bluuebunny/crossref_metadata_2025 huggingface dataset:
Preperitoneal fat thickness in childhood obesity: Association with serum insulin concentration
Authors: Tamura Akiho , Mori Tetsuo , Hara Yoji , Komiyama Atsushi
Published: March 2003

Abstract

Background
: The clinical significance of visceral fat accumulation in childhood obesity has remained controversial.

Methods
: In 35 subjects (18 boys and 17 girls) aged 9–15 years, visceral and subcutaneous fat were estimated by measuring the maximum thickness of preperitoneal fat (Pmax) and the minimum thickness of subcutaneous fat (Smin) in the upper median abdomen, respectively, by ultrasonography. The associations with fasting serum insulin levels converted to logarithm (log(IRI)) were studied for six obesity‐related indices, including the obesity index, body fat percentage, waist‐to‐hip circumference ratio (WHR), Pmax, Smin and the ratio of Pmax to Smin (abdominal wall fat index, AFI).

Results
: In girls, the log(IRI) was positively correlated with the Pmax, obesity index, body fat percentage and Smin. In contrast, the log(IRI) was positively correlated only with the Pmax and Smin in boys. There were no significant correlations between the log(IRI) and the WHR or AFI in either sex. The Pmax revealed the highest correlation with the log(IRI) in both boys (r=0.703, P<0.001) and girls (r=0.921, P<0.0001).

Conclusion
: These results indicate the important contribution of visceral fat accumulation to the development of hyperinsulinemia, regardless of sex. Accordingly, it is suggested that evaluating Pmax by ultrasonography may be the most sensitive and reliable method of predicting insulin resistance‐associated metabolic derangements in children, compared with other conventional indices of obesity.
Nasopharyngeal colonization with penicillin‐resistant Streptococcus pneumoniae in Turkish children
Authors: Çiftçi Ergin , Doğru Ülker , Aysev Derya , Ince Erdal , Güriz Haluk
Published: March 2003

Abstract Background: Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world‐wide increase in the frequency of penicillin‐resistant S. pneumoniae.

Methods
: One hundred and fifty sick children with a clinical diagnosis of pneumonia, meningitis, acute otitis media, acute sinusitis and septicemia or bacteremia, and 150 healthy children without any infection were examined. Streptococcus pneumoniae, which were isolated from the nasopharynx, were analyzed with respect to penicillin susceptibility using the agar dilution method.

Results
: The S. pneumoniae carriage rate was observed to be 43.3% in the group of sick children and 30.0% in the control group (P<0.05). The penicillin resistance of S. pneumoniae isolated from the nasopharynx was determined to be 35.4% from a total of 110 isolates, with an intermediate resistance of 32.7% and a high resistance of 2.7%. The penicillin resistance of S. pneumoniae carried in the nasopharynx was determined to be 41.5% in the group of sick children and 26.6% in the control group (P>0.05). Resistance rates of other antibiotics were determined as follows: cefotaxime 2.7%, erythromycin 19%, clarithromycin 5.4%, tetracycline 21.8%, trimethoprim–sulfamethoxazole 4.5% and rifampin 0%.

Conclusions
: Penicillin resistance of S. pneumoniae has recently become a problem in Turkey. Because of this, we require new strategies to limit the spread of drug‐resistant S. pneumoniae.
Case‐control study of perinatal factors and hepatoblastoma in children with an extremely low birthweight
Authors: Maruyama Kenichi , Ikeda Hitoshi , Koizumi Takenobu , Tsuchida Yoshiaki , Tanimura Masako , Nishida Hiroshi , Takahashi Naoto , Fujimura Masanori , Tokunaga Yasuyuki
Published: March 2003

Abstract Background: There is a significant association between hepatoblastoma and low birthweight. A case‐control study was conducted to reveal risk factors for hepatoblastoma in children of extremely low birthweight (<1000 g).

Methods
: Prenatal and postnatal histories, including parental histories, of 12 hepatoblastoma cases and 75 birthweight‐matched controls were compared.

Results
: The gestational age of the hepatoblastoma cases (23–32 weeks; median 25 weeks), tended to be lower than that of the controls (23–36 weeks; median, 27 weeks; P=0.072). The time for an infant’s bodyweight to return to the same level as the birthweight also tended to be longer in hepatoblastoma cases than in controls (P=0.055). All hepatoblastoma cases received oxygen therapy for a period of 4–508 days (median 114 days), which was significantly longer than the 0–366 days (median 62 days) in the controls (P=0.022). Furosemide was given to all hepatoblastoma cases and was used for a significantly longer period in these infants (6–460 days; median 89 days) than in the controls (0–241 days; median 44 days P=0.027). A univariate Cox regression demonstrated that the time taken to regain bodyweight at birth and the duration of both oxygen therapy and furosemide treatment were significantly associated with the development of hepatoblastoma (hazard ratio (HR)=1.044, P=0.013; HR=1.006, P=0.001; and HR=1.007, P=0.001, respectively). Although there were significant correlations between the factors, a multivariate Cox regression analysis identified the duration of oxygen therapy as a significant independent risk factor (HR=1.006, P=0.001).

Conclusions
: Oxygen therapy and furosemide treatment, along with the rate of growth, are risk factors for the development of hepatoblastoma in children of extremely low birthweight, and the duration of oxygen therapy is the most important factor in predicting the development of hepatoblastoma. Further studies are necessary to determine the real reasons for the development of hepatoblastoma and to protect children of low birthweight from the development of cancer.
Safety and immunogenicity of live attenuated varicella vaccine in 9‐month‐old children
Authors: Kanra Güler , Ceyhan Mehmet , Özmert Elif
Published: March 2003

Background
: The present study was conducted to evaluate the safety and immunogenicity of live attenuated varicella vaccine (Oka‐strain) in 9‐month‐old infants.

