bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Energy Microwave Thermotherapy in the Treatment of Benign Prostatic Hyperplasia
Authors: Cavarretta L. , Scremin E. , Cucciarrè G. , Todeschini M. , Novella G. , Tasca A.
Published: July 2003

Introduction: Transurethral microwave thermotherapy is an anesthesia-free, outpatient method of treating lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Our results with the use of this technique in 25 patients are reported. Materials and Methods: Twenty-five patients with BPH, 8 of whom with complete urinary retention, were treated with high-energy transurethral microwave thermotherapy (HE-TUMT) (Prostatron system). Preoperative investigations included digital rectal examination, urinary free flow rate, PSA, urinalysis, urine culture, transrectal ultrasonography, urodynamic evaluation, International Prostatic Symptom Score (IPSS) and quality of life (QoL). Main selection criteria included: large prostate, high surgical risk, reluctance to undergo surgery. All patients were obstructed according to the Abrams-Griffith’s nomogram. For the statistical analysis a repeated-measures, one-way ANOVA was performed on previously non-catheterized patients. Results: Six of the 8 patients with catheter before treatment were able to urinate spontaneously with no significant post-voiding residual urine. In the 17 remaining patients, IPSS decreased from a mean of 18.5 at baseline to 7.30 and QoL from a mean of 3.9 to 1.2. Mean maximum flow rates during uroflowmetry increased from 8.5 to 16.9 ml/s. Pdet Qmax decreased from a mean of 83.0 cm H2O at baseline to 50.7 cm H2O and Qmax increased from a mean of 6.8 ml/s at baseline to 15.1 ml/s during the pressure-flow study. After TUMT, 13 patients were unobstructed and 4 equivocal according to the Abrams-Griffith’s nomogram. Conclusion: Our study performed in a selected population of patients with BPH documents the efficiency and safety of HE-TUMT. This technique appears to be a valid therapeutic option, particularly in patients with high surgical risk.
Management of Symptomatic Benign Prostatic Hyperplasia in Southern Italy: A Retrospective Analysis of the Sicilian-Calabrian Society of Urology (SSCU) of 32,000 Patients
Authors: Serretta Vincenzo , Morgia Giuseppe , Fondacaro Luigi , Curto Gaetano , Pirritano Domenico , Lo Bianco Antonio , Melloni Darwin , Orestano Fausto , Motta Mario , Pavone-Macaluso Michele
Published: July 2003

Introduction: The availability of new pharmacological and surgical options is responsible for important changes in the management of symptomatic benign prostate hyperplasia (BPH). The Sicilian-Calabrian Society of Urology performed a retrospective survey to assess the management of BPH in southern Italy in 1997 and 1998. Patients and Methods: A 3-page questionnaire was sent to the 36 urological units of these two regions. The real number of patients treated was required. The numbers were checked with data obtained from the Health Regional Offices. Results: Twenty-six urological units (72.3%) replied. Almost all patients underwent urinalysis, determination of serum prostate-specific antigen and creatinine levels, and renal and postvoid vesical echography. Uroflowmetry was performed in 69% and transrectal ultrasound in 56% of the patients. International Prostate Symptom Score or other symptom scores were used in 36% of the cases. Out of 31,558 patients with symptomatic BPH, 5,636 were surgically treated. Admission was due to acute urinary retention in 1,324 cases (23.5%). Transurethral resection of the prostate was the commonest procedure, accounting for 59.5% of the interventions. Open prostatectomy was performed in 1,804 patients (32%). Minimally invasive therapies accounted for less than 9% of the treatments. Conclusions: The present survey provides a picture of the current surgical practice in BPH in southern Italy in the late 1990s. Symptom scores are not routinely adopted. The low rate of transurethral prostate resections is in keeping with the worldwide decline. On the contrary, a high rate of open prostatectomies has been detected.
Effects of Forced Diuresis Achieved by Oral Hydration and Oral Diuretic Administration on Uroflowmetric Parameters and Clinical Waiting Time of Patients with Lower Urinary Tract Symptoms
Authors: Öztürk Bülent , Çetinkaya Mesut , Öztekin Volkan , İnal Gürdal , Adsan Öztuğ , Uğurlu Özgür , Özden Cüneyt
Published: July 2003

Introduction: We studied the impact of diuresis forced by oral hydration or single-dose oral diuretic administration on uroflowmetric parameters and clinical waiting time of patients with lower urinary tract symptoms. Patients and Methods: A total of 58 patients with a mean age of 59 (range 41–77) years who presented with lower urinary tract symptoms were included in the study. The patients were grouped with respect to their International Prostate Symptom Scores as having mild, moderate, or severe symptoms. The prostatic volumes of the patients were calculated using transrectal ultrasound. Uroflowmetric measurements were performed on 3 consecutive days. On the 1st day, the test was performed without diuretic stimulation; on the 2nd day, oral hydration was applied, and on the 3rd day, the patients received 20 mg of furosemide orally. Voiding time, maximum flow rate, voided volume, and the time elapsed in minutes until voiding (waiting time) were recorded. Results: Diuretic stimulation did not significantly alter the uroflowmetric parameters in each symptom group, but the waiting time was significantly reduced. Forced diuresis caused acute urinary retention in 5 of 20 (25%) severely symptomatic patients. Conclusions: Forced diuresis with oral hydration or oral administration of diuretics improves patient comfort and test applicability by shortening clinical waiting time and reducing the number of attempts to reach the sufficient urine volume for reliable measurements and can be applied safely for mild and moderately symptomatic patients. On the other hand, the risk of 25% of acute urinary retentions should be reconsidered, and the decision about diuretic stimuli should be made carefully by the clinician in severely symptomatic patients.
A Prospective Randomized Study of Combined Visual Laser Ablation and Transurethral Resection of the Prostate versus Transurethral Prostatectomy Alone
Authors: Planz Bernhard , Kalem Tomislav , Sprenger Christian , Deix Thomas , Djavan Bob , Hanke Peter
Published: July 2003

