bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung Function Decline in 4-Monthly Repeated Spirometric Measurements: Due to Silt Aerosol Exposure or Decreasing Effort?
Authors: Radon K. , Wegner R. , Szadkowski D.
Published: April 2003

Background: Workers on dredgers and lighters on rivers are exposed to the inhalation of aerosols and dusts. Objective: The aim of this study was to investigate effects of river silt aerosol and dust exposure on the respiratory health of dredging employees. Methods: Six examinations were performed over a period of 2 years at 4-monthly intervals in 54 seamen with higher silt aerosol exposure and 36 controls of the same employer. Results: No significant differences could be observed between the groups at any time of the study but there was an unexpected significant decrease in the age-corrected expiratory vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and midexpiratory flow rate (MMEF25/75) over the six series in both groups. This may indicate a loss of effort of the participants in re-examinations since biological and technical influences were highly unlikely to be the cause of these findings. Conclusions: Ignoring this possible decline of effort in frequently repeated measurements may result in overestimating potential effects of occupational exposure.
Detection of CMV Pneumonitis after Lung Transplantation Using PCR of DNA from Bronchoalveolar Lavage Cells
Authors: Bewig Burkhard , Haacke Thyra Caroline , Tiroke Andreas , Bastian Andreas , Böttcher Heidi , Hirt Stefan W. , Rautenberg P. , Haverich Axel
Published: April 2003

Background: Cytomegalovirus (CMV) is known as a common pathogen causing infections after lung transplantation. Rapid diagnosis of CMV infection is important for the initiation of a specific treatment. Objective: Evaluation of methods for the rapid diagnosis of CMV pneumonitis. Methods: The detection rates of CMV DNA in bronchoalveolar lavage (BAL) and bronchial brushes by polymerase chain reaction (PCR), of viral antigens (p52 and IE1) in BAL and of pp65 antigen in peripheral blood leukocytes were compared to the clinical status after lung transplantation. In 28 patients, 105 BAL, 96 blood samples and 14 brushes were analyzed. Results: In 6 patients, a total of eight episodes of CMV pneumonitis occurred. Five of the 6 with positive CMV antigens in BAL (p52 or IE1) showed signs of CMV pneumonitis. All episodes of CMV pneumonitis were detected by the PCR of BAL cells. Fourteen samples positive for CMV pp65 antigen in blood were negative in BAL PCR. In these cases, no clinical signs of pulmonary CMV infection occurred. Overall sensitivity, specificity, and positive and negative predictive values for the detection of CMV pneumonitis by PCR of BAL cells were 100, 98.9, 88.9 and 100%, respectively. In brush samples, PCR did not provide additional information to the results of the PCR of BAL cells. Conclusions: PCR of DNA from BAL cells is suitable for reliable and rapid detection of CMV pneumonitis.
Miliary Sarcoidosis following Miliary Tuberculosis
Authors: Hatzakis K. , Siafakas N.M. , Bouros D.
Published: April 2003

A patient who presented with a miliary radiographic pattern due to tuberculosis and later with a similar miliary pattern due to sarcoidosis is described. The patient, a 47-year-old man, was admitted to the hospital due to coughing, weakness, weight loss and an abnormal chest radiograph with a miliary pattern. A gastric fluid culture was positive for Mycobacterium tuberculosis and he was treated appropriately. He showed complete clinical and radiological remission. One year later he presented with a dry cough and a similar miliary pattern on the chest roentgenogram. Lung biopsy taken by thoracoscopy revealed sarcoidosis. The patient had a complete remission with corticosteroids. To our knowledge, this is the first report describing a miliary pattern as presenting radiological sign in a patient with tuberculosis who subsequently developed a new miliary pattern due to sarcoidosis.
High-Resolution Computed Tomography in Cases with Environmental Exposure to Asbestos in Turkey
Authors: Topçu Füsun , Bayram Hasan , Şimşek Masum , Kaya Kenan , Özcan Ceyhan , Işık Recep , Şenyiğit Abdurrahman
Published: April 2003

Background and Objectives: Although all parts of the lung can be affected as a consequence of asbestos exposure, most CT protocols tend to scan only the middle and lower parts of the thorax. The aim of this study was to investigate parenchymal and pleural lesions of persons exposed to environmental asbestos, using a high-resolution computed tomography (HRCT) protocol scanning the whole thorax. Methods: We analyzed the chest radiographs and HRCT scans of 26 patients who presented bilaterally with multiple pleural plaques related to environmental asbestos exposure. Results: Twenty-four cases (92%) had an abnormal HRCT suggestive of asbestosis. Apart from common HRCT changes related to asbestosis, we detected apical pleural thickening (APT) in 9 cases as well as a coarse honeycomb pattern adjacent to APT in 7 of these cases. Cavitary lesions due to pulmonary tuberculosis were observed on HRCT scans from 4 patients in total. Neither apical pulmonary fibrosis nor cavitary lesions were visible on chest radiographs. Conclusions: We suggest that the HRCT protocol for examining asbestos-exposed individuals with pleural plaques on chest X-rays should include the whole thorax, since the asbestos-related pathologies may involve all parts of the lung.
Geriatric Men at Altitude: Hypoxic Ventilatory Sensitivity and Blood Dopamine Changes
Authors: Serebrovskaya T.V. , Karaban I.N. , Kolesnikova E.E. , Mishunina T.M. , Swanson R.J. , Beloshitsky P.V. , Ilyin V.N. , Krasuk A.N. , Safronova O.S. , Kuzminskaya L.A.
Published: April 2003

