bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Magnetic Resonance Image-Based Evaluation of Thalamotomy and Pallidotomy Lesion Volumes
Authors: Tollefson Travis T. , Burns Jeffrey , Wilkinson Steve , Overman John , Kieltyka Jennifer , Goodman Scott H. , Koller William C. , Tröster Alex , Lyons Kelly , Pahwa Rajesh , Batnitzky Solomon , Wetzel Louis , Gordon Michael
Published: April 2003

Acute thalamotomy and pallidotomy lesion volumes based on magnetic resonance (MR) images were measured in 22 patients (11 thalamotomy and 11 pallidotomy patients). Thalamotomy inner lesion volumes (0.06 ± 0.04 ml; thermocoagulative zone) were smaller than pallidotomy inner lesion volumes (0.14 ± 0.08 ml) as determined using T1-weighted 3D-MPRAGE (1.5-mm slice spacing). Similar results were found using T1-weighted (6-mm slice spacing) image sets (0.09 ± 0.05 ml, thalamotomy; 0.13 ± 0.05 ml, pallidotomy). No differences were found when comparing thalamic or pallidal inner lesion volumes when the comparison was based on T2 weighted images. Thalamotomy total lesion volumes (thermocoagulative and surrounding edematous zones) were less than pallidotomy total lesion volumes independent of the MR protocol. The difference in thalamotomy and pallidotomy lesion volumes is most likely based on the distance between each discrete lesion placed along the lesioning tracts. In 7 of 11 thalamotomies, this distance was 1 mm with the remaining having 2 mm between each discrete lesion. All pallidotomy discrete lesions were 2 mm apart. More overlap between discrete lesioning sites for thalamotomies is likely to produce reduced lesion volumes.
Temperature Distribution Produced in Brain Tissue and Other Media by a Radiofrequency Hyperthermia Generator
Authors: Chua Eric , Gose Earl , Vinas Federico C. , Dujovny Manuel , Star Jeniffer
Published: April 2003

The temperature distribution produced in living brain tissue by a radiofrequency, Neuro N-50, hyperthermia probe was measured as a function of probe temperature, heating duration, and distance from the heating probe by a sensor containing five thermocouples for durations up to 2 min. Brain sections were examined to determine the effects of heating at various temperatures. It was found that a simple theoretical conductive heat transfer model predicted the steady-state temperature distributions quite well. At distances up to 7.4 mm from the heating probe, a heating time of 20 s was sufficient to produce about 90% of the temperature rise measured at 120 s. The equilibrium temperature at any distance from the center of the probe was a linear function of the reciprocal of this distance. The time constant for heating was approximately 3 s at 0.95 mm from the heating probe and about 10 s at 7.4 mm for brain tissue, while these values are about 5–20 s in egg white. For a given probe size, higher probe temperatures increased the size of the region of cell death. According to the heat transfer model, the diameter of the region of tissue that attains a given temperature is proportional to the diameter of the probe. The use of probe temperatures up to 90°C would enable an increase in the volume of the region of cell death, or the use of a smaller diameter probe to produce a lesion of a given size.
Electrophysiological Recordings in Pallidotomy Localized to 3D Stereoscopic Imaging
Authors: Lehman Richard M. , Micheli-Tzanakou Evangelia , Zheng Jian , Hamilton Jennifer L.
Published: April 2003

A quantitative on-line analysis of electrical activity in the pallidum of Parkinsonian patients has been developed to determine the focal point of lesioning. A 3D volume image system has been developed to display basal ganglia anatomy and coregister the electrophysiological data within the globus pallidus. Thirty patients undergoing 41 pallidotomies are presented. Neuronal activity from the pallidum is recorded using a semi-microelectrode. Based on this activity, lesioning is performed. Postlesion recordings are made to determine the necessity of additional lesioning. A stereoscopic 3D volume MR image system has been developed that along with on-line signal processing allows visualization of high neural activity in the pallidum and postlesion residual activity.
Electrical Inhibition of Basal Ganglia Nuclei in Parkinson’s Disease: Long-Term Results
Authors: Barcia-Salorio J.L. , Roldan P. , Talamantes F. , Pascual-Leone A.
Published: April 2003

Since 1995 a group of 57 patients with familial tremor and Parkinson’s disease have been operated in two main sets: the first, with 11 cases, with predominant tremor, where the ventro-oralis posterior (Vop) thalamic nucleus was stimulated, and the second, with 44 cases, with mainly rigidity and akinesia, where the globus pallidus internus (GPi) was unilaterally (10 cases) or bilaterally (34 cases) stimulated. In 2 cases, a combined thalamic-pallidal stimulation was achieved. In the last cases, an image fusion software with 3D correlation of MR and CT images and volumetric image matching has been used to correct MRI distortion. In all cases, an Itrell II stimulation system (Medtronic) was implanted. Result analysis shows that Vop stimulation is mostly effective for tremor, and GPi stimulation is better for rigidity and akinesia. Transcortical magnetic stimulation tests suggest that GPi pallidal electrical inhibition increases cortical excitability, as opposed to Vop thalamic stimulation, which implies a different mechanism of action.
Outcomes and Complications of Fetal Tissue Transplantation in Parkinson’s Disease
Authors: Jacques Deane B. , Kopyov Oleg V. , Eagle Kaaren S. , Carter Thomas , Lieberman Abraham
Published: April 2003