Introduction: Visual laser ablation of the prostate (VLAP) has a clinical failure rate of up to 18% which is 3 times higher than transurethral resection of the prostate (TURP) alone. Prolonged spontaneous passage of necrotic debris is the major shortcoming of this method. Therefore combined visual laser-assisted and transurethral prostatectomy was compared to TURP alone. Materials and Methods: 105 patients were evaluated in a prospective randomized study comparing TURP alone and VLAP combined with TURP. The patients were evaluated 1, 3 and 12 months after surgery. First VLAP was performed using a neodymium:yttrium-aluminum-garnet laser with the prolase fiber followed by standard resection of the necrotic and remaining prostatic tissue. Treatment efficacy was assessed by the American Urological Association (AUA) symptom score, measurements of peak urinary flow, residual urine volume, intraoperative bleeding, and by the occurrence of intra- and postoperative complications. Results: The use of VLAP and consecutive TURP improved the AUA symptom score, urinary flow and residual volume and was comparable in all patients treated. Intraoperative bleeding was significantly reduced from 522 ± 45 ml by TURP to 214 ± 33 ml by VLAP+TURP (p < 0.05). There was a significant improvement in the postoperative values of the parameters observed in both groups. Conclusions: It appears that the combined method for treatment of benign prostatic hyperplasia reduced the specific intraoperative morbidity of TURP while achieving the same clinical effect as TURP alone.
Dynamic Rectus abdominis Tendon Colposuspension for Female Stress Urinary Incontinence: A New Procedure and Its Follow-Up
Authors: Goel Mahesh C. , Roberts J.G.
Published: July 2003

Aims and Objective: To describe the technique, results and follow-up of dynamic rectus abdominis tendon colposuspension (DRTC) in the management of female stress urinary incontinence (SUI). Patients and Methods: Eighteen patients with SUI were studied prospectively from 1998 to 1999 who underwent DRTC. Type I and type II SUI patients with or without mild to moderate cystocoele were included in the study. A complete preoperative work-up was done as described in detail in this article. Follow-up assessment was done at 6 weeks, 3 and 6 months and then annually involving a SEAPI quality-of-life score, a satisfaction questionnaire, urge symptoms and assessment of dryness. Results: Mean follow-up of these 18 patients was 20 ± 6 months. Cure of symptoms and dryness was achieved in 16/18 (89%) of the patients. Four of 9 patients had residual urge symptoms and 2 developed de novo urge, which settled by 3 months; no patient required long-term anticholinergics. Three patients required clean self-intermittent catheterization (CSIC) immediately postoperatively but only 1 patient continued to perform CSIC after 3 months. Mean operating time was 41 ± 10 min and mean hospital stay was 3.5 ± 1 days. There were two failures, one in a patient with a neurogenic bladder and one in a patient with multiple previous pelvic operations. One so-called failure uses <2 pads/day postoperatively with an improvement in both symptom and dryness score. Postoperative complications include blood transfusion in 1, urinary tract infection in 1 and wound infection in 1 patient. All the patients with initial good results showed persistent results over follow-up. Conclusions: DRTC is a simple procedure with minimal morbidity showing good results, which are consistent on follow-up.
Quality of Life, Functional Outcome and Durability of the AMS 800 Artificial Urinary Sphincter in Patients with Intrinsic Sphincter Deficiency
Authors: ter Meulen Ph.H. , Zambon V. , Kessels A.G.H. , van Kerrebroeck Ph.E.V.
Published: July 2003

Objective: To evaluate the quality of life, functional outcome and durability of the AMS 800 artificial urinary sphincter (AUS) in patients with urinary incontinence due to intrinsic sphincter deficiency of mixed origin. Patients and Methods: Between 1991 and 2000, 34 AUS were implanted in 31 patients (24 males/7 females) with mean age of 59 (range 15–75) years. Using a questionnaire, patients’ urinary function and quality of life were assessed in 22 patients with an AUS in situ. To evaluate efficacy and durability of the device, the primary adequate function (P-AF) and additional procedure-assisted adequate function (APA-AF) rates were determined on the basis of a Kaplan-Meier survival analysis. Results: The social continence rate (0–1 pads/24 h) was 55% with a mean follow-up of 46 months. The revision rate was 26% and the explantation rate 35%. The 5-year P-AF and APA-AF rates were 41 and 44%, respectively. The pad score decreased from 2.95 to 1.23 after AUS implantation (p < 0.0001) leading to a high mean patient satisfaction (rated as 4.0 on a visual analog scale of 0–5). Twenty-one patients (95%) would undergo the procedure again under the same circumstances. Patients with previous anti-incontinence procedures showed a significantly higher explantation rate (p = 0.004). Conclusion: In spite of a relatively high re-operation rate and moderate social continence state, patient satisfaction was found to be great mainly due to the relative improvement in incontinence. The AMS 800 AUS is a reliable device with few mechanical complications. Extensive preoperative counseling is mandatory.
Urodynamic Study and Potassium Sensitivity Test for Women with Frequency-Urgency Syndrome and Interstitial Cystitis
Authors: Kuo Hann-Chorng
Published: July 2003

