bluuebunny/crossref_metadata_2025 huggingface dataset:
Relapsing polychondritis
Authors: ALATAŞ Füsun , ÖZKAN Ragip , METINTAŞ Muzaffer , MORAL Hale , ERGINEL Sinan , UÇGUN Irfan
Published: March 2003

Relapsing polychondritis (RP) is a rare, inflammatory disease with multisystem involvement and it should be considered in the aetiology of sudden respiratory distress. A 49‐year‐old woman was admitted to the emergency service of Osmangazi Hospital in acute respiratory distress. She had a tracheostomy following a diagnosis of laryngeal stenosis 10 years earlier. She was managed thereafter at another hospital with a diagnosis of asthma. At admission she was in respiratory distress, had arthralgias, bilateral subconjunctival hyperaemia, periorbital oedema and skin lesions. A thoracic CT showed tracheal wall thickening. Calcification of the auricular regions were noted bilaterally. Bronchi, conjunctiva and skin lesions were biopsied with a provisional diagnosis of RP. The diagnosis of RP in this patient was based on clinical, pathological and radiological findings. Steroid therapy was begun and she was referred to a surgical centre for stenting. This case report emphasizes the need to consider the possibility of RP as a cause of sudden respiratory distress.
Floral scent differentiation among coflowering, sympatric species ofGeonoma(Arecaceae)
Authors: Knudsen Jette T.
Published: March 2003

This paper presents an investigation of the chemical composition of the floral scent of eight coflowering, sympatric taxa ofGeonoma, a neotropical genus of understory palms with little or no variation in floral characteristics. The objective was to evaluate if floral scent might function as a reproductive isolation mechanism. Floral scent was collected with headspace techniques and the chemical composition analyzed and determined by gas chromatography–mass spectrometry. The eight studied taxa each had a characteristic, distinct floral scent composition, as revealed by grouping of individuals of each taxon together in a principal component analysis. As flower morphology and colors, as well as the diurnal flowering phenology, often vary little between sympatric, coflowering plants, other mechanisms to keep the species reproductively isolated are needed. It was concluded that variation in floral scent composition potentially is of importance to keep taxa ofGeonomareproductively isolated.
Pollen odor chemicals as modulators of bumble bee foraging on Rosa rugosa Thunb. (Rosaceae)
Authors: Dobson Heidi E. M. , Danielson Erica M. , Wesep Isaac D. Van
Published: March 2003

Behavioral field studies were conducted to determine if bumble bees (Bombus terrestris L.) can use pollen odor to assess pollen availability in flowers of Rosa rugosa (Rosaceae), a nectarless species with a distinctive pollen odor. Pollen volatiles were added singly and in mixtures to newly opened flowers from which anthers were removed and were offered to free‐flying bumble bees in an array that included intact flowers as controls. The addition of 2‐tridecanone and geranyl acetate reduced landing responses, but the addition of tetradecyl acetate and especially eugenol significantly increased landing frequency as well as the display of vibratile pollen‐collecting behavior, suggesting that they are key chemicals in a bee’s assessment of pollen availability in individual flowers. Bee responses to flowers in which androecia were exchanged between first‐day flowers (with pollen reward) and second‐day flowers (without pollen reward) provide evidence that bee discrimination between flowers is based mainly on stimuli from the anthers. Overall, the findings show that bumble bees foraging on R. rugosa use primarily pollen odor in concert with visual stimuli from the androecium and secondarily petals odors and colors in selecting rewarding flowers. Controlled pollination and bagging studies indicate that R. rugosa requires cross‐pollination by insects, pointing to the selective advantage that pollen odor provides by increases plant fitness through the enhanced foraging efficiency of bumble bee pollinators.
Pollen presentation and pollination syndromes, with special reference to Penstemon
Authors: Thomson James D. , Wilson Paul , Valenzuela Michael , Malzone Maria
Published: March 2003

Pollen presentation theory (PPT) allows for a re‐examination of some classic themes in pollination biology. Here, we outline its implications in the context of bee‐ and bird‐adapted species of Penstemon and Keckiella (Scrophulariaceae). PPT models the optimal schedule of pollen presentation, based on the frequency of visits by pollinators, and the capacities of those pollinators to remove and deposit pollen. High visitation rates, high removal and low deposition all favor plants that present pollen in many small doses. Dosing is achieved through gradual opening of anthers and through anthers opening only narrowly. We hypothesize that bees have higher rates of removal and lower rates of deposition than birds; therefore, bee‐pollinated species should have anthers that open more gradually and less completely than bird‐pollinated species. Before presenting preliminary results that affirm this prediction, we critically discuss the characterization of species by pollination syndrome. PPT sheds new light on why plants may specialize on particular pollinators. Stebbins’ most effective pollinator can be recast as the pollinator that deposits more of the pollen that it removes, thereby making other visitors into conditional parasites. Pollinator shifts might occur when a pollinator with low removal and high deposition becomes abundant; the plants would then be selected to discourage their previous pollinators who are now parasites. Bird‐pollination may favor anthers that open quickly and widely, thereby making bees wasteful parasites. Bee‐pollination may favor anthers that open slowly and narrowly, thereby making birds ineffective pollinators. In paired comparisons of closely related species, the hummingbird‐visited species were redder, had narrower or longer floral tubes, more exserted anthers and stigmas, less pronounced landing platforms, more inclined orientation, produced more nectar of a lower concentration, and had anthers that dehisce faster and more extensively.
Plasma brain natriuretic peptide concentrations in patients with Kawasaki disease
Authors: Kawamura Takashi , Wago Masakuni , Kawaguchi Hiroshi , Yuge Masahiro Tahara and Masako
Published: March 2003

Abstract Background: Brain natriuretic peptide (BNP) is a cardiac hormone and plasma levels of it increase in patients with congestive heart failure and in those with acute myocardial infarction. Kawasaki disease (KD) is a well‐known generalized vasculitis and the most prominent features of this disease are the cardiovascular manifestations, which involve the pericardium, myocardium, endocardium and coronary arteries. It was hypothesized that the plasma concentrations of BNP in patients with KD might be increased and that plasma BNP might be a useful biological marker of cardiovascular manifestations in patients with KD.

