bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastrocystoplasty in a Woman with Radiation-Induced Ureteral Obstruction and Low-Compliance Bladder
Authors: Yashi Masahiro , Muraishi Osamu , Kobayashi Yutaka , Tokue Akihiko
Published: April 2003

A 56-year-old woman presented with bilateral hydronephrosis and moderate renal insufficiency. A diagnosis of bilateral ureteral obstruction and low-compliance bladder following pelvic irradiation was made by urological examinations. She underwent gastrocystoplasty to facilitate bilateral ureteral reimplantation with an uneventful postoperative course. We consider that the use of the stomach to reconstruct the urinary tract injured by pelvic irradiation is valuable to avoid an abdominal urinary stoma.
Eosinophilic Cystitis Masquerading as Invasive Bladder Cancer
Authors: Sekine Hideaki , Kojima Shin-Ichi , Ohya Kazuhiro
Published: April 2003

We report the case of a 33-year-old woman with eosinophilic cystitis, which masqueraded as invasive bladder cancer. The patient remained well with no recurrence or progression after vigorous transurethral resection of the lesion.
Effects of Transurethral Prostate Resection and Transurethral Laser Prostatectomy on Plasma Hormone Levels
Authors: Türkölmez Kadir , Bozlu Murat , Sarica Kemal , Gemalmaz Hakan , Özdiler Erol , Gogus Orhan
Published: April 2003

Objective: The short and long-term effects of two common transurethral procedures (TURP and TULP, transurethral prostatic resection and laser prostatectomy, respectively) on plasma hormone levels in patients with benign prostatic hyperplasia (BPH) have been evaluated. Patients and Methods: Totally 57 patients with histologically proven BPH (age range 54–81 years, mean 62.5 years) were included into the study program. Of these 57 patients, 44 underwent TURP and 13 underwent TULP for treatment of their bladder outlet obstructions. 20 patients with bladder cancer undergoing transurethral resection (n = 15) and those undergoing transurethral laser ablation (n = 5) constituted the control group. Plasma luteinizing hormone (LH), prolactin (PRL), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), cortisol, aldosterone, dihydroepiandrosterone sulfate (DHEA-S) and testosterone levels were assessed in all patients before and after 3 weeks and 3 months following the aforementioned procedures. Comparative evaluation of the results with respect to the effect of different procedures have been made between study and control groups. Results: Preoperatively, we were not able to demonstrate any significant difference with respect to all but plasma prolactin levels (p < 0.05) between the study and control groups. Prolactin levels were found to be significantly higher in BPH patients. In BPH patients undergoing TURP, while LH levels were significantly higher during the 3 weeks’ evaluation (p < 0.001) no significant difference could be shown during the 3 months’ examination (p > 0.05). Again, prolactin levels did significantly decline (p < 0.05) in patients undergoing TURP during the 3 weeks’ follow-up evaluation, no difference was present 3 months postprocedure. On the other hand, in patients undergoing TULP, while we were not able to show any significant difference with respect to plasma prolactin levels (p > 0.05) pre- and postoperatively, plasma LH levels were significantly increased during the 3-month evaluation (p < 0.05). Conclusions: Alterations in the plasma levels of LH and prolactin following prostatectomy during follow-up evaluation, led the physicians to consider possible effects of some factors released from resected prostate gland. Behavior of prolactin and LH after TURP and laser ablation is quite different in our study. It may be related to the higher amount of residual prostate tissue after TULP. On the other hand, normalization of hormone levels 3 months following TURP, led us to think about the activation of some factors responsible for hormonal regulation which in turn institutes a new hormonal balance.
Is Magnetic Resonance Imaging Necessary in the Staging of Prostate Cancer?
Authors: Tüzel Emre , Sevinç Murat , Obuz Funda , Sade Murat , Kırkalı Ziya
Published: April 2003

Objective: To evaluate the necessity of using magnetic resonance imaging (MRI) in the staging of patients with clinically localized prostate cancer. Methods: Sixty-one patients with prostate cancer were evaluated with MRI for preoperative staging with a conventional body-coil (Siemens Magnetom, 1.0 Tesla superconducting system). Twenty-nine patients underwent radical prostatectomy for presumed clinically localized disease. Of those, 17 were staged both with MRI and computerized tomography (CT). The remaining patients were staged with CT alone. MRI and CT findings, and the final pathologic staging of patients are reviewed. Results: On pathological examination of the surgical specimens, the tumor was found to extend beyond the prostate in 7 patients (41%). Among the 17 patients who were operated, extraprostatic extension (EPE) was detected accurately in 3 patients with MRI (sensitivity 20%, specificity 92%, accuracy 70.5%). No metastatic lymph nodes were detected on the basis of MRI (sensitivity 0%, specificity 93%, accuracy 88.2%). In 1 patient EPE was correctly identified by CT (sensitivity 14%, specificity 100%, accuracy 64.7%). Conclusion: Neither MRI with conventional body-coild nor CT are sufficient to indicate local extension of disease in clinically localized prostate cancer.
An Unexpected Complicationof the Remote-Controlled Intraurethral Valve Pump for Urinary Incontinence
Authors: Pannek Jürgen , Müller Michael , Haupt Gerald
Published: April 2003

We report an unexpected complication of the remote-controlled intraurethral valve pump in a patient with neurogenic bladder. A meningomyelocele patient with an atonic bladder received an intraurethral valve pump. Acute urinary retention was caused by a mucus clot obstructing the pump. Prior to extended clinical use, the remote-controlled intraurethral valve pump should be evaluated in prospective multicenter studies.
Surgical Challenge of Massive Bilateral Staghorn Renal Calculi in a Spinal Cord Injury Patient
Authors: Issa Muta M. , McNamara Diane E. , Myrick Samuel E. , Hansen Moritz H. , Gong Michael , Perkash Inder
Published: April 2003

