bluuebunny/crossref_metadata_2025 huggingface dataset:
Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children
Authors: Coskun Senol , Yuksel Hasan , Tikiz Hakan , Danahaliloğlu Selahattin
Published: March 2003

Abstract

Background
: Beta‐2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of beta‐2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhytmogenic risk of these two treatment strategies in children with acute asthmatic attacks.

Methods
: Forty‐three children with the diagnosis of moderate to severe acute asthma were enrolled in the study. Standard dose of nebulized albuterol therapy (0.15 mg/kg) were administered to 20 patients (group 1) and low dose of nebulized albuterol (0.075 mg/kg) plus nebulized ipratropium bromide therapy (250 μg/dose) were given to the remaining 23 patients (group 2). Respiratory distress score, peak expiratory flow rate, arterial blood pressure, O2 saturation, serum potassium and urea nitrogen levels were studied and QT interval parameters were measured from the standard 12‐lead electrocardiograms at baseline and after treatment.

Results
: Significant improvement was achieved in respiratory distress score and peak expiratory flow rate after three dose inhalation. No significant difference was observed between the pre and post‐treatment values of serum potassium, blood urea nitrogen, O2 saturation and arterial blood pressure values. The evaluation of the corrected QTd (QTcd) showed that while there was no statistical difference in the pre and post‐treatment values in group 2 (30.4±3.1 msn vs 32.1±3.9 msn), QTcd was found to be significantly increased in group 1 after treatment (29.0±3 msn vs 40.6±5.1 msn, P<0.0001).

Conclusion
: The data of the present study suggest that the increase of the QTd is more prominent with the use of a standard dose of albuterol compared to low dose albuterol plus ipratropium therapy. Therefore, it may be concluded that a low dose of albuterol plus ipratropium bromide therapy may be preferred to avoid rhythm disturbances in asthmatic children.
Sotalol in treatment of pediatric cardiac arrhythmias
Authors: Çeliker Alpay , Ayabakan Canan , Özer Sema , Özme Sencan
Published: March 2003

Abstract

Background
: There is limited experience on sotalol use in the management of childhood arrhythmias. This study reviews the results of our experience with oral sotalol for treatment and prevention of tachyarrhythmias in children.

Methods
: The records of 62 patients (27 female, 35 male, mean age: 8.5±5.3 years) treated with sotalol for supraventricular or ventricular arrhythmias from 1994 to 1999 at our institution were reviewed. Demographic, clinical, echocardiographic, electrocardiographic (ECG), ambulatory ECG and electrophysiologic variables were collected.

Results
: Forty‐two (63.6%) patients had re‐entrant supraventricular tachycardia, eight patients (12.9%) had atrial tachycardia, one patient (1.6%) had junctional ectopic tachycardia, four patients (6.5%) had ventricular tachycardia, and seven patients (11.3%) had complex ventricular arrhythmias, as evidenced by surface or ambulatory ECG records; or revealed during the electrophysiological study. The mean sotalol dose was 3.9±1.2 mg/kg per day. In 15.5±13.9 months of sotalol use 50% (n=31) had complete relief of symptoms and/or arrhythmia and 29% (n=18) had partial relief. Sotalol was ineffective in 20% (n=13). Sotalol was more effective in re‐entrant type supraventricular tachycardias (P=0.012). Sotalol was the first choice in 35.5% of patients. The sotalol therapy was initiated in inpatient settings in 40.3% (25 patients). Complications due to sotalol were seen in six patients (five patients developed bradycardia/pauses, and one patient had torsades de pointes) for which the sotalol dose was modified. In patients with sick sinus syndrome, a pacemaker was implanted and in another patient sotalol was stopped.

Conclusion
: Sotalol, being an effective and safe drug particularly in children, is a good therapeutic alternative for the preventive treatment of childhood tachyarrhythmias.
Comparative pharmacokinetics of oral 6‐mercaptopurine and intravenous 6‐mercaptopurine riboside in children
Authors: Mawatari Hideo , Unei Kazuhiko , Nishimura Shin‐Ichiro , Sakura Nobuo , Ueda Kazuhiro
Published: March 2003

Abstract

Background
: The poor absorption of orally administered 6‐mercaptopurine (6MP) causes a wide variation in its cytotoxic efficacy. An i.v. dosage form would eliminate this problem. Our objective was to compare the pharmacokinetics of 6MP administered orally with those of an i.v. dosage form 6‐mercaptopurine riboside (6MPR), in children with acute lymphoblastic leukemia or malignant lymphoma.

Methods
: A total of 10 children were treated with oral 6MP, 50 mg/m2 per day, while five children were treated with 6MPR, 50 mg/m2 per day, administered by rapid i.v. injection. The plasma concentrations of 6MP and of 6MPR were measured on day 0, while the concentrations of 6‐thioguanine nucleotides (6TGN) in red blood cells (RBC) were measured on day 2. The area under the plasma concentration‐time curve (AUC1–5) was calculated from 1 to 5 h after drug administration.

