bluuebunny/crossref_metadata_2025 huggingface dataset:
Significance of leaf longevity in plants
Authors: Kikuzawa Kihachiro , Ackerly David
Published: March 2003

The cost–benefit model of leaf life span is extended by incorporating the cost of construction and maintenance of supporting structures, such as shoots and roots. Published data on leaf longevities were reviewed, and they support qualitative predictions of optimal leaf life span based on the present model. In relation to life form, leaf life span increases in the following sequence, due to increasing costs of support structures: floating leaves of aquatic plants < annual herbs < perennial herbs < deciduous trees. Within species, leaf life span increases with plant size as support costs per unit of leaf increase. This prediction is supported by comparisons of seedlings and adults of temperate trees. These results suggest that the construction and maintenance costs of supporting structures significantly influence life span of individual leaves. Leaf longevity, in turn, connects the ecophysiology of the individual leaf to growth of the individual plant and energy and matter cycling at the ecosystem level.
Variations in reproductive traits at inflorescence and flower levels of an arctic legume,Astragalus alpinusL.: Comparisons between a subalpine and an alpine population
Authors: Kudo Gaku , Molau Ulf
Published: March 2003

The reproductive traits ofAstragalus alpinusL. between a subalpine and an alpine population in northern Sweden were compared. This species was physiologically self‐incompatible and mainly pollinated by bumblebees. Mean flower size was larger and anthesis was longer in the alpine population than in the subalpine population. There were no significant differences in ovule fertilization rate and seed predation rate per inflorescence between the populations. However, the abortion rate of fertilized ovules was higher in the alpine population, probably because of resource limitation. The difference in seed production per inflorescence was small between the populations. Dense ovule packing within each flower may have compensated for the lower fruit production in the alpine population, where pollinator activity was low. Although the alpine population produced a smaller number of mature seeds per inflorescence, total seed mass per inflorescence did not differ between the populations due to larger seed size in the alpine population. Within an inflorescence, upper flowers had a smaller size, a relatively larger allocation to stamens, lower seed production (for both populations) and higher pollen viability (only for the alpine population) than did lower flowers. Thus, reproductive values through male and female functions may differ among flowers within an inflorescence.
Time‐course changes of eosinophil counts in premature infants: No effects of medical manipulation, except erythropoietin treatment, on eosinophilia
Authors: Ehara Akira , Takeda Yuko , Kida Takeshi , Mizukami Susumu , Hagisawa Masahiro , Yamada Yutaka
Published: March 2003

Abstract In order to determine the factors responsible for eosinophilia during the neonatal period, we counted the eosinophils of premature infants every week and compared the medical profiles of infants with eosinophil counts above the 95th percentile and those below that percentile during the course of study. Medical treatments such as mechanical ventilation, antibiotics administration and intravenous catheterization had no significant effects on the increase of eosinophils. Furthermore, the incidence of eosinophil counts above the 95th percentile was not different between breast‐fed and formula‐fed infants. The infants treated with erythropoietin had greater eosinophil counts than those with no treatment. It is probable that medical manipulation using foreign bodies such as intratracheal tube, intravenous catheter, antibiotics and artificial formula had no significant effects on the increase of eosinophil counts, except for exogenous erythropoietin.
Recent increase in the frequency of infant measles in Japan
Authors: Ohsaki Masaya , Tsutsumi Hiroyuki , Takeuchi Ryoh , Chiba Kimihira Seki and Shunzo
Published: March 2003

Abstract Background: Because there has been no major outbreak of measles in Japan during the last decade, subclinical boosting of pre‐existing immunity by exposure to epidemic measles is unlikely to have occurred. Consequently, the measles immunity of mothers of this generation is less well developed and they provide less effective passive immunity to their infants. An increase in the frequency of infant measles is therefore probable.

Method and results
: A retrospective review was undertaken of the clinical records of all measles cases that occurred in the last 3 years in eight hospitals and two out‐patient clinics in Hokkaido. Of 541 recorded cases, 96 (17.7%) were infants and of these, 66 patients (68.8%) were over 9 months of age. Only 20 children had received measles vaccination.

Conclusion
: There has been a recent increase in the frequency of infant measles, suggesting an increased population of infants susceptible to measles before the age of 1. Of the older patients, 95% had not been vaccinated against measles. Increasing the rate of measles vaccination may help suppress future measles outbreaks and assist in protecting infants until they pass their first birthday.
Age‐dependent expression of abdominal symptoms in patients with Yersinia enterocolitica infection
Authors: Ehara Akira , Egawa Kiyoshi , Kuroki Fumiko , Okawa Osamu Itakura and Masahito
Published: March 2003

Abstract Background: The aim of the present study was to determine the relationship between the expression of abdominal symptoms and the age of patients with Yersinia enterocolitica infections.

Methods
: Twenty‐four patients with positive fecal cultures of Yersinia enterocolitica participated in the present study. The abdominal symptoms were taken from medical records. Statistical analysis was performed by Mann–Whitney U‐test.

Results
: Patients with diarrhea were younger than those without diarrhea (P=0.014). Older children had abdominal pain or irritability more frequently than younger children (P=0.004).