Purpose: The intravesical potassium chloride (KCl) sensitivity test has been used to detect urothelial leakage in patients with frequency-urgency syndrome and interstitial cystitis (IC). It is unclear whether urodynamic studies can predict a positive KCl test. This study compared the urodynamic results for women with different KCl responses who suffered from frequency-urgency syndrome and IC. Methods: A total of 196 women suffering from frequency, urgency and/or bladder pain were enrolled in this study. These patients underwent a urodynamic study with a concurrent KCl test. The urodynamic results were compared between the patients who had positive and those who had negative KCl tests and between the patients with and without characteristic IC under cystoscopic hydrodilatation. Results: Among 196 women, 138 (70.4%) had a positive and 58 (29.6%) a negative KCl test. Among the patients with a positive KCl test, 128 underwent cystoscopic hydrodilatation: 44 were proven to have characteristic IC, and 84 were not. Patients with a negative KCl test had a larger residual urine volume and a higher incidence of poor relaxation of the urethral sphincter than those with a positive test. However, patients with a positive KCl test and proven IC did not differ in urodynamic parameters from non-IC patients. The symptom of bladder pain could not predict a positive KCl test nor characteristic IC either. Conclusions: This study shows that no specific urodynamic parameter or specific symptoms can predict a positive KCl test in patients with frequency-urgency syndrome or IC. Patients with bladder pain at full bladder and a positive KCl test had only a 45.2% chance to have characteristic IC.
Pathological Findings of Penile Fractures and Their Surgical Management
Authors: Gontero Paolo , Muir Gordon H. , Frea Bruno
Published: July 2003

Objective: In the present review we discuss the clinical presentation and the surgical approach, together with the intraoperative findings and postoperative complications which occurred in 7 patients presented for our observation with a penile injury and submitted to immediate surgical exploration. Materials and Methods: Our series, despite the relatively small number of cases, provide a complete pattern of the different intraoperative findings that may be encountered when approaching a penile trauma. This includes extremely rare cases like a completely transected urethra, a fracture at the base of the penis and a rupture of the deep dorsal vein. Conclusion: After a thorough examination of the recent literature we conclude that the management of a penile fracture should not include any further investigation other than surgical exploration.
Reliability of Venous Diameter in the Diagnosis of Subclinical Varicocele
Authors: Çaşkurlu Turhan , Taşçı Ali İhsan , Resim Sefa , Şahinkanat Tayfun , Ekerbiçer Hasan
Published: July 2003

Objective: The diameters of the veins in the pampiniform plexus have been used to diagnose subclinical varicocele. But there are many cutoff points and some controversies about the diagnosis. These cause difficulty in the evaluation of the results of epidemiological and clinical studies. Our aim is to establish the reliability of vein diameters in the pampiniform plexus in the diagnosis of subclinical varicocele. Methods: Physical examination, scrotal gray scale ultrasonography (SU) and color Doppler ultrasonography (CDU) were performed to assess varicocele in 100 infertile patients without clinical varicocele (group I), 100 infertile patients with clinical left varicocele (group II), and 50 fertile men without clinical varicocele (group III) as a control group. The diameter of the veins in the pampiniform plexus was measured with SU. According to various cutoff points of venous diameter and CDU criteria, the diagnosis of varicocele was made. The highest mean venous diameters were calculated with and without varicocele in men whose diagnoses had been made with CDU. The results were correlated with each other and the control group. Results: According to venous diameter cutoff points, the varicocele ratio did not correlate with the CDU results (p < 0.05) except for the left side of patients with clinical left-sided varicocele. The highest mean diameters of the veins in group III (control group) did not show a significant difference to the other groups (p > 0.05) except for the left side of group II patients. We did not find an exact relation between the highest venous diameter in the men who have and those who do not have subclinical varicocele with CDU. The highest mean diameter was 2.17 ± 0.34 (SD) mm for men who have subclinical varicocele and 2.00 ± 0.31 mm for men who do not have subclinical varicocele by CDU (p < 0.05). Conclusion: Our results indicate that venous diameters should not be used as diagnostic criteria for subclinical varicocele. Only the evaluation of venous diameter in varicocele should be used to document and quantify pathology, but it should not be used to establish the diagnosis.
Alterations of Intracorporeal Structures in Patients with Erectile Dysfunction
Authors: Yaman Önder , Yilmaz Erdal , Bozlu Murat , Anafarta Kadri
Published: July 2003

Objective: We sought to quantify intracavernosal smooth muscle content (SMC), endothelial cells (EC) and elastic fibres (EF) in both potent and impotent men. We compare the results in impotent men with regard to patient age, aetiology of impotence, presence or absence of diabetes mellitus and smoking. Patients and Methods: Seventy penile biopsies were taken from 10 potent patients with congenital penile curvature (age 17–24 years, mean: 21 ± 1.16) and from 60 impotent patients (age 28–64 years, mean: 46 ± 7.64). Biopsies were stained immunohistochemically to quantify the percentage of SMC by anti-desmin and anti-SMA, anti-CD-34 for EC and Verhoeff’s histochemical staining for EF. Statistical analyses were performed by using one-way Anova after square root transformation. Results: We observed a statistically significant difference in the amounts of corporeal SMC, EC and EF with regard to the following subgroups: potent versus impotent men; men with arterial aetiology versus veno-occlusive aetiology; men under the age of 45 versus men over the age of 45; patients with diabetes mellitus versus non-diabetes mellitus, and smokers versus non-smokers. Conclusion: Quantification of intracavernosal structures appears to be important for either understanding the mechanism of impotence or deciding the appropriate treatment.
Assessment of the Efficacy of Viagra® (Sildenafil Citrate) Using the Erectile Dysfunction Inventory of Treatment Satisfaction (Edits)
Authors: Sadeghi-Nejad Hossein , Lim Hong , Long Karen , Gilhooly Patricia
Published: July 2003