Methods
: Blood was obtained to measure and compare plasma BNP concentrations in the acute (n=32) and convalescent (n=35) phases of KD and in the acute phase of the patients with viral infection (n=26), which included adenovirus, influenza, measles and herpes group virus infection. In patients with KD, two‐dimensional echocardiography was performed to check for pericardial effusion and coronary arterial lesions and to measure the dimensions of the left ventricle at diastole and the shortening fraction of the left ventricle (LVSF).

Results
: The mean plasma BNP concentration in patients with KD in the acute phase was 55.0~39.5 pg/mL, but was 6.8~7.3 pg/mL in patients with viral infection. The plasma BNP concentration in patients with KD in the acute phase was significantly higher than in patients with viral infection (P<0.0001). In 31 cases of KD, the plasma BNP concentrations were measured both in the acute and convalescent phases. The mean plasma BNP concentration in the acute phase of KD was 55.3~40.1 pg/mL and in the convalescent phase was 5.9~5.7 pg/mL. The level of plasma BNP decreased significantly in the convalescent phase (P<0.0001). The mean BNP level in patients with KD with pericardial effusion (n=8) in the acute phase was 80.3~43.4 pg/mL and that in patients without pericardial effusion (n=24) was 46.5~35.1 pg/mL. The BNP level in patients with pericardial effusion was significantly higher than that of patients without pericardial effusion (P<0.05). There was no significant correlation between the plasma concentrations of BNP in the acute phase of KD and LVSF (r=– 0.161, P=0.39, n=31).

Conclusion
: It was shown that the plasma BNP concentration increased in the acute phase of KD and decreased to within normal range in the convalescent phase. Further examinations are needed to clarify the mechanism by which the elevated levels of plasma BNP occur in the acute phase of KD. However, plasma BNP might be a useful biological marker of the cardiovascular manifestations in patients with KD.
Headache etiology in children: A retrospective study of 125 cases
Authors: Deda Gülhis , Çaksen Hüseyin , Öcal Aylin
Published: March 2003

Abstract

Background
: To determine the headache etiology in children in the middle Anatolia region of Turkey.

Methods
: The clinical and laboratory findings of 125 patients, who were followed up after a diagnosis of headache in our hospital, were reviewed retrospectively. The criteria defined by the International Headache Society (IHS) were used in the classification of patients. The patients were divided into two subgroups according to age intervals: (i) group I, 5–10 years of age; and (ii) group II, 11–16 years of age.

Results
: There were 62 males and 63 females in the study. The patients’ ages ranged from 5 to 16 years (mean (± SD) age 10.67~2.72 years). Headache was more commonly noted between 11 and 16 years of age. While headache was more frequent in male children in group I, there was female predominance in group II. However, there was no significant difference between the groups with respect to age and gender (P>0.05). The most frequent cause of headache was migraine and the remaining causes, in decreasing order, included sinusitis (no. 11 according to IHS criteria) and tension‐type and psychosomatic headaches (no. 13 according to IHS criteria). Of the 125 patients in the study, 85 (68%) had acute headache and 40 (32%) had chronic headache; 44 (35.2%) patients had acute localized‐type headache, 39 (31.2%) suffered from acute recurrent‐type headache, 38 (30.4%) had chronic non‐progressive headache and acute generalized and chronic progressive‐type headache were diagnosed in two (1.6%) patients. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain were performed in 50 and seven patients, respectively; there were abnormal findings in six patients on CT examiniation and in two patients following MRI.

Conclusions
: In conclusion, we stress that the most frequent cause of headache in childhood is migraine and the remaining causes, in decreasing order of frequency, were sinusitis and tension‐type and psychosomatic headaches. Neuroimaging studies, such as CT or MRI, need to be performed, especially in patients with complicated symptoms.
Vagus nerve stimulation for children and adolescents with intractable epilepsies
Authors: Wakai Shuji , Kotagal Prakash
Published: March 2003

Background
: Vagus nerve stimulation (VNS) has been shown to be efficacious in the treatment of patients >12 years of age with refractory partial epilepsies and it is suggested that VNS should be considered as one of the treatment options for these patients.

Methods
: Four patients had partial epilepsies and one had symptomatic generalized epilepsy. After observation of the baseline seizure frequency and the average seizure frequency for 3 months, the VNS system was implanted. Thereafter, seizure frequency, average seizure frequency of each seizure type during the month just before the evaluation, seizure severity, side effects and quality of life were recorded.

Results
: In four of five patients, overall seizure frequency was reduced >50% after VNS treatment. The seizure types that showed a >50% reduction in frequency were auras, focal clonic, generalized tonic clonic seizures, astatic, versive, hypomotor, generalized tonic and generalized clonic seizures according to Lüders’ classification. In two patients, as major convulsive seizures were reduced in number after VNS treatment, dialeptic seizures (non‐convulsive seizure with lapse of consciousness) gradually appeared. In one patient without significant seizure reduction, quick recovery from postictal periods after generalized tonic seizure was seen after treatment. In one patient with generalized epilepsy, improvement of cognitive function was reported by his guardians. After VNS, the number of antiepileptic drugs was reduced from three to one in one patient. No significant adverse effects were noted in any patients.

