with the Ag‐zeolite product.