bluuebunny/crossref_metadata_2025 huggingface dataset:
The Unified Biosocial Model of Personality in Schizophrenia Families and Controls
Authors: Stompe T. , Willinger U. , Fischer G. , Meszaros K. , Berger P. , Strobl R. , Berger K. , Isenberg E. , Todd R.D. , Cloninger C.R. , Reich T. , Aschauer H.N.
Published: April 2003

This report describes the application of a unified biosocial model of personality developed by C.R. Cloninger to a sample of families identified through a proband with schizophrenia and a sample of controls. Families of schizophrenic patients were ascertained in USA and Austria. We could detect differences between females and males in their response to positive reinforcement (Reward Dependence) and differences between young and old people with respect to the response to new and/or exciting situations (Novelty Seeking). In general, results obtained for individuals from schizophrenia families and controls were similar. These results are not substantially influenced by psychiatric disorders in individuals. Psychiatric diagnosis may have an influence on the third dimension of Cloninger’s model, designated Harm Avoidance. Analysis showed that patients with a diagnosis of schizophrenia or from the schizophrenia spectrum try harder to avoid punishment or aversive stimuli than family members with another psychiatric disorder or without a psychiatric diagnosis as well as controls. The results are promising and further research is needed to evaluate the structure of the proposed personality model in families and the relationship of personality to psychiatric status.
‘Alice in Wonderland’ Syndrome as a Precursor of Depressive Disorder
Authors: Mizuno, Masafumi , Kashima, Haruo , Chiba, Hiromi , Murakami, Masaaki , Asai Masahiro
Published: April 2003

A 54-year-old Japanese businessman who was found to exhibit the ‘Alice in Wonderland’ syndrome and went on to develop a depressive disorder is described. Lengthening and shortening of time experience continued intermittently for about 3 months, and metamorphopsia, distortion of body image, and the quick-motion phenomenon (alteration in time sense) persisted for almost 2 days without interruption. There were no abnormal physical findings. The authors review studies on ‘Alice in Wonderland’ syndrome and suggest that depressive illness may be a causal factor.
Patterns of Relation and Premorbid Personality in Late Paraphrenia and Depression
Authors: Fuchs Thomas
Published: April 2003

38 patients with late paraphrenia and 38 with endogenous depression of late onset were compared regarding interpersonal relations and personality traits by means of semistructured interviews. The prevalence of premorbid personality disorder was determined by the Structured Clinical Interview for DSM-III-R Personality Disorders. The main objective of the study was to look for lifetime relation patterns and personality traits distinguishing the two groups and pointing to a specific premorbid vulnerability of paranoid and depressive patients. A high rate of personality disorder comorbidity was found in both groups, with mainly paranoid and schizoid disorder in late paraphrenic patients (39%) and avoidant, dependent or compulsive personality in depressives (35%). As a rule, this corresponded to a lifelong pattern of seclusion and self-sufficiency in the paranoid, and of close intimacy and heteronomy in the depressive patients. On the basis of the results, a polar typology of personality and interpersonal relations in both patient groups is developed.
Quality of Life in Psychiatry as an Ethical Duty: From the Clinical to the Societal Perspective
Authors: Kilian Reinhold , Angermeyer Matthias
Published: April 2003

It is the aim of this paper to discuss the ethical roots of the concept of quality of life and the historical background of its introduction into mental health service evaluation research. It will be argued that the original broad meaning of the quality of life concept has been brought closely in line with the clinical view, neglecting the ethical and the societal dimensions of this concept. In conclusion, expansion of the scope of quality of life research in psychiatry from a clinical to a societal perspective will be suggested. On the basis of this argument, seven research questions concerning the most important nonclinical factors influencing the quality of life of mentally ill patients will be formulated.
Winter Depression with Spring Exacerbation: A Frequent Occurrence in Women with Seasonal Affective Disorder
Authors: Lingjærde Odd , Føreland Anne Regine
Published: April 2003

Winter depression (WD) usually starts in October/November and remits in February/March, but some experience a relatively short depressive exacerbation in spring. To further characterize this spring exacerbation (SE), 84 previously diagnosed WD patients rated in retrospect whether they had experienced SE after their otherwise typical WD in the years before receiving active treatment. Thirty-nine percent of the women and 12% of the men reported to have experienced SE many times or practically every year; another 28 and 29%, respectively, had experienced SE a few times. In general, the symptomatology during SE was about the same as during WD. Female patients who had experienced SE many times or practically every year were marginally older (p = 0.05) and had suffered many more previous WD episodes (p = 0.0005) than female patients having experienced SE only a few times or never.
Stereotypies: Prevalence and Association with Compulsive and Impulsive Symptoms in College Students
Authors: Niehaus Dana J. , Emsley Robin A. , Brink Paul , Stein Dan J.
Published: April 2003

Background: Although stereotypic behaviors have been well described in patients with mental retardation, there has been relatively little work on the prevalence and nature of these phenomena in intellectually normal subjects. Stereotypies may conceivably be related to obsessive-compulsive disorder, to perfectionism, or to impulse dyscontrol. Methods: This study attempted to assess the prevalence of stereotypic behaviors in a college population and to determine their relationship to compulsive and impulsive symptoms and traits by means of self-rated questionnaires. Questionnaires assessed stereotypies as well as obsessive-compulsive symptoms, perfectionism, and impulsive-aggressive traits. Results: Stereotypic behaviors were common in this population, and they were time-consuming or problematic in a subgroup of subjects. The total number of stereotypic behaviors was significantly associated with increased scores of obsessive-compulsive symptoms, of perfectionism, and of impulsive-aggressive traits. Other measures of the severity of stereotypic behavior were also associated with obsessive-compulsive symptoms and perfectionism. Conclusions: Although the nature of stereotypic behaviors is not well understood, these phenomena can be clinically important in intellectually normal subjects. Stereotypic behaviors deserve further attention from researchers and clinicians.
Bipolar II Disorder and Its Premorbid Personality
Authors: Takata Tomoji , Takaoka Ken
Published: April 2003