Results
: With the intravenously administered 6MPR, the AUC1–5 ranged from 124 to 186 (1.5‐fold range, median 145) μM min; only two samples were obtained for the RBC concentration of 6TGN, and were 121 and 273 pmol per 25 mg hemoglobin. With the orally administered 6MP, the AUC1–5 ranged from 23 to 65 μM min (2.8‐fold range, median 56); the RBC concentration of 6TGN ranged from 18 to 152 pmol per 25 mg hemoglobin (median 75).

Conclusion
: The i.v. administration of 6MPR showed less interindividual variation in the AUC1–5 coupled with a higher RBC level of 6TGN as compared with those by oral 6MP. We conclude that the i.v. administration of 6MPR achieves stable blood levels of active drug in children undergoing cancer chemotherapy.
Prophylactic effect of inactivated influenza vaccine on young children
Authors: Maeda Taro , Shintani Yukihiro , Miyamoto Hajime , Kawagoe Hiroyuki , Nakano Kanako , Nishiyama Atsusi , Yamada Yoshiyasu
Published: March 2003

Background
: The effectiveness of inactivated influenza vaccine in healthy infants and young children has been controversial. The aim of this study was to determine the prophylactic effect of inactivated influenza vaccine in young children.

Methods
: Eighty‐six healthy infants and children younger than 7‐years‐old were immunized by a subcuta­neous injection of inactivated influenza vaccine before the 1999/2000 influenza season. Ninety‐four age‐matched children were randomly assigned as the control. These children were followed‐up from January to April, 2000. A diagnosis of influenza A virus infection was made rapidly by a positive result of the the enzyme immunoassay membrane test using enzyme‐conjugated monoclonal antibodies specific for a conserved epitope of influenza A nucleoprotein. The incidence of influenza A infection was compared and statistically assessed.

Results
: The prevalence of influenza A
virus infection, diagnosed by the influenza A rapid detection test,
was 5.8% in the vaccine group and 17.0% in the
control group, that is significantly lower in the vaccine receiving group
than the non‐receiving group (P = 0.016). However, four out of five infected children in the vaccine group were younger than 2‐years‐old.

Conclusion
: We conclude that inactivated influenza vaccine reduces the incidence of influenza A virus infection in 2–6‐year‐old children.
Attenuated nitrergic inhibitory neurotransmission to interstitial cells of Cajal in the lower esophageal sphincter with esophageal achalasia in children
Authors: Watanabe Yoshio , Ando Hisami , Seo Takahiko , Katsuno Shinsuke , Marui Yuji , Ono Yasuyuki , Torihashi Shigeko
Published: March 2003

Abstract
Background
: Esophageal achalasia (EA) is a rare disease in children, the etiology and pathogenesis of which remain controversial. Previous studies have suggested that a specific class of interstitial cells of Cajal (ICC) act as mediators in nitrergic inhibitory neurotransmission in the lower esophageal sphincter (LES). The aim of this investigation is to clarify the status of ICC and nitrergic inhibitory neurons in the LES of EA using immunohistochemistry.

Methods
: Specimens were obtained from two patients with EA (aged 6 and 10 years) and two patients with esophageal carcinoma (aged 56 and 63 years) not involving the lower esophagus as controls. Immunohistochemistry was used to study the distribution of ICC and nitrergic inhibitory neuron.

Results
: The LES contains the c‐kit positive ICC in the muscle layers, which form close relationships with nitric oxide synthase (NOS)‐containing nerve fibers in the controls. The distribution of ICC was almost the same between samples with EA and controls. However, such nerve fibers were absent in EA with a longer duration of the symptoms, but were reduced in a shorter duration.

Conclusions
: Decreased nitrergic inhibitory neurotransmission to ICC in LES is a possible cause of sphincter achalasia in pediatric patients with EA. The decrease in NOS‐positive neurons of patients with achalasia may be gradual, which may account for the long duration of symptoms prior to treatments. Further advancement of esophageal motility damage was suspected in pediatric EA.
IgG and IgG subclasses deficiency in children undergoing continuous ambulatory peritoneal dialysis and its provocative factors
Authors: Akman Sema , Güven Ayfer Gür , Ince Selma , YeĞin Olcay
Published: March 2003

Background
: Low levels of serum IgG or IgG subclasses may be responsible for the defective peritoneal defense and for peritonitis attacks in continuous ambulatory peritoneal dialysis (CAPD) children. Malnutrition, peritoneal loss or frequent peritonitis may lead to IgG or IgG subclasses deficiency.

Methods
: Levels of IgG subclasses were determined

in 12 children undergoing CAPD treatment. Radial immunodiffusion

technique was used for determination. Patients were aged from 6

to 16 years (mean age 12.3 years) and had been

on CAPD for 11−26 months (mean duration 19.4 months).

We evaluated whether IgG and IgG subclasses deficiency are related

to malnutrition, the peritonitis rate and the duration of CAPD using

the spss program.

Results
: Serum total IgG levels were found to be low in eight out of 12 patients. Eight patients showed low levels of IgG1, four patients IgG2, one patient IgG3 and three patients IgG4. Total IgG values were found to be positively correlated to malnutrition status, peritonitis rate and duration of CAPD. The IgG2 values were found to be related to the duration of CAPD. The IgG4 values were found to be correlated to the peritonitis rates.

