bluuebunny/crossref_metadata_2025 huggingface dataset:
Ureteroscopic Stone Management in Prepubertal Children
Authors: Ozkan Keramettin Uğur , Bakan Vedat , Mil Ayhan , Ozturk Senol
Published: October 2010

Introduction: We retrospectively assessed our experience with ureteroscopy (URS) for ureteric calculi in prepubertal children. Patients and Methods: The records of all children who underwent URS at our institution for ureteral calculi between September 2007 and July 2009 were retrospectively reviewed. Patient demographics, stone location and size, pre- and postoperative stenting, intraoperative active dilatation, stone-free rates and complications were noted. Results: A total of 26 patients (20 males and 6 females; mean age 59.9 months) underwent 30 URS procedures with rigid ureteroscopes for 31 ureteral calculi. The mean size of ureteral stones was 8.6 mm. A total of 18 URS procedures were performed without any active ureteral dilatation, and 8 patients underwent 12 passive dilatations of initially inaccessible ureters. Stents remained in place for 2–4 weeks. The stone-free rate was 84.6% for all patients and all procedures. Postoperatively, 12 patients (46%) had stent placement for 2–5 days because of stone burden, edema of the ureteral orifice and hematuria. Conclusions: URS treatment of ureteral stones without active dilatation can be performed safely and effectively in prepubertal children. Passive ureteral dilatation might be necessary in some cases to enable ureteral access.
Clinical Analysis of 249 Cases of Adrenal Tumors in a Chinese Hospital
Authors: Chen Gang , Yao Jin , Mou Lunpan , Fang Xiaowen , Huang Huibin , Liang Jixing , Li Liantao , Ye Liefu , Lin Lixiang , Wen Junping
Published: October 2010

Objective: This study was designed to evaluate the clinical and pathological characteristics of adrenal masses. Methods: The clinical data of 249 cases of adrenal masses which were confirmed at operation and by pathology were analyzed. Results: The series comprised 103 males and 146 females. Overall, females were more commonly represented than males, especially with Cushing’s syndrome and typical pheochromocytoma (female:male ratio 3.3:1.9), however the prevalence of adrenal incidentalomas (AIs) in males and females was similar. In our series, 148 (59.4%) were symptomatic, of which 4 (2.7%) were malignant, and 101 (40.6%) were incidental, of which 20 (19.8%) were malignant. Hormonal work-up demonstrated that 30.3% of the AIs were functional. Of 109 adrenocortical adenomas, 47 were primary aldosteronism, 31 were Cushing’s syndrome, 30 were AIs, and 1 was adrenal virilization. Of 72 benign pheochromocytomas, 51 were typical pheochromocytomas and 21 were AIs. Of 14 adrenal nodular hyperplasias, 6 were Cushing’s syndrome and 8 were primary aldosteronism. Of the remaining 30 benign tumors, all presented as AIs. The diameter of malignant tumors (10.9 ± 5.6 cm) was significantly larger than that of benign tumors (4.5 ± 3.7 cm) (p < 0.001). Conclusion: This study shows a high rate of AIs in patients with adrenal masses selected for surgery. Hormone levels should be determined in symptomatic or incidental patients with adrenal masses. Imaging examination (CT and MRI) is the first method used to detect and localize adrenal masses. Tumor size is an important parameter of diagnosis and management of patients with adrenal masses, especially AIs.
Emphysematous Pyelonephritis: Tertiary Care Center Experience in Management and Review of the Literature
Authors: Dhabalia Jayesh V. , Nelivigi Girish G. , Kumar Vikash , Gokhale Aniruddha , Punia Mahendra S. , Pujari Nandan
Published: October 2010

Introduction: In recent years there have been changes in management modality and a lower mortality with conservative management. We analyzed the result of emphysematous pyelonephritis (EPN) management by a review of the literature. Material and Methods: We made a retrospective study for the period from August 2005 to July 2009. Patients were evaluated by CT and subclassified based on CT. The patients managed in different modalities and their outcomes were compared. Results: A total of 28 patients were admitted with the diagnosis of EPN. The age range was 22–70 years. Five patients were managed conservatively, 17 patients underwent minimally invasive modalities (double J stent, pigtail drainage). Open drainage of the abscess was conducted in 2 patients, and 4 patients required emergency nephrectomy. Emergency nephrectomy is associated with a high mortality (75%). Conclusions: In the majority of cases, EPN was successfully treated by resuscitation and minimally invasive modalities. Percutaneous drainage should be part of the initial management strategy. This strategy is associated with a lower mortality than emergency nephrectomy.
Oxidative Stress in Benign Prostatic Hyperplasia and Prostate Cancer
Authors: Pace Gianna , Di Massimo Caterina , De Amicis Daniela , Corbacelli Carlo , Di Renzo Laura , Vicentini Carlo , Miano Lucio , Tozzi Ciancarelli Maria Giuliana
Published: October 2010

Objective: The aim was to verify whether oxidative stress could represent a common key factor of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Subjects and Methods: 15 patients affected by BPH, 15 with PCa and 15 controls were enrolled. Blood samples were withdrawn systemically and locally during radical retropubic prostatectomy in patients with PCa and during transvesical retropubic adenomectomy in patients diagnosed with BPH. Plasma oxidized low-density lipoprotein, peroxides, and total equivalent antioxidant capacity (TEAC) including plasma superoxide dismutase (SOD) determination were analyzed as oxidative markers. Results: With respect to the control group, high plasma peroxides and decreased TEAC levels were measured in patients affected by both PCa and BPH. Plasma peroxides were significantly higher in patients with PCa with respect to BPH. A positive correlation was found between peroxides and TEAC values in samples withdrawn locally in patients affected by PCa. An inverse correlation between peroxides and TEAC was observed in patients with BPH. No statistically significant modifications were observed as concerns SOD activity and LDL oxidability. Conclusions: Our findings confirm a significant unbalance of redox status in patients affected by BPH and PCa, and suggest a potential involvement of oxidative stress as a determinant in the pathogenesis of these diseases.
Gender, Depressive Symptoms and Patterns of Alcohol Use among College Students
Authors: Pedrelli Paola , Farabaugh Amy H. , Zisook Sidney , Tucker Dorothy , Rooney Kate , Katz Judith , Clain Alisabeth J. , Petersen Tim J. , Fava Maurizio
Published: October 2010