Conclusions
: In Yersinia enterocolitica infections, younger children are predisposed to diarrhea and older children are predisposed to abdominal pain.
Development of antirotavirus agents in Asia
Authors: Gu Yanhong , Gu Qingjiu , Kodama Hiroko , Mueller Werner EG , Ushijima Hiroshi
Published: March 2003

Abstract Human rotaviruses are the major etiologic agents of diarrhea in infants and young children under 2 years of age worldwide. Rotavirus diarrhea is a life‐threatening disease for children; many efforts are made to reduce the morbidity and mortality in Asia. To date many natural compounds and some Western medicines have exhibited their antirotavirus effects in clinical studies, in animal experiments and in vitro. Compared with antirotavirus agents in the USA and Europe, natural compounds have been identified as ideal candidates for antirotaviral drugs in Asia because they are cheaper and effective, have no side‐effect and no toxicity. We have attempted to reveal the antirotavirus mechanism of some natural compounds. We found that cacao pigment, tea extract and pine seed shell extract inhibit rotavirus adsorption to cells while cacao pigment may also inhibit rotavirus reproduction in vitro. The usage of antirotavirus agents in Asia demonstrated that additional effective approaches to control rotavirus infection, such as antirotavirus agents, are necessary, in particular for the children with rotavirus diarrhea who have severe complications.
Efficacy of interferon‐α2b treatment in children with chronic hepatitis B who have previously undergone therapy for cancer
Authors: Kasirga Erhun , Isenlik Sitki , Aksoylar Serap , Yaprak Işin , Kansoy Savaş , Yüce Gül
Published: March 2003

Abstract

Background
: The aim of the present study was to evaluate the efficacy of treatment with recombinant interferon (IFN)‐α2b in 12 children with chronic hepatitis B who had previously undergone therapy for cancer.

Methods
: Nine children had acute leukemias and the other three children had solid tumors. The mean (±SD) age of the children was 8.4~3.8 years (range 4–16 years). All cases were hepatitis B virus (HBV)‐DNA positive and 11 were hepatitis B e antigen (HBeAg) positive. One was anti‐HBe positive (mutant strain). Four cases were anti‐delta IgG positive. Liver biopsy revealed chronic hepatitis B in 11 patients and cirrhosis in one patient. Interferon‐α2b was given at a dose of 5 MU/m
2 three times a week, subcutaneously, for 12 months.

Results
: Elimination of serum HBV‐DNA was obtained in three cases, but a further three patients demonstrated a marked decrease in HBV‐DNA levels after therapy. Three of 11 patients seroconverted from HBeAg to anti‐HBe. Alanine aminotransferase (ALT) levels returned to normal in three of nine cases in whom the ALT levels were high before treatment. At the end of therapy, the mean histologic activity index score was significantly diminished (P=0.0039).

Conclusions
: In conclusion, a 12 month course of IFN‐α2b induces some beneficial effects on virologic, biochemical and histologic indices in children with chronic hepatitis B who have previously undergone therapy for cancer.
Interferon‐alpha therapy in idiopathic thrombocytopenic purpura
Authors: Dikici Bunyamin , Bosnak Mehmet , Kara Ismail H , Dogru Omer , Alkaya Asuman , Hasolat Kenan
Published: March 2003

Abstract

Background
: Acute idiopathic thrombocytopenic purpura (ITP) represents the most frequent hemorrhagic diathesis in childhood. Up to 30% of patients with ITP are regarded as refractory to standard therapy. The rare mortality from acute ITP in childhood is almost exclusively due to intracranial hemorrhage. This complication occurs in less than 1% of ITP patients. This study was designed to evaluate the effect of α‐interferon (IFN‐α) in eight patients whom did not respond to conventional therapy.

Method
: In spite of conventional therapies, the patient whose platelet count could not be increased to 50`109/L were accepted as refractory ITP. Eight of these patients whose platelet count lower than 20`109/L were included in the prospective cohort study. Interferon alpha 2b 5 MU/m2 was administered subcutaneously three times a week, totalling 12 times in a month. According to the platelet count on the 28th day of therapy, we grouped the patients into three categories. After 60 days, the survey was re‐evaluated according to the platelet count.

Results
: The mean age of children was 3.5±2.5 (ranged between 3.5 and 9) years. Six of them were boys and two were girls. There was no response in one patient, partial response in one, and good response in six patients on the 28th day of therapy. The maximum rise in platelet count was observed from 7 to 14 days after the initiation of interferon. The median platelet count which was 15±5`109/L before therapy, raised to 60±12`109/L after therapy. However, on the 60th day of therapy, there were only two patients who had a platelet count over 100`109/L.

Conclusion
: In our study, we did not observe the long‐term benefit of IFN‐α therapy in refractor ITP in childhood. However, in good responding patients, platelet levels were increased in a short time. Alpha‐interferon may be alternative therapy for patients whom had a platelet count below 20`109/L and not responding to standard therapy, or for patients whom immunosuppressive therapy is contraindicated.
Fetal growth and the timing of exposure to maternal smoking
Authors: Ohmi Hiroki , Hirooka Kenzou , Mochizuki Yoshikatsu
Published: March 2003

Background
: Maternal smoking during the third trimester reduces the birthweight of the full‐term neonate. We assessed the relationship between the timing of exposure to maternal smoking, gestational period, weight and body length for both full‐term and preterm neonates.