Background: Short-term exposure to high-altitude hypoxia increases hypoxic ventilatory sensitivity (HVS) in healthy humans. Dopamine (DA) is the implicated neurotransmitter in carotid body (CB) chemoreceptor response, and the microenvironmental conditions in CB tissue are comparable to blood. Continuous DA infusion affected ventilation in animals and humans. Age-related oscillations in blood DA levels may influence peripheral chemoreflexes. Objective: Hypoxic ventilatory responses (HVR) relative to blood DA concentration and its precursor, dihydroxyphenylalanine (DOPA) was measured in young and elderly men during short-term altitude adaptation. Methods: Nine elderly climbers (group 1: 61 ± 1.4 years) and 7 young healthy subjects (group 2: 23 ± 2 years) were tested at sea level on day 0, on day 3 after passive transport to 2,200 m, and on day 14 after climbing to 4,200 and 5,642 m. Results: Sea level HVR in group 1 was 47% lower than in group 2, accompanied by higher blood DOPA (300%) and DA (37%) content. Initial DA and DOPA concentrations showed a negative correlation with initial HVR but a positive correlation with age. Passive transport to middle altitude (2,200 m) increased HVS, doubling HVR slopes in groups 1 and 2 and producing increased maximum expired minute ventilation during isocapnic rebreathing (29 and 28%, respectively). Day 3 2,200-meter blood DOPA content decreased by 22% in group 1 and increased by 300% in group 2. DA increased in both groups. Conclusion: The relationship between HVR and the reciprocal DA and DOPA values seen in both groups is associated with age, producing decreased DA receptor sensitivity and enhanced DA reuptake during adaptation to high altitude.
Influence of Oxygen Concentration on Argon Plasma Coagulation-Induced Tissue Damage in Isolated Pig Tracheas
Authors: Schreiber J. , Hofman B. , Schumann H.J. , Rosahl W.
Published: April 2003

Background: Argon plasma coagulation (APC) is used during bronchoscopy to restore passage of central airways. Concern has been raised about the possibility that elevated oxygen concentration may increase the tissue damage by APC. Objective: to examine the extent of tissue damage at different concentrations of oxygen in isolated pig tracheas. Methods: The APC-induced tissue damage was investigated macroscopically and microscopically in isolated and artificially ventilated pig tracheas at oxygen concentrations of 21, 50, 75 and 100%. Results: There was deep coagulation of all tissue layers reaching the adventitia independent of the oxygen concentration up to 75% O2. With 100% O2, only tissue damage increased and combustion occurred. Conclusions: APC-induced tissue damage in ex vivo pig tracheas was independent of the oxygen concentration relevant for clinical practice.
Clinical Features Associated with a Delayed Diagnosis of Cystic Fibrosis
Authors: McCloskey M. , Redmond A.O.B. , Hill A. , Elborn J.S.
Published: April 2003

Background: The majority of patients with cystic fibrosis (CF) are diagnosed in the first decade of life. In a small number of patients, the diagnosis is not made until later. Objective: In this study, the clinical and genetic features of patients diagnosed after the age of 10 were examined. Methods: All living patients in Northern Ireland diagnosed prior to 1983, when neonatal screening was introduced, were studied. A total of 103 patients were identified of whom 18 were diagnosed after the age of 10. The relationships between late diagnosis and clinical presentation, sputum microbiology, pancreatic sufficiency, nutritional status, genotype and distance from the regional CF centres was determined by multiple regression analysis. Results: All 18 late-diagnosed patients had a sweat (chloride >70 mmol/l). Late diagnosis was significantly related to carriage of the R117H mutation (r2 = 0.45) and pancreatic sufficiency (r2 = 0.37). There was a weak relationship with pulmonary function (r2 = 0.09). Conclusions: In Northern Ireland, late diagnosis in mainly associated with pancreatic function and carriage of the R117H mutation.
Pleural SC5b-9: A Test for Identifying Complicated Parapneumonic Effusions
Authors: Vives M. , Porcel J.M. , Gázquez I. , Pérez B. , Rubio M.
Published: April 2003

Background and Objective: We have tested whether the complement activation products SC5b-9 and C3a-desArg are useful to distinguish complicated (CPE) from uncomplicated parapneumonic effusions (UPE). Design: A total of 66 patients were enrolled in the study: 5 with empyema, 19 with CPE, 12 with UPE, and 30 transudates who served as controls. SC5b-9 and C3a-desArg were measured by commercial ELISA tests, and their performances were evaluated using receiver operating characteristic (ROC) analysis. Results: Patients with CPE had higher mean levels of pleural SC5b-9 (8,218 μg/l) and C3a-desArg (8,790 μg/l) than those with UPE (2,227 and 3,772 μg/l, respectively; p < 0.0001), whereas concentrations in the latter were comparable with controls for the SC5b-9 test. Empyemas had a wide range of pleural complement activation product values. Pleural SC5b-9 and C3a-desArg showed very high diagnostic accuracy in the diagnosis CPE (90.3 and 77.8%, respectively) when corresponding cutoff points of 2,000 and 4,000 μg/l were used. In a stepwise logistic regression analysis, the combination of SC5b-9 ≥2,000 μg/l, LDH ≥1,000 U/l and a pleural polymorphonuclear percentage ≥85% provided the highest discriminative power for the diagnosis of CPE (area under ROC curve 0.97). Conclusion: This pilot study suggests that measurement of pleural SC5b-9 can be useful in the workup of patients with a parapneumonic effusion in order to differentiate CPE from UPE.
Anatomical Structures in the Leksell Pallidotomy Target
Authors: Patil Arun-Angelo , Hahn Francis , Sierra-Rodriguez Jeorge , Traverse John , Wang Stephanie
Published: April 2003