This study was undertaken to investigate the outcomes, complication rates and risk factors of stereotactic intrastriatal neurotransplantation for Parkinson’s disease (PD). Bilateral stereotactic neurotransplantation was performed (as previously described) in 60 patients with idiopathic PD. Clinical outcome was evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS). The incidence of complication was evaluated by retrospective analysis of the clinical outcomes of the transplanted patients. Patients demonstrated significant improvement in UPDRS scores 12 months after transplantation. Nine patients experienced adverse effects after neurotransplantation, 3 requiring surgical intervention. Patients showed a significant overall improvement and no greater incidence of risk than that of other intracranial procedures.
MKM-Guided Resection of Diffuse Brainstem Neoplasms
Authors: Lévesque Michel F. , Parker Fabrice
Published: April 2003

Objectives: Some primary brainstem tumors, when extensive, are considered inoperable. We wanted to assess the value of robotic image-guided microscopic surgery in the resection of these tumors and to improve survival and quality of life for these patients. Methods: Two patients with extensive brainstem tumors were evaluated at our center. They previously underwent several biopsies, attempted partial resections, radiotherapy and shunting. They presented with progressive neurological deterioration, ‘coma vigil’ for several months, and required life-supporting measures prior to surgery. Both patients underwent frameless stereotactic craniotomy using a MKM robotic microscope, intraoperative neurophysiological monitoring, and extensive resection of their recurrent brainstem tumors. Results: In the immediate weeks after surgery, both patients became interactive and regained major motor and cranial nerve deficits present prior to surgery. Nine months after surgery, 1 patient succumbed to pneumonia. At 2 years after the operation, 1 patient has maintained his neurological status and showed no recurrence on imaging studies. Conclusions: Image-guided surgery with an MKM microscope allows surgical outlines to be injected in the microscope viewer and facilitates resection of extensive brainstem tumors previously considered inoperable.
Staged Functional Neurosurgery Using Image Fusion
Authors: Eljamel M. Sam , Forster Alan , Tulley Mark , Matthews Keith
Published: April 2003

The unforgiving nature of the thalamus, the globus pallidus and the subthalamic nucleus necessitates precise localization of functional targets. This requires the total attention of both the patient and the surgeon. To maximize the concentration of the patient and provide the most accurate localization, we performed staged stereotactic functional procedures. The first stage was performed under general anesthesia to abolish any head movement. We fused CT and MRI images and correlated the fused images with a digitized Talairach brain atlas. We calculated the target coordinates and fixed a modified Bennett Sphere to the skull with the central hole defining the trajectory to the target. The surrounding 12 holes gave parallel trajectories to targets surrounding the anatomical target at 2-mm intervals. The second stage was performed at least a week later under local anesthesia. Microelectrode recording using three simultaneous channels was used to refine the target. Once the microelectrode recordings and macrostimulation confirmed the desired target, a lesion was created or an Activa neurostimulator was inserted. Our early results using this technique in 28 procedures (in 19 patients) indicate a good outcome in 86% and a technical failure in 1 patient.
Percutaneous Endoscopic Marsupialization of a Pyelocaliceal Diverticulum with Milk ofCalcium Stones
Authors: Kikuchi Eiji , Sumitomo Makoto , Hatakeyama Naoki , Baba Shiro , Murai Masaru
Published: April 2003

Numerous reports have described the management of pyelocaliceal diverticula associated with milk of calcium renal stones. Traditionally, open surgical techniques to manage such diverticula have included marsupialization and fulguration of the diverticulum, or partial/total nephrectomy. Recently, however, these invasive procedures have been replaced by percutaneous techniques. We report a patient with spontaneous rupture of a pyelocaliceal diverticulum with milk of calcium renal stones, who was successfully treated with endourological procedures.
Experimental Partial Ureteric Obstruction in Newborn Rats
Authors: Josephson S. , Jacobsson E. , Larsson E.
Published: April 2003

Partial obstruction of the left ureter was created in newborn rats. Unobstruction was performed after 2 or 7 days. The investigations were carried out at 9 weeks of age – under slight hydropenia to institute an element of stress. Unobstruction was successful. On the unobstructed side, there were nevertheless impairments as compared to controls: urine osmolality (–32%), free water reabsorption (–44%), potassium excretion (–34%), renal blood flow (–36%) and glomerular filtration (–36%). On the intact contralateral side, tubular changes were the only signs of an attempt to compensate. Thus, consistent renal damage remained despite a very early unobstruction. Furthermore, the changes were similar to those we observed during long-term permanent obstruction. The injury seems to be established within a very short time and imitates the probable development seen in the affected fetus: after start of production, the urine is confronted by the preformed obstruction at the pyeloureteral junction. A high-pressure-prone system is built up and is not reversed, until the pelvis has become dilated and thus capable to buffer urinary flow peaks. Thereafter, no further deterioration occurs except in specific conditions. If clinically applicable, these observations implicate that there is no advantage with surgical intervention, even when performed early in fetal life, and there is no need for swift intervention, as the damage does not progress after its establishment. Most of the cases probably do not require surgery at all, unless pain, obvious functional impairment or urinary tract infection supervene.
Primary Erectile Dysfunction in Combination with Congenital Malformation of the Cavernous Bodies
Authors: Matter Lukas E. , Hailemariam Seife , Huch Rahel A. , Hauri Dieter , Sulser Tullio
Published: April 2003