We report a rare case of massive bilateral staghorn calculi in a spinal cord injury patient with significant renal compromise. The patient was successfully treated with percutaneous nephrolithotomy to achieve a stone-free status. The various options of treatment are discussed with special attention to the technical aspects necessary to achieve complete eradication of the stone burden during percutaneous nephrolithotomy. Furthermore, the importance of treating bladder dysfunction and urinary metabolic abnormalities is emphasized.
Cortical Benign Fibromatous Tumor (Fibroma) of the Kidney
Authors: Lopes Maria , Raciti Giovanni , Maira Alessandro , Magro Gaetano
Published: April 2003

Benign fibromatous tumor (BFT), also named ‘fibroma’, is a distinctive clinico-pathologic entity occurring in epididymis, spermatic cord, paratesticular structures, testis, renal peripelvis and rarely in renal parenchyma. We report the first case of a BFT (fibroma) located in the cortex of the kidney, and a critical review on the topic is provided. Tumor was found incidentally at autopsy as a small cortical nodule. With the increasing use of radiological imaging of the abdomen, it is likely that an increased number of incidental and asymptomatic benign renal tumors will be diagnosed. We underline that BFT (fibroma) should be considered in the preoperative differential diagnosis of renal cortical nodules.
Bladder Neck Suspension Using Percutaneous Bladder Neck Stabilization to the Pubic Bone with a Bone-Anchor Suture Fixation System:A New Extraperitoneal Laparoscopic Approach
Authors: Takeda Masayuki , Hatano Akihiko , Kurumada Shigenori , Takahashi Hitoshi , Wakatsuki Syun-ji , Go Hideto , Watanabe Ryusuke , Tomita Yoshihiko , Takahashi Kota
Published: April 2003

A 39-year-old woman with type 1 genuine stress urinary incontinence was treated using a novel extraperitoneal laparoscopic bladder neck suspension procedure with a bone-anchor suture fixation system. Operative time and blood loss were 2.5 and 50 g, respectively. The patient showed a remarkable improvement on chain cystography and in subjective and objective well-being with no complications, even 12 months after surgery. Extraperitoneal laparoscopic bladder neck suspension using the bone-anchor suture fixation system is an easy and feasible procedure.
Paraganglioma of the Urinary Bladder: A Case Report and Review of the Japanese Literature
Authors: Shono Takefumi , Sakai Hideki , Minami Yuzo , Suzu Hiroshi , Kanetake Hiroshi , Saito Yutaka
Published: April 2003

We describe a patient with primary paraganglioma of the urinary bladder associated with typical clinical symptoms. Systolic blood pressure frequently increased to 300 mm Hg immediately after micturition. Levels of urinary vanillylmandelic acid excretion and serum norepinephrine were significantly elevated. The tumor was removed by partial cystectomy. Histological examination of the tumor revealed paraganglioma of the urinary bladder. Compared with a review of 53 similar cases reported in Japan, the distribution of age, sex and tumor location in the bladder differed from those described worldwide.
Stenturia: An Unusual Manifestation of Spontaneous Ureteral Stent Fragmentation
Authors: Kumar Manal , Aron Monish , Agarwal Anjani K. , Gupta N.P.N.P.
Published: April 2003

Two patients presented with passage of worm-like stent fragments in the urine. The first had undergone attempted percutaneous removal of left renal calculus and ureteral stenting 4 months prior to presentation. The second had left-sided stent placement for obstructive anuria on account of bilateral renal calculi 3 months earlier. The stents had fragmented into multiple pieces over a mean indwelling time of only 3.5 months. Apart from calculus disease, both patients had documented urinary tract infection. Stent fragmentation is a relatively rare (0.3%) but major complication. However, spontaneous excretion of these fragments has not been hitherto reported. These cases of rapid stent disintegration highlight the need for closer monitoring of the indwelling stents, especially in patients with calculus disease and associated persistent infection. In such patients the stent should probably be changed within 3 months.
Detection of Prostate-Specific Antigen Immunoreactivity in Amniotic Fluid
Authors: Wolff J.M. , Heyl W. , Borchers H. , Brehmer Jr. B. , Rath W. , Jakse G.
Published: April 2003

Objective: To examine whether prostate-specific antigen (PSA) is present in amniotic fluid, whether the amniotic fluid PSA concentration changes with gestational age, and whether there is an association between amniotic fluid PSA and fetal sex. Methods: The PSA concentration was measured in the amniotic fluid of 48 pregnant women. Thirty-four samples were obtained during routine amniotic fluid analyses performed during gestational weeks 16–18, whereas 14 samples were obtained during cesarean section performed after gestational week 36. Results: PSA was detected in all amniotic fluid samples. The median amniotic fluid PSA was 0.193 ng/ml during gestational weeks 16–18 and 0.39 ng/ml after gestational week 36 (p = 0.1). Furthermore, no significant association was seen between amniotic fluid PSA and fetal sex. The median amniotic fluid PSA level was 0.233 ng/ml for the 21 boys and 0.222 ng/ml for the 27 girls investigated (p = 0.72). Conclusions: These results confirm recent literature reports that PSA may serve as a growth regulator during normal fetal development. However, further studies are necessary to elucidate the exact role of PSA during fetal development.
Flow-Cytometric Measurement of Cellular Changes in Urine: A Simple and Rapid Method for Perioperatively Monitoring Patients after Kidney Transplantation
Authors: Yu Dah-Shyong , Sun Guang-Huan , Lee Shang-Sen , Wu Ching-Jiunn , Ma Chen-Ping , Chang Sun-Yran
Published: April 2003