Objective: Because interruption of pallidal outflow signals by pallidotomy is believed to play an important role in the motor improvement in Parkinson’s disease, the anatomical relationship of the two major pallidofugal tracts, namely the ansa lenticularis (AL) and the fasciculus lenticularis (FL) to the Leksell pallidotomy target (LPT) were studied. Methods: Magnetic resonance (MR) scans of 20 patients with Parkinson’s disease were studied. The scans were obtained in the inversion recovery and fast spin echo sequences and viewed in the reverse video mode. Results: The pallidofugal tracts appeared as bands of high intensity on MR scan. FL was wide and extended from the posterior half of the globus pallidus interna (GPi) medially into the internal capsule. AL was narrow, parallel and posterior to the anterior commissure, parallel to and 3 mm above the optic tract, and just beneath the FL. The part of the FL immediately lateral to the internal capsule overlapped the lateral end of the AL. The center of this overlapping area was termed the ‘operlapping point’ (OP). In all cases, the OP was within the range of LPT. Conclusion: It is concluded that the structures in the LPT are FL and AL; and therefore, this procedure could also be known as ‘fasciculoansatomy’.
Comparison of Actual Pallidotomy Lesion Location with Expected Stereotactic Location
Authors: Tsao KuoJen , Wilkinson Steve , Overman John , Kieltyka Jennifer , Tollefson Travis , Koller William C. , Pahwa Rajesh , Troster Alexander I. , Lyons Kelly E. , Batznitzky Solomon , Wetzel Louis , Gordon Michael A.
Published: April 2003

Accuracy of pallidotomy lesion placement was assessed by comparing actual lesion locations with expected pallidotomy lesion locations based on stereotaxy. Actual and expected lesions were compared in anteroposterior, dorsoventral and lateral axes. In 22 pallidotomies, actual lesion locations were determined using axial MR images. Expected lesion locations were calculated using a starting point derived from preoperative computerized tomography, displacements from the starting point based on microelectrode-driven electrophysiological refinement, and the trajectory angle of the lesioning tract relative to the anterior-posterior commissural plane. On average, actual lesion locations were found 2.91 ± 2.23 mm posterior, 3.22 ± 2.49 mm ventral, and 0.05 ± 1.80 mm lateral compared to the expected lesion location. Discrepancies between the actual lesion and expected lesion locations may be mostly accounted for by posterior and ventral lesion spread from the exposed electrode tip, in-plane and volume averaging effects associated with MR images, and possible brain shifting during surgery. However, despite the remaining small differences between actual and expected lesion location, good clinical outcome of reduced dyskinesias and ‘off’ time along with UPDRS-based improvement in mentation, motor and activity of daily living measures was observed.
Neuronal Activity in GP and Vim of Parkinsonian Patients and Clinical Changes of Tremor through Surgical Interventions
Authors: Hayase N. , Miyashita N. , Endo K. , Narabayashi H.
Published: April 2003

Microrecordings were performed during pallidotomy and thalamotomy for Parkinson’s disease (PD). Neuronal activity in globus pallidus (GP) was in general agreement with previous studies of human and primate models of PD. Neuronal activity, where frequency of tremor appeared to oscillate independently from peripheral input, was encountered in GPi. In contrast, neuronal activity in Vim regarding frequency of firing also correlated with tremor and was passively driven by kinesthetic stimuli with a somatotopic arrangement. Pallidal lesions based on microrecording induced relative reductions of tremor, while small Vim lesions immediately alleviated tremor.Basal ganglia pathology due to dopamine depletion could generate oscillatory neuronal activity in GPi, which may cause tremor. However, peripheral feedback to the motor cortex via Vim is also significant for tremorgenesis, because Vim may be an excitatory driving source for motor cortical neurons. Thus, a Vim lesion could reduce excitability of the motor cortical neurons and abolish tremor.
Results and Complications from the Use of a Frameless Stereotactic Microscopic Navigator System
Authors: Fountas K.N. , Kapsalaki E.Z. , Smisson, III H.F. , Hartman L.P. , Johnston K.W. , Robinson Jr. J.S.
Published: April 2003

We present a series of 21 patients, 12 males and 9 females, aged 41–76 years, with the preoperative diagnosis of a brain tumor. Both preoperatively and postoperatively, all of our patients underwent either a brain computed tomography (CT) or magnetic resonance imaging (MRI). All the radiographic studies were taped and loaded preoperatively in the Stereotactic Microscopic Navigator (SMN) workstation (Zeiss, Germany). The mean duration of this procedure was 25 ± 6 min. All our patients were operated on in our institute with the use of the SMN system. The specificity of tumor localization using CT scan was 2.20 ± 0.25 mm and for the MRI scan 2.6 ± 0.25 mm. As assessed by postoperative radiographic studies, total gross tumor resection was possible in 20 patients (95.23%). No major intraoperative or early postoperative complications were noted in our series. We believe that the SMN system is a safe, well-tolerated by the patients and simple method with extremely high accuracy and specificity.
Interactive Image-Guided Surgery System with High-Performance Computing Capabilities on Low-Cost Workstations: A Prototype
Authors: Roldan P. , Barcia-Salorio J.L. , Talamantes F. , Alcañiz M. , Grau V. , Monserrat C. , Juan C.
Published: April 2003