Primary erectile dysfunction in combination with congenital malformation of the cavernous bodies has only rarely been reported. We report on 2 young patients with different congenital malformations. To our knowledge this is the first time partial aplasia of the distal part of the cavernous bodies is described, whilst complete isolation of the cavernous bodies in combination with veno-occlusive dysfunction has yet been described in 3 cases. After complete examination, including penile angiography and cavernosometry, a surgical correction with a fully satisfying result was achieved in the patient with distal aplasia. In case of isolated cavernous bodies with severe veno-occlusive dysfunction, the implantation of a penile prosthesis remains the treatment of choice.
Long-Term Outcome of a Patient with Intrascrotal Extratesticular Malignant Schwannoma
Authors: Şafak Mut , Baltacı Sümer , Özer Gökhan , Türkölmez Kadir , Uluoglu Ömer
Published: April 2003

We have the opportunity to present a rare case of late local recurrence after treatment of intrascrotal extratesticular malignant schwannoma with rhabdomyoblastic features in an adult man. As our case is the first in the literature, we want to inform the reader about the long-term follow-up of our patient and suggest that these tumors may have a long survival and late recurrences may occur even after 5 years postoperatively.
Transcaval Biopsy of Retroperitoneal Fibrosis
Authors: Pfammatter T. , Hilfiker P.R. , Kurrer M. , Sulser T.
Published: April 2003

An additional use of the transjugular hepatic Tru-cut biopsy needle is reported. A periaortic mass was biopsied with this device inserted through the femoral vein under fluoroscopy guidance. Based on the sampled tissue, a diagnosis of idiopathic retroperitoneal fibrosis was made. The procedure was well tolerated, and long-term follow-up confirmed the diagnosis. Transcaval retroperitoneal biopsy may represent an alternative to surgical biopsy of diffuse retroperitoneal disease in high operative-risk patients.
Primary Male Infertility Caused by Congenital Prostatic Cyst: Sonographic and Magnetic Resonance Imaging Findings
Authors: Aalame Nadine M. , Sulser Tullio , Egli Urs , Krestin Gabriel P. , Kubik-Huch Rahel A.
Published: April 2003

Congenital cysts in the midline of the prostate gland can cause obstruction of the ejaculatory ducts leading to congestion and dilation of the seminal vesicles with the result of small volume ejaculate or infertility. We report the case of a patient who underwent transrectal ultrasound and magnetic resonance imaging for evaluation of primary male infertility. The images obtained revealed a congenital cyst of the prostate gland. Transurethral marsupialization of the cyst subsequently resulted in normalization of the semen analysis and restitution of the patient’s fertility.
A Clinicopathological Study of p53, p21 (WAF1/CIP1) and Cyclin D1 Expression in Human Prostate Cancers
Authors: Shiraishi Taizo , Watanabe Masatoshi , Muneyuki Tsuyoshi , Nakayama Tsuyoshi , Morita Jyouji , Ito Haruo , Kotake Toshihiko , Yatani Ryuichi
Published: April 2003

A series of 66 prostate cancer samples were studied immunohistochemically for expression of p53, p21, a cyclin-dependent kinase inhibitor regulated by p53, and cyclin D1, a cell cycle regulatory protein. Twenty samples (30%) showed positive staining for p53, 14 (21%) for p21, and 20 (30%) for cyclin D1. p53 expression was correlated with a high Gleason score while p21 and cyclin D1 did not demonstrate any clear clinicopathological factors. A positive correlation between p53 and p21 expression was observed, however these samples with both positive immunoreactivity had no p53 mutation, suggesting the possibility that p53 may be wild-type and induce p21 expression, and/or p21 is likely to be induced by a p53-independent pathway.
Transurethral Needle Ablation of the Prostate: An Alternative Minimally Invasive Therapeutic Concept in the Treatment of Benign Prostate Hyperplasia
Authors: Braun M. , Zumbé J. , Korte D. , Solleder G. , Heidenreich A. , Engelmann U.
Published: April 2003

Alternative minimally invasive methods treating benign prostate hyperplasia (BPH) have become more and more important. Transurethral needle ablation (TUNATM) has been demonstrated to be effective in both canine and the human prostate. The goal of our study was to prove the safety, feasibility and tolerance of this new procedure. In this prospective nonrandomized study, 33 patients underwent TUNATM-treatment. One, 3 and 6 months postoperatively, follow-up examinations were carried out assessing urodynamic parameters such as urinary flow rates, residual urine levels, and IPSS-scores. During the last visit additional cystomanometry and urethrocystoscopy were done. Six months postoperatively IPSS-score and residual urine volumes were decreased by 50% (range: 1–72%) and 75% (range: 12–97%). Improvement in maximum flow rate was 63% (range: 5–125%). No serious postoperative complications occurred. After a short ‘learning period’ most of the treatments where performed as an out-patient-procedure so the patients could leave the hospital without the need for indwelling catheters. The TUNATM appears to be a minimally invasive and safe out-patient procedure for the treatment of selected cases of BPH.
An Unusual Filling Defect in the Ureter
Authors: Biyani Chandra Shekhar , Mackay A.M. , Sissions Guy , Pettersson Bo
Published: April 2003

A case of benign ureteric haemangioma is reported. A conservative approach is recommended when the kidney is capable of function.
Parotid Metastasis from Renal Clear Cell Adenocarcinoma
Authors: Vara Alejandro , Madrigal Beatriz , Pérez del Río María José , Díaz Ana , Mateos Ana , Sales Covadonga
Published: April 2003

Metastasis to the parotid region is rare, and originates primarily from head and neck squamous cell carcinoma and melanoma of the skin. Renal clear cell adenocarcinoma has considerable metastatic potential and the parotid gland is one possible destination. Histopathologic study is important to differentiate this entity from primary clear cell parotid neoplasm.
Prejunctional Muscarinic Receptors Modulating Acetylcholine Release in Rabbit Detrusor Smooth Muscles
Authors: Inadome Akito , Yoshida Masaki , Takahashi Wataru , Yono Makoto , Seshita Hiroshi , Miyamoto Yutaka , Kawano Takashi , Ueda Shoichi
Published: April 2003

