bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Beclomethasone Dipropionate Multidose Powder Inhaler in the Treatment of Bronchial Asthma
Authors: Nieminen M.M. , Vidgren P. , Kokkarinen J. , Laasonen K. , Liippo K. , Lindqvist A. , Paananen M. , Poukkula A. , Ruotsalainen E.-M. , Salomaa E.-R. , Sovijärvi A. , Söderblom T. , Silvasti M. , Vidgren M. , Laitinen L.A.
Published: April 2003

The clinical efficacy, tolerability and acceptability of a new multidose powder inhaler (MDPI) containing beclomethasone dipropionate (BDP) were compared with those of a BDP aerosol administered with a large volume spacer (MDI-spacer) among adult asthmatics currently receiving from 500 to 1,000 µg/day of an inhaled corticosteroid. During the study, the dosage of BDP from both devices was 400 µg twice daily. Ninety-one patients were randomized to the MDPI group and 42 to the MDI-spacer group. The trial was performed as an open, randomized, parallel group multicenter study. The duration of the treatment period was 12 weeks, and the study was preceded by a 2-week run-in period. During the run-in period, the mean morning peak expiratory flow (PEF) was 487 and 466 1/min in the MDPI and MDI-spacer groups, respectively. After the 12-week treatment, the morning PEF was 491 l/min in the MDPI group and 463 l/min in the MDI-spacer group. The evening values were 500 and 479 l/min during the run-in period and 496 and 476 l/min after the 12-week treatment, respectively. Asthma symptom scores and the use of rescue medication were low in both groups, indicating good efficacy of the preparations tested. The median dose of histamine required to decrease forced expiratory volume in 1 s by 15% increased during the study from 800 to 1,098 µg in the MDPI group and from 795 to 960 µg in the MDI-spacer group. The most frequent adverse events in both groups were hoarseness and sore throat. There were no statistically significant differences between the treatment groups in serum cortisol values or in the number of patients with thrush. Seventy-two percent of the patients regarded the MDPI easier to use while 95% considered it more portable. Over 80% of the patients felt that the MDPI was also easier to clean and as easy or easier to learn to use than the MDI-spacer. To conclude, the novel powder inhaler is well tolerated and at least equally effective as the conventional MDI-spacer combination in the treatment of asthma with BDP. However, in everyday use, patients clearly favored the powder inhaler.
Dirithromycin Concentrations in Bronchial Mucosa and Secretions
Authors: Leroyer Christophe , Muller-Serieys Claudette , Quiot Jean-Jacques , Benhamou Daniel , Clavier Jean , Bergogne-Bérézin Emilie
Published: April 2003

Since a high tissue penetration of dirithromycin (D) has been assessed in early studies, the aims of this study were to determine D concentrations in bronchial mucosa and secretions in patients suffering from an acute exacerbation of chronic bronchitis (AECB), to compare intra-individual bronchial mucosa and secretion concentrations and to relate bronchial concentrations of D and clinical efficacy. The main inclusion criteria were comprised of (1) AECB, defined by the presence of an increase in dyspnea, sputum production and change in sputum purulence, and (2) clinical indication of fiberoptic bronchoscopy allowing performance of bronchial biopsies. All patients were treated with a 500-mg once-daily D dose for 5 days. Patients were randomly divided into three groups, according to sampling times (24, 48 and 72 h after the last dose). Tissue concentration analyses were performed by one blinded microbiologist (microbiological agar diffusion assay). The results showed: (1) 37 out of the 46 patients (80.4%) had a favorable response to treatment at the time of fiberoptic bronchoscopy (14 cured, 23 improved); (2) bronchial mucosa concentrations were high in all groups, and (3) mean values at 24, 48 and 72 h after the last dose were respectively 6.51 ± 1.44, 6.61 ± 2.7, 5.67 ± 1.02 mg·kg–1; no statistical difference was observed between the groups. In bronchial secretions collected simultaneously, concentrations were lower, i.e. 1.26 ± 0.3, 0.61 ± 0.12, 0.84 ± 0.12. Significant associations were observed between bronchial mucosa and secretion concentrations (r = 0.71, p = 0.0001), and between clinical response and bronchial concentrations (p = 0.03, Kruskall-Wallis test). In conclusion, these results may confirm the clinical significance of tissue concentrations measured in bronchial tissues of patients with AECB.
A Study of Peripheral Airway Findings Using an Ultrathin Bronchofiberscope and Bronchoalveolar Lavage Fluid with Diffuse Panbronchiolitis
Authors: Kikawada Masayuki , Ichinose Yuichi , Minemura Kazushige , Takasaki Masaru , Toyama Keisuke
Published: April 2003

We investigated the peripheral airways using an ultrathin bronchofiberscope and analyzed bronchoalveolar lavage fluid (BALF) in 10 patients with diffuse panbronchiolitis (DPB; refractory and responsive to treatment with macrolide antibiotics) and 10 healthy volunteers. Refractory DPB patients had obstruction at the 11th or 12th level of bronchial branches and secretion from the 5th to 6th order bronchi to the 11th–12th level of bronchial branches. In responsive DPB patients, there was no obstruction of peripheral airways, but secretion in the bronchial lumens still remained in nearly all observed bronchial branches. Despite macrolide therapy, BALF from patients with refractory DPB contained a high percentage of neutrophils and had a lower CD4/CD8 ratio. Two-color analysis of T cell subsets in BALF revealed a high percentage and number of CD8+S6F1+ cells (activated cytotoxic T cells) in refractory DPB patients. Our findings suggest that obstruction around the terminal bronchioles may be correlated with BALF abnormalities and may be irreversible despite macrolide therapy in progressive DPB.
Effects of Air Pollution and Weather Conditions on Asthma Exacerbation
Authors: de Diego Damiá A. , León Fabregas M. , Perpiñá Tordera M. , CompteTorrero L.
Published: April 2003