Objective: In renal transplant patients having graft dysfunction, it is usually difficult to obtain the accurate diagnosis, such as acute rejection, acute tubular necrosis, infection, or ciclosporin nephrotoxicity. An accurate diagnosis can provide the proper treatment of these patients, thereby lessening the chance of kidney loss. Methods: A total of 42 patients were enrolled. By using the flow-cytometric technique, the white cell populations of urine in these patients were analyzed and linked to their clinical course. All patients underwent sonography-guided biopsy of the transplanted kidney with a definitive diagnosis. Results: When 10% lymphocytes and 15% granulocytes in urine were set as the cutoff point of a normal ratio threshold, the flow-cytometric analysis presented the highest sensitivity and the highest negative predictive rate for acute tubular necrosis. However, a lower sensitivity and positive predictive rate was found in acute rejection cases. Conclusions: Our results suggest that flow-cytometric analysis of the urinary cell population can be used as an adjunct in patient follow-up after kidney transplantation.
Locally Recurrent Malignant Fibrous Histiocytoma: A Rare and Aggressive Genitourinary Malignancy
Authors: Froehner Michael , Manseck Andreas , Haase Michael , Hakenberg Oliver W. , Wirth Manfred P.
Published: April 2003

Objective: In this study, 22 cases of locally recurrent urological malignant fibrous histiocytoma were reviewed considering therapeutic options, follow-up and prognosis. Patients and Methods: In the available literature on this topic we identified 19 cases of locally recurrent genitourinary malignant fibrous histiocytoma. Three additional cases are discussed, primarily arising from the kidney, the bladder and the paratesticular region. Results: The prognosis of locally recurrent urological malignant fibrous histiocytoma was found to be extraordinarily poor. Only 2 of 22 patients have survived for longer than 3.5 years. One of them reported herein is still alive 10 years after extensive lymphatic spread accompanying the first local recurrence. In this case, late local recurrence occurred after an 8-year interval free of disease. Conclusion: Malignant fibrous histiocytoma is an unusual urological malignancy with a high rate of local recurrence. The latter is frequently accompanied by metastatic disease and unrelenting progression. Despite the poor prognosis early detection of local failure and aggressive salvage therapy might offer the chance of long-term survival in selected cases. Close and life-long follow-up is advisable for patients once treated for recurrent urological malignant fibrous histiocytoma.
Vesicocutaneous Fistula 23 Years after Hip Arthroplasty
Authors: Gallmetzer Josef , Gozzi Christian , Herms Achim
Published: April 2003

Vesicocutaneous fistula after total hip replacement is a very rare but severe complication, which can appear months or years after operation. Intrapelvic cement (methylmethacrilate) spilling, loosening and dislocation of the prosthesis and infection are believed to be the cause of fistula formation. Only 4 cases of this kind of fistula have been reported in the literature. A new case of vesicocutaneous fistula is presented. The fistula developed 23 years after arthroplasty mainly because of hip-joint infection. Urinary tract symptoms caused by urinary infection appeared only few months earlier.
Penetrating Trauma to the Scrotumand the Corpora cavernosa Caused by Gunshot
Authors: Ficarra Vincenzo , Caleffi Giuseppe , Mofferdin Alessandro , Zanon Giovanni , Tallarigo Carlo , Malossini Gianni
Published: April 2003

The authors describe a case of gunshot wound of the male genitalia by two low-velocity bullets. The first bullet caused a lesion of the right testicle and came out of the right hemiscrotum; the second one had penetrated the left gluteal region with no exit wound. The penile ultrasound confirmed the presence of the bullet at the root of the right corpus cavernosum. The patient underwent exploratory surgery, drainage of the voluminous bilateral scrotal hematoma, and suture of a laceration of the right-testicle cranial portion. Due to the absence of active bleeding, voluminous hematoma and serious injuries in the corpus cavernosum, no surgical removal of the bullet in the right corpus cavernosum was required. The patient regained a normal sexual function 1 month after the operation.
Urethral Carcinoma Recurrence in Ileal Orthotopic Neobladder: Urethrectomy and Conversion in a Continent Pouch with Abdominal Stoma
Authors: Bartoletti Riccardo , Natali Alessandro , Gacci Mauro , Rizzo Michelangelo , Selli Cesare
Published: April 2003

A patient who had previously undergone ileal neobladder with Studer technique presented an urethral recurrence of a transitional cell carcinoma. Further surgical treatment consisted of urethrectomy and creation of an intussuscepted ileal loop which was anastomosed to the pouch and provided a continence mechanism allowing self-catheterization.
Results and 10-Year Follow-Up in Patients with Squamous Cell Carcinoma of the Penis
Authors: Derakhshani P. , Neubauer S. , Braun M. , Bargmann H. , Heidenreich A. , Engelmann U.
Published: April 2003

