bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between pulmonary microthromboembolism and coagulation variables in hypercoagulable states: An autopsy study
Authors: Katsumura Yukio , Ohtsubo Koh‐Ichiro
Published: March 2003

Objective: This autopsy study was carried out to investigate the relationship between the number of pulmonary microthromboemboli and coagulation tests in patients with coagulation abnormalities.

Methodology: Fifty‐one patients in whom coagulation studies were performed within 2 days prior to death were studied. The coagulation tests included platelet counts, prothrombin times expressed as International Normalized Ratios (INR), activated partial thromboplastin times, fibrinogen concentrations, plasma fibrinogen/fibrin fragment E antigen levels, and plasma D‐dimer levels. For microscopic analysis, five tissue blocks of the lung were taken from each subject and the number of pulmonary microthromboemboli per 20 cm
2 of tissue sections was calculated.

Results: Thirty‐six of the 51 patients had pulmonary microthromboembolism. International Normalized Ratios were higher than 1.7 in 12 of 36 embolic and in two of 15 non‐embolic patients (33.3% of sensitivity and 86.7% of specificity). There was no significant difference in D‐dimer levels between the two groups. Multiple regression analysis identified that INR was significantly related to the number of microthromboemboli (P = 0.042).

Conclusions: D‐dimer levels appear to be inappropriate as a single screening test for disseminated intravascular coagulation (DIC) in critically ill patients because the levels in these subjects are elevated irrespective of the presence of microthromboemboli. Because of the high specificity, INR could be a specific marker for microthromboemboli. The significant association between the number of microthromboemboli and INR might indicate the importance of the extrinsic pathway in the initiation of DIC.
Expression of transforming growth factor‐β1 and tumour necrosis factor‐α in bronchoalveolar lavage cells in murine pulmonary fibrosis after intraperitoneal administration of bleomycin
Authors: Maeda Akihiro , Ishioka Shinichi , Taooka Yasuyuki , Hiyama Keiko , Yamakido Michio
Published: March 2003

Objective:

We previously observed increased expression of interleukin‐1β, platelet‐derived growth factor‐A, and insulin‐like growth factor‐I in bronchoalveolar lavage (BAL) cells during the development of pulmonary fibrosis after an intraperitoneal administration of bleomycin in mice. The purpose of this study was to investigate the roles of tumour necrosis factor (TNF)‐α and transforming growth factor (TGF)‐β1 in this model.

Methodology: We investigated the mRNA expression levels of TNF‐α and TGF‐β1 in BAL cells of Institute for Cancer Research mice after 10 days of the intraperitoneal administration of bleomycin with or without treatment with a specific neutrophil elastase inhibitor, ONO‐5046·Na.

Results: On day 1 but not on days 15 and 29, the relative amount of TGF‐β1 mRNA in the bleomycin‐treated mice was significantly decreased compared with control mice. In the mice treated with both bleomycin and ONO‐5046·Na intermediate values for TGF‐β1 were obtained. No significant differences in TNF‐α expression were observed in any of the treatment groups.

Conclusions: These results suggest that a reduced expression of TGF‐β1 in BAL cells in the early phase may be important during the development of murine pulmonary fibrosis induced by an intraperitoneal administration of bleomycin.
Effects of continuous positive airway pressure on lung function in patients with chronic obstructive pulmonary disease and sleep disordered breathing
Authors: Mansfield Darren , Naughton Matthew T
Published: March 2003

Objective:

Sleep disordered breathing (SDB), namely hypoventilation and obstructive sleep apnoea, occur in about 50% of patients with severe chronic obstructive pulmonary disease (COPD). Previous studies that have investigated the reversal of SDB in such patients with nasally applied intermittent positive airway pressure have reported a fall in PaCO2 but little change in airflow obstruction. We reasoned that the lack of improvement in airflow obstruction may be due to insufficient expiratory pressure. Accordingly, we sought to determine the effects of chronic nasal continuous positive airway pressure (CPAP), at highest tolerable levels, upon blood gases and airflow obstruction in patients with severe COPD and SDB.

Methodology: Fourteen patients were studied, ten of whom were able to tolerate CPAP (10.2 ± 0.9 cmH2O) for at least 3 months.

Results: Within the CPAP compliant group, there was a fall in PaCO2 (58.0 ± 3.5 to 48.0 ± 0.9 mmHg, P = 0.015) associated with a rise in PaO2 (54.8 ± 3.8 to 63.2 ± 1.8 mmHg, P = 0.015) and forced expiratory volume in 1 s (0.95 ± 0.13 to 1.10 ± 0.13 L, P < 0.005). Concurrent with these improvements was a substantial fall in hospitalization rates (from 3.85 to 0.73 admissions per annum).

Conclusion: Improvements in gas exchange, airflow obstruction and hospitalization rates were observed in patients with COPD and SDB treated with nasal CPAP during sleep.
Assessment of factors predicting outcome of acute respiratory distress syndrome in North India
Authors: Gupta Dheeraj , Ramanathan Ramanathan P. , Aggarwal Ashutosh N. , Jindal Surinder K.
Published: March 2003

Objectives: Information on the spectrum and outcome of acute respiratory distress syndrome (ARDS) in tropical countries is scanty. This study was designed to assess the factors predicting the outcome of ARDS in North India.

Methodology: Consecutive patients requiring mechanical ventilation for ARDS over a 2 year period at the Respiratory Intensive Care Unit (RICU) of a tertiary referral hospital were studied. Hospital survival was correlated with age, aetiology, disease severity scores (APACHE III, SAPS II, lung injury score) and organ failure using univariate analysis. Factors significantly influencing mortality were examined by multivariate analysis to identify factors independently affecting outcome.