Background: Serious alcohol-related negative consequences are associated with a number of drinking behaviors among college students. Thus, it is critical to identify students who are at greater risk for hazardous drinking. Although some studies have shown that depressive symptoms may be associated with alcohol use in this population, findings are not consistent. The current study extends previous research by investigating the relationship between depressive symptoms, daily alcohol use and compulsive drinking among college students and whether gender moderates these relationships. Sampling and Methods: The participants were 904 college students (495 females; mean age = 20.07 ± 1.85 years) who filled out questionnaires that focused on drinking behaviors and severity of depressive symptoms. Results: Gender moderated the relationship between depressive symptoms and daily alcohol consumption. In male college students, worse depressive symptoms were associated with increased daily alcohol use and with greater risk for compulsive drinking. In female college students, worse depressive symptoms increased the risk for compulsive drinking, but not for greater daily alcohol use. Conclusions: Results suggest that prevention programs aimed at decreasing harmful alcohol use among college students must take into consideration the role of both gender and depressive symptoms in the development of problematic drinking behaviors.
Outcomes of Empirical Eating Disorder Phenotypes in a Clinical Female Sample: Results from a Latent Class Analysis
Authors: Dechartres Agnes , Huas Caroline , Godart Nathalie , Pousset Maud , Pham Alexandra , Divac Snezana M. , Rouillon Frederic , Falissard Bruno
Published: October 2010

Background/Aims: To empirically classify phenotypes of eating disorders (ED) using latent class analysis (LCA), and to validate this classification based on clinical outcomes. Methods: LCA was applied to 968 inpatients. The resultant classes were validated by clinical outcomes including mortality. Results: A 5-class solution showed the best fit. The symptoms of latent class 1 (LC1; 26% of the sample) resembled anorexia nervosa (AN), bingeing-purging (AN-B/P) subtype; those of LC2 (23%) resembled bulimia nervosa; those of LC3 (11%) were close to AN-B/P without weight and body concerns; those of LC4 resembled restrictive anorexia nervosa (RAN) without weight and body concerns, and those of LC5 RAN. A history of hospitalization for ED was significantly more frequent for LC3 and LC4. The lowest BMI at admission were presented in LC4. LC1 showed the highest level of psychological disturbances and LC4 the lowest. LC3 and LC4 differed from LC1 and LC5 by higher percentages of treatment dropout (64.9 vs. 57.2 and 55.7 vs. 47.5%, respectively; overall p = 0.001). Survival rates tended to be different between the LC (p = 0.09). Conclusions: Subgroups of AN patients with low weight and body concerns seem more severe at hospitalization and more difficult to manage, with a higher rate of treatment dropout than the ‘typical’ AN patients.
Feasibility and Activity of Sorafenib and Sunitinib in Advanced Penile Cancer: A Preliminary Report
Authors: Zhu Yao , Li Hui , Yao Xu-Dong , Zhang Shi-Lin , Zhang Hai-Liang , Shi Guo-Hai , Yang Li-Feng , Yang Zhong-Yi , Wang Chao-Fu , Ye Ding-Wei
Published: October 2010

Introduction: We describe our experience with sorafenib and sunitinib in the treatment of chemotherapy-refractory advanced penile squamous cell carcinoma (SCC). Patients and Methods: Between May 2008 and June 2009, 6 advanced penile cancer patients were treated with sorafenib or sunitinib in our center. All of them had previously received at least two chemotherapy regimens. Tumor responses were evaluated by radiologic assessment and serum SCC antigen change. Immunohistochemical staining of CD34 and Ki-67 was performed in 3 paired tumor tissues before and after treatment. Results: In the 6 patients, 1 partial response and 4 stable diseases were observed. Three patients showed pain response and had an improvement in quality of life. After molecular-targeted therapies, reduction in microvessel density and Ki-67 labeling index was observed in paired specimens. Serum SCC antigen levels were decreased in 5 patients after 1 week of medication. The patient who achieved partial response had an SCC antigen reduction of nearly 95% after treatment with sunitinib. Serious adverse events were fatal infection and rupture of the femoral vessel, which were unlikely related to the medication. Conclusions: The feasibility and activity of sorafenib and sunitinib in our series suggest that this approach may be a promising alternative in chemotherapy-refractory advanced penile SCC.
Intensive Intravesical Mitomycin C Therapy in Non-Muscle-Invasive Bladder Cancer: A Dose Intensity Approach
Authors: Racioppi Marco , Volpe Andrea , Cappa Emanuele , D’Agostino Daniele , Pinto Francesco , D’Addessi Alessandro , Sacco Emilio , Bassi PierFrancesco
Published: October 2010