Penile malignancies are infrequent but represent a diagnostic and therapeutic challenge as patients tend to disregard early asymptomatic lesions of the disease. Due to the lack of studies involving large patient numbers, the therapeutic concepts for different stages of the disease could not be defined by prospective studies. Long-term results are rare. We present the therapeutic concepts and the 10-year results of our experience with 42 cases of penile carcinoma treated at our institution between 1973 and 1986. Therapy included radical circumcision in 10 cases, local excision of the tumor in 4, partial or total glandular resection in 6 patients, partial penectomy in 20, and total penectomy in 2 cases. Inguinal lymphadenectomy was performed initially in 14 cases with positive histology in 7 patients (50%). Complications included meatal stenosis in 8 cases (19%), urethral stricture in 1 case, death due to fulminant pulmonary embolism in 1 case and local infections in 2 cases. Follow-up of patients with initially nonmetastatic disease showed a progression to death in 4 of 35 patients (11.6%) with a mean survival of 30 (range 11.5–56) months, in patients with initial lymph node metastases progression to death occurred in 5 of 7 patients (71.4%) with a mean survival of 9.76 months (range 9 days to 24 months). Stage-related disease-specific 10-year survival rates are 100% for stages 0 and 1, 90.9% for stage 2, and 20% for stage 3, while no patient in stage 4 survived for 5 years. From our data we conclude that the single most important prognostic factor in the treatment of carcinoma of the penis is lymph node involvement. Therefore increased attention has to be paid to the recognition of early stages of this potentially curable disease.
Immunotherapy of Renal Cell Carcinoma
Authors: Mickisch Gerald H.
Published: April 2003

Treatment of choice for nondisseminated disease is surgery. However, the 5-year survival rates for all stages do not exceed 60%, even in contemporary series. Further improvement will most likely have to await the development of a more effective systemic therapy and the application of combined treatment modalities to counter the relatively high number of patients presenting with advanced stages. Treatment options in metastatic disease include nephrectomy, sometimes in combination with metastasectomy in selected cases, alone or cytoreductive surgery followed by immunotherapy. Alternatively, one may apply immunotherapy initially and perform adjuvant nephrectomy in the case of a response, or proceed to immunotherapy as a monotherapy. Nevertheless, long-term survival ranges merely from 5 to 10% depending strongly on patient selection criteria. Concepts and progress in this field appear to be of major interest for modern uro-oncologists following the advent of immunotherapeutic strategies that require a surgical intervention at some stage of the treatment cascade.
Diagnosis and Staging of Prostatic Carcinoma: What Is Really Necessary?
Authors: Schmid H.-P. , Oberpenning F. , Pummer K.
Published: April 2003

Diagnosis and staging of prostatic carcinoma should be considered in men in whom treatment with curative intent is possible. The primary tools for detection of cancer are digital rectal examination (DRE) and serum prostate-specific antigen (PSA), whereas transrectal ultrasonography is best used to guide the needle for biopsy. Staging should be based on the TNM system. The most reliable staging methods include a combination of DRE, PSA and systematic biopsies for local tumor extension, pelvic lymphadenectomy for regional lymph nodes, and PSA and bone scintigraphy for distant metastases. Computed tomography and magnetic resonance imaging are not necessary in most cases.
Curative Treatment of Prostate Cancer
Authors: Wirth M.P. , Hakenberg O.W.
Published: April 2003

The guidelines for the curative treatment of prostate cancer presented by the German Society of Urology are discussed. They are based on the current knowledge of the outcomes of surgical and radiotherapeutic treatment for prostate cancer. Radical prostatectomy is recommended as the first-line treatment for organ-confined prostate cancer in patients with an individual life expectancy of at least 10 years. Radiotherapy can be considered as an alternative treatment modality, although current knowledge does not allow a definite assessment of the relative value of radiotherapy compared to radical prostatectomy. Locally advanced cT3 prostate cancer is overstaged in about 20% and curative treatment is possible in selected cases. Guidelines represent rules based on the available evidence. This implies that exceptions must be made whenever appropriate and that guidelines have to be reviewed regularly as new information becomes available.
Loss of Tissue Immunoreactive Androgen Receptor in Prostate Cancer Presenting Initially as an Intracranial Tumor
Authors: Ehara Hidetoshi , Yang Muzheng , Kawamura Takeshi , Deguchi Takashi , Kawada Yukimichi , Shimokawa Kuniyasu , Tanaka Takuji
Published: April 2003

We report a case of prostate cancer that presented initially as an intracranial tumor. Biopsy specimens of the prostate before endocrine treatment were nearly negative immunohistochemically for prostate-specific antigen and the androgen receptors. All metastases including those in the brain expressed neither androgen receptor nor prostate-specific antigen at the protein and mRNA levels. The tumor, which did not respond to the anti-androgen therapy, had an aggressive course. In this case, the androgen-independent growth and rapid progression might be associated with the initial loss of the antigen and androgen characteristics of the prostate.
Primary Renal Malignant Fibrous Histiocytoma
Authors: Papadopoulos I. , Rudolph P.
Published: April 2003

We report on a case of primary renal malignant fibrous histiocytoma. Primary manifestation in the kidney is rare with only 22 cases reported in the literature. Preoperatively, a renal cell carcinoma cannot be distinguished from a malignant mesenchymal tumor with clinical or imaging techniques. We discuss the pathologic differential diagnosis, therapeutic strategies and prognosis of this infrequent tumor.
Effect of Injury to the Dorsal Funiculus of the Thoracic Spinal Cord on Micturition in Decerebrate and Freely-Moving Cats
Authors: Sugaya Kimio , Ogawa Yoshihide , Hatano Tadashi , Koyama Yuzo , Miyazato Tomonori , Oda Masami
Published: April 2003