We investigated the presence and subtypes of functionally prejunctional receptors in cholinergic nerve endings of rabbit detrusor smooth muscle strips using high-performance liquid chromatography coupled with a microdialysis procedure. The effects of pretreatment with various drugs on acetylcholine (ACh) release and contractile responses induced by electrical field stimulation were evaluated. Although atropine (a muscarinic nonselective antagonist) and 4-DAMP (a muscarinic M3 antagonist) did not influence the ACh release, they markedly reduced the contractile responses. Pirenzepine (M1 antagonist) decreased ACh release and contractile responses. Methoctramine (M2 antagonist) increased the ACh release, but did not influence to the contractile responses. These results suggest that the muscarinic receptors in the rabbit detrusor smooth muscle are heterogeneous, prejunctional facilitatory (M1 receptors), and inhibitory (M2 receptors) for ACh release and postjunctional M3 receptors mediating contractile responses.
Asymptomatic Intrarenal Arteriovenous Fistula Accompanying Severe Renal Vein Dilatation Detected 30 Years after Percutaneous Renal Biopsy
Authors: Okamura Takehiko , Tatsura Hiroyuki , Kohri Kenjiro
Published: April 2003

We report on a patient with asymptomatic intrarenal arteriovenous fistula (AVF) accompanying severe renal vein dilatation detected 30 years after percutaneous renal biopsy. The patient was found to have microscopic hematuria. Three-dimensional computerized tomography confirmed the presence of an AVF, and arterial embolization was performed. Three-dimensional computerized tomography is very useful and effective to image the physiology of vascular lesions for the diagnosis of a renal AVF.
Development of an in vitro Assay for the Screening of Substances Capable of Dissolving Calcium Oxalate Crystals
Authors: Saso L. , Valentini G. , Leone M.G. , Grippa E. , Silvestrini B.
Published: April 2003

Despite the risk of kidney damage, lithotripsy is the usual way of treating calcium oxalate (CaOx) stones, the most common type of nephrolithiasis, because no effective chemolytic agents are available. However, the search of new calcium chelators, less toxic than the current ones, continues, and some of them could be tested in experimental models of nephrolithiasis, after their ability of dissolving CaOx crystals is verified. In this connection, we developed a simple assay that requires only inexpensive equipment available in most laboratories for the screening of substances potentially capable of dissolving CaOx crystals. In particular, we decided to investigate whether substances previously shown to inhibit CaOx precipitation were also capable of dissolving this salt. Briefly, CaOx tablets of highly reproducible weight (4.55 ± 0.07 mg) were prepared by spinning, at high speed (16,000 g), microcentrifuge tubes in which 500 µl aliquots of 0.1 M sodium oxalate and 0.1 M calcium chloride at pH 6 were added. When these tablets were incubated overnight with solutions at different concentrations of EDTA, sodium citrate, manganese chloride, sodium sulfate, sodium chloride, malic acid, succinic acid and gluconic acid, a significant dissolving activity was observed for EDTA (∼25% at 0.25 M), sodium citrate (∼30% at 1 M) and manganese chloride (∼20% at 0.5 M). A good linear correlation (r2 = 0.84, p < 0.05) was found between the affinity for calcium and the activity of EDTA, sodium citrate, sodium sulfate, malic acid, succinic acid and gluconic acid, indicating that these compounds act mainly by chelating the calcium ion. Instead, manganese was supposed to act by interacting with the oxalate ion.
Urodynamic Evaluation after Endoscopic Modified Bladder Neck Suspension
Authors: Serel T. Ahmet , Güngör Mete
Published: April 2003

A total of 45 simplified double-needle bladder neck suspensions for genuine stress incontinence were clinically and urodynamically evaluated pre- and postoperatively. After a mean follow-up of 26 months, the subjective cure rate was 82.2% and the objective cure rate was 86.6%. Comparison of the pre- and postoperative urodynamic parameters showed a significant change in the maximum urethral closure pressure, functional urethral length, bladder capacity and maximum urine flow rate but no significant alteration in maximum detrusor pressure and first sensation during bladder filling. In summary, the modified bladder neck suspension effectively restores normal urethral function urodynamically.
Serum Ferritin as a Clinical Markerfor Renal Cell Carcinoma: Influenc e of Tumor Size and Volume
Authors: Kırkalı Ziya , Güzelsoy Muhammet , Mungan M. Uǧur , Kırkalı Güldal , Yorukoglu Kutsal
Published: April 2003

Objectives: There is no established tumor marker for renal cell carcinoma (RCC). Ferritin is shown to be expressed by the tumor, and proposed as a tumor marker. The aim of this study is to assess the relation between ferritin levels and tumor volume, size and prognosis in RCC. Methods: We studied ferritin levels in serum from peripheral and renal veins of 52 patients with RCC who underwent surgery. Ferritin levels were measured by an enzyme immunoassay method. Tumor volume and the largest tumor diameter were calculated from the pathologic specimens. Results: The mean serum ferritin level from the renal vein (RVF) was statistically higher than the ferritin level from the peripheral vein (PVF) (p = 0.028). Although mean RVF level increased with increasing stage, it was not significant. While there was a correlation with tumor size, volume and RVF, PVF was in correlation with disease status. PVF in patients with metastatic and/or locally advanced disease was significantly higher than the patients with localized disease (p = 0.023). The initial RVF and PVF levels were predictive of survival (p = 0.028 and p = 0.034, respectively). Conclusions: Higher levels in the renal vein, its positive correlation with tumor size and volume suggest that ferritin is expressed by RCC. Initial peripheral serum values of ferritin can be indicative of disease status and also be a prognosticator of survival.
A Case of Primary Adrenal Lymphoma Diagnosed from Percutaneous Needle Biopsy
Authors: Takai Kimio , Hiragino Takeshi , Isoyama Riichiro , Takahashi Mutsuo , Naito Katsusuke
Published: April 2003