This study psychopathologically analyzes and compares the premorbid personalities associated with bipolar II disorder and unipolar depression. Using Cloninger’s tridimensional personality theory, we evaluated 14 inpatients with bipolar II disorder and 14 inpatients with unipolar depression. The results indicate that the premorbid personality associated with bipolar II disorder is characterized as ‘the reward-dependent, passive-avoidant/dependent tendency of personality’ or ‘the dependent tendency of personality’. We also clarified that atypical symptoms of bipolar II disorder, such as the hypomanic state and the mixed state, were induced by the mingling of this tendency with the melancholic personality type (Tellenbach) or the cycloid personality type (Kretschmer), both of which are based on syntony (Minkowski), categorized by the use of an obsessional defense mechanism to maintain stable social relations. When an insufficiency in the obsessional defense weakens the syntony, the dependent tendency engenders the symptoms stated above. Although few serious problems associated with the dependent tendency may have occurred previously, it may have resulted in conflicts with others after onset of the bipolar II disorder. Therefore, psychotherapy for these conflicts is necessary along with the administration of mood stabilizers.
Pain Complaints in Depressed Inpatients
Authors: Corruble E. , Guelfi J.D.
Published: April 2003

Pain complaints were assessed in 150 depressed inpatients at admission (D0), after 10 days (D10) and 28 days of treatment (D28) using the Symptom Check List, 90 items, revised version (SCL-90R). Pain complaints were present in 92% of patients at D0, several pain complaints being reported by 76% of patients. Headache and chest pain were more frequent in women, whereas myalgia and numbness were more frequent in men. Pain complaints were related to depressive and anxious complaints as assessed by the SCL-90R, but not to age, suicide attempts and depression severity as assessed by the psychiatrist. Pain complaints decreased between D0 and D10, whereas depression scores decreased both between D0 and D10 and between D10 and D28. As compared to responders to treatment at D28, nonresponders had lower Montgomery and Asberg Depression Rating Scale scores at D0 and higher pain complaint scores at D0 and D10.
Utility of Transfer Factor to Detect Different Bronchodilator Responses in Patients with Chronic Obstructive Pulmonary Disease
Authors: Izquierdo-Alonso J.L. , Sánchez-Hernández I. , Fernández Francés J. , Castelao Naval J. , Carrillo Arias F. , Gallardo Carrasco J.
Published: April 2003

Previous studies have described that there are different types of disease in patients with established chronic obstructive pulmonary disease (COPD) with different clinical course and functional responses. The aim of this study was to evaluate if the presence of low transfer factor (LTF) values can predict the effectiveness of bronchodilator therapy, and to assess whether this group has different risk factors that may be related with the responses. Eighty patients with COPD were evaluated on three occasions. Initial assessment included a standard respiratory questionnaire, blood analysis, skin prick test and baseline lung function, all performed on the first visit. Bronchodilator response was evaluated after low (0.2 mg) and high (1 mg) doses of salbutamol, and after 2 weeks of oral prednisone. In patients with normal TLCO/VA % (NTF), a higher proportion of subjects with previous history of atopy was the only statistically significant difference compared to those with LTF (odds ratio 4.33; 95% confidence interval 1.06–25.15). Although the mean response in forced expiratory volume in 1 s (FEV1) to treatment was analogous in both groups, when bronchodilation was expressed as percent of predicted, there was a clear trend to a lower response in patients with LTF (0.2 mg salbutamol: 6.99 ± 5.64 vs. 8.94 ± 6.61, p = 0.15; 1 mg salbutamol: 10.18 ± 6.37 vs. 13.45 ± 7.90, p < 0.05; oral prednisone: 5.51 ± 6.94 vs. 8.74 ± 10.81, p = 0.06). The percentage of patients who had >12% improvement from that predicted in FEV1 was also lower in this group (42 vs. 72%; p < 0.05). Moreover, TLCO/VA% was significantly lower in those subjects with a negative bronchodilator trial with salbutamol (68 ± 25 vs. 81 ± 26; p < 0.05) and prednisone (69 ± 26 vs. 90 ± 22; p < 0.01). In patients with LTF and NTF, airway responsiveness was only significantly related with basal airflow limitation (LTF, r = 0.44; NTF, r = 0.38). All other interaction terms were not statistically significant. These results indicate that in patiens with similar serverity of COPD, the presence of LTF indicates a decreased probability of a positive bronchodilator response, probably reflecting different pathological lesions. We suggest that transfer factor should be taken into consideration when bronchial response is evaluated in large clinical trials.
Large Tension Bronchogenic Cyst in an Adult Mimicking the Swyer-James Syndrome
Authors: Kollias Vasilios D. , Kantidakis George H. , Panagiotides Hercules C.
Published: April 2003

A case report of a large tension bronchogenic cyst in an adult that appeared as the Swyer-James/Macleod’s syndrome is presented. Despite the thorough preoperative examinations the diagnosis was confirmed only after exploratory thoracotomy and histopathological study.
Pulmonary Gas Exchange in Life-Long Nonsmoking Patients with Diabetes mellitus
Authors: Minette Ph. , Buysschaert M. , Rahier J. , Veriter C. , Frans A.
Published: April 2003

