bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibrogenic stresses activate different mitogen‐activated protein kinase pathways in renal epithelial, endothelial or fibroblast cell populations
Authors: PAT Betty K , CUTTLE Leila , WATTERS Dianne , YANG Tao , JOHNSON David W , GOBE Glenda C
Published: July 2003

SUMMARY:  Fibrogenic stresses promote progression of renal tubulointerstitial fibrosis, disparately affecting survival, proliferation and trans‐differentiation of intrinsic renal cell populations through ill‐defined biomolecular pathways. We investigated the effect of fibrogenic stresses on the activation of cell‐specific mitogen‐activated protein kinase (MAPK) in renal fibroblast, epithelial and endothelial cell populations. The relative outcomes (cell death, proliferation, trans‐differentiation) associated with activation or inhibition of extracellular‐regulated protein kinase (ERK) or stress activated/c‐Jun N terminal kinase (JNK) were analysed in each renal cell population after challenge with oxidative stress (1 mmol/L H2O2), transforming growth factor‐β1 (TGF‐β1, 10 ng/mL) or tumour necrosis factor‐α (TNF‐α, 50 ng/mL) over 0–20 h. Apoptosis increased significantly in all cell types after oxidative stress (P < 0.05). In fibroblasts, oxidative stress caused the activation of ERK (pERK) but not JNK (pJNK). Inhibition of ERK by PD98059 supported its role in a fibroblast death pathway. In epithelial and endothelial cells, oxidative stress‐induced apoptosis was preceded by early induction of pERK, but its inhibition did not support a pro‐apoptotic role. Early ERK activity may be conducive to their survival or promote the trans‐differentiation of epithelial cells. In epithelial and endothelial cells, oxidative stress induced pJNK acutely. Pretreatment with SP600125 (JNK inhibitor) verified its pro‐apoptotic activity only in epithelial cells. Transforming growth factor‐β1 did not significantly alter mitosis or apoptosis in any of the cell types, nor did it alter MAPK activity. Tumor necrosis factor‐α caused increased apoptosis with no associated change in MAPK activity. Our results demonstrate renal cell‐specific differences in the activation of ERK and JNK following fibrotic insult, which may be useful for targeting excessive fibroblast proliferation in chronic fibrosis.
Angiotensin‐converting enzyme polymorphism gene and evolution of nephropathy to end‐stage renal disease
Authors: ORTIZ M Angels , DE PRADO Anna , DOÑATE Teresa , GALLART Lluis , CLARAMUNT Helena , HERNÁNDEZ Marta , MARTÍNEZ Joaquin , MARTÍNEZ Esther , POU Jose M
Published: July 2003

SUMMARY:  Genetic polymorphisms of the renin‐angiotensin system (RAS) have been implicated in the pathogenesis of nephropathy and end‐stage renal disease (ESRD). The association between angiotensin‐converting enzyme (ACE) gene polymorphism and nephropathy evolution was studied. A random sample of 161 subjects from the Nephrology Department (of Hospital de Sant Pau) were divided into two groups: (i) 117 with end‐stage renal disease; (ii) 44 with established nephropathy; and (iii) control groups of 129 subjects. The ACE gene polymorphism was performed by using polymerase chain reaction. High DD genotype presentation was observed in the two groups of subjects with nephropathy (46.12 and 61.37%, respectively vs 35.66% in controls; P < 0.0482), and also, a decrease was observed in the II genotype (6.4 and 4.54%, respectively vs 13.17% in controls, P < 0.0404). Glomerular filtration rate (GFR) was evaulated after 44 months of follow up. An important decrease of GFR was observed in patients with DD polymorphism versus other genotypes (initial, 32.3 ± 7.9 and at 44 months, 18.35 ± 3.3 mL/min vs 31.4 ± 11.9 and 11.7 ± 3.2 mL/min; P < 0.039). In a non‐longitudinal study of patients in ESRD, patients with an ACE‐DD genotype had a lower period of time between diagnosis of nephropathy and ESRD than patients with other genotypes (10.45 ± 9.32 vs 19.5 ± 8.4 years; P < 0.034). In conclusion, the ACE gene that controls RAS response may influence the development and progression of nephropathy to ESRD. Patients who develop several types of nephropathy have a higher risk of severe evolution if they have a profile of ACE‐DD genotype.
Wireworm (Coleoptera: Elateridae) identity, monitoring and damage in sugarcane
Authors: Samson Peter R , Calder Andrew A
Published: July 2003

Abstract Wireworms (Coleoptera: Elateridae) damage the eyes and young shoots of germinating cane setts in many growing regions. Insecticides can be applied at planting to avoid damage. However, there are no guidelines for deciding on whether treatment is warranted and a sampling method to detect wireworms before planting has not been developed. Baits of rolled oats were tested as a method for detecting wireworms in preplant fallows. In 1995 at Bundaberg, the reduction in crop establishment when treatment was withheld was positively correlated with the catch of wireworms at baits before planting. However, no similar relationship was seen in 1996 or at Mackay in either 1995 or 1996: severe damage was recorded on one farm at Mackay where no wireworms had been found. A sampling plan was developed to estimate wireworm numbers at baits with a fixed level of precision. Wireworms collected at the baits and in samples from established canefields in Queensland and New South Wales included five named and 21 unnamed species from five genera, the most abundant being Agrypnus, Conoderus and Heteroderes. Possible barriers to the adoption of baiting as a decision‐support tool are discussed. Development of a reliable monitoring system would require considerably more research, which could not be justified at present.
Two new Australian Monomorium Mayr (Hymenoptera: Formicidae), including a highly distinctive species
Authors: Heterick Brian E
Published: July 2003