Objective: The aim of this work was to verify the tolerability and the preliminary clinical results of intensive intravesical instillations of a mitomycin C (MMC) regimen. Patients and Methods: From September 2007 to November 2009, 40 consecutive evaluable patients with pathologically confirmed intermediate-risk non-muscle-invasive bladder cancer (NMIBC) were enrolled after complete transurethral resection of all visible tumors. The mean age of the patients was 64.5 years. 40 mg MMC diluted in 50 ml of saline was instilled in the bladder three times a week for 2 weeks. The median follow-up was 9 months. Results: All patients fulfilled the scheduled treatment. The local adverse events seen were negligible, while no significant deviation from normal values was observed in blood counts for each patient. Twenty-three of 40 patients (57.5%) showed negative at the cystoscopic control which was performed every 3 months with normal spontaneous and washing cytological exams. Conclusion: MMC is a well-known chemotherapeutic agent for the intravesical therapy of NMIBC. With a view to improving its results, we changed the frequency and intensity of the instillations. No significant local or systemic toxicity was reported. Intensive intravesical instilllations of MMC might become a tool in the management of NMIBC.
Fecal Expression of Human β-Defensin-2 following Birth
Authors: Campeotto F. , Baldassarre M. , Laforgia N. , Viallon V. , Kalach N. , Amati L. , Butel M.J. , Dupont C. , Kapel N.
Published: October 2010

Background: Newborns display high intestinal permeability and a naive adaptive immune system, but infections are rare, indicating strong innate defense mechanisms. Objective: To measure the kinetics of fecal β-defensin-2 (HBD2), an inducible endogenous antimicrobial peptide produced by intestinal epithelial cells, in full-term and preterm infants. Methods: As a first step of this bicentric study, we enrolled 30 healthy full-term infants and 20 healthy preterm infants, with fecal samples collected at days 3, 7 12 and 30 in full-term infants and at days 15, 30 and 60 in preterm infants. As a second step, we enrolled 10 preterm infants with intestinal distress, either necrotizing enterocolitis (NEC) Bell’s stage III (n = 3) or isolated rectal bleeding (n = 7) and 20 controls, cross-matched for gestational age and age at sampling. Results: HBD2 decreased significantly from day 3 to day 7 (227 ng/g; 14–440 vs. 117 ng/g; 30–470, p = 0.01) then moderately until day 30 (84 ng/g; 10–500) in healthy full-term infants. Healthy preterm infants showed similar high levels between days 15 and 60 (82 ng/g; 30–154 and 85 ng/g; 26–390, respectively). No significant variation of fecal HBD2 levels was observed between infants with clinical features of intestinal distress (77 ng/g, 2–1,271) and cross-matched controls (56 ng/g, 31–164). However, 2/3 infants with NEC and 1/7 infants with isolated rectal bleeding had HBD2 levels above the maximal level observed in controls. Conclusions: The kinetics of fecal HBD2 in the neonatal period indicate that this inducible defensin can be detected at high level in the feces of full-term and preterm infants, independently of gestational age or mode of feeding. The potential role of fecal HBD2 in detecting NEC is suggested.
Inhibitory Effect of L-Type Voltage-Dependent Calcium Channel Blocker on Response of Urinary Bladder with Acute Ethanol Intoxication
Authors: Oh Mi Mi , Bae Jae Hyun , Kim Je Jong , Kim Hyung Jee , Moon Du Geon , Lee Jeong Gu
Published: October 2010

Purpose: This study was performed to assess the effect of L-type voltage-dependent calcium channel (VDCC) blocker (dilitiazem) on the response of the urinary bladder with ethanol intoxication in in vivo and in vitro studies. Materials and Methods: Sprague-Dawley rats were used for in vivo and in vitro studies. The strips were divided into 5 groups according to pretreatment. Group I-A was treated with ethanol (0.1%), group I-B with ethanol (0.5%), group II with diltiazem treatment (10–6M), group III-A with pretreatment of diltiazem (10–6M) with ethanol intoxication (0.1%) and group III-B with pretreatment of diltiazem with ethanol intoxication (0.5%). The carbachol-induced tension was compared before and after each pretreatment. In separate in vivo experiments, the changes of maximal vesical pressure and intercontraction interval after intra-arterial administration of each agent (identical grouping with in vitro study) were monitored. Results: The carbachol-induced contractions in group I-A, group I-B, group II, group III-A and group III-B were significantly decreased after each pretreatment (95 ± 2.73%, 92.6 ± 2.5%, 65.4 ± 2.0%, 52.61 ± 5.16%, 14.9 ± 1.4% of the control). The degree of increment of intercontraction interval and decrement of maximal vesical pressure showed a significant difference in the presence of diltiazem and ethanol intoxication (0.5%) compared with the diltiazem-treated and ethanol-intoxicated groups (0.5%). Conclusions: There is a possibility that ethanol and L-type VDCC blockers have synergistic depressive effect on bladder contractility and that ethanol and L-type VDCC blockers act through a common ionic pathway.
Early Enteral Fat Supplementation with Microlipid® and Fish Oil in the Treatment of Two Premature Infants with Short Bowel
Authors: Yang Qing , Welch Cherrie D. , Ayers Kathleen , Turner Charles , Pranikoff Thomas
Published: October 2010

The infusion of Intralipid® is a main risk factor for parenteral nutrition-associated cholestasis in infants with short bowel syndrome. Early provision of enteral fat to reduce the use of Intralipid while providing adequate fat for the growth of infants with short bowel has not been reported. We present 2 cases of premature infants with short bowel who received early supplementation of enteral Microlipid® and fish oil. This approach allowed us to discontinue Intralipid shortly after initiating feedings. The infants tolerated Microlipid/fish oil well without adverse reactions, had appropriate weight gain and ostomy output. They underwent bowel reanastomosis 3 weeks after enteral feeding began, and were discharged on full oral feedings. In case 1, the infant did not develop parenteral nutrition-associated cholestasis; in case 2, cholestasis had developed before initiating feeds, but was not aggravated by enteral fat and was improving prior to discharge.
Is Repeat Transurethral Resection Effective and Necessary in Patients with T1 Bladder Carcinoma?
Authors: Yucel Mehmet , Hatipoglu Namik Kemal , Atakanli Cengiz , Yalcinkaya Soner , Dedekarginoglu Galip , Saracoglu Ugur , Aras Erol
Published: October 2010