Methods
: One hundred and fourteen infants were vaccinated once with live attenuated varicella vaccine (Valrix®; SmithKline Beecham Biologicals, Rixensart, Belgium) containing a mean virus titer of 104.0 plaque‐forming units (p.f.u.) per dose. Signs and/or symptoms after vaccination were followed for 42 days. Home visits were made to detect solicited local reactions (0–3 days) and solicited general reactions (0–21 days), as well as unsolicited reactions. Specific varicella antibodies were determined by an indirect immunofluorescence method. The geometric mean titer and seroconversion rate were calculated.

Results
: Signs and/or symptoms were reported in 47.4% (54/114) of cases following vaccination. The only local symptom reported was pain on digital pressure at the injection site and this was reported in 28.1% (32/114) of infants. General symptoms were reported in 38.6% (44/114) of cases. The most frequently reported findings were fever (27.2%), which was mostly mild, restlessness (20.2%) and cough (11.4%). Only four unsolicited symptoms were reported and they were all unrelated to vaccination. No serious adverse event was reported. Of the 109 infants included in the immunogenicity analysis, 105 were seronegative and four were seropositive for antibodies against varicella before vaccination. The vaccine elicited seroconversion in 97.1% of initially seronegative cases. The post‐vaccination geometric mean titer for these infants was 30.9 geometric mean titer (GMT).

Conclusions
: The vaccine was found to be safe and immunogenic when given to infants as young as 9 months of age. This may be of clinical significance during outbreaks of varicella and especially for developing countries.
Ventricular energetics in Fontan circulation: Evaluation with a theoretical model
Authors: Nogaki Mio , Senzaki Hideaki , Masutani Satoshi , Kobayashi Jun , Kobayashi Toshiki , Sasaki Nozomu , Asano Haruhiko , Kyo Shunei , Yokote Yuji
Published: March 2003

Abstract

Background
: Both pulmonary and systemic circulation must be maintained by a single pump in Fontan circulation. This unique property of Fontan circulation may be related to decreased exercise tolerance or increased instantaneous postoperative mortality rate, often observed in patients with this circulation. To better understand Fontan physiology, the present study theoretically investigated cardiac performance of Fontan circulation by using ventricular–vascular coupling framework analysis.

Methods
: End‐systolic volume elastance (Ees), as a chamber contractile property, and effective arterial elastance (Ea), a lumped measure of ventricular afterload, were estimated both in normal left ventricular systemic circulation and in Fontan circulation.

Results
: End‐systolic volume elastance was decreased and Ea was increased in Fontan circulation. Both ventricular external stroke work (SW) and mechanical efficiency (EFF) under Fontan circulation were lower compared with those under normal circulation. Furthermore, the Ees–Ea relationship in Fontan circulation predicted limited cardiac reserve in terms of SW and EFF. Such cardiac performance in Fontan circulation stemmed from increased impedance due to the additional connection of the pulmonary vascular bed to the systemic vasculature and from the lack of a compensatory increase in contractility for increased afterload.

Conclusions
: Thus, it was inferred that Fontan circulation had intrinsic disadvantages and this may explain, in part, abnormal functional status and decline in survival following this procedure.
Mutation analysis of Crouzon syndrome and identification of one novel mutation in Taiwanese patients
Authors: Tsai Fuu‐Jen , Yang Chi‐Fan , Wu Jer‐Yuarn , Tsai Chang‐Hai , Lee Cheng‐Chun
Published: March 2003

Abstract
 

Background
: Crouzon syndrome is an autosomal dominant disorder causing premature fusion of the cranial suture. Mutations have been reported in exon IIIa or IIIc of the fibroblast growth factor receptor 2 (FGFR2) gene.

Methods
: In the present study, nine unrelated Crouzon syndrome patients were screened for mutations in the two exons of FGFR2 by polymerase chain reaction and direct sequencing.

Results
: Mutations were detected in 67% (6/9) of all cases. More than half the studied Crouzon patients carried a mutation resulting in either the loss or gain of a cysteine residue. A novel mutation, Tyr281Cys substitution, was discovered at exon IIIa.

Conclusions
: The mechanisms by which the same genotypes cause different phenotypes for each type of craniosynostosis syndrome in still uncertain. However, the molecular identification of the FGFR gene has made a great impact on the clinical classification of craniosynostosis syndromes; a new classification based on genotypes seems to be unavoidable.
Physical signs associated with excessive television‐game playing and sleep deprivation
Authors: Tazawa Yusaku , Okada Kyoji
Published: March 2003

Abstract

Background
: To elucidate significance of physical signs seen in excessive television‐game (TVG) players complaining of unexplained persistant symptoms, a cross‐sectional cohort study was designed.

Methods
: A total of 1143 school children, aged between 6 and 11‐years‐old, and their parents were included in the study. Questionnaires were sent to guardians asking the number of hours that their children watched TV, TVG, and slept. All children were examined to check for three physical signs, black rings in the skin under the eye (BR), muscle stiffness in the shoulder (MS), and displacement of the scapula associated with muscle stiffness in the shoulder (DS/MS) by inspection and palpitation.