Abstract Two new Australian ants of the genus Monomorium Mayr (Hymenoptera: Formicidae) are described. The most distinctive of the two species, Monomorium sublamellatum sp. n., pushes back the diagnostic boundaries of the genus Monomorium, and can not be placed at present in existing Australian species‐groups of Monomorium. Monomorium punctulatum sp. n. belongs to the Monomorium rubriceps species‐group.
Revision of the Australian species ofHyalobathraMeyrick (Lepidoptera: Pyraloidea: Crambidae: Pyraustinae) based on adult morphology and with description of a new species
Authors: Sutrisno Hari , Horak Marianne
Published: July 2003

AbstractThe genusHyalobathraMeyrick is redefined based on five Australian species including the type  species. The four named Australian species,H. archeleucaMeyrick,H. unicolor(Warren), H. miniosalis(Guenée) andH. minialis(Warren), are redescribed and a new species,H. crenulatasp. n., is described. Hyalobathra unicoloris removed from synonymy withH. illectalis(Walker), and lectotypes are designated forH. archeleuca,H. minialisand forH. rhodoplectaTurner, a synonym ofH. miniosalis. The presence ofH. paupellalis(Lederer) in Australia could not be confirmed, but its genitalia are figured. Two previously included species, ‘Hyalobathra’aequalis(Lederer) and ‘H.’ brevialis(Walker), are excluded fromHyalobathra,as they lack its generic apomorphies, but cannot at present be assigned to any other genus.
Rearing and release of Homichloda barkeri (Jacoby) (Coleoptera: Chrysomelidae: Alticinae) for the biological control of prickly acacia, Acacia nilotica ssp. indica (Mimosaceae) in Australia
Authors: Lockett Catherine J , Palmer William A
Published: July 2003

Abstract Prickly acacia, Acacia nilotica ssp. indica, a major weed of the Mitchell Grass Downs of northern Queensland, has been the target of biological control projects since the 1980s. The striped leaf‐feeding beetle, Homichloda barkeri (Coleoptera: Chrysomelidae: Alticinae), was the third insect approved for release for the control of this weed in Australia. However, mass rearing this insect under glasshouse conditions proved to be difficult and time consuming as there were problems associated with low egg‐hatching rates and poor larval survival. Eggs in diapause were stimulated to hatch by repeated wetting and drying. Larvae were fed on potted prickly acacia plants in cages. Late‐instar larvae were collected and transferred to a mix of sand, peat moss and vermiculite for pupation and adult emergence. Over 10 500 adults were released at 28 sites in north Queensland between November 1996 and December 1999. Initial releases of insects confined to gauze cages resulted in limited adult survival, oviposition and development of first‐generation larvae. First‐generation larvae were observed at two sites where cages were not used. However, later inspections of release sites, including those made in April and December 2000, April 2001 and late March 2002, failed to find any trace of the insect, which is assumed to have failed to establish. Possible reasons for this failure are discussed.
Relationships between the lucerne flea, Sminthurus viridis (L.) (Collembola: Sminthuridae), and damage to lucerne
Authors: Bishop Alan L , Barchia Idris M
Published: July 2003

Abstract The effect of lucerne flea, Sminthurus viridis, on plant growth (stem length and leaf number) and damage (percentage of leaves damaged and the percentage reduction in leaf area in the top, mid and lower thirds of stems) was considered at 2‐weekly intervals in three consecutive lucerne growth cycles, each with a different mode of attack. The data were analysed to progressively determine relationships leading to a proposal for plant‐based thresholds for lucerne flea control. Lucerne flea affected each factor measured, with damage considered more appropriate for making control decisions than plant growth. Damage increased from the base of plants upwards and its effect on yield was carried over into subsequent growth cycles. Damage was significantly related to lucerne flea numbers (P < 0.001) in two growth cycles and was higher when large nymphs or adults were dominant in one of these cycles. Yield was closely and best related to the percentage of the total number of leaves damaged (R2 = 81.3%). The percentage of leaves damaged was also related to loss of final yield estimated at 2 (R2 = 81.3%), 4 (R2 = 78.9%) and 6 (R2 = 66.6%) weeks into the first growth cycle only. Direct damage in the other two cycles did not result in yield loss. The percentage of leaves damaged (± confidence intervals) equating to 5% increments in yield loss were estimated at 2, 4 and 6 weeks into the first growth cycle. These are proposed as damage or treatment thresholds for testing.
Biological and ecological aspects of Chinese wax scale, Ceroplastes sinensis Del Guercio (Hemiptera: Coccidae): a two‐year study from Central Greece
Authors: Stathas George J , Kavallieratos Nickolas G , Eliopoulos Panagiotis A
Published: July 2003