Conclusions
: The IgG and IgG subclasses deficiency may develop in children while on CAPD treatment. Periodical determinations of either serum IgG or the subclasses may be useful in the follow‐up of these patients.
Dyslipidemia in young Japanese children: its relation to familial hypercholesterolemiaand familial combined hyperlipidemia
Authors: Ohta Takao , Kiwaki Kohji , Endo Fumio , Umehashi Hozo , Matsuda Ichiro
Published: March 2003

Background
: Most cases of dyslipidemia found inadults are non‐familial. However, in children, especially youngchildren, dyslipidemias other than familial hypercholesterolemia(FH) have not yet been characterized.

Methods
: From April 1990 to March 1999, 56 181children were screened, and 1380 showed abnormal levels of apolipoproteinB (more than 2.5 standard deviations above the mean). Among these,1198 were re‐examined and further characterized by measuring lipidsand apolipoproteins, and by their familial histories.

Results
: Seventy‐seven percent of the children(928 of 1198) recalled were diagnosed as being dyslipidemic. Ninety‐onechildren were FH, 423 were type IIa, 128 were type IIb, 98 weretype IV, and 188 were hypoalphalipoproteinemia. The presumed incidenceof FH was 0.19%, IIa 0.87%, IIb 0.26%,IV 0.20%, and hypoalphalipoproteinemia 0.39%,taking into account the percentage of subjects who refused recall.At regular follow‐ups, in many children with type IIb, the phenotypicexpression changes from type IIb to IIa or IV. Thus, lipid and apolipoproteinlevels were determined in 77 family members in 34 families of childrenwith type IIb. Forty‐five family members were dyslipidemic (typeIIa 18, type IIb 11, type IV 16). As a result, 27 children(79%) with type IIb met the criteria for familial combinedhyperlipidemia.

Conclusion
: Children with dyslipidemia had morefamily or genetic background than adults. Unexpectedly, childrenwith type IIb were mostly familial combined hyperlipidemia. Thus,setting appropriate eating patterns during childhood might be importantfor normalizing risk factors for atherosclerotic coronary heartdisease, especially in children with FH or type IIb.
Variations and inconsistencies in maternal and child health indicators in Ishikawa Prefecture, Japan
Authors: Makimoto Kiyoko , Tsukasaki Keiko
Published: March 2003

As part of a community health assessment, variations in maternal and child health‐related vital statistics data in Ishikawa Prefecture, Japan, from 1984 to 1993 were studied. Annual vital statistics reports published by the Prefectural government were used for the analysis. The following rates by public health district were calculated: abortion rate, early fetal mortality rate, late fetal mortality rate, perinatal mortality rate, neonatal mortality rate, and infant mortality rate. Maternal mortality rates were calculated for the Prefecture because of the small number of events. A few northern public health districts had relatively high perinatal mortality and infant mortality rates throughout the study period. Cause‐specific infant mortality rates showed that the northern region had higher infant mortality rates related to the level of perinatal care, injury, and poisoning. Inconsistencies in the pattern of mortality were found in one of the 10 public health districts. No indirect maternal deaths were reported for the 10‐year study period. This study identified potential problems for perinatal care in some districts. Results also suggest the potential misclassification of vital events, such as fetal deaths, induced abortions, and maternal deaths.
Characteristics of circadian change in urinary frequency, bladder capacity and residual urine volume in elderly men with lower urinary tract symptoms
Authors: Satoh Wakako , Nakada Teruhiro
Published: March 2003

Abstract In order to compare the daily voiding traits of elderly men with those of middle‐aged men with lower urinary tract symptoms (LUTS), urinary frequency, bladder capacity at normal desire to void (CNDV), residual urine volume (RUV) and functional bladder capacity were evaluated at home during a 24 h period using a non‐invasive method. The results showed that in both groups, urinary frequency was lowest from midnight to 06.00 h. The urinary frequency was the highest from 12.00 to 18.00 h. The CNDV in the elderly group was less than that of the middle‐aged group for 1 day. In particular, bladder capacity from 24.00 to 06.00 h showed the greatest difference (P < 0.05). The RUV in elderly men tended to accumulate more than those in middle‐aged men. The findings suggest that the functional bladder capacity of elderly men was lower than that of middle‐aged men in the home.
Sternal Wound Infection Prediction Scale: A test of the reliability and validity
Authors: Troutman Soundra G. , Hussey Leslie C. , Hynan Linda , Lucisano Karen
Published: March 2003

Abstract The purpose of the present study was to determine the reliability and validity of the Sternal Wound Infection Prediction Scale. The tool was developed to fill the need for a quick and easy way to determine which patients are at risk of developing a sternal wound infection in order that preventive measures can be instituted. Data were collected by a retrospective chart review of 56 patient records, 27 who developed a sternal wound infection and 29 who did not. In this group of patients, obesity and diabetes were found to be statistically significant risk factors. Pharmacological support was found to be a clinically significant factor. Of the infected group, 68.4% of patients who developed a sternal wound infection were predicted to do so by the tool.
Learning needs of Taiwanese nurses caring for patients with irritable bowel syndrome
Authors: Chen Huan‐hwa , McCutcheon Helen
Published: March 2003