Conclusions
: Our results suggest that VNS is well tolerated in young patients with intractable epilepsies and it may be an important non‐pharmacologic treatment option for children with severe epilepsies who cannot tolerate medical therapy and/or are not candidates for epilepsy surgery.
Denver developmental screening test II for early identification of the infants who will develop major neurological deficit as a sequalea of hypoxic‐ischemic encephalopathy
Authors: Hallioglu Olgu , Topaloglu Ali Kemal , Zenciroglu Aysegul , Duzovali Oznur , Yilgor Esat , Saribas Sezen
Published: March 2003

Abstract

Background
: The primary aim of this study was to find widely available, inexpensive, and non‐invasive parameters for early identification or prediction of the infants with hypoxic‐ischemic encephalopathy (HIE) who will have a severe adverse outcome (classified as death or a major neurological deficit).

Methods
: Fifty‐seven full‐term or near‐term newborn infants with a diagnosis of HIE were consecutively admitted to the neonatal intensive care unit and studied. Occurrence of seizures during the first 24 h, cranial ultrasonography (US) findings within the first 5 days of life, and Denver developmental screening test II (DDST II) at 6 months of age, were analyzed in relation to mortality and neurological status at 2 years of age.

Results
: Of the 57 infants, 10 were lost to follow‐up. Twenty of the remaining 47 infants had a severe adverse outcome. Among the predictors of severe adverse outcome, occurrence of seizures was found to have a poor predictive accuracy. Cranial US had 100% sensitivity, however with a rather low specificity (55%). However, DDST II at 6 months of age, yielded a very high predictive accuracy (sensitivity=100%, specificity=95%).

Conclusion
: We conclude that DDST II at 6 months of age could be used in predicting severe neurological outcome in infants with HIE.
High‐dose chemotherapy in children with metastatic hepatoblastoma
Authors: Nishimura Shin‐Ichiro , Sato Takashi , Fujita Naoto , Yamaoka Hiroaki , Hiyama Eiso , Yokoyama Takashi , Ueda Kazuhiro
Published: March 2003

Background
: Despite the advent of effective chemotherapy, a poor prognosis has been reported for patients with metastatichepatoblastoma. To improve this prognosis, we conducted high‐dose chemotherapy with autologous bone marrow rescue in patients withmetastatic hepatoblastoma.

Methods and results
: Three patients were treated with high‐dose chemotherapy. In patient 1, high‐dose chemotherapywas given after the patient’s first pulmonary relapse. Additional pulmonary metastases, which developed more than 6 monthsafter high‐dose chemotherapy, were treated by multiple thoracotomy without additional chemotherapy. Patient 2 presented additionalpulmonary metastases soon after the end of the first thoracotomy and high‐dose chemotherapy. Because of a decreased serum alpha‐fetoproteinlevel after re‐excision of the pulmonary metastases, a second round of high‐dose chemotherapy was performed. In patient 3, multiplepulmonary metasteses responded to preoperative chemotherapy and disappeared according to the chest computed tomography. Intensivetreatment with a high‐dose chemotherapeutic regimen was performed at the end of postoperative chemotherapy. All three patients are aliveand well, more than 6 years after receiving their diagnosis.

Conclusion
: The role of high‐dose chemotherapy in treatment of metastatic hepatoblastoma could not be clarified,because of the small number of patients. However, the better outcome of our patients indicates that multimodal therapy, including high‐dosechemotherapy, may improve the outcome of the patients with metastatic hepatoblastoma.
The influence of bright light during the daytime upon circadian rhythm of core temperature and its implications for nocturnal sleep
Authors: Wakamura Tomoko , Tokura Hiromi
Published: March 2003

Abstract The purpose of the present study was to investigate how bright light during the daytime could influence circadian rhythms of core temperature and nocturnal sleep. Seven females (age 20 ± 2 years) served as participants. The participants lived in the experimental unit for 4 days and were exposed to either 6000 lx (bright) or 200 lx (dim) light during the daytime. Rectal temperature (Tre) was measured during the experimental period. Subjective alertness was measured by the Kansei‐gakuin Sleeping Scale five times a day. The minimum Tre was significantly lower after bright exposure (P < 0.05). The Tre fell rapidly after bright exposure before they retired (P < 0.05) and increased more rapidly during bright light after they woke up (P < 0.05). The morning wakefulness under bright exposure was more active than under dim exposure (P < 0.05). The melatonin secretion at wake up during bright exposure was significantly lower than during dim exposure (P < 0.05). Exposure to bright light during daytime lowered the nocturnal level of Tre, its evening fall was faster and the morning rise quicker. This suggests that indoor light during daytime should be bright enough to promote healthy sleep at night.
Influences of cognitive status, depression and health on the use of memory strategies among residents of Japanese geriatric nursing facilities
Authors: Ide Satoshi , McDougall Graham J.
Published: March 2003