Results: Sepsis (28.6%), followed by malaria (21.4%), were the commonest risk factors. Seven out of eight patients (87.5%) with sepsis died. The presence of sepsis, more than three organ failure prior to admission, APACHE III score > 57 and SAPS II score > 39 were significantly associated with mortality. Only APACHE III score > 57 or SAPS II score > 39 were, however, independently predictive of a poor outcome following multivariate analysis.

Conclusions: Sepsis, associated with a very poor outcome, and malaria were important risk factors for the development of ARDS. APACHE III score > 57 or SAPS II score > 39 were associated with increased risk of mortality.
Progressive rise of Mycobacterium tuberculosis resistance to rifampicin and streptomycin in Riyadh, Saudi Arabia
Authors: AL‐HAJJAJ MOHAMED SALEH , AL‐KASSIMI FEISAL ABDALLAH , AL‐MOBEIREEK ABDALLAH FAHAD , ALZEER ABDULAZIZ HAMD
Published: March 2003

Objective: The aim of this study was to investigate, for the first time, the factors associated with resistance to antituberculous drugs in Saudi Arabia, and to follow the long‐term trends in drug resistance.

Methodology: A retrospective study of patients with positive Mycobacterium tuberculosis recorded at the Riyadh Tuberculosis Center in 1990 was undertaken. The resistance figures from the same centre for the period July 1996 to June 1997 were reviewed for comparison.

Results: Resistance was significantly higher in those previously treated (71%) than in those who denied previous treatment (34%). There was a trend towards association of resistance with cavitatory, multilobar, and acid fast bacilli‐positive cases. Nationality (Saudis, Yemenis, others) had no significant effect on resistance. The Riyadh Region now has the same high prevalence of rifampicin resistance as previously reported in the Western Region of the Kingdom. The figures on resistance for the years 1986‐88, 1990, and 1996‐97 were: isoniazid 19.5/13.8/11.1%, rifampicin 10/20.7/24.6%, streptomycin 5/22/27.4%, ethambutol 3.7/3.9/1.8%, respectively. The reduction in isoniazid and ethambutol resistance coincided with a rise in resistance to rifampicin and streptomycin. We speculate that this resulted from the fact that isoniazid and ethambutol are restricted only to the treatment of tuberculosis and cannot, by law, be dispensed by general practitioners or private pharmacies. Rifampicin and streptomycin, however, are widely used for brucellosis; an endemic disease in Saudi Arabia where up to 12 weeks of rifampicin therapy is recommended.

Conclusions: There has been a significant increase in rifampicin and streptomycin resistance in Saudi Arabia over the last 10 years. Possible causes include poor compliance and wide use of these two drugs for non‐tuberculosis conditions. These findings could jeopardize the benefits of the directly observed therapy short course policy which is being implemented in Saudi Arabia. Consideration should be given to prohibiting the routine use of rifampicin for the treatment of brucellosis.
Floral ecology, breeding system and pollination in Antigonon leptopus L. (Polygonaceae)
Authors: Raju Aluri Jacob Soloman , Raju V. Kanaka , Victor P. , Naidu S. Appala
Published: March 2003

Antigonon leptopus is a tropical climber, which grows year‐long with alternation between flowering, fruiting and vegetative phases. Dianthesis, temporal dioecy and facultative xenogamy are exhibited by A. leptopus flowers, which are obligately dependent on vectors for pollination. Pollination vectors are unspecialized and promiscuous, even for short‐tongued anthophiles. The flowers are foraged by bees, wasps, flies, butterflies and thrips with the first group playing a key role in pollination. Antigonon leptopus is also capable of thriving by vegetative reproduction. The dual reproductive behavior exhibited by A. leptopus is an adaptation for its survival as a successful weed in tropical latitudes.
Eating disorders in adolescent girls*
Authors: Emans S Jean
Published: March 2003

Abstract Eating disorders are common in contemporary society. New information is emerging on the pathogenesis of anorexia nervosa and bulimia nervosa and includes psychologic, biologic, family, environmental, genetic and social factors. The physician providing care to adolescents is challenged to carry out a careful evaluation and monitor the patient for complications, especially loss of bone mass. Treatment requires a multidisciplinary team.
Cerebral blood flow abnormalities in symptomatic West syndrome: A single photon emission computed tomography study
Authors: Karagöl Ugur , Deda Gülhis , Uysal Serap , Kabakus Nimet , Ibis Erkan , Gençoglu Arzu , Aras Gülseren
Published: March 2003

Background
: Infantile spasm (IS) is an age‐dependent epileptic encephalopathy of variable etiology. Although IS is well studied, its pathogenesis is unclear. Infantile spasm is usually considered a generalized epilepsy, but recent studies point to focal cerebral blood flow (CBF) abnormalities.

Methods
: In six symptomatic IS patients, single photon emission computed tomography (SPECT) with [99mTc]‐HMPAO, electroencephalography (EEG), magnetic resonance imaging (MRI)/computed tomography (CT) and their correlation were evaluated.

Results
: Single photon emission computed tomography showed unifocal (regional) cerebral hypoperfusion in two infants, multifocal (diffuse) cerebral hypoperfusion in three infants and normal perfusion in the other infant. Electroencephalograms obtained in near‐time of the SPECT studies showed diffuse abnormalities in five infants with hypoperfusion on SPECT. Cranial MRI/CT showed diffuse and/or localized cerebral lesions in all infants, all of whom had corresponding areas of hypoperfusion on SPECT. In one patient whose spasms were stopped with anticonvulsants, SPECT was normal, in two patients SPECT showed unifocal lesions, while in another three patients whose spasms were decreased but not stopped, SPECT showed multifocal hypoperfusion.