We present a new frameless stereotatic system prototype that has been initially validated in functional neurosurgery operations and that makes use of an optical position tracker for image-guided neurosurgery. Several devices for tracking different surgical instruments have been designed and manufactured. These devices include an array of infrared light-emitting diodes that are tracked by three charge-coupled device cameras. The system presents several new approaches for surgery planning. For high-quality 3D images of the patient’s anatomy, we have developed a parallel version of a volume-rendering algorithm, thus enabling real-time 3D anatomy manipulation on low-cost PC workstations. In order to test the accuracy of the system, the localization of the target by means of a stereotatic frame has been compared with frameless techniques, obtaining a difference of about 1 ± 1 mm.
Subthalamic Stimulation in Parkinson’s Disease
Authors: Lévesque M.F. , Taylor S. , Rogers R. , Le M.T. , Swope D.
Published: April 2003

Objectives: We wanted to evaluate chronic subthalamic nucleus (STN) stimulation as an alternative to pallidotomy for severe Parkinson’s disease symptomatology. Methods: Nine patients met clinical criteria for unilateral standard pallidotomy. All had severe medically refractory drug-induced dyskinesia and had reached maximal daily levodopa therapy. Pre- and postoperative videos, neuropsychometric testings and clinical stagings were administered. Three patients were selected to undergo stereotactic implantation of a deep brain stimulator (DBS) after Institutional Review Board approval and informed consent. These were performed using digitized microrecordings. The other group received unilateral pallidotomy. Results: At a mean follow-up of 6 months, our results support recent findings of significant major improvement in motor scores, activity of daily living and decrease in amount of daily levodopa intake by close to 50% after 3 months of stimulation. Conclusions: Chronic stimulation of the STN appears to provide significant motor improvement in patients with severe Parkinson’s disease and is more beneficial than pallidotomy.
MRI Assessment of the Anatomy of Optic Radiations after Temporal Lobe Epilepsy Surgery
Authors: Guenot M. , Krolak-Salmon P. , Mertens P. , Isnard J. , Ryvlin P. , Fischer C. , Vighetto A. , Mauguière F. , Sindou M.
Published: April 2003

Objective: The aim of this study was to determine the course of the temporal optic radiations. Material and Methods: Eighteen patients were included in this prospective study. All of them underwent a temporal lobectomy for epilepsy, including the mesial temporal structures and a variable extent of lateral neocortex (from 2 to 7 cm behind the temporal tip). An MRI was performed 2 months postoperatively, allowing assessment of the extent of lateral resection. Postoperative visual fields were determined by automatic static perimetry (ASP). Results: (1) No patient complained of a disabling visual field deficit. (2) ASP, a highly sensitive technique, however, detected postoperative visual field deficits in 83% of patients, confined to the superior homonymous field contralateral to the resection. (3) A strong correlation was found between the presence of a visual field deficit and the extent of laterotemporal resection. (4) The smallest anteroposterior resection resulting in a field defect was limited to 20 mm from the temporal tip. Conclusion: (1) This study confirms a strong correlation between postoperative visual field deficits and the extent of lateral
neocortical temporal resection. (2) The anterior limit of Meyer’s loop is likely to be located more rostrally than previously believed. (3) Despite this, lateral resection remains useful
in some cases for seizure control.
Precentral Cortex Stimulation for the Treatment of Central Neuropathic Pain
Authors: Mertens P. , Nuti C. , Sindou M. , Guenot M. , Peyron R. , Garcia-Larrea L. , Laurent B.
Published: April 2003

The authors report a series of 23 patients with central neuropathic pain who were treated with the recently developed technique of precentral cortex stimulation (PCS). Of the 20 patients with a follow-up of more than 1 year (mean of 23 months) 25% had an excellent, 35% a good and 15% a fair relief of pain. In 25% the method failed. On the basis of these findings and the literature data (127 reported cases), the authors advocate PCS in patients with severe and medically refractory poststroke pain.
Response of Prostate-Specific Antigen after Androgen Withdrawal and Prognosis in Men with Metastatic Prostate Cancer
Authors: Furuya Yuzo , Akimoto Susumu , Akakura Koichiro , Igarashi Tatsuo , Murakami Shino , Shimazaki Jun , Ito Haruo
Published: April 2003

Objective: Patients with prostate cancer generally respond to androgen withdrawal therapy, but progression to androgen independence is frequently observed. To evaluate prognostic factors in metastatic prostate cancer, patients who had been treated with endocrine therapy were investigated. Methods: One hundred and thirty-nine patients with untreated metastatic prostate cancer (TxNxM1) who received endocrine therapy between 1986 and 1993 were included in the present study. Blood chemistry, histological grade, extent of bony metastases, clinical response to hormone therapy, and the prognosis of the patients were evaluated. Results: With univariate analysis, performance status, hemoglobin concentration, serum alkaline phosphatase, lactate dehydrogenase, histological grade, extent of bony disease, and response of prostate-specific antigen (PSA) at 3 months were shown to be significant prognostic factors. With multivariate analyses, response of PSA and histological grade were significant factors predicting prognosis. Conclusions: Patients whose PSA had not normalized 3 months after the start of endocrine therapy were in the high-risk group, and should be given more aggressive treatment.
Transurethral Ureterolithotomy in 100 Lower Ureteral Stones
Authors: Hamano Satoshi , Tanaka Masashi , Suzuki Noriyuki , Shiomi Kou , Igarashi Tatzuo , Murakami Shino
Published: April 2003