Results
: The three signs, BR, MS and DS/MS, were present in 165 (14.4%), 229 (20.0%) and 72 (6.2%) children, respectively. Boys had greater frequencies of two signs than girls (BR, 19.6%vs 8.9%, P<0.01; MS, 26.1%vs 13.6%, P<0.01), respectively. Boys spent more time on TVG playing than girls (1.1±0.7 h/day vs 0.4±0.6 h/day, P<0.0001), respectively. Excessive TVG players, who spent ≥ 1 h/day for TVG had greater frequencies of two signs, BR and MS, than those of non‐TVG‐players (18.9%vs 13.0%, P<0.05; 25.6%vs 14.4%, P<0.01), respectively. The TVG playing time correlated with two signs, BR (P=0.0143) and MS (P=0.0048). Furthermore, sleep deprivation related to three signs, BR (P=0.0078), MS (P<0.0001) and DS/MS (P=0.0290).

Conclusions
: Excessive TVG playing links to the occurrence of BR and MS. Other factors, which cause sleep deprivation, may underlie in the occurrence of the three signs. The amount of time spent on TVG playing should be regulated to < 1.0 h/day.
Serum cystatin‐C values in children by age and their fluctuation during dehydration
Authors: Takuwa Satoshi , Ito Yuhei , Ushijima Kosuke , Uchida Kazuo
Published: March 2003

Background
: Serum creatinine level (Cr) is extensively used as an index of glomerular filtration rate (GFR) with bedside patients. As serum Cr level differ by the muscle volume, the use of serum Cr as an index of GFR has long been considered problematic in children.

Methods
: The subjects of this study were 135 healthy children aged from 1 to 15‐years‐old. As a pathological condition, the changes in serum cystatin C (Cys‐C) in the children whose blood urea nitrogen exceeded 20 mg/dL during the acute stage of dehydration were also investigated.

Results
: The mean serum Cys‐C value was 0.67 ± 0.19 mg/L on the whole. There was not any male‐female difference. The mean serum Cys‐C values of the 12 cases in the acute stage and the recovery stage were 0.61 ± 0.12 mg/L and 0.64 ± 0.14 mg/L, respectively, indicating no significant difference.

Conclusion
: Serum Cys‐C is considered as a favorable index of GFR in children because it is not influenced by age and sex. As it is not influenced by the prerenal factors either, serum Cys‐C is useful in children over 1‐years‐old.
Free carnitine levels in children with steroid–sensitive nephrotic syndrome
Authors: Gousseinov Afig , Kantar Mehmet , Mir Sevgi , Keskinoglu Ahmet , Coker I‚Sil
Published: March 2003

Background
: Carnitine transports long‐chain fatty acids accross the inner mitochondrial membrane. Carnitine metabolism is disturbed in some renal diseases, such as chronic renal failure. Previous studies have shown that children had normal serum free carnitine (FC) and total carnitine levels in idiopathic nephrotic syndrome, IgA nephropathy, non‐IgA nephropathy and focal segmental glomerulosclerosis. The aim of the present study was to determine FC concentrations in plasma and urine during acute and remission periods of steroid‐sensitive nephrotic syndrome (SSNS) and its association with hyperlipidemia.

Methods
: Plasma and urinary FC concentrations were assayed in 15 children with SSNS in acute and in 16 children in remission period. Six of them were followed‐up longitudinally in both periods.

Results
: Plasma FC concentrations were significantly higher in the acute period of the disease than in the remission period and of the controls. The patients had lower FC levels in the remission period as compared to the controls. Urinary FC concentration was decreased in acute disease period when compared to the remission period and the controls. The FC concentrations in plasma and urine did not correlate with each other. Plasma FC exhibited significant positive correlation with low‐density lipoprotein cholesterol, total cholesterol and trygliceride, but negative correlation with high‐density lipoprotein cholesterol.

Conclusions
: The present study showed disturbed FC concentration in SSNS. Increased plasma and decreased urinary FC levels in acute disease might be associated with its altered renal handling or some extrarenal factors such as hyperlipidemia.
Seroepidemiology of Helicobacter pylori infection in children living in eastern Turkey
Authors: AyŞe SelimoĞlu Mukadder , Ertekin Vildan , İnandi Tacettin
Published: March 2003

Background
: The prevalence of Helicobacter pylori is higher in developing countries, with most infections occurring in childhood. Because the prevalence in eastern Turkey has not been previously reported, we carried out an investigation to detect the prevalence of H. pylori infection in a large city center in this region.

Methods
: Serum samples of 466 randomly selected healthy schoolchildren aged 6−17 years were tested for the presence of anti‐H. pylori IgG antibodies.

Results
: Overall 300 (64.4%) samples were seropositive. The frequency of H. pylori infection was similar in males and females (P = 0.47), was correlated with age (P < 0.0001) and was inversely correlated with economic status (P < 0.0001). Those who had a larger sibship size had a higher seroprevalence (P < 0.0001). There was no significant difference between children whose parents of different educational status (P = 0.56 for fathers and P = 0.86 for mothers).