Abstract Biological and ecological aspects of the scale Ceroplastes sinensis are investigated on citrus in central Greece through regular samplings during 1999−2001 on Citrus sinensis (Sapindales: Rutaceae) in Attiki County. The scale was univoltine. Overwintering stages were the third‐instar nymph and the adult female. From the end of May until the end of June the population comprised preovipositing females. Oviposition occurred from mid‐June until mid‐July and hatching took place during July. First‐ and second‐instar nymphs were recorded from the end of July until the end of August, and from mid‐August until the end of September, respectively. Third‐instar nymphs appeared at the end of August and were present until the beginning of September. Some of the population of third‐instar nymphs reached the adult stage during October and November, whilst the remainder completed development in the following April. Small numbers of male nymphs were recorded during October and November. The mean fecundity of adult females was 3260 ± 770 eggs per female. The most abundant natural enemy of C. sinensis was Scutellista caerulea (Fonscolombe) (Hymenoptera: Pteromalidae), whose eggs, larvae and pupae were found in up to 42% of the total live population of the scale. Two predators, Chilocorus bipustulatus (L.) and Exochomus quadripustulatus (L.) (Coleoptera: Coccinellidae), were also observed.
Biology and host specificity of the chromolaena stem gall fly, Cecidochares connexa (Macquart) (Diptera: Tephritidae)
Authors: McFadyen Rachel E Cruttwell , Desmier de Chenon Roch , Sipayung A
Published: July 2003

Abstract The stem‐galling tephritid fly Cecidochares connexa (Macquart) was investigated as a potential biocontrol agent against the weed Chromolaena odorata (L) King & Robinson in Indonesia. Adults were tested in choice and no‐choice tests, on 55 non‐target plant species in 17 families. No oviposition was recorded on 53 of the species, while oviposition but no larval development was recorded on two. Field releases commenced in 1995 and establishment was immediate. The gall fly is now widely established in most Indonesian provinces, where gall parasitism and predation is generally low.
First record of the subfamily Dirrhopinae (Hymenoptera: Braconidae) from the Australian region, with a discussion of relationships and biology
Authors: Belokobylskij Sergey A , Iqbal Muhammad , Austin Andrew D
Published: July 2003

Abstract The subfamily Dirrhopinae (Hymenoptera: Braconidae) is recorded for the first time from the Australian region on the basis of Dirrhope minor Belokobylskij collected at light from several sites in northern Queensland. The species is redescribed and a discussion of relationships, distribution and biology of the subfamily is presented.
Palatability and defense in the aposematic diurnal whistling moth, Hecatesia exultans Walker (Lepidoptera: Noctuidae: Agaristinae)
Authors: Talianchich Adam , Bailey Winston J , Ghisalberti Emilio L
Published: July 2003

Abstract Aposematic colours may warn predators that an individual or species is chemically defended and unpalatable. This study examines a diurnal Australian whistling moth, Hecatesia exultans (Noctuidae, Agaristinae) where adults, although cryptic at rest, display their bright orange, yellow and black colouration in flight. Aposematically coloured larvae feed mainly on Cassytha, a parasitic vine that contains aporphine alkaloids. Alkaloids isolated from the plants and moths were analysed for the presence of these compounds. While alkaloids were found in the stomach and frass of 18 moth larvae, no alkaloids were present in the body and similarly no alkaloids were detected from 65 adult male moths collected from three widely separated populations. We conclude that the larvae and adults do not sequester alkaloids. Lycosid spiders and singing honeyeaters (Lichenostomtus virescens) were used to assess the palatability of H. exultans adults. The spiders and the birds consumed all adult moths. Adult moths appear to avoid predation by employing quick flights with rapid changes of direction and, while the adults are brightly coloured, they are not chemical defended.
Apodeme and ovarian development as predictors of physiological status in Bactrocera cacuminata (Hering) (Diptera: Tephritidae)
Authors: Raghu S , Halcoop Peter , Drew Richard AI
Published: July 2003

Abstract Assessing resource‐use by different life stages of insects is crucial to our understanding of their ecology. Development of appropriate methods by which different physiological states can be identified is therefore significant. We develop one such method for the dacine fly Bactrocera cacuminata (Hering) (Diptera: Tephritidae). In male flies, the ejaculatory apodeme, a structural part of the reproductive endoskeleton, grows as a function of age of the fly. This growth pattern is sigmoid, reaching a maximum threshold that corresponds with the attainment of sexual maturity, as measured by the incidence of first mating. Similarly, in female flies ovarian development appears to be a reliable indicator of sexual maturity. Assuming that similar growth thresholds occur in wild flies, it is possible to use apodeme and ovarian development as measures of physiological/reproductive status in this species.
The accuracy of external blood loss estimation by ambulance and hospital personnel
Authors: Tall Gary , Wise David , Grove Peter , Wilkinson Chris
Published: July 2003

Objective: To determine if emergency personnel, either ambulance or hospital based, can estimate the volume of external blood loss accurately enough to be of potential clinical use in guiding fluid resuscitation.

Methods: A total of 61 ambulance and 35 hospital personnel viewed nine scenarios consisting of volumes of blood (100 mL, 400 mL and 700 mL) spilt onto three surfaces — carpet, vinyl and a clothed manikin. They were asked to estimate the blood loss in each case.

Results: Estimates of volumes of blood loss on all surfaces were generally inaccurate. Both ambulance and hospital groups were comparable in this regard. Hospital personnel had higher mean estimates than those of ambulance personnel. Of particular clinical relevance were the findings that blood loss on carpet was underestimated and small volumes on a clothed manikin were overestimated.

Conclusion: External blood loss estimation by ambulance and hospital personnel is generally too inaccurate to be of clinical use.
The heaviest repeat users of an inner city emergency department are not general practice patients
Authors: Dent Andrew Wesley , Phillips Georgina A , Chenhall Antony J , McGregor Lachlan Robert
Published: July 2003

Objective: To test the hypothesis that frequent attenders to the ED are suitable for diversion to general practice.

Methods: A retrospective review of a computerized database for the top 500 frequent presenters to an inner city adult teaching hospital ED.