A case of bilateral lymphoma of the adrenal glands is reported. A 72-year-old woman was admitted to our hospital for evaluation of bilateral adrenal masses. A 20-gauge core needle biopsy of the left adrenal tumor was performed under ultrasonographic guidance. The pathological specimen revealed a malignant lymphoma. The diagnostic procedure for adrenal lymphoma is discussed.
Multiple Pulmonary Metastasis of Prostatic Carcinoma with Little or No Bone or Lymph Node Metastasis
Authors: Kume Haruki , Takai Kazuhiro , Kameyama Shuji , Kawabe Kazuki
Published: April 2003

We describe 2 cases of prostatic carcinoma with pulmonary metastasis. In the first case there was no lymph node or bone metastasis, and in the second case there was only one bony metastatic lesion. Presentation, etiology and management are discussed.
Effect of Ageing on Blood Flow to the Bladder and Bladder Function
Authors: Saito Masahiko , Ohmura Masaharu , Kondo Atsuo
Published: April 2003

Ischemia, induced by atherosclerosis, is a common cause of disorders in the elderly. Bladder dysfunction in older people may be caused by detrusor ischemia. We compared blood flow to the bladder and detrusor function in vivo and in vitro in young (6-month-old) and aged (24-month-old) male Sprague-Dawley rats. In both young and old rats, blood flow to the bladder measured by a laser Doppler flowmeter decreased as intravesical volume increased and was smaller in old rats than in young rats. Cystometrograms performed under anesthesia showed that old rats had smaller voiding pressure and larger bladder capacity than young rats. In isolated bladders, the pressure increase in response to bethanechol and low frequency field stimulation were impaired by aging. Volume-pressure studies showed that in isolated bladders of old rats compliance was greater and peak response to field stimulation was observed at a larger capacity. These findings indicate that bladders of older rats have a larger capacity with good compliance, but less contractility. Aging changes correlate with a decrease in blood flow to the bladder.
CT Appearance of a Renal Aspergilloma in a Patient with the Acquired Immunodeficiency Syndrome
Authors: Poll Ludger Wilhelm , Koch Jens-Albrecht , Medve Martin , May Philip , Sarbia Mario , Engelbrecht Volkher , Mödder Ulrich
Published: April 2003

The appearance of a unilateral renal aspergilloma on computed tomography is described in a 32-year-old man with acquired immunodeficiency syndrome (AIDS). Aspergillus infections are uncommon in the AIDS population. Only 9 cases of renal aspergilloma have been described in AIDS. The treatment performed was percutaneous drainage followed by antifungal drug administration and unilateral nephrectomy. This case report emphasizes the fact that renal fungal infections need to be considered in differential diagnosis of kidney infections in AIDS patients.
Idiopathic Clitoral Hypertrophy
Authors: Shiraishi Koji , Ishizu Kazuhiko , Takeuchi Keiji , Takai Kimio , Takihara Hiroshi , Koga Mayumi , Naito Katsusuke
Published: April 2003

We report a case of clitoral hypertrophy of unknown origin. A 3-year-old girl showed clitoral hypertrophy at birth. Biochemical analysis of peripheral blood and endocrinological examinations were normal. Other virilizing symptoms were not recognized. Clitoroplasty was carried out, and the clitoris has not enlarged 20 months after the operation. Her mother was administered cefotiam and terbutaline (β-stimulant) during pregnancy because of threatened abortion. No virilizing agents such as progesterone were used during pregnancy.
Spontaneous Closure of Vesicouterine Fistula
Authors: Jóźwik Maciej , Jóźwik Marcin
Published: April 2003

Objectives: To analyze the incidence of spontaneous closure, or non-surgical resolution, of vesicouterine fistula and discuss the resultant implications for the management. Methods: Review of the literature supplemented by case report of a young woman with spontaneous healing of vesicouterine fistula. Results: This is the 41st patient with spontaneous closure of vesicouterine fistula reported to date. Her clinical course was suggestive of endocrine involvement in the lesion’s formation. Spontaneous healing was observed in 5% of 796 vesicouterine fistula cases. Induction of amenorrhea was effective in 8 (89%) of the 9 patients treated, a rate significantly higher (p < 0.001) than that observed without hormonal manipulation (4%). Conclusions: Conservative management by means of hormonal treatment should be considered before surgical repair. We suggest the role of estrogens and the endometrium in the formation of vesicouterine fistulas.
Bilateral Adrenal Myelolipoma
Authors: Segura Martín Miguel , Lorenzo Romero Juan G. , Salinas Sánchez Antonio A. , Hernández Millán Ibrahim , Cañamares Pabolaza Luis , Virseda Rodriguez Julio A.
Published: April 2003