Introduction: We investigated the efficacy and necessity of repeat transurethral resection (Re-TUR) in T1 bladder cancer. Patients and Methods: From September 2004 to September 2009, 62 patients with pathologically confirmed T1 bladder tumours were investigated. Re-TUR was routinely performed within 3–6 weeks following the initial resection. The pathological results of the Re-TUR were reviewed, and the risk of recurrence was investigated. Results: Of the 62 patients who underwent Re-TUR, 22 had a residual tumour pathologically. Visible residual tumours were detected in 9 patients (14.5%). The risk of having a residual tumour was directly correlated with the diameter of the initial tumour in T1 tumours (p = 0.007). Conclusions: Upstaging to T2 of the disease led to radical cystectomy in 11.29% of the patients in our series. Re-TUR should be routinely performed on all patients, especially on patients with high-grade tumours and with tumour diameters greater than 3 cm in T1 bladder cancer.
Bladder Preservation Strategy Based on Combined Therapy in Patients with Muscle-Invasive Bladder Cancer: Management and Results at Long-Term Follow-Up
Authors: Villavicencio Humberto , Rodriguez Faba Oscar , Palou Joan , Gausa Luis , Algaba Ferran , Marcuello Eugenio
Published: October 2010

Objective: To evaluate a bladder preservation strategy in patients with either muscle-invasive bladder cancer (MIBC) or development of MIBC cancer due to progression of non-muscle-invasive bladder cancer (NMIBC). Methods: Between October 1982 and March 1998, 48 patients (mean age 61 years, range 45–75) with MIBC (T2a–b and T3a) were treated using transurethral resection followed by three cycles of systemic chemotherapy. 42 patients (87.5%) had primary MIBC and 6 (12.5%) had MIBC subsequent to NMIBC. After chemotherapy, 39 patients (81.25%) achieved complete remission and 4 (8.3%) partial remission. Results: With a median follow-up of 98.5 months (13–246), the overall survival of the 48 patients was 62.6%. The cancer-specific survival (CSS) of the 39 patients with complete remission was 80.8%. Among the 39 patients with complete remission, 19 had invasive recurrence during follow-up with a CSS of 53.2%; by comparison, among patients with preserved bladders, CSS was 72.1% (p = 0.046). Predictive factors analysed were age, sex, tumour size >3 cm, grade, associated carcinoma in situ (CIS), number of tumours and number of previous recurrences. In multivariate analysis only tumour size and CIS were significant predictive factors for progression after preservation. Of the 6 patients with MIBC after NMIBC, 3 (50%) had no remission and underwent cystectomy and 15 patients (38.6%) had NMIBC recurrences during follow-up. CIS and high-grade tumours were treated with bacillus Calmette-Guérin. A bladder preservation rate of 81% and a CSS rate of 89% were obtained in the group with NMIBC recurrences. Conclusions: Conservative management of MIBC cancer is a feasible alternative to cystectomy in selected cases. Patients with MIBC after progression of primary NMIBC are not good candidates for a bladder preservation approach. NMIBC recurrences after bladder preservation in patients with MIBC respond to transurethral resection and bacillus Calmette-Guérin instillations.
Radical Cystectomy for Bladder Cancer in the 70+ Population: A Nation-Wide Registry Analysis of 845 Patients
Authors: Madersbacher Stephan , Bauer Wilhelm , Willinger Manfred , Wehrberger Clemens , Berger Ingrid , Brössner Clemens
Published: October 2010

Aim: To analyze demographics, perioperative mortality and overall survival of radical cystectomy (RC) in patients aged 70+ years in Austria in a nation-wide registry cohort. Patients and Methods: All patients >69 years who underwent RC in public hospitals (covering >95% of all surgical procedures) in Austria between 1992 and 2004 were analyzed. Data were provided by the Austrian Health Institute (ÖBIG). Results: A total of 845 patients aged 70–89 years (mean 74) entered the analysis. The annual number of cystectomies in this age group increased from 27 in 1992 to 79 (+292%) in 2004. The mean length of hospital stay declined from 37.1 days (in 1992) to 27.1 days (in 2004). The 60-day mortality of the entire cohort was 1.5% and increased to 5.2% in patients aged 80+ years. Almost 50% of patients had to be rehospitalized within 30 days. The 5-year overall survival declined from 62% in those aged 70–74 years to 61% in those aged 75–79 years to 46% in the oldest age group (80+ years). Conclusions: The annual number of cystectomies in patients aged 70+ years increased substantially during the study period. These nation-wide registry data provide insights into the current status of RC in the elderly in Austria and demonstrate that cystectomy in this age cohort can be done with an acceptable perioperative mortality and overall survival.
The Relationship between Personality Organization and Psychiatric Classification in Chronic Pain Patients
Authors: Fischer-Kern Melitta , Kapusta Nestor D. , Doering Stephan , Hörz Susanne , Mikutta Christian , Aigner Martin
Published: October 2010