Treatment satisfaction is a predictor of long-term compliance in patients with erectile dysfunction (ED). We assessed patient satisfaction with and efficacy of Viagra® (sildenafil citrate) using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and 3 global efficacy questions. Twenty-nine men with ED who had completed a prior study of MUSE® (alprostadil) versus Caverject® (alprostadil) took a 50-mg dose of Viagra 1 h preceding intercourse. Efficacy and patient satisfaction with Viagra were high. Satisfaction as measured by EDITS was highly correlated to patients’ final ED treatment choice. This correlation could make EDITS useful in identifying long-term patient satisfaction, and thus of considerable clinical benefit.
Evaluation of the Effects of Sildenafil Citrate (Viagra) on Canine Renal Artery, Carotid and Aortic Blood Flow with the Aid of Color Doppler Sonography
Authors: Serhatlioglu Selami , Kiris Adem , Kocakoc Ercan , Canpolat Ibrahim , Bozgeyik Zulkif , Han Mehmet Cengiz
Published: July 2003

Introduction: Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Oral use of sildenafil citrate has been proved to be effective in the treatment of erectile dysfunction. Although the effects of sildenafil citrate have been investigated in several studies, its effect on aortic, carotid and renal artery blood flow is unknown. The aim of this study was to investigate the early and late phase effects of sildenafil citrate on canine aortic, carotid and renal artery blood flow using color Doppler sonography (CDS). Materials and Methods: A total of 6 healthy adult dogs was used in this study. With the aid of CDS peak systolic flow rate, end diastolic flow rate, resistivity index (RI) and pulsatility index in aortic, renal and carotid artery were determined before the administration of sildenafil citrate, 45–75 min after drug administration and after 15 days of drug administration. Data were statistically analyzed using Friedman and Wilcoxon rank tests. p < 0.05 was considered to be statistically significant. Results and Conclusions: Significant changes were determined in only 4 out of 28 parameters studied. The significantly changed parameters were as follows: a significant increase in the early and late phase of the postdrug peak of systolic aortic blood flow compared to values before drug administration, an increase in pre- and postdrug RI values of the aorta, a significant decrease in maximum velocity of the right carotid artery, and peak systolic maximum velocity of the left renal segmental artery after drug administration compared to their respective predrug basal values. The results from this study indicate that sildenafil citrate has no significant effects on aortic, renal and carotid artery blood flow rate either in the early or in the late phase. Since this study involved only 6 dogs there is a need for further clinical studies involving larger groups of subjects to conclude that this drug is safe with respect to the hemodynamic parameters evaluated in this study.
Abdominal Ganglioneuromas in Adults
Authors: Kouriefs C. , Leris A.C.A. , Mokbel K. , Grossman A.B. , Reznek R. , Carpenter R.
Published: July 2003

Ganglioneuromas are rare tumours of the parasympathetic nervous system. Their definitive diagnosis is made on histological examination. When they arise from the adrenal medulla, their assessment and management are the same as those of other adrenal tumours. We here report 3 cases of ganglioneuromas highlighting important points regarding the radiological assessment, management, decision making and surgical approaches.
Rhabdomyosarcoma of the Spermatic Cord
Authors: Moroni Michele , Nesi Gabriella , Travaglini Fabrizio , Rizzo Michelangelo , Amorosi Andrea , Dominici Alberto
Published: July 2003

Rhabdomyosarcoma is a rare malignant tumor that may occur in the spermatic cord in childhood. So far, 62 cases have been reported in the English literature. We describe a case of embryonal rhabdomyosarcoma of the spermatic cord in a 15-year-old boy, detailing clinical history, light microscopy, immunohistochemistry and treatment. In order to unquestionably demonstrate the myogenic differentiation of the neoplasm, it was decided to use a monoclonal antibody against MyoD1. The nuclear positivity of this phosphoprotein in the tumor cells confirmed the diagnosis of embryonal rhabdomyosarcoma. Consequently, the patient was treated with right radical orchiectomy and retroperitoneal lymph node dissection (RPLND). The latter is usually required because of the high incidence (more than 50% of cases) of positive retroperitoneal nodes, whereas subsequent adjuvant therapy is occasionally necessary. In the present case, we decided for a careful follow-up on the basis of the small size of the tumor and the absence of metastasis at diagnosis. The patient is alive and free of disease 12 months after surgery.
Leiomyosarcoma of the Bladder in a Retinoblastoma Patient
Authors: Bléoo Stacey L. , Godbout Roseline , Rayner David , Tamimi Yahya , Moore Ronald B.
Published: July 2003

We report a rare case of leiomyosarcoma in the bladder which occurred in an 18-year-old female with a prior history of retinoblastoma (RB). Molecular characterization of this tumor displayed a homozygous RB deletion and a reduced p53 expression. These results suggest that the loss of RB and p53 may have contributed to the initiation and/or progression of the leiomyosarcoma of the bladder in this patient.
Transitional Cell Carcinoma Involving the Ureterovesical Part of a Transplanted Ureter
Authors: Kmetec Andrej , Kaplan-Pavlovčič Staša , Ovčak Zdenka
Published: July 2003