Abstract This is a secondary analysis of a larger metamemory study among Japanese nursing facility residents. The purpose of this study was to investigate memory strategies used among Japanese nursing facility residents and to examine the influences of health status, depression and cognitive status on the use of memory strategies. One hundred and seventeen subjects from seven nursing facilities located in the Tokyo area participated in the study. The Mini‐Mental State Exam, Metamemory in Adulthood Questionnaire, Geriatric Depression Scale, Health Scale and demographic questionnaires were used in face‐to‐face interviews. There were no significant differences in the use of internal and external strategies among the subjects. The use of the note strategy was significantly different between the cognitively impaired and the intact group, and between the depressed and non‐depressed group. The results suggested that the note‐taking strategy and list‐making strategy would not be an effective means of memory support for people with depression and/or cognitive impairment.
Characteristics of housebound elderly by mobility level in Japan
Authors: Kono Ayumi , Kanagawa Katsuko
Published: March 2003

Abstract The purpose of the present study was to describe characteristics of the housebound elderly by their mobility levels. Disabled elderly people in Japan were interviewed at home by nurses. Housebound status was defined as people who left the house less than once a week. Characteristics of housebound elderly were compared with non‐housebound elderly by three mobility levels: (i) Non‐walking group (n = 72); 5 m‐walking group (n = 153); going‐by‐bus group (n = 96). Housebound elderly were not found in the going‐by‐bus group. Among the elderly in the non‐walking group, the cognitive function of the housebound elderly was significantly lower and the housebound elderly were less well cared for; however, their caregivers rated their caregiving burden significantly lower than did caregivers of the non‐housebound elderly. Among those in the 5 m‐walking group, the autonomy and social networks of the housebound elderly were significantly less than for the non‐housebound. The characteristics of housebound elderly showed differences by mobility levels.
Versatility and flexibility: Attributes of the Critical Incident Technique in nursing research
Authors: Keatinge Diana
Published: March 2003

Abstract This article explores the value of using the Critical Incident Technique to capture qualitative data relating to nurses’ experiences in three diverse clinical contexts: (i) neonatal intensive care; (ii) palliative care; and (iii) care of the demented elderly. It is suggested that this technique enables the researcher to capture the reality of contemporary nursing practise, and nurses’ experiences of that practise. It is also suggested that the versatility and flexibility of the Critical Incident Technique reveals the subtleties and complexities in nurses’ experiences of practising nursing in diverse contexts, thereby promoting a deeper understanding of meanings underpinning this practise.
Role of protein kinase C in cisplatin nephrotoxicity
Authors: Ikeda Shigenori , Fukuzaki Atsushi , Kaneto Hiroyuki , Ishidoya Shigeto , Orikasa Seiichi
Published: March 2003

Background: Cisplatin is widely used in cancer treatment. The major disadvantage of this antitumor agent is its nephrotoxicity. The mechanism of cisplatin‐induced nephrotoxicity has not been clarified. Recent evidence suggests protein kinase C (PKC)‐related signal transduction pathways may modulate cisplatin‐induced cytotoxicity.

Methods: The effect of cisplatin administration on PKC expression in the kidney and the effect of a PKC inhibitor on cisplatin‐induced renal impairment were investigated in rats.

Results: A single intraperitoneal injection of 8 mg/kg cisplatin induced remarkable damage in the proximal tubules located in the outer medulla, which was associated with impaired renal function, within 48 h. An immunoblotting study revealed marked expression of α‐PKC in membrane fractions of medullary tubules prepared from cisplatin‐treated rats. In addition, pretreatment with the PKC inhibitor (H‐7) protected kidneys from cisplatin‐induced damage.

Conclusions: These findings suggest that the nephrotoxic effects of cisplatin may, in part, be related to PKC activation in the renal tubules.
Angiomyofibroblastoma of the female urethra
Authors: Kitamura Hiroshi , Miyao Noriomi , Sato Yoshikazu , Matsukawa Masanori , Tsukamoto Taiji , Sato Takashi
Published: March 2003

Background: Angiomyofibroblastoma is a relatively recently described rare tumor of the superficial soft tissues. To date, 57 cases of angiomyofibroblastoma of the external genitalia in women have been reported.

Methods/Results: We describe a case of a 24‐year‐old woman who presented with the urinary stream flowing out in the posterior direction and whose diagnosis was a urethral tumor, angiomyofibroblastoma.

Conclusions: Angiomyofibroblastoma has a potential arising from the female urethra as well as other areas of the external genitalia.
The value of γ‐seminoprotein in combination with prostate specific antigen in detecting prostate cancer
Authors: Nakashima Jun , Nagata Hirohiko , Sumitomo Makoto , Miyajima Akira , Tachibana Masaaki , Baba Shiro , Jitsukawa Seido , Murai Masaru
Published: March 2003

Background: The present study was undertaken to investigate the value of gamma‐seminoprotein (γ‐Sm) and the γ‐Sm/prostate specific antigen (PSA) ratio in combination with serum PSA in detecting prostate cancer.

Methods: Prostate specific antigen, γ‐Sm and the γ‐Sm/PSA ratio were evaluated in 112 patients with untreated prostate cancer and 90 patients without prostate cancer who had serum PSA and γ‐Sm levels above their respective detection limits.

Results: When data for all of the patients were analyzed, serum PSA and γ‐Sm levels were significantly higher and the γ‐Sm/PSA ratio was significantly lower in patients with prostate cancer than patients without prostate cancer. The serum PSA and γ‐Sm levels significantly increased and the γ‐Sm/PSA ratio significantly decreased with advancing clinical stage in patients with prostate cancer. Among the patients with serum PSA levels ranging from 1.8 to 6 ng/mL, the γ‐Sm/PSA ratio was significantly lower (P < 0.05) and γ‐Sm levels were lower (P = 0.054) in the patients with prostate cancer than in those without prostate cancer, but serum PSA levels were not significantly different (P = 0.53). A receiver operating characteristic (ROC) analysis demonstrated that the areas under the ROC curves were 0.54 for PSA, 0.65 for γ‐Sm and 0.69 for the γ‐Sm/PSA ratio for prediction of prostate cancer in the PSA range from 1.8 to 6 ng/mL, although the ROC analysis suggested that the γ‐Sm/PSA ratio does not provide significant advantage over PSA in detecting prostate cancer when all of the patients were analyzed.