A total of 100 patients with lower ureter stones received transurethral ureterolithotripsy (TUL) using a pulsed dye laser and/or a pneumatic lithotriptor. Extracorporeal shock wave lithotripsy treatment was added in 15 patients because fragments larger than 4 mm had been pushed back to the renal pelvis. The median stone size was 8 mm (range 3–22 mm). Operative time ranged between 3 and 157 min with a median of 30 min. Stone size correlated well with impaction, when impaction was defined as the inability of a guidewire to pass over the stone. Complete removal was defined as total clearance at 1 month without retreatment. The overal stone-free rate was 93%. Among the 7 not-stone-free cases, 5 cases were considered to have been treated successfully because asymptomatic residual fragments were smaller than 4 mm, 1 case required retreatment to become stone free, and 1 case with a silent residual fragment of 8 mm had been followed up for 3 months. The success rate was 98% when successful treatment was defined as total clearance or the presence of asymptomatic residual fragments of 4 mm or less without retreatment. Impaction was not a significant determining factor of stone-free rate (95.7 and 86.7%, respectively, p >0.05) and in situ stone-free rate (TUL alone; 85.7 and 76.7%, respectively, p >0.05). Two minor ureteral perforations were encountered. No patient required percutaneous nephrostomy or open surgery, or showed any late complications. TUL is a safe and successful method in managing lower ureteral stones.
Ovarian Cystoid Causing Kock Pouch Incontinence
Authors: Pannek Jürgen , Sommerfeld Hans-Jörg
Published: April 2003

The Kock pouch is a well-known standard technique for continent urinary diversion. If incontinence occurs, it is mostly related to insufficiency of the efferent nipple valve. We present the rare case of a young woman with a Kock pouch suffering from urine loss caused by a large cystoid in the left ovary leading to compression of the pouch and destabilization of the nipple.
The Relationship between Diabetes mellitus, Impotence and Veno-Occlusive Dysfunction in Peyronie’s Disease Patients
Authors: Ģulha M. , Alici B. , Acar O. , Mutlu N. , Gökalp A.
Published: April 2003

Peyronie’s disease is an ill-defined condition that often leads to severe penile deformity and sometimes erectile dysfunction. Penile Doppler studies indicate veno-occlusive dysfunction as the principal cause of poor rigidity in Peyronie’s disease patients. Diabetes mellitus is also a known cause of impotence and its prevalence tended to be higher in patients with Peyronie’s disease. We evaluated 143 patients with Peyronie’s disease, also 92 impotent men (37 diabetic, 55 nondiabetic) as control group. Penile vascular studies were performed on each group. Diabetes mellitus was also investigated in patients with Peyronie’s disease. Veno-occlusive dysfunction was found as the main cause of impotence in both groups (81.1% in diabetic, 89% in nondiabetic control group and 88.8% in Peyronie’s disease patients). In our study group the prevalence of diabetes mellitus tended to be higher than in the control population but it did not alter the ratio of veno-occlusive dysfunction and impotence in Peyronie’s disease patients. We believe there is a close relationship between diabetes mellitus and Peyronie’s disease, considering our high incidence. We also conclude that diabetes mellitus is not the main cause of impotence in patients with Peyronie’s disease.
Biphasic Action of Phenylephrine on the Ca2+-Activated K+ Channel of Human Prostatic Smooth Muscle Cells
Authors: Kurokawa Yasushi , Kojima Keiji , Kagawa Susumu , Minami Kazushi , Nakaya Yutaka
Published: April 2003

The elevation of cytosolic Ca2+ ([Ca2+]i) is known to regulate smooth muscle contractility. A physiological concentration of phenylephrine induced the elevation in [Ca2+]i of human prostatic smooth muscle cells; however, contraction of prostatic tissues in vitro needs a higher concentration of phenylephrine than the physiological level. To investigate this discrepancy, we investigated the functional importance of the Ca2+-activated K+ channel (KCa channel) of human prostatic smooth muscle cells in phenylephrine-induced contraction. Using the patch-clamp technique, the KCa channel of human prostatic smooth muscle cells was activated by phenylephrine at a physiological concentration (10–7–10–5 M) but was inhibited at a higher concentration (10–4–10–3 M). Phenylephrine (10–3 M) also inhibited the KCa channel which was activated by 10 µM A23187, a calcium ionophore. Similar inhibition was obtained with 1 µM phorbol 12-myristate 13-acetate, an activator of protein kinase C (C-kinase). Both inhibitions were reversed by subsequent application of 1 nM staurosporine, a protein kinase inhibitor. These results suggested that C-kinase mediated the phenylephrine-induced inhibition of the KCa channel. In this study, a physiological concentration of phenylephrine induced activation of the KCa channel of human prostatic smooth muscle cells, which brought about membrane hyperpolarization and relaxation of human prostatic smooth muscle cells. The regulation of the KCa channel by phenylephrine may explain the need of a high concentration of phenylephrine for the contraction of prostatic tissue.
Absorption of Epirubicin Instilled Intravesically Immediately after Transurethral Resection of Superficial Bladder Cancer
Authors: Tsushima Tomoyasu , Miyaji Yoshiyuki , Noda Masatoshi , Nasu Yasutomo , Kumon Hiromi , Ohmori Hiroyuki
Published: April 2003

As postoperative adjuvant therapy for superficial bladder cancer, intravesical instillation therapy is commonly conducted. In this case, from the view point of prevention of intraoperative dissemination, commencement of instillation therapy at an early postoperative period is preferred. However, increased drug permeability is suspected because of damage to the bladder mucosa during operation. Therefore, this study was conducted to investigate the plasma level of epirubicin (EPI) instilled immediately after transurethral operation. EPI (20 mg/40 ml or 50 mg/100 ml) was instilled immediately after a transurethral operation, and retained in the bladder for 1 h. Blood samples were obtained before instillation, as well as 30, 60, 120 and 240 min after instillation, and EPI levels were assayed. The mean EPI concentrations (ng/ml) among the 20-mg/40 ml group (n = 5) were <2.5 and <2.0 at 30 and 60 min, respectively, after which they were undetectable. The 50-mg/100 ml group (n = 5) recorded 5.0, 4.4 and <3.0 after 30, 60 and 120 min, respectively, and after 240 min it was undetectable. Intravesical instillation of EPI immediately after a transurethral operation causes a small increase in the plasma level and it is thought to cause small systemic side effects.
Comparison of Testicular Volumes before and after Varicocelectomy
Authors: Çulha Melih , Mutlu Nazım , Acar Oǧuz , Baykal Murat
Published: April 2003