Bladder sensation is transmitted both via the spinothalamic tract in the lateral funiculus and the dorsal system in the dorsal funiculus. We transected the dorsal funiculus in 10 female cats to clarify the functional roles of these two ascending pathways. The dorsal funiculus was transected at T10 in 5 decerebrate and 5 freely-moving cats, and micturition parameters were compared before and after transection. Transection of the dorsal funiculus did not affect any of the parameters of reflex micturition in the 5 decerebrate cats. Within 1 week after transection, 4 of the 5 freely-moving cats used the normal micturition posture, but the remaining one performed micturition in a prone position as if she had lost micturition sensation. All 5 cats urinated with a normal micturition posture by 2 weeks after transection. The mean single voided volume was decreased transiently up to 1 week, but returned to normal by 2 weeks after transection. None of the 5 cats had any residual urine before and after transection. Both the ascending and descending limbs of the micturition reflex pass through the lateral funiculus. Bladder sensation is transmitted both via the spinothalamic tract coursing in the lateral funiculus and the dorsal system in the dorsal funiculus. The dorsal system may play a major role in the transmission of bladder sensation to the cerebral cortex, but may not be essential.
Benign Ureteral Tumors
Authors: Kiel H.-J. , Ullrich T. , Roessler W. , Wieland W.F. , Knuechel-Clarke R.
Published: April 2003

The diagnosis of benign ureteral polyps should be considered especially in patients younger than 40 years with filling defects of the proximal ureter on the intravenous pyelogram (IVP). The excellent results of conservative organ-saving surgery (open resection, ureteroscopic resection, laser coagulation) require precise diagnostic management preoperatively in these patients.
49,XXXXY Syndrome with Hydronephrosis Caused by Intravesical Ureterocele
Authors: Kojima Yoshiyuki , Hayashi Yutaro , Maruyama Tetsuji , Sasaki Shoichi , Mogami Tohru , Kohri Kenjiro
Published: April 2003

A 1-month-old boy was referred to our hospital with right hydronephrosis. Excretory urography showed poor visualization of the right kidney and a filling defect in the bladder. Chromosomal analysis of peripheral blood revealed a karyotype of 49,XXXXY, and a diagnosis of 49,XXXXY Klinefelter’s syndrome associated with hydronephrosis caused by intravesical ureterocele was made. 49,XXXXY Klinefelter’s syndrome with anomalies of the urinary tract is extremely rare, and only 2 cases have been reported so far.
Ureterocele Arising from a Lower-Pole Moiety
Authors: Harb John F. , Tiguert Rabi , Hurley Patrick M. , Gheiler Edward L. , Smith Craig
Published: April 2003

We report on an uncommon case of a ureterocele arising from the lower-pole ureter in a duplex system. To our knowledge, this represents the 3rd such case reported in the English literature. Ultrasonography and retrograde pyelogram established the diagnosis. The patient underwent a left upper-pole nephroureterectomy with excision of the ureterocele and cross-trigonal ureteral reimplantation.
Primary Renal Malignant Fibrous Histiocytoma
Authors: Ptochos A. , Karydas G. , Iosifidis N. , Tyrothoulakis E. , Papazafiriou G. , Kehagia-Koutoufari T.
Published: April 2003

Primary renal malignant fibrous histiocytoma is a rare tumor of the kidney. We report an additional case noting, as other authors have, the similarity in clinical presentation with renal cell carcinoma. We also review the 23 documented cases of the international literature, emphasizing the current diagnostic approaches and therapeutic management.
Five-Year Survival Results of Subcutaneous Low-Dose Immunotherapy with Interleukin-2 Alone in Metastatic Renal Cell Cancer Patients
Authors: Bordin Veronica , Giani Luisa , Meregalli Sofia , Bukovec Roberta , Vaghi Massimo Maria , Mandalà Mario , Paolorossi Franco , Ardizzoia Antonio , Tancini Gabriele , Barni Sandro , Frigerio Franco , Fumagalli Luca , Bordoni Arrigo , Valsuani Gianni , Di Felice Greta , Lissoni Paolo
Published: April 2003

After the discovery of its essential role in anticancer immunity, IL-2 cancer immunotherapy has shown that comparable results may be obtained with different schedules, including intravenous high-dose IL-2 as a bolus or as a 24-hour intravenous infusion or prolonged subcutaneous injection of low-dose IL-2 with or without IFN-α. This study shows the long-term results obtained in 92 metastatic renal cell cancer (RCC) patients with low-dose subcutaneous IL-2, which was given at 3 million IU twice/day for 5 days/week for 6 consecutive weeks. In nonprogressing patients, a second cycle was planned after a 21-day rest period, followed by maintenance therapy consisting of 5 days of treatment every month until disease progression. Complete response (CR) was achieved in only 2/92 (2%) patients, and partial response (PR) was observed in 19 patients (21%). Therefore, the response rate (CR + PR) was 21/92 (23%), with a median duration of response of 25 months. Stable disease (SD) occurred in 37 patients (40%), whereas the other 34 (37%) had a progressive disease (PD). The response rate was significantly higher in patients with a disease-free interval of >1 year than in those with a lower interval, in patients with a high performance status (PS) than in those with a low PS, and in patients with sites of disease other than the liver. A 5-year survival was obtained in 9/92 (9%) patients, and the percent of survival was significantly higher in patients with a response or SD than in those with PD. The treatment was well tolerated in all patients. This study confirms that low-dose subcutaneous IL-2 alone in an effective and well tolerated therapy of metastatic RCC, with results comparable to those described with more aggressive and toxic IL-2 schedules.
Carcinoma following Augmentation Ileocystoplasty
Authors: Lane Tim , Shah Julian
Published: April 2003

Carcinoma of the bladder following augmentation cystoplasty is rare. Only 15 cases have been reported worldwide. We report a further 2 cases, 1 of which, a squamous cell carcinoma, has not previously been described in this context.
Primary Adenosquamous and Squamous Cell Carcinoma of the Upper Urinary Tract
Authors: Papadopoulos I. , Wacker H.-H.
Published: April 2003