Results: Five hundred patients presented 12 940 times, an average of 26 times per patient, accounting for (8.4%[8.3, 8.6]) of total ED presentations over 64 months. There were 7699 (59.5%[58.7, 60.4]) presentations deemed appropriate for ED. Of the remaining 5241 presentations, 1553 (29.6%[28.4, 30.9]) were between 22.00 and 07.00 hours, outside the hours of most actual or proposed primary care clinics. This left 3688 (28.5%[27.7, 29.3]) presentations by the heaviest users of the ED as potentially appropriate for general practice. Of these presentations 1507 (40.9%[39.3, 42.5]) were by people who were homeless. A total of 2574 (69.8%[68.3, 71.3]) had pre‐existing case management, either by the hospital or another service. Nine hundred and seventy‐eight (26.5%[25.1, 28.0]) had primary psychiatric or altered conscious states due to drugs and alcohol as the presenting problem. At least 90 of these 500 frequently presenting patients died during the study period.

Conclusion: The majority of the presentations by the heaviest users of an ED in a city teaching hospital are not suitable for general practice. Attempting diversion of the heaviest repeat ED users to a general practice in this setting may not be successful due to the severity, acuity and nature of casemix of the presentations and would have minimal impact on crowding in similar emergency departments.
Inpatient mortality as related to triage category in three New South Wales regional base hospitals
Authors: Doherty Steven R , Hore Craig T , Curran Shane W
Published: July 2003

Objective: To establish the incidence of death after admission via the ED for each of the five categories of the Australasian Triage Scale in three New South Wales base hospitals, and to compare this with published data from an adult tertiary referral hospital in Victoria. To examine the causes of death in each category.

Methods: Information was collected from databases established as part of quality assurance projects at three New South Wales rural base hospitals from 1 January 2000 to 31 December 2000.

Results: Overall mortality rates per ED presentation and per ED admission were significantly lower than for similar data from an adult tertiary referral hospital. There were significant differences in mortality per ED presentation for categories 2, 3 and 4 and significant differences in mortality per admission for Australasian Triage Scale categories 2 and 3. The commonest causes of death were acute cardiac/respiratory and malignancy related conditions. Triage category 3 had both the highest number of total admissions and the highest number of deaths post admission. This finding differs from published data from an adult tertiary referral hospital where category 4 represented the largest number of admissions and of in‐hospital deaths following admission.

Conclusion: This study has established the mortality rates per ED presentation and admission for each of the five categories of the Australasian Triage Scale in three New South Wales rural base hospitals. Significant differences were found between these rates and the published rates for an adult tertiary referral hospital.
Spectrum of acute allergic diseases in an emergency department: An evaluation of one years’ experience
Authors: Bellou Abdelouahab , Manel Jacques , Samman‐Kaakaji Hassan , De Korwin Jean Dominique , Moneret‐Vautrin Denise Anne , Bollaert Pierre‐Edouard , Lambert Henri
Published: July 2003

Objective: There is limited available literature on the incidence of allergic diseases in ED. The objective of this study was to investigate the clinical records of patients admitted to the ED with a suspected allergic reaction.

Methods: A 1 year retrospective study was carried out and data were collected from the patients’ computerized medical reports.

Results: A total of 324 patients were admitted for an allergic event. Of those, 165 patients (50.9%) were female and their mean age was 55 ± 18.5 years. Diagnoses included: asthma in 100 patients (30.9%); hymenoptera allergy in 78 patients (24.1%); food allergy in 31 patients (9.5%); drug allergy in 25 patients (7.7%); and allergic conjunctivitis in 12 patients (3.7%). No diagnosis was found in the medical records of 78 patients (24.1%). Anaphylactic shock was observed in 12 patients (3.7%) with a diagnosis of food allergy (six cases), drug allergy (three cases) and hymenoptera allergy (three cases). Ninety patients (27.7%) were hospitalized in the following units: 38 in allergy unit (42.2%); 20 in intensive care unit (22.2%); 10 in pulmonary unit (11.1%); eight in the dermatology unit (8.9%); six in the internal medicine unit (6.7%); and eight in other units (8.9%). Overall, 42 patients (12.9%) were evaluated by an allergologist after ED discharge with positive allergy results in 28 cases (66.6%).

Conclusions: Acute allergic diseases are not rare in ED, representing 1% of the annual visits in our series. A low rate of allergologist referral was observed. Emergency physicians must work closely with allergologists to ensure a better evaluation, long‐term care and preventive management of patients with allergic diseases admitted to the ED.
Information sources accessed by parents following childhood poisoning
Authors: Rush Jennifer A , Reith David M
Published: July 2003

Objective: To ascertain the sources of information accessed by parents/caregivers following an incident of child poison ingestion, prior to their presentation to an ED.

Methods: A questionnaire based survey of the parents/caregivers of children presenting to the Mater Children's Hospital Emergency Department with poisoning from March to October 2001.

Results: A total of 121 parents/caregivers were surveyed. In 117 cases (97%), information was sought prior to presentation. The Poisons Information Centre (PIC) was the initial source of information in 39 cases (32%), the ED in 25 cases (21%) and the family doctor (by telephone or consultation) in 21 cases (17%). Poisons Information Centres, emergency departments and family doctors were the sole sources of information for 18%, 15% and 12% of cases, respectively. For 46% of cases multiple sources of information were accessed, and overall, in 57 cases (47%) the Poisons Information Centre was accessed, the ED in 38 cases (31%) and the family doctor in 34 cases (28%).