Abstract This study, building on work on irritable bowel syndrome conducted by Letson and Dancey (1996), explores Taiwanese nurses’ knowledge, perceptions and beliefs about caring for patients with irritable bowel syndrome (IBS). A 46‐item questionnaire was completed voluntarily by 120 registered nurses from a large tertiary acute care facility in Taiwan. The study used a descriptive research design and a questionnaire was developed that used a five‐point Likert scale (strongly agree = 5, to strongly disagree = 1). The questionnaire consisted of six categories: demographic information; nurses’ sources of IBS information; nurses’ knowledge about IBS; nurses’ perceptions about patients with IBS; nurses’ beliefs about IBS; and learning requirements for nurses. Overall, the results indicted that Taiwanese nurses who participated in this study had little specific knowledge of IBS. The researchers developed a booklet containing information on the condition of IBS that may be used by the participants in this study to fill the knowledge gaps about this condition and provide useful information.
Challenges of recruiting a vulnerable population in a grounded theory study
Authors: Chiang Vico C. , Keatinge Diana , Williams Ann K.
Published: March 2003

Abstract Recruitment is a crucial and fundamental part of research and one that poses various degrees of difficulty. This is particularly so when the area of research is one that is either highly sensitive, or that involves participants who are deemed to be particularly vulnerable. This article explores the inherent tensions in matters of participant recruitment among meeting the demands of institutional ethics committees, satisfying the concerns of clinicians in the field and the need to maintain methodological rigor. A postgraduate research student’s experience of these tensions underpins the discussion. The article concludes with an outline of the student’s strategies and resolution of these issues.
Loneliness, Social Support and Family Function among Elderly Korean Women
Authors: Kim Ok‐Soo , Baik Sung‐Hee
Published: March 2003

The purpose of this study was to examine the relationships among social support (network and satisfaction), family function, and loneliness among elderly Korean women. A sample of 68 elderly Korean women, who were at least 60 years of age and lived in Seoul, Korea, was obtained. Data were collected by interview, using the translated Korean versions of the Revised University of California Los Angeles (UCLA) Loneliness Scale (RULS), Family APGAR, and Social Support Questionnaire 6. The results indicate that the subjects were moderately lonely (M = 45.04) and had moderately functional families (M = 5.60). The means for social support were 1.37 for network size and 4.17 for satisfaction. Twenty‐one percent of the subjects lived with their spouses. The subjects who lived with their spouse had a larger number of network members than those who did not live with their spouse (t = −0.26, P < 0.05). However, living with their spouse was not found to be associated with their social support satisfaction and family function. The level of loneliness was found to be related negatively to the level of social support network (r = −0.41, P < 0.01), social support satisfaction (r = −0.43, P < 0.01), and family function (r = −0.58, P < 0.01). Thirty‐four percent of the variance in their loneliness was accounted for by their social support and family function. Family function was found to be the significant predictor of loneliness. Subjects who had a lower level of family function were found to be more lonely than those who had a higher level of family function (β = −0.39, P < 0.01).
Study of the Aging Perception
Authors: Shin Kyung Rim , Kim Mi Young , Kim Young Hye
Published: March 2003

The purpose of this qualitative research study was to explore the perception of aging in community‐dwelling adults in Seoul. Participants consisted of 15 men and 19 women and they ranged in age from 40 to 80 years. Interviews were recorded on tape. Each interview session took 1–1.5 h. Colaizzi's phenomenological method of analysis was used to identify common meanings of aging. Findings revealed seven categories of perception of aging: change of body, body management, aging perception, change of territory, direction of life, reformation of a relationship, and internal maturity. These descriptive data add to the knowledge base available to nurses providing geriatric nursing care.
Model Construction on Quality of Family Caregiving in the Elderly
Authors: Lee Keum Jae
Published: March 2003

The purpose of this study was: (i) to examine the variables related to the quality of family caregiving provided to the elderly and to its improvement; and (ii) to construct a theoretical framework that would influence the quality of family caregiving provided to the elderly by checking the interrelationship between the variables. Such a framework could be used to verify a hypothetical model whereby nursing intervention could be developed that would facilitate the quality of life of the elderly. In order to verify the constructed hypothetical model, data were collected from visiting families living with elderly who were over 65 years of age, in Seoul, from 30 June 2000 to 11 August 2000. A self‐report questionnaire, an interview and observation of the surveyors were used. Three hundred and two copies were put into the final analysis. In order to retrieve statistics on the data, sas for Windows was used. Covariance structural analysis, through LISREL Windows program version 8.12, was used to verify the hypothetical model and the modified model. The result of verification of the modified model produced 20 hypotheses among 23 hypothetical paths. Forty percent of the quality of care derived by the elderly was explained by: the caregiving belief of assessing role, the caregiver's health status, the elderly's cognitive impairment and disruptive behavior, the amount of social support, the caregiving belief of monitoring role and the discrepancy between the past and the present image of the elder. Eighty‐nine percent of the quality of caregiving evaluated by the caregivers was explained by: the family's stress, the caregiving belief of assessing role, the caregiving burden, general factors, the caregiving belief of monitoring role, the amount of social support, the discrepancy between the past and the present image of the elderly person, and the caregiver's health status. Forty‐six percent of the caregiving burden was explained by: their economic status, the family's stress, the amount of social support, the activities of daily living, the discrepancy between the past and the present image of the elderly person and by general factors.
Moral stress and burnout: Qualitative content analysis
Authors: Severinsson Elisabeth
Published: March 2003