Methods
: A retrospective study with a questionnaire was conducted in 1194 infants who participated in the official medical examination for 3‐year‐old infants.

Results
: The risk of preterm birth from mothers who smoked during any trimesters was significantly increased. The body length of neonates whose mothers smoked during the third trimester was shorter than that of neonates whose mothers did not smoke during the third trimester. The weight of full‐term neonates whose mothers smoked during the third trimester was lighter than that of neonates whose mothers did not smoke during the third trimester.

Conclusions
: Maternal smoking during any trimesters increased the risk of preterm birth. Maternal smoking during the third trimester reduced the body length of both full‐term and preterm neonates, and the birthweight of the full‐term neonate in a somewhat dose‐dependent manner.
Effects of child seats on the cardiorespiratory function of newborns
Authors: Nagase Hiroaki , Yonetani Masahiko , Uetani Yoshiyuki , Nakamura Hajime
Published: March 2003

Background
: This study aims to determine the effect of differently positioned infant car seats on cardio­respiratory parameters in healthy full‐term newborns.

Methods
: We examined 15 healthy term newborns for respiratory compromise due to normal restraint in a recommended infant car seat. There are currently two types of car seats available in Japan: a chair‐shaped car seat and a bed‐shaped car seat. Using a sleep apnea recorder, we simultaneously monitored heart rate, percutaneous oxygen saturation, chest impedance and nasal airflow in infants placed in each of the car seats and also placed in the supine position on a nursery cot. Episodes of oxygen desaturation below 95% and longer than 10 s (mild desaturation) and below 90% longer and than 10 s (moderate desaturation) were evaluated over 30 min observation period.

Results
: The amount of time infants spent in a sleep state was significantly longer in the car seats than it was on the cot (P = 0.0015 for bed‐shaped, P = 0.0012 for chair‐shaped) and there was no difference in this measure between the two types of car safety seats. Mean of oxygen saturation with the chair‐shaped car seat (95.8%) was significantly lower than that with the bed‐shaped car seat (98.8%) (P = 0.0008). Newborn infants laid on the cot showed no episodes of desaturation. Newborn infants placed in the chair‐shaped car seat had significantly more episodes of mild desaturation (mean, 7.33 times in nine of 15 infants), whereas in the bed‐shaped seat observed only once each in two infants (P = 0.008). Moderate desaturation was observed in four of 15 infants in the chair‐shaped car seat, whereas not observed in the bed‐shaped car seat (P = 0.068).

Conclusion
: The results suggest that prior to discharge the degree of oxygen desaturation that occurs when an infant is placed in a chair‐style car seat should be checked.
Helicobacter pylori infection in patients with idiopathic short stature
Authors: Takahashi Masahisa , Kimura Hiroshi , Watanabe Kazuyoshi
Published: March 2003

Background
: Some investigators have recently described

an association between Helicobacter pylori infection and children with short stature. In the present study, we aimed to evaluate children with short stature with different etiologies.

Methods
: This study evaluated short patients aged

from 1 to 16 years. These patients were divided into a growth

hormone deficient short stature group (n = 27)

and an idiopathic short stature group (n = 14).

A control group included children with normal growth and no abdominal

pain (n = 47). Anti‐H. pylori antibodies were measured in each group (total of 88).

Results
: The antibody positivity rates for each

group were as follows: growth hormone deficient short stature group,

7.4%; idiopathic short stature group, 28.6%; and

control group, 6.4%. The H. pylori antibody positivity rate in the idiopathic short stature group was significantly higher than in the control group.

Conclusion
: Our findings suggest an association

between H. pylori infection and idiopathic short stature.
Metabolic alkalosis with hypoelectrolytemia in infants with cystic fibrosis
Authors: Fustik Stojka , Pop‐Jordanova Nada , Slaveska Nevenka , Koceva Svetlana , Efremov Gorgi
Published: March 2003

Background
: Infants with cystic fibrosis (CF) can develop episodes of hyponatremic hypochloremic dehydration with metabolic alkalosis when they sweat excessively, which is not caused by sweating in normal infants. We investigated the incidence of the metabolic alkalosis with hypoelectrolytemia in CF infants, the possible risk factors for its occurrence and the importance of the manifestation in the diagnosis of CF.

Methods
: In order to evaluate the incidence and the risk factors for the development of this sweat‐related metabolic disorder in CF, we reviewed the records of all children diagnosed as having CF before the age of 12 months in a 10‐year period. Data analysis included medical history data, clinical features, biochemical parameters (blood pH, serum bicarbonate, sodium, chloride and potassium levels), sweat chloride test values, as well as genetic analysis data.

Results
: The prevalence of metabolic alkalosis in association with low serum electrolyte concentrations (hyponatremia, hypochloremia, and hypokalemia) in infant CF population in our region was 16.5%. We found no season predilection in its occurrence. Early infant age, breast‐feeding, delayed CF diagnosis, heat exhaustion and the presence of severe CF transmembrane conductance regulator mutations are predisposed factors for the development of metabolic alkalosis with hypoelectrolytemia.