Conclusions
: This pilot study may indicate that there are CBF anomalies in symptomatic IS. The degree of CBF may be a predictor of prognosis and multifocal hypoperfusion may be a poor prognostic criteria in IS.
A prospective clinical study on inhaled nitric oxide therapy for neonates in Japan
Authors: Yamaguchi Nobuyuki , Togari Hajime , Takase Masashi , Hattori Satoshi , Yamanami Sadao , Hasegawa Hisaya , Hoshino Rikuo , Tamura Masanori , Mimura Shunji , Suzuki Satoshi , Futamura Masahide , Aotani Hirofumi , Sumi Kiyoaki , Kusuda Satoshi , Ichiba Hiroyuki , Yong‐Kye Lee , Uetani Yoshiyuki , Nakao Hideto , Higuchi Ryuzo
Published: March 2003

Background
: This is the first report about a prospective clinical investigation to study the efficacy and safety of nitric oxide (NO) inhalation in infants with persistent pulmonary hypertension of the newborn (PPHN) in Japan.

Methods
: Patients in the present study had to meet the following entry criteria: (i) they had to be younger than 7 days of age; (ii) they had to have evidence of PPHN as defined by echocardiograph; (iii) they had to have severe systemic hypoxemia under mechanical ventilation at 100% oxygen supplementation; and (iv) they had to have a failure to respond to conventional therapies. Patients were excluded from this trial if they had any of the following: hypoplastic lung, structural cardiac lesions or severe multiple anomalies.

Results
: Nitric oxide inhalation therapy was performed in 68 infants who had severe PPHN at 18 hospitals between May 1995 and May 1997. At birth, 21 of 68 infants (31%) weighed less than 1500 g and 39 infants weighed more than 2500 g. The diagnoses associated with PPHN were as follows: 27 infants had meconium aspiration syndrome, 15 infants had dry lung syndrome, nine infants had congenital diaphragmatic hernia, six infants had respiratory distress syndrome, three infants had pneumonia and eight infants had other diagnoses. The mean oxygenation index (OI) before NO inhalation therapy in 68 infants was 43.2; 55 infants (81%) had good responses.

Conclusions
: These results may be valuable for further randomized controlled and double‐blind trials in Japan to evaluate whether NO inhalation therapy is more effective than conventional therapy in infants with severe PPHN.
Effect of vibration on auditory organ systems in low‐birth weight infants treated with high‐frequency oscillatory ventilation: 5 year outcome
Authors: Hosono Shigeharu , Imura Souichi , Akiyama Kazunori , Takigawa Itsurou , Ishizeki Shinobu , Takeda Hiroko
Published: March 2003

Background
: To determine the effects of vibration exposure caused by high‐frequency oscillatory ventilation (HFOV) on the auditory organ systems in low‐birth weight (LBW) infants.

Methods
: Between 1989 and 1990, 30 LBW infants who received assisted ventilation with HFOV (n=14) or conventional mechanical ventilation (CMV; n=16) in the level III neonatal intensive care unit at Tokyo Metropolitan Ohtsuka Hospital were enrolled in this study. The effects of vibration exposure on the auditory system structures were investigated with auditory brainstem responses (ABR) at 37–41 weeks of post‐conceptional age and at 6, 12, 18 and 24 months of age until they passed and follow‐up studies were performed at least until 5 years of age.

Results
: All infants enrolled in the study survived at discharge and one (7.1%) infant in the HFOV group and two (12.5%) in the CMV group failed the initial ABR test, but there were no significant differences between the two groups. Auditory brainstem response abnormalities were still observed in one infant in the HFOV group at 6 months of age, but this child died at 9 months of age because of meningitis. In contrast, in the CMV group, one patient passed the ABR test at 6 months of age, but another remained abnormal at 5 years of age. One of three infants with ABR abnormalities at 6 months of age had neurologic sequelae at 5 years of age and one of 28 infants who passed the initial ABR test was detected with cerebral palsy. No patients with hearing loss were clinically detected at 5 years of age.

Conclusions
: The results of the serial ABR examinations and the 5 year follow‐up studies suggest that vibration exposure caused by HFOV may not increase the adverse effects on the auditory system in LBW infants.
Growth and endocrine function during school age in very low‐birth weight infants
Authors: Takeuchi Toshio , Tanaka Daisuke , Saikawa Noriko , Satoh Hiroyuki , Iwasaki Jyunya , Inoue Makoto , Narui Kenji , Iikura Yoji
Published: March 2003

Abstract

Background
: Short stature and low bodyweight are commonly encountered problems in the clinical follow up of premature infants. However, details about the underlying pathophysiology are unknown in these cases.

Methods
: Evaluations of growth and endocrine function were performed in 23 very low‐birth weight (VLBW) infants between 11.3 and 14.3 years of age.

Results
: The mean (±SD) scores for height and weight were –0.50±0.97 and –0.50±1.10 SD, respectively. Mean serum insulin‐like growth factor (IGF)‐I and urine growth hormone (GH) levels were 402±138 ng/mL and 18.0±17.5 pg/mg creatinine, respectively. Serum IGF‐I and urine GH levels were within the normal range for all patients. The bone age values were consistent with the patient’s true age. Physical signs of puberty were detected in 15 of 23 patients (65%). Using bone ages to predict final adult height yielded a score of –0.52±1.08 SD.