Conclusions: These results suggest that the γ‐Sm/PSA ratio and γ‐Sm may facilitate differentiation between patients with and without prostate cancer who have intermediate PSA levels.
Endorectal ultrasonography for the assessment of rectal wall invasion in intrapelvic tumor: A preliminary report
Authors: Shirahama Tsutomu , Niwa Kiyoshi , Katsura Yoshinori , Yamada Kazutaka , Nagayama Kazuhiro , Yanase Ichirou , Aikou Takashi , Ohi Yoshitada
Published: March 2003

Background: The purpose of the present study was to determine the usefulness of endorectal ultrasonography (ERUS) in assessing rectal wall involvement in intrapelvic tumors.

Methods: Rectal wall invasion was assessed in 16 patients; 14 with deeply invasive bladder tumors, one with prostatic leiomyosarcoma, and one with prostatic leiomyoma. Computed tomography (CT), magnetic resonance (MR) imaging and ERUS with a flexible‐type radial scanner (7.5 MHz) were used and the results were compared with the histopathologic findings in surgical specimens. Results: The normal rectum was shown by ERUS to be a five‐ or seven‐layer structure. Characteristic abnormal ERUS findings included disappearance of the perirectal fat tissue layer with or without disruption of the propria muscle layer. Endorectal ultrasonography accurately assessed rectal wall involvement in all four patients who had two bladder tumors, plus the one patient with prostatic leiomyoma and the one with prostatic leiomyosarcoma. However, ERUS overstaged one of 12 bladder tumors with no rectal wall involvement, which was strongly adhesive to the rectum because of an inflammatory change but had no tumor invasion. There were no cases of understaging by ERUS. In comparison, CT accurately assessed rectal wall involvement in two patients, but overstaged in three and understaged in two. Magnetic resonance imaging, which was performed in 14 patients, accurately assessed rectal wall involvement in two patients, but overstaged in three and understaged in one.

Conclusion: This preliminary study suggests that ERUS more accurately assesses rectal wall involvement in intrapelvic tumor than CT or MRI.
A case of ileal ureter with proximal antireflux system
Authors: Kato Haruaki , Abol‐Enein Hassan , Igawa Yasuhiko , Nishizawa Osamu , Ghoneim Mohamed
Published: March 2003

Background: The initial experience of constructing a new antirefluxing valve at the uretero‐ileal junction with ileal substitution is reported.

Methods: A new antirefluxing valve was constructed at the uretero‐ileal junction with ileal substitution by fixing the distal part of the ureter between the psoas muscle and ileal segment (the ileo‐psoas tunnel technique).

Discussion: The valve created by the technique has been working effectively for preventing the ileo‐ureteral reflux. Pre‐operative hydronephrosis was improved and the renal function has been well preserved.

Conclusion: The ileo‐psoas tunnel technique is worthwhile when ileal substitution of the ureter is indicated.
Endocrinologically active retroperitoneal ganglioneuroma with positive iodine‐131‐ metaiodobenzylguanidine scintigraphy
Authors: Tosaka Akira , Ando Masao , Arisawa Chizuru , Okano Tadao
Published: March 2003

Background
: A case of retroperitoneal ganglioneuroma incidentally found by ultrasonography in a 56‐year old woman is presented.

Methods/Results
: Computed tomography revealed a solid round tumor 6 cm in diameter on the upper pole of the right kidney. Iodine‐131‐metaiodobenzylguanidine weakly accumulated in the tumor 24 and 48 h after the injection. Her serum catecholamines were within normal limits apart from slightly elevated norepinephrine at one of the two examinations. During the operation her serum epinephrine and dopamine levels were elevated to about 50 and 800 times higher than preoperative values, respectively.

Conclusion
: This case is a rare ganglioneuroma in an adult patient that is endocrinologically active.
Leiomyosarcoma of the spermatic cord
Authors: Watanabe Jun , Soma Takahito , Kawa Gen , Hida Shuichi
Published: March 2003

Abstract
Background
: A rare case of leiomyosarcoma from the spermatic cord is described. A 72‐year‐old man complained of a hard, golf‐ball sized mass in the right inguinal canal.

Methods
: Transinguinal radical orchiectomy was performed and histologic examination revealed leiomyosarcoma originating from the spermatic cord. Distant metastases were not observed by further examinations. Radiation as adjuvant therapy was carried out in order to prevent the local recurrence.