Conclusions: Poisons Information Centres are under‐utilized as the first point of contact after childhood poisoning but in nearly all cases of poison ingestion that presented to the ED, information was sought prior to presentation and in most cases this was from direct contact with a health professional.
The status of the Glasgow Coma Scale
Authors: Gabbe Belinda J , Cameron Peter A , Finch Caroline F
Published: July 2003

The Glasgow Coma Scale (GCS) was first introduced in the 1970s to provide a simple and reliable method of recording and monitoring change in the level of consciousness of head injured patients. Since its introduction, the GCS has been widely utilized in the trauma community and its use expanded beyond the original intentions of the score. In the context of traumatic injury, this paper discusses the use of the GCS as a predictor of outcome, the limitations of the GCS, the reliability of the GCS and potential alternatives through a critical review of the literature. The relevance to Australian trauma populations is also addressed.
Emergency management of eclampsia and severe pre‐eclampsia
Authors: Lew Martin , Klonis Evangelos
Published: July 2003

Eclampsia and severe pre‐eclampsia are rare, but potentially life‐threatening conditions that emergency physicians must be able to diagnose and treat promptly, because initial presentations to the ED are real possibilities. The treatment of the major complications of this disorder, hypertension and seizures, have been the focus of much research. Magnesium sulphate is now the first line agent for acute treatment and prophylaxis of seizures in eclampsia and pre‐eclampsia. Severe pre‐eclampsia should be treated with magnesium to prevent progression to eclampsia. Severe hypertension requires treatment with an intravenous antihypertensive agent familiar to the clinician. No single antihypertensive has been proven to be better than another, although in Australia, hydralazine is probably the initial intravenous agent of choice. Routine use of invasive haemodynamic monitoring and volume expansion is not recommended and consultation with obstetric colleagues is essential.
Giving a voice to the community: A qualitative study of consumer expectations for the emergency department
Authors: Stuart Peter John , Parker Steven , Rogers Mark
Published: July 2003

Objective: To identify consumer expectations with respect to the ED.

Methods: Semi‐structured focus groups comprising representatives from a wide range of community groups. Data was analysed using a qualitative analytical approach.

Results: The major themes of the groups were communication, triage, waiting area, cultural issues and carers. Consumers expressed the need to be informed about how the ED functions, particularly with regard to the triage process, patient assessment and admissions procedure. Privacy at the triage desk, comfort and safety of the waiting area, provision of facilities for children, cultural awareness of staff, access interpreter services and recognition of the needs of carers were identified as key issues.

Conclusion: The recognition of consumer needs provides the opportunity for the ED to develop strategies to match patient needs to service delivery.
Presumed Angel's trumpet (Brugmansia) poisoning: Clinical effects and epidemiology
Authors: Isbister Geoffrey K , Oakley Patrick , Dawson Andrew H , Whyte Ian M
Published: July 2003

Objective: To investigate the pattern and epidemiology of anticholinergic plant poisoning, and to characterize its time course and clinical features.

Methods: We reviewed all anticholinergic plant poisonings using a prospective database of all poisonings admitted to a major toxicology unit in Australia. All patients that presented with anticholinergic plant poisoning between July 1990 and June 2000 were included. Patient demographics, details of poisoning, diagnostic clinical features, adverse effects (seizures, arrhythmias, hypotension, accidental injury), and treatments required were obtained. Important diagnostic features were analysed and compared to previous studies.

Results: Thirty‐three patients were presumed to have ingested Brugmansia spp. (Angel's trumpet) based on their description of the plant; median age 18 years (interquartile range 16–20); 82% males. Thirty‐one ingested a brewed tea or parts of the plant (flower). Thirty‐one used it recreationally. Common clinical features were: mydriasis (100%), mean duration 29 h (SD 13) and delirium (88%) with a mean duration of 18 h (SD 12). Tachycardia only occurred in 11 of the 33 patients (33%). In 24 patients where the time of ingestion was certain, 7 of 8 (88%) patients presenting within 5 h had tachycardia and only 5 out of 16 (31%) presenting after 5 h had tachycardia. There were no deaths, seizures or arrhythmias (excepting tachycardia). One patient had hypotension and two sustained accidental traumatic injuries. Nineteen patients required sedation, mainly with benzodiazepines. Physostigmine was used diagnostically in eight cases.

Conclusions: Anticholinergic plant abuse is sporadic in nature. Most cases were moderate in severity, requiring sedation only, and severe toxicity was rare. Mydriasis and delirium were the commonest features, the later having important implications for management.
Comparison of two needle types for intraosseus access in an animal model
Authors: Boyd Russell J , Schutz Jackie , Stuart Peter
Published: July 2003

Objectives: This study was designed to investigate the success rate, time for insertion and perceived difficulty in gaining intraosseus access in a porcine‐derived animal model. The model was selected to have bone characteristics similar to human adult bone. Prehospital care personnel used two varieties of commercially available intraosseus needles, Cook Paediatric Intraosseus Insertion Needles and Cook Osteo‐site needles.

Methods: Sixteen ambulance paramedic trainees were trained to use both of two intraosseus needle types. They were timed from start of insertion attempt to successful insertion and asked to score perceived difficulty of intraosseus needle insertion using a modified Likert scale.

Results: Sixteen of 16 (100%) of the insertions with the Cook Osteo‐site needle were successful. Eleven of 16 (69%) insertions with the Cook Paediatric Intraosseus Insertion needle were successful. There was a statistically significant difference between the two groups (P = 0.033). The Cook Osteo‐site needle was perceived to be significantly easier to use than the Cook Paediatric Intraosseus Insertion needle (P = 0.0085) and there was a non‐significant trend to shorter insertion times for the Cook Osteo‐site needle.