Conclusions
: Despite the almost normal results of serum IGF‐I, urine GH levels and bone age, the physical growth of these VLBW infants was less than that of normal birth weight children, as was their predicted adult growth.
High prevalence of eosinophilia in growth hormone‐deficient children
Authors: Kawada Yasusada , Yamamoto Yukiyo , Noda Masanori , Asayama Kohtaro , Shirahata Akira
Published: March 2003

Abstract

Background
: To determine the clinical significance of eosinophilia in growth‐hormone (GH)‐deficient children, a clinical study consisting of 72 children and adolescents (mean age 9 years and 6 months at diagnosis) with GH deficiency (GHD) was undertaken. Patients were treated with GH, along with supplementation for the combined deficiency in patients with multiple hormone deficiency.

Methods
: A complete blood count and hemogram with microscopic examination of a peripheral blood smear was performed.

Results
: Before treatment, differential eosinophil counts exceeded 5% in 30 subjects (41.7%) and absolute eosinophil counts were >350 /μL in 27 subjects (37.5%). Growth hormone therapy did not significantly affect eosinophil counts. There was an inverse relationship between absolute eosinophil count and peak GH value in response to the

L‐dopa stimulation test (n=65; Rs=–0.252; P=0.044).

Conclusions
: For the diagnosis of GHD, one should take into account that GH response to

L‐dopa stimulation can be selectively blunted in patients with eosinophilia.
Investigation of risk factors for penicillin‐resistant Streptococcus pneumoniae carriage in Turkish children
Authors: Çi̇ftçi̇ Ergi̇n , Aysev Ülker Doğru Derya , İnce Erdal , Güri̇z Haluk
Published: March 2003

Abstract

Background
: Nasopharyngeal colonization plays an important role for infections caused by Streptococcus pneumoniae. Emergence of penicillin resistance in this organism has made it difficult to treat pneumococcal infections. The objectives of this study were to investigate the risk factors for nasopharyngeal colonization with S. pneumonia and for nasopharyngeal colonization with penicillin‐resistant S. pneumoniae.

Methods
: Three hundred children with or without evidence of infection were investigated for various risk factors. Streptococcus pneumoniae isolated from children’s nasopharyngeal swabs were examined for penicillin susceptibility.

Results
: Day‐care attendance (odds ratio OR=2.82, P=0.003) and upper respiratory tract infection within the last month (OR=1.83, P=0.02), have been determined to be risk factors for S. pneumoniae carriage. The use of antibiotics within the last 3 months (OR=81.07, P<0.001), the presence of more than five people living in the house of the child (OR=6.63, P=0.03), and having a sibling under 5‐years‐old (OR=4.60, P=0.03) have been determined to be risk factors for penicillin‐resistant S. pneumoniae carriage.

Conclusion
: Some children are inevitably exposed to and colonized with penicillin susceptible or resistant S. pneumoniae. Changes in day‐care organizations, better living conditions, and restriction of antibiotic use seems to be useful precautions to prevent the emerging and colonization with penicillin‐susceptible or ‐resistant S. pneumoniae.
Interventional treatment for fetus and newborn infant with congenital heart disease
Authors: Satomi Gengi , Yasukochi Satoshi , Imai Toshiro , Takigiku Kiyohiro , Tekehiko Ishida , Harada Yorikazu , Takeuchi Takamasa , Watanabe Makoto , Ishikawa Setsuya
Published: March 2003

Abstract

Background
: Catheter intervention has become popular not only in adult patients but in younger patients with congenital heart disease. The early neonatal catheter interventional treatment has also been attempted in conjunction with the development of prenatal diagnosis of the congenital heart disease.

Method
: Recent articles concerning several severe structural cardiac diseases in newborns, such as critical aortic stenosis, complete transposition of the great arteries, premature constriction of the ductus arteriosus, and pulmonary stenosis or atresia with intact ventricular septum are introduced with consideration.

Results
: This study investigated our own experiences of early neonatal balloon valvuloplasty in a patient with critical aortic stenosis carried out imediately after the delivery following prenatal diagnosis. A case with prenatal diagnosis of premature constriction of ductus arteriosus which could prevent persistent pulmonary hypertension of the newborn by early delivery at 39 weeks and 1 day of gestation were reported.

Conclusion
: Several cardiac interventional treatments performed in the present time during the perinatal period and some prospects in the near future are described in the discussion.
Coronary diameter in normal infants, children and patients with Kawasaki disease
Authors: Kurotobi Shunji , Nagai Toshisaburo , Kawakami Nobuhiro , Sano Tetsuya
Published: March 2003

Background
: The coronary assessments in Kawasaki disease are mainly based on the Japanese Ministry of Health and Welfare criteria, which is simply classified according to the patient’s age, over 5 years and less than 4‐years‐old.

Methods
: We obtained normal values of coronary diameters adjusted for the body surface area and for the coronary anatomical site from 71 healthy children using 2‐D echocardiography. We also studied patients with Kawasaki disease at three stages from the onset of illness: (i) 43 patients at admission; (ii) the subsequent 2–3 weeks; and (iii) 62 children followed at a clinic, for a median 2.2 years after the onset. No patients showed any coronary abnormalities by several echographic exams.

Results
: The coronary diameters were strongly
correlated with the body surface area (r = 0.81
in left main, r = 0.89 in proximal
right, r = 0.89 in left anterior
descending artery). The coronary diameters in the patient groups
at admission and at 2–3 weeks later were significantly
larger than those in the normal group (P < 0.01). Although the coronary diameters in the follow‐up group did not show a significant difference compared with those of normal, 19% retained their coronary diameters at greater than two standard deviations above the expected mean in at least one coronary artery.