Ureterovesical malignancy in the renal transplant recipient is an infrequent occurrence. We report a woman with a cadaver kidney recipient, transplanted 10 years ago, with transitional-cell carcinoma at the ureterovesical part of the transplanted ureter invading the bladder muscle around the orifice. Though aggressive surgery and chemotherapy of such patients is proposed, most patients die after an average of 16–17 months. In our patient we have done partial ureter and bladder resection in order to preserve kidney graft and bladder. We continued immunosuppressive treatment. The patient has survived 16 months and is symptom free. Our case suggests that nonaggressive operative treatment without chemotherapy in selected patients may provide comparable survival to patients with aggressive treatment, but with better quality of life.
Priapism in a Patient Receiving Long-Term Chlorpromazine Therapy
Authors: Kilciler Mete , Bedir Selahattin , Sümer Fahri , Dayanç Murat , Peker Ahmet Fuat
Published: July 2003

Priapism is an uncommon urologic emergency with a variety of known etiologies including the use of psychotropic medications. We report a priapism case who has taken chlorpromazine for 3 years.
Analysis of the Expression of Aquaporin-1 and Aquaporin-9 in Pig Liver Tissue: Comparison with Rat Liver Tissue
Authors: Talbot Neil C. , Garrett Wesley M. , Caperna Thomas J.
Published: July 2003

Aquaporins (AQPs) are cellular proteins involved with the movement of water across cell membranes and are fundamentally important to the fluid transport in the bile ducts and ductules of the liver. An immunohistochemical analysis of AQP-1 and AQP-9 was undertaken to describe their expression in fetal and adult pig liver, while immunoreagents specific to some other AQPs were screened for their efficacy on pig liver tissues. Anti-AQP-1 antibody reacted with the bile duct of the portal space and the bile ductules at the periphery of the liver lobules. Histological identification of bile ductules was confirmed by positive reactivity with anti-cytokeratin-7 and antilaminin immunostaining. Anti-AQP-1 signals were also pronounced in the endothelium of the portal space blood vessels and peripheral distributing venules. Antibody to AQP-9 reacted strongly with small ductules peripheral to the liver lobules, but only weakly with the bile ducts of the portal space. Anti-AQP-adipose antibody bound to the smooth muscle cells of the arteries in the portal space and sporadically with certain binucleated cells in the liver lobule. Antibodies to AQP-3, AQP-4, AQP-7, and AQP-8 were nonreactive with any of the tissues of the adult pig liver. For comparative purposes, immunohistochemical analysis of rat liver tissue was done with the anti-AQP-1 and AQP-9 antibodies. Anti-AQP-1 reacted weakly with the rat liver’s bile ducts, but robustly with the endothelium of the liver’s veins and arteries. It also reacted strongly with the central vein of the rat liver lobules, and, because the staining was continuous with hepatic sinusoids, it appeared that the reactivity was specific to the endothelial cells. Anti-AQP-9 antibodies reacted with rat hepatocytes and was not associated with the canaliculi, as judged by concurrent phalloidin staining of actin. The results indicate that specific AQPs are expressed in the tissues of the pig liver and that AQP-9 expression is distinct from its expression in the rat liver.
Effect of Undernutrition on the Cranial Growth of the Rat
Authors: Cesani María F. , Orden Bibiana , Zucchi Mariel , Muñe María C. , Oyhenart Evelia E. , Pucciarelli Héctor M.
Published: July 2003

The cumulative effect of undernutrition on successive generations was tested. The cranial growth of three generations of undernourished rats (F1, F2, F3) was compared to that of the parental generation (P), in order to (1) measure the extent to which the growth of each facial and neurocranial functional component was retarded when animals were undernourished and (2) determine whether any cumulative effect between generations can be found. The P generation was fed ad libitum, and the undernourished generations were fed 50% (F1) and 75% (F2 and F3) of the parental diet. Nine radiographs were taken from the age of 20–100 days. The length, width and height of the neurocranial and facial components were measured on each radiograph. Neurocranial (VNI), facial (VFI), and neurofacial (NFI) indices were calculated. Data were processed by the Kruskal-Wallis and Kolmogorov-Smirnov tests. An impairment in neurocranial and facial growth was found, the latter being more affected than the former in F1. At variance, the neurocranium was more affected than the face in F2 and F3, resulting in variations of the shape of the skull. A cumulative effect of moderate transgenerational undernutrition was evident and points to the need for further analysis on this topic.
Anatomy of the Nasal Cavity in the Chinchilla
Authors: Jurcisek Joseph A. , Durbin Joan E. , Kusewitt Donna F. , Bakaletz Lauren O.
Published: July 2003