In a companion paper, we have found that the alveolar epithelial basal lamina, endothelial basal lamina and both fused were significantly thicker in 6 autopsied diabetics than in 6 control subjects. The purpose of the present work was to assess whether these lesions have detrimental effects on gas exchange. We investigated 20 life-long nonsmoking subjects: 10 healthy subjects and 10 insulin-dependent diabetics. All of them had one to four diabetic complications of the following organs: kidney, retina, nerves or arteries. Their pulmonary gas exchange and their transfer factor were measured at rest and during two levels of submaximal exercise. Spirometric data, specific airway conductance, transfer factor, transfer coefficient, oxygen consumption and arterial blood gases were normal and almost identical in both groups. In conclusion, the thickening of lung basal laminae has no detrimental effect on pulmonary gas exchange in insulin-dependent diabetics with peripheral complications.
Light’s Criteria Revisited: Consistency and Comparison with New Proposed Alternative Criteria for Separating Pleural Transudates from Exudates
Authors: Romero Santiago , Martinez Adela , Hernandez Luis , Fernandez Cleofe , Espasa Antonia , Candela Alfredo , Martin Concepcion
Published: April 2003

Objectives: The first objective was to assess the diagnostic value of new biochemical criteria proposed to discriminate pleural transudates from exudates and to compare their efficiency with those of Light’s criteria. The second objective of the study was to assess the interstudy variability of the parameters repeatedly determinated in two different groups of patients with pleural effusion. Patients and Methods: We recorded clinical characteristics and final diagnoses and measured pleural fluid (PF) and serum levels of protein, LDH, cholesterol and cholinesterase of 243 patients with pleural effusion. Results: Sixty-one (25%) pleural effusions were transudates and 182 were exudates. The sensitivity (99%) and accuracy (96%) of Light’s criteria were higher than those of the other criteria tested, although the differences with those of the PF LDH-cholesterol combination (96 and 93%) did not show statistical significance. Pleural LDH concentration was the criterion with the highest specificity (95%), being significantly higher (p < 0.05) than that of Light’s criteria. The sensitivity, specificity and accuracy of most criteria tested did not vary when compared with those obtained in a study performed 5 years previously. Conclusions: Light’s criteria remain the criteria of choice for segregating exudates from transudates. Based on cost-efficiency reasons, the PF LDH-cholesterol combination appears as an alternative. Because both sets of criteria misdiagnose a substantial percentage of transudates, exceptions based on good clinical judgment and the complementary use of a more specific criterion, as the PF concentration of LDH, must be considered.
Bronchiolitis obliterans Organizing Pneumonia: A Distinct Pulmonary Complication in Cystic Fibrosis
Authors: Häusler Martin , Meilicke Rainer , Biesterfeld Stefan , Kentrup Heiner , Friedrichs Frank , Kusenbach Gregor
Published: April 2003

Organizing pneumonia in cystic fibrosis has hitherto been considered a nonspecific reparative process. We report on an adult patient with cystic fibrosis and histologically proven bronchiolitis obliterans organizing pneumonia, who experienced sustained clinical improvement under corticosteroid therapy. This case suggests that bronchiolitis obliterans organizing pneumonia may be a distinct pulmonary complication in cystic fibrosis and improve with specific therapy.
Rebreathing KCO and Single Breath KCO Measured at the Same Mean Alveolar Volume Reveal a Physiological Relationship between Unequal Diffusion and Unequal Ventilation in Normal Subjects
Authors: Jansons H. , Fokkens J.K. , van der Tweel I. , Kreukniet J.
Published: April 2003

Background: The single breath (SB) method for determining the transfer factor for carbon monoxide is influenced by an unequal distribution of diffusion and ventilation. The rebreathing (RB) method is thought not to be influenced by these inequalities. Therefore, a comparison of the results of the two methods enables us to investigate unequal ventilation and diffusion. We have previously shown that even in normal subjects unequal ventilation influences the relation between the transfer factor as measured by the RB method and by the SB method. Objectives: To investigate to what extent unequal diffusion influences the relation between the RB and SB transfer factor in normal subjects. Methods: Measurements were performed in 8 normal subjects. Differences in alveolar volume as measured by the RB and SB method were prevented from influencing the results by comparing the RB and SB transfer factor per liter of alveolar volume, i.e. the RB and SB Krogh factor, instead of the RB and SB transfer factor. The effect of the known dependence of the Krogh factor on inspired volume was prevented by measuring the SB Krogh factor at an inspired volume equal to the mean inspired volume of the RB measurement. This SB Krogh factor was compared with the RB Krogh factor calculated as the quotient of the RB transfer factor and the mean alveolar volume during the RB measurement. Results: This RB Krogh factor was always larger than the corresponding SB Krogh factor. The difference was significant (p = 0.006). A high percentage (80%) of the variance in the quotient of the two Krogh factors, which can be considered as a parameter for unequal diffusion, was explained by the variance in the quotient of the mean RB volume and the corresponding SB volume. The latter quotient is a measure of unequal ventilation. Conclusions: The finding suggests a physiological relation between unequal diffusion and unequal ventilation. A plausible explanation was found in the decrease of the Krogh factor with an increasing ratio of inspired volume to residual volume for each part of the lung separately. The consequence is that in the absence of unequal ventilation the RB transfer factor is equal to the SB transfer factor measured at an inspired volume equal to the mean RB inspired volume.
Significance of the Interleukin-1 Receptor Antagonist/Interleukin-1β Ratio as a Prognostic Factor in Patients with Pulmonary Sarcoidosis
Authors: Mikuniya Takeshi , Nagai Sonoko , Takeuchi Minoru , Mio Tadashi , Hoshino Yuma , Miki Hiroyuki , Shigematsu Michio , Hamada Kunio , Izumi Takateru
Published: April 2003