Background: The present study investigated the relationship between psychiatric classification and personality organization (PO) in a secondary/tertiary clinical sample of chronic pain patients (CPPs). Sampling andMethods: Forty-three patients were administered the Structured Clinical Interview for DSM-IV (SCID I+II) and the Structured Interview of Personality Organization (STIPO). The prevalence of axis I and axis II disorders was correlated with the STIPO level of PO. The STIPO dimensional ratings of patients without personality disorder (PD) were compared to those of patients diagnosed with one or more PDs. Results: Axis I comorbidity was high (93%), and 63% of the patients met the criteria for at least one axis II diagnosis. Twenty-five patients (58%) were diagnosed as borderline PO, with high-level impairments in the dimensions ‘coping/rigidity’, ‘primitive defenses’ and ‘identity’. Higher axis I and axis II comorbidity corresponded with greater severity of PO impairment. No difference was found between the dimensional ratings of patients without PD and those of patients with one or more PDs. Conclusions: The assessment of PO is a crucial issue for diagnosis and treatment planning in CPPs, since it represents a measure of structural impairment that is to a considerable extent independent of axis I and II diagnoses. Moreover, the STIPO dimensional rating focuses on the most salient dysfunctions at a given time.
Fluorescent Microsatellite Analysis of Urine Sediment in Patients with Urothelial Carcinoma
Authors: Liang Jian-Fang , Zheng Hui-Xia , Li Ning , Yin Yan , Cheng Cai-Xia , Wang Hong-Kun , Wu Li-Na , Xiao Hong
Published: October 2010

Aims: To detect microsatellite loci alterations by fluorescent multiplex PCR in urine sediment cell of urothelial carcinoma, and to determine if they can be used as genetic markers for diagnosis of urothelial carcinoma. Materials and Methods: Microsatellite alteration analysis was conducted using fluorescent multiplex PCR with samples from 64 cases of urothelial carcinomas of the bladder. Three microsatellites spanning the 3p14 and two additional microsatellites in 9q33 and 9p22 were analyzed. Microsatellite alterations (microsatellite instability and/or loss of heterozygosity) in urine sediment cells of urothelial carcinoma patients matched for peripheral blood and tumor tissue were all analyzed. Results: The frequency of microsatellite alterations in urothelial carcinoma was chromosome 3p (D3S1234: 14.6% (7/48), D3S1300: 16.7% (8/48), D3S1313: 8.35% (4/48)); 9q (D9S242: 33.3% (16/48)), and 9p (D9S162: 27.1% (13/48)). Microsatellite alterations happened in 62.5% (40/64) of the patients when combined with all five markers. Our study showed a significant correlation between the microsatellite alteration of the five-locus panel and recurrence (p = 0.010) and smoking habit (p = 0.006). Conclusions: The results suggest that these microsatellite loci alterations may have an important role in the recurrence of urothelial carcinomas. Further studies are needed to better determine the effect of microsatellite loci alterations on prognosis.
Clinical Significance of Heme Oxygenase-1 Expression in Non-Muscle-Invasive Bladder Cancer
Authors: Miyake Makito , Fujimoto Kiyohide , Anai Satoshi , Ohnishi Sayuri , Nakai Yasushi , Inoue Takeshi , Matsumura Yoshiaki , Tomioka Atsushi , Ikeda Tomohiro , Tanaka Nobumichi , Hirao Yoshihiko
Published: October 2010

Introduction: In several malignant diseases, elevated heme oxygenase-1 (HO-1) is associated with progression or resistance to chemotherapy. We evaluated the clinical significance of HO-1 expression in non-muscle-invasive bladder cancer. Patients and Methods: We examined 109 patients with non-muscle-invasive bladder cancer. The immunoexpression of HO-1, p53, and Ki-67 was analyzed using paraffin-embedded tissue from transurethral resection in comparison with the clinicopathological variables. Results: Positive expression of HO-1 was found in 66 of 109 tumors (61%), and the positivity of HO-1 correlated significantly with high tumor grade and the altered expression patterns of p53 and Ki-67. In our analysis of 16 cases treated by intravesical administration of anthracyclines, the positive expression of HO-1 correlated with poor disease-free survival (p = 0.015). In in vitro experiments using urothelial cancer cell lines, HO-1 upregulation was observed by exposure to doxorubicin. Moreover, siRNA-mediated suppression of HO-1 upregulation sensitized the urothelial cancer cells to doxorubicin. Conclusions: Our findings suggested that resistance against anthracyclines correlated with HO-1 and expression analysis of HO-1 may be a useful predictive marker for intravesical administration of anthracyclines.
Childhood Trauma and Psychopathology among Alcohol-Dependent Men: No Interaction with Temperament and Character
Authors: Evren Cuneyt , Sar Vedat , Dalbudak Ercan , Durkaya Mine , Cetin Rabia , Evren Bilge , Cakmak Duran , Ertem-Vehid Hayriye
Published: October 2010

Objective: The aim of this study was to evaluate possible interactions between childhood trauma, temperament, character, and psychopathology among alcohol-dependent men. Methods: Participants were 156 alcohol-dependent men consecutively admitted to a dependency treatment unit. The Childhood Abuse and Neglect Questionnaire, the Temperament and Character Inventory, and the Symptom Checklist-Revised were administered to all participants. Results: Childhood abuse and neglect did not have any effect on temperament and character scores in multivariate analysis. Whereas childhood abuse had a significant main effect on all types of clinical psychopathology except depression and psychoticism scores, childhood neglect only had a significant main effect on depression scores. There was no interaction between childhood abuse and neglect on these analyses. Conclusions: Among alcohol-dependent men, childhood abuse and neglect contribute to general psychopathology through distinct clinical consequences, independently of temperamental and characterological features.
Exon 2 Methylation Inhibits hepaCAM Expression in Transitional Cell Carcinoma of the Bladder
Authors: Pan Cuicui , Wu Xiaohou , Luo Chunli , Yang Shuzhe , Pu Jun , Wang Chunyuan , Shen Shali
Published: October 2010