Background: Meteorological conditions and a high concentration of air pollutants have been associated with increased respiratory morbidity. However, few studies have examined the association between asthma exacerbation and air pollution. Objectives: In the present study, the possible relationship of the concentration of black smoke and SO2 in the air, the local weather conditions and emergency room visits for asthma is investigated. Methods: The weekly total of emergency room admissions for asthmatic adults during a 1-year period was recorded together with daily metereological conditions (average temperature, humidity, rainfall, wind speed and barometric pressure) and average weekly levels of daily pollutant concentrations (black smoke and SO2). The relationship was assessed by stepwise regression linear models and analysis of variance. The analysis took into account season and metereological variables. Results: Both air pollutants correlated significantly with emergency room admissions for asthma (SO2 [r = 0.32], black smoke [r = 0.35]); however, multiple regression analysis showed that black smoke was the only significant predictor of weekly visits. There were approximately 3.5 admissions a week per SD of change (34.6 µg·m–3). There were no significant correlations between weekly emergency room visits and the weather variables. Analysis of the data stratified by season and weather conditions demonstrated that the association of black smoke with asthma exacerbation was more pronounced in autumn (r = 0.67) or when temperatures were higher than average. Conclusion: In our city, a high concentration of certain air pollutants is indeed associated with an increase in the number of hospital emergency room admissions for asthma.
Effect of Endothelin-1 on the Serotonin-Induced Contraction of Smooth Muscle in the Guinea Pig Trachea
Authors: Yoshida Makoto , Aizawa Hisamichi , Hara Nobuyuki
Published: April 2003

Background: Endothelin (ET), a potent constrictor of smooth muscle including that of the airways, may contribute to the development of airway hyperresponsiveness. Objective: To investigate the role of ET-1 on the airway smooth muscle, we examined the effects of ET-1 on the serotonin-induced contraction of guinea pig tracheal smooth muscle. Methods: The changes in isometric tension evoked by serotonin were measured before and after the application of a subthreshold dose (a dose which did not induce smooth muscle contraction by itself) of ET-1. Results: Serotonin caused smooth muscle contraction in a dose-dependent manner. The subthreshold doses of ET-1 (1 pM) and sarafotoxin 6c (1 pM), a selective ETB receptor agonist, were found to potentiate significantly the contraction induced by serotonin. A potentiating effect of ET-1 was not altered by indomethacin or calphostin C, a protein kinase C inhibitor. Conclusion: These results suggest that a subthreshold concentration of ET-1 can potentiate serotonin-induced contraction of smooth muscle through the activation of ETB receptor, while in contrast cyclooxygenase and protein kinase C were found not to be involved in this mechanism.
Diagnostic Value of Endoscopic Ultrasonography- Guided Fine-Needle Aspiration Cytology ofMediastinal Masses in Patients with Intrapulmo nary Lesions and Nondiagnostic Bronchoscopy
Authors: Fritscher-Ravens A. , Petrasch S. , Reinacher-Schick A. , Graeven U. , König M. , Schmiegel W.
Published: April 2003

Several procedures are available for the cytopathological diagnosis of mediastinal lesions. The purpose of this study was to evaluate the diagnostic value of endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) in patients with mediastinal mass lesions/lymph node enlargement. All patients had intrapulmonary lesions on chest X ray and/or CT scan, and inconclusive findings by endobronchial forceps biopsy and/or brush cytology. EUS-guided FNA was performed in 16 patients using a modified oblique forward-viewing gastroscope with an electronic multielement curved linear ultrasound transducer. After the region of interest was localized, a 22-gauge Vilmann-Hancke needle was introduced via the 2-mm biopsy channel. The cytological diagnosis of EUS-guided FNA was conclusive for cancer in 9 patients and in the other 7 patients the aspirated samples revealed a benign lesion. In 10 patients the final diagnosis was cancer, thus EUS-guided FNA was diagnostic for malignancy in all but 1 of the lesions (sensitivity 90.0%). In 1 patient epitheloid cell granuloma was detected by cytological examination of the FNA. Following tuberculostatic treatment the lesions disappeared completely on CT scan and EUS. The overall accuracy in this study amounted to 93.7%. From this and other studies discussed, it is assumed that the procedure is an accurate and safe technique to examine nodular lesions suggestive of metastatic lymph node involvement.
A Man with a Prosthetic Ear and Multiple Pulmonary Nodules
Authors: Bradshaw D.
Published: April 2003

Basal cell carcinoma is generally regarded as a relatively indolent tumor easily controlled with local therapy. When neglected or inadequately treated this tumor can become locally aggressive and in rare circumstances metastasize. This report documents a case of basal cell carcinoma metastatic to the lung that resulted in rapidly progressive respiratory failure and death.
Bilateral Hemothorax Revealing Mediastinal Parathyroid Adenoma
Authors: Santelmo N. , Hirschi S. , Sadoun D. , Kambouchner M. , Cohen R. , Valeyre D. , Azorin J.
Published: April 2003

We report the case of a 63-year-old woman admitted to hospital because of bilateral hemothorax associated with acute respiratory failure and laterotracheal neoformation. A right thoracoscopy biopsy revealed a paratracheal parathyroid adenoma which was responsible for bilateral hemothorax and primary hyperparathyroidism. A curative resection was successfully performed by cervicotomy.
Decrease in Lung Volume Depends on End-Expiratory Pressure in a Rabbit Model of Airway Lavage
Authors: Krause Martin F. , Hoehn Thomas
Published: April 2003