Three cases of adenosquamous cell carcinoma and squamous cell carcinoma of the upper urinary tract are presented. The fact that the urothelium normally has no glandular or squamous structures renders the pathogenesis of these tumours interesting. The process is assumed to begin with an urothelial metaplasia resulting from a reaction to chronic irritation, leading to dedifferentiation, dysplasias and, in the end, to a squamous cell carcinoma or adenocarcinoma. The relevant medical histories include chronic episodes of pyelonephritis or nephrolithiasis. Diagnosis, therapeutic approaches and prognosis of these rare tumours are discussed.
Results of Questionnaires Regarding Video Recordings of Benign Prostatic Obstruction by Flexible Cystourethroscopy Responded to by Urologists
Authors: Watanabe Takeshi , Miyagawa Ikuo
Published: April 2003

Objective: To evaluate the reliability of subjective diagnoses of benign prostatic obstruction (BPO) using flexible cystourethroscopy as compared to the actual degree of bladder outlet obstruction as measured by a pressure-flow study (PFS), and to investigate the difference of subjective diagnoses among different urologists. Methods: A standardized PFS was done in 33 BPO patients. The degree of BPO (0∼VI) was determined by linear PURR. Flexible cystourethroscopy was also performed in order to evaluate the BPO by video recording. Nine urologists, who have served on the Japanese Board of Urology, diagnosed the degree of the BPO (0∼VI) by watching the video recordings. The degree of obstruction revealed by cystourethroscopy was dependent upon the subjective impression of each urologist who wrote their diagnoses on questionnaires. Results: A positive correlation was found between the results of the PFS and the subjective evaluations based on the cystourethroscopy video (p < 0.001), and the trained urologists arrived at a similar obstruction grade in most cases. However, relatively large gaps between linear PURR and cystoscopic finding were found in some cases. We suggest that these gaps could be caused by dynamic obstructions which cannot be detected by cystourethroscopy. Conclusions: Even though it is difficult to establish an objective measurement of the degree of a BPO using cystourethroscopy, our results show that it is a simple and reliable tool for the assessment of BPO in most cases.
Total Replacement of the Aorta and the Inferior Vena cava after Resection of an Extra-Adrenal Malignant Pheochromocytoma
Authors: Hanazawa Kisaburo , Koizumi Kazuo , Tanaka Michio , Watanabe Ryota , Fujime Makoto
Published: April 2003

Extra-adrenal malignant pheochromocytomas are difficult to operate on because of a tight adhesion to the circumference of tumors. However, an operation is the most curable treatment. Sometimes a replacement of the inferior vena cava with grafts is necessary for removing tumors completely. We totally replaced the aorta and the inferior vena cava after resection of an extra-adrenal malignant pheochromocytoma. No recurrence has been detected, and the aortic graft has had a good patency after 36 months postoperatively. But the vena caval graft has had no patency after 21 months postoperatively.
Endothelin A Receptor Antagonist Reduces Renal Vasoconstriction Induced by Mechanical Manipulation of Renal Artery
Authors: Watarai Yoshihiko , Yoshioka Mitsuhiro , Tanda Katsutoshi , Seki Toshimori , Saito Hideya , Koyanagi Tomohiko
Published: April 2003

The purpose of this study was to make a model of renal vasoconstriction induced by mechanical manipulation of the renal artery and to investigate the influence of endothelin (ET) in renal vasoconstriction. Renal arteries of anesthetized rats were stretched with a 30-gram weight for 5 min, and released. Renal blood flow (RBF) was monitored with a laser flowmeter. To determine the role of ET, a selective ETA receptor antagonist, BQ-123 (0.1 and 1 mg/kg) was administered into the aorta. The manipulation was invariably followed by a flow reduction of about 57% after temporary hyperemia. RBF returned to the basal level 5 min after the release. BQ-123 partially, but significantly, inhibited the mechanical manipulation-induced reduction of RBF in a dose-dependent manner. These results suggest that endogeneous ET may play an important role in renal vasoconstriction induced by mechanical manipulation of the renal artery.
Relation of Sexual Dysfunction to Hormone Levels, Diseases and Drugs Used in Andrological Patients
Authors: Krause Walter , Müller Hans-Helge
Published: April 2003

In 169 patients visiting our department complaining of sexual dysfunction, the medical history was taken using a semistructured interview. A clinical investigation and a hormone analysis were added. The age of patients, hormone values, and items of the interview were collected into a common database. The items were categorized as either dichotomous (yes/no) or ordinal. Statistical analysis was performed using regression analysis with the aim to generate hypotheses of relations. An increase of FSH levels and a decrease of testosterone levels with age occurred. None of the relations of hormone levels or diseases to symptoms of sexual dysfunction produced odds ratios (OR) statistically significant different from 1. However, the risk of having a reduced libido and reduced morning erections was lower in psychoneurological diseases, the risk of reduced arousal and libido was lower in men with diabetes mellitus, but the risk of reduced morning erections was higher in these men. The testosterone levels were not associated with the risk of having reduced penile rigidity, duration of erection, arousal and sexual libido, reduced morning erections and the ability to masturbate. Smoking was not associated with reduced arousal, libido and morning erections. However, a significant increase of testosterone levels with number of cigarettes used was observed. We conclude that sexual dysfunction in patients visiting an andrological department for diagnosis and treatment is mostly not associated to any single evaluable factor.
Emphysematous Cystitis following Brain Contusion
Authors: Mimata Hiromitsu , Tasaki Yoshihisa , Nomura Yoshio
Published: April 2003

Emphysematous cystitis is a rare disorder most commonly seen in patients with urinary tract infection and diabetes mellitus. We present a nondiabetic case of a 46-year-old woman with this entity following brain contusion.
Intravesical Migration of AMS 800 Artificial Urinary Sphincter and Stone Formation in a Patient Who Underwent Radical Prostatectomy
Authors: Bartoletti Riccardo , Gacci Mauro , Travaglini Fabrizio , Sarti Enrico , Selli Cesare
Published: April 2003