There is currently great interest worldwide in developing noninvasive methods for the delivery of vaccines for upper respiratory tract diseases, including middle ear infection (otitis media, OM). One such noninvasive approach believed to have great potential for the prevention of diseases of the airway is to deliver vaccines by the intranasal (i.n.) route. Induction of a local, mucosal immune response in the upper respiratory tract, and particularly in the nasopharynx, would be a highly efficacious approach to prevention of OM. The chinchilla is the preferred rodent host for studying OM. However, although the anatomy of the chinchilla vomeronasal organ, inner ear, middle ear and Eustachian tube have been well-studied, to date there have been no reports in the literature of a similar complete analysis of the nasopharynx and nasal cavities of the chinchilla. In order to develop a relevant animal model of i.n. delivery as a potential immunization approach for the prevention of OM and to use these models for preclinical assessments of various vaccine candidates, it was important that we better understand the anatomy of the chinchilla nasal cavities and nasopharynx. Our anatomical studies revealed that the naso- and maxilloturbinates of the chinchilla nasal cavity more closely resemble the simple turbinates found in other rodents rather than the branched or complex turbinates seen in dogs, cats, and rabbits thus facilitating the i.n. delivery of vaccine candidates. The chinchilla nasal mucosa also contains numerous lymphoid aggregates like that of other rodents. Our findings thus suggest that we will be able to deliver i.n. vaccines effectively to chinchillas and that these vaccines will likely be able to induce specific immune responses.
How to Interpret Serum CA 125 Levels in Patients with Serosal Involvement? A Clinical Dilemma
Authors: Sevinc Alper , Camci Celalettin , Turk H. Mehmet , Buyukberber Suleyman
Published: July 2003

The clinical utility of tumor markers is limited due to their low specificity. CA 125, an ovarian tumor marker, is a sensitive but nonspecific tumor marker used especially in the follow-up of ovarian cancer for monitoring the efficacy of therapy and for early detection of recurrence. The use of the CA 125 serum assay as a single diagnostic tool is restricted by the fact that the antigen to CA 125 is also produced by normal epithelia (peritoneum, pleura, and pericardium). Since an elevated serum CA 125 level is a marker of ovarian cancer, a laparotomy is the final tool of the physician to clarify the etiology. However, unnecessary operations have been reported in the literature revealing no ovarian pathology (e.g. cirrhosis, tuberculous peritonitis or pancreatic cancer) in such patients. Elevated serum CA 125 levels require a cautious operative planning in patients without a notable tumor mass. A secondary interpretation is needed in case of elevated CA 125 levels whenever serosal (peritoneal, pleural, or pericardial) fluid is present.
Alveolar Soft Part Sarcoma in Japan: Multi-Institutional Study of 57 Patients from the Japanese Musculoskeletal Oncology Group
Authors: Ogose Akira , Yazawa Yasuo , Ueda Takafumi , Hotta Tetsuo , Kawashima Hiroyuki , Hatano Hiroshi , Morita Tetsuro
Published: July 2003

Objective: The clinical features and the management of alveolar soft part sarcoma (ASPS) are not well known. The efficacy of chemotherapy for soft tissue sarcoma, including high-dose ifosfamide and cisplatin, has not been established yet. Some reports suggest ASPS may occur primarily in bone. Methods: We report on a series of 57 patients with ASPS over 20 years. Their ages ranged from 7 to 75 years (mean 25). Results: There were 37 females and 20 males. Thirteen lesions (23%) showed bone involvement at the primary site, and 6 of them were diagnosed as bone tumors at presentation. Thirty-seven patients had distant metastases at presentation. Tumor size, bone involvement at the primary site and the presence of metastases at presentation were prognostic indicators (p < 0.05). Marginal excision with radiotherapy or wide excision without radiotherapy achieved good local control. Chemotherapy was performed in 47 patients with different regimens. Two patients treated with intra-arterial chemotherapy regimens responded partially, but intravenous chemotherapy with high-dose ifosfamide or cisplatin failed. Conclusions: ASPS can present primarily as a bone tumor. No advantage of chemotherapy with high-dose ifosfamide or cisplatin could be demonstrated.
Long-Term Prognosis of Stage I Ovarian Carcinoma
Authors: Mizuno Mika , Kikkawa Fumitaka , Shibata Kiyosumi , Kajiyama Hiroaki , Suzuki Takahiro , Ino Kazuhiko , Kawai Michiyasu , Mizutani Shigehiko
Published: July 2003

Objective: There are a few long-term follow-up studies of patients with stage I ovarian carcinoma. The objective of this study was to evaluate prognostic factors for long-term survival. Methods: Two hundred fourteen stage I ovarian carcinomas (registered by the Tokai Ovarian Tumor Study Group from 1988 to 1999) were analyzed. Staging according to the International Federation of Gynecology and Obstetrics was set without considering the pathologic findings of the lymph nodes. Stage Ic was divided into Ic(b) and other Ic. Results: Seventy-four patients were stage Ia, 2 were stage Ib, and 138 were stage Ic, consisting of 75 Ic(b) and 63 other Ic patients. The ratios of stage Ic to Ia and stage Ic(b) to Ic were highest in clear-cell adenocarcinoma among histologies analyzed. There were significant differences in disease-free survival curves between each group. In clear cell adenocarcinoma, there was a significant difference in disease- free survival curves between stage Ic(b) and other Ic (p = 0.0373), while this tendency was also observed in other histologies except for mucinous carcinoma. Multivariate analysis demonstrated that substage was a significant prognostic factor of both disease-free and overall survival. Conclusions: Stage Ic(b) patients showed poorer survival than stage Ia patients but better than survival in other Ic. Thus, cautious treatment of ovarian tumor during surgery is quite important to avoid rupture.
Fas Ligand Expression Is Correlated with Metastasis in Colorectal Carcinoma
Authors: Nozoe Tadahiro , Yasuda Mitsuhiro , Honda Masayuki , Inutsuka Sadaaki , Korenaga Daisuke
Published: July 2003

