bluuebunny/crossref_metadata_2025 huggingface dataset:
Compliance of adolescents with asthma
Authors: Kyngäs Helvi A.
Published: March 2003

The purpose of this paper is to describe the health regimen compliance of adolescents with asthma and some factors related to it. The following research questions were addressed: (i) to what extent do adolescents with asthma comply with health regimens; and (ii) what type of factors are associated with compliance of adolescents with asthma? A total of 300 individuals aged 13–17 years were randomly selected from the Finnish Social Insurance Institution’s register. Every 15th person on the list was included in the sample and were sent questionnaires. A total of 88% (n = 266) of adolescents returned the questionnaire. The results showed that 42% of the adolescents with asthma complied fully with the health regimens, 42% placed themselves in the category of satisfactory compliance, and the remaining 18% reported poor compliance. Compliance with the need to avoid foods, animals and pollens that cause asthma attacks was poorest, while the highest degree of compliance was observed for medication and control visits to medical staff. Background variables, such as age, family size, exercise, smoking, alcohol intake and severity of disease, were significantly associated with compliance (P < 0.001). Good motivation, a strong sense of normality, energy and will‐power, support from the parents, physicians and nurses, a positive attitude towards the disease and treatment, no threat to social wellbeing and no fears of complications had statistically significant relation to good compliance (P < 0.001).
Promoting screening and early detection of cancer in men
Authors: Lantz John M. , Fullerton Judith T. , Harshburger Ryan J. , Sadler Georgia Robins
Published: March 2003

Abstract Gender is a factor in the risk assessment for many diseases. It may also impact on the way in which men assess their personal health or illness status and take action to prevent illness or promote well‐being. This paper is focused on three objectives: (i) to foster an understanding of gender differences in health promoting behaviors; (ii) to review three health issues affecting males for which dissemination of health education, increased personal awareness and early detection may be beneficial in the reduction of morbidity and mortality; and (iii) to offer suggestions for nurses and other health care professionals to promote positive patient–provider interactions within a health‐care framework for action.
Intra‐abdominal abscess due to patient non‐compliance after construction of an ileal neobladder: Case report and review of the literature
Authors: Doehn Christian , Böhle Andreas , Jocham Dieter
Published: March 2003

Purpose: A case report of patient with an intra‐abdominal abscess 8 weeks after radical cystectomy and construction of an ileal neobladder is presented.

Methods/Results: The patient was admitted with nausea, vomiting and singultus. A perforation of the neobladder due to overdistension was assumed to be the underlying cause of the intra‐abdominal abscess formation as the patient admitted infrequent voiding during the day and no emptying of the neobladder at night. The patient underwent explorative laparotomy and 4200mL of pus was removed from the abdominal cavity. The patient made an uneventful recovery and was discharged from hospital after 5 weeks. Neobladder function remained stable and the patient was leading a normal life at 24 months follow‐up.

Conclusions: The present case demonstrates the need for careful patient selection prior to radical cystectomy with continent urinary diversion. Reduced compliance and mental disabilities of a patient can increase the complication rate.
Ectopic vas deferens opening into the ureter
Authors: Matsumoto Fumi , Suzuki Mari , Hosokawa Syozo , Shimada Kenji
Published: March 2003

Purpose: A pediatric case of ectopic vas deferens opening into the ipsilateral ureter is reported.

Methods/Results: Ectopic opening of the vas deferens was detected incidentally at ureterocystoneostomy being performed for vesicoureteral reflux to the solitary kidney of a 7‐month‐old boy with anorectal anomaly.

Conclusions: The preservation of the patency of the seminal tract is recommended.
Extracorporeal shock wave lithotripsy for lower pole calculi: Our experience
Authors: Deliveliotis Charalambos , Skolarikos Andreas , Louras Georgios , Kostakopoulos Athanasios , Karagiotis Evangelos , Tekerlekis Panagiotis
Published: March 2003

Introduction: This study was performed in order to evaluate the immediate and long‐term outcome of patients undergoing extracorporeal shock wave lithotripsy (ESWL) for isolated lower pole calculi.

Methods: Three hundred and seventy renal units of 350 patients (240 men and 110 women; mean age 55 years) with isolated lower pole renal stones of smaller than 2 cm2 were studied. Follow up ranged from 1 to 52 months (mean, 15 months) to time of censorship, significant period of secondary urologic evaluation.

Results: Out of 370 renal units in 350 patients, 212 (57,29%) were stone‐free 1 month after ESWL and 21 (5.67%) spontaneously became stone‐free within another 1–52 months (mean, 15 months). Intervention was required after 1–52 months (mean, 17.5 months) and accomplished by ESWL alone (30/350 patients 8.57%) or combined with retrograde endoscopy (10/350 patients 2.85%) while retrograde manipulation was necessary in two of the 350 patients (0.57%).

Conclusion: Extracorporeal shock wave lithotripsy is the initial treatment of choice in patients with lower pole stones < 2 cm2, because the overall stone‐free rate is acceptable and because even in the residual calculi, the risk of suffering symptomatic episodes requiring secondary intervention is low.
Effect of Bcl‐2 overexpression in human prostate cancer cells in vitro and in vivo
Authors: Kajiwara Takahiro , Takeuchi Takumi , Ueki Tetsuo , Moriyama Nobuo , Ueki Keisuke , Kakizoe Tadao , Kawabe Kazuki
Published: March 2003

Abstract
Background
: Cancer cells often develop mechanisms to resist apoptosis and the extent of such anti‐apoptotic ability has been shown to parallel tumor progression in various malignancies. Among various molecules implicated in regulating apoptosis pathway, bcl‐2 and its family members are best characterized.