Conclusion
: This very high prevalence of H. pylori in eastern Turkey seems to depend on environmental factors.
Empathic understanding: Constructing an evaluation scale from the microcounseling approach
Authors: Nagano Hiroko
Published: March 2003

Abstract The Empathic Understanding Scale measures the depth of the nurse–patient relationship. As a nurse cares for a patient it is necessary to first establish a relationship. The author identified empathic understanding as the key concept for this study. The primary theme was to develop a scale to measure the nurse's level of empathic understanding of the patient. The purpose of the study was to examine a 23‐item questionnaire using the microcounseling model to prove whether empathy is an effective tool in establishing a nurse–patient relationship. Using these results, factors were extracted to measure the level of the nurse's empathic understanding of the patient. Eighteen subjects participated in the pilot study: eight nurses employed by the psychiatric ward of one of Shizuoka's prefectural hospitals, Yoshinso, and 10 students learning to be public health workers. All 18 subjects verbally agreed to participate in the study. Data collection was through experimental interviews according to microtraining models and through questionnaires comprising four elements: moral, emotional, cognitive and communication action. The results were analyzed by principle factor analysis, two‐way analysis of variance and multiple regression analysis of variance. Analysis resulted in four factors being extracted. Using the Emotional Empathy Scale for comparison, the content validity of those factors was confirmed. In the second study, these four factors were used as an evaluation instrument in the form of a list of 20 items of evaluation. Measurements were derived by evaluating the 327 nursing students who were the subjects for this study. The subjects performed pseudo‐counseling role plays based on the microcounseling method. Five evaluators studied the counselor’s behavior and attitude by observing the interaction between the client and counselor roles as the subjects performed role plays. A Likert scale was used to collect data and the data were analyzed by principle factor analysis. The Empathic Understanding Scale consists of four factors: ‘acceptance attitude’, ‘cognitive awareness attitude’, ‘reflective attitude regarding emotions and meaning’ and ‘verbalization prompting attitude’. These four factor structure groups that were extracted were found to be the same in both the pilot study and the second study. In the second study, however, a more valid and reliable Empathic Understanding Scale was established.
Determinants of nurses' intention to administer opioids for pain relief
Authors: Edwards Helen E. , Nash Robyn E. , Najman Jake M. , Yates Patsy M. , Fentiman Belinda J. , Dewar Anne , Walsh Anne M. , McDowell Jan K. , Skerman Helen M.
Published: March 2003

Abstract A statewide cross‐sectional survey was conducted in Australia to identify the determinants of registered nurses' intention to administer opioids to patients with pain. Attitudes, subjective norms and perceived control, the key determinants of the Theory of Planned Behavior, were found to independently predict nurses' intention to administer opioids to these patients. Perceived control was the strongest predictor. Nurses reported positive overall attitudes towards opioids and their use in pain management. However, many negative attitudes were identified; for example, administering the least amount of opioid and encouraging patients to have non‐opioids rather than opioids for pain relief. The findings related to specific attitudes and normative pressures provide insight into registered nurses' management of pain for hospitalized patients and the direction for educational interventions to improve registered nurses' administration of opioids for pain management.
Efficacy of transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia
Authors: Namiki Kazunori , Shiozawa Hiroaki , Tsuzuki Masahiro , Mamiya Yoshimi , Matsumoto Tetsuo , Miki Makoto
Published: March 2003

Background: We evaluated the efficacy and safety of transurethral needle ablation (TUNATM) of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH) as one institute participating in a Japanese clinical trial.

Methods: Thirty‐three patients with symptomatic BPH were treated with the TUNATM procedure in our institute. The international prostate symptom score (IPSS), quality of life (QOL) score, residual urine volume (RV), prostate volume (PV) and peak urinary flow rates (Qmax) were measured and complications were assessed.

Results: We followed and evaluated 30 of the 33 cases. At 12 months there were significant improvements in the IPSS (20.7 to 11.2, P < 0.0001), QOL score (4.9 to 2.1, P < 0.0001), RV (46.6 to 22.6 mL, P < 0.01), PV (37.8 to 30.0 mL3, P < 0.002) and Qmax (8.00 to 11.0 mL/s, P < 0.002). There were no serious complications.

Conclusion: This trial shows that the TUNATM procedure is a safe and efficacious treatment for symptomatic BPH.
Fistula advancement operation in the treatment of selected cases of persistently recurrent urethrocutaneous fistula following distal penile hypospadias repair
Authors: MARZOUK ESSAM
Published: March 2003

Background: Hypospadias fistula may be a persistently recurrent problem in some cases. The present paper describes a urethral mobilization procedure as a new way to solve this problem.

Methods: The procedure was performed on seven children suffering from recurrent hypospadias fistula that had failed more than once to be repaired by the classic ways of closure. Selection of suitable cases should be done intra‐operatively, when urethral mobilization has successfully allowed the fistula opening to easily reach the glans top. The described procedure is an extensive urethral mobilization that advances the fistula opening to the neomeatus at the glans top through a glanular tunnel.

Results: The operation resulted in a straight penis with the neomeatus at the glans top in all seven children, without complications, over a period of 6–18 months follow up.

Conclusions: The fistula advancement operation, as it is called by the author, can, in selected cases, solve the problem of persistently recurrent hypospadias fistula with a high success rate. Thus, the author recommends that this technique is added to urologists’ armamentarium.
Glomus tumor of the penis
Authors: SAITO TOSHIHIRO
Published: March 2003

Glomus tumors of the penis are extremely rare. A patient with multiple regional glomus tumors involving the penis is reported. A 16‐year‐old boy presented with the complaint of painless penile masses and resection of the lesions was performed. The pathologic diagnosis was glomus tumor of the penis. This is the ninth case of glomus tumor of the penis to be reported in the literature.
Cytoreductive surgery with liver‐involved renal cell carcinoma
Authors: Kawata Nozomu , Hirakata Hitoshi , Yuge Humikazu , Kodama Masahito , Sugimoto Shuji , Yagasaki Hiroki , Mochida Junichi , Fujimura Kei , Takimoto Yukie
Published: March 2003