Abstract The aim of the present study was to describe and interpret the narrative of an Australian nurse's experience of burnout. A qualitative content analysis was used for the text of the interview. The main findings of this study concern moral stress and burnout. Three themes were identified: shortcomings and health problems; hovering between suffering and desire; and responsibility for oneself. All themes are related to the nurse's identity, the nurse's personal experience of, and reflections on, ethical problems and the existential issues of suffering, and the responsibilities and difficulties nurses face. The findings are explained and discussed in light of several theories. In conclusion, nurses’ needs have to be recognized. They need both emotional support and the right to receive systematic clinical supervision to help them reflect on their practical work and interpret the needs of patients.
Non‐traumatic renal arteriopelvic fistula
Authors: Shinojima Hirokazu , Seki Toshimori , Kumagai Akira , Sakurai Yasuo , Shinno YUICHIRO
Published: March 2003

Purpose: In the present paper, we report on a 34‐year‐old female with macroscopic hematuria due to a non‐traumatic renal arteriopelvic fistula (APF). The patient initially presented at another hospital with asymptomatic macroscopic hematuria. Following abdominal ultrasonography, computed tomography (CT) and laboratory data, no abnormal findings were seen. Therefore, the patient was referred to Teine Keijinkai Hospital for a more precise evaluation of the urinary tract and vascular abnormality.

Methods/Results: Endoscopically, there was bleeding from the right ureteral orifice, so the patient was admitted for further examination. No abnormal findings were seen on urinary cytology and following an intravenous pyelogram. A selective right lower polar renal arteriogram revealed arterial extravasation directly into the pelvis before the venous phase, so APF of the kidney was diagnosed. The patient had no history of urinary tract trauma, so the APF was thought to be idiopathic. After transcatheter arterial embolization (TAE) with a gelatine sponge, macroscopic and microscopic hematuria disappeared and a low‐density area was seen in the middle pole of the right kidney in an abdominal CT scan 4 days after TAE. This was thought to be renal infarction due to TAE.

Conclusions: After discharge, the patient had no further hematuria.
Seminoma associated with bilateral cryptorchidism in Down’s syndrome: A case report
Authors: Miki Masaya , Ohtake Nobuaki , Hasumi Masaru , Ohi Masaru , Moriyama Shin’ichi
Published: March 2003

Backgound: A case of testicular typical seminoma associated with bilateral undescended testes in Down’s syndrome is reported. A 42‐year‐old institutionalized male patient developed left testicular seminoma with retroperitoneal metastasis.

Methods/Results: Neither adjuvant chemotherapy nor radiotherapy were performed due to his severe mental retardation. He died as a result of the cancer 2 years after a left radical orchiectomy and an autopsy was carried out.

Discussion: Recently an increase in the incidence of the association of testicular tumors and Down’s syndrome has been repeatedly documented. Thirty‐six cases of testicular tumors associated with Down’s syndrome have been reported and of these 17.1% had cryptorchidism. This is a much lower percentage considering the high risk of cryptorchidism in males with Down’s syndrome. The relationship between testicular germ cell tumors associated with cryptorchidism and Down’s syndrome is discussed.
Orthotopic ileal neobladder in male patients: Functional outcomes of 66 cases
Authors: Arai Yoichi , Taki Yoji , Kawase Norio , Terachi Toshiro , Kakehi Yoshiyuki , Okada Takuya , Okabe Tatsushiro , Kanba Tomomi , Konami Teruo , Kin Sojun , Oishi Kenji , Miyakawa Mieko , Takeuchi Hideo , Ueda Tomohiro , Hamaguchi Akikazu , Okada Yusaku
Published: March 2003

Background
: Orthotopic urinary diversion has become the preferred form of bladder reconstruction after cystectomy. We report on our experience with 66 male patients undergoing this procedure from November 1990 to February 1998.

Methods
: A neobladder was constructed using an ileal segment with a Hautmann type bladder. Complications were assessed and subdivided into early and late types. Voiding function was evaluated in terms of voiding pattern and continence. Median follow up was 19.5 (range 3.5–87.7) months.

Results
: There was one (1.5%) perioperative death. The most frequent pouch‐related and unrelated early complications were persistent urine leak (7.6%) and prolonged ileus (16.7%), respectively, the majority of cases of which were managed conservatively. Analysis of late complications revealed 6.2% ureteroileal stenosis and 1.5% urethrointestinal stenosis rates, but no case of bladder stone formation. Of the 61 patients in whom voiding function was evaluable, 95.1% achieved excellent daytime continence, while only 67.2% had night‐time continence. With regard to posture at voiding, 23 (37.7%) voided in a sitting position. Three of the patients (4.9%) were unable to void and required regular intermittent catheterization.