Methods
: To investigate the effect of bcl‐2‐mediated anti‐apoptotic ability on tumor growth and progression in prostate cancer, a cell line overexpressing bcl‐2 (LNCaP/bcl‐2) was established by genetically engineering a prostate cancer cell line LNCaP. Tumor growth of LNCaP/bcl‐2 was compared with the parental cell line in vitro and in vivo.

Results
: LNCaP/bcl‐2 cells show resistance to apoptosis caused by nutrient deprivation and did not arrest when cultured in serum‐free or androgen‐free medium, while parental LNCaP cells or LNCaP cells transfected with the vector only (LNCaP/control) underwent extensive apoptosis on nutrient deprivation and sustained growth suppression in serum‐free or androgen‐free medium. When injected subcutaneously into nude mice, tumors deriving from LNCaP/bcl‐2 cells grew faster compared with LNCaP/control for about 3 weeks (P = 0.02), but this effect was not evident after 5 weeks. Upon castration, the control tumors regressed but LNCaP/bcl‐2‐derived tumors showed resistance, as was previously reported.

Conclusions
: These data confirm the notion that anti‐apoptotic function of bcl‐2 is oncogenic and confers resistance to androgen deprivation and also indicate that it may also play a critical role in earlier stages of tumorigenesis.
A case of prostatic cancer metastasizing to the orbit
Authors: INAGAKI TAKESHI , EBISUNO SHOICHI , MIYAI MASAHIRO , NAKAMURA JUN
Published: March 2003

Purpose: We report on a case of prostatic cancer with multiple bone metastases, including right orbital involvement.

Methods/Results: Hormonal treatment and local irradiation to the right orbit were performed. Subjective symptoms with exophthalmos and pain disappeared.

Conclusions: We report on a case of prostatic cancer metastasizing to the right orbital bone.
Hamartoma of the urinary bladder
Authors: Ota Tomonori , Kawai Koji , Hattori Kazunori , Uchida Katsunori , Akaza Hideyuki , Harada Masaoki
Published: March 2003

Background: Hamartomas of the urinary bladder are extremely rare. We report on a case in a 58‐year‐old female who presented with the chief complaint of pain on urination.

Methods/Results: Cystoscopy revealed a solid tumor on the left posterior wall of the bladder. Transurethral resection of the tumor failed to provide a definitive pathological diagnosis of the tumor. Thus, we performed partial cystectomy. The pathological diagnosis was hamartoma arising from the urinary bladder.

Conclusion: This is the ninth case diagnosed as urinary bladder hamartoma to be reported in the literature.
Enterocolitis with pathogenic Escherichia coli infection in renal transplant recipients: Case reports
Authors: Watarai Yoshihiko , Takeuchi Ichiro , Usuki Tomoaki , Hirano Tetsuo , Koyanagi Tomohiko
Published: March 2003

Purpose
: We report three cases of enterocolitis associated with pathogenic Escherichia coli infection in renal transplant recipients.

Methods/Results
: Patients presented with abdominal pain and diarrhea at 1, 3 and 7 years after living‐related renal transplantation. Pathogens of enterocolitis were identified by stool culture as verotoxin‐2‐producing O157:H7 E. coli, non‐verotoxin‐producing E. coli 06 and 0125. All patients were basically treated with fluid replacement with additional fosfomycin administration in the patient with O157:H7 E. coli infection. Immunosuppressive drugs were kept at maintenance doses throughout the treatment.

Conclusion
: All patients recovered uneventfully within 10 days after the onset of enterocolitis without severe complications.
Extracorporeal shock wave lithotripsy for a ureteral stone in crossed fused renal ectopia
Authors: Kato Masanori , Ioritani Naomasa , Aizawa Masataka , Inaba Yasuo , Watanabe Ryuji , Orikasa Seiichi
Published: March 2003

Abstract Background: A 63‐year‐old woman presented with right flank pain and macroscopic hematuria.

Results/Methods
: A plain film showed a calcific shadow on the right iliac bone. On excretory urography, the right kidney was seen in the normal position, but the left kidney was not. Bilateral retrograde pyelogram revealed the S‐shaped kidney and mild obstruction from a 12 × 5 mm calculus in the proximal ureter of the crossed kidney. The patient was successfully treated with in situ extracorporeal shock wave lithotripsy (ESWL) treatment and is stone free at 1 month follow up.

Conclusion
: We believe this is the first case of successful ESWL in a crossed kidney.
Primary malignant melanoma of the male urethra
Authors: Watanabe Jun , Yamamoto Shingo , Souma Takahito , Hida Shuichi , Takasu Kosho
Published: March 2003

Abstract
Background
: We describe a rare case of malignant melanoma originating from the male urethra.

Methods/Results
: This case, which presented a tan‐colored lesion at the distal urethra on urethroscopy, was considered as transitional cell carcinoma by transurethral biopsy. Pathologic examination of widely resected urethra revealed scattering cells, which included melanin granules in cytoplasm, and then immunohistochemical stains established the diagnosis as amelanotic melanoma. Although partial penectomy and inguinal lymph node dissection were subsequently performed, 7 months later, total cystourethrectomy was required because of multifocal recurrence at the residual urethra.