Background: In the past, the rabbit model of repeated airway lavage has been extensively used to induce a decrease in lung volume accompanied by impairment in lung mechanics and gas exchange. Objectives: The rationale of our study was to investigate the influence of different end-expiratory pressure (EEP) levels (0.4–4.2 cm H2O) on changes in functional residual capacity (FRC) and the efficacy of lavages administered. Methods: Forty-five rabbits were subjected to 2–8 lavages with 20 ml/kg warm normal saline until arterial/alveolar oxygen tension (a/A ratio) had decreased to ≤0.12. Results: FRC and dynamic compliance of the respiratory system (Crs) decreased significantly (both p < 0.001; from 19.1 ± 4.2 to 10.5 ± 5.6 ml/kg and from 1.17 ± 0.27 to 0.47 ± 0.10 ml/cm H2O, respectively, means ± SD). The decrease in FRC was significantly influenced by EEP (–28.6 ± 15.8% at EEP = 1 cm H2O vs. –58.7 ± 12.9% at EEP = 3 cm H2O, p < 0.0001). There was a significant correlation between the number of lavages and EEP (p < 0.01), indicating that successive lavages at higher EEP became ineffective in lowering FRC compared to those at lower EEP. Conclusions: We conclude that the EEP levels used in this model are of critical importance for the prediction of a decrease in lung volume (FRC) and the efficacy of lavages.
PACAP Reverses Airway Hyperresponsiveness Induced by Ozone Exposure in Guinea Pigs
Authors: Aizawa H. , Shigyo M. , Matsumoto K. , Inoue H. , Koto H. , Hara N.
Published: April 2003

Background: We previously demonstrated that pituitary adenylate cyclase activating peptide (PACAP) inhibits airway smooth muscle contraction and plasma extravasation. Objective: We thus hypothesized that PACAP may regulate airway responsiveness through these effects and examined the effects of exogenously applied PACAP on the airway hyperresponsiveness induced by ozone exposure. Methods: Ozone exposure was carried out in awake, spontaneously breathing guinea pigs using 3 ppm for 2 h. Airway responsiveness to histamine was determined before and 30 and 90 min after the termination of ozone exposure for 2 h in anesthetized animals. Extravasation of Evans blue was measured before and 90 min after the termination of ozone exposure. Either PACAP (10–6 mol/kg) or vehicle was administered intravenously 60 min after exposure. The airway responsiveness was expressed as the concentration of histamine required to produce a 200% increase in total pulmonary resistance (PC200). Results: Ozone exposure caused a significant decrease in PC200 (n = 5, p < 0.05) 30 min after ozone exposure which persisted 90 min thereafter, thus suggesting that ozone caused airway hyperresponsiveness. PACAP significantly suppressed the increase in airway hyperresponsiveness induced by ozone 90 min after exposure (n = 5, p < 0.05). In contrast, this peptide did not have any effect on plasma extravasation. Conclusion: We thus conclude that PACAP decreases ozone-induced airway responsiveness, and, therefore, intravenously administered PACAP may be useful in reversing airway hyperresponsiveness.
Pulmonary Function Tests of Mycobacterium avium-intracellulare Infection: Correlation with Bronchoalveolar Lavage Fluid Findings
Authors: Yamazaki Yoshitaka , Kubo Keishi , Fujimoto Keisaku , Matsuzawa Yukinori , Sekiguchi Morie , Honda Takayuki
Published: April 2003

Background: The pulmonary Mycobacterium avium-intracellulare (MAI) infection in patients with neither predisposing lung disease nor immunodeficiency is recognized to occur predominantly in older or middle-aged and thin females, and has characteristic chest computed tomography (CT) findings with multiple nodules and bronchiectasis. Objective: To investigate the pathophysiology with and individual of MAI infection with neither predisposing lung disease nor immunodeficiency. The bronchoalveolar lavage (BAL) fluid (BALF) was recovered directly from the affected segments identified by the chest CT. Methods: We performed a pulmonary function test (PFT) and BAL in 15 patients (all females) with MAI infection and 5 normal female volunteers. Results: The residual volume and the slope of phase III (ΔN2) were significantly increased and v̇25 was significantly decreased in the 15 patients compared with the normal control subjects. The patients’ BALF showed significant increases in neutrophils and activated CD4 lymphocytes, proinflammatory cytokines, and neutrophil elastase (NE) compared to those in the controls. We analyzed the PFT and BALF findings, and observed a significant correlation between the ΔN2 and interleukin (IL)-8 concentration (r = 0.65, p < 0.01), IL-8/albumin ratio (r = 0.51, p < 0.05) and NE/albumin ratio (r = 0.57, p < 0.05) in the BALF and ΔN2, respectively. Conclusions: These findings suggest that small airway dysfunction in MAI infection without predisposing lung disease is related to the inflammation probably related to the neutrophil.
Malignant Mesothelioma in Subjects with Marfan’s Syndrome and Ehlers-Danlos Syndrome: Only an Apparent Association?
Authors: Bisconti Mario , Bisetti Alberto , Bidoli Paolo
Published: April 2003