Conclusions
: The results from our study suggest that metabolic alkalosis with hypoelectrolytemia is a relatively common manifestation of CF in infancy. The possibility of CF should be seriously considered in any infant with this metabolic disorder.
Development of an instrument to measure technological caring in nursing
Authors: Locsin Rozzano
Published: March 2003

Twenty‐seven statements make up the Technological Caring Instrument (TCI) which was developed to measure technological caring in nursing. In order to establish a database and its reliability and validity, responses were generated from 193 professional nurses who participated in the study. The results indicate that the TCI has a high internal consistency, construct validity, and sufficient split‐half reliability. Cronbach’s alpha was 0.8129 with split‐half alpha of 0.666 for 14 items in Part 1 and 0.828 for 13 items in Part 2. Significant differences were found between factors (F = 97.0199, P = 0.0000). Factor analysis identified eight items with the first factor revealing nine cluster statements with values of 0.51–0.84. The second factor had two cluster statements with 0.75 and 0.74 values. The independent sample t‐test results demonstrated the influence of education, area of expertise, and years of experience on the technological caring of registered professional nurses. The utilization and continued investigation of TCI are suggested.
Supportive care for women with breast cancer: Australian nurses’ perspective
Authors: Wilkes Lesley , White Kate , Beale Barbara , Cole Rosemary , Tracy Sally
Published: March 2003

Abstract A research project was undertaken to describe how the support needs of women who have had treatment for breast cancer were being met in New South Wales, Australia. Data were collected from both the women and the nurses who cared for them. The findings from the first part of the study examined the nurses’ perceptions of the women’s needs and how they as health professionals, fulfilled these needs. Analysis was both qualitative and quantitative. Seventy‐eight nurses responded to a questionnaire and 15 were interviewed. The findings indicated that the nurses perceived information on disease process and physical aspects of the disease as essential to supporting the women with breast cancer. While they saw providing emotional support to the women as important the nurses themselves often lacked the time and skills to provide it.
Nursing in Thailand
Authors: Anders Robert L. , Kunaviktikul Wipada
Published: March 2003

The aim of this study is to describe nursing and nursing education in Thailand. Historical information about the development of nursing in Thailand, nursing licensing laws, nursing programs, and the description of a typical nursing program is provided. The nursing educational system in Thailand is growing and can serve as a model for other developing countries.
A critical review of research on hospital mortality among medical–surgical and acute myocardial infarction patients
Authors: Schultz Mary Anne , Servellen Gwen van
Published: March 2003

Abstract Research results reporting the relationships of hospital structural characteristics to inpatient mortality for medical–surgical and Acute Myocardial Infarction patients are inconclusive. Hospital characteristics thought to be significantly associated with mortality are: percentage of board‐certified physicians, the hospital's teaching status, and technological resource availability. Yet studies of these characteristics have yielded mixed results. Only Registered Nurse ratios (measures of Registered Nurse hours per patient days or per patient) have been shown to be consistently (and inversely) associated with mortality. However, far fewer studies have examined the impact of this variable and design weaknesses, including the absence of a conceptual framework to guide the selection of a given study's explanatory variables, have hindered those that have. Further, inconsistencies, indeed clear contradictions, in these studies’ findings (with the exception of nurse ratios) necessitate further analysis of both research methods and interpretation of results. Such analyses must occur to promote advances in research design and methodology in studies of inpatient mortality.
Introduction
Authors: Tomonaga Susumu
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Risk Factor Prevalence, Risk Status and Perceived Risk for Coronary Heart Disease among Thai Elderly
Authors: Pothiban Linchong , Srisuphan Wichit , Chaiwan Sombat , Klinkajorn Yupin , Dechaprom Nitaya , Boonchuang Pikul , Pinyokham Nitaya , Pleanbangyang Sirirat , Soiwong Pratum
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
A Study on Urinary Incontinence of Elderly Korean Women
Authors: Shin Kyung Rim
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Family Caregiving Research in Thailand
Authors: Sirapo‐ngam Yupapin
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Globalization of tertiary nursing education in post‐Mao China: A preliminary qualitative assessment
Authors: Xu Zhaomin , Xu Yu , Sun Jiemin , Zhang Jianhui
Published: March 2003

Abstract This article examines China’s collaborative initiatives with Western countries to assess the impact of globalization on Chinese nursing education, especially at the post‐secondary level, in the post‐Mao era. Through the theoretical framework of mutuality, it evaluates the outcomes of globalization in two broad domains: pedagogy and system‐institution‐program building. In addition, case studies on two collaborative projects between Chinese nursing programs and Western institutions were conducted to further illustrate the principles of mutuality. This qualitative assessment is primarily based on a systematic review of published studies on the multifaceted dimensions of globalization in Chinese post‐secondary nursing education in both English and Chinese nursing literature since 1990. It is supplemented by unpublished documents and data obtained from a research trip to China in 2000. The study concludes that globalization has been, and will remain, one of the major forces underpinning Chinese nursing education (and the nursing profession in general), which is moving towards integration into the global nursing community. However, there is a significant imbalance in the knowledge transfer equation both in the national and international context. Great efforts need to be made to synthesize nursing knowledge in the East and West to achieve an integrative nursing science.
Cross‐cultural menopausal experience: Comparison of Australian and Taiwanese women
Authors: Fu Shiu‐Yun , Anderson Debra , Courtney Mary
Published: March 2003