Conclusions
: An orthotopic neobladder can be constructed with acceptable morbidity and excellent functional results. We believe that orthotopic urinary diversion offers an attractive alternative to a bladder substitute when cystectomy is required.
A case of female large urethral diverticulum treated by electrofulguration
Authors: Fujikawa Keita , Matsui Yoshiyuki , Fukuzawa Shigeki , Soeda Asaki , Takeuchi Hideo
Published: March 2003

Female urethral diverticulum is not an uncommon disease. We report a case of female urethral diverticulum which caused severe urethral pain, but for which the diagnosis had not been obtained at many hospitals for many years. Transurethral electrocauterization of the diverticulum was very effective in this case.
Multidisciplinary treatment, including laser hyperthermia, for extensive regional metastasis of a penile tumor
Authors: Shirahama Tsutomu , Enokida Hideki , Yanase Ichirou , Nobori Takuo , Ohyama Masaru , Ohi Yoshitada
Published: March 2003

Background: There is no reliable treatment for penile tumor with lymph node metastasis.

Methods: We report on a patient with a penile tumor with extensive regional metastasis that was successfully managed with combined laser hyperthermia, radiation and chemotherapy.

Results: The patient has survived more than 7 years without evidence of disease.

Conclusions: Multidisciplinary treatment, including laser hyperthermia, may be useful for the treatment of regional metastasis of penile tumor.
Serous‐lined extramural tunnel technique for uretero‐ileal implantation in urinary diversion
Authors: KATO HARUAKI , IIZUKA KEIJI , IGAWA YASUHIKO , NISHIZAWA OSAMU
Published: March 2003

Purpose: We present our initial experience of a serous‐lined extramural tunnel technique for anti‐refluxing uretero‐ileal anastomosis in five cases of orthotopic ileal bladder and four cases of continent ileal pouch.

Methods/Results: Ureters were implanted into serous‐lined tunnels formed from a detubularized W‐configurated ileal segment. Neither upper tract dilatation nor reflux were observed in any patient postoperatively.

Conclusion: The technique can provide an effective uretero‐ileal anastomosis for reflux prevention with minimal use of the ileal segment and without the use of any artificial materials.
Possible misinterpretation on computed tomography of left inferior vena cava as retroperitoneal lymph node metastasis: A report of two cases
Authors: Arisawa Chizuru , Kihara Kazunori , Fujii Yasuhisa , Ishizaka Kazuhiro , Masuda Hitoshi , Oshima Hiroyuki
Published: March 2003

Purpose: We report on two cases of retroperitoneal lymph node metastasis of testicular cancer with left inferior vena cava.

Methods/Results: A 25‐year‐old man with a left testicular cancer with pulmonary and retroperitoneal lymph node metastases received three courses of VIP (etoposide, ifosfamide and cisplatinum) chemotherapy. Subsequent abdominal computed tomography (CT) revealed round lesions enhanced with contrast agent on both sides of the aorta inside the degenerated lymphadenopathy. These lesions were regarded as a duplicated inferior vena cava (IVC) and this was confirmed at retroperitoneal lymph node dissection. The second case is of a 21‐year‐old man with a left testicular cancer with pulmonary, liver and widespread lymph node metastases. Subsequent to a course of VIP chemotherapy, super high‐dose chemotherapy was administered. Abdominal CT revealed a round mass enhanced with contrast agent on the left side of the aorta adjacent to the degenerated lymphadenopathy, which was regarded as the transposed left IVC and this was confirmed at lymph node dissection.

Conclusions: In both cases, initial CT failed to detect the lesions as the left IVC and there was a possibility for the misinterpretation of such venous anomalies with residual lymphadenopathy.
Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma
Authors: Amano Toshiyasu , Takemae Katsuro , Niikura Susumu , Kouno Masanori , Amano Masako
Published: March 2003

Background

: A very rare case of retroperitoneal bleeding due to spontaneous rupture of a large adrenal myelolipoma in a 62‐year‐old woman is reported.

Methods/Results

: She consulted the emergency room of the Nagano Red Cross Hospital with a complaint of sudden left flank pain. A computerized tomography (CT) scan revealed a tumor with areas of fat density and hematoma in the left retroperitoneal space. After her general condition improved, an operation was performed. The tumor strongly adhered to the left kidney and a left nephrectomy with the tumor was curative. Histologic diagnosis was adrenal myelolipoma. No blood transfusion was required.

Conclusions
: A CT scan is very useful in the pre‐operative diagnosis of adrenal myelolipoma with retroperitoneal hemorrhage. Watch and wait treatments before operation and nephrectomy with adhered tumor are safe and curative.
Hematospermia: An investigation of the bleeding site and underlying lesions
Authors: Furuya Seiji , Ogura Hiroshi , Saitoh Nobuhito , Tsukamoto Taiji , Kumamoto Yoshiaki , Tanaka Yoshinori
Published: March 2003

Background
: The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance.

Methods
: Twenty‐one patients aged 26–75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS).