Conclusions
: The more strictly defined criteria adjusted for body size and for the anatomical site should be used to detect the subtle changes and to prevent the misclassification of the coronary artery abnormalities in KD.
Trend of neonatal group B streptococcal infection during the last 15 years
Authors: Hoshina Kiyoshi , Suzuki Yoko , Nishida Hiroshi , Kaneko Kazuhiko , Matsuda Seiji , Kobayashi Masumi , Kadoi Nobuaki
Published: March 2003

Background
: The survey was designed to determine the trend of group B streptococcal (GBS) infection during the last 15 years, as well as update the reality of this disease.

Methods
: Questionnaires were administered every 5 years towards neonatal intensive care unit‐equipped hospitals. The first survey was made from 1983 to 1987, the second one from 1988 to 1992 and the third one from 1993 to 1997. The 15‐year questionnaire survey included a total of 831 patients. The changes in number of patients, the ages at onset, the diagnosis, the serotypes of causative agents, the presence or absence of complicated delivery and the prognosis were analyzed.

Results
: It seems that the increasing trend of the number of patients has stopped in the period from 1993 to 1997 (third survey). The most common causative subtype was type III GBS, regardless of early onset type or late onset type. As to perinatal abnormality, approximately 40% of the early onset cases were free from risk factors. Concerning the prognosis, 22.6% of early onset cases and 38.7% of late onset cases died or had sequelae.

Conclusion
: The number of GBS‐infected cases has stopped increasing, but it is still necessary to carry out screenings of pregnant women for the purpose of decreasing the onset of the disease.
Reflections on written comments by women on their abuse
Authors: Pakieser Ruth A. , Lenaghan Patricia A.
Published: March 2003

AbstractIn a study to differentiate injuries of physical abuse from non‐physical abuse, 103 women wrote uninvited comments that were analyzed in two ways: Q‐sort and phenomenology analyses. Q‐sort identified two categories: helplessness and assertiveness. Comparisons with subject responses about current or previous violence indicated that women who wrote assertive comments were less likely to be in a violent relationship than women who wrote helpless comments. Phenomenological analysis indicated that women who were categorized as silent, received or subjective were in abusive relationships; some had been abused on the day of admission. Two women wrote comments considered subjective procedural; both were living with their abuser and stated that the abuse no longer occurred. Health‐care professionals must question the appropriate goal to counsel abused women. Whether these two continua reflect a readiness to leave the relationship or result from having left, the comments by two women who say they are no longer being abused are more assertive and appear to show higher levels of knowing.
Evaluating student learning: An Australian case study
Authors: Edwards Helen E. , Chapman Helen , Nash Robyn E.
Published: March 2003

Abstract Determining the quality of student learning is an ongoing challenge to all educators. However, for educators and students in the health professions, evaluation of learning takes on a different dimension in terms of ensuring that graduates are competent, and thus safe, practitioners. This paper outlines the processes and methods by which student learning has been evaluated throughout a 22‐year period at a large school of nursing in a Australian university. First, a historical overview of the major methods used demonstrates how relevant educational theories and sociopolitical forces and movements have influenced the whole curriculum including evaluation methods. Second, examples of current evaluation methods for undergraduate clinical and theoretical units are described. Reflections about past successes and future challenges conclude the paper.
The Aging Experience of Well Elderly Women: Initial Results
Authors: Duggleby Wendy , Bateman Joan , Singer Shannon
Published: March 2003

In aging research, the concentration of the majority of studies on the effects of disease and other problems has resulted in a view of aging that focuses on losses (Agen, 1998). However, little is actually understood about the aging experience in well elderly women and how they adapt to changes in aging. The purpose of this study was to explore the aging experience among well community‐living older women participating in activities at a seniors’ center. The specific aims were: (i) describe the experience of aging; and (ii) describe how participants deal with aging. A descriptive qualitative focus group design was used. Fourteen women who attend a seniors’ center in a large urban multi‐purpose recreation center in north central Texas participated in focus groups based on their age: young–old (65–74); old–old (75–84) and oldest old (85 years of age and older). The focus group interviews were audiotaped, transcribed and analyzed using content analysis methodology. One member from each focus group confirmed the results. All three age groups described changes in interests, loss of friends, loss of spouse, and retirement. The ‘old–old’ and ‘oldest old’ groups described physical changes that interfered with ‘doing what they did before’. All three groups said the best part about growing older was a sense of freedom and the most difficult was loss of spouse. They all dealt with the changes by maintaining relationships with family and friends, faith, staying physically and mentally active and staying involved. The participants identified seniors’ programs as helping them with changes. However, transportation was an issue. They also described how they needed others to be patient with them as they dealt with their changes.
Effects of insulin treatment on diabetes‐induced alterations in endothelin receptors in rat ureter
Authors: Saito Motoaki , Weiss Robert , Latifpour Jamshid
Published: March 2003

Background: The present investigation was undertaken to examine the effect of insulin treatment on diabetes‐induced alterations in endothelin (ET) receptors in rat ureters.

Methods: The biochemical properties of ET receptors were examined in rat ureters from the following groups: 8 weeks diabetic (D8); 8 weeks age‐matched control (C8); 16 weeks diabetic (D16); 16 weeks diabetic‐insulin treated (insulin started 8 weeks after the onset of diabetes) (DI16); and 16 weeks age‐matched control (C16). Diabetes was induced by the i.v. injection of 65 mg/kg streptozotocin (STZ).