Conclusions
: In cases of amelanotic melanoma, it should be noted that a lack of melanin granules in tumor cells may lead pathologists and urologists to a misdiagnosis due to the histologic non‐specific appearance. With respect to surgical management, of significance is the fact that malignant melanoma may progress multifocally along the total urethra; therefore, total urethrectomy should be considered as radical surgery for the primary site, even if the tumor is confined to the distal urethra.
Renal masses detected by general health checkup
Authors: Tsuboi Narumi , Horiuchi Kazutaka , Kimura Go , Kondoh Yukihiro , Yoshida Kazuhiro , Nishimura Taiji , Akimoto Masao , Miyashita Tsuguhiro , Subosawa Toshiyuki
Published: March 2003

Abstract Background A total of 60 604 persons underwent a general health checkup at Toma Hospital, Saitama, Japan, between January 1993 and June 1997, and transabdominal ultrasonography (US) was performed on all persons. We investigated the usefulness of transabdominal US in detecting renal tumors during general health checkups.

Methods A definite diagnosis was made in cases where the re‐examination by US revealed calculus with acoustic shadow or a simple cyst. Computed tomography (CT) was conducted in patients suspected of having a renal tumor, and a diagnosis of renal angiomyolipoma (AML) was made if plain CT gave evidence of a fatty component. Patients diagnosed as having a renal cell carcinoma (RCC) with non‐uniform enhancement underwent nephrectomy. If a definite diagnosis could not be made even by contrast CT, the monitoring by US and contrast CT once a year was continued.

Results Of 97 (0.16%) patients whose transabdominal US findings indicated a diagnosis of suspected renal tumor, 58 underwent the re‐examination by US; of these, CT was conducted in 47. Detailed US revealed a hyperechoic pattern in 44 patients, a mixed pattern in nine and an iso‐hypoechoic pattern with internal echo in five. By plain CT, 24 patients were diagnosed as having AML, and two as having renal calcification. Contrast CT enabled a diagnosis of renal cyst to be made in two patients and renal tumor in 14. All 14 patients with RCC except one underwent nephrectomy, which provided pathologic evidence supporting the diagnosis. Five patients had a tumor unidentifiable by CT, with continuing periodic follow‐up by US and CT. Eleven patients underwent no CT.

Conclusion Of the 60 604 persons who underwent a general health checkup, we found 14 cases of RCC and 24 cases of AML. As a small RCC has a favorable prognosis, patients greatly benefit from early detection; therefore, we should recognize the importance of identifying renal masses by US screening during general health checkups.
Retrovesical leiomyosarcoma
Authors: Ataus Suleyman , Yaycioglu Özgür , Demirkesen Oktay , Uygun Nesrin , Yalcin Veli , Solok Vural
Published: March 2003

Abstract A case of retrovesical leiomyosarcoma in a male patient is described. The preoperative radiological and laboratory studies were inconclusive in determining the primary origin of the tumor. Diagnosis of a malignant tumor with smooth muscle origin was suggested by needle biopsy. However, the definitive diagnosis and the primary site of origin could only be determined by surgical exploration and subsequent histopathologic examination after excision. No sign of recurrence or metastasis was present 12 months after complete surgical resection.
Deep vein thrombosis during chemotherapy in a patient with advanced testicular cancer: Successful percutaneous thrombectomy under temporary placement of retrievable inferior vena cava filter
Authors: Koga Fumitaka , Yamada Tetsuhisa , Ishimaru Hisashi , Sadaoka Shun‐Ichi , Mizuo Toshiyuki
Published: March 2003

Abstract A 27‐year‐old man with advanced testicular cancer experienced two events of deep vein thrombosis (DVT) during three cycles of cisplatin‐based combination chemotherapy; the first thrombotic event occurred in the inferior vena cava (IVC) following the initial two cycles of chemotherapy and the second thrombotic event occurred in the right iliac vein following the third cycle. For both thrombotic events, he was successfully managed with thrombolytic therapy and percutaneous thrombectomy using a transcatheter hydraulic thrombectomy device under temporary placement of a retrievable IVC filter. Stasis of the IVC due to compression by a retroperitoneal lymphadenopathy of 7 cm in diameter, which was demonstrated on computed tomographic scans at presentation, was considered a major cause of DVT during chemotherapy. Patients with bulky retroperitoneal disease causing stasis of major veins are at high risk of DVT associated with chemotherapy and thromboprophylaxis should be strongly considered during their chemotherapy.
Brachytherapy for prostate cancer in Japan
Authors: Saito Shiro , Momma Tetsuo , Dokiya Takushi , Murai Masaru
Published: March 2003

Abstract The temporary implantation of iridium‐192 (Ir‐192) is available in Japan if the patient is isolated in a radiation control area during the treatment. In this study, brachytherapy for prostate cancer was preceded by using low‐dose rate Ir‐192. Twenty‐six patients with localized prostate cancer were treated with brachytherapy since December 1997. The age of patients ranged from 61 to 82 (median 76) years and the initial serum prostate‐specific antigen (PSA) level ranged from 4.3 to 141 (median 17.4) ng/ml. Ten to 14 needles with Teflon sheaths were introduced into the prostate via a transperineal approach and an Ir‐192 wire was placed in each sheath. The dose–distribution curve based on computed tomography imaging was drawn and the irradiation time was calculated for the whole prostate to receive over 70 Gy. During the 1–22‐month follow‐up period, all cases with an initial PSA level of less than 25 ng/ml showed continuous PSA decrease without biochemical failure. Magnetic resonance imaging demonstrated tumor regression in all cases within 6 months after the treatment. One‐year biopsy specimens from patients with PSA failure demonstrated viable tumor cells, and the specimens from patients with favorable progress revealed fibrosis replacement without any variable tumor cells. Characterization of nocturnal penile tumescence data and IIEF 15 score proved the minimal effect of the treatment on erectile function. No major side effects or complications were observed. Brachytherapy using Ir‐192 is a less invasive and safe procedure, which is expected to become a standard treatment for localized prostate cancer patients with relatively low PSA levels.
Testicular cancers occurring in brothers with cryptorchism
Authors: SUETOMI TAKAHIRO , KAWAI KOJI , SEKIDO NORITOSHI , KIKUCHI KOJI , TAKESHIMA HITOSHI , AKAZA HIDEYUKI
Published: March 2003