Background: Various factors such as serum angiotensin-converting enzyme (sACE) activity, bronchoalveolar lavage (BAL) fluid lymphocyte percent, CD4/CD8 ratio, and shadows on chest radiograph have been identified as indexes of disease activity in patients with sarcoidosis. However, it remains to be confirmed whether these factors can predict clinical outcomes. Objective: To examine whether the interleukin-1 receptor antagonist (IL-1ra)/IL-1β ratio can predict the clinical course, we prospectively followed the clinical courses of 30 patients with pulmonary sarcoidosis 4 years after measurement of immunoreactive amounts of IL-1ra or IL-1β in the culture supernatants obtained from BAL fluid macrophages. Methods: Immunoreactive amounts of IL-1ra or IL-1β were measured using ELISA. Changes in pulmonary function, sACE activity, and shadows on chest radiographs during observation periods were evaluated as markers of changes in disease activity. Results: We found that the patients whose shadows on chest radiographs showed improvement had a higher molar IL-1ra/IL-1β ratio than the patients whose shadows persistently remained 4 years after BAL examination (p < 0.05). The molar ratio was found to be positively correlated with improvement of percent vital capacity (p < 0.05) and negatively correlated with the ratio of sACE activity at the time of the last observation to sACE activity at the time of BAL (sACELAST/sACEBAL, p < 0.01). The sACELAST/sACEBAL ratio was significantly lower in patients whose shadows on chest radiographs decreased than in those whose shadows remained unchanged (p < 0.005). Conclusion: The IL-1ra/IL-1β ratio in the BAL fluid macrophage culture supernatants in patients with pulmonary sarcoidosis could be a useful marker in predicting the persistence of granulomatous lesions (chronicity).
Absence of Central Microtubules and Transposition in the Ciliary Apparatus of Three Siblings
Authors: Bautista-Harris G. , Julià-Serdà G. , Rodríguez de Castro F. , Santana-Benitez I. , Cabrera-Navarro P.
Published: April 2003

We studied the cases of three siblings with a history of chronic bronchitis and infertility. The electron-microscopic investigation of the tracheal and bronchial biopsies showed a ciliary defect consisting in the absence of the central microtubules and the transposition of a peripheral doublet. This is a rare and infrequently reported abnormality included in the primary ciliary diskinesia syndrome.
Balloon Compression of the Gasserian Ganglion for the Treatment of Trigeminal Neuralgia
Authors: Corrêa Claudio Fernandes , Teixeira Manoel Jacobsen
Published: April 2003

The authors describe the results of the treatment of trigeminal neuralgia by balloon microcompression of the Gasserian ganglion. One hundred and eighty-seven procedures were performed in 158 patients. There were no deaths or complications of clinical importance and pain was relieved in all patients. It was concluded that the treatment of trigeminal neuralgia by the microcompression method is safe, simple, cheap, and is especially recommended in cases of pain affecting the first division of the trigeminal nerve and in clinically ill or non-cooperative patients.
Effect of Fentanyl and Naloxone on a Thalamic Induced Painful Response in Intractable Epileptic Patients
Authors: Velasco, Marcos , Brito, Francisco , Jimenez, Fiacro , Gallegos, Monica , Velasco, Ana Luisa , Velasco Francisco
Published: April 2003

Acute high-frequency (60/s) high-intensity (2,100–2,300 µA) stimulation of the mesial, caudal and inferior portion of the centromedian thalamic region within or close to the parafascicular nucleus produced a sharp, intense, cramp-like painful response localized to the face and shoulder (medial stimulation) or arm and hand (lateral stimulation) contralateral to the stimulation site in 4 intractable epileptic patients in whom depth electrodes had been implanted as a part of a neuroaugmentive procedure for seizure control. This thalamic induced painful response was always accompanied by objective clinical signs (facial gesticulation and contraction of the corresponding muscles) during thalamic stimulation and significant increments in EEG, EKG and respiratory frequencies and EMG muscular tonus from 10 s before to 10 s after thalamic stimulation. Opioid agonists (fentanyl 5.0 µg/kg) and antagonists (naloxone 3.5 µg/kg) were administered to induce and regulate a state of neuroleptanalgesia used for the subcutaneous internalization of the chronic stimulation systems. Under these conditions, we observed that fentanyl greatly attenuated and naloxone increased the intensity of the painful response, as well as the EEG, somatic and vegetative parameters evaluating such a painful response. Differences were significant when one compares the changes in response to electrical stimulation in EEG, EKG, respiration and EMG after the administration of fentanyl (decrease p = 0.001) and naloxone (increase p = 0.01) compared to those obtained after the administration of saline or no drugs during baseline recordings. These data suggest that this thalamic induced painful response is mediated by inhibition or activation of the morphine receptors of the thalamic cells primarily related to the pain process.
Concordance between Functional Magnetic Resonance Imaging and Intraoperative Language Mapping
Authors: Ruge M.I. , Victor J. , Hosain S. , Correa D.D. , Relkin N.R. , Tabar V. , Brennan C. , Gutin P.H. , Hirsch J.
Published: April 2003