Myelolipomas are rare benign tumors often found incidentally due, in the majority of cases, to the fact that they are asymptomatic. The incidence of adrenal myelolipomas at autopsy is low (0.2%). These tumors are made up of fat and hematopoietic cells. Their origin is unclear and different theories have been put forward, including development from rests of mesenchymal stem cells, embolism of bone marrow, extramedullary hematopoiesis and, according to the most widely accepted theory, metaplasia of the reticuloendothelial cells of blood capillaries. Due to their uncertain etiology and low frequency, management of adrenal myelolipomas is usually individualized and carried out depending on the protocols of each center. The development of improved imaging techniques has increased their diagnosis in routine clinical practice. Thus, they have been included in the heterogenous group of ‘incidentalomas’ of the adrenal gland.
Carcinoma of the Penis Metastasizing to the Dorsal Spine
Authors: Lal Punita , Halder Shikha , Datta Niloy Ranjan
Published: April 2003

Carcinoma of the penis tends to have a predictable route of spread by direct invasion and by regional lymphatic involvement to the inguinal group of lymph nodes. Blood-borne distant spread is rare, last to occur, and is seen in 1–3% of cases. Metastasis to the spine is even rarer. We encountered one such case who presented with spinal metastasis, as documented by the whole body bone scan, and this was later followed by involvement of the inguinal nodes. This case is unique in its site of metastatic presentation as well as its pattern of presentation.
Tumor-Adopted Diagnosis of Bladder Cancer
Authors: Brauers Andreas , Jung Peter , Jakse Gerhard
Published: April 2003

70% of our patients suffering from bladder cancer present themselves initially with a superficial tumor (Tis, Ta, T1) and only 30% are initially seen with a muscle-invasive carcinoma (T2, T3–4, N+, M+). Clinical history, physical examination, urine cytology, IVP and cystoscopy in combination with adequate tissue harvest by transurethral resection are the basis of our diagnostic procedures. Bimanual palpation, systematic biopsies, sonography, computed tomography, bone scan and further procedures are not to be considered as routine examinations and are only used in special situations. Only exactly defined diagnostic algorithms permit the development and use of valid prognostic parameters. They further allow to perform a tumor-orientated therapy and to compare patient groups which have been treated in different institutions according to similar or different therapeutic regimens. This includes the importance of a TNM-oriented therapy. It has to be stressed though that the prevalence of distinct pathological changes, such as bone metastases in T1 tumors, as well as financial resources, have to be taken into account. Further, definite therapeutic intention such as a curative vs. palliative regimen is a decisive criterium for the amount of performed diagnostic procedures. It also is of importance that new diagnostic modalities, if introduced into the clinical routine, have to be investigated concerning their validity in relevant and large patient cohorts and their rationale in our diagnostic algorithm has to be defined. This is predominantly not the case in radiological imaging techniques and thus a large amount of resources are wasted.
Possibility of Improving the Acceptance Rateof Early Detection Testing for Prostate Cancerwith a One-Step Test for Prostate-Specific Antigen in Whole Blood
Authors: Berg W. , Linder Ch. , Eschholz G. , Link St. , Schubert J.
Published: April 2003

In order to increase the acceptance rate of early detection testing for prostate cancer, a qualitative prostate-specific antigen (PSA) one-step test has been developed. Determining the PSA level with this test system takes 10 min. The blood samples of 190 men were tested in this qualitative assay, which uses 50 μl of EDTA whole blood and in which the results are ascertained visually. Parallel samples were tested in serum-based, quantitative assays (Abbott Imx, EIA). The findings of the two kinds of assays were compared and evaluated regarding their correspondence (<4.0 and ≥4.0 ng/ml). For the 74 blood samples in which the quantitative assay showed PSA levels <4.0 ng/ml, the PSA one-step test showed 83.8% correct negative results (corresponds to diagnostic specificity). For the 116 samples in which the classic assay showed PSA levels ≥4.0 ng/ml, the one-step test showed 90.5% correct positive results (sensitivity). The noted deviations appear especially around the cut-off value of 4.0 ng/ml, i.e. within the PSA concentration range of 3.0 < 4.0 and 4.0 < 5.0 ng/ml. The qualitative PSA one-step test presented here demonstrates good reproducibility. It can be conducted by the patient and is easy to use. The test offers a simple, feasible method for early detection programs for prostate cancer.
Multifocality in Renal Cell Carcinoma: A Bilateral Event?
Authors: Wunderlich H. , Schlichter A. , Zermann D.-H. , Reichelt O. , Kosmehl H. , Schubert J.
Published: April 2003

Objectives: The major disadvantage of nephron-sparing surgery for renal cell carcinoma is the risk of local recurrence. This is most likely a manifestation of undetected small additional tumors in the renal remnant. To define more clearly the incidence and nature of unilateral and bilateral multifocal tumors, an autopsy study was undertaken. Materials and Methods: In a series of 14,793 autopsies from 1985 to 1995, 260 renal cell carcinomas were found. In all cases of renal cell carcinoma a search for small renal lesions was performed in the apparently normal-appearing portion of the kidneys. Every kidney was serially and systematically cut (5 mm) to probe for intraparenchymal lesions. Results: Of the 260 renal cell carcinomas 36 cases (13.85%) had multifocal malignant and/or benign nodules. The number of the additional nodules ranged from 2 to 18. 12% of the malignant multifocal carcinomas were limited to the ipsilateral kidney and 88% were bilateral. The average size of the multifocal renal lesions was 8.7 × 9.0 × 9.5 (range 3–23) mm. Renal cell carcinomas with low stage and good grading have a higher incidence of multifocal nodules. No significant difference was found with regard to metastasized and nonmetastasized renal cell carcinomas. In 38.1% of all chromophilic renal cell carcinomas additional nodules were found. Conclusions: Multifocality in renal cell carcinomas cannot be predicted reliably, although the papillary histological pattern, good grading and low staging seems to be associated with a higher incidence of multifocality. Nearly 90% of the multifocal nodules were bilateral.
Multilocular Cystic Adenomyoma of the Pelvic Cavity: A Rare Clinical and Histological Entity in a Young Man
Authors: Matsumoto Seiji , Ohtsuka Kayo , Tahara Hideo , Akiyama Takahiro , Hashimoto Sigeo , Kurita Takashi
Published: April 2003