Aim: We aimed to investigate the mechanisms of hepaCAM inactivation in transitional cell carcinoma of the bladder through the analysis of hepaCAM exon 2 methylation. Methods: The methylation of hepaCAM exon 2 and the expression of hepaCAM were determined by methylation-specific restriction PCR assay and RT-PCR in bladder cancer cells (T24, BIU-87) as well as in 55 paired bladder cancer specimens. The methylated bladder cancer cells were treated with 5-Aza- 2′-deoxycytidine (5-Aza-CdR), a demethylating agent. MTT was used to detect the proliferation of T24 and BIU-87 cells. Results: The proliferation of T24 and BIU-87 cells was suppressed by treatment with different concentrations of 5-Aza-CdR; the expression of hepaCAM was absent in T24 and BIU-87 cells, and we found that exon 2 of hepaCAM was methylated in the 2 cells. hepaCAM mRNA was re-expressed and the methylation status of hepaCAM exon 2 was reversed after treatment with 5-Aza-CdR. The expression of hepaCAM mRNA in bladder cancer tissues was significantly lower than that in adjacent tissues. The methylation rate of hepaCAM exon 2 was significantly higher in bladder cancer tissues than in adjacent tissues. The methylation of hepaCAM exon 2 was related to hepaCAM expression in bladder cancer tissues. Conclusions: Downregulation of hepaCAM expression plays an important role in the tumorigenesis and development of bladder cancer. DNA methylation may be important for downregulation of hepaCAM expression in bladder cancer.
Retroperitoneal versus Transperitoneal Laparoscopic Pyeloplasty: Our Experience
Authors: Qadri Syed Javid Farooq , Khan Muneer
Published: October 2010

Objective: Laparoscopic pyeloplasty, which has been quoted to have a success rate equivalent to open pyeloplasty for ureteropelvic junction obstruction (UPJO), can be performed transperitoneally and retroperitoneally. The aim of the present study is to report our experience with these 2 routes of laparoscopic pyeloplasty and to further improve our understanding of the merits and demerits of these 2 routes. Patients and Methods: A total of 47 laparoscopic pyeloplasties were performed at our center from June 2000 to August 2009. Twelve pyeloplasties were performed transperitoneally and 35 retroperitoneally. Results: In the retroperitoneal group, we had a success rate of 91.5% after a mean follow-up of 22 months, and in the transperitoneal group, we had a success rate of 91.7% after a mean follow-up of 48 months. The mean operative time was 156 min in the retroperitoneal group and 195 min in the transperitoneal group. Conclusion: This study shows a success rate comparable with open pyeloplasty and favors the retroperitoneal route with a shorter operative time, less dissection needed, a higher sensitivity of detecting crossing vessels, a decreased risk in visceral injury and an early start of oral feeds.
Post-Stroke Apathy and Hypoperfusion in Basal Ganglia: SPECT Study
Authors: Onoda Keiichi , Kuroda Yoko , Yamamoto Yasushi , Abe Satoshi , Oguro Hiroaki , Nagai Atsushi , Bokura Hirokazu , Yamaguchi Shuhei
Published: October 2010

Background: Although apathy has been reported as one of the neuropsychiatric symptoms following stroke, there are few studies on regional cerebral blood flow (rCBF) in stroke patients with apathy. The present study compared rCBF between apathetic and non-apathetic patients after stroke. Methods: We recruited 102 patients with cerebral infarction within 1 month after stroke and performed neuropsychiatric assessments that included the apathy scale. rCBF was quantitatively measured using N-isopropyl-p-123I-iodoamphetamine single-photon emission computed tomography. Results: Thirty-seven patients (36%) had apathy. The apathetic group showed lower cognitive function and a higher depressive state than the non-apathetic group. rCBF in the basal ganglia was reduced for the apathetic group compared with the non-apathetic group. Furthermore, lesions in the left basal ganglia were associated with hypoperfusion in bilateral basal ganglia and the presence of apathy. Conclusion: These findings demonstrate that apathy is a frequent symptom among stroke patients and that hypoperfusion caused by basal ganglia lesions may contribute to post-stroke apathy.
Little Association between Intracranial Arterial Stenosis and Lacunar Stroke
Authors: Wardlaw Joanna M. , Doubal Fergus N. , Eadie Elizabeth , Chappell Francesca , Shuler Kirsten , Cvoro Vera
Published: October 2010

Atheromatous middle cerebral artery (MCA) stenosis could cause lacunar stroke by occluding lenticulostriate artery origins, but atheroma is common, and previous studies lacked suitable controls. We aimed to determine if intracranial atheroma was more common in lacunar than in cortical ischaemic stroke. We recruited patients with lacunar stroke and controls with mild cortical stroke, confirmed the stroke subtype with magnetic resonance imaging and used transcranial Doppler ultrasound imaging to record flow velocity and focal stenoses in the basal intracranial arteries 1 month after stroke. We compared ipsi- and contralateral MCA mean flow velocities between stroke subtypes and tested for associations using linear mixed models. Amongst 67 lacunar and 67 mild cortical strokes, mean age 64 and 67 years, respectively, we found no difference in MCA mean flow velocity between cortical and lacunar patients. Increasing age and white matter lesion scores were independently associated with lower MCA flow velocities (0.2 cms–1 fall in velocity per year increase in age, p = 0.045; 3.75 cms–1 fall in flow velocity per point increase in white matter lesion score, p = 0.004). We found no intracranial arterial stenoses. MCA atheromatous stenosis is unlikely to be a common cause of lacunar stroke in white populations. Falling velocities with increasing white matter lesion scores may reflect progressive brain tissue loss leaving less tissue to supply.
Stroke History and Chagas Disease Are Independent Predictors of Silent Cerebral Microembolism in Patients with Congestive Heart Failure
Authors: Jesus Pedro A.P. , Neville Iuri , Cincurá Carolina , Menezes Daniela F. , Vieira-de-Melo Rodrigo M. , Lacerda Amanda M. , Viana Leila C. , Pereira Davidson F. , Ribeiro-dos-Santos, Jr. Valter , Reis Francisco J.F.B. , Macedo Cristiano , Oliveira-Filho Jamary
Published: October 2010