Malignant mesothelioma is a rare neoplasm which could be favored by an hereditary predisposing factor. So far, malignant mesothelioma have never been described in patients with hereditary diseases of the connective tissue. Here, we report some cases of mesothelioma affecting subjects who were not exposed to inhalation of asbestos. One of these subjects was affected by Ehlers-Danlos syndrome, whereas in two brothers, mesothelioma was associated with Marfan’s syndrome. The observation of the same histologic subtype of mesothelioma in two brothers and the coexistence of two pathologic conditions of mesodermal origin indicate the presence of hereditary factors predisposing to the cancerogenic action of even small amounts of asbestos. Structural alterations of collagen and primary immunodeficiency may represent the host factor inducing development of the neoplasm. We conclude that the association between these rare disorders of the connective tissue and mesothelioma may not be coincidental, but could be the result of the exposition to small amounts of asbestos in predisposed individuals.
Interleukin-10 Secretion by Alveolar Macrophages and Monocytes in Sarcoidosis
Authors: Bingisser Roland , Speich Rudolf , Zollinger Andreas , Russi Erich , Frei Karl
Published: April 2003

Background: Alveolitis and the production of proinflammatory cytokines are known features of sarcoidosis. Because of the usually spontaneous resolution of alveolitis despite local secretion of mediators causing inflammation and granuloma formation, we hypothesized that downmodulating mechanisms such as anti-inflammatory cytokines might be involved in this process. Objective: Investigation of the secretion of the macrophage deactivating cytokines interleukin-10 (IL-10) and transforming growth factor-β (TGF-β) by alveolar macrophages in untreated sarcoidosis of the lung. Methods: Fourteen consecutive and untreated patients with pulmonary sarcoidosis and 18 volunteers underwent bronchoscopy. Alveolar macrophages (AM) were obtained by bronchoalveolar lavage and the secretion of IL-10 and TGF-β was studied. Results: Spontaneous IL-10 production by AM was found in 6 of 14 patients and in 2 of 18 controls. The IL-10 level of lipopolysaccharide-stimulated AM was significantly higher in patients. Monocytes secreted significantly more IL-10 than AM, but there was no difference between sarcoid and control monocytes. No difference was found in the secretion of TGF-β between patients and controls. Conclusion: Increased local secretion of IL-10 – but not TGF-β – may represent a downmodulating mechanism involved in the spontaneous resolution of alveolitis in sarcoidosis.
Microelectrode Recordings Define the Ventral Posteromedial Pallidotomy Target
Authors: Lozano Andres M. , Hutchison William D. , Tasker Ronald R. , Lang Anthony E. , Junn Fred , Dostrovsky Jonathan O.
Published: April 2003

The benefits of stereotactic ventral posteromedial pallidotomy in the treatment of Parkinson’s disease have been recently rediscovered. Optimal lesion location and lesion volume, however, have yet to be determined. Micro-electrode recording and microstimulation are carried out to determine an appropriate site for the placement of electrocoagulation lesions in the medial pallidum. The cellular activity of the globus pallidus is examined for characteristic firing patterns, mean firing rates, movement-evoked activity, and presence of tremor cells, laminae, and border zones. Microstimulation allows the identification of the adjacent optic tract by reports of visual sensation and of the internal capsule by sensorimotor responses. Lesions are centred at sites in the internal segment of the globus pallidus at least 3 mm from these structures, to avoid injury to them during pallidotomy.
Targeting for Thalamic Deep Brain Stimulator Implantation without Computer Guidance: Assessment of Targeting Accuracy
Authors: Alterman Ron L. , Reiter G. Timothy , Shils Jay , Skolnick Brett , Arle Jeffrey E. , Lesutis Mary , Simuni Tanya , Colcher Amy , Stern Matthew , Hurtig Howard
Published: April 2003

The authors assess the accuracy of targeting nucleus ventralis intermedius (Vim) with fast spin echo inversion recovery (FSE/IR) magnetic resonance imaging (MRI) in 18 successful deep brain stimulator (DBS) implants for medically refractory tremor. FSE/IR-MRI-derived coordinates are compared to the final coordinates employed for DBS lead placement, selected with intraoperative neurophysiology. The authors conclude that FSE/IR MRI is sufficiently reliable to serve as the sole means of anatomically targeting Vim for DBS lead placement. An independent computer workstation is not required for accurate targeting; however, intraoperative neurophysiology remains essential.
Prediction of Urinary Continence following Radical Prostatectomy
Authors: van Kampen M. , De Weerdt W. , van Poppel H. , Feys H. , Castell Campesino A. , Stragier J. , Baert L.
Published: April 2003

The aim of this study was to assess the incidence of incontinence after radical prostatectomy and to identify the various factors that can predict urinary continence after radical prostatectomy. Urinary continence following a radical prostatectomy was evaluated in 175 consecutive patients who underwent surgery. Immediately after catheter withdrawal, on the 15th postoperative day, 66% of the patients were incontinent. Varying degrees of incontinence persisted in 53% of the cohort at 1 month postoperatively. Thirty-three, 12, 8 and 2% of the patients remained incontinent at respectively 3, 6, 9 and 12 months of follow-up. A number of possible pre- and peroperative factors which might predict the continence status were examined and related to it at subsequent intervals after the surgical intervention. Preservation of the neurovascular bundles, prior transurethral resection of the prostate, preoperative micturition disorders and age were significant contributors in the prediction of urinary incontinence after radical prostatectomy.
Cytokeratin 8/18 Levels in Patients with Prostate Cancer and Benign Prostatic Hyperplasia
Authors: Wolff J.M. , Borchers H. , Brehmer Jr. B. , Brauers A. , Jakse G.
Published: April 2003