Results/Discussion
: The patient has been alive for 16 months with no evidence of disease. In leiomyosarcoma of the spermatic cord, locoregional recurrence is common. In addition to transinguinal radical orchiectomy, local radiation therapy should be carried out as an adjuvant.
Transitional cell carcinoma of ureteral stump after radical nephrectomy for renal cell carcinoma
Authors: Nagatsuma Katsumi , Tachibana Masaaki , Miyakawa Ayako , Asanuma Hiroshi , Murai Masaru
Published: March 2003

A 68‐year‐old male presented with microscopic hematuria during a routine checkup after undergoing a radical nephrectomy for renal cell carcinoma. Retrograde ureterography demonstrated a ureteral stump tumor. The ureteral stump was completely resected with a bladder cuff and histologic diagnosis was grade 2 to 3 transitional cell carcinoma of the ureteral stump. He is doing well and has been tumor‐free for 2 years. The ureteral stump must be correctly evaluated using retrograde ureterography in any patient with a prior history of bladder cancer. Even if a patient had no history of ureterial cancer, whenever hematuria is present in the follow‐up period after nephrectomy for renal cell carcinoma, a retrograde pyelogram should be performed.
Post‐traumatic high flow priapism: A case report
Authors: Touge Hiroshi , Watanabe Toshiyuki , Fujinaga Takuji , Kawabata Mamoru
Published: March 2003

A case of post‐traumatic high flow priapism in a 32‐year‐old man is reported. The diagnosis was based on cavernous blood gas analysis and left internal pudendal arteriography. He was treated by unilateral super‐selective embolization of the fistula with coils and gelatin sponge. At 1 month after embolization, erectile function had recovered, as demonstrated by measurement of nocturnal penile tumescence.
Burch bladder neck suspension for cystocele repair: The necessity of combined vaginal procedures for severe cases
Authors: Sekine Hideaki , Kojima Shin‐Ichi , Igarashi Kazumasa , Toyoshima Toyoteru , Hayashi Tetsuo , Shimoji Yoshitaka
Published: March 2003

Background: Burch operation is an accepted form of bladder neck suspension for small cystoceles. The purpose of the present study was to evaluate the efficacy of Burch repair for severe cystoceles compared with Burch repair along with vaginal procedures.

Methods: A total of 14 patients with severe cystocele (grade III–IV) treated with open Burch operation were evaluated retrospectively. Of these patients, eight were Burch only and the remaining six underwent combined Burch with vaginal repair (anteroposterior vaginal wall plasty and hysterectomy).

Results: After a mean follow up of 40 months (range 6–80), cystocele recurred in one patient at 1 month, and rectocele became prominent in three patients, including one who also presented uterine prolapse among the Burch‐only group. Conversely, all six patients who underwent the combined operation showed no occurrence of cystocele or rectocele. The proportion of patients not failing treatment was significantly higher in the combined operation group than in the Burch‐only group. Intermittent self‐catheterization was needed in one patient from the combined operation group for 6 months, but all other patients had restored smooth urination within a few weeks after the operation.

Conclusions: The results suggest that, for severe cystoceles, Burch‐only repair is insufficient and combined Burch with vaginal repair should be used to manage various pelvic hypermobility symptoms.
Effect of recombinant human granulocyte colony stimulating factor (lenograstim) on chemotherapy induced neutropenia in patients with urothelial cancer
Authors: KOTAKE TOSHIHIKO , USAMI MICHIYUKI , MIKI TSUNEHARU , TOGASHI MASAKI , AKAZA HIDEYUKI , KUBOTA YOSHINOBU , MATSUMURA YOUSUKE
Published: March 2003

Background: A multicenter cooperative study to evaluate clinical usefulness of recombinant human granulocyte colony stimulating factor (rG‐CSF; lenograstim) in the treatment of neutropenia associated with cancer chemotherapy was conducted in patients with urothelial cancer.

Methods: Therapeutic responses were compared within each patient between the observation and study treatment phases.

Results: Treatment with rG‐CSF raised the nadir of the neutrophil count (343 to 3015/mm3), reduced the duration of neutropenia (6.2 to 0.4 days) and hastened recovery from the neutropenic state (23.5 to 5.5 days). Febrile neutropenia was encountered in 12 patients during the observation phase alone and in only one patient during the study treatment phase alone. The mean duration of febrile neutropenia was also shortened (0.39 to 0.12 days). In addition, the duration of antibiotic therapy was significantly reduced during treatment. The percentage of patients completing the chemotherapeutic regimens of combination M‐VAC therapy was markedly increased to 81.0% as a result of rG‐CSF therapy compared with 44.8% in the observation phase. Adverse reactions were observed in four patients and abnormal laboratory values were found in nine patients. None of these adverse events was of a serious nature.

Conclusions: These results indicate that rG‐CSF is a useful drug for the treatment of neutropenia associated with chemotherapy in urothelial cancer.
A case of renal pseudotumor associated with chronic pachymeningitis
Authors: TANAKA TSUTOMU , HAMAGUCHI AKIKAZU , KUSHIMA RYOJI , OKADA YUSAKU
Published: March 2003

Background: A 56‐year‐old woman was referred to our hospital with a left renal mass.

Methods/Results: Radiologic studies demonstrated a solitary space‐occupying lesion in the left kidney and a malignant tumor was suspected. Left radical nephrectomy was then performed. Pathological examination revealed a sclerotic fibrous lesion with a rather distinct margin and no evidence of malignancy. These pathological findings were consistent with the diagnosis of a renal pseudotumor.