The purpose of this study was to demonstrate the benefits of cytoreductive surgery for renal cell carcinomas that also involve the liver. Between 1994 and 1997, four patients with renal cell carcinoma with liver involvement were surgically treated with nephrectomy and hepatectomy. Two of them underwent a simultaneous hepatectomy and nephrectomy (group 1), and the remaining two patients underwent a hepatectomy after a nephrectomy and had a diagnosis of postoperative recurrence (group 2). Two patients, one from each group, died of multiple bone metastasis and lung metastasis 30 months and 12 months after the hepatectomy; the second patient from group 1 died 40 months after the first operation due to gastrointestinal hemorrhaging. The second patient from group 2 displayed no evidence of recurrence 18 months after the second surgical procedure. The survival rates for these patients were 66% and 33% at 1 and 3 years, respectively. Autopsy studies revealed that one patient from group 2 had a local recurrence in the liver while the other two patients from group 1 did not. Our results suggested that a progressive approach may therefore be useful for patients demonstrating renal cell carcinoma where there is liver involvement.
Changes in serum prostate‐specific antigen following prostatectomy in patients with benign prostate hyperplasia
Authors: Furuya Yuzo , Akakura Koichiro , Tobe Toyofusa , Ichikawa Tomohiko , Igarashi Tatsuo , Ito Haruo
Published: March 2003

Abstract Purpose To investigate how prostatectomy for patients with benign prostate hyperplasia (BPH) affected the serum prostate‐specific antigen (PSA) levels.

Methods In 193 patients who underwent prostatectomy for BPH, serum PSA levels were measured before and three months after the operation. The total prostate weight measured by transrectal ultrasonography (TRUS) and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in PSA levels after the operation.

Results The transition zone volume measured by TRUS could well estimate the weight of the surgical specimen in patients who underwent subcapsular prostatectomy and transurethral resection of the prostate. The concentration of preoperative serum PSA showed a significant correlation with the prostatic volume and with the transition zone volume. Removal of 1 g of BPH tissue reduced serum PSA levels by an average of 0.18 ng/mL. The change in serum PSA levels after the prostatectomy correlated with the total prostatic gland volume and with the transition zone volume.

Conclusions The elevated PSA levels in patients with BPH were caused by the enlargement of the transition zone. After the resection of the adenoma, PSA levels should be expected to decrease to the normal range.
Surgical treatment for an idiopathic renal arteriovenous fistula with a large aneurysm
Authors: Hayakawa Kunihiro , Aoyagi Teiichiro , Ohashi Masakazu , Ishikawa Hiromichi , Hata Makoto
Published: March 2003

Abstract Interventional embolization is currently the first line treatment for arteriovenous fistulas; however, the efficacy of repeated embolization remains controversial. A case is reported of an idiopathic renal arteriovenous fistula with large aneurysmal dilatation treated by surgery following the failure of interventional embolization. A 42‐year‐old woman was admitted to Ichikawa General Hospital, Japan, with gross hematuria containing many clots. Right renal arteriogram showed an aberrant vessel arising from the main trunk of the renal artery, which was followed by the formation of an aneurysm and rapidly ended in arteriovenous shunting. The aneurysm was approximately 35mm in size. As interventional embolization had failed, surgical treatment including extracorporeal renal surgery was performed. Postoperative renal angiography revealed excellent renal function and beautiful vascular architecture. Although the indication for surgical treatment of renal vascular disease has decreased owing to the advancement of interventional techniques, there are still some risky cases for which surgical repair should be recommended.
Transurethral needle ablation of the prostate: An initial Japanese clinical trial
Authors: Murai Masaru , Tachibana Masaaki , Miki Makoto , Shiozawa Hiroaki , Hirao Yoshihiko , Okajima Eigoro
Published: March 2003

Abstract Objectives: Transurethral needle ablation of the prostate is a new alternative endoscopic thermal therapy that uses a low‐energy radio frequency delivered into the prostatic adenoma. Herein is reported the initial clinical experience by multiple institutes in Japan of transurethral needle ablation of the prostate for the treatment of symptomatic benign prostatic hyperplasia.

Methods: A total of 93 patients were treated with this technique. Transurethral needle ablation of the prostate was generally performed under low‐spinal anesthesia. Before and after the procedure, international symptom score (IPSS), quality of life (QOL) score, peak urinary flow rate (Qmax), postvoid residual urine volume and prostate size were evaluated.

Results: There was a reduction of IPSS of more than 50% when compared with that of pretreatment, being 51.3% (57/93 patients) and 60.2% (56/93 patients) at 3 months and 6 months after the procedure, respectively. Sixty‐seven patients who were available for a 12‐month follow‐up period demonstrated a markedly decreased mean IPSS when compared with that measured before the treatment for a statistically significant difference (P < 0.01). Fifty‐eight patients who were available for uroflowmetric study at 12 months exhibited a notably increased mean Qmax of 11.2 ± 4.5 mL/s, which was a statistically significant increase when compared with that found before treatment (P < 0.05). Although all patients suffered some degree of gross hematuria after the procedure, none of them required any specific treatment for complications.