Although the correspondence between functional-magnetic resonance imaging (fMRI) representations of the sensorimotor cortex and intraoperative electrophysiology (including somatosensory evoked potential, SSEP, recordings and direct cortical stimulation) has been reported, a similar correspondence between fMRI and intraoperative localization of the language-sensitive cortex is not as well established. The aim of the present study was to evaluate the concordance between fMRI and intraoperative electrophysiology with respect to the localization of the language-sensitive and sensorimotor cortices. We present the results of 21 patients who underwent language and sensorimotor mapping by fMRI and intraoperative electrophysiology including SSEP recordings (n = 21), direct cortical stimulation of motor cortex (n = 15) and direct cortical stimulation of Broca’s and Wernicke’s area (n = 5). When responses were obtained with both methods, localization of function concurred in all cases. These observations suggest that fMRI represents a reliable preoperative tool for the identification of language-sensitive areas.
The Relationship of Imaging Techniques to the Accuracy of Frameless Stereotaxy
Authors: Schulder Michael , Fontana Peter , Lavenhar Marvin A. , Carmel Peter W.
Published: April 2003

Objective: We analyzed the accuracy of a frameless stereotactic system using computed tomographic (CT) and magnetic resonance imaging (MRI) scans of different slice thickness and T1 versus T2 weighting of MRI. Methods: An open skull with graphite pegs fixed to its base was used for all scans. CT scans were done with slice thicknesses of 1, 2 and 3 mm. MRI-visible markers were placed on top of pegs for T1-weighted and T2-weighted MRI scans, which were acquired at thicknesses of 1.5, 3 and 5 mm. For each scan, 3 separate registrations of a probe were performed; the distance between the actual probe location and that displayed on the registered image was noted. Each measurements was repeated 3 times for each registration. Results: Greatest accuracy was achieved with 3-mm-slice CT scans; this was not improved by using thinner slices. T1-weighted 1.5-mm MRI scans were 23% less accurate and T2-weighted 3-mm scans 37% less accurate. Conclusions: Frameless stereotaxy should be done using CT scans when the greatest possible accuracy is desired. There appears to be no advantage to using slice thicknesses less than 3 mm. For most craniotomy applications, T1-weighted MRI using 3-mm slices provides sufficient accuracy. Lesions imaged only on T2-weighted MRI also can be approached with
adequate precision using 3-mm scans.
Usefulness of the Dipole Tracing Method with a Scalp-Skull-Brain Head Model: Relationship between the Epileptic Focus and Equivalent Current Dipole Locations
Authors: Chitoku Shiro , Hoshida Tohru , Hirabayashi Hidehiro , Sakaki Toshisuke
Published: April 2003

Purpose: We examined whether the dipole tracing (DT) method with a realistic three-shell head model and inhomogeneous electric conductivity is useful to estimate the epileptic focus from interictal spikes. Method: This study included 17 temporal lobe epilepsy (TLE) cases, classified into three types as type A (unilateral), type B (intermediate) and type C (bilateral) and 5 extratemporal epilepsy (XTLE) cases. The epileptic areas were determined by noninvasive and/or invasive examinations. Selected interictal spikes were analyzed and the calculated equivalent current dipoles (ECDs) of dipolarity greater than 0.98 were superimposed over the realistic head model in each patient. We evaluated the ECD concentration within and around the epileptic area. Results: In TLE cases, types A showed better ECD concentration (87%) within the epileptic area than other types (type B: 68%; type C: 74%). XTLE exhibited variable ECD distribution within and around the epileptic area. Conclusion: The DT method with a realistic head model and inhomogeneous electric conductivity can be useful to estimate the epileptic area from interictal spikes, especially in unilateral TLE cases.
Obstructive Jaundice: A Unique Presentation of Primary Obstructive Megaureter
Authors: Hemal A.K. , Dorairajan L.N. , Aron M. , Wadhwa S.N.
Published: April 2003

A case of giant hydronephrosis leading to obstructive jaundice due to primary obstructive megaureter in an adult is the subject of this presentation. Giant hydronephrosis due to primary obstructive megaureter in adults is uncommon. This is also the first case of obstructive jaundice due to primary obstructive megaureter reported in the literature. The patient was initially treated with a percutaneous nephrostomy till the jaundice resolved. This was followed by definitive surgery in the form of ureteral tailoring and reimplantation along with nephroplication and nephropexy, with a successful outcome.
Fournier’s Gangrene: Viability Monitoring of SubcutaneouslyTransported Testis following Extensive Debridement by C olor-Coded Duplex Sonography and Nuclear Magnetic Resonance
Authors: Andresen Reimer , Wegner Hartmut E.H.
Published: April 2003

We report the case of a subcutaneously transposed testis after surgical depridement for Fournier’s gangrene. Its viability was successfully monitored using color-coded duplex sonography and nuclear magnetic resonance.
Prostatic Adenocarcinoma Diagnosed by Prostate-Specific Antigen Analysis of Pleural Fluid
Authors: Brown Gordon A. , Ginsberg Phillip C. , Harkaway Richard C.
Published: April 2003

Adenocarcinoma of the prostate may result in a malignant pleural effusion. However, most of these cases involve patients with either a known primary prostate cancer or radiographic evidence of pulmonary metastases. Occasionally, the initial diagnosis of prostate cancer is made because of prostate-specific antigen (PSA) staining cells in the pleural fluid. We report a case of adenocarcinoma of the prostate that was suspected only because of an elevated PSA in the pleural fluid in a patient who lacked malignant cytology, a history of prostate cancer, and radiographic evidence of pulmonary disease.
Selective Interactions between Prostate Fibroblast and Epithelial Cells in Co-Culture Maintain the BPH Phenotype
Authors: Bayne Colin W. , Ross Margaret , Donnelly Frank , Chapman Karen , Buck Colin , Bollina Prasad , Habib Fouad K.
Published: April 2003