We report a case of familial testicular cancer associated with undescended testes in two brothers. The older brother (49 years) presented with a testicular tumor located in the right inguinal canal. The pathologic diagnosis was pure seminoma. Computerized tomography revealed iliac and retroperitoneal lymph node metastases. Four years later, the younger brother (44 years) developed bilateral testicular tumors, one located in the inguinal canal, the other located in the pelvic cavity. The pathologic diagnosis of both tumors was pure seminoma. Radiological examination revealed retroperitoneal lymph node metastases. Both patients received cisplatin‐based combination chemotherapy as the initial treatment. The older brother suffered from repeated recurrences with lymph node metastases in the iliac and inguinal regions, but he was successfully treated with high‐dose chemotherapy. The younger brother achieved long‐term remission after retroperitoneal lymph node dissection following initial chemotherapy. We briefly review the reported cases of familial testicular cancer and discuss the association of the maldescent of the testes and familial testicular cancer cases.
Extracorporeal shock wave treatment for Peyronie’s disease using EDAP LT‐02; preliminary results
Authors: Kiyota Hiroshi , Ohishi Yukihiko , Asano Koji , Hasegawa Norio , Madarame Jun , Miki Kenta , Kato Nobuki , Kimura Takahiro , Ishiyama Takehito , Maeda Shigetaka , Shimomura Tatsuya , Shiono Yutaka , Miki Jun
Published: March 2003

Abstract
Background
: Peyronie’s disease is an idiopathic fibrosis of the tunica albuginea of the penis, which often causes erectile dysfunction. No effective therapy except surgery has been available for Peyronie’s disease. We investigated the clinical efficacy of extracorporeal shock wave treatment (ESWT) using EDAP LT‐02 as an alternative method of treatment for Peyronie’s disease.

Methods
: Five patients aged 35–65 years were treated by ESWT. All patients had undergone unsuccessful medical treatment before ESWT. Each patient was treated by ESWT (7–40 storages at an energy density of 45–96 MPa) between three and five times at 4‐week intervals. Although no patient needed anesthesia, all were administered diclofenac suppository (50 mg) before ESWT.

Results
: Of the five patients, four were eligible for evaluation. The penile plaque disappeared in one patient (25%). In the other three patients (75%), the penile plaque did not disappear, but softened. Although no improvement of erectile penile curvature was recognized, erectile penile pain disappeared in all patients.

Conclusions
: These results indicate that ESWT is a possible alternative to surgery in the treatment of Peyronie’s disease.
Long‐term effects of transurethral microwave thermotherapy
Authors: OHIGASHI TAKASHI , BABA SHIRO , OHKI TAKAHIRO , NAKASHIMA JUN , MURAI MASARU
Published: March 2003

Background
:

To identify the clinical valuables predicting a favorable outcome after transurethral microwave thermotherapy (TUMT) of the prostate with Prostatron.

Methods
:

One hundred and two patients with lower urinary symptoms were treated with TUMT using a Prostatron device with the low‐energy protocol (Prostasoft version 2.0 J). The pre‐operative subjective score and objective voiding parameters were collected from the medical record. To test the differences in the risk of the necessity for additional treatments for several subgroups, Kaplan–Meier survival analyses and log‐rank tests were used.

Results
:

The Kaplan–Meier analyses showed that 67% of the patients received additional treatment within five years. The median period for receiving additional treatment was 37 months. The patients with a peak flow rate greater than 6.5 mL per second, with a urethral length less than 40 mm, or with an age over 64 years all demonstrated a significantly longer period before receiving additional treatment, when compared with their counterparts. These three factors were also significant in multivariate analysis to predict the long‐term outcome.

Conclusions
:

Overall durability of TUMT was limited. Aged patients with a relatively high peak flow rate or with a short prostatic urethral length resulted in lower risk of receiving additional treatments after TUMT.
Primary malignant melanoma of the male urethra
Authors: Kubo Hiroyuki , Miyawaki Itaru , Kawagoe Mari , Kuriwaki Kazumi , Hatanaka Shingo , Tanaka Kazuhiko , Nakagawa Masayuki
Published: March 2003

We report a case of primary malignant melanoma of the male urethra in a patient whose penile shaft was successfully preserved, but who proceeded to acute renal failure (ARF) after interferon (IFN)‐β adjuvant immunotherapy. Primary malignant melanoma of the male urethra is rare and usually shows highly malignant potential. Therefore, urologists must often perform phallectomy, which impacts on the patient both sexually and mentally. A 64‐year‐old man presented at Saiseikai Sendai Hospital with asymptomatic gross hematuria and was diagnosed as distal urethral tumor. We predicted the highly malignant potential of this tumor from the urethroscopic finding and from urinary cytological examination. We did not select trans‐urethral resection (TUR), but selected partial urethrectomy.