Conclusion: Transurethral needle ablation technique for the treatment of symptomatic benign prostatic hyperplasia is safe and effective. However, a much longer follow‐up study is essential for fully evaluating the extended effectiveness of this technique.
Primary retroperitoneal ganglioneuroblastoma in an adult
Authors: Yamanaka Masanori , Saitoh Fumitada , Saitoh Hisao , Nisimura Syohji , Sawada Yoshiaki , Tsukui Atsushi , Kaimori Mitsuomi , Takahashi Nobuyoshi
Published: March 2003

Abstract A case of retroperitoneal ganglioneuroblastoma in a 60‐year‐old man is reported. This retroperitoneal tumor was surgically removed and pathologic diagnosis was ganglioneuroblastoma. Ganglioneuroblastoma usually occurs in children and is extremely rare in adults. The characteristics are described of an unusual tumor based on the published reports.
Voiding dysfunction in a patient with adolescent adrenoleukodystrophy
Authors: Shinbo Hitoshi , Kageyama Shinji , Hayami Shinsuke , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio , Miyajima Hiroaki
Published: March 2003

Abstract The details are reported of bladder dysfunction in a Japanese boy with adrenoleukodystrophy. He developed gait disturbance at the age of 15 years. Spastic paraparesis progressed from the legs to the hands and brain magnetic resonance imaging showed characteristic degenerative change. Detrusor hyperreflexia was found by a urodynamic study and detrusor‐sphincter dyssynergia was also suspected.
Renal pelvic carcinoma of horseshoe kidney caused systemic metastasis by implantation in prostate
Authors: Yamamoto Shingo , Sasaguri Takakazu , Shimizu Yousuke , Watanabe Jun , Shibata Kotaro Roberts , Iwasaki Renpei
Published: March 2003

Abstract A case is reported of renal pelvic carcinoma of the horseshoe kidney in a 69‐year‐old man, which showed an interesting metastatic pattern by implantation in the prostate. A few months after transurethral resection of the prostate for benign prostate hyperplasia and extracorporal shock wave lithotripsy for renal stones, the patient complained of severe back pain due to multiple metastatic bone tumors. Autopsy revealed transitional cell carcinoma in the pelvis as well as in the prostate with remarkable vessel invasion. The clinical course and autopsy findings suggested that the systemic expansion of cancer cells from the renal pelvis was caused not only by direct metastasis but also by implantation in the prostate.
An unusual complication of suprapubic catheterization with Cystofix: Catheter knotting within the bladder
Authors: Arda İrfan Serdar , Özyaylali İpek
Published: March 2003

Abstract Cystofix is commonly used to drain urine temporarily from the bladder. Common complications are hematuria, bladder wall edema and bladder spasm due to irritation by the catheter itself. A case is described where a Cystofix catheter became curled and knotted inside the bladder, probably due to deep introduction or increased detrussor contraction occurring with the irritation of the bladder wall.
Appendiceal carcinoma invading the urinary bladder
Authors: Arisawa Chizuru , Takeuchi Sin‐Ichi , Wakui Mamoru
Published: March 2003

Abstract A case is reported of a 78‐year‐old woman with appendiceal carcinoma invading the bladder causing irritative symptoms. Although several imaging studies suggested that the secondary bladder tumor was of cecal or appendiceal origin, such as abscess or mucocele, histologic findings on transurethral and transvaginal biopsy were inconclusive. However, following laparotomy, pathologic examination of the frozen sections revealed a mucinous cystadenocarcinoma originating in the appendix and a right hemicolectomy and en bloc partial cystectomy were performed. One year after the operation, the patient was well with no evidence of recurrent cancer.
Osteogenic sarcoma of the prostate
Authors: Nishiyama Tsutomu , Ikarashi Toshihiko , Terunuma Masahiro , Ishizaki Satoshi
Published: March 2003

Abstract A 76‐year‐old man was treated with bilateral orchiectomy, estramustine phosphate and pelvic irradiation for prostate cancer. Osteogenic sarcoma of the prostate developed 18 months after the treatment. Postmortem examination revealed that the tumor was 8 cm in diameter and had infiltrated into the bladder and rectal walls and had resulted in peritoneal dissemination. There was no distant metastasis. Macroscopically, the tumor was ashen, firm and relatively homogenous and diffusely spread. Histologically, it was composed of spindle and pleomorphic cells, which were making osteoid with calcification. There was no ordinary tubular formation as shown in adenocarcinoma of the prostate. No positive immunostaining for prostate‐specific antigen, epithelial membrane antigen and cytokeratin (AE‐1, AE‐3) were confirmed. Positive immunostaining for nonepithelial marker vimentin was confirmed. The ultimate diagnosis was osteogenic sarcoma of the prostate.
Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study
Authors: Unal Dogan , Yeni Ercan , Verit Ayhan , Karatas Omer Faruk
Published: March 2003

Abstract Background: The purpose of the study was to compare the effect of varicocelectomy with that of clomiphene citrate on seminal improvement and pregnancy rates in patients with subclinical varicocele.

Methods: A total of 42 infertile men with left subclinical varicocele were randomized to group I (21 patients, surgery) and group II (21 patients, medical therapy). The patients in group I were treated with varicocelectomy and those in group II with clomiphene citrate, 50 mg/day, orally. Sperm parameters (sperm density, motility and morphology) were recorded before and 6 months after beginning the treatment and pregnancy rates were estimated. In statistical analysis, paired and independent‐samples t‐tests, Kaplan–Meier and Log rank tests and Fisher's exact test were used.

Results: Mean ± SD age of the series was 32.7 ± 6.1 years, that of group I was 32.2 ± 5.5 years and that of group II was 33.1 ± 6.7 years (P = 0.680). All seminal parameters increased after both surgical and medical treatment, but only increases in sperm density and motility following varicocelectomy were statistically significant. Changes in seminal parameters between groups I and II were statistically insignificant. Pregnancy was seen in two cases in group I and in one in group II (P = 0.500). The cumulative pregnancy rates were 12.5% in group I and 6.7% in group II (P = 0.589).