Results: The densities of ET receptors (Bmax values), as determined by saturation experiments with [125I]‐ET‐1, in the ureteral plasma membranes of D8, C8, D16, DI16 and C16 were 91.7 ± 10.1, 42.1 ± 7.2, 71.1 ± 2.4, 51.5 ± 6.3 and 45.1 ± 3.3 fmol/mg of protein, respectively. [125I]‐ET‐1 binding to the ET receptors in rat ureteral membrane particulates was inhibited by ET‐1 (non‐selective), ET‐3 (ETB/C selective), BQ 610 (ETA selective) and IRL 1620 (ETB selective) with the following rank order of Ki values: ET‐1 < BQ 610 < ET‐3 < < IRL 1620. The pharmacological profile of the ET receptors was similar in all groups examined and was consistent with the predominance of the ETA receptor subtype in the ureteral membrane particulates. The subtype specificity of ET receptors in the ureteral tissues is confirmed with inhibition data obtained from similar binding studies in cloned human ETA and ETB receptors.

Conclusion: The data indicate that diabetes results in an up‐regulation of ET receptors in the rat ureter, which is normalized by insulin treatment.
Prospective evaluation of prostate cancer detection by prostate‐specific antigen‐related parameters
Authors: Egawa Shin , Suyama Kazuho , Takashima Rikiya , Mizoguchi Hideyuki , Kuwao Sadahito , Baba Shiroh
Published: March 2003

Abstract
Background
: The diagnostic value of prostate‐specific antigen (PSA) for differentiating prostate cancer from benign prostatic conditions is limited by its lack of specificity. Several PSA‐related parameters have been suggested as enhancing the discriminatory power of total PSA values, but their clinical utility should be considered preliminary until established in a prospectively evaluated cohort.

Methods
: In a prospective cohort study, results of ultrasound‐guided biopsy and/or transurethral resection of the prostate gland were assessed in 706 consecutive Japanese men. The clinical usefulness of total PSA, free PSA, percentage of free PSA, PSA density (PSAD), PSA density for transition zone (PSADT) and gland volume for predicting prostate cancer was investigated using receiver operating characteristic (ROC) curve analysis in 16 different patient subgroups.

Results
: Overall, 150 of the 706 patients (21.2%) had prostate carcinoma. The ROC curve analysis showed that PSAD and PSADT were more powerful predictors of prostate cancer than total PSA in most of the 16 patient subgroups tested. The improvement in performance was modest, however. No substantial difference was noted between PSAD and PSADT. Total gland volume did not significantly affect the performance of these parameters. The use of a PSAD threshold value of 0.11–0.15 ng/mL per cm3 (or a PSADT value of 0.23–0.27 ng/mL per cm3) would have avoided 24–48% (or, for PSADT, 34–40%) of unnecessary biopsies at the cost of missing 5–10% of detectable cancers in a patient subgroup with intermediate total PSA levels. The performance of free PSA and percentage of free PSA was worse than that of any other test in this study. This may be due to inappropriate handling of sera prior to measurement.

Conclusions
: The discriminatory potential of total PSA for predicting prostate cancer was modestly improved by the use of PSAD and PSADT. No substantial advantage of PSADT over PSAD could be demonstrated. Stringent and standardized storage conditions should always be maintained when applying free PSA‐related parameters.
A case of perirenal hemangioma mimicking renal cell carcinoma
Authors: OKUNO TETSUO , ANDO MASAO , ARISAWA CHIZURU , OKANO TADAO
Published: March 2003

Purpose: We present a rare case of perirenal hemangioma that was detected incidentally.

Methods/Results: Radiographic examinations revealed a 3.5 cm mass at the left renal hilum adjacent to the left renal parenchyma, which was difficult to differentially diagnose from renal cell carcinoma. Tumor resection was performed successfully.

Conclusions: There was no recurrence observed 14 months after surgery.
Postchemotherapy retroperitoneal residual mass in infantile yolk sac tumor
Authors: KUO JUNNE‐YIH , HSIEH YUH‐LIN , CHIN TAIWEI , WEI CHOUFU , CHEN KUANG‐KUO , CHANG LUKE, S
Published: March 2003

Background: Persistent postchemotherapy retroperitoneal residual mass with normalization of α‐fetoprotein (AFP) in infantile yolk sac tumor is rare.

Methods/Results: A 38‐month‐old boy with recurrent yolk sac tumor was treated with cisplatin‐based combination chemotherapy. After chemotherapy, the retroperitoneal lymph node metastasis, 7 x 6 cm in size, decreased to 2 x 2 cm. Serum AFP levels returned to normal. The retroperitoneal residual mass was resected and histologically showed complete necrosis without viable cancer cells.

Conclusion: The patient has remained free of disease for 36 months after operation.
Long‐term outcome of endoscopic biopsy and subsequent nephroureterectomy for upper urinary tract tumor
Authors: Minowada Shigeru , Homma Yukio , Takeuchi Takumi , Kamijo Toshiyuki , Kitamura Tadaichi
Published: March 2003

Abstract Background: Upper urinary tract tumors can be biopsied using a flexible ureterorenoscope. This study examined retrospectively possible adverse effects of this procedure on patient outcome.

Methods: The study subjects consisted of 16 consecutive patients with renal pelvic tumor (n = 13) and upper ureteral tumor (n = 3). All subjects underwent endoscopic biopsy of their tumor and subsequent total nephroureterectomy between 1989 and 1995. The follow‐up period ranged from 4.1 to 9.5 (mean 5.2) years.

Results: The overall 5‐year survival rate was 87.0%, being 100% in 12 patients with tumors of grade 1 or 2. In contrast, of four patients with grade 3 tumor, three (75%) developed systemic lymphogenous and/or multiple lung metastases within 1 year postoperatively.