This patient proceeded to ARF 1 month after natural IFN‐β treatment as an adjuvant immunotherapy. As IFN‐β rarely induces the delayed renal failure, urologists should be aware of renal dysfunction after IFN‐β therapy for the treatment of malignant melanoma.
Tolterodine: As effective but better tolerated than oxybutynin in Asian patients with symptoms of overactive bladder
Authors: Lee Jeong Gu , Hong Jae Yup , Choo Myung‐Soo , Kwon Hun Young , Chung Do Young , Lee Kyu Sung , Lee Ji Youl , Lee Tack
Published: March 2003

Background:
This double‐blind, multicenter study compared the efficacy and tolerability of tolterodine (Pharmacia, Los Angeles, USA) with that of oxybutynin (Alza, Palo Alto, USA) in Asian patients with overactive bladder.

Methods:
Two‐hundred‐and‐twenty‐eight adults with overactive bladder symptoms were randomized to receive tolterodine 2 mg twice daily (bid) (n = 112) or oxybutynin 5 mg bid (n = 116). After 8 weeks’ treatment, changes in micturition diary variables, patients’ perception of treatment benefit, and tolerability endpoints were determined.

Results:
The mean (± SD) number of micturitions/24 h decreased by 2.6 ± 2.9 (−21%) with tolterodine and 1.8 ± 4.2 (−15%) with oxybutynin (both P = 0.0001 vs baseline). The mean number of incontinence episodes/24 h decreased by 2.2 ± 2.3 (−85%) in the tolterodine group and by 1.4 ± 1.8 (−58%) in the oxybutynin group (both P = 0.0001 vs baseline). Patient perception of treatment benefit was over 70% in each treatment group. Adverse events were significantly lower in the tolterodine group compared with oxybutynin‐treated patients (55%

vs 82%; P = 0.001). Dry mouth was reported by significantly fewer patients on tolterodine, compared with oxybutynin (35%

vs 63%; P = 0.001) and withdrawals due to adverse events were lower in the tolterodine group than with those treated with oxybutynin (10%

vs 16%). There were no safety concerns.

Conclusions:
Tolterodine 2 mg bid is equally or more effective than oxybutynin 5 mg bid in the treatment of Asian patients with overactive bladder, and shows significantly better tolerability. This may enhance compliance during long‐term treatment.
Detection and identification of oxalate‐degrading bacteria in human feces
Authors: Kodama Takaomi , Akakura Koichiro , Mikami Kazuo , Ito Haruo
Published: March 2003

Background : Oxalate is detoxified (catabolized) via the action of two enzymatic proteins, formyl coenzyme A transferase (encoded by the frc gene) and oxalyl coenzyme A decarboxylase (encoded by the oxc gene), contained in the cytosol of Oxalobacter formigenes that colonizes the human intestinal tract. It is speculated that oxalate‐degrading bacteria decrease oxalate absorption from the intestines and their absence in the gastrointestinal tract correlates with the formation of calcium‐oxalate urolithiasis.

Methods : Two methods of detection and identification of this bacterial strain were studied in human fecal samples collected from Japanese subjects. Genomic DNA was isolated from bacterial culture, and specific 16S rDNA was amplified by polymerase chain reaction (PCR) followed by sequencing. The oxc gene was amplified directly from human feces by PCR using the specific primers.

Results : Oxalate‐degrading bacteria were identified by comparing the sequences of 16S rDNA. The oxc gene was directly detected from human feces by PCR. It was ascertained that a combined PCR detection method using both 16S rDNA and the oxc gene allows for identification of O. formigenes in human fecal samples.

Conclusion : This detection and identification method of oxalate‐degrading bacteria using 16S rDNA and oxc gene should be applied in examination of clinical samples.
Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy
Authors: Tsuru Nobuo , Kurita Yutaka , Masuda Hiroaki , Suzuki Kazuo , Fujita Kimio
Published: March 2003

Background: The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography.

Methods: From April 1996 to December 1997, a total of 214 men aged 48–86 years with symptoms of BPH were prospectively enrolled to participate in our study. All patients presented to our clinic with lower urinary tract symptoms. Transrectal ultrasonography was used to calculate the total prostate volume (TPV), transition zone (TZ) volume, transition zone index (TZI = TZ volume/TPV) and presumed circle area ratio (PCAR). Power Doppler imaging was used to identify the capsular and urethral arteries of the prostate and measure its resistive index (RI) value.

Results: The RI of capsular arteries significantly correlated with theTPV, TZ volume, TZI
(r = 0.470; P < 0.0001) and PCAR
(r = 0.334; P < 0.0001). Correlations were found
between the RI of capsular arteries and the International Prostatic Symptom Score (IPSS)
(r = 0.389; P < 0.0001), peak flow rate of
uroflowmetry (r = ‐0.393; P < 0.0001).

Conclusion: We demonstrated that an increase of the RI of capsular arteries correlated with increases in the TZI and PCAR in BPH. The lower IPSS and peak flow rate correlated with the high RI of capsular arteries; however, no correlation between the RI of urethral arteries and prostatic parameters was found. The findings suggested that the RI of capsular arteries may become the index for measuring lower urinary obstruction in the future.
Prospective randomised trial comparing diethylstilboestrol and flutamide in the treatment of hormone relapsed prostate cancer
Authors: Burns‐Cox Nick , Basketter Vanessa , Higgins Bernard , Holmes Simon
Published: March 2003

Background: Patients with hormone relapsed prostate cancer (HRPC) are often treated with flutamide or diethylstilboestrol. However, which of these two options is the best treatment for HRPC remains unclear.

Methods: We carried out a prospective study to determine and compare the prostate‐specific antigen (PSA) response and survival in patients with hormone relapsed prostate cancer (HRPC), all of whom had previously shown a good response to medical or surgical castration. The patients were randomised to treatment with diethylstilboestrol (DES) and aspirin, or the antiandrogen flutamide. In addition, quality of life was determined by interview and questionnaire.