Paracrine interactions between primary cultured prostate epithelial cells and stromal fibroblasts were investigated in relation to morphology, growth, androgen sensitivity and secretory activities using co-cultures in which the two populations were separated by a microporous membrane. In this new model system, both cell types maintained several aspects of the differentiated phenotype including the capacity to express 5α-reductase iso-enzymes and androgen receptors, to respond to androgens and to secrete prostate-specific antigen by the epithelial cells. Morphological studies demonstrated that the cells grown in co-culture exhibited round nuclei, tonofibrils and microvilli in epithelial cells and elongated nuclei, large amounts of Golgi apparatus and cilia in the fibroblasts, all indicative of the differentiated state. The co-culture system highlights the importance of the metabolic co-operation between prostate fibroblast and epithelial cells for preserving the phenotypic characteristics associated with the human prostate in vivo.
Potential of Limited Day 21 Post-Chemotherapy CT Scan in Predicting Need for Post-Chemotherapy Surgery in Nonseminomatous Testicular Germ Cell Cancer
Authors: Tsetis Dimitrios , Sharma Amita , Easty Marina , Brown Ivan , Oliver Tim , Chan Otto
Published: April 2003

Nonseminomatous germ cell cancers (NSGCC) have a varied response to chemotherapy, some melting away with resultant cure, some have tumour stem cell necrosis and residual benign disease whilst others are resistant to treatment. The latter two require surgical excision in order to identify those needing high intensity chemotherapy. Objective: The aim of this study was to investigate whether it was possible to give an earlier prediction of need for surgery after chemotherapy on the basis of a limited CT scan performed after the first course. Materials and Methods: Twenty-three patients with metastatic NSGCC undergoing induction chemotherapy were studied. The site of the maximum disease was noted before treatment and only this area was rescanned at day 21. The change in disease bulk, measured as maximum transverse diameter (MTD), was compared with appearances on a CT scan immediately after chemotherapy and post-treatment response. Results: Of those patients showing a poor response on the day 21 scan (i.e. no change, or less than 50% reduction in MTD), 70% required early surgical excision of residual disease, while none of the good responders (i.e. greater than 50% reduction in MTD), required immediate surgery (p < 0.001). Conclusion: It is concluded that a limited day 21 CT scan may represent an independent predictor of good and poor response to chemotherapy, thus enabling reduction in chemotherapy and its toxicity in good responders and early identification of those who may need surgical excision, thereby permitting easier scheduling of these often difficult surgical procedures.
Angiographic Arterial Occlusion and Extra-Anatomical Vascular Bypass for the Management of a Ureteral-Iliac Fistula: Case Report and Review of the Literature
Authors: Gheiler Edward L. , Tefilli Marcos V. , Tiguert Rabi , Friedland Mark S. , Frontera Rene C. , Pontes J. Edson
Published: April 2003

Ureteroarterial fistulas related to nonvascular etiology are rare clinical entities that are difficult to diagnose and manage. Diagnosis is best made by a combination of studies, including digital subtraction angiography. Low morbidity and mortality rates have been described with either percutaneous thrombosis of the iliac artery and extra-anatomic bypass, or by placement of a stented graft in the involved artery. We report on a well-documented case of a ureteroarterial fistula managed successfully with interventional radiologic embolization of the common iliac artery and immediate femoral-femoral arterial bypass. A review of the literature supports this approach.
Reassessing the Role of Urodynamics after Cerebrovascular Accident
Authors: Khorsandi Moez , Ginsberg Phillip C. , Harkaway Richard C.
Published: April 2003

Background and Purpose: To determine whether there is a gender difference in the need for urodynamics in the evaluation of urinary incontinence after cerebrovascular accident (CVA). Materials and Methods: We studied 72 consecutive post-CVA patients with new onset urinary incontinence documented by the patients or the persons who looked after them. Patients were evaluated between 4 and 6 weeks after their CVA and all had negative urine cultures and a postvoid residual urine determination. Exclusion criteria included narrow angle glaucoma, postvoid residual urine greater than 100 cm3 and radiographic evidence for a brainstem infarct. This left 30 male (mean age 65) and 30 female (mean age 67) patients evaluable. Patients were empirically started on anticholinergic medications and timed voids for 4 weeks after which cytoscopy and cystometry were performed. Results: 28/30 females (93%) reported subjective improvement in their continence with conservative measures. 1 (3%) was found to have a urethral diverticulum, and 1 (3%) had uninhibited detrusor contractions that did not improve with medications. In the male group, 20/30 (67%) reported subjective improvement, 5 (17%) developed elevated postvoid residual urine volumes, 3 (10%) were diagnosed with urethral strictures, 1 (3%) had a bladder neck contracture, and 1 (3%) had transitional cell carcinoma in situ in the bladder. Conclusion: In the patient with new onset urinary incontinence in the initial period after CVA, an empiric trial of anticholinergic medications and timed voiding may be warranted in a select population of female patients without urodynamic testing or cystoscopy. This conservative approach may not be appropriate in males because of their increased likelihood of having secondary urologic conditions.
Scrotal Lymphangioma in Children
Authors: Alaminos-Mingorance M. , Sánchez-López-Tello C. , Castejón-Casado J. , Valladares-Mendías J.C. , Martínez-Meca S.
Published: April 2003