We report a large complex cystic pelvic mass encountered in a 16-year-old man complaining of perineal discomfort. A large and elastic hard mass was palpated on the right anterior wall of the rectum with no discernible prostate on digital rectal examination. Prostatic tumor markers were elevated. Excretory urography and urethrocystography showed a filling defect with a smooth edge on the right side of the bladder. Magnetic resonance imaging demonstrated a mass with a mosaic pattern between the right side of the bladder and the rectum. We performed ultrasound-guided transrectal needle core biopsy of the mass. The pathologist suspected hyperplastic glandular epithelium of prostatic origin with focal inflammatory cell infiltration, but there was no sign of malignancy. We thought that the tumor arose from the prostate. Surgery was successfully performed. The tumor was located on the right side of the pelvic cavity and adhered to the right lobe of the seminal vesicle. En bloc excision was performed. This lesion histologically proved to be a multilocular prostatic tissue with a seminal vesicle component, without communication to the surrounding tissue. Such a lesion has not previously been reported in the literature.
Lower Ureteral Obstruction due to a Persistent Umbilical Artery
Authors: Gupta N.P. , Kumar Manal , Karan S.C. , Aron Monish
Published: April 2003

A 32-year-old lady presented with primary infertility and a 1-year history of recurrent left-flank pain. She was found to have left lower ureteric obstruction on intravenous urography. No specific cause for the obstruction could be determined preoperatively. The patient underwent open extraperitoneal surgery to determine the cause and to treat the obstruction. A 4-mm vessel was seen crossing over the ureter at the site of narrowing. It was the persistent umbilical artery traced in continuity from the internal iliac artery. The vessel was resected, and the ureter was reimplanted into the bladder. Extrinsic obstruction of the distal ureter because of aberrant or persistent vessels has been infrequently reported. Such reports predominantly refer to children, and the diagnosis is usually made at laparotomy, frequently following previous failed attempts at endourological management.
Inverted Papilloma of the Urinary Bladder in a Girl
Authors: Yagi Hiroshi , Igawa Mikio , Shiina Hiroaki , Shigeno Kazushi , Yoneda Tatsuaki , Wada Yukihiro , Urakami Shinji
Published: April 2003

We report a case of inverted papilloma of the urinary bladder in a 10-year-old girl. She was referred to us with intermittent asymptomatic gross hematuria. A polypoid, pedunculated mass, which had a thin and long stalk, approximately 6 × 20 mm in diameter, was observed by cystscopic examination at the right paratrigone. The lesion was resected endoscopically. Histological findings were compatible with the trabecular type of inverted papilloma. There have been only 3 cases reported of inverted papilloma in children, and no report has previously been published concerning a girl. Since the biological potential of pediatric inverted papilloma remains unclear, we believe that our patient should undergo periodic and detailed urological examinations.
Renal Cell Carcinoma in Cases of Adult Polycystic Kidney Disease: Changing Diagnostic and Therapeutic Implications
Authors: Hemal A.K. , Khaitan Anurag , Singh Iqbal , Kumar Manal
Published: April 2003

Renal cell carcinoma in adult polycystic kidney disease is of rare occurrence and poses a diagnostic and therapeutic challenge. We have treated three such patients in our department. One was male and two were females ranging in age from 20 to 60 years. All were diagnosed preoperatively with ultrasonography or contrast-enhanced CT. Radical nephrectomy was performed in all patients. During the follow-up no patient had recurrence in the contralateral kidney. One patient had local recurrence in the renal fossa and was treated with local radiotherapy and immunotherapy. In the past due to difficulty in diagnosis, invasive investigations like angiography were recommended and prophylactic contralateral nephrectomy was often undertaken. With the availability of reliable noninvasive investigations these patients can be diagnosed accurately and the contralateral kidney saved in most cases.
No Generalized Skin Phototoxicity after Intravesical Application of 5-Aminolevulinic Acid for Fluorescence Diagnosis ofSuperficial Bladder Cancer
Authors: Filbeck T. , Wimmershoff M.B. , Pichlmeier U. , Karrer S. , Wieland W.F. , Szeimies R.-M. , Rössler W.
Published: April 2003

Introduction: A prospective monocenter open study was carried out to evaluate if generalized phototoxic skin reactions occur after intravesical application of 5-aminolevulinic acid (ALA) for fluorescence diagnosis of superficial bladder carcinomas. Patients and Methods: On 21 patients, skin phototoxicity was determined prior to as well as 4, 8 and 28 h after intravesical instillation of a 3% ALA solution by exposing small skin areas to a progressively graded series of defined UVA-light doses (n = 9; 5–80 J/cm2). Results: Prior to ALA instillation, erythema or pigmentation as signs of cutaneous phototoxicity occurred at an UVA-light dose of 28 ± 1.5 J/cm2 (mean ± SEM). A reduction of the minimal phototoxic dose (MPD) was not detected 4 (28 ± 1.9 J/cm2), 8 (28 ± 1.6 J/cm2) and 28 h (28 ± 1.5 J/cm2) after ALA instillation. Consequently phototoxic reactions were not observed. Conclusions: A reduction of MPD for UVA was not detected. Therefore, it is not necessary to protect the skin of patients from ambient or daylight after intravesical instillation of ALA for fluorescence diagnosis.
Eosinophilic Cystitis in a Case Presenting with an Initial Diagnosis of Invasive Bladder Tumor
Authors: Göğüş Çağatay , Türkölmez Kadir , Tulunay Özden , Göğüş Orhan
Published: April 2003