Results: Twenty‐eight patients were randomised for treatment options.There was a significantly greater fall in the PSA (65% vs 35%; P = 0.034) after treatment with diethylstilboestrol compared to treatment with flutamide. Median survival also rose after treatment with diethylstilboestrol (18 months) compared to flutamide (11 months), but this difference did not reach statistical significance. There was no difference in the quality of life parameters between the two groups. There were no cardiovascular complications in the stilboestrol group.

Conclusions: In HRPC, treatment with stilboestrol is associated with a greater PSA fall and an increase in median survival when compared to flutamide treatment.
d‐Xylose absorption after urinary orthotopic bladder replacement: colon neobladder compared with ileal neobladder
Authors: Hara Shoji , Miyake Hideaki , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao , Hara Isao
Published: March 2003

Background: To evaluate the digestive and absorptive status using the d‐xylose test in patients who underwent radical cystectomy and orthotopic bladder replacement either by colon or ileal segment.

Methods: d‐Xylose serum levels after an oral load, nutritional status, plasma vitamin B12 levels, and acid–base and electrolyte balances were studied in 18 patients with colon neobladder and 12 patients with ileal neobladder. Mean follow‐up period was 51 months. Results of both types of bladder replacement and a healthy control group were compared.

Results: Although no significant difference in the changes of plasma levels of d‐xylose after oral load was observed between patients with colon neobladder and healthy controls, plasma levels of d‐xylose 90 min after oral load in patients with ileal neobladder were significantly lower than those with colon neobladder. In contrast, there was no significant difference in nutritional status, plasma levels of vitamin B12, and acid–base and electrolyte balances between patients with colon and ileal neobladders.

Conclusion: Despite acceptable nutritional status, intestinal malabsorption might be present in patients with ileal neobladder, as indicated by the plasma levels of d‐xylose, while the colon neobladder group showed no significant differences compared with normal controls. Therefore, absorptive and metabolic status should be carefully monitored after ileal neobladder creation.
Prostatic carcinosarcoma: A case report and review of literature
Authors: FUKAWA TOMOYA , NUMATA KOUSAKU , YAMANAKA MASAHITO , MIYAMOTO TADAYUKI , KUROKAWA YASUSHI , KANAYAMA HIRO‐OMI , KAGAWA SUSUMU , UTSUNOMIYA MASATO , HIROKAWA MITSUYOSHI
Published: March 2003

Abstract A unique case of carcinosarcoma of the prostate detected in a 71‐year‐old man is presented. Pelvic exenteration was performed, and the resected prostatic mass was found to consist of two histologically distinct elements; adenocarcinoma and sarcoma with focal osteosarcomatous element. The patient is still alive with neither metastasis nor recurrence. This is the 42nd case of carcinosarcoma of the prostate to be reported in the literature.
α‐Interferon 2a and 13‐cis‐retinoic acid for the treatment of metastatic renal cell carcinoma
Authors: Wong M. , Goldstein D. , Woo H. , Testa G. , Gurney H.
Published: March 2003

Background: It is suggested that immunotherapy may have a better role than cytotoxic chemotherapy in the treatment of metastatic renal cell carcinoma.

Aims: A phase II study of α‐interferon 2a (IFN2a) and 13‐cis‐retinoic acid (CRA) in the treatment of metastatic renal cell carcinoma.

Methods: Twenty‐two patients with no previous systemic therapy were treated with IFN2a daily at 3 million units (MU) and escalated to 6 and 9 MU if tolerated, together with CRA given orally at 1 mg/kg per day in two divided doses. Changes in quality of life were also assessed.

Results: Twenty patients were available for assessment. Three patients (14%) achieved a partial response and five patients (23%) had stable disease. No patient achieved a complete response. A durable response was observed in partial responders with median length of response of 44 weeks (range 32−59 weeks). Therapy was stopped in seven (35%) patients due to treatment‐related toxicities, and quality of life was worsened in the majority of patients.

Conclusion: IFN2a and CRA has a low response rate and significant toxicity, and the combination as standard treatment of metastatic renal cell carcinoma is not recommended, despite the suggestion that CRA may lengthen the response to IFN2a. (Intern Med J 2002; 32: 158−162)
Retrospective survey of unselected hospital patients with and without cancer comparing outcomes following venous thromboembolism
Authors: Cook N. , Thomas D. M.
Published: March 2003

Background:  Cancer patients are at risk of venous thromboembolism (VTE). Currently, management of these patients is based on studies performed in the general population.

Aims:  To determine whether the natural history of VTE in cancer patients differs sufficiently from patients in general such that a specific management approach is required.

Methods:  A retrospective survey was conducted using case records from three tertiary referral hospitals (1993−2001). One hundred and forty‐seven VTE patients with cancer and 82 control patients matched for age and gender were followed for a median of 24 months (0−104 months).

Results:  The overall prevalence of cancer among patients with VTE was 19.3% (vs 4% in patients with arterial thromboembolic events). In the follow‐up groups, cancer conferred a significantly worse functional status, although other risk factors for VTE were similar. Proximal sites of VTE were twice as common in cancer as in non‐cancer patients. The majority of patients in both groups were treated with oral anti­coagulants. Complications were more common in cancer patients (40%vs 23%) and occurred more frequently despite apparently adequate anticoagulation. Following VTE, cancer patient survival (median 4.1 months, 127 deaths) was markedly worse than non‐cancer patients (median not reached, eight deaths). Thirty‐five cancer deaths occurred within 5 weeks of VTE. Eleven deaths in cancer patients were directly related to VTE compared to three in patients without cancer.