Conclusions: This patient had a history of chronic pachymeningitis that formed a thoracic epidural focus causing spinal cord compression and the histologic appearance of this focus was similar to the renal lesion. It was concluded that this was a rare case of a renal pseudotumor associated with multifocal fibrosclerosis.
A case of incidentally detected Castleman’s disease with retroperitoneal paravertebral localization
Authors: Aygun Cem , Tekin M Ilteris , Demirhan Beyhan , Peskircioglu C Levent , Agildere Muhtesem , Ozkardes Hakan
Published: March 2003

Castleman’s disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin. The expected localization is mediastinum and rarely retroperitoneum. An asymptomatic case is reported with multimodality imaging and postoperative findings. The lesion was detected incidentally on routine chest radiogram. Surgical exploration revealed a retroperitoneal mass and the mass was resected successfully through a thoracoabdominal flank incision. Castleman’s disease should be included in the list of differential diagnosis of retroperitoneal masses which are mostly malignant tumors.
Endoscopic neodymium:yttrium aluminium garnet (Nd:YAG) laser irradiation of a bladder hemangioma associated with Klippel–Weber syndrome
Authors: Kato Masanori , Chiba Yutaka , Sakai Kiyohide , Orikasa Seiichi
Published: March 2003

A case of endoscopic neodymium:yttrium aluminium garnet (Nd:YAG) laser coagulation of a bladder hemangioma associated with Klippel–Weber syndrome is presented. The patient presented with extensive nevus and swelling of the left lower limb since birth. She was diagnosed with Klippel–Weber syndrome by angiography at the age of 1 year. Gross hematuria had been observed since she was 1 year old and, in addition, endoscopic examination revealed diffuse bladder hemangiomas. At 8 years of age, gross hematuria became worse and gait disturbance also appeared. She was referred to the Department of Urology at Tohoku University School of Medicine for endoscopic treatment in June 1998. Under general anesthesia, the bladder was inflated with CO2 gas and the hemangiomas were coagulated by Nd:YAG laser photonic irradiation endoscopically. Gross hematuria was markedly improved immediately following this treatment. Klippel–Weber syndrome is a rather uncommon disease which shows various types of vascular anomaly and hypertrophy of the lower extremities. Three to 6% of the patients have associated bladder hemangiomas. Although Nd:YAG laser irradiation provides results superior to alternative therapy and is the preferred treatment for most patients with bladder hemangioma, in this case, hemangiomas are multiple and present the possibility of re‐bleeding, therefore long‐term and close follow up is important.
Congenital urethrocutaneous fistula
Authors: Nakane Akihiro , Hayashi Yutaro , Kojima Yoshiyuki , Mizuno Kentaro , Okada Atsushi , Sasaki Shoichi , Kohri Kenjiro
Published: March 2003

Abstract
Background
: A 3‐year‐old boy visited our hospital for aberrance of urination. He had a fistula on his ventral penile shaft. Our diagnosis was congenital urethrocutaneous fistula.

Methods/Results
: We performed one‐stage repair transverse preputial onlay island flap urethroplasty. Postoperatively, the patient was voiding comfortably with no recurrence of fistula.

Conclusions
: Congenital urethrocutaneous fistula is rare. Eighteen cases of congenital urethrocutaneous fistula have been reported previously. We consider the etiology of congenital urethrocutaneous fistula as a deficiency of the urethral plate and fusion of urethral folds.
Malignant phyllodes tumor of the prostate
Authors: Yamamoto Shinya , Ito Takaaki , Miki Makoto , Serizawa Hiromi , Maekawa Suguru , Furusato Masakuni
Published: March 2003

We report a case of malignant phyllodes tumor of the prostate which is the eleventh reported case in the world. Phyllodes tumor of the prostate is extremely rare and histologically resembles mammary phyllodes tumor. Phyllodes tumor of the prostate is classified into benign, borderline and malignant, but health professionals should carefully follow up the borderline cases in case they take a malignant clinical course. This case was the first to be treated by pre‐ and postoperative radiation therapy. Although the patient had a slight response to radiation therapy, he eventually developed metastasis. Because malignant phyllodes tumor of the prostate is a very aggressive tumor, people with the condition should undergo systemic chemotherapy as adjuvant therapy.
Immunohistochemical demonstration of cyclin D1 in bladder cancers as an inverse indicator of invasiveness but not an independent prognostic factor
Authors: Takagi Yasuharu , Takashi Munehisa , Koshikawa Takashi , Sakata Takao , Ohshima Shinichi
Published: March 2003

Background:Cyclin D1 is essential for G1progression through the cell cycle phase. It is a possible proto‐oncogene whose aberrant expression may be responsible for the occurrence of some types of human neoplasms. The objective of the present study was to demonstrate immunohistochemically cyclin D1 expression in bladder cancer tissues and establish any relationship with the histologic findings and the clinical course.

Methods:Tissue from 102 patients with bladder cancers and bladder tissue from five normal subjects were used for an immunohistochemical study of cyclin D1 using the avidin–biotin complex method.

Results:Nuclear staining of cyclin D1 was found in 79 (77%) out of the 102 cases of bladder cancer. The five cases of normal epithelium had no immunostaining for cyclin D1. All grade 1 tumors were positive for cyclin D1. With the advance of tumor grade the incidence of cyclin D1 decreased. All pTa tumors stained positively for cyclin D1, whereas the positive staining rates of invasive tumors were 47% in pT1, 73% in pT2, 31% in pT3 and 0% in pT4 tumors. Although a univariate analysis revealed patients with lesions positive to cyclin D1 had more favorable survival rates than those with negative findings, a multivariate analysis showed that positivity for cyclin D1 is not an independent prognostic factor. No relationship was discovered between positivity for cyclin D1 and tumor recurrence in patients with superficial bladder cancers.

Conclusions:These findings suggest that cyclin D1 demonstrated immunohistochemically could be used as an inverse indicator for the level of invasiveness of bladder cancer, but not as an independent prognostic factor.
Changes in the incidence of lower urinary tract stones in Japan from 1965 to 1995
Authors: Terai Akito , Okada Yusaku , Ohkawa Tadashi , Ogawa Osamu , Yoshida Osamu
Published: March 2003

Abstract Background The changes over time of the annual incidence of lower urinary tract stones in Japan from 1965 to 1995 were analyzed.