Abstract A more universal approach to the understanding of menopause can offer health professionals a broader view of the phenomenon. The present study's objectives were to describe and explain the menopausal experiences of Asian and Occidental women, and to examine the relationship between social/cultural factors and women's menopausal symptoms. Questionnaires were used to investigate psychosocial and cultural factors and menopausal symptoms in 45–55 years old Taiwanese (n = 105) and Australian (n = 450) women. The variables investigated included: social demography; menopause status; attitudes toward menopause; mental health; vitality; social functioning; and menopausal symptoms. Significant differences were found between Taiwanese and Australian women in their attitude towards menopause, menopausal symptoms and vitality scores. No significant differences were seen in the areas of social functioning, mental health and menopause status. The results suggest that cultural factors may influence the experience of menopause for women. These findings may improve health professionals’ understanding of cultural beliefs relating to menopause so that culturally appropriate care can be provided.
Results of conservative treatment of upper urinary tract transitional cell carcinoma
Authors: Fujimoto Naohiro , Sato Hideki , Mizokami Atsushi , Inatomi Hisato , Matsumoto Tetsuro
Published: March 2003

Background
: The treatment preserving the kidney for upper urinary tract tumor is still controversial. The indications and results of conservative treatment remain to be elucidated. Experiences of this type of treatment are reported.

Methods
: Between April 1981 and March 1998, 14 patients with upper urinary tract transitional cell carcinoma were treated with renal preserving methods. Five were elective and nine were imperative cases. Treatments performed were partial nephrectomy, partial ureterctomy with or without adjuvant chemotherapy, endoscopic tumor resection and topical bacillus Calmette‐Guerin instillation in one, 10, two and one patient, respectively.

Results
: Crude and cause‐specific 5 year‐survival rates were 91.7 and 100%, respectively. Of 14 patients, five had bladder recurrences, but ipsilateral local recurrence developed in only one patient. Two patients died from metastasis of transitional cell carcinoma 61 and 89 months after initial treatment. The lesions of carcinoma in situ were well controlled with topical bacillus Calmette‐Guerin therapy.

Conclusion
: The results of conservative treatment for upper urinary tract tumor were satisfactory and local excision can be indicated for low grade, solitary tumors located in the distal ureter.
Mechanisms of drug resistance in chemotherapy for urogenital carcinoma
Authors: Naito Seiji , Yokomizo Akira , Koga Hirofumi
Published: March 2003

Cancer chemotherapy is the principal approach for urogenital cancers. However, the acquisition of resistance to anticancer agents is a critical factor that limits the successful treatment of malignancies. The multidrug resistant (MDR) phenotype has been widely recognized in cancer chemotherapy in urogenital tumors and the mechanisms underlying MDR have also been extensively studied. One of the principle mechanisms in MDR is caused by the overexpression of P‐glycoprotein (P‐gp), encoded by the multidrug resistance gene (MDR1). It functions as an ATP‐dependent active efflux pump of chemotherapeutic agents in human cancer cells. Recently, other drug resistance proteins, including multidrug resistance‐associated protein (MRP1) and cMOAT (or MRP2), were also identified from multidrug resistant cells. A functional analysis of MRP1 has shown that MRP1 may have the potential to act as a transporter of glutathione conjugates, which has been known as a central detoxification pathway in anticancer agents. Furthermore, several other resistance‐related proteins (e.g. glutathione S‐transferase, metallothionein, thioredoxin, topoisomerase I, II, O
6‐alkylguanine‐DNA methyltransferase, etc.) have been found to be up‐ or down‐regulated in resistant cells and these molecules are believed to contribute to the resistant phenotype as well. Based on the molecular characteristics identified in MDR, several experimental and clinical approaches have been studied to overcome MDR. One of these strategies is to reverse MDR by using such P‐gp inhibitors as verapamil and cyclosporine A. In this review, we summarize the recent advances in MDR‐related molecules and clinical trials to circumvent MDR in urogenital carcinomas.
Comparative study of long‐term stone recurrence after extracorporeal shock wave lithotripsy and open stone surgery for kidney stones
Authors: KOŞAR ALIM , SARICA KEMAL , AYDOS KAGˇAN , KÜPELI SADETTIN , TÜRKÖLMEZ KADIR , GÖGˇÜS ORHAN
Published: March 2003

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for most calculi of upper urinary tract and the need for open stone surgery (OSS) have considerably reduced. However, stone recurrence is often encountered as a long‐term problem requiring re‐treatment.

Methods: In the present retrospective study, the recurrence rates of ESWL and OSS were compared in the treatment of kidney calculi. During the 1 year period of the present study, 43 patients were treated by OSS and 400 underwent ESWL (the Dornier MPL 9000 lithotriptor). The recurrence of stone was defined as reappearance of the stone on plain abdominal radiography during the follow‐up period.