Conclusions: Cancer patients with VTE fare extremely poorly compared to the general hospital population. Prospective treatment studies, specifically in cancer patients with VTE, are needed. (Intern Med J 2002; 32: 437−444)
Weed control with alfalfa pellets in transplanting rice
Authors: XUAN TRAN DANG , TSUZUKI EIJI , UEMATSU HIDEO , TERAO HIROYUKI
Published: March 2003

Alfalfa [Medicago sativa L. (M. media, M. falcate)] plants
contain allelochemicals that have detrimental effects on their own growth and that
of surrounding plants. Alfalfa pellets, used as a food for livestock, were used as
the material for the control of weeds in this study. In a greenhouse experiment,
alfalfa pellets applied at 1–3 tons ha−1 completely inhibited
the emergence of abunome (Doparium junceum Hamilt.), false pimpernel (Lindernia
pyxidaria L.), and long stemmed water wort (Elatine trianda Schk. var.
pedicellata Krylov) The number and the dry weight of emerged Echinochloa
oryzicola plants were significantly reduced. Application of 3 tons ha−1
alfalfa pellets completely inhibited the emergences of Eleocharis acicularis
and Rotala indica. Results demonstrated that the inhibitory effect of alfalfa
pellets became greater as the dose increased, and it also varied among weed species.
Furthermore, the paddy field experiment suggested that the dose of 1–2 tons
ha−1 of alfalfa pellets could control more weed species without any rice plant injury.
Molecular identification of Echinochloa oryzicola Vasing. and E. crus‐galli (L.) Beauv. using a polymerase chain reaction–restriction fragment length polymorphism technique
Authors: YASUDA KENTARO , YANO AZUSA , NAKAYAMA YUICHIRO , YAMAGUCHI HIROFUMI
Published: March 2003

Polymerase chain reaction (PCR) and polymerase chain reaction–restriction fragment length polymorphism (PCR‐RFLP) techniques were applied for establishing the reliable practice in identification of Echinochloa oryzicola Vasing. and E. crus‐galli (L.) Beauv. (barnyardgrass). Total DNA was extracted from 18 accessions and 86 individuals of E. oryzicola, 33 accessions and 140 individuals of E. crus‐galli var. crus‐galli, 23 individuals of E. crus‐galli var. praticola, and six individuals of E. crus‐galli var. formosensis that were collected from Japan. A partial region of intergenetic spacer between trnT and trnL, and an intron of trnL were amplified separately using a trn‐a and trn‐b1 primer set, and a trn‐c and trn‐d primer set, respectively. All individuals of E. oryzicola showed the same fragment amplified by the trn‐a and trn‐b1 primer set. The fragment was 481 bp in length, and was undigested by EcoR I, whereas all individuals of E. crus‐galli, including three botanical varieties, showed the same fragment with a 449‐bp length. The fragment was digested by EcoR I into two fragments (178 and 271 bp). The fragment amplified by the trn‐c and trn‐d primer set in all individuals of E. oryzicola was digested by Alu I into two fragments (174 and 452 bp), but undigested by Dra I. In contrast, the fragment amplified by the trn‐c and trn‐d primer set in all individuals of E. crus‐galli was digested by Dra I into two fragments (134 and 487 bp), but undigested by Alu I. There was no intraspecific variation in these regions; thus, these two species are easily identifiable by using our method.
Increased activity and reduced sensitivity of glutamine synthetase in glufosinate‐resistant vetiver (Vetiveria zizanioides Nash) cells
Authors: PRASERTSONGSKUN SOMPORN , SANGDUEN NITSRI , SUWANWONG SRISOM , SANTISOPASRI VILAI , MATSUMOTO HIROSHI
Published: March 2003

Vetiver (Vetiveria zizanioides Nash) cells derived from an inflorescence were cultured in a modified N6 liquid medium supplemented with 10 µm 2,4‐D and 10 mm proline. Exponentially growing cell suspensions were subcultured with a selection medium containing glufosinate (ammonium dl‐homoalanin‐4‐yl(methyl)phosphinate). The glufosinate‐resistant cells which can grow in a medium containing 5 × 10−5 M glufosinate was selected by a stepwise selection, and its I50 value was determined to be 4.2 × 10−5 M. The growth of susceptible cells was inhibited by lower concentrations of glufosinate and its I50 value was 2.5 × 10−7 M. This indicated that the selected cells were 170‐fold resistant compared with the susceptible cells. Glutamine synthetase (GS) activity of the resistant cells was twice as high as that of the susceptible cells. The I50 values of glufosinate were 3.2 × 10−5 M and 9.0 × 10−7 M for GS from the resistant and susceptible cells, respectively. The accumulation of ammonia caused by GS inhibition was higher in the susceptible cells. Absorption of [3,4–14C]glufosinate was not significantly different between the resistant and susceptible cells. Both cell types did not metabolize glufosinate. These results suggest that the resistance of the selected vetiver cell suspension to glufosinate is mainly due to increased GS activity and its decreased sensitivity to the herbicide.
Differential gene expression of the α‐chain of mitochondrial H+‐transporting ATP synthase between dormant and non‐dormant seeds of paddy Echinochloa weeds
Authors: FUKAO TAKESHI , IDA SHOJI , RUMPHO MARY E. , KENNEDY ROBERT A. , YAMASUE YUJI
Published: March 2003