Eosinophilic cystitis is a rare condition of the bladder that presents with hematuria, dysuria and suprapubic tenderness. A case of eosinophilic cystitis presenting as an invasive bladder tumor is reported.
Superselective Microcoil Embolization of a Traumatic Pseudoaneurysm of the Cavernosal Artery
Authors: Mourikis Dimitrios , Chatziioannou Achilles N. , Konstantinidis Pantelis , Panourgias Evangelia , Antoniou Aris , Vlachos Lambros
Published: April 2003

According to the literature, straddle injuries of the perineum may result in arteriosinusoidal fistula and secondary high-flow priapism. We report a case of a 23-year-old man who developed a traumatic pseudoaneurysm of the cavernosal artery, secondary to straddle injury, and presented with painless priapism. It was treated successfully with superselective microcoil embolization and the priapism resolved.
Embolization of a Segmental Renal Artery Pseudoaneurysm after Partial Nephrectomy in a Solitary Kidney
Authors: Chatziioannou A. , Mourikis D. , Awad M. , Konstantinedes P. , Panourgias E. , Vlachos L.
Published: April 2003

Renal pseudoaneurysms are a well-documented complication following trauma or after percutaneous biopsy. When symptomatic, patients present with hematuria and deteriorating renal function. We present the case of a 62-year-old man who, due to development of a pseudoaneurysm, presented with gross hematuria 10 days after partial nephrectomy for a renal cell carcinoma in a single kidney. A segmental artery was embolized with stainless steel coils without significant loss of the limited renal vascularization.
Aggressive Variant of Morphologically Typical T Large Granular Lymphocyte Leukemia/Lymphoma Lacking NK Cell Markers
Authors: Passetto Falcão Roberto , Pinto Simões Belinda , Garcia Aglair B. , Fonseca Benedito A.F. , Terra Filho João
Published: April 2003

A 46-year-old woman with a previous diagnosis of sarcoidosis presented with morphologically typical large granular lymphocyte (LGL) leukemia/lymphoma with an aggressive clinical course. Epstein-Barr virus DNA was detected in peripheral blood mononuclear cells by PCR. The phenotype was typical of the T cell lineage (CD2+ CD3+ CD5+ CD7+ CD8+ TCRαβ+) but with the absence of the CD16, CD56, CD57 NK cell markers. In addition, the LGLs expressed CD122 (p75) in the absence of CD25 which is characteristic of LGLs. These leukemic LGLs did not exhibit NK activity. The clonal nature of this proliferation was demonstrated by the rearrangement of the TCRγ gene. This phenotypically unusual but morphologically typical LGL leukemia/lymphoma may represent the clonal expansion of a minor normal subset of T-LGLs which do not express any NK cell markers, probably corresponding to in vivo activated T cells.
Pleural Effusion in Chronic Myelomonocytic Leukemia
Authors: Bourantas K.L. , Tsiara S. , Panteli A. , Milionis C. , Christou L.
Published: April 2003

Pleural effusion in 4 patients with chronic myelomonocytic leukemia (CMML) is described in this report. According to the literature, pleural effusion in CMML is a poorly understood and rare occurrence. Two of our patients presented with pleural effusion as an initial symptom while the other 2 developed it during the course of the disease. In only 1 patient was the pleural effusion due to leukemic infiltration while in the other 3 it was a reactive phenomenon. Peripheral lymphadenopathy was observed only in the former patient who died of acute leukemia. After prednisolone therapy the pleural effusions resolved in the other 3 patients.
Development of Pyothorax-Associated Pleural Lymphoma in Relation to Focal Cytokinemic Condition and Epstein-Barr Virus Infection
Authors: Danbara Mikio , Takano Yasuo , Fujino Yumi , Okayasu Isao , Shionoya Shigeru
Published: April 2003

We report an initial case of pyothorax-associated pleural lymphoma (PAPL) in which the level of interleukin 6 (IL-6) was remarkably high in the pleural fluid contaminated with tumor cells; at the same time Epstein-Barr virus (EBV)-encoded small RNAs (EBERs) were detected in the lymphoma cells by in situ hybridization. These findings suggest the possibility that EBV-transformed B cells proliferated in the focal cytokinemic condition caused by long-standing chronic inflammation of the pleura and give us a clue to the lymphoma genesis of PAPL.
Translocation t(1;10) (q21;q26) in a Case of Acute Nonlymphocytic Leukemia
Authors: Terreros María Cristina , Quesada Marlen , Slavutsky Irma Rosa
Published: April 2003

Chromosome banding studies carried out on bone marrow cells from a 16 year-old boy with an M1 acute nonlymphocytic leukemia (ANLL) revealed an unbalanced translocation involving chromosomes 1 and 10: der(10) t(1;10) (q21;q26) that results in a partial trisomy 1q between bands 1q21-1qter. Marker del(6)(q21) and trisomies of chromosomes 18, 21 and 22 were also observed. To our knowledge, this der(10) is the first to be reported in a patient with ANLL.