Results
: Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient.

Conclusion
: Puncture of the seminal vesicles and/or müllerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.
Hypercalcemia in a patient with renal cell carcinoma producing parathyroid hormone‐related protein and interleukin‐6
Authors: Ueno Munehisa , Ban Shin‐Ichi , Nakanoma Takashi , Tsukamoto Takuji , Nonaka Shoichi , Hirata Risa , Iida Masahiro , Deguchi Nobuhiro
Published: March 2003

A patient with renal cell carcinoma who developed humoral hypercalcemia of malignancy is reported. A 52‐year‐old male patient was diagnosed with renal cell carcinoma and multiple lung metastases. A cell line isolated from the surgical specimen exhibited continuous production of parathyroid hormone‐related protein (PTHrP) in vitro. The production of PTHrP from the cancer cells was confirmed by RT‐PCR and immunoradiometric assay. The serum calcium level was not enhanced, whereas the lung lesion was developing and producing interleukin‐6, a possible modulator of osteoclastic resorption. Hypercalcemia was induced when the PTHrP concentration increased up to 3.3 pmol/L.
Advanced adenocarcinoma of the urinary bladder successfully treated by the combination of cisplatinum, mitomycin‐C, etoposide and tegafur‐uracil chemotherapy
Authors: Kasahara Kotaro , Inoue Keiji , Shuin Taro
Published: March 2003

Abstract Primary adenocarcinoma of the urinary bladder has shown an extremely poor response to radiation or chemotherapy. Therefore, radical surgery is the only therapeutic treatment for it. A case report is presented of a primary advanced adenocarcinoma of the urinary bladder invaded into the uterus with distant metastases which responded completely to systemic combination chemotherapy including tegafur‐uracil. The patient was a 53‐year‐old woman with a history of asymptomatic macrohematuria. She was treated with the combination of cisplatinum, mitomycin‐C, etoposide and tegafur‐uracil chemotherapy. After four courses of the chemotherapy, computed tomography showed marked regression of the primary tumor of the urinary bladder and the complete disappearance of the distant metastases in the liver, lung and para‐aortic lymph node. Subsequently, she underwent radical cystectomy and cutaneous ureterostomy. Pathologically, no viable cancer cells were detected. Three years after the operation, she has no evidence of disease recurrence. Treatment of advanced adenocarcinoma of the urinary bladder by this combination chemotherapy is of benefit.
Anterior urethral valve as a cause of end‐stage renal disease
Authors: Aygün Cem , Güven Oguz , Tekin Mehmet I.lteriş , Peşkircioğlu Levent , Özkardeş Hakan
Published: March 2003

Abstract Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end‐stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end‐stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions.
Endoscopic management of a traumatic disruption of the bulbous urethra using a thin trocar puncture
Authors: Nakajima Koichi , Deguchi Masao , Ishii Norie , Kawakami Toshifumi , Nozawa Eiyu , Hara Hiroshi , Miura Kazukiyo , Ishii Nobuhisa
Published: March 2003

Abstract A case is reported in which complete disruption of the bulbous urethra resulted in a straddled‐type injury, which was managed by endoscopic realignment with a thin trocar needle. The endoscopic urethroplasty consisted of: (i) direct observation of the proximal end of the obliterated urethra by an antegrade flexible cystoscope; (ii) adjustment of the direction of trocar penetration under fluoroscopy and direct vision; (iii) confirmation of the exact trocar position and penetration by antegrade flexible cystoscope; and (iv) placement of the guidewire following the trocar penetration as guidance for urethrotomy. A Foley catheter was left in place for 6 weeks. To date, no further endoscopic revision has been required. Although long‐term follow up and more experience are required, this technique is reported because it appears to be safe, reproducible, simple and minimally invasive.
Treatment outcome by risk group after radical prostatectomy in Japanese men
Authors: Egawa Shin , Suyama Kazuho , Arai Yoichi , Tsukayama Chohtatsu , Matsumoto Kazumasa , Kuwao Sadahito , Baba Shiro
Published: March 2003

Background:

North American investigators have suggested the usefulness of risk‐group stratification based on prostate‐specific antigen (PSA), clinical stage and biopsy Gleason score for predicting the biochemical outcome of prostate cancer after radical prostatectomy. There have been no reports of the application of this stratification to early biochemical outcome after radical surgery in Japanese men.

Methods:

The study population consisted of 178 men treated with radical retropubic prostatectomy and bilateral pelvic lymph node dissection at Kitasato University Hospital (n = 110) and Kurashiki Central Hospital (n = 68) between October 1992 and May 1999. Pathologic and biochemical outcomes after radical prostatectomy were analyzed based on risk‐group stratification. Risk groups were further analyzed according to detailed pathologic findings at biopsy.

Results:

The median follow‐up period for the 178 patients after radical surgery was 41.5 months (range, 2.0–82.0 months; mean, 40.9 months). Fifty‐eight patients experienced PSA failure at a median of 8.0 months following surgery (range, 0.0–58.0). Risk‐group stratification distinctly defined groups of pathologic findings in the radical prostatectomy specimens. The proportion of patients with PSA failure for low, intermediate and high‐risk groups were 9.5%, 23.9% and 56.9%, respectively (P < 0.0001). Use of the number of cores with cancer and maximum cancer length in biopsy cores failed to improve risk stratification for PSA outcome in all risk groups.