Objectives: Recently, tissue polypeptide-specific antigen (TPS), a cytokeratin 18 marker, was described to be discriminative between cancer of the prostate (CaP) and benign prostatic hyperplasia (BPH). Cyfra 8/18, a marker which recognizes both cytokeratin 8 and 18 fragments, is discussed to improve sensitivity and specificity of TPS. We investigated whether Cyfra 8/18 serum concentration discriminates between patients with clinically localized CaP and BPH. Methods: Serum Cyfra 8/18 levels were determined in patients with untreated CaP before radical prostatectomy (pT1-3pNoMo; n = 11) and with histologically confirmed BPH (n = 22). Cyfra 8/18 concentration was correlated to the prostate-specific antigen (PSA) concentration. Results: Median Cyfra 8/18 level was 0.64 ng/ml in CaP patients and 0.57 ng/ml in BPH patients. This difference is statistically not significant (p = 0.91). Furthermore, no correlation to PSA levels could be established (CaP: r = 0.036; BPH: r = 0.09). Conclusion: In contrast to a recent report we found the Cyfra 8/18 serum concentration to be a nondiscriminative parameter between CaP and BPH.
Percutaneous Suprapubic Transvesical Route: A New and Comfortable Method of Intraprostatic Injection
Authors: Yavaşçaoğlu İsmet , Çamlıkıyı Hakan , Oktay Bülent , Şimşek Ümit , Özyurt Mustafa
Published: April 2003

To assess the efficacy and safety of the percutaneous suprapubic transvesical route (STR) for intraprostatic antibiotic injections and compare it with the transperineal route (TPR), a total of 37 patients suffering from chronic bacterial prostatitis, resistant even to treatment with fluoroquinolones, were randomized to intraprostatic amikacin injections using either STR (n = 19) or TPR (n = 18). Follow-ups were done at weeks 4, 12, 24 and 52. Patients found to have failures at the first follow-up were given an additional injection using the initial route. At the 24th week, 15 patients from both groups were given another injection using the alternative route and were asked to report any subsequent voiding difficulties and compare the discomfort and pain experienced. At the end of 52 weeks, bacteriological cure rates did not differ significantly (44.4 vs. 47.3%). Overall improvement rates in the severity of symptoms and signs were similiar. Considerable difficulty in directing the needle to the prostate due to an excessive amount of subcutaneous fat was experienced, and more than 1 skin puncture was necessary in 5 of the STR group, whereas in the TPR group 7 patients with external hemorrhoids and 1 patient with a rectal fissure had prominent discomfort and pain during the transperineal procedures. Complications such as dysuria or hemospermia were encountered infrequently in both groups, but hematuria was observed more frequently in the STR group (85 vs. 54%). Less discomfort (p < 0.01) and pain (p < 0.01) were reported during access to the prostate by STR, but pain during the injection of the drug did not differ significantly. In conclusion, the percutaneous STR may well be used efficiently and comfortably as an alternative method to TPR when intraprostatic injections are needed in a limited number of cases such as those with a known hypersensitivity to fluoroquinolones or with a history of failure despite long-term systemic treatment with these agents.
The Long-Term Outcome of Cystinuria in Japan
Authors: Akakura Koichiro , Egoshi Kenichi , Ueda Takeshi , Nozumi Kuniyoshi , Kotake Tadashi , Masai Motoyuki , Ito Haruo
Published: April 2003

Recurrence of growth of urinary stone is frequently observed during the clinical course of cystinuria patients. The aim of the present study is to examine the long-term outcome of cystinuria in Japan and clarify the effects of medical treatment on urinary stone. Thirty-one patients with cystinuria who had been followed up longer than 6 months were included. The follow-up period was 6–264 months with a mean of 89.5 months. Stone event was defined as appearance of new stone or radiological evidence of stone growth. All patients were managed with forced hydration and urine alkalization. Twenty-eight patients were treated with administration of thiol such as D-penicillamine or α-mercaptopropionylglycine. Stone events per year ranged from 0 to 1.09 with a median of 0.09. Stone events per patient-year was 0.19 for all patients. The average urinary cystine concentration during treatment in the favorable outcome group (stone events per year < 0.3) was lower that that in the unfavorable outcome group (stone events per year ≥0.3); 221.2 ± 75.2 vs. 303.3 ± 93.5 mg/l, although the difference was not statistically significant. Prognosis of urinary stone in Japanese patients with cystinuria was relatively good with large variation. The medical treatment to reduce urinary cystine concentration would be useful for the management of cystinuria.
Infertility and Multiple Urogenital Abnormalities in a Male with Mosaic 46,XY/45,XO/47,XXY Karyotype and Mixed Phenotype
Authors: Filiadis Ioannis F. , Syrrou Maria B. , Bai Maria C. , Georgiou Ioannis A. , Pagoulatos Gerasimos N. , Giannakopoulos Xenophon
Published: April 2003

We hereby present a rare case of a 46,XY/45,XO/47,XXY mosaic male patient with a predominance of the XY cell line. The patient, who exhibited phenotypic stigmata of both XO gonadal dysgenesis and Klinefelter syndromes, suffered from infertility and multiple urogenital abnormalities, as our investigation revealed.
Evaluation of the Effects of Desmopressin in Acute Ureteral Obstruction
Authors: Moro U. , De Stefani S. , Crisci A. , De Antoni P. , Scott C.A. , Selli C.
Published: April 2003