The Fas/Fas ligand (FasL) system is one apoptotic pathway through which malignant tumors can evade immune surveillance. While FasL is expressed in malignant tumors, Fas is conversely downregulated to escape host immune attack, resulting in tumor invasion. The aim of the current study was to find out further clinicopathological significance of FasL expression in carcinoma of the colon and rectum. FasL expression was investigated using immunohistochemical staining in 143 consecutive patients with primary colorectal carcinomas. Seventy-nine carcinomas (55.2%) expressed FasL. The incidence of lymph node and distant metastases in carcinomas expressing FasL was significantly higher than in carcinomas that did not express FasL (p = 0.031 and p = 0.0003, respectively). Although univariate analysis showed that survival in patients with carcinomas expressing FasL was significantly poorer than that in patients with carcinomas without FasL expression (p = 0.001), only Dukes’ stage was an independent prognosticator by multivariate analysis. FasL expression was found to be correlated with lymph node involvement and distant metastases in colorectal carcinoma.
Long-Term Follow-Up of Sudden Cardiac Arrest Survivors and Electrophysiologically Guided Antiarrhythmic Therapy
Authors: Hennersdorf Marcus G. , Niebch Verena , Vester Ernst G. , Winter Joachim , Perings Christian , Strauer Bodo E.
Published: July 2003

Sudden cardiac arrest survivors have a high risk of suffering from recurrent arrhythmic events. Recent studies have shown that these patients have a significantly decreased mortality rate, if they are supplied with an implantable cardioverter/defibrillator (ICD). The aim of this study was to evaluate the long-term prognosis of patients with electrophysiologically guided antiarrhythmic drug therapy in comparison to patients with ICD. 204 consecutive survivors of sudden cardiac arrest were enrolled in this study. All patients were examined with an initial electrophysiologic study (EPS) with programmed ventricular stimulation. Patients were treated with antiarrhythmic drugs (if the inducible tachycardia was suppressed) or with the implantation of an ICD. The maximal follow-up period was 120 months, the mean period was 53.3 ± 31.4 months (ICD) versus 60.3 ± 35.5 months (EPS, nonsignificant). Patients with ICD showed an overall mortality rate of 14.6%, whereas EPS-guided patients had a mortality rate of 43.2% (p < 0.001). The cardiac and arrhythmogenic mortality rates were significantly lower in the ICD group (12 vs. 43%, p < 0.01, and 1 vs. 16%, p < 0.001, respectively). A reduction of the mortality risk was observed in the ICD group by up to 61% (all-cause mortality), 52% (cardiac mortality) and 97.2% (arrhythmogenic mortality). In arrhythmic event survivors with ICD, arrhythmic and overall mortality rates are significantly lower compared to patients with an EPS-guided drug therapy. In the secondary prevention of sudden cardiac death, ICD should be the first choice of antiarrhythmic therapy.
Long-Term Outcome of Intravenous Magnesium Therapy in Thrombolysis-Ineligible Acute Myocardial Infarction Patients
Authors: Shechter Michael , Hod Hanoch , Rabinowitz Babeth , Boyko Valentina , Chouraqui Pierre
Published: July 2003

The aim of our study was to analyze the long-term survival and cardiac function in 194 consecutive, thrombolysis-ineligible acute myocardial infarction (AMI) patients receiving 48-hour intravenous magnesium sulfate (22 g) – 96 patients, compared with placebo – 98 patients. After a mean 4.8-year follow-up, all-cause mortality and cardiac mortality were significantly lower in the magnesium compared to the placebo group [(18 vs. 33 patients, p < 0.01) and (12 vs. 30 patients, p < 0.001), respectively]. Rest radionuclide ventriculography tests for left-ventricular ejection fraction (LVEF) were assessed in surviving patients up to completion of follow-up. Magnesium-treated patients had a significantly higher LVEF (0.51 ± 0.10 vs. 0.44 ± 0.14, p < 0.05) and a lower incidence of heart failure compared to placebo-treated patients (12 vs. 3 patients, p = 0.02). Beneficial effects of intravenous magnesium therapy in thrombolysis-ineligible AMI patients appeared to last for at least 4.8 years, concomitant with preserved LVEF, suggesting a favorable role for acute magnesium treatment in these patients.
Cultural Adaptations of Current Psychiatric Classifications: Are They the Solution?
Authors: López-Ibor Jr. Juan J.
Published: July 2003

Despite the limitations of modern nosological systems the development of cultural adaptations is a step backward, leading to unavoidable pitfalls in spite of the fact that cultural diversity is imposing new attitudes and demands on psychiatrists. Cultural adaptations challenge the principles of the universality of science and of ethics. ICD-10 and DSM-IV rely on the symptoms present to classify psychiatric diseases. This kind of classification has many advantages: it is a theoretical, close to clinical reality, easy to grasp and less prone to untested hypotheses. But they have some drawbacks: they do not say what diseases are, since the concept of symptom is not totally clear in psychiatry. The greatest disadvantage of this approach is the dispersion of disorders that may be related or even unique. Furthermore, when too many symptoms are present, this method requires a hierarchical structure (as in DSM-III) – unless one is willing to live with multiple diagnoses, the so-called co-morbidities (as in DSM-IV). But at other times, too few symptoms are present, leading to atypical, waste-basket and subsyndromal categories. Another problem is that symptoms may not be consistent across cultures, leading to the need of cultural adaptations. In the case of diseases diagnosed according to symptomatic criteria, cultural adaptations of internationally accepted classifications are often sought because symptoms are deemed to be inconsistent across cultures. But at a closer look, very often the symptoms are not so different and it is only the cultural halo which makes them attractive; even when they are particular to a given culture they can easily be interpreted (e.g., the penis invagination of latah). Indeed, they represent a way of experiencing common feelings such as anxiety (e.g., the susto of Latin America, which is a typical panic disorder) and depression. To put too much emphasis on local symptoms bears the risk of yielding to social and cultural pressure.
Assessing Adult Attention-Deficit/Hyperactivity Disorder: A Turkish Version of the Current Symptoms Scale
Authors: Aycicegi Ayse , Dinn Wayne M. , Harris Catherine L.
Published: July 2003