Conclusions: Use of intraosseus needles to gain access in an animal model is possible. The use of the Cook Osteo‐site needle is associated with excellent success rates for insertion and appears easier to use than the Cook Paediatric Intraosseus Insertion needle. Further work to evaluate the use of the intraosseus access device in the prehospital care situation is required.
Signet‐ring cell carcinoma of the prostate effectively treated with maximal androgen blockade
Authors: AKAGASHI KEIGO , TANDA HITOSHI , KATO SHUJI , OHNISHI SHIGEKI , NAKAJIMA HISAO , NANBU AKIHITO , NITTA TOSHIKAZU , KOROKU MIKIO
Published: July 2003

Abstract Primary signet‐ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72‐year‐old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.
Papillary adenoma of the prostatic urethra: Report of two cases
Authors: TAN MUSTAFA ÖZGÜR , KORDAN YAKUP , DENİZ NURİ , ERDEM ÖZLEM , ŞEN İLKER , BOZKIRLI İBRAHİM
Published: July 2003

Abstract Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower urinary tract obstruction, especially in young adults. We report two cases of papillary adenoma and their endoscopic views. One of the patients had a lesion located on the verumontanum and presented with hematuria, hemospermia and symptoms of lower urinary tract obstruction. The other patient had papillary lesions located in the paramontanal gutter and presented with persistent painless hematuria. The origin of both lesions was proven to be prostatic epithelial differentiation using immunohistochemical identification of prostate‐specific antigen. Papillary adenoma is believed to be benign, therefore, both lesions were carefully excised and fulgurated transurethrally.
Successful long‐term disease‐free survival following multimodal treatments in a patient with a repeatedly recurrent refractory adrenal cortical carcinoma
Authors: FUJII YASUHISA , KAGEYAMA YUKIO , KAWAKAMI SATORU , MASUDA HITOSHI , ARISAWA CHIZURU , AKAMATSU HIDEKI , AKASHI TAKUMI , KIHARA KAZUNORI
Published: July 2003

Abstract A 47‐year‐old male patient underwent surgery for a 10‐cm adrenal cortical carcinoma. A large invasive adrenal mass was surgically removed en bloc with the right kidney and the lower lobe of the liver. Two months postoperatively, a 7‐cm recurrent mass developed in the right psoas muscle. After a partial response was achieved by irradiation (40 Gy) and high‐dose chemotherapy (carboplatin and etoposide) with peripheral blood stem cell transplantation, the patient underwent surgery with a wide excision of the psoas muscle. Twelve months after the initial surgery, an 8‐cm rib metastasis developed and the patient again underwent surgery after a combination of irradiation (50 Gy) and chemotherapy (cisplatin and etoposide). The patient has been doing well without any evidence of recurrence for 5 years. Refractory or metastatic adrenal cortical carcinomas have been thought to be lethal, therefore, the present case provides support for multimodal treatments of refractory adrenocortical cancers.
Metastatic renal cell carcinoma to the bladder 12 years after radical nephrectomy
Authors: SHIRAISHI KOJI , MOHRI JUN , INOUE RYO , KAMIRYO YORIAKI
Published: July 2003

Abstract We report, herein, a case of metastatic renal cell carcinoma of the urinary bladder. A 76‐year‐old man presented to our hospital. He had undergone right radical nephrectomy at 64 years of age. Cystoscopy revealed a solitary, spherical tumor 1.5 cm in size protruding into the urinary bladder. Transurethral resection was performed and the pathological diagnosis of the lesion was clear cell carcinoma. The patient is alive 12 months after recurrence to the bladder, under the administration of interleukin‐2.
Adrenocorticotropin‐independent macronodular adrenal hyperplasia treated by simultaneous bilateral laparoscopic adrenalectomy
Authors: MURAMAKI MOTOTSUGU , OKADA HIROSHI , SAKAI YUTAKA , GOTOH AKINOBU , FUJISAWA MASATO , KAMIDONO SADAO , KAWABATA GAKU
Published: July 2003

Abstract A 61‐year‐old woman was admitted to our hospital with hypertension and diabetes mellitus, and was found to have Cushing's syndrome. Radiological and endocrinological findings suggested adrenocorticotropic hormone‐independent macronodular adrenal hyperplasia. Simultaneous bilateral laparoscopic adrenalectomy was performed, minimizing the number of trocar sites and operation time. Success was attributed to the careful selection of trocar sites to permit safe dissection.
Retrospective analysis of 74 cases of seminoma treated with radiotherapy
Authors: GÜDEN METIN , GÖKTAŞ SERDAR , SÜMER FAHRI , ULUTİN CÜNEYT , PAK YÜCEL
Published: July 2003

Background:  Standard post‐orchiectomy radiotherapy (RT) is accepted as a standard management option for stage I seminoma.

Methods:  Retrospective evaluation of 74 patients with stage I seminoma was performed according to the Royal Marsden staging system. All of the patients underwent RT in the Radiation Oncology Department of Gülhane Military Medical Academy between 1974 and 1995. The median age of patients was 27 years (range, 20–56). Radiotherapy was applied to all of the patients after orchiectomy for adjuvant purposes. Sixty‐nine patients underwent RT while five patients who had recurrence received chemotherapy following radiotherapy.

Results:  After a mean follow‐up period of 54 months, the 5‐year overall survival rate was 98.61%, which complied with the literature. The disease‐free survival rate was 90.54%. According to the World Health Organization toxicity scale, acute enteritis was 9.4% for grade I and 5.4% for grade II, while nausea/vomiting was 36.4% for grade I and 5.4% for grade II.