A patient who underwent placement of AMS 800 urinary sphincter for incontinence after salvage prostatectomy after radiation therapy failure, experienced urethral erosion of the cuff after 54 months. He was treated with cuff removal and prosthesis deactivation. Thirteen months later, a large bladder stone was removed transvesically, and it contained the reservoir. The remaining sphincter components were also removed. Patients with previous radiotherapy are particularly at risk for sphincter erosion, but intravesical displacement of the reservoir is a very uncommon complication.
Induction of Polyploidization by Jaspamide in HL-60 Cells
Authors: Nakazawa Hideyuki , Kitano Kiyoshi , Cioca Daniel P. , Ishikawa Masayo , Ueno Mayumi , Ishida Fumihiro , Kiyosawa Kendo
Published: April 2003

Jaspamide, a natural peptide isolated from the marine sponge Hemiastrella minor, was used in the study of polyploidy in HL-60 cells. Jaspamide at 5 × 10–8 M concentration exhibited antiproliferative activity and an increased CD4 and CD14 surface expression. After 2 days of cultivation, 56.3% of the exposed cells became multinuclear compared with 2.4% in controls. Moreover, the size and the number of nuclei of the cells increased in a time-dependent manner. An increased number of metaphase chromosomes was observed by microscopical enumeration after colcemid treatment for 60 min. The analysis of the DNA content of these cells, measured by propidium iodide staining, revealed a significant increase in the cells percentage with increased DNA content. Taken together, these findings indicate that the jaspamide treatment induces polyploidization in the HL-60 cell line.
Three Gaucher-Disease-Producing Mutations in a Patient with Gaucher Disease: Mechanism and Diagnostic Implications
Authors: Beutler Ernest , Liebman Howard , Gelbart Terri , Stefanski Ellen
Published: April 2003

As Gaucher disease is an autosomal recessive disorder, most patients are either homozygotes or compound heterozygotes for glucocerebrosidase mutations. We have encountered a patient with three mutations, two c.1226A→G (1226G, N370S) and one c.1448 T→C (1448C, L444P). This was shown to be due to a gene conversion event in which the sequence of the glucocerebrosidase pseudogene that includes the 1448C mutation had been imposed on a glucocerebrosidase gene that already had the 1226G mutation. The patient had relatively mild disease which had been discovered after an attack of infectious mononucleosis, a relationship that has been observed previously. If it had not been recognized that this patient had the 1226G/1226G,1448C genotype, prenatal testing might have falsely identified a 1226G,1448C/wt (wild type) fetus as having Gaucher disease.
CD4+/CD45RA+ ‘Naive' T Cells and Immunological Response to Influenza Virus Vaccine in B-Cell Chronic Lymphocytic Leukaemia Patients
Authors: Marotta Giuseppe , Bucalossi Alessandro , Galieni Piero , Bigazzi Catia , Nuti Sandra , Valenzin Pier Egisto , Bocchia Monica , Lauria Francesco
Published: April 2003

B-cell chronic lymphocytic leukaemia (B-CLL) is characterized by a high frequency of infections, including those of viral aetiology. Previous reports have demonstrated a specific immunologic response to influenza virus vaccine in B-CLL patients with normal IgG levels. In this study, we have evaluated different immunophenotypically defined B and T cell subsets in 18 B-CLL patients before immunization with killed-influenza-virus vaccine. A correlation between immunological response to vaccination and both absolute numbers of CD4+/CD45RA+ naive T cells and CD5– B cells was found. These data may suggest a supporting role of the CD4+/CD45RA+ T cell subset in the specific antibody response to vaccination with influenza virus vaccine in B-CLL patients.
Isolated Pancreatic Extramedullary Hematopoiesis
Authors: Crider Steven , Kroszer-Hamati Agnes , Krishnan Koyamangalath
Published: April 2003

A 59-year-old man with lung cancer, peripheral blood leukocytosis and thrombocytosis without peripheral lymphadenopathy and hepatosplenomegaly was found to have pancreatic extramedullary hematopoiesis (EMH) in association with an ‘atypical’ myeloproliferative disorder. Studies for the Philadelphia chromosome and bcr-abl fusion product were negative. This is the first documented case in the literature of isolated EMH in the pancreas.
Bone Marrow Dysplasia with Basophilic Cells in a Patient with Angiocentric Lymphoma
Authors: Mori Akio , Hashino Satoshi , Imamura Masahiro , Kahata Kaoru , Kawakami Hiroshi , Kobayashi Sumiko , Tanaka Junji , Musashi Manabu , Asaka Masahiro
Published: April 2003

We report a 46-year-old man suffering from angiocentric lymphoma of the skin. On admission, he had atypical cells rich in basophilic granules in the bone marrow and peripheral blood, in addition to skin eruptions and bone marrow dysplasia. Immediately after diagnosis, the patient was treated with multidrug combination chemotherapy. At first, the chemotherapy markedly relieved the skin eruption and bone marrow dysplasia, and atypical cells in the bone marrow and peripheral blood disappeared rapidly. However, the disease gradually became resistant to chemotherapy, resulting in a gradual deterioration of the skin eruption and bone marrow dysplasia, and reappearance of atypical cells. The levels of serum cytokines such as interleukin-4 and interleukin-6, and of soluble interleukin-2 receptor correlated well with the disease states. These results suggest that the lymphoma cells directly or indirectly induce the production of these cytokines and that a dysregulated cytokine network, which might be caused by lymphoma cells, induces an increase in atypical cells.
Immune Response and Neurotrophic Factor Interactions in Peripheral Nerve Transplants
Authors: Gulati Adarsh K.
Published: April 2003