Conclusions: The excellent patient outcomes deny any adverse effect of endoscopic biopsy on patients with grade 1 or 2 tumor. However, the endoscopic procedure should be performed prudently when a high grade tumor is suspected.
Evaluation of the efficacy and safety of laparoscopic nephrectomy
Authors: Yoshimura Kazuhiro , Yoshioka Toshiaki , Miyake Osamu , Nishimura Kazuo , Miyoshi Susumu , Takahara Shiro , Okuyama Akihiko
Published: March 2003

Abstract
Purpose:
To evaluate the efficacy and safety of laparoscopic nephrectomy.

Methods:
From June 1994 to November 1999, 10 patients underwent laparoscopic nephrectomy at Osaka University Medical Hospital and Osaka Rosai Hospital. Laparoscopic nephrectomy was performed either via transperitoneal or retroperitoneal approach under general anesthesia. These 10 cases were reviewed in respect of primary disease of the kidney, operative time, complications and postoperative convalescence.

Results:
Of the 10 patients, five were preoperatively diagnosed as having a non‐functioning kidney with hydronephrosis, two patients were diagnosed as having an atrophic kidney, two had renal cell carcinoma and one had renal pelvic tumor. The average operative time was 374 min (range 270–675 min). The mean blood loss was 330 mL (range 60–800 mL). One patient required transfusion due to postoperative oozing. The average hospital stay after operation was 7 days. No major postoperative complications were observed.

Conclusion:
Laparoscopic nephrectomy is an option in surgically managing renal disorders, including malignancies, although it has a longer operative time compared to conventional open surgery.
Bladder stones around a migrated and missed intrauterine contraceptive device
Authors: Güvel Sezgin , Tekin M. İlteriş , Kilinç Ferhat , Peskircioğlu Levent , Özkardeş Hakan
Published: March 2003

Abstract Bladder stones occasionally develop because of foreign bodies in the bladder. Bladder stones in a 30‐year‐old woman were found to have formed around an intrauterine contraceptive device that had gone missing many years previously and had migrated into the bladder. Plain abdominal radiograms should be a part of the evaluation in patients with a history of an unretrieved intrauterine contraceptive device.
Age‐related prevalence of erectile dysfunction in Japan: Assessment by the International Index of Erectile Function
Authors: Marumo Ken , Nakashima Jun , Murai Masaru
Published: March 2003

Abstract
Background:
The effects of age and concomitant chronic illness on male sexual function were investigated to obtain insight into the prevention of erectile dysfunction (ED).

Methods:
A questionnaire from the International Index of Erectile Function (IIEF) was given to 2311 non‐institutionalized men aged 23–79 years along with a survey of health status. The study sample consisted of 1517 men who provided complete responses to the questionnaire. For statistical analysis, ANOVA was conducted to evaluate the effect of aging on the sexual functions and a logistic regression model was used to identify significant independent risk factors for ED.

Results:
There was a significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. The prevalence of moderate and severe cases of ED were 1.8% and 0% for ages 23–29; 2.6% and 0% for ages 30–39; 7.6% and 1.0% for ages 40–49; 14.0% and 6.0% for ages 50–59; 25.9% and 15.9% for ages 60–69; and 27.9% and 36.4% for ages 70–79 years, respectively. Hypertension, diabetes mellitus, heart disease, chronic hepatitis, disc herniation and cerebral infarction under treatment with anticoagulants were significant independent risk factors for ED.

Conclusions:
The results obtained indicated a significant association between aging and chronic diseases and erectile function. Further epidemiologic research and analysis of individual risk factors are required to allow more effective future strategies for the treatment and prevention of ED.
Assessment of renal function with color Doppler ultrasound in autosomal dominant polycystic kidney disease
Authors: Kondo Akira , Akakura Koichiro , Ito Haruo
Published: March 2003

Abstract Background: Measurement of renal blood flow by color Doppler ultrasound is useful for assessment of renal function in a variety of renal disorders. In autosomal dominant polycystic kidney disease (ADPKD), however, it might be difficult to visualize interlobar arteries because of deformity of renal structure. To evaluate the usefulness of color Doppler in ADPKD, parameters determined by blood flow examination were compared with the results of ordinal renal function tests.

Methods: Twenty‐one patients with ADPKD were examined by color Doppler ultrasound measurement. In each patient, 10 interlobar arteries in both kidneys were investigated. Minimum blood flow velocity (Vmin), maximum blood flow velocity (Vmax), mean blood flow velocity (Vmean), acceleration, resistive index and pulsatility index were measured in relation to the results of creatinine clearance, serum creatinine, blood urea nitrogen and 15 and 120 min values of the phenolsulfonphthalein test.

Results: In all patients, interlobar arteries were able to be visualized and blood‐flow profile was measured. Although variations of Vmin, Vmax, Vmean and acceleration were relatively large, the resistive index and pulsatility index varied little in each kidney. Mean values of Vmin (P < 0.005), Vmean (P < 0.05), resistive index (P < 0.005) and pulsatility index (P < 0.005) were well correlated to creatinine clearance with statistical significance.

Conclusions: In ADPKD, color Doppler ultrasound measurement is a useful method for assessment of renal function and could be used for monitoring the dynamic state of renal blood flow as a non‐invasive technique.
Are tobacco use and urine pH indicated as risk factors for bladder carcinoma?
Authors: Wada Seiji , Yoshimura Rikio , Masuda Chikayoshi , Hase Taro , Ikemoto Shin‐Ichi , Kishimoto Taketoshi , Fukushima Shoji
Published: March 2003

Abstract Background: Many case‐control and cohort studies have shown a positive relationship between bladder carcinoma and tobacco use. Recently, urine pH has been reported to influence aromatic amine carcinogenesis, which have been implicated as potent carcinogens in bladder carcinoma patients. Herein the correlation between bladder carcinoma, tobacco use and urine pH is reported.