Conclusion:  To avoid acute toxicity related to RT, prognostic risk factors should be well‐known and patients with low risk factors should be monitored carefully after orchiectomy. RT should be directed to the para‐aortic ± ipsilateral pelvic lymph nodes in high risk patients. Although post‐orchiectomy RT is a traditional management option for clinical stage I seminoma, the results of RT should be well‐known to compare it with other treatment options (e.g. RPLND, adjuvant chemotherapy and surveillance).
Further investigation of the epitope recognized by the new monoclonal antibody 2C9
Authors: KATO KEITARO , YOSHIKAWA KAZUHIRO , TAKI TOMOHIRO , SHITARA KENYA , NAKAMURA KAZUYASU , HIROTA MAIKO , HANAI NOBUO , NAKAMURA KOGENTA , KOKUBO HIROTO , MITSUI KENJI , YAMADA YOSHIAKI , HONDA NOBUAKI , UEDA RYUZO , SAGA SHINSUKE , FUKATSU HIDETOSHI
Published: July 2003

Objective:  We established a new monoclonal antibody (2C9) that reacted with prostate tissue. The immunohistochemical reactivity of this antibody is similar to anti‐prostate‐specific membrane antigen (PSMA). Herein, we report the antigenic determinant of 2C9 antibody.

Methods:  The reactivity of the antibody was characterized by immunohistochemical staining and the antigen target was characterized by amino acid sequencing after immuno‐affinity purification from an LNCaP cell lysate and cloning of a cDNA using a mammalian expression cDNA cloning system.

Results:  The amino acid and nucleotide sequences for the antigen molecule recognized with 2C9 monoclonal antibody demonstrated identity with PSMA.

Conclusion:  The target molecule of the 2C9 monoclonal antibody is PSMA, pointing to future diagnostic and therapeutic applications.
Urolithiasis in Okinawa, Japan: A relatively high prevalence of uric acid stones
Authors: HOSSAIN RAYHAN ZUBAIR , OGAWA YOSHIHIDE , HOKAMA SANEHIRO , MOROZUMI MAKOTO , HATANO TADASHI
Published: July 2003

Aim:  The aim of the present study was to investigate the composition of urinary tract stones in patients from Okinawa, the most southern island group of Japan.

Methods:  The study was conducted by 12 hospitals in Okinawa. A total of 1816 urinary tract calculi were obtained from 1816 patients (1323 males; 493 females). The patients had a mean age of 53 ± 15.3 years (mean ± SD). The calculi were examined to determine their chemical composition. Stone samples were analyzed by computed infrared spectrophotometer.

Results:  Pure stones comprised 58.4% of the total, with calcium oxalate stones accounting for 40% (21% monohydrate [whewellite]; 6.6% dihydrate [weddellite]; and 12.4% combined monohydrate and dihydrate stones), uric acid/urate stones for 9.6%, calcium phosphate stones for 5.1%, and struvite stones for 3.7%. The other 41.6% of the stones consisted of calcium oxalate mixed with other components. The male‐to‐female ratio was 2.7 : 1.

Conclusion:  In our series, calcium oxalate stones accounted for 81.6% of the urinary tract calculi, while uric acid/urate stones accounted for 15.8%. Uric acid stones, predominantly the anhydrous and/or dihydrate forms, showed a relatively high prevalence. Calcium oxalate stones, predominantly in the form of whewellite, showed a high prevalence among pure calculi; while the predominant combinations among mixed calculi were weddellite + calcium phosphate and whewellite + uric acid/urate.
Determinants of quality of life of bladder cancer survivors five years after treatment in France
Authors: MATSUDA TOMOHIRO , APTEL ISABELLE , EXBRAYAT CATHERINE , GROSCLAUDE PASCALE
Published: July 2003

Objectives:  The aim of the population‐based study presented here was to evaluate quality of life (QOL) among bladder cancer survivors at least five years after diagnosis, ascertain the long term effects of treatments, and investigate important pathological and sociodemographic factors influencing the QOL of such survivors.

Methods:  A Functional Assessment of Cancer Therapy (FACT) questionnaire with a bladder‐specific option (FACT‐Bl), was sent by mail to patients randomly selected from the database of the Isère and Tarn cancer registries in France. Ninety‐five valid completed questionnaires were returned by 78 males and 17 females, with a median age of 72 years (range, 33–90). The pathological information contained in the completed questionnaires was examined.

Results:  Of the 95 patients (76 with a superficial tumor, 17 with an invasive tumor), 20 had undergone total cystectomy. Total cystectomy clearly deteriorates the autonomy of survivors (ECOG‐PSR), as well as their scores on the bladder cancer‐specific sub‐scale in sexuality‐related questions. Survivors claimed impotency and loss of sexual interest after the cystectomy. In contrast, neither the type of treatment nor the time from the most recent major treatment were score‐modifying factors. Negative psychological effects of treatments in the long‐term were not observed. Rather, patients’ QOL was affected by their autonomy in daily life and by old age. In addition, familial situation had a critical impact on emotional and Familial/Social Well‐being.