Results: Complete removal of all stone fragments was achieved in 51.2% of patients (n = 22) treated with OSS. In the ESWL group, the stone free rate was 56.7% (n = 237). The recurrence rate was 31.8% within a mean of 40 months (range 32–48 months) in the OSS group, whereas this figure was 13.9%, with a mean period of 46 months (range 42–48 months) in the ESWL group (P < 0.05). The mean periods of recurrence in ESWL and OSS groups were 20 (range 6–42 months) and 11 months (range 8–44 months), respectively (P < 0.05). However, the mean stone burdens of both groups were different (2.9 ± 0.8 vs 1.4 ± 1.1 cm). For comparable stone burdens, the recurrence rate was similar. In the ESWL group, stones in the lower calyx, multiple stones and larger stones showed a higher recurrence rate. The recurrence after OSS was also influenced by stone burden.

Conclusions: The results of the present study demonstrate that stone burden may be the primary risk factor for stone recurrence after ESWL and OSS.
Fate of residual fragments after successful extracorporeal shock wave lithotripsy
Authors: Shigeta Masanobu , Kasaoka Yoshinobu , Yasumoto Hiroaki , Inoue Katsumi , Usui Tsuguru , Hayashi Mutsuo , Tazuma Susumu
Published: March 2003

Purpose: The aim of the present study was to investigate the reason residual fragments from upper urinary tract calculi failed to clear after successful extracorporeal shock wave lithotripsy (ESWL).

Methods: Risk factors were analyzed in 161 patients with residual fragments (≤ 4 mm) that had remained for more than 3 months after ESWL. The factors examined in the present study were gender, a history of urolithiasis, the number, location and size of stones, hydronephrosis 3 months after ESWL and bacteriuria before ESWL. The mean follow‐up period was 20.0 months (range 6–69 months).

Results: The overall stone‐free rate was 14.3%. The stone‐free rate in patients with multiple stones or hydronephrosis 3 months after ESWL was significantly lower than that in patients without these conditions (P < 0.05 and P < 0.01, respectively). The cumulative non‐clearance rate in patients with hydronephrosis was significantly higher than in patients without this condition (P < 0.05). Results of Cox’s proportional hazards model indicated that hydronephrosis was the most important and only significant factor for failure to clear of the seven factors investigated (P < 0.05).

Conclusion: Hydronephrosis was most highly correlated with the fate of residual fragments after ESWL.
A case of neuroleptic malignant syndrome in a patient with hemodialysis
Authors: Kunishima Yasuharu , Masumori Naoya , Kadono Masao , Tsukamoto Taiji
Published: March 2003

A 63‐year‐old man with chronic renal failure who had received hemodialysis three times per week for 4 years developed neuroleptic malignant syndrome 10 days after taking amoxapine. His condition was characterized by muscle rigidity, elevation of body temperature and altered consciousness. Although he was treated with dantrolen and supportive care as well as discontinuation of amoxapine, his condition rapidly deteriorated, resulting in death. Because the pharmacokinetics of drugs, especially those such as antidepressants, in patients with chronic renal failure has not been fully clarified, one should be careful about giving such patients these drugs.
Histology of the fetal prune belly syndrome with reference to the efficacy of prenatal decompression
Authors: Shimada Kenji , Hosokawa Shyozo , Tohda Akira , Matsumoto Fumi , Johnin Kazuyosi
Published: March 2003

Background
: Deficient abdominal musculature, complex abnormalities of urinary tracts and bilateral abdominal cryptorchidism represent the basic characteristics of prune belly syndrome (PBS). Although prenatal diagnosis of PBS is rarely made, because of the wide variety of ultrasonographic images, reported cases have gradually increased. Once a fetus suspected of having PBS is found, it is sometimes difficult for the pediatric urologists to decide how to treat them. The histology of the kidney and urinary tracts in fetuses with PBS was reviewed in order to give suggestions on the management of prenatal cases.

Methods
: Autopsy records of nine fetuses (5 males, 2 females and 2 undetermined) with characteristically distended and deficient abdominal wall were reviewed. Gestational age (GA) at detection ranged from 12 to 25 weeks and at delivery from 13 to 32 weeks.

Results
: Renal histology in two fetuses showed earlier than normal disappearance of cortical nephrogenic zone replaced by cortical cysts and dysplastic structures. The nephrogenic zone was retained in five fetuses which were younger than GA 20 weeks. While the number of glomeruli along the medullary ray was normal for the age in three fetuses younger than GA 20 weeks, it was decreased in all others. Bladder histology was variable showing both increased musculature and defective or dysplastic muscles. There was a tendency for connective tissues in the bladder wall to increase in proportion to GA, The ureter revealed scarcity of muscle bundles among dense connective tissue. The urethra was atretic in eight fetuses.

Conclusion
: The clinical implication from the renal histology is that decompression of the urinary tract should be done before GA 20 weeks. However, the early fetal treatment appears to have no effect on the urodynamics in this disorder with deficient musculature.
What is the optimal treatment for lower ureteral stones larger than 1cm?
Authors: KÜpeli Bora , Alkībay Turgut , Sinik Zafer , KaraoĞlan ÜstÜnol , Bozkirli ībrahim
Published: March 2003

Purpose
: To compare the treatment options for lower ureteral stones larger than 1 cm.

Methods
: The records of 449 patients with lower ureteral calculi larger than 1 cm were reviewed retrospectively. Of these patients 342 (76.1%) were treated with extracorporeal shock wave lithotripsy (ESWL) (group 1), 66 (14.7%) with pneumatic lithotripsy (PL) (group 2) and 128 (28.5%) with ureterolithotomy (group 3). Eighty‐seven (19.5%) patients underwent any of the two treatment modalities because of unsuccessful primary treatment.