Methods Data on lower urinary tract calculi were abstracted from the past three nationwide surveys of urolithiasis, which covered nearly all major hospitals and urologists in Japan and enumerated all outpatient visits diagnosed as urolithiasis in the years 1965, 1975, 1985 and 1995. Chronological changes in the sex‐ and age‐related annual incidences of lower urinary tract stones and stone composition were estimated.

Results Lower urinary tract stones were predominant in men 60 years of age or older. Between 1965 and 1995, the annual incidence has significantly decreased in men ≥ 60 years of age from 37.2 to 27.0 per 100 000 and significantly increased in women ≥ 60 years of age from 2.4 to 4.8 per 100 000. In men, an increased proportion of uric acid and calcium stones as well as a decreased frequency of infection stones is a phenomenon common to upper urinary tract stones. However, infection and calcium stones have been two major stone types in women.

Conclusions In contrast to upper urinary tract calculi, the incidence of lower urinary tract stones has decreased over the last 30 years in men ≥ 60 years of age predisposed to this disease.
Roles of p53 and MDM2 in tumor proliferation and determination of the prognosis of transitional cell carcinoma of the renal pelvis and ureter
Authors: Hashimoto Hiroshi , Sue Yoichi , Saga Yuji , Tokumitsu Masayuki , Yachiku Sunao
Published: March 2003

Abstract Background The significance of p53 overexpression for the prognosis of transitional cell carcinoma (TCC) of the renal pelvis and ureter remains controversial. Simultaneous evaluation of p53 and MDM2 may enable better prediction of tumor proliferation and patient prognosis than that obtained with evaluation of p53 alone.

Methods Immunohistochemical detection of p53 protein, MDM2 protein and Ki‐67 antigen as proliferation markers was performed for tissue samples obtained from 74 patients with TCC of the renal pelvis and ureter. The correlations of p53/MDM2 overexpression with conventional pathological features, Ki‐67 labelling index (LI) and patient survival were studied.

Results Overexpression of p53 was related to progression of each of the pathological features examined (grade, stage, type of infiltration, vascular invasion and lymphatic invasion) and Ki‐67 LI was significantly higher with high p53 expression than with low p53 expression. However, overexpression of MDM2 was related to neither disease progression nor Ki‐67 LI. Survival analyses were performed for 66 patients. Univariate analysis showed p53 to be a useful prognostic indicator, but in a multivariate analysis only type of infiltration and Ki‐67 LI were independent survival markers, while p53 was not. Overexpression of MDM2 was unrelated to patient survival, and the combination of p53 and MDM2 for survival indication was found not to be useful.

Conclusions Overexpression of p53 is related to disease progression, increased tumor proliferation and patient survival for TCC of the renal pelvis and ureter, but the independent prognostic value of p53 did not reach statistical significance. Combined analysis of MDM2 with p53 cannot be recommended for examination of the malignant potential of TCC of the renal pelvis and ureter.
Microscopic hematuria as a screening marker for urinary tract malignancies
Authors: Sugimura Kazunobu , Ikemoto Shin‐Ichi , Kawashima Hidenori , Nishisaka Noboyasu , Kishimoto Taketoshi
Published: March 2003

Abstract Background: Although a mass screening urinalysis is a widely accepted procedure, it has not yet been shown if microhematuria is an appropriate and useful screening marker for urologic malignancies.

Methods: (1) The incidence of hematuria was studied in 113 patients with renal cell carcinoma (RCC), 185 with bladder carcinoma and 51 with renal pelvic or ureteral carcinoma. The association of the T stage with the intensity of hematuria in each malignancy was also examined. (2) In 823 asymptomatic adults with microhematuria, the prevalence of these malignancies was studied retrospectively to find the positive predictive value (PPV).

Results: (1) The incidence of hematuria was 35% for RCC, including gross and microhematuria. Advanced RCC (T3 and T4) were diagnosed more frequently in the gross hematuria group than in the microhematuria and no hematuria groups. In contrast, the incidence of hematuria was 94% for urothelial carcinomas either in the upper urinary tract or in the bladder. There was no significant difference in the T stage nor grade between the gross hematuria group and the microhematuria group. (2) Regarding asymptomatic microhematuria, the PPV was 1.7% (14 cases) for bladder carcinoma, 0.4% (3 cases) for ureteral/renal pelvic carcinoma and 0.2% (2 cases) for RCC. In men aged 50 years or older, PPV was 6.2% for urothelial carcinomas. In 14 cases of bladder carcinoma, 3 cases showed muscle invasion.

Conclusions: Microhematuria is an appropriate screening marker for urothelial carcinomas, particularly in elderly men, but not for RCC. However, it is unlikely that a mass screening urinalysis using a single voided urine sample would contribute to earlier detection of bladder carcinoma.
Lower abdominal phlegmon due to spontaneous rupture of an ileal neobladder
Authors: Takenaka Atsushi , Yamada Yuji , Tanaka Kazushi , Minami Rieko , Yamanaka Nozomu
Published: March 2003

Abstract A case is presented of spontaneous rupture of an ileal orthotopic neobladder due to a large residual urine volume. The present case is the 13th such case reported; however, this case is the first to show lower abdominal phlegmon and in which the perforation site was detected using computed tomography scanning. The indications for neobladder should be considered with great care. If spontaneous rupture is suspected, an early diagnosis of the perforation site and a measure of the extravasation volume using computed tomography are necessary. Appropriate treatment should include laparotomy.