Conclusion:  The present study showed the long‐term negative effect of total cystectomy on survivors. Survivor autonomy and other sociodemographic backgrounds were also determinants of their QOL. The maintenance of good health, sexual function and active family relationships should be promoted so that patients can lead full lives after treatment.
Morbidity of laparoscopic radical prostatectomy: Summary of early multi‐institutional experience in Japan
Authors: ARAI YOICHI , EGAWA SHIN , TERACHI TOSHIRO , SUZUKI KAZUO , GOTOH MOMOKAZU , KAWAKITA MUTSUSHI , TANAKA MASATOSHI , TERADA NAOKI , BABA SHIRO , OKUMURA KAZUHIRO , HAYAMI SHINSUKE , ONO YOSHINARI , MATSUDA TADASHI , NAITO SEIJI
Published: July 2003

Aim:  Laparoscopic radical prostatectomy is being evaluated throughout the world. The aim of the present study is to report early multi‐institutional experience of the procedure in Japan.

Methods:  A total of 148 men who were diagnosed with clinically localized prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early complications (within 30 days postoperatively) and postoperative convalescence were reviewed retrospectively. The median age of patients was 68.0 years (range, 51–80).

Results:  The median operative time was 403 minutes (range, 167–925; average, 427). Blood loss ranged from 50 to 5000 mL (median, 540; average, 856). A total of 66 complications were reported in 55 patients (37.2%). Intraoperative complications were noted in 25 of 148 patients (16.9%): 10 rectal injuries (6.8%); five bladder injuries (3.4%); five cases of subcutaneous emphysema (3.4%); two intestinal injuries (1.4%); one major vessel injury (0.7%); one ureteral injury (0.7%); and one obturator nerve injury (0.7%). Overall, 16 of 148 patients (10.8%) required open conversion or postoperative open surgical repair. The most common postoperative complications were anastomotic leakage (6.8%), wound‐related complications (4.7%) and perineal pain (4.7%). The bladder catheter was removed on day 7 or earlier in 73 cases (49.3%). The median time to ambulation was 1 day (mean 1.4, range 1–5). Oral intake was started on postoperative day 1 in 67 patients (45.2%) and on postoperative day 2 in 65 (43.9%).

Conclusion:  Although laparoscopic radical prostatectomy is technically demanding, reduced blood loss and shorter convalescence periods can be expected from the procedure. Surgeons should be aware of the disturbingly high morbidity rate related to early experience. By mastering laparoscopic skills and sharing knowledge, surgeons could reduce the impact of the learning curve required to complete this procedure competently.
Device to promote pelvic floor muscle training for stress incontinence
Authors: SUGAYA KIMIO , OWAN TOMOKO , HATANO TADASHI , NISHIJIMA SAORI , MIYAZATO MINORU , MUKOUYAMA HIDEKI , SHIROMA KAZUO , SOEJIMA KYOKO , MASAKI ZENJIRO , OGAWA YOSHIHIDE
Published: July 2003

Aim:  Many patients with stress urinary incontinence do not have enough motivation to continue pelvic floor muscle training (PFMT) by themselves. Therefore, a device was created to support PFMT, and its effect was examined.

Methods:  Forty‐six women with stress urinary incontinence were assigned to a control group or a device group in order of presentation. A pamphlet on PFMT was given to control patients, while the same pamphlet plus the device and instructions on its use were given to patients in the device group. The device had a chime that was set to sound three times a day when exercise sessions were scheduled. PFMT consisted of fast and slow pelvic floor muscle contraction exercises that were performed for 2 min and followed a rhythm set by the device.

Results:  After 8 weeks, 20 patients from the control group and 21 patients from the device group could be evaluated. In the control group, only the quality of life (QOL) index improved significantly. In the device group, however, the daily number of incontinence episodes, the number of pads used daily, the QOL index, and the pad weight in the pad test improved significantly. Patients in the device group said that they felt obligated to perform PFMT when the chime sounded. Forty‐eight percent of patients from the device group were satisfied with the outcome of PFMT, while only 15% were satisfied in the control group.

Conclusion:  This device may be useful to support the management of stress urinary incontinence.
Ionotropic glutamate receptors in isolated horizontal cells of the rabbit retina
Authors: Blanco Román , De La Villa Pedro
Published: July 2003

With the use of the whole‐cell voltage‐clamp technique, we have recorded the currents induced by ionotropic glutamate receptor agonists on isolated axonless horizontal cells (HC) of rabbit retina. Bath application of the non‐N‐methyl‐d‐aspartate receptor agonists: kainate (KA), α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) and l‐glutamate (GLU) produced an increase in the conductance for non‐selective cations. All the isolated horizontal cells responded to GLU, AMPA and KA. Responses elicited by GLU and AMPA but not KA exhibited a concentration‐dependent desensitization. Application of N‐methyl‐d‐aspartate (NMDA) evoked no responses. The rank order affinities of the agonists as estimated from EC50 values were AMPA > GLU > KA. Whereas KA had the lowest affinity of the agonists tested, it produced the largest currents. Hill coefficients of the concentration–response data were near 1 for AMPA, and 2 for KA and GLU. Coapplication of AMPA with cyclothiazide (CTZ) blocks AMPA receptor desensitization, and enhanced its effects on conductance. However, CTZ did not change the KA ‐induced conductances. In all cells tested, 6,7‐dinitroquinoxaline (DNQX) completely and reversibly blocked the effects of KA and AMPA. The KA‐ and AMPA‐induced currents were also completely blocked by 1‐(4‐aminophenyl)‐4‐methyl‐7,8‐methylenedioxy‐5H‐2,3‐benzodiazepine (GYKI 52466), a selective AMPA receptor antagonist. These results indicate that the responses to glutamate agonists in HC were mediated almost exclusively by AMPA receptors. Our study indicates that AMPA receptors play a fundamental role in mediating the synaptic input into rabbit horizontal cells.