Conclusions: Clomiphene citrate did not increase sperm density and motility as effectively as subclinical varicocelectomy, but there was no statistically significant difference between surgical and medical therapy methods in terms of seminal improvement and pregnancy rate.
Prognostic factors for survival and bladder recurrence in transitional cell carcinoma of the upper urinary tract
Authors: Morioka Masaaki , Jo Yoshimasa , Furukawa Yoji , Kinugawa Keigo , Sone Atsushi , Matsuki Takakazu , Kobayashi Tatsuya , Fujii Tomohiro , Tanaka Hiroyoshi
Published: March 2003

Abstract Background: Prognostic factors for survival in transitional cell carcinoma of the upper urinary tract have been extensively evaluated, but detailed analyses of patterns of bladder recurrence after surgery have been rare.

Methods: The outcome and tumor recurrence of 93 patients with transitional cell carcinoma of the upper urinary tract surgically treated between 1975 and 1999 were reviewed, retrospectively. Disease‐specific survival by pathologic stage and grade were analyzed by the Kaplan–Meier method. Prognostic factors for survival and bladder recurrence were examined by univariate and multivariate analysis.

Results: The 5‐year disease‐specific survival rates of the patients with pTa, T1 and T2 were 92.9%, 100% and 88.9%, respectively. However, that of the pT3 patients was 61.9% and the median survival of the pT4 cases was only 7 months. Bladder recurrence was seen in 40 cases and recurrences occurred within 1 year in 32 of these patients. The stage and grade of metachronous bladder tumors usually resembled those of primary tumors, but invasive recurrences were seen in 19% of recurrent cases with primary pTa, pT1 tumors. The significant prognostic factor for survival was pathologic stage (pT3, pT4), but no significant variables were detected for bladder recurrence by multivariate analysis.

Conclusions: The prognosis of pT3, pT4 patients is poor and effective systemic adjuvant therapy is necessary. Invasive bladder recurrence occurred in 19% of patients with superficial primary tumors. As no significant prognostic variables for bladder recurrence were identified, careful follow up for bladder recurrence is important even if the primary tumors are non‐invasive.
Adenovirus‐mediated suicide‐gene therapy in an orthotopic murine bladder tumor model
Authors: Cheon Jun , Moon Du Geon , Cho Hyun Yee , Park Hong Seok , Kim Je Jong , Gardner Thomas A. , Kao Chinghai
Published: March 2003

Background:
  Patients with high‐grade transitional‐cell carcinoma (TCC) of the bladder frequently experience recurrence and progress and have a low response rate to chemotherapy in metastatic TCC. In this study, we evaluated the feasibility and long‐term efficacy of suicide‐gene therapy using adenovirus (Ad)‐mediated herpes simplex virus thymidine kinase gene (HSV‐TK) and prodrug ganciclovir (GCV) as a potential therapeutic approach in murine‐orthotopic models of TCC.

Methods:
A replication defective adenoviral vectors containing toxic HSV‐TK gene under the transcriptional control of RSV (Rous sarcoma virus) promoter (Ad‐RSV‐TK) was used. Orthotopic bladder TCC was established with 1 × 106 murine (MBT‐2) TCC cells in syngenic C3H/He female mice. Intratumoral injection of Ad‐RSV‐TK in combination with GCV (20 mg/kg body weight/day i.p. b.i.d. × 7 days) was administered in vivo for the determination of treatment efficacy and long‐term host survival in separate controlled experiments.

Results:
In vivo experiments demonstrated greater than three‐fold reductions in MBT‐2 tumor growth for the animals treated with Ad‐RSV‐TK (5 × 108 plaque forming units (pfu)/GCV therapy (P < 0.01)). Central tumor necrosis and apoptosis were revealed by histomorphology and immunohistochemistry compared with other control animals (non‐treated, GCV alone, Ad‐RSV‐TK alone). Direct intratumoral injection with Ad‐RSV‐TK/GCV also resulted in significantly improved survival over the control groups in separated experiment (log–rank test, P < 0.05).

Conclusions:
Suicide‐gene therapy using Ad‐RSV‐TK/GCV provides an effective therapy in an experimental murine orthotopic bladder cancer by significantly inhibiting tumor growth and improving long‐term host survival.
Clear cell adenocarcinoma of the urinary bladder inducing acute renal failure
Authors: Matsuoka Yoh , Machida Tatsuya , Oka Kaoru , Ishizaka Kazuhiro
Published: March 2003

We report a case of clear cell adenocarcinoma of the urinary bladder. A 59‐year‐old male was referred to our hospital complaining of oliguria, left lower abdominal pain and loss of appetite. Ultrasonography revealed bilateral hydroureteronephrosis and obstructions at the ureterovesical junction. Magnetic resonance imaging demonstrated an invasive irregular tumor located in the posterior wall of the urinary bladder and urinary infiltration to the left retroperitoneal space.The clinical diagnosis was acute post renal failure due to bilateral ureteral obstructions from an invasive bladder tumor. After we performed bilateral percutaneous nephrostomy, the patient underwent trans urethral biopsy of the bladder tumor, which showed clear cell adenocarcinoma extending from the submucosa to the muscular layer, histopathologically. The patient died of metastatic disease 8 months after diagnosis. To our knowledge, the present case is the 23rd to be reported and demonstrates the shortest survival period in the related literature.
Impact of arterial occlusion during partial nephrectomy on residual renal function: An evaluation with 99m technetium‐dimercaptosuccinic acid scintigraphy
Authors: Kondo Tsunenori , Nakazawa Hayakazu , Ito Fumio , Onitsuka Shiro , Ryoji Osamu , Yago Rie , Hashimoto Yasunobu , Toma Hiroshi
Published: March 2003