We report normative data for a Turkish translation of the Current Symptoms Scale (CSS), a screening measure of adult attention-deficit/hyperactivity disorder (ADHD). The CSS yields 3 scores reflecting diagnostic criteria for: (1) ADHD, predominantly hyperactive-impulsive type; (2) ADHD, predominantly inattentive type, and (3) ADHD, combined type. For comparison purposes, we also present normative data from a community sample in the United States. Central tendency, variability, and correlation patterns among Turkish subjects (n = 181) were similar to patterns demonstrated by respondents in the United States (n = 114). Mann-Whitney U tests revealed that the Turkish and US groups did not differ significantly on the subscales assessing inattentive and hyperactive-impulsive symptoms. Both versions demonstrated acceptable levels of internal consistency (Cronbach’s alpha coefficients ranged from 0.65 to 0.78 for the Turkish version, and from 0.63 to 0.75 for the English version). The Turkish version of the CSS demonstrated excellent test- retest reliability. The test-retest coefficient for the CSS (total score) was 0.82. The inattentive type subscale also showed good test-retest reliability, with r = 0.78. The test-retest coefficient for the hyperactive-impulsive type subscale was appreciably lower, with r = 0.68; albeit, in the acceptable range. Investigators have determined that many adults, initially diagnosed with ADHD as children, continue to demonstrate clinically significant symptoms. Since adult ADHD is associated with a number of comorbid psychiatric conditions and treatment of the underlying attentional, executive, and impulse control difficulties is associated with a reduction in comorbid psychiatric symptoms, the routine screening for adult ADHD in psychiatric and mental health settings may be warranted.
Expression of NHERF-1, NHERF-2, PDGFR-α, and PDGFR-β in Normal Human Kidneys and in Renal Transplant Rejection
Authors: Weinman Edward J. , Lakkis Jay , Akom Michael , Wali Ravinder K. , Drachenberg Cinthia B. , Coleman Richard A. , Wade James B.
Published: July 2003

Sodium-hydrogen exchanger regulatory factor-1 and -2 (NHERF-1 and NHERF-2) are adaptor proteins that regulate renal electrolyte transport and interact with the platelet-derived growth factor receptors (PDGFR). The distribution of the NHERF proteins and PDGFR was studied in normal human kidneys and in renal transplant rejection using immunocytochemistry. In normal kidneys, NHERF-1 was detected in proximal tubules. NHERF-2 was detected in glomeruli, peritubular capillaries, and collecting duct principal cells. NHERF-2 was also weakly detected in the proximal tubule. PDGFR-β was detected in glomeruli but not in tubules while PDGFR-α was detected in renal tubules and minimally in glomeruli. Acute and chronic transplant rejection was associated with increased expression of PDGFR-α in tubules and expression in the glomeruli. PDGFR-β expression in the glomeruli was increased in transplant rejection and became detectable in tubules. Expression of NHERF-1 and NHERF-2 was not different in the patient groups. These results indicate that in contrast to the rat, both NHERF isoforms are detected in the human proximal tubule. In renal transplant rejection, there is increased expression of both PDGFR subtypes consistent with a role for PDGF in injury or repair.
A Role of Histone H4 Hypoacetylation in Vascular Endothelial Growth Factor Expression in Colon Mucosa Adjacent to Implanted Cancer in Athymic Mice Cecum
Authors: Kuniyasu Hiroki , Chihara Yoshitomo , Kondo Hideaki
Published: July 2003

Expression of angiogenic factors is upregulated in hyperplastic mucosa adjacent to colon cancer, and this upregulation is closely associated with cancer growth and metastasis. We investigated the role of histone acetylation in vascular endothelial growth factor (VEGF) expression in hyperplastic mucosa adjacent to orthotopic colon cancer in mice. In the hyperplastic mucosa adjacent to KM12SM tumor in the cecum of athymic mice, VEGF upregulation was associated with hypoxia-inducible factor (HIF)-1α induction. The hyperplastic mucosa also showed hypoacetylation of histone H4 and reduction of both p53 and von Hippel-Lindau (VHL) proteins. To examine the effects of growth factors and cytokines on histone acetylation and levels of p53, VHL and HIF-1α, the rat intestinal epithelial cell line IEC6 was treated with epidermal growth factor (EGF) and interleukin (IL)-15 for 35 days. Acetylated histone H4, p53 protein and ubiquitinated protein levels were reduced, whereas HIF-1α production was upregulated in EGF- and IL-15-treated IEC6 cells. These findings suggest that EGF- or IL-15-induced histone H4 hypoacetylation is associated with repression of p53 and VHL genes in intestinal epithelial cells. The subsequent suppression of protein ubiquitination leads to upregulation of VEGF production by HIF-1α retention.