The intrascrotal localization of lymphangioma in children is uncommon, especially when the lymphangioma does not depend on testicular structures. We present the case of a 13-year-old male who started with a right intrascrotal mass unconnected with the testicle, clinically and ultrasonically compatible with cystic lymphangioma. The mass was excised because of progressive growth over the previous 5 months, and at surgery a scrotal lymphangioma was disclosed projecting towards the umbilical area through the subcutaneous cell tissue of the anterior abdominal wall. There have been no complications or recurrences to date, 6 months afterwards. Surgical removal is the only efficacious therapeutic approach and is the best way to achieve a definitive diagnosis in these patients.
Clinical Efficacy of Oxybutynin on Sensory Urgency as Compared with That on Motor Urgency
Authors: Hashimoto Kiyoshi , Ohnishi Norio , Esa Atsunobu , Sugiyama Takahide , Park Young-Chol , Kurita Takashi
Published: April 2003

Objective: Anticholinergic drug is widely accepted as an effective medication for frequency, urgency and urge incontinence related to detrusor overactivity (motor urgency). In order to elucidate whether anticholinergic drug is also effective for these symptoms related to bladder hypersensitivity (sensory urgency), clinical efficacy of oxybutynin on sensory urgency was compared with that on motor urgency. Method: Twenty-four patients with sensory urgency, and 53 patients with motor urgency were treated with oxybutynin (6 mg/day) for 4 weeks and subjective and objective efficacies were evaluated. Subjective parameters were quantified with urge score (grade 0–3) and daily numbers of voiding and incontinence. Objective efficacies were evaluated with pre-/ postcomparison of cystometric parameters. Results: Excellent or good overall efficacy was obtained in 62.5% (15/24) of the sensory urgency group and 60.4% (32/53) of the motor urgency group. There was no statistical difference between these two groups. Objective cystometric parameters, bladder volume at first sensation and maximum cystometric capacity, statistically improved after the treatment in both groups. Conclucion: The results suggest that oxybutynin works as well on sensory urgency as it does on motor urgency.
Management of Ureterointestinal Obstruction and Extensive Loss of the Ureter by Creating a Pedicle Tube Graft from the Orthotopic Neobladder
Authors: Bedük Yaşar , Baltaci Sümer , Türkölmez Kadir , Bozkurt Ömer F.
Published: April 2003

We report a case of ureterointestinal obstruction and extensive loss of the ureter following radical cystectomy and orthotopic bladder replacement. The patient was successfully treated by creating a pedicle tube graft from the orthotopic Mainz pouch.
Effect of Fleroxacin on Mouse Bladder Carcinogenesis with N-Butyl-N- (4-Hydroxybutyl) Nitrosamine
Authors: Ebisuno Shoichi , Nishikawa Toru , Kohjimoto Yasuo , Nishihata Masaya , Inagaki Takeshi , Watanabe Toshiyuki , Ohkawa Tadashi
Published: April 2003

We recently reported fleroxacin significantly affected cell proliferation in a dose-dependent manner in transitional cell carcinoma cell lines. In this study, we investigated the effect of fleroxacin on mouse bladder carcinogenesis with N-butyl-N-(4-hydroxybutyl) nitrosamine (BHBN). Five-week-old C57BL/6 female mice were divided into three groups. The forced oral administrations of fleroxacin (10 or 50 mg/kg/day) were done for 1 week, then the 0.05% BHBN was given for 8 or 12 weeks. Fleroxacin treatments were continued until sacrifice. The mice were sacrificed at 4 weeks or 8 weeks latent period after BHBN administration, and the histological changes in the bladder were examined. Our study suggested that fleroxacin tended to suppress the development of bladder carcinoma or the malignant changes induced by a shorter period of BHBN administration (8 weeks) in mice. However, in the group of the BHBN administration for 12 weeks, there were no significant effects on the prevention of bladder carcinoma in both of the treatment groups with fleroxacin (10 or 50 mg/kg/day). This study did not make it clear that oral administration of fleroxacin suppressed the development of bladder carcinoma induced by BHBN in mice. However, it is very preliminary data and further experiments need to be done with a much higher dose of the fleroxacin or with other kinds of fluoroquinolone antibiotics.
Traumatic Dislocation of the Testis
Authors: Yagi Hiroshi , Igawa Mikio , Shiina Hiroaki , Shigeno Kazushi , Yoneda Tatsuaki , Wada Yukihiro
Published: April 2003

We report on a patient having testis dislocated into the superficial crus caused by an accident on a fishing boat. On physical examination, the left hemiscrotum was empty, and a painful mass was palpable inside the left thigh. On sonography, the testis appeared to be normal. Magnetic resonance imaging showed that the mass was located between subcutaneous tissue and muscle layer of the thigh. Surgical intervention was performed, and the left testis was found within the subcutaneous tissue inside the thigh, with slight torsion of the spermatic cord. The testis was fixed in the left hemiscrotum. To our knowledge, traumatic dislocation of the testis into the superficial crus is rare, and only 2 cases have been reported.
Uric Acid Urolithiasis and Crystallization Inhibitors
Authors: Grases F. , Ramis M. , Villacampa A.I. , Costa-Bauzá A.
Published: April 2003