Background: Partial nephrectomy (PNx) has been performed with temporary renal arterial occlusion and in situ renal hypothermia (conventional PNx). However, the impact of temporary renal arterial occlusion on residual renal function has not been well assessed. To address this question, we performed renal scintigraphy with 99mtechnetium‐dimercaptosuccinic acid (DMSA) for the quantitative measurement of postoperative residual renal function after conventional PNx and partial nephrectomy without arterial occlusion (non‐clamping PNx).

Methods: Thirty‐four patients underwent postoperative DMSA scintigraphy after PNx for renal cell carcinoma. No obvious difference in preoperative renal function between the diseased kidney and the contralateral kidney was found in any of the patients. Of these patients, 24 underwent conventional PNx, and 10 underwent non‐clamping PNx. Residual renal function was evaluated using the relative DMSA uptake of the operated kidney.

Results: The relative DMSA uptake of the operated kidney was 39.9 ± 7.3% (25.1–58.8) after conventional PNx compared to 34.8 ± 8.9% (13.5–45.5) after non‐clamping PNx. This difference was not statistically significant (P = 0.15). Total ischemic time during conventional PNx had no adverse influence on the residual renal function. In the analysis of the other determinant factors influencing residual renal function, tumor size was the only significant factor that inversely correlated with the relative DMSA uptake.

Conclusion: Our results showed that arterial clamping during PNx has no negative impact on the functional residual capacity as long as insitu renal hypothermia is adequately performed.
Elevated serum estradiol suggesting recurrence of Leydig cell tumor nine years after radical orchiectomy
Authors: Maeda Toshihiro , Itoh Naoki , Kobayashi Ko , Takahashi Atsushi , Masumori Naoya , Tsukamoto Taiji
Published: March 2003

We report a case of a Leydig cell tumor that showed retroperitoneal lymph node metastasis 9 years after radical orchiectomy. Elevated serum estradiol (E2) suggested recurrence of the Leydig cell tumor. Retroperitoneal lymph node dissection (RPLND) was performed and the lymph node was proved histopathologically to have a metastatic Leydig cell tumor. After RPLND, serum E2 returned to the normal range. This is the first reported case in which changes in the endocrinological findings were useful as likely tumor markers to detect the recurrence of a Leydig cell tumor.
Plasma amino‐terminal pro‐brain natriuretic peptide levels in subjects presenting to the Emergency Department with suspected acute coronary syndrome: possible role in selecting patients for follow up?
Authors: Campbell D. J. , Munir V. , Hennessy O. F. , Dent A. W.
Published: March 2003

Background: Plasma amino‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level is a sensitive and specific indicator of cardiac dysfunction.

Aim: To determine whether plasma NT‐proBNP level is elevated at the time of presentation with acute coronary syndrome (ACS) and whether it may assist in the diagnosis of heart failure and myocardial ischaemia in the Emergency Department.

Methods: Plasma NT‐proBNP levels were measured prospectively in 201 unselected presentations to the Emergency Department with suspected ACS where cardiac injury markers were requested by clinicians as part of routine assessment. NT‐proBNP levels were correlated with clinical, electrocardiogram (ECG), biochemical and radiological findings.

Results: Elevated NT‐proBNP level detected heart failure with high sensitivity (95–96%). Among patients without heart failure, NT‐proBNP levels were increased more frequently in patients with previously diagnosed ischaemic heart disease. Elevated NT‐proBNP level predicted cardiomegaly and a cardiac cause of presentation. However, the NT‐proBNP level was not associated with ECG or biochemical markers of myocardial ischaemia, and only one‐third of patients with ACS showed an increase of 40% or more in NT‐proBNP level at repeat measurement of cardiac injury markers 5 h after presentation.

Conclusions: Although elevated NT‐proBNP level detected heart failure with high sensitivity, NT‐proBNP level did not assist in the diagnosis of acute myocardial ischaemia. These findings indicate that the major determinant of elevated NT‐proBNP level on presentation with suspected ACS was underlying cardiac dysfunction rather than acute myocardial ischaemia. This suggests that NT‐proBNP measurement in patients with a suspected cardiac reason for presentation to the Emergency Department may identify a previously unrecognized group of patients without acute ischaemia who may nevertheless benefit from further investigation of cardiac function. (Intern Med J 2001; 31: 211–219)
Outcomes research: what is it and why does it matter?
Authors: Jefford M. , Stockler M. R. , Tattersall M. H. N.
Published: March 2003

Abstract

Outcomes research is a broad umbrella term without a consistent definition. However it tends to describe research that is concerned with the effectiveness of public‐health interventions and health services; that is, the outcomes of these services. Attention is frequently focused on the affected individual − with measures such as quality of life and preferences − but outcomes research may also refer to effectiveness of health‐care delivery, with measures such as cost‐effectiveness, health status and disease burden. The present review details the historical background of outcomes research to reveal the origins of its diversity. The value and relevance of outcomes research, commonly employed research techniques and examples of recent publications in the area are also discussed. (Intern Med J 2003; 33: 110−118)