Background: Chagas disease is endemic in South and Central America, where 18 million individuals are infected by Trypanosoma cruzi, causing congestive heart failure (CHF) and cardioembolic stroke. Transcranial Doppler (TCD) is able to detect real-time microembolic signals (MES) to the brain vessels and may represent a surrogate marker of stroke risk. We aimed to determine predictors of MES in a population of patients with CHF. Methods: Consecutive CHF patients from a university-based cardiomyopathy clinic underwent TCD recording of the middle cerebral artery for 60 min by a single investigator who was blinded to all clinical data including cardiomyopathy etiology. Predictors of MES were sought by multivariable logistic regression analysis. Results: From April 2004 to February 2009, 144 patients were studied, including 62 (44.6%) patients with Chagas disease. MES were detected in 9 (6.2%) patients and were more frequent in patients with Chagas disease than in patients with other causes of CHF (12.9 vs. 1.2%, p = 0.005). In multivariate analysis corrected for age and left-ventricular ejection fraction, predictors of MES were Chagas disease (odds ratio = 1.15, 95% confidence interval = 1.05–1.26, p = 0.004) and stroke history (odds ratio = 1.27, 95% confidence interval = 1.08–1.50, p = 0.005). Conclusions: Chagas disease and stroke history are risk factors for MES independent of cardiac disease severity. Other mechanisms besides structural cardiac disease may be operative, increasing embolic risk in Chagas disease.
Is Transition Zone Sampling at Repeated Saturation Prostate Biopsy Still Useful
Authors: Pepe Pietro , Candiano Giuseppe , Fraggetta Filippo , Galia Antonio , Grasso Giuseppe , Aragona Francesco
Published: October 2010

Objectives: To evaluate retrospectively the detection rate of prostate cancer (PCa) located only in the transition zone (TZ) by directed cores at repeated saturation prostate biopsy (SPB). Methods: From July 2001 to December 2009, 380 and 43 patients (median age: 63 years) underwent second and third SPB because they were persistently suspicious for PCa. Indications for biopsy were: prostate-specific antigen (PSA) of >10 ng/ml, and PSA between 4.1 and 10 ng/ml or 2.6 and 4 ng/ml with free/total PSA of ≤25 and ≤20%, respectively. A median of 23 cores were taken in the posterior zone, including 3 (median) cores in the TZ. The median PSA was 12.8 and 19.5 ng/ml and the digital rectal examination was positive in 36 (9.5%) and in no cases at second and third SPB, respectively. In patients with persistent and/or increasing PSA or abnormal free/total PSA values after negative second and third SPB, a transurethral prostate resection (TURP) was suggested to avoid the risk of missing a cancer localized in the TZ. Results: PCa was detected in the TZ only in 2/82 cases (2.5%), and in details in 1/79 (1.2%) and 1/3 (33.3%) of the men diagnosed at second and third SPB, respectively. After TURP, a PCa was found in 18/95 men (18.9%; 14 stage T1a and 4 stage T1b) and in 3/15 men (20%; 2 stage T1a and 1 stage T1b) previously having had negative second and third SPB. Conclusions: Sampling from the prostatic TZ by directed needle biopsies at repeated SPB was associated with a very low incidence of PCa (2.5%), especially if compared to TURP (19% detection rate), and could be omitted.
Stroke in Asymptomatic Trypanosoma cruzi-Infected Patients
Authors: Carod-Artal Francisco Javier , Vargas Antonio Pedro , Falcao Thiago
Published: October 2010

Background: The knowledge about the natural history of stroke in Chagas disease is incomplete. Methods: Vascular risk factors and stroke subtypes of asymptomatic  Trypanosoma cruzi-infected patients with no clinical evidence of heart failure were assessed. They were compared with chronic chagasic cardiomyopathy patients who suffered a stroke and with a control group of 60 T. cruzi-noninfected stroke patients. Eighty-six consecutive chagasic stroke patients (mean age: 57.4 years; 64% females) were studied. Results: 38.4% of chagasic stroke patients had asymptomatic T. cruzi infection. Smoking was more frequent in asymptomatic chagasic stroke patients (21.2 vs. 5.7%; p = 0.04). Prevalence of hypertension, diabetes and prior stroke was similar in both groups. Small-vessel infarction (15.6 vs. 3.8%) and large-vessel atherosclerosis (9.4 vs. 3.8%) were significantly more frequent in asymptomatic than in symptomatic T. cruzi-infected stroke patients (p = 0.001). Nevertheless, their frequency was even higher in T. cruzi-noninfected stroke patients (36.7 and 13.3%, respectively). Apical aneurysm (27.3%), left atrial dilatation (12.1%), left ventricle hypokinesia (9.4%) and right bundle branch block (36.4%) were also detected in asymptomatic T. cruzi-infected stroke patients. Conclusions: Ischemic stroke may be the first manifestation of Chagas disease in asymptomatic patients with mild left ventricle dysfunction. Other noncardioembolic stroke subtypes can occur in asymptomatic T. cruzi-infected patients.
Toll-Like Receptor 4 Immunohistochemical Expression Is Enhanced in Macrophages of Symptomatic Carotid Atherosclerotic Plaques
Authors: Katsargyris Athanasios , Tsiodras Sotirios , Theocharis Stamatios , Giaginis Konstantinos , Vasileiou Ioanna , Bakoyiannis Christos , Georgopoulos Sotiris , Bastounis Elias , Klonaris Chris
Published: October 2010