Method: One hundred and forty‐one patients with bladder carcinoma and 128 patients with benign prostatic hyperplasia or urolithiasis as controls were selected. All patients were admitted to Osaka City University Hospital for the purpose of surgical treatment. Urine pH was checked by a test tape.

Results: Of the patients with bladder carcinoma, 106 were smokers and 35 were non‐smokers. In contrast, the number of smokers in the control group was 76 and that of non‐smokers was 52. The odds ratio in the bladder carcinoma group calculated for the smoker patients was 2.07, showing a significant correlation between bladder carcinoma and tobacco use. Regarding urine pH, acidic urine was found in 126 patients in the bladder carcinoma group and in 116 patients in the control group. The odds ratio in the bladder carcinoma group for acidic urine was 0.87, showing no significant relationship between bladder carcinoma and urine pH.

Conclusion: The study found a positive relationship between bladder carcinoma and tobacco use; however, it could not establish a clear relationship between bladder carcinoma and urine pH, even in the smoker group.
Urothelial mucosal concentration of levofloxacin administered before transurethral resection: Is the mucosal concentration predictable?
Authors: Hattori Tomotaka , Kimura Go , Kondo Yukihiro , Horiuchi Kazutaka , Tsuboi Narumi , Yoshida Kazuhiro , Akimoto Masao
Published: March 2003

Background: Although it is an established surgical technique, transurethral resection (TUR) is associated with a certain incidence of postoperative bacteriuria. Assessment was made whether the urothelial mucosal concentration of an antibiotic administered before TUR was high enough to decrease the incidence of urinary tract infection (UTI). Also investigated were factors predicting the organ concentration.

Methods: Forty‐nine patients (45 men and four women aged 51–79 years with a median age of 70 years) who underwent TUR between August 1996 and September 1997 were enrolled in the study. Each patient received 200 mg of levofloxacin (LVFX) about two hours before surgery. Blood and bladder urine were collected and urothelial mucosa was harvested at the time of TUR. Then the LVFX concentration in these samples was measured using high‐performance liquid chromatography. The association between drug levels, or the ratio to the serum concentration, and factors likely to affect the vascular system that delivers the drug (age, bodyweight, blood pressure, pulse rate, total cholesterol and diabetes mellitus) were investigated.

Results: The mean serum drug level was 2.4 μg/mL, and it was 206.4 μg/mL in the urine and 5.7 μg/mL in the urothelial mucosa. The mean ratio of the mucosal to serum concentrations was 2.6. The urinary drug concentration showed no association with any of the factors assessed, while the serum concentration decreased with increasing bodyweight (P = 0.03). As the diastolic blood pressure increased, both the mucosal drug concentration and the mucosa/serum ratio decreased (P < 0.01). When the relationship between the serum and mucosal concentrations was investigated, no correlation was found. However, the mucosa/serum ratio (indicating the transfer of LVFX from the blood) was positively correlated with the mucosal concentration.

Conclusion: Preoperative administration of LVFX was demonstrated to have potential value for the prophylaxis of UTI after TUR. Both the mucosal concentration and the mucosa/serum ratio were correlated with the diastolic blood pressure. As the diastolic blood pressure seems to be an indicator of the tissue concentration of LVFX, it may be possible to set the optimum dose based on the diastolic pressure.
A clinical study of urine basic fetoprotein and urine polyamine as tumor markers in epithelial cancer of the urinary tract
Authors: Sato Daisuke , Kase Takahisa , Tajima Masaharu , Sawamura Yoshikatsu , Matsushima Masahiro
Published: March 2003

Abstract Background: The reliability of a new screening test for epithelial cancer of the urinary tract was evaluated and the results were compared with those obtained employing urinary cytology in routine use.

Methods: The subjects consisted of 187 cases selected randomly from among the patients who attended Toho University Ohashi Hospital during a period of 1 year from January 1998. The values for urine basic fetoprotein (BFP) and polyamine and urinary cytology were examined.

Results: Urine BFP is considered useful for screening and monitoring urinary tract epithelial cancer as is urinary cytology. Urine BFP showed a statistically significant difference (P < 0.05) for G1 compared with urinary cytology and a significantly high level compared with urinary cytology as to the positive rate in the low stage group (P < 0.05). The positive rate of urine BFP was high in patients with urinary tract infection.

Conclusion: Determining urine BFP, when combined with urinary cytology, is considered very useful for diagnosing patients with urinary tract epithelial cancer. This study suggests the possibility of urine BFP being superior to urinary cytology for screening early cancer and also as an indicator for observations on the clinical course.
Neurofibroma of the bladder wall in von Recklinghausen's disease
Authors: Aygun Cem , Tekin M. Ilteris , Tarhan Cagla , Ozdemir Handan , Peskircioglu Levent , Ozkardes Hakan
Published: March 2003

Abstract Neurofibromatosis, or von Recklinghausen's disease, is an autosomal dominant disease with multiple neurofibroma and café‐au‐lait spots. However, neurofibroma in the bladder wall is a rare condition in von Recklinghausen's disease. A 31‐year‐old man with neurogenic voiding dysfunction due to sacral meningocele and acute urinary retention with neurofibroma of the bladder wall is presented with detailed radiologic evaluation. Patients with von Recklinghausen's disease should be carefully evaluated if urological symptoms exist.