We attempted to determine the testicular volume changes in patients with unilateral varicocele, before and after varicocelectomy. Testicular volume differences were correlated for each group of varicocele grade. 123 men with a unilateral left varicocele were presented for surgery: 36 had grade I, 49 had grade II, and 38 had grade III varicoceles. A Prader orchidometer was used for testicular volume determination before and after varicocelectomy in each patient. Both left and right testicular volumes were compared. After the repair of grade I varicoceles, an improvement in testicular volumes was noticed, but the difference was not statistically significant (p > 0.05). Both right and left testicular volumes increased significantly after operation in patients with grades II and III varicoceles (p < 0.001). Right testicular volume improved more than left in most of the patients. Men with large varicocele had significantly decreased testicular volumes than men with small varicocele before operation. So testicular growth arrest was more significant in patients with large varicocele and postoperative results indicated a more dramatic improvement.
Sacral Agenesis in Siblings
Authors: Sarica Kemal , Pinar Tuǧrul , Sarica Neşe , Yagci Faruk , Eryigit Murat Öz
Published: April 2003

Sacral agenesis is a rare congenital abnormality of the lower vertebral column which is fequently associated with neurological, orthopedic as well as urological malformations. With regard to the incidence of the anomaly, although approximately 200 cases have been reported previously, the occurrence of sacral agenesis in siblings has only rarely been found. To date only two pairs of siblings have been reported. Herein we present 2 siblings with partial sacral agenesis and emphasize the need for a careful family investigation, early diagnosis and appropriate treatment.
Technetium-99m-Labelled RBC Erection Penogram to Differentiate Psychogenic from Vasculogenic Impotence
Authors: Shen Yeh-You , Kao Chia-Hung
Published: April 2003

The 99mTc-labelled RBC erection penogram (Tc-RBC penogram) coupled with intracavernosal injection of prostaglandin E1 (PGE1) was used to evaluate the penile hemodynamic changes during tumescence. As expected, the method is useful to differentiate organic from psychogenic impotence, and arteriogenic from venogenic impotence. Thirty-four patients with psychogenic impotence, 23 patients with arteriogenic impotence, and 27 patients with venogenic impotence were included in the study. A Tc-RBC penogram was performed on each patient after intracavernosal injection of PGE1. Several parameters calculated from the time-radioactivity curve of the Tc-RBC penogram were used to evaluate hemodynamic changes of the penis. They included (1) the arterial phase: slope and time to peak (TTP), and (2) the venous phase: washout index (WOI). During the arterial phase, the patients with psychogenic and venogenic impotence had higher slope and shorter TTP than those of patients with arteriogenic impotence (p < 0.01). During the venous phase, the patients with psychogenic and arteriogenic impotence had a lower WOI than that of patients with venogenic impotence (p < 0.01). We conclude that the Tc-RBC penogram is a simple, noninvasive, and valuable method for the objective differentiation among psychogenic, arteriogenic, and venogenic impotence.
Silica Urolithiasis without Magnesium Trisilicate Intake
Authors: Ichiyanagi Osamu , Sasagawa Isoji , Adachi Yuichi , Suzuki Hitoshi , Kubota Yoko , Nakada Teruhiro
Published: April 2003

Two cases of silica stones, without previous oral intake of magnesium trisilicate, are reported. A 64-year-old Japanese woman had bilateral renal stones. Infrared spectrophotoscopy revealed that one of the fragments consisted of silicate and the others consisted of calcium oxalate. A 75-year-old woman had right renal stones. The composition of 1 stone was a mixture of silicate and unspecified matrices. Silicate urolithiasis may not necessarily be related to oral intake of silicate-containing antacids.
Malacoplakia or Prostate Cancer? Similarities and Differences
Authors: Agostinho Aparecido Donizeti , Corrêa Luiz Antonio , Amaro João Luiz , Bacchi Carlos Eduardo , Viana de Camargo João Lauro
Published: April 2003

Malacoplakia is a granulomatous inflammatory disorder clinically and ultrasonographically very similar to prostatic adenocarcinoma. Symptoms and physical findings are similar to prostatism and in half of the patients the differential diagnosis includes malignancy, mainly because of the presence of a hard nodule on digital rectal examination. Additionally, cases of malacoplakia can show hypoechoic nodes on transrectal ultrasound mimicking adenocarcinoma. We report a case of malacoplakia of the prostate with emphasis on its similarities and differences with prostate adenocarcinoma.
Giant Hydronephrosis – A Diagnostic Dilemma
Authors: Mountney J. , Chapple C.R. , Johnson A.G.
Published: April 2003

We report a complex case in which the left kidney had undergone giant hydronephrotic change after chronic obstruction at the vesicoureteric junction. Minor blunt abdominal trauma caused rupture of the parenchyma of this expanded and dilated kidney, with bleeding into its collecting system. The mixture of blood and urine remained contained within the kidney’s structural layers, so producing a tense, cystic, fluid-filled mass arising from the left hypochondrium. Pathogenesis, differential diagnosis and investigation of giant hydronephrosis and its rupture are discussed. The observation is made that gross distortion of the renal parenchyma by rupture or hydronephrosis impairs arterial inflow to the kidney.
Enhanced External Counterpulsation as a New Treatment Modality for Patients with Erectile Dysfunction
Authors: Froschermaier S.E. , Werner D. , Leike S. , Schneider M. , Waltenberger J. , Daniel W.G. , Wirth M.P.
Published: April 2003