Background: A growing body of evidence supports a role for Toll-like receptor 4 (TLR4), a primary receptor of the innate immune system, in atherosclerosis initiation and progression. Carotid atheroma macrophages (MACs) and smooth muscle cells (SMCs) express TLR4; nevertheless, correlations with epidemiological and clinical variables and especially cerebrovascular symptomatology remain unsettled. Methods: Carotid atherosclerotic plaques were obtained by standard carotid endarterectomy on 157 patients with carotid artery disease (84 asymptomatic – 73 symptomatic). TLR4 expression in MACs and SMCs of carotid atheroma was detected by immunohistochemistry techniques. TLR4 positivity, overexpression and intensity of immunostaining in MACs and SMCs were correlated with cerebrovascular symptomatology, epidemiological and clinical variables. Results: MAC TLR4 positivity was noted in 129 (82.2%) patients. Patients receiving statins had significantly lower TLR4 expression. Rates of MAC TLR4 positivity were higher among symptomatic patients (odds ratio, OR = 5.1; 95% confidence interval, CI = 1.8–14.3; p < 0.001); the association was stronger for transient ischemic attacks. TLR4 overexpression was also significantly enhanced among symptomatic patients (OR = 2.3; 95% CI = 1.02–5.03; p < 0.05). No correlations were detected between SMC TLR4 expression and cerebrovascular symptoms. In multivariate models adjusting for age, gender, body mass index, hyperlipidemia and smoking, MAC TLR4 positivity was associated with a cerebrovascular event during the last 6 months (OR = 4; 95% CI = 1.2–13.3; p = 0.02). Conclusions: Symptomatic carotid artery plaques are characterized by increased expression of TLR4 in macrophages supporting a potential role for TLR4 in the pathophysiology and clinical presentation of cerebrovascular disease. Further investigation is warranted.
Common Carotid Artery Intima-Media Thickness: The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) Study Results
Authors: Touboul Pierre-Jean , Vicaut Eric , Labreuche Julien , Acevedo Monica , Torres Victor , Ramirez-Martinez Jesus , Vinueza Raul , Silva Honorio , Champagne Beatriz , Hernandez-Hernandez Rafael , Wilson Elinor , Schargrodsky Herman ,   on behalf of the CARMELA Study Investigators
Published: October 2010

Background: Measurement of far wall common carotid artery intima-media thickness (CCAIMT) has emerged as a predictor of incident cardiovascular events. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was the first large-scale population-based assessment of both CCAIMT and cardiovascular risk factor prevalence in 7 Latin American cities; the relationship between CCAIMT and cardiovascular risk markers was assessed in these urban Latin American centers. Methods: CARMELA was across-sectional, population-based, observational study using stratified, multistage sampling. The participants completed a questionnaire, were evaluated in a clinical visit and underwent carotid ultrasonography. Clinical measurements were obtained by health personnel trained, certified and supervised by CARMELA investigators. Mannheim intima-media thickness consensus guidelines were followed for measurement of CCAIMT. Results: In all cities and for both sexes, CCAIMT increased with higher age. CCAIMT was greater in the presence of cardiovascular risk factors than in their absence. In all cities, there was a statistically significant linear trend between increasing CCAIMT and a growing number of cardiovascular risk factors (p < 0.001). After adjustment for age and sex, metabolic syndrome was strongly associated with increased CCAIMT (p < 0.001 in all cities), as were hypercholesterolemia, obesity and diabetes (p < 0.001 in most cities). By multivariate analysis, hypertension was independently associated with an increase in CCAIMT in all cities (p < 0.01). Conclusions: CARMELA was the first large-scale population study to provide normal CCAIMT values according to age and sex in urban Latin American populations and to show CCAIMT increases in the presence of cardiovascular risk factors and metabolic syndrome.
Sequential Bilateral Cochlear Implantation in Children: Development of the Primary Auditory Abilities of Bilateral Stimulation
Authors: Sparreboom Marloes , Snik Ad F.M. , Mylanus Emmanuel A.M.
Published: October 2010

The advantages of sequential bilateral cochlear implantation were assessed in 29 children with a severe to profound hearing loss. The effect of age at second implantation and the effect of duration of bilateral implant use on the outcomes in speech perception and directional hearing were investigated. The children received their second cochlear implant at an age ranging from 2.8 to 8.5 years. Measurements were carried out preoperatively and postoperatively after 6, 12 and 24 months of bilateral implant use. A matched control group of 9 children with a unilateral implant were also measured over time and were compared with the study group after 12 and 24 months. Speech reception in both quiet and in noise and lateralization were measured. After 24 months, a minimum audible angle task was carried out. Bilateral advantages with regard to speech reception in quiet and in noise were already present after 6 months of bilateral implant use and improved thereafter. After 24 months, speech reception in noise had significantly improved with bilateral implants compared to that of children with a unilateral implant. The percentage of children that could accurately lateralize increased from 57% after 6 months to 83% after 24 months. With regard to the minimum audible angle task, loudspeakers were placed on average at ±42°. Age at second implantation did not have an influence on all outcomes. From the results it can be concluded that the advantages of bilateral hearing occur after sequential bilateral implantation and that age at second implantation does not influence the amount of bilateral advantage. Furthermore, it can be concluded that longer periods of bilateral implant use lead to greater bilateral advantages.
Cochlear Implants in Forty-Eight Children with Cochlear and/or Vestibular Abnormality
Authors: Dettman Shani , Sadeghi-Barzalighi Ana , Ambett Ranjeeta , Dowell Richard , Trotter Matthew , Briggs Robert
Published: October 2010

CT and MRI scans for 48 children with cochlear and/or vestibular abnormality were classified in decreasing severity; common cavity, Mondini plus enlarged vestibular aqueduct, Mondini dysplasia alone and enlarged vestibular aqueduct alone. No significant relationship between degree of cochlea abnormality and surgical issues (cerebrospinal fluid gusher, depth of insertion, number of electrodes) or speech perception/language outcomes was found. A significant relationship was observed between cerebrospinal fluid gusher and partial electrode insertion, fewer active electrodes and poorer sentence understanding. Optimum language outcomes were associated with younger age at implant.