Objective: To evaluate the effects of desmopressin on pressure values inside the pelvis and ureter of the rat following acute obstruction. Materials and Methods: By means of a microsurgical technique, 24 male Wistar rats were submitted to ureteral obstruction; pressure inside the ureter was recorded using a cannula and a micrometric glass column. In the treatment group (14 animals) 6 mg/kg of desmopressin were administered 30 min before the beginning of the experiment. Results: Rats pretreated with desmopressin showed a statistically significant reduction in mean intraureteral pressure following acute obstruction (p = 0.05). Conclusions: In Wistar rats desmopressin demonstrated a powerful antidiuretic effect, reducing the intraureteral pressure. The experimental model is useful for a better understanding of physiopathology of renal colic and acute obstruction.
Urinary Diversion following Cystectomy in a Patient with Situs inversus totalis
Authors: Rodrigues Gustavo P. , Gheiler Edward L. , Tefilli Marcos V. , Da Silva E. Alexsandro , Tiguert Rabi , Pontes J. Edson
Published: April 2003

Situs inversus totalis is a rare syndrome. The association of malignancies with situs inversus totalis is rare, and only 9 cases were reported. The management of invasive bladder cancer in the presence of situs inversus totalis has not been reported previously, and herein we report the 1st case.
Interaction between Osteopontin on Madin Darby Canine Kidney Cell Membrane and Calcium Oxalate Crystal
Authors: Yamate T. , Kohri K. , Umekawa T. , Konya E. , Ishikawa Y. , Iguchi M. , Kurita T.
Published: April 2003

We recently reported that the addition of the protein osteopontin (OPN) resulted in an increase in the deposition of calcium oxalate (CaOx) crystals on the surface of Madin Darby canine kidney (MDCK) cells. To determine the degree to which this increased deposition is caused by OPN, we investigated the extent to which the CaOx crystal deposition produced by the expression of OPN at the cell surface was suppressed by 4 different methods prior to the determination of the level of CaOx crystal binding. MDCK cells (2 × 106 cells/well) were cultured to a confluent state, and the binding of OPN to the cellular surface was then inhibited by adding one of the following 4 substances: human OPN polyclonal antibody, thrombin, cyclic Arg-Gly-Asp (RGD) peptides and tunicamycin. The cells were cultured for 24 h. We then used a fluorescent antibody technique with an OPN polyclonal antibody to determined whether the expression of OPN at the cell surface was inhibited, and we measured the degree of CaOx crystal deposition using the isotope 45Ca. The degree of CaOx crystal deposition was inhibited by 80% or more in the antibody-treated group, by 50–80% in the thrombin-treated group, by 60–80% in the cyclic RGD-treated group, and by 50–60% in the tunicamycin-treated group. These results suggest that OPN in the extracellular matrix is the main cause of CaOx crystal deposition on the surface of MDCK cells.
Osteopontin Expression in Prostate Cancer and Benign Prostatic Hyperplasia
Authors: Tozawa Keiichi , Yamada Yasuyuki , Kawai Noriyasu , Okamura Takehiko , Ueda Kosuke , Kohri Kenjiro
Published: April 2003

Objectives: Osteopontin (OPN), a secreted adhesive glycoprotein, has been shown to be produced in excessive amounts in a variety of experimental models of malignancy. Increased levels of OPN exist in blood from the lungs, breasts, and gastrointestinal tracts of cancer patients with metastases. However, there have been no reports on the expression of OPN in human urological malignancies. The present study investigates the presence of OPN in adenocarcinoma of the human prostate and in benign prostatic hyperplasia (BPH). Patients and Methods: Using prostate tissue from 34 patients with primary prostate cancer, 13 patients with prostate cancer after having undergone hormonal therapy, and 12 patients with BPH, formalin-fixed paraffin sections were prepared. Specimens were obtained by needle biopsy or radical prostatectomy. Immunohistochemical staining (ABC method) was then performed. Staining was divided into either negative or positive categories. Results: Positive staining of OPN was observed on cancer cells and macrophages in 52.9% of the primary prostate cancers and 14.5% of the prostate cancers after hormonal therapy. In BPH specimens, 66.7% of the cases displayed positive staining of OPN. The staining level of OPN showed no correlation with serum prostate-specific antigen, but did correlate with stage, differentiation, and Gleason’s score. Conclusions: The result postulates that the expression of OPN is an indicator of cell differentiation; however, it cannot be used as a marker of malignance in prostate cancer.
Rhabdomyosarcoma of the Bladder in an Adult
Authors: Yasui Takahiro , Tanaka Hajime , Sasaki Shoichi , Kohri Kenjiro
Published: April 2003

We report a case of rhabdomyosarcoma of the bladder in an adult. A 73-year-old male was referred to our hospital due to macrohematuria. Ultrasonography, CT and MRI revealed a bladder tumor, and cystoscopic biopsy of the tumor pathologically revealed rhabdomyosarcoma. Total cystectomy with ileal conduit urinary diversion was performed.
A Large Primary Malignant Melanoma of the Female Urethra
Authors: Girgin Cengiz , Tarhan Hüseyin , Sezer Akif , Ermete Murat , Gürel Gözen
Published: April 2003

We present a case of large, primary malignant melanoma of the female urethra with poor prognosis in this case report. Malignant melanoma is one of the rare tumors of the female urethra and accounts for 0.2% of all malignant melanoma cases. Large (5.6 cm in diameter), primary malignant melanoma of the female urethra is exceedingly rare.
Open Thumb Forceps
Authors: Ansari M.S. , Goel Apul , Hemal A.K. , Gupta N.P.
Published: April 2003

A great variety of foreign bodies in the urethra have been reported in the literature. Mostly, these cases were reported to emphasize the unusual nature of the objects requiring technical modifications for their removal. We report an interesting case of self introduced open thumb forceps into the urethra and technique of its retrieval.
Bronchogenic Cyst
Authors: Reichelt O. , Grieser T. , Wunderlich H. , Möller A. , Schubert J.
Published: April 2003