Enhanced external counterpulsation (EECP) is a noninvasive treatment modality which can increase arterial blood flow in peripheral and coronary arterial disease. Several studies have demonstrated an increase in the flow of the internal iliacal artery and in carotid and renal perfusion during EECP treatment. We investigated the effect of EECP in patients with erectile dysfunction (ED). Thirteen patients were treated with EECP for 20 days, 1 h per day. Patients reported a significant improvement of penile rigidity after completion of the EECP treatment and a significant improvement of penile peak systolic flow was measured by Doppler sonography. No adverse effects were observed. In conclusion, EECP seems to be an effective treatment modality in patients with ED.
Chromophobe Cell Renal Carcinoma
Authors: Megumi Yuzuru , Nishimura Kazuo
Published: April 2003

Chromophobe cell renal carcinoma is a recently established subtype of renal cell carcinoma. Herein we report a case of chromophobe cell renal carcinoma in a 67-year-old male patient who occasionally underwent computed tomography. In a microscopic study with hematoxylin and eosin stain, clear eosinophilic cytoplasm, and a moderately atypical nucleus were observed. And it was stained positively by Hale’s colloidal iron. Ultrastructurally, the cytoplasm was filled with numerous microvesicles. From these results, this tumor was pathologically diagnosed as chromophobe cell renal carcinoma.
Occupational Risk of Hepatitis B and C Infections in Urologists
Authors: Öge Ömer , Özen Haluk , Öner Sedat , Akova Murat , Bilen Cenk Y.
Published: April 2003

The purpose of this study is to evaluate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and the related risk factors among urologic surgery patients and urologists. This cross-sectional, prospective study included 300 consecutive urologic surgery patients and 24 urologists working in our department. The patients and urologists with positive serology for any of the hepatitis viruses were questioned for risk factors including previous transfusions, surgery, endoscopy, intravenous drug abuse and homosexuality. Positive serology for HBV and/or HCV was found in 47.4% of the patients, and the rate of the patients with antigenemia, the major risk group for the urology team, was 9.9%. Of the 24 urologists working in our department, 3 were antibody to HCV (anti-HCV) positive and 2 were hepatitis B surface antigen (HBsAg) positive. The presence of a risk factor among patients with HBsAg was found in 78.9% and in 100% of those with anti-HCV. The prevalence of hepatitis in urologic surgery patients and urologists is poorly described. This study indicates a high prevalence of HBV and HCV seropositivity in urology patients. In urology wards, the risk of hepatitis transmission is estimated to be appreciably high because of the renal transplantation procedure and frequent use of blood and blood-contaminated solutions for transurethral resections or catheter irrigations. Vaccination with HBV vaccine and application of universal precautions during daily practice seem to be the only and most effective means of protection against blood-borne infections.
Granulocyte-Macrophage Colony-Stimulating Factor and Interferon-Alpha 2B in Patients with Advanced Renal Cell Carcinoma
Authors: Lümmen G. , Sperling H. , Luboldt H. , Otto T. , Rübben H.
Published: April 2003

Objective: Biological response modifiers such as interferon-α2B (IFN-α2B) have well-known clinical activities against renal cell carcinoma (RCC). Recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) has antitumorigenic effects both in vitro and in vivo. Therefore, a phase-I/II trial of IFN-α2B and GM-CSF was performed in patients with metastatic RCC. Methods: 21 patients in groups of 3 patients received GM-CSF at 7 different dose levels (15–300 μg) subcutaneously in combination with IFN-α2B at a fixed dose of 10 × 106 IU s.c. three times weekly for 12 weeks. Results: Two complete remissions have been observed, both with lung metastases only. With increasing dose levels of GM-CSF a slight tendency to more toxicity was detectable. Due to grade-3 toxicities 5 patients (24%) dropped out of the treatment schedule. Increases in WBC, neutrophils, lymphocytes, and monocytes were noted but were not related to the dose levels of GM-CSF. Conclusions: Results demonstrate that simultaneous administration of GM-CSF and IFN-α2B is tolerated up to doses of 120–150 μg GM-CSF three times weekly. But there is no additional antitumorigenic effect of GM-CSF because the overall response rate of the combined administration of GM-CSF/IFN-α2B is similar to IFN-α2B alone and there is no obvious dose relationship between increasing doses of GM-CSF and the responses.
An Unusual Presentation of a Foreign Body in the Urinary Bladder: A Migrant Intrauterine Device
Authors: Yalçın Veli , Demirkesen Oktay , Alıcı Bülent , Önol Bülent , Solok Vural
Published: April 2003

A 35-year-old woman, who had had an intrauterine device inserted 7 years earlier, presented with dysuria, pollakiuria, suprapubic pain and urethral irritation. The intrauterine device was found in the bladder with stone formation and was removed by endoscopy.
Early Diagnosis and Management of Neonatal Abdominoscrotal Hydroceles
Authors: Cooper Christopher S. , Kirsch Andrew J. , Snyder, III Howard M.
Published: April 2003

We present the two youngest patients diagnosed and treated for abdominoscrotal hydrocels. Given the progressive nature of this disease and the possible complications, early intervention is warranted.
Excretion of Tamm-Horsfall Protein in Patients with Uric Acid Stones
Authors: Bichler K.-Horst , Mittermüller Bärbel , Strohmaier Walter L. , Feil Gerhard , Eipper Ewald
Published: April 2003