Gene expression was compared under favorable germination conditions between dormant and non‐dormant seeds of rice paddy Echinochloa weeds and a domesticated Echinochloa species lacking dormancy. Two dormancy‐specific cDNAs, Ecd1 and Ecd2, were identified by differential display. Northern blot analysis revealed that these genes were more strongly expressed in dormant seeds than in non‐dormant seeds. A database search for the Ecd1 sequence revealed no significant homology with any known proteins, but the Ecd2 sequence was highly homologous with the α‐chain of mitochondrial H+‐transporting adenosine triphosphate (ATP) synthase in rice (Oryza sativa L.). These findings indicate that the gene encoding the enzyme associated with conventional aerobic respiration is more abundantly transcribed in dormant seeds. The results reported in the present study suggest that dormant seeds of paddy Echinochloa weeds, which appear during the period when paddy soil becomes aerobic by drainage, may maintain viability primarily by efficient conventional aerobic respiration, including ATP synthesis catalyzed by the mitochondrial H+‐transporting ATP synthase.
Anaesthetic management of a child with Burkitt's lymphoma of the larynx
Authors: Douglas Palmer Christopher , Graham Stack Charles , Barker Ian
Published: March 2003

An eight‐year‐old boy with a Burkitt's lymphoma of the upper airway is described. The use of sevoflurane for induction of anaesthesia in patients with airway obstruction is discussed. The logistical problems of upper airway surgery and anaesthesia in this type of patient are considered.
Convective warming blankets improve peroperative heat preservation in congenital heart surgery
Authors: SCHLÜNZEN LISE , LUNDBØL VESTERGAARD ALICE , MØLLER‐NIELSEN INGE , PEDERSEN JENS , HJORTHOLM KIRSTEN , SLOTH ERIK
Published: March 2003

Peroperative heat preservation, following hypothermic cardiopulmonary bypass (CPB) in children, has always been a challenge to the anaesthetist. We studied the efficiency of a convective heating system on peroperative heat preservation in 50 children undergoing congenital heart surgery. Twenty‐five children, rewarmed by CPB and heating mattress, were randomly selected (Group 1). Another 25 children, rewarmed by CPB, heating mattress and convective warming blankets in addition (Group 2), were selected so the two groups were comparable regarding age, weight and anaesthetic management. The central and peripheral temperatures were measured during bypass, at the end of bypass and at the end of operation. A retrospective evaluation showed that during bypass the peripheral temperature was significantly lower in Group 2 than in Group 1, with no significant difference in central temperature. At the end of bypass there was no significant difference between the two groups. At the end of operation the central and peripheral temperatures were significantly higher in Group 2. In conclusion convective warming blankets are effective in keeping or even raising the temperature following congenital heart surgery.
Unintentional paediatric subdural catheter with oculomotor and abducens nerve palsies
Authors: Haughton Andrew John , Chalkiadis George A.
Published: March 2003

A 13‐year‐old female with a past history of lumbar laminectomy developed a subdural block 18 h after the commencement of an epidural infusion of bupivacaine 0.125% and fentanyl 2 μg·ml−1. Signs at presentation included bilateral abducens nerve palsies in the absence of headache and a previously unreported unilateral third cranial nerve palsy. An epidurogram displayed subdural placement.
Acute epiglottitis despite vaccination with Haemophilus influenzae type B vaccine
Authors: Wagle A. , Jones R.M.
Published: March 2003

We present the case of a 20‐month‐old child who required admission to the intensive care with a presumptive diagnosis of acute laryngo–tracheo‐bronchitis, for the management of acute upper airway obstruction. This child had received a complete course of Haemophilus influenzae type B (Hib) vaccine. Subsequent events showed that the diagnosis was not laryngo–tracheo‐bronchitis but acute epiglottitis. We propose that a full course of vaccination is no guarantee against a subsequent illness with Hib and may actually lead to the wrong diagnosis and possibly life‐threatening consequences.
A new modification of anaesthesia mask for fibreoptic intubation in children
Authors: KITAMURA SEIJI , FUKUMITSU KAZUO , KINOUCHI KEIKO , TAKADA KOJI , TANIGUCHI AKIHIRO
Published: March 2003

We made a paediatric anaesthesia mask suitable for fibreoptic intubation by modifying a commercially available disposable mask with a ventilation port (Vent port) on a side. We added a large fibreoptic port (FO port, 22 mm in ID) in the middle of the mask to allow the passage of all sizes of paediatric tracheal tubes. This FO port was covered with an elastic rubber membrane to allow air‐tight fibrescopic manipulation. Fibreoptic intubation was performed safely through the FO port under continuous manual ventilation with anaesthetic gases via a Vent port connected to the breathing circuit. We succeeded in tracheal intubation in several infants and children with difficult airway in less than ten min, mainly via the nasotracheal route. This fibreoptic mask provides a safer technique for fibreoptic intubation in patients with difficult airways, especially in infants and small children.
Management of difficult airways with a laryngeal mask airway under propofol anaesthesia
Authors: BAHK JAE‐HYON , HAN SOUNG‐MOON , KIM SEONG‐DEOK
Published: March 2003

We report four cases of difficult airway managed with a laryngeal mask airway (LMA) under propofol anaesthesia; this method was chosen to minimize psychological and physical trauma. Case 1 was a boy with dermatomyositis; Case 2, a girl wearing a base ring of a stereotactic frame; Case 3, a boy with Treacher–Collins syndrome; Case 4, a boy with Goldenhar syndrome. They were anaesthesized with propofol and though spontaneous ventilation became shallower, or apnoea occurred, the stimulus of inserting an LMA awakened the patient and caused more active spontaneous ventilation while a patent airway was established by the LMA. All tracheal intubations were performed smoothly and without delay through the LMA, and we believe that psychological and physical trauma was thus minimized.