Subdiaphragmatic bronchogenic cysts are rare, and those located retroperitoneally are exceptional. A review of the English-language literature revealed only 16 reported cases. We describe an additional case of a retroperitoneal cyst presenting as an asymptomatic adrenal mass and discuss clinical, radiographic, surgical and pathological findings as well as its embryological background.
Immunological Phenotype Analysis of Patients with Fanconi’s Anaemia and Their Family Members
Authors: Castello Giuseppe , Gallo Ciro , Napolitano Maria , Ascierto Paolo A.
Published: April 2003

In contrast to patients affected with Fanconi’s anaemia (FA), who are homozygotes, parental heterozygotes are generally considered normal. In this preliminary work the main immunological phenotypes of circulating mononucleated cells were studied, both in homozygous and heterozygous subjects. The statistical analysis of results showed that two sets of variables may be distinguished: (a) the first set, including CD20, CD4, CD8 cell markers and CD20/CD3 and CD4/CD8 ratios, that was able to differentiate between FA patients and the other subject groups; (b) the second set, including CD25, HLA-DR, HLA-DP, HLA-DQ cell markers, that was able to differentiate healthy subjects from the other groups. Therefore, in contrast with the literature data, immunological abnormalities may already be present in parental heterozygotes of FA patients. These subjects displayed a reduced number of cells expressing both specific (CD25) and non-specific (HLA) antigens. This defect was more severe in FA homozygous patients, who showed, in addition, a reduced total lymphocyte count, reduced levels of T helper (CD4+) and B lymphocytes (CD20+), and a reduced CD4+/CD8+ cell ratio. In conclusion, our results suggest the presence of a grading of immunological defects in FA patients and family members. Our suggestion needs to be confirmed by functional studies.
Pure Red Cell Aplasia Responsive to Interferon-α in a Patient with Hepatitis C Virus Infection
Authors: Davidovitz Y. , Halpern Z. , Vardi J. , Ballin A. , Meytes D.
Published: April 2003

A 51-year-old man presented with severe anemia, mild splenomegaly and elevated serum aspartate aminotransferase and serum alanine aminotransferase levels. The bone marrow findings were consistent with pure red cell aplasia (PRCA) with a ‘maturation arrest’ at the level of pronormoblast. The patient has been transfusion-dependent for 8 months. Following diagnosis of chronic active hepatitis due to hepatitis C virus (HCV), therapy with interferon-α was initiated. Two weeks later, the hemoglobin level stabilized, and he has not required any transfusion ever since. In spite of ongoing HCV viremia, cessation of interferon therapy, and deterioration of the liver function tests, the patient, followed for 2 years, maintains a high-normal hemoglobin level. To the best of our knowledge, this is the first report of prolonged PRCA corrected by interferon-α therapy, with or without an ongoing HCV infection. We speculate that the ‘maturation arrest’ of the erythroid lineage seen in the bone marrow was the result of an immune mechanism, possibly induced by the HCV, and that the elimination of this mechanism, rather than the elimination of the HCV, provided the opportunity for regeneration of erythropoiesis.
All-Trans-Retinoic-Acid- and Growth-Factor- Mediated Induction of Alkaline Phosphatase Activity in Freshly Isolated Chronic Myeloid Leukemia Cells
Authors: Stagno Fabio , Guglielmo Patrizia , Consoli Ugo , Fiumara Paolo , Longo Giuseppe S.A. , Giustolisi Rosario
Published: April 2003

Reduced or absent neutrophil alkaline phosphatase (NAP) activity is a common feature of neutrophilic granulocytes from patients with chronic myeloid leukemia (CML). In this study we examined whether NAP activity could be restored in vitro by stimulating CML cells with different promoters such as all-trans-retinoic acid (ATRA), granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF). The results obtained indicated that ATRA and G-CSF, either alone or in combination, were effective in inducing NAP activity in CML cells, whereas GM-CSF was not. Further, NAP restoration in ATRA- and G-CSF-treated cultures was accompanied by increased morphologic differentiation of the CML clone. It might be concluded that the CML clone could be driven in vitro by ATRA and G-CSF both to achieve granulocytic maturation and to correct functional NAP-related defects.
Superior Sagittal Sinus Thrombosis Occurring at High Altitude Associated with Protein C Deficiency
Authors: Boulos Pauline , Kouroukis Chrisostomos , Blake Geoffrey
Published: April 2003

A 42-year-old male presented with right-sided weakness, dysphasia and seizures while climbing the French Alps at an approximate altitude of 3,000 m. Imaging studies were consistent with superior sagittal sinus thrombosis with hemorrhage. Laboratory testing for thrombophilic states, 18 days after presentation at our hospital, showed a low protein C level (0.32 U/ml, normal 0.80–1.60 U/ml). A family member was also found to have protein C deficiency without a history of thrombosis. The patient gradually improved and was discharged on warfarin and valproic acid. This is the first reported case of cerebral venous thrombosis in a patient with congenital protein C deficiency who ascended to high altitude. We postulate that the ascent to high altitude represented an additional prothrombotic risk factor to the congenital protein C deficiency leading to cerebral thrombosis.
CD3+, CD4–, CD8–, TCRαβ–, TCRγδ+ Granular Lymphocyte Proliferative Disorder without Lymphocytosis and Clinical Symptoms
Authors: Kondo Haruki , Uematsu Miki , Watanabe Jun’ichiro , Takahashi Yoko , Hayashi Kazumi , Iwasaki Hisayo
Published: April 2003