An in vitro study of the inhibitory effects that some substances occasionally present in urine can provoke on the crystallization of uric acid has been performed. The most remarkable crystallization inhibitory effects were produced by mucine at concentrations of >0.5 mg/l. Pentosan polysulfate and chondroitin sulfate also clearly increased the uric acid crystallization times at concentrations of >100 mg/l. Saponins, such as escin and glycyrrhizic acid, also produced a notable delay in uric acid crystallization times at concentrations of >10 mg/l. Similar effects were observed in the presence of a surfactant substance, lauryl sulfate. N-Acetyl-L-cysteine caused crystallization perturbations only when it was present at concentrations of >50 mg/l. Citric acid and phytic acid caused no effects on uric acid crystallization even at the highest concentrations assayed (1,000 and 5 mg/l, respectively). From the results obtained it can be deduced that mainly glycoproteins, glycosaminoglycans and surfactant substances can exert protective effects against uric acid crystallization.
Role of Urologic Evaluation in the Adult Spina bifida Patient
Authors: Persun Michelle L. , Ginsberg Phillip C. , Harmon Justin D. , Harkaway Richard C.
Published: April 2003

Objective: To evaluate a population of adult spina bifida patients performing clean intermittent catheterization (CIC) and determine the indications for urologic consultation and intervention. Methods: We evaluated 52 adults (ages 18–37 years) with a history of lumbar myelomeningocele, all of whom performed CIC and were dry between catheterizations. We excluded 12 patients with conditions potentially predisposing to renal insufficiency (staghorn calculus, n = 3; multiple admissions for pyelonephritis, n = 5; history of vesicoureteral reflux, n = 2, and renal scarring on ultrasound, n = 2), leaving 40 patients evaluable. Each patient kept a catheterization diary for 2 weeks from which an average catheterized volume was recorded. Results: In patients with normal ultrasound and normal serum creatinine (<1.5 mg/dl), there were no individuals (0/20) whose average catheterized volume corresponded to a bladder pressure of >40 cm H2O on cystometry. However, in the patients with hydronephrosis and/or elevated creatinine, 30% (6/20) had average catheterized volumes corresponding to a bladder pressure of >40 cm H2O, and are therefore theoretically at risk for upper tract deterioration. Conclusion: Many spina bifida patients receive urologic care only as children, and those without urinary calculi or urinary incontinence are assumed to be urologically stable. However, certain patients have urodynamic parameters which put them at risk for renal deterioration even if they appear to be problem-free. We recommend a yearly renal ultrasound and serum creatinine determination in all adult spina bifida patients with immediate urologic consultation and urodynamics if either is abnormal.
Paravesical Granuloma after Inguinal Herniorrhaphy
Authors: Kise Hideaki , Shibahara Takuji , Hayashi Norio , Arima Kiminobu , Yanagawa Makoto , Kawamura Juichi
Published: April 2003

Paravesical granuloma after herniorrhaphy is an unusual complication due to infected suture material and often mimics bladder or urachal malignancy. We present 3 cases of this disease and reviewed 21 previously reported cases. Our patients underwent hernial repair 2–7 years before examination and presented urinary symptoms. They were treated with antibiotics and underwent exploration of the inguinal wound infection but the symptoms did not resolve. En bloc excision and partial cystectomy were performed and resulted in complete resolution of the symptoms. It is important to consider paravesical granuloma in patients who had undergone herniorrhaphy in the differential diagnosis of bladder or urachal tumors.
Intra-Arterial Infusion Chemotherapy for Penile Carcinoma with Deep Inguinal Lymph Node Metastasis
Authors: Huang Xu Yuan , Kubota Yoko , Nakada Terahiro , Sasagawa Isoji , Suzuki Hitoshi , Ishigooka Manabu
Published: April 2003

From July 1994 to January 1999, three patients with penile squamous cell carcinoma with deep inguinal lymph node metastases without distant metastases were treated with multimodality treatment including intra-arterial infusion chemotherapy mainly with monthly courses of cisplatin, methotrexate and bleomycin. One patient achieved a complete response and 2 achieved a partial response. It appears to be reasonable to presume that intra-arterial chemotherapy has a benificial effect in the management of penile cancer with fixed metastatic inguinal lymph nodes, but a larger number of patients and longer follow-up are required to confirm these results.
5-Aminolevulinic Acid-Induced Fluorescence Endoscopy for the Detection of Lower Urinary Tract Tumors
Authors: Kriegmair Martin , Zaak Dirk , Knuechel Ruth , Baumgartner Reinhold , Hofstetter Alfons
Published: April 2003

The use of a photodynamic fluorescence marker for diagnosis of tumors is an intriguing concept to improve the thoroughness of surgical tumor resection. Complete surgical resection of multifocal bladder tumors and flat lesions such as carcinoma in situ is known to be difficult, and thus a source of recurrences. We report on the recent experience with the intravesical application of the photosensitizer prodrug 5-aminolevulinic acid (5-ALA), which is a nontoxic physiological heme substrate. Initial results from fluorescence diagnosis using krypton laser light, and recent results with a modified incoherent light source constantly showed a 25% increase in urothelial tumor detection in comparison to white light endoscopy. Due to the high sensitivity, the number of biopsies could be decreased constantly in comparison to routine random biopsies taken under white light endoscopy. The results show about 25–30% of cases with fluorescent lesions which are histologically benign. 5-ALA is a promising tool for the diagnosis of bladder cancer. The outcome of the admission study for 5-ALA in urology in Germany is positive, and is being continued by prospective multicenter clinical studies to prove the hypothesis of reduction of tumor recurrence with this method. 5-ALA-based fluorescence endoscopy is strongly recommended for further clinical testing.