Conclusions:

Risk‐group stratification based on preoperative variables may significantly improve a physician’s ability to counsel patients about PSA outcome after radical prostatectomy. Further improvement in risk stratification may call for use of variables other than the pathologic information in biopsy cores.
Incidentally discovered giant renal arteriovenous malformation
Authors: Asakuma Junichi , Miyajima Akira , Sawazaki Harutake , Mizuguchi Yasunori , Seguchi Kenji , Ito Keiichi , Asano Tomohiko , Ogata Shou , Tamai Seiichi , Hayakawa Masamichi
Published: March 2003

A case is presented of giant renal arteriovenous malformation (AVM). A 61‐year‐old woman was admitted to the National Defense Medical College Hospital for further evaluation of a renal cyst. Doppler ultrasonography and magnetic resonance imaging revealed a giant renal AVM, although the patient had no history nor clinical sign suggesting an AVM. Under the diagnosis of a right renal AVM, the patient underwent AVM resection.
Retroperitoneoscopic ureterolithotomy for impacted ureteral stone
Authors: Kiyota Hiroshi , Ikemoto Isao , Asano Koji , Madarame Jun , Miki Kenta , Yoshino Yasumasa , Hasegawa Taro , Ohishi Yukihiko
Published: March 2003

Abstract Retroperitoneoscopic ureterolithotomy was successfully performed in two patients with impacted upper ureteral stone. The retroperitoneal space was extended using a balloon dissector and four ports were established into the retroperitoneal space according to Gaur's procedure (1993). The impacted ureteral stone was removed after the ureter was incised using a hook electrode. An indwelling splint or stent was placed in the ureter. The incised ureter was not sutured and an indwelling drain was placed in the retroperitoneal space. Urine leakage ceased within 3 days postoperatively. With regard to complications, the first patient developed wound infection caused by methicillin‐resistant Staphylococcus aureus and the second patient had abscess formation in the psoas muscle. Retroperitoneoscopic ureterolithotomy should be useful as an alternative treatment for impacted ureteral stones because it involves minimal postoperative pain.
Radical prostatectomy: Making it a better operation in the new millennium
Authors: Myers Robert P
Published: March 2003

Abstract Radical prostatectomy provides the best hope for long‐term survival, free of disease, for organ‐confined adenocarcinoma of the prostate. The operation is performed successfully only by understanding the remarkable anatomic variability of the prostate apex and the cylindrical nature of the striated urethral sphincter. When surgical techniques are used that take into account variations at the apex, with preservation of (i) neurovascular structures; (ii) the sphincteric urethra; and (iii) the adjacent levator ani, patients can look forward to a cure and the rapid return of urinary control and erectile function.
A case of angiomyolipoma presenting as a huge retroperitoneal mass
Authors: Tsutsumi Masakazu , Yamauchi Atsushi , Tsukamoto Sadamu , Ishikawa Satoru
Published: March 2003

Abstract A 60‐year‐old man was admitted to Hitachi General Hospital, Hitachi, Japan, with general fatigue and epigastric fullness. A large mass was palpated on whole abdomen and abdominal computed tomography scan showed a large lobulated fatty mass surrounding the right kidney, which indicated the existence of angiomyolipoma arising from the right kidney. The tumor was success‐fully resected through a thoracoabdominal incision. The total weight of the resected specimen was 3500 g, apparently the largest angiomyolipoma resected by operation in Japan.
Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique
Authors: Aygün Cem , Peskircioglu Levent , Tekin M Ilteris , Dirim Ayhan , Özkardes Hakan
Published: March 2003

Abstract Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.
A case of testicular tunica albuginea cyst with psammoma body
Authors: Rha Koon Ho , Choi Young Deuk , Lee Woong Hee , Lee Joong Shik , Choi Ho Sung , Key Cho Young , Lee Moo Sang
Published: March 2003

Cystic testicular masses have been considered rare but due to advances in ultrasonographic technologies their incidence has risen. Many testicular cystic masses are benign but there is a chance of malignancy. Psammoma bodies are found in various malignancies that occur in the genital tract of women but rarely in men. We report a case of testicular tunica albuginea cyst with psammoma bodies.
Asynchronous (heterochronic) bilateral renal infarction associated with primary antiphospholipid syndrome
Authors: Kitta Takeya , Takeyama Yoshihiro , Seki Toshimori , Togashi Masaki , Harada Hiroshi
Published: March 2003

We report the rare case of a 51‐year‐old man with asynchronous (heterochronic) bilateral renal infarction associated with primary antiphospholipid syndrome. He was treated for right renal infarction, but 2 months later, while under anticoagulant treatment, he had a recurrence on the other side of the renal infarction. The laboratory work‐up confirmed antiphospholipid syndrome. Six months later the patient has not experienced any new thrombotic episodes and is receiving oral anticoagulants and antiplatelet therapy.