Granular lymphocyte-proliferative disorder is characterized by a proliferation of large granular lymphocytes (LGLs). It is often associated with neutropenia, rheumatoid arthritis (RA), and pure red cell aplasia (PRCA). Phenotypic analysis has demonstrated that in most cases, the LGLs show a clonal rearrangement of the TCRαβ rearrangement. We are reporting a patient with TCRγδ LGL proliferation without clinical findings and lymphocytosis. The patient showed an expansion of the CD3+, CD16+, CD56+, and CD57+ LGL populations which involved coexpression of TCRγδ with TCR Jγ and Jδ1 gene rearrangement. Autoimmune manifestations, including RA and PRCA, have not appeared and the results of laboratory examinations have not changed for 1 year after the diagnosis.
Involvement of Immunopathogenic Mechanisms in a Spontaneously Occurring Glomerulopathy in Mice
Authors: Chen Ann , Sheu Lai-Fa , Chou Wei-Yuan , Ho Yat-Sen , Lin Yu-Feng , Lin Fu-Gong , Lee Wei-Hwa
Published: April 2003

Mice have been found to be susceptible to spontaneous renal localization of immune deposits. However, the significance of these immune deposits is still debated. We investigated the immunopathogenesis of a naturally occurring glomerulopathy associated with progressive proteinuria and glomerulosclerosis in 75 BALB/c mice. The mice were divided into five groups of 15 and killed at the age of 1, 3, 6, 12, or 18 months for laboratory and renal pathologic studies. These mice showed persistently increasing serum levels of immune complexes, a marked increase of glomerular immune deposits which were capable of fixing C3, and interstitial infiltration of lymphocytes and plasma cells, followed by the occurrence of proteinuria, mesangiopathy, and glomerulosclerosis. Our findings suggest that an immune system mediated process occurred in the kidneys of the mice tested.
Folic Acid Supplementation Rarely Improves Erythropoietin Response
Authors: Blumberg Alfred , Zehnder Carlos , Huber Andreas
Published: April 2003

Pronai et al. [1995] published an article in Nephron which claimed that folic acid supplementation improves erythropoietin (EPO) response. The authors studied 13 patients who were resistant to EPO given at a dosage of 75 U/kg (per week or per dose?). Eight patients responded with a fall in mean corpuscular volume (MCV) and a rise in hematocrit when they were given folic acid.
Crescentic Glomerulonephritis due to Rifampin Treatment in a Patient with Pulmonary Atypical Mycobacteriosis
Authors: Ogata Hisanobu , Kubo Michiaki , Tamaki Kiyoshi , Hirakata Hideki , Okuda Seiya , Fujishima Masatoshi
Published: April 2003

A 64-year-old male was treated continuously with rifampin, isoniazid and streptomycin for pulmonary atypical mycobacteriosis, Mycobacterium kansasii. Five weeks after beginning the treatment, the patient suddenly developed acute renal failure. A renal biopsy showed crescentic lesions characteristic of rapidly progressive glomerulonephritis with moderate interstitial changes. Serum antirifampin antibody was detected, and the cessation of rifampin treatment was followed by a rapid spontaneous recovery of the patient’s renal function. This is, to our knowledge, the first case of rapidly progressive crescentic glomerulonephritis associated with rifampin treatment where circulating antirifampin antibody is demonstrated and the renal function spontaneously improved after discontinuing rifampin treatment.
Intercellular Adhesion Molecule 1 Mediates Mononuclear Cell Infiltration into Rat Glomeruli after Renal Ablation
Authors: Miyatake Nobuyuki , Shikata Kenichi , Sugimoto Hikaru , Kushiro Masahiko , Shikata Yasushi , Ogawa Saeko , Hayashi Yoshiko , Miyasaka Masayuki , Makino Hirofumi
Published: April 2003

Mononuclear cells, primarily macrophages and lymphocytes, infiltrate the renal glomeruli and are involved in the progression of various glomerular diseases. Intercellular adhesion molecule 1 (ICAM-1) is expressed on the vascular endothelium and mediates the infiltration of leukocytes into the site of inflammation. Although the expression of ICAM-1 can be induced by the stimulation of inflammatory cytokine, ICAM-1 expression can also be induced by such nonimmune mechanisms as shear stress. Glomerular hyperfiltration is a major mechanism that contributes to the progression of the glomerular sclerosis that results from the loss of functioning nephrons. In the present study, we examined the role of ICAM-1 for mononuclear cell infiltration in the glomeruli of the five-sixth nephrectomized rat as a model of glomerular hyperfiltration. The fluorescence intensity score of the staining for ICAM-1 in the glomeruli of the five-sixth nephrectomized rats was significantly increased as compared with that in the control (sham-operated) rats at 1 week (1.51 ± 0.15 vs. 0.61 ± 0.13; p < 0.01) and 2 weeks (1.31 ± 0.17 vs. 0.51 ± 0.09; p < 0.01). The number of leukocytes present in the glomeruli was significantly increased in the five-sixth nephrectomized rats compared with control (sham-operated) rats at 1 week (3.44 ± 0.16 vs. 0.99 ± 0.08; p < 0.01) and 2 weeks (3.14 ± 0.14 vs. 0.89 ± 0.07; p < 0.01). Leukocytes mainly consisted of macrophages in the five-sixth nephrectomized rats at 1 week (2.39 ± 0.19) and 2 weeks (1.46 ± 0.11). Anti-ICAM-1 monoclonal antibody effectively prevented the infiltration of macrophages into the glomeruli following nephrectomy. These results indicate that glomerular hyperfiltration may be involved in the induction of the expression of ICAM-1 and the infiltration of macrophages into the renal glomeruli following glomerular injury.