Several types of immunocompetent cells of hematopoietic origin are involved in determining the immunological and regenerative fate of peripheral nerve transplants used for neurosurgical repair. The present study compares the immunological fate of nerve isografts and allografts with emphasis on the immunobiological events and neurotrophic interactions leading to graft survival and nerve fiber regeneration through them. The nerve transplantation model is unique as tissue rejection/inflammation is observed along with the nerve regeneration process. Nerve grafts become vascularized within a few days via neovascularization after transplantation. This is followed by progressive invasion of host macrophages and T lymphocytes that recognize the histocompatible antigens and initiate the rejection response. Two main types of donor resident cells are involved in early stages of graft rejection. These are macrophages and Schwann cells. Both of these cells have been found to possess antigen-presenting function and also can produce several cytokines. The most relevant to the peripheral nerves are tumor necrosis factor (TNF-α), interleukin-1 (IL-1), interferon-γ (IFN-γ) and IL-12. TNF-α in addition to its capacity to kill cells is involved in activation of macrophages. IL-12 and IFN-γ have a potential role in modulating and enhancing of the immune response. Finally, IL-1 is of special significance because it promotes the expression of nerve growth factor (NGF) by the Schwann cells of the peripheral nerve and is important for nerve fiber regeneration. NGF in turn has been shown to enhance macrophage function and inflammatory response. Taken together, these findings show that NGF levels and inflammation in injured tissue play an important role in determining the success of transplants and in tissue repair.
Cytokines and Soluble Adhesion Molecules in Sickle Cell Anemia Patients during Hydroxyurea Therapy
Authors: Saleh A.W. , Duits A.J. , Gerbers A. , de Vries C. , Hillen H.F.P.
Published: April 2003

Hydroxyurea (HU) induces HbF production and can reduce painful crises in some patients with sickle cell anemia (SS). However, HbF induction alone cannot explain the beneficial effect of HU treatment as some patients experience clinical improvement while showing only minor increases in HbF. Other actions of HU, in particular its effects on vascular endothelium, adhesion molecule expression and cytokine production may also play a role in the final therapeutic outcome. In order to analyze these effects we studied the levels of interleukin-3 (IL-3), interleukin-6, granulocyte-macrophage colony-stimulating factor, erythropoietin, stem cell factor, soluble vascular adhesion molecule-1, soluble intercellular adhesion molecule-1, soluble E-selectin and soluble P-selectin in 7 SS patients before and during 5 months of HU treatment. Use of HU seems to have no detectable effect on soluble adhesion molecules, but the steady state levels of soluble vascular adhesion molecule-1 are enhanced in SS patients compared to normal controls. Of the cytokines studied, only IL-3 showed an increase during therapy, suggesting HU may induce early erythroid progenitors capable of producing HbF by a direct or indirect effect on IL-3 production. Remarkably, the steady state stem cell factor levels in sickle cell patients seemed to be decreased compared to healthy controls.
A Novel Variant of B-Lymphoid Leukemia Expressing Kappa/Lambda Light Chains
Authors: Kawada Hiroshi , Fukuda Ryuki , Yoshida Miyoko , Kawakami Takeshi , Kawada Tsutomu , Miyachi Hayato , Tsutsumi Yutaka , Yonekura Shuji , Ichikawa Yukinobu , Hotta Tomomitsu
Published: April 2003

We studied a patient with an indolent leukemia which behaved similarly to chronic lymphocytic leukemia (CLL). Leukemic cells, however, showed larger cell diameters and lower nuclear/cytoplasmic ratios than typical CLL cells, and contained numerous cytoplasmic vacuoles. The cells also demonstrated some morphologic characteristics of hairy cell leukemia. Furthermore, flow-cytometric analysis demonstrated a distinct population of κ/λ double-positive tumor cells, as well as κ single and λ single populations. Southern blot analysis confirmed rearranged bands for both light chains with a monoclonal heavy chain rearrangement. Despite a decision not to treat this asymptomatic patient, disease progression was not observed. This case may represent a unique variant of B lymphoid leukemia. Possible mechanisms of abnormal light chain expression are discussed.
Rabbit IgG Antibodies against Cord Red Blood Cell Membranes Bind to Complement Receptor 1 (CD35)
Authors: Giuliani Anna Lisa , Pora Roberto , Verenini Marina , Unis Lorenza , Graldi Giuseppe , Ferrari Luisa , Lanza Francesco , Wiener Edith , Lutz Hans U. , Vesce Fortunato , Berti Gilberto
Published: April 2003

We have previously shown that a subpopulation of cord/fetal red blood cells (RBC) binds rabbit IgG antibodies raised against cord RBC and absorbed on adult RBC (F-IgG), while control IgG, raised against and absorbed on adult RBC (A-IgG), fails to do so. In the present study, F-IgG maintained its binding to cord RBC surface antigens following absorption on spectrin but not after absorption on skeleton-stripped RBC membranes. Spectrin-absorbed F-IgG- but not A-IgG-affinity-purified material from cord RBC contained polypeptides with apparent MW of complement receptor 1 (CR1) allotypes. Moreover, on immunoblotting these polypeptides reacted with 125I-F-IgG as well as with 125I-anti-CR1 mAb, and binding of 125I-anti-CR1 mAb was inhibited by unlabelled F-IgG. In addition, cord RBC incubated with F-IgG prior to reaction with anti-CR1 showed decreased fluorescence intensity on flow cytometry. Taken together the results suggest that F-IgG binds to CR1 which shows increased expression/accessibility on a subpopulation of cord/fetal RBC.