Results
: The overall stone‐free rates were 32.4, 90.9 and 95.3% for ESWL, PL and ureterolithotomy, respectively. These values were 84.4% for primary PL and 96.7% for primary ureterolithotomy. The re‐treatment rate (46.4%) and secondary procedures were much more frequent in the ESWL group. There was no difference in the complication rates of the three groups.

Conclusions
: Pneumatic lithotripsy with ureteroscopy seems to be an appropriate treatment for larger ureteral stones. While ESWL can be tried as a first treatment option because of its non‐invasive nature, lower success and higher re‐treatment rates limit its usefulness. Ureterolithotomy is still a reasonable alternative for these large or unfragmented stones.
Diagnosis and treatment of post‐herniorrhaphy vas deferens obstruction
Authors: Matsuda Tadashi
Published: March 2003

Childhood inguinal herniorrhaphy (IH) is one of the most frequent causes of seminal tract obstruction. The incidence of vasal obstruction was found to be as high as 26.7% in subfertile patients with a history of childhood IH. The distal end of the vas deferens was found at the internal inguinal ring or in the pelvic cavity in 56.7% of cases, more than 3 cm of the vas deferens had been resected in 37.9% of cases, and sperm was found in vasal fluid in 45.5% of cases during corrective surgery. Microsurgical two‐layer vasovasostomy resulted in the postoperative appearance of sperm in 39% of patients. In patients with postoperative azoospermia, a secondary epididymal obstruction caused by a long‐term vasal obstruction is a highly probable cause. Ipsilateral epididymovasostomy following successful inguinal vasovasostomy results in the postoperative appearance of sperm in the ejaculate in 100% of the patients and a subsequent natural pregnancy rate of 50%. The overall pregnancy rate among couples, following surgery in 18 patients, was 43%, excluding pregnancies achieved by in vitro fertilization or intracytoplasmic sperm injection. Microsurgical reanastomosis of the seminal tract resulted in high impregnation rates among partners of patients with seminal tract obstruction caused by childhood IH. After receiving sufficient information on each treatment modality, patients can choose their preferred treatment, either reanastomosis of the seminal tract or assisted reproductive technology using epididymal or testicular sperm.
Urinary tract cancer screening through analysis of urinary red blood cell volume distribution
Authors: Wakui Mamoru , Shiigai Tatsuo
Published: March 2003

Background
: Hematuria is differentiated between glomerular and urinary tract origins on the basis of urinary red cell morphology. We used this distinction in a program of mass screening for urinary tract cancer to achieve cost‐effective and safe hematuria screening.

Methods
: Of a total of 21 372 adults (mean age 52.3 years; range 20–79 years) participating in a health screening, 912 (4.3%) had a positive dipstick for hematuria and were enrolled in the present study. Urinary red cell volume distribution curves (RDC), the simplest method of assessing urinary red cell morphology, were calculated and subjects were divided into two groups based on their RDC patterns. Group I subjects had a normocytic or mixed pattern and they were immediately investigated for urinary tract malignancy because of the associated risk for urological disease. Group II subjects had a microcytic pattern and, therefore, were judged to be at a low risk of urologic malignancy and were followed up 3 years later without urologic investigations.

Results
: Among the 38 subjects in group I (4% of all dipstick‐positive subjects), one case of bladder cancer was detected. In the remaining 37 patients, 15 cases of benign diseases were discovered. Group II was composed of 869 subjects (96%). The inquiry into their health status conducted 3 years later revealed that 831 (95.6%) were healthy and, of these, 13 had experienced gross hematuria during the period but urological malignancies were ruled out by their urologists, two (0.2%) had died of diseases other than urological cancer and 36 (4.1%) were lost to follow‐up. With our method, total costs have been reduced by 93.8% against a conventional setting of a full evaluation for all cases of hematuria.

Conclusions
: Microcytic hematuria, accounting for 96% of asymptomatic microhematuria cases in the present study, was not associated with a risk for urinary tract malignancy. Compared with conventional hematuria screening with a complete work‐up of all cases of hematuria, investigating only subjects with mixed or normocytic RDC patterns was safe and cost effective.
Per‐operative frozen section examination of pelvic nodes is unnecessary for the majority of clinically localized prostate cancers in the prostate‐specific antigen era
Authors: Kakehi Yoshiyuki , Kamoto Toshiyuki , Okuno Hiroshi , Terai Akito , Terachi Toshiro , Ogawa Osamu
Published: March 2003

Background
: The incidence of unsuspected lymph node metastasis seems to be decreasing in the prostate‐specific antigen (PSA) era. It remains controversial as to whether routine pelvic lymph node dissection and per‐operative frozen section examination should be performed. In addition, it is still unclear whether an aggressive approach to local disease by surgery or irradiation confers survival benefits on stage D1 patients.