The cause of reduced Tamm-Horsfall protein excretion in patients suffering from uric acid diathesis is still unknown. Our investigation was conducted based on the hypothesis that the solubility of uric acid is increased by Tamm-Horsfall protein and that an increased uric acid content in the urine might cause a decrease in Tamm-Horsfall protein. In 20 patients with uric calculi the excretion of Tamm-Horsfall protein, uric acid, calcium, and citrate was measured. 65% of the patients had pure uric acid stones (group I) and 35% showed mixed stones with at least 30% of uric acid (group II). Reduced Tamm-Horsfall protein excretion was found in 63% of the patients of group I and in 43% of the patients of group II. The excretion of Tamm-Horsfall protein was significantly reduced in pure uric acid stone formers compared to normal subjects (p < 0.0001). The excretion of uric acid was elevated in 61% of the patients of group I and in 86% of the patients of group II. There was no significant correlation between Tamm-Horsfall protein excretion and uric acid excretion (r = 0.2139). Calcium excretion was elevated in 57% of the patients with mixed stones. The excretion of citrate was reduced in almost all of the patients of groups I and II. Our results do not support the hypothesis that an increased content of uric acid in the urine causes a decrease in Tamm-Horsfall protein. In our opinion the lower excretion of Tamm-Horsfall protein in some of the stone patients might be caused by damage in the distal tubular epithelium. Moreover, it has to be supposed that there are defects both in the distal and the proximal tubule in patients prone to develop uric acid calculi.
Inflammatory Pseudotumor of the Urinary Bladder and Sigmoid Colon
Authors: Saito Motoaki , Watanabe Nobuyuki , Abe Bungo , Matsui Katsuaki
Published: April 2003

We report an unusual case of an inflammatory pseudotumor of the bladder. A biopsy specimen prior to surgical treatment suggested leiomyosarcoma, and computerized tomography and magnetic resonance imaging strongly suggested bladder tumor with sigmoid colon invasion. Accordingly, radical surgical treatment consisting of total cystectomy, anterior resection of the sigmoid colon, and ileal conduit was performed. After operation, however, histological examination revealed an inflammatory pseudotumor of bladder and sigmoid colon. These findings were confirmed by immunohistochemical staining for smooth muscle specific actin, desmin, S-100, and vimentin. Histological examination revealed a diverticulum of the sigmoid colon in the middle of the pseudotumor, and this diverticulum may have ruptured to cause the inflammatory pseudotumor of bladder and sigmoid colon.
Radio-Contrast Enhancement of a Urinary Tract Calculus
Authors: Brierly R.D. , Mostafid A.H. , Fletcher M.S.
Published: April 2003

We report the case of a woman who presented with obstruction and urosepsis of her left kidney secondary to small cystine calculi. The calculi could not be seen on initial plain abdominal X-ray. However, following percutaneous nephrostogram the calculi became more radio-dense and visible on later X-rays. Experimental enhancement of calculi has been described before but not in man. We presume that the contrast medium was adsorbed by the calculus to increase the radio-density. Further investigation of this phenomenon could prove useful in the management of complex radiolucent calculi.
Neuroendocrine Differentiation in Prostatic Carcinomas: Histogenesis, Biology, Clinical Relevance, and Future Therapeutical Perspectives
Authors: Helpap B. , Köllermann J. , Oehler U.
Published: April 2003

Since the introduction of immunohistochemistry, there is an increasing interest in neuroendocrine (NE) differentiation in prostatic carcinomas. Focal NE differentiation in prostatic adenocarcinomas is a very frequent finding. It is subject of numerous studies, since a negative impact on prognosis and an important role in antiandrogen therapy failure are suspected. NE-differentiated small-cell carcinoma is a very rare tumor comprising 0.5–2% of all prostatic carcinomas. Nevertheless, although very rare, it is of clinical importance because it is one of the most aggressive tumors of the prostate with a very poor prognosis. This review is focused on actual concepts of histogen-esis, cell biology, clinical implications, and possible future therapeutic perspectives of these two tumor entities.
Nephroureterectomy through a Single Lumbar Incision Combined with Endoscopic Incision of a Bladder Cuff
Authors: Shental Joseph , Rozenman Jacob , Chaimowitch Gima , Almog David
Published: April 2003

Nephroureterectomy is the accepted approach in treating upper urinary tract carcinoma. We present a modification of transurethral resection of the intramural ureter, using endoscopic incision of a bladder cuff around the ureteral ostium as the first step in performing nephroureterectomy through a single lumbar incision.
Renal Metastasis from Prostatic Adenocarcinoma: A Potential Diagnostic Pitfall
Authors: Denti F. , Wisard M. , Guillou L. , Francke M.-L. , Leisinger H.-J.
Published: April 2003

We report a case of renal metastases from prostate cancer to show that the possibility of tumor metastasis, although rare, should always be considered in the differential diagnosis of renal mass.
Giant Retroperitoneal Hemangiopericytoma with Paraneoplastic Gynecomastia
Authors: Derakhshani P. , Neubauer S. , Braun M. , Heidenreich A. , Engelmann U.
Published: April 2003

We report on a 38-year-old patient with a giant retroperitoneal hemangiopericytoma associated with bilateral paraneoplastic gynecomastia, which led to an almost uncontrollable hemorrhage on initial surgery due to the extreme hypervascularity of the process. After angiographic evaluation and superselective embolization, a complete surgical excision of a hemangiopericytoma weighing almost 1,000 g could be achieved. To reduce the risk of recurrence adjuvant radiotherapy with 49 Gy followed. Follow-up of 24 months showed no sign of recurrence on CT scans. To our knowledge this is the first reported case of hemangiopericytoma associated with a paraneoplastic syndrome. The literature and the therapeutic concepts are presented and discussed.