Methods
: Eighty‐eight consecutive patients with clinically localized prostate cancer who underwent pelvic lymph node dissection prior to radical prostatectomy during the period between 1985 and 1998 were analyzed. The incidence of lymph node metastases after 1992 was compared with that before 1992. Sensitivity and specificity of frozen section examination was assessed. Progression‐free survival and cause‐specific survival curves of node‐positive patients who underwent radical prostatectomy were estimated by the Kaplan–Meier method.

Results
: Six of 17 patients (35.3%) treated before 1992 and five of 71 patients (7.0%) treated after 1992 showed unsuspected lymph node metastasis (P = 0.0059). Eight of 11 node‐positive patients underwent radical prostatectomy and two have so far demonstrated clinical progression and cancer death with a median follow‐up period of 63 months. The 5 year progression‐free rate and the cause‐specific survival rate for these patients were 71.4 and 85.7%, respectively. Sensitivity of frozen section examination for micrometastasis and gross‐metastasis cases, respectively, was 3/6 (50%) and 4/4 (100%), while specificity was 85/85 (100%).

Conclusions
: The incidence of unsuspected lymph node metastases has been significantly decreased in the PSA era. Frozen section examination of pelvic nodes can be omitted and radical prostatectomy is an acceptable choice of treatment in patients without macroscopically apparent nodal metastases.
Renal arteriovenous malformation with thrombus in the inferior vena cava
Authors: Harada Hiroshi , Togashi Masaki , Abe Takashige , Takeyama Yoshihiro , Seki Toshimori , Ohashi Nobuo
Published: March 2003

Background
: Thrombus formation in the inferior vena cava (IVC) is usually seen in cases with malignancy. In contrast, vascular anomalies hardly ever accompany this disorder. Herein, a case of thrombus formation in the IVC associated with renal arteriovenous malformation (AVM) is reported.

Methods/Results
: A 50‐year‐old woman who received transarterial embolization (TAE) for AVM in the right kidney noticed right flank pain with macrohematuria 12 months later. Because radiographic evaluation could not rule out malignancy in the kidney, nephrectomy was performed. During nephrectomy, a palpable thrombus was found in the IVC, so thrombectomy was performed simultaneously. Histopathologic examination revealed an old infarction due to the TAE, circumferential arteriovenous thrombi and a large organized thrombus up to the IVC, but neither renal cell carcinoma nor transitional carcinoma in the kidney.

Conclusions
: Careful observation may be required, even after treatment for renal AVM, such as TAE, to avoid the formation of an IVC thrombus.
Impact of citrate therapy on the circadian rhythm of urinary magnesium ammonium phosphate saturation in normal individuals
Authors: Ogawa Yoshihide , Sugaya Kimio , Koyama Yuzo , Hatano Tadashi
Published: March 2003

Background
: Alkaline citrate has been used widely in the prevention of stone formation. However, the risk of struvite stone during the alkalinizing therapy has not been adequately studied in terms of magnesium ammonium phosphate saturation.

Methods
: The circadian rhythm of the urinary saturation of magnesium ammonium phosphate was estimated by using the differential Gibbs' free energy values of magnesium ammonium phosphate before and during 5 days of treatment with sodium–potassium citrate (1 g t.i.d., 1 g q.i.d. or 3 g t.i.d.) in five healthy male volunteers.

Results
: The magnesium ammonium phosphate saturation varied during the day, peaking far below the solubility product between 08.00 and 10.30 h and between 13.00 and 18.00 h. The mean peak levels were increased by each treatment regimen in comparison with the control day. The mean increase on day 1 was significant between 10.30 and 23.00 h with the 3 g t.i.d. regimen, but the mean saturation still remained below the solubility product throughout the day.

Conclusions
: The urinary magnesium ammonium phosphate saturation appeared hard to exceed the solubility product with a high dose of alkaline citrate.
Expression of the insulin‐like growth factor system and cancer progression in hormone‐treated prostate cancer patients
Authors: Mita Koji , Nakahara Mitsuru , Usui Tsuguru
Published: March 2003

Abstract
Background
: The insulin‐like growth factor (IGF) system, which is composed of two ligands (IGF‐I and IGF‐II), two receptors (IGFR‐I and IGFR‐II) and six binding proteins (IGFBP‐1 to ‐6), plays an important role in cell biology. To identify the main components in the IGF system that contribute to human prostate cancer progression after hormone therapy, mRNA expression of the IGF system in human prostate cancer tissue was systematically examined.

Methods
: Expression of the IGF system in 24 carcinomas obtained from total prostatectomies after hormone therapy was examined. Expression levels of mRNA of each component of the IGF system were analyzed by quantitative reverse transcription–polymerase chain reaction procedures and compared with clinicopathologic parameters.

Results
: Expression of the IGF system, except IGFBP‐1, was detected in all prostate cancer tissue samples. The expression of IGF‐II and IGFBP‐2 significantly correlated with pathologic stage, lymph node metastasis, histologic differentiation and serum prostate‐specific antigen (PSA) levels after hormone therapy. However, expression of IGF‐I was significantly lower in locally advanced prostate cancer tissue than in tissue from the early stage. Expression of IGFBP‐5 was significantly related to only serum PSA levels after hormone therapy.

Conclusions
: In the IGF system, IGF‐II and IGFBP‐2 play a role in human prostate cancer progression and their increased expression is a possible candidate for a prognostic indicator in hormone